Sintering temperature accuracy and its effect on translucent yttria-stabilized zirconia: Flexural strength, crystal structure, tetragonality and light transmission.

OBJECTIVES: A crucial step in the preparation of yttria-stabilized zirconia materials (YSZ) is the final sintering step. Sintering parameters affect phase composition, grain growth and porosity of the material which, in turn, influence both mechanical and optical properties. Discrepancies of + /- 5% are common between actual and displayed firing temperatures depending on sintering furnace brand and condition. The aim of this study was therefore to investigate how such sintering temperature deviations in dental furnaces compared to the recommended firing protocols affected certain material properties of different yttria-stabilized zirconia materials. METHODS: Disc-shaped specimens were made from four different translucent and high translucent YSZ-powders and analysed regarding crystal structure; unit cell volume for the c, t, and t' -phases along with the tetragonality for the t and t' phases. Biaxial flexure strength and the spectral transmittance through the ceramic specimens were also measured. RESULTS: Deviations of 5% from the sintering temperature recommended for YSZ materials with different yttria content influenced material properties such as light transmittance, flexural strength, crystal phase fractions, tetragonality, and grain growth. Too low temperature resulted in decreased strength for some of the translucent zirconia materials, while others where less affected. Light transmittance varied depending on several factors such as grain size, crystal phase fractions and binder content in the start material prior to pre-sintering. SIGNIFICANCE: The use of high quality, wellcalibrated furnaces is crucial when sintering YSZ materials to avoid unwanted material changes. CONCLUSIONS: Deviations of 5% from the sintering temperature recommended for YSZ materials with different yttria content influence material properties such as light transmittance, flexural strength, crystal phase fractions, tetragonality, and grain growth. Too low temperature results in decreased strength for some translucent zirconia materials, while others are less affected. Light transmittance varies depending on several factors such as grain size, crystal phase fractions and binder content in the start material prior to pre-sintering. Consequently, the use of high quality, well-calibrated furnaces is crucial when sintering YSZ materials to avoid unwanted material changes.

Light curing procedures - performance, knowledge level and safety awareness among dentists.

OBJECTIVES: This study aimed to investigate dentists' exposure to curing light and to obtain information about the dentists' knowledge on practical use and technical features of their curing lights as well as their safety awareness. METHODS: A pre-coded questionnaire was sent electronically to all dentists (n=1313) in the Public Dental Service (PDS) in Norway in 2015. RESULTS: The Response rate was 55.8%. The dentists spent on average 57.5% of their working days placing restorations, ranging from 1 to 30 (mean 7.7, SD 3.6) restorations per day. The average length of light curing one normal layer of composite was 27s. The longest individual mean curing time per day was about 100 times higher than that of the lowest. The mean curing time for lamps of the lower reported irradiances was similar to the time representing exceedance of international guidelines for limit values for blue light to the eyes. Almost one-third of the dentists used inadequate eye protection against blue light. The odds of using adequate eye protection were significantly higher among young dentists (p<0.01). The majority of the respondents (78.3%) were unaware of the irradiance value of their curing lights, thus rendering the curing time uncertain. More dentists in this group did not perform regular maintenance of their curing lights compared with all respondents (17.1% vs. 3.3%, p<0.01). CONCLUSIONS: This study revealed considerable variations among Norwegian dentists in the Public Dental Service with respect to performance of light curing of restorations, safety awareness and technical knowledge of the curing light. CLINICAL SIGNIFICANCE: The questionnaire study identifies specific knowledge gaps among Norwegian dentists with regard to curing lights and use of personal protection. Today's dependence on technology in dentistry necessitates that the operator possesses knowledge of essential technical specifications and safe use of devices and instruments routinely used in dental treatment.

Influence of formulation on photoinactivation of bacteria by lumichrome.

Lumichrome, a photodegradation product of riboflavin, is an endogenous compound in humans. The compound is more photostable and a more efficient photogenerator of singlet oxygen than riboflavin. It absorbs radiation in the UVA and blue-light region, which can be an advantage in antibacterial photodynamic therapy (aPDT) of superficial infections. The aim of this study was to investigate the in vitro aPDT effect of various lumichrome pharmaceutical formulations. Solutions of lumichrome (10(-5) - 10(-3)M) were prepared in plain phosphate buffered saline (PBS) or in PBS solutions containing cyclodextrins, DMSO, PEG 400 or polyoxamers (Pluronic). Supersaturated solutions of lumichrome in PBS were prepared via the cosolvent and solvent evaporation method. Phototoxic effects of selected lumichrome preparations were studied in planktonic Gram-positive (E. faecalis) and Gram-negative (E. coli) bacteria models. The UVA/blue light source emitted mainly in the range 340-440 nm. Lumichrome was up to tenfold more phototoxic against Gram-positive than to Gram-negative bacteria. Bacterial eradication was induced after exposure of lumichrome formulations (PBS, PEG 400 and HPγCD) combined with 24J/cm2 UVA/blue light. Increasing the concentration of lumichrome did not enhance the phototoxic effect, probably due to radiation attenuation in the highly absorbing solution (inner filter effect). Cyclodextrins were efficient enhancers of the lumichrome solubility in aqueous solutions, but inhibited the phototoxic effect. The study demonstrates that assuming the use of an optimized formulation, lumichrome has potential as a UVA/blue light photosensitizer in aPDT.

Side effects of external tooth bleaching: a multi-centre practice-based prospective study.

OBJECTIVE: The study was performed to assess the risk of at-home and in-office bleaching procedures, and to recognise potential predictors for side effects. DESIGN: Multi-centre, questionnaire-based prospective study with follow-ups at around 14 days and around one year post-treatment. SETTING: General practices and university clinics during the years 2007-2009 in Scandinavia. SUBJECTS: Patients with tooth bleaching as part of the treatment plan. RESULTS: The prevalence of experienced tooth sensitivity at first follow-up was independent of bleaching procedure (at-home = 50.3% [n = 143]; in-office = 39.3% [n = 28]; p >0.05; 95% CI [OR]: 0.198-1.102) whereas prevalence of gingival irritation was higher after in-office treatment (at-home = 14.0%; in-office = 35.7%; p <0.05) (mean age: 37.3 years; 73.7% women; n = 171). At the second follow-up, two and three patients reported side effects attributed to the bleaching treatment in the at-home and in-office groups, respectively. Predictors for side effects were tooth sensitivity, surface loss and gingivitis when observed at inclusion. Treatment-related predictors were bleaching concentration and contact between tray and gingiva. CONCLUSIONS: Bleaching treatment, irrespective of method, caused a high prevalence of side effects. Patients associated with the predictors at inclusion mentioned above should be notified of the risk for side effects and treated only if bleaching is indicated based on a proper diagnosis.

Solid dispersions for preparation of phototoxic supersaturated solutions for antimicrobial photodynamic therapy (aPDT): Studies on curcumin and curcuminoides L.

Curcumin is under investigation as a potential photosensitizer (PS) in antimicrobial photodynamic therapy (aPDT). The therapeutic potential of curcumin as a PS is limited by its low aqueous solubility, susceptibility to hydrolytic and photolytic degradation, and limited phototoxicity toward Gram negative (G-) bacteria. Supersaturated solutions of curcumin have demonstrated high phototoxicity toward several species of Gram positive (G+) bacteria as well as the G-Escherichia (E) coli. Thus, solid dispersions that can form supersaturated solutions of curcumin upon hydration may be beneficial in aPDT. In the present study, solid dispersions of curcumin have been prepared through lyophilization of concentrated solutions obtained from dissolution of hydroxypropyl-ß-cyclodextrin (HPßCD)-curcumin co-precipitates. Hydroxypropyl methylcellulose (HPMC) was added to curcumin solutions prior to lyophilization. The resulting lyophilizates were porous, amorphous and hydrated and dissolved rapidly in contact with a model physiological salt solution. The detected drug load of the lyophilizates was in the range 0.5-1.0% (w/w) and was dependent on the selected ratio between HPßCD and curcumin in the co-precipitate. The lyophilizate with the highest drug load could easily be dissolved in aqueous medium to form curcumin solutions of relevant concentrations for aPDT (i.e., 10µM). Selected solutions of the curcumin solid dispersions showed a pronounced decrease in curcumin concentration up to 90% after storage for 168h, which indicated that supersaturated curcumin solutions were initially formed upon dissolution of the lyophilizates. Both freshly prepared and 2days old solutions of one selected curcumin lyophilizate induced significant inactivation of E. coli (∼1% bacterial survival) after exposure to a light dose of only 5J/cm(2).

Photoinactivation of Staphylococcus epidermidis biofilms and suspensions by the hydrophobic photosensitizer curcumin--effect of selected nanocarrier: studies on curcumin and curcuminoides XLVII.

Solubilization and stabilization from rapid degradation by the use of nanocarriers are necessary to exploit curcumin's phototoxic potential towards pathogenic bacteria. However, maintenance of the phototoxicity requires a careful selection of type and amount of nanocarrier. The phototoxicity of an aqueous supersaturated curcumin solution without nanocarrier was compared to that of curcumin solubilized in polyethylene glycol 400 (PEG 400), Pluronic® F 127 (F 127) and hydroxypropyl-γ-cyclodextrin (HPγCD) on Staphylococcus (S.) epidermidis biofilms and suspensions. The nanocarriers stabilized the hydrophobic photosensitizer (PS) towards physical precipitation and hydrolytic degradation; however, photobleaching was pronounced (46-100% degradation) after irradiation with a dose of ≈ 9 J/cm(2) blue light depending on selected nanocarrier. Complete inactivation of S. epidermidis in suspension was achieved after exposure of ≈ 5 J/cm(2) combined with curcumin in 20% PEG 400 and 0.5% HPγCD and less than 1J/cm(2) light in case of a supersaturated curcumin solution. Curcumin in 1.5% F 127 induced phototoxicity towards bacterial biofilms; however, it was not phototoxic towards planktonic S. epidermidis. All curcumin preparations investigated demonstrated significant and similar phototoxicity towards biofilms (13-29% bacterial survival). A ≈ 9 J/cm(2) light dose was not sufficient to eradicate S. epidermidis biofilm completely under the current conditions.

Sealing ability of mineral trioxide aggregate, glass ionomer cement and composite resin when repairing large furcal perforations.

OBJECTIVE: To evaluate the sealing ability of different repair materials and the pathway of bacterial penetration after closure of large pulp chamber floor perforations. MATERIALS AND METHODS: Perforations were made in the furcation area of extracted human molars and sealed with either mineral trioxide aggregate (MTA), glass ionomer cement or resin composite. The bacterial leakage method was used with Enterococcus faecalis as microbial tracer. The time of leakage (in days) was recorded for each specimen. Statistical analysis of bacterial leakage was performed using the survival analysis and pairwise comparison of groups. A p-value less than 0.05 was considered statistically significant. Leaking specimens were prepared and inspected for the presence of bacteria by a scanning electron microscope (SEM). RESULTS: The percentage of leaking samples was significantly higher in resin composite than in the other groups and the negative control group (p<0.05). SEM inspection revealed the presence of bacteria in all leaking specimens. Bacteria were observed along the filling-dentine interface as well as in dentinal tubules at some distance from the filling. CONCLUSIONS: The resin composite material leaked significantly more than the MTA and glass ionomer cements when used to repair large furcation perforations. Bacteria could penetrate into dentine even at a distance from the perforation filling.

A screening of curcumin derivatives for antibacterial phototoxic effects studies on curcumin and curcuminoids. XLIII.

Curcumin, bis(4-hydroxy-3-methoxyphenyl)-1,6-heptadiene-3,5-dione, has potential as a photosensitiser for photodynamic treatment of localised superficial infections in e.g., the mouth or skin. The aim of the present study was to evaluate the in vitro antibacterial phototoxic potential of a series of five curcumin derivatives. The gram-positive Enterococcus faecalis and the gram-negative Escherichia coli were used as bacterial models. The bacteria were exposed to curcuminoid preparations in two concentrations (2.5 and 25.0 microM) in combination with a constant irradiation dose (5 J/cm2). The UV-VIS absorption spectrum of the curcuminoids was in the same range as curcumin, 300-500 nm. Compound 1 (dimethoxycurcumin; C1) and compound 3 (bisdemethoxycurcumin; C3) were strongly phototoxic towards E. faecalis (no surviving bacteria) and showed a lower but significant effect towards E. coli (< or = 0.5 log reductions and 1 - 4 log reductions, respectively). Compound 2 (C2) and compound 4 (C4) in combination with blue light reduced the colony forming ability of E. faecalis (approximately 1-4 log reductions). The phototoxic effect of the curcuminoids varied with concentration, and for compounds C1, C2 and C3 it was further influenced by the addition of polyethylene glycol 400 (PEG 400) to the preparations. 2,6-Divanillylidenecyclohexanone (C5) showed very low phototoxic potential (< 0.2 log reductions) under the conditions used in the present study. The addition of polyethylene glycol 400 (PEG 400) seemed to increase the solubility of compound C1, C3 and C5 in phosphate buffered saline (PBS). This investigation demonstrates the importance and influence of the substituents on the phenolic rings and the keto-enol moiety for the phototoxic potential of curcumin and its derivatives.

Formulation and bacterial phototoxicity of curcumin loaded alginate foams for wound treatment applications: studies on curcumin and curcuminoides XLII.

Curcumin loaded alginate foams are proposed for application in antimicrobial photodynamic therapy of infected wounds. The drug loaded foams were formulated to provide a burst release of the photosensitizer when hydrated. The foams remained intact after hydration and would be possible to remove from the wound prior to irradiation without causing any tissue damage. The characterization of the prepared foams showed that both curcumin loaded and unloaded foams hydrated within 1 min and absorbed from 12 to 16 times their dry weight of a model physiological fluid. Curcumin, the model photosensitizer, has an extremely low solubility in water and may aggregate in aqueous environment. Cyclodextrins (CDs) and polyethylene glycol 400 (PEG 400) were therefore selected as solubilizers of curcumin in the foams to provide a burst release of the photosensitizer. Exposure to the prepared foams in combination with visible light irradiation (∼9.7 J/cm(2)) resulted in >6 log reduction of Entrococcus faecalis cells. However, curcumin mediated photokilling of Escherichia coli was ineffective when CDs were selected as solubilizer of curcumin in the foams. An 81% reduction in viable E. coli cells was detected after treatment with the foam containing PEG 400 as the only solubilizer of curcumin combined with visible light irradiation (∼29 J/cm(2)).

Photokilling of bacteria by curcumin in selected polyethylene glycol 400 (PEG 400) preparations. Studies on curcumin and curcuminoids, XLI.

Curcumin, bis(4-hydroxy-3-methoxyphenyl)-1,6-heptadiene-3,5-dione, is a yellow-orange pigment which can be synthesised chemically or isolated from the plant Curcuma longa L. Curcumin has a rather broad absorption peak in the range 300-500 nm (maximum approximately 430 nm) and has potential as a photosensitiser for treatment of localised superficial infections in e.g., the mouth or skin. Previously, we have demonstrated phototoxic effects of curcumin in selected aqueous preparations against both gram-positive Enterococcus faecalis and Streptococcus intermedius and gram-negative Escherichia coil bacteria in vitro. One of the most efficient preparations was curcumin in polyethylene glycol (PEG 400) dissolved in phosphate buffered saline (PBS), pH 6.1. In this study the solubilising effect of PEG 400 on curcumin molecules and the in vitro phototoxic effects of these preparations were further evaluated. The effect of varying the curcumin concentration (2.50 microM -25.00 microM), the radiant exposure (0.5-30 J/cm2) and the physical state of curcumin against the survival of E. coli was investigated. PEG 400 showed an increasing physically stabilising effect towards crystallisation of curcumin in aqueous preparation with increasing concentrations (2.5%-10.0% v/v). Despite a higher solubility of curcumin with increasing PEG 400 concentrations, the surfactant reduced the phototoxicity of curcumin against E. coil. The highest phototoxic effect was obtained when curcumin was present in the least physically stable preparation, a stock solution in ethanol added to PBS with or without the lowest test concentration of PEG 400 (2.5% v/v). The obtained phototoxic effect can be increased by increasing the irradiation dose or by choosing an optimal curcumin concentration. E. faecalis was efficiently killed by the lowest concentration of curcumin in combination with the lowest radiant exposure when curcumin was dissolved in certain PEG solutions (< 0.02% survival), but showed no reduction when exposed to preirradiated curcumin.

Photokilling of bacteria by curcumin in different aqueous preparations. Studies on curcumin and curcuminoids XXXVII.

Curcumin has potential as a photosensitiser (PS) in photodynamic therapy (PDT) for localised superficial infections. However, it is a challenge to make an optimal curcumin formulation in which curcumin has acceptable solubility and stability at physiological pH and combined with high selective phototoxic activity towards bacteria. In the present study, the phototoxic effects of curcumin against gram-negative and gram-positive bacteria were investigated in selected aqueous preparations. The gram-positive Enterococcus faecalis and Streptococcus intermedius and the gram-negative Escherichia coli were used as bacterial models. The bacteria were exposed to 1-25 microM curcumin solubilised in DMSO, cyclodextrines, liposomes and surfactants known to interfere with membranes. After 30 min incubation the bacteria were irradiated with fluorescent tubes emitting blue light (emission max 430 nm). The irradiance was 17 mW/cm2 and the radiant exposure (light dose) was 0.5-30J/cm2. The bacterial survival was calculated as a percentage compared to controls. Various post-irradiation incubation times were tested. Curcumin's native fluorescence was exploited in examination of curcumin uptake in or adherence to bacteria by fluorescence microscopy. Changes in post-irradiation incubation time, curcumin concentration, irradiation dose and preparation strongly influenced the phototoxic efficiency of curcumin in vitro. Aqueous preparations of DMSO, polyethyleneglycol and the pluronic block copolymer poly(ethylene glycol)-block-poly(propylene glycol)-block-poly(ethylene glycol) were the most efficient vehicles for curcumin to exert photokilling of gram-positive and gram-negative bacteria.

Toxicity evaluation of root canal sealers in vitro.

AIM: To compare the toxicity of methacrylate resin-based root canal sealers with sealers based on epoxy resin and silicone by two-well established cell culture methods. METHODOLOGY: Specimens of AH Plus, EndoREZ, RoekoSeal and Epiphany were prepared for direct contact in the Millipore filter diffusion test and as extracts in the MTT assay. Mouse fibroblasts (L929) were used as toxicity targets. Differences in cytotoxicity between fresh and set specimens and between the extracts of root canal sealers were determined by t-test (P < 0.05). RESULTS: In the filter diffusion test, freshly mixed Epiphany and AH Plus were rated severely toxic and RoekoSeal and EndoREZ nontoxic. When set, Epiphany was moderately toxic, whereas AH Plus, RoekoSeal and EndoREZ were nontoxic. Epiphany was significantly more toxic than RoekoSeal and EndoREZ (P < 0.05). In the MTT assay with set specimens, Epiphany was rated severely toxic; AH Plus and RoekoSeal slightly toxic; and EndoREZ nontoxic. Epiphany was significantly more toxic than the other three materials in this test (P < 0.001). CONCLUSION: The multi-methacrylate resin-based (Epiphany) root canal sealer was significantly more toxic to L-929 cells than the silicone-based Roeko Seal and the single methacrylate-based EndoREZ root canal sealers. AH Plus showed intermediate toxicity.