Compressibility of two polyvinyl siloxane interocclusal record materials and its effect on mounted cast relationships

Adeliani Almeida Campos, DDS, MSD, DScD,a and Dan Nathanson, DMD, MSDb Federal University of Cear, Cear, Brazil Statement of problem. Addition silicones (polyvinyl siloxanes) are universally accepted as accurate and stable impression materials. They have also gained popularity as interocclusal record materials. However, it has not been defined if it is possible to work with polyvinyl siloxanes without changing the recorded maxillomandibular relations. Purpose. This study examined the compressibility of 2 addition silicones as interocclusal record materials, analyzing the changes of maxillomandibular relations at the condyle region when different compressive forces are used to stabilize articulated casts. Material and methods. Sixteen interocclusal records, obtained from the same patient (8 of each polyvinyl siloxane, Blu-Mousse, Fast Set), were interposed between the patient casts in a new measuring system obtaining 48 curves of load versus maxillomandibular positional changes in 3 axes (x, y, z). These curves were compared with curves obtained with the casts in maximum intercuspation without interocclusal records (reference curves). Analysis of variance was used to compare maxillomandibular positional changes among the 3 groups (n = 48 each): Blu-Mousse, Fast Set, and control group or maximum intercuspation without interocclusal record. Results. There was no significant change in maxillomandibular relations when forces up to 1 kgf were applied to stabilize the casts related by means of Blu-Mousse and Fast Set addition silicone interocclusal records. Conclusion. It is possible to use these polyvinyl siloxanes as interocclusal record materials without changing the recorded maxillomandibular relations. (J Prosthet Dent 1999;82:456-61.)

CLINICAL IMPLICATIONS
When addition silicone interocclusal records are used to relate maxillary and mandibular casts, changes in the maxillomandibular relations at the condylar region were insignificant in the presence of the different compressive forces used to stabilize the casts.

rticulators have been devised to simulate mandibular movement to allow the fabrication of indirect restorations, which, on insertion in the mouth, can be properly integrated with normal masticatory function. An accurate transfer of maxillomandibular relations from the mouth to the articulator is essential in the treatment of occlusal reconstructions. The facebow transfer and the centric, lateral, and protrusive jaw relation records together establish the simulation of mandibular function on the articulator. However, the degree of correlation between the patient and articulator depends on many factors, including biologic considerations and the properties of the materials used during the process of transferring maxillomandibular records from the patient to the articulator. Interocclusal records have become the most popular method of transfer of maxillomandibular relations from
aAdjunct

the mouth to the articulator. Comparative studies of interocclusal record materials have shown that the selection of the record material is an important factor to be considered during the transfer procedure. If the selected material is dimensionally unstable, the mounted casts will not reproduce the recorded maxillomandibular relationship on the articulator.1 Walls2 demonstrated the problems of inaccuracy in the transfer of maxillomandibular relations from the mouth to a semiadjustable articulator. When the teeth do not offer vertical and horizontal stability between the arches, or during registration of centric relation position without tooth contact, an interocclusal record is needed to relate the casts.3 When traditional interocclusal record materials are used during the transfer of maxillomandibular relations to an articulator, errors will occur.4-13

Professor, Department of Restorative Dentistry. bProfessor and Chair, Department of Restorative Dentistry, Boston University School of Dental Medicine, Boston, Mass. 456 THE JOURNAL OF PROSTHETIC DENTISTRY

ERRORS OF COMMONLY USED INTEROCCLUSAL RECORD MATERIALS

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ing material because of its ease of manipulation. However, some properties of this material, such as a high coefficient of thermal expansion and high resistance to closure, have classified this material as the most inaccurate among the interocclusal record materials studied.4-10 Changes of vertical dimension can be induced by thermal effects when compound and wax recordings are used. Additional correction of compound recordings with zinc oxide-eugenol paste creates an increase of the vertical distance of more than 100 m in the anterior region after storage for 30 minutes.12 Assif et al11 also found that wax plus a zinc oxide-eugenol paste resulted in an increase in vertical dimension, which was attributed to distortion of the wax material. It is essential that the interocclusal record material used for recording centric relation position provides limited resistance before setting to avoid displacing the mandible during closure.13 Records of impression plaster provide this limited resistance before setting and are rigid after setting; however, the plaster is difficult to handle in the mouth and the final interocclusal record is brittle. Muller et al12 found an increase of the vertical dimension of occlusion induced by recordings with impression plaster and attributed the increase to the setting expansion of gypsum. Zinc oxide-eugenol pastes as interocclusal record materials are considered to be effective. Because of the fluidity of the pastes before setting, zinc oxide-eugenol ensures minimal interference with mandibular closure and it is rigid after final set. However, zinc oxideeugenol pastes have a lengthy setting time, significant brittleness and they stick to the teeth. Vital portions of the record can be lost through breakage on removal from the mouth.13 Elastomers as interocclusal record materials consistently yielded the least error among the materials studied.4,5,13 They are easy to manipulate and do not need a carrier when used in the mouth. They offer little or no resistance to closure, set to a consistency that makes them easy to trim without distortion, and accurately reproduce tooth details.4 Fattore et al5 compared polyethers with and without a carrier, pink baseplate wax, reinforced wax, and zinc oxide-eugenol paste, and concluded that the polyether without a carrier was the most reliable interocclusal material in his study. However, a spring action found in the polyether interocclusal records caused articulated casts to open in the centric relation position. They recommended that the records should be trimmed and carefully seated over the occlusal surfaces to minimize this negative spring action. Lassila and McCabe14 found that polyether interocclusal records expanded considerably when stored in water (expansion of 1.4% over 72 hours). Millstein et al15,16 evaluated 2 types of condensation silicone and 2 brands of self-cured resins and reported that all tested materials exhibited some degree of
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weight loss as a result of volatile and concomitant change over time. Although the condensation silicones can present significant distortion due to the liberation of byproducts when setting, addition silicones (polyvinyl siloxanes) exhibit the least amount of distortion when compared with other elastomeric impression materials.17 Accuracy, stability after setting, minimal resistance to closure, and easy manipulation (because there is no need for a carrier) are the main advantages of addition silicones as interocclusal record materials.13 The major disadvantage of using elastomers is that any compressive force exerted on these materials during mounting procedures may cause inaccuracies during the mounting of the casts.4 Breeding and Dixon18,19 tested the resistance to compression of different elastomeric interocclusal record materials. The Blu-Mousse bite registration polyvinyl siloxane material (Parkell, Farmingdale, N.Y.) exhibited the greatest resistance to compression at 2 kgf. The rationale for the selected load was explained as follows: Rubber bands are commonly used to sustain the contact of opposing casts during mounting procedures. The maximal force exerted by the use of one standard office supply rubber bandwas approximately 25 N.18 Although this study showed that Blu-Mousse registration material has the rigidity after setting, it was not shown if it is possible to mount casts with this polyvinyl siloxane interocclusal recording material without changing the recorded maxillomandibular relations. The purpose of this study was to examine the compressibility of 2 addition silicones as interocclusal record materials, analyzing the changes of maxillomandibular relations at the condyle region when different compressive forces are used to stabilize articulated casts. In addition, this study analyzed directly the compressibility of the material itself, this study analyzed the changes in recorded maxillomandibular relations during the mounting procedure with polyvinyl siloxane interocclusal recording materials, as a consequence of the compressibility of the material.

MATERIAL AND METHODS

A patient with complete dentition and stable maximum intercuspation was selected to provide maxillary and mandibular casts and multiple interocclusal records. Impressions were taken with addition silicone impression material (Imprint3M Dental Products, St Paul, Minn.). Casts were mounted in a semiadjustable articulator (Denar Mark II, Teledyne Water Pik, Fort Collins, Colo.). The maxillary cast was mounted with a face-bow transfer (Slidematic, Denar Corp) and the mandibular cast was mounted in the maximum intercuspation position with hand articulation (reference position). The casts in the reference position were transferred to the 3 dimensional analyzer instrument,19
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analysis of variance (ANOVA) was performed to compare maxillomandibular positional changes from 0 to 1 kgf among the 3 groups tested for each side in the 3 axes.

RESULTS
For each of the 8 Blu-Mousse interocclusal records tested, 6 curves were generated. A total of 48 curves were obtained and cast positional changes (Table I) were calculated for each curve. Sixteen curves demonstrated displacements of maxillary cast during stabilization of casts, in an anteroposterior direction (x-axis), 8 curves in the right condyle region and 8 in the left condyle region. Displacements in the x-axis were registered on the calipers positioned on the back of the 3-dimensional analyzer instrument. Sixteen curves demonstrated displacements of cast, in a superoinferior direction (y-axis), 8 in both the right and left condyle region. Displacements in the y-axis were registered on the calipers positioned on the top of the 3-dimensional analyzer instrument. Sixteen curves demonstrated displacements of cast, in a mediolateral direction (z-axis); again, 8 in both the right and in the left condyle regions. Displacements in the z-axis were registered on the calipers positioned on the sides of the 3-dimensional analyzer (Fig. 1). For 3M Fast Set Bite registration material (n = 8) and control group or maximum intercuspation (n = 8), 48 curves generated 48 casts displacements calculated for each group in the same manner as presented in the group of 8 Blu-Mousse interocclusal records. Calculated maxillomandibular positional changes from 0 to 1 kgf revealed that on the x-axis (anteroposterior displacements) Blu-Mousse registration material presented the same mean displacement as maximum intercuspation without interocclusal records (0.01 mm on the left and right sides), but was 0.03 mm for 3M Fast Set Bite registration material (right and left sides). On the y- (superoinferior displacements) and z- (mediolateral displacements) axes, Blu-Mousse and 3M Fast Set Bite registration materials presented the same mean displacements (0.01 mm on right and left sides), whereas maximum intercuspation mean displacement was zero. The results of the ANOVA comparing the maxillomandibular positional changes revealed that there were no significant differences in the maxillomandibular positional changes for Blu-Mousse or 3M Fast Set Bite interocclusal records when compared with maximum intercuspation without interocclusal records if forces of 1 kgf are used to stabilize articulated casts. These findings are consistent on the x-, y-, and z-axes (P<.05) (Table I).

Fig. 1. Illustration of 3-dimensional analyzer instrument with cast in place.

a previously tested measuring device for comparative measurements of maxillomandibular relations, with a resolution of 0.010 mm and a measurement error of 0.005 mm19 (Fig. 1). Two polyvinyl siloxane interocclusal record materials were used, Blu-Mousse (Parkell Biomaterials Division) and 3M Fast Set Bite registration material (3M Dental Products). To test the compressibility of these materials, 16 interocclusal records were obtained from the selected patient (8 of each polyvinyl siloxane material). To preserve the same thickness between records, a resin jig was interposed between the anterior teeth during the recording procedure. After interocclusal registration, each record was carefully trimmed and interposed between the patient casts in the 3-dimensional analyzer instrument (HiTech Machine & Tool Inc, Wilmington, Mass.). To analyze the interaction of addition silicone interocclusal records with different stabilization forces, the 3-dimensional analyzer instrument19 was positioned in an Instron testing machine (Instron Corp, Attleboro, Mass.). Compressive forces were progressively applied on the center screw of the 3-dimensional analyzer instrument.19 The load was applied from 0 to 6 kgf and the positional changes in the maxillomandibular relation at the condyle region were registered in 3 axes (x, y, and z) at each 0.2 kgf interval (Fig. 2). After the curves of load versus displacement of the cast were obtained, maxillomandibular positional change from 0 to 1 kgf was calculated for each interocclusal curve. A total of 8 recordings for each material were tested. Each recording generated 6 curves (Fig. 2), or a total of 48 curves per material tested. An
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DISCUSSION
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E
Fig. 2. Three-dimensional analysis of load versus deformation curves. A, x-axis, left condyle; B, x-axis, right condyle; C, y-axis, left condyle; D, y-axis, right condyle; E, z-axis, left condyle; and F, z-axis, right condyle.

clusal record material presented a curve similar to maximum intercuspation with hand articulation when forces were applied from 0 to 6 kgf. This finding indicates that the resistance to compression does not seem to be a contraindication for using Blu-Mousse material for interocclusal records. These findings are in accordance with those of Breeding and Dixon,18 who subjected specimens of elastomeric impression materials to
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a constant compressive force of 25 N (2 kgf). They concluded that Blu-Mousse registration material presented the biggest resistance to compression at 2 kgf when compared with other elastomers at most tested material thicknesses. The results of our study indicated that 1 kgf can be applied to stabilize casts articulated with other polyvinyl siloxane interocclusal record material with no
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Table I. Maxillomandibular positional changes (mm) from 0 to 1 kgf because of the compressibility of interocclusal record material
Positional changes Axis Side X anteroposterior Right Left Y superoinferior Right Left Z mediolateral Right Left

3M Fast Set Bite Blu-Mousse Maximum intercuspation P*

Mean SD Mean SD Mean SD

0.03 0.012 0.01 0.035 0.01 0.08 .73

0.03 0.015 0.01 0.028 0.01 0.09 .73

0.01 0.015 0.01 0.038 0 0.1 .78

0.01 0.025 0.01 0.037 0 0.07 .76

0.01 0.014 0.01 0.01 0 0.01 .3

0.01 0.011 0.01 0.011 0 0.01 .1

P = Probability of null hypotheses (H0) being true. H0 = There is no statistically significant difference between maxillomandibular displacements from 0 to 1 kgf when casts are articulated by means of polyvinyl siloxane interocclusal records or without interocclusal records (maximum intercuspation with hand articulation). P>.05 demonstrates no significant difference.

significant changes to the recorded maxillomandibular relationships. Analyzing the curves at the point where 1 kgf force was applied, the maxillomandibular positional changes with Blu-Mousse and 3M Fast Set Bite materials did not have a significant difference, which indicated that one can use either one of these materials if 1 kgf is applied to stabilize the casts during the mounting procedures.

3. Resistance to compression does not seem to be a disadvantage to preclude the use of Blu-Mousse polyvinyl siloxane as an interocclusal record material, or does it preclude the use of 3M Fast Set Bite registration material if force up to 1 kgf is used to stabilize the casts during mounting procedures.
We acknowledge CNPq, Brazil, for supporting this research; Fabio Luz Desenhos e Produes Grficas, Brazil, for the drawings of the 3-dimensional analyzer instrument.

Application of the measurement system in the research of other materials

A stress-strain curve is built from an obtained load versus deformation curve. In our study, we were able to analyze these curves in 3 axes. According to Craig,17 when stress-strain curves are analyzed, we can determine the proportional limit, elastic limit, and yield strength as the most important properties relative to materials applied in restorative dentistry. Therefore, the principle of associating the centric relation 3-dimensional analyzer instrument19 with the Instron universal machine, which produced stress-strain curves in 3 axes, is believed to be of great potential value in the evaluation of dental materials.19

REFERENCES
1. Balthazar-Hart Y, Sandrik JL, Malone WF, Mazur B, Hart T. Accuracy and dimensional stability of four interocclusal recording materials. J Prosthet Dent 1981;45:586. 2. Walls AW, Wassell RW, Steele JG. A comparison of two methods for locating the intercuspal position (ICP) whilst mounting casts on an articulator. J Oral Rehabil 1991;18:43-8. 3. Freilich MA, Altieri JV, Wahle JJ. Principles for selecting interocclusal records for articulation of dentate and partially dentate casts. J Prosthet Dent 1992;68:361-7. 4. Mullick SC, Stackhouse JA Jr, Vincent GR. A study of interocclusal records materials. J Prosthet Dent 1981;46:304. 5. Fattore L, Malone WF, Sandrik JL, Mazur B, Hart T. Clinical evaluation of the accuracy of interocclusal recording materials. J Prosthet Dent 1984;51:152-7. 6. Millstein PL, Kronman JH, Clark RE. Determination of the accuracy of wax interocclusal registrations. J Prosthet Dent 1971;25:189-96. 7. Millstein PL, Clark RE, Kronman JH. Determination of the accuracy of wax interocclusal registrations. II. J Prosthet Dent 1973;29:40-5. 8. Millstein PL, Clark RE. Determination of the accuracy of laminated wax interocclusal wafers. J Prosthet Dent 1983;50:327. 9. Millstein PL. Accuracy of laminated wax interocclusal wafers. J Prosthet Dent 1985;54:574-7. 10. Lassila V. Comparison of five interocclusal recording materials. J Prosthet Dent 1986;55:215-8. 11. Assif D, Himel R, Grajower Y. A new electromechanical device to measure the accuracy of interocclusal records. J Prosthet Dent 1988;59:6726. 12. Muller J, Gotz G, Bruckner G, Kraft E. An experimental study of vertical deviations induced by different interocclusal recording materials. J Prosthet Dent 1991;65:43-50. 13. Balthazar Y, Fattore LD, Hart TO, Malone WF. Interocclusal records. In: Malone WFP, Koth DL, Cavajos E Jr, Kaiser DA, Morgano SM, editors. Tylmans theory and practice of fixed prosthodontics. 8th ed. St Louis: Ishiyaku EuroAmerica Inc; 1989.

CONCLUSIONS
Within the limits of this study, the following conclusions were drawn: 1. Curves of load versus deformation indicated that Blu-Mousse interocclusal record material had a greater dimensional stability when compressive forces were applied from 0 to 6 kgf when compared with 3M Fast Set Bite registration material. 2. There was no significant difference in the maxillomandibular positional changes when 1 kgf was used to stabilize casts articulated with Blu-Mousse (Parkell), 3M Fast Set Bite registration material, or without interocclusal recordings (control group).
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14. Lassila V, McCabe JF. Properties of interocclusal registration materials. J Prosthet Dent 1985;53:100-4. 15. Millstein PL, Clark RE, Myerson RL. Differential accuracy of siliconebody interocclusal records and associated weight loss due to volatiles. J Prosthet Dent 1975;33:649-54. 16. Millstein PL, Clark RE. Differential accuracy of siliconebody and selfcuring resin interocclusal records and associated weight loss. J Prosthet Dent 1981;46:380-4. 17. Craig RG. Restorative dental materials. 8th ed. St Louis: CV Mosby; 1989. 18. Breeding LC, Dixon DL. Compressive resistance of four interocclusal recording materials. J Prosthet Dent 1992;68:876-8. 19. Campos AA. Three dimensional analyzer: a new device for comparative measurements of maxillomandibular relations. [Masters thesis.} Boston: Boston University School of Dental Medicine; 1994.

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Noteworthy Abstracts of the Current Literature

Fracture strength of glass infiltratedmagnesia core porcelain Evans DB, OBrien WJ. Int J Prosthodont 1999;12:38-44.

Purpose. This study determined the fracture strength of magnesia-core porcelain after using a glass infiltration firing technique. Material and methods. A stainless steel master die milled to the dimensions of a maxillary premolar prepared for a porcelain crown was used to create 80 refractory dies. Core porcelain was applied to the refractor dies using traditional condensation methods and then formed into standardized copings with a centrifugal sculpturing device. Copings were vacuum fired from 593C to 1 of 8 high temperatures (857C to 1121C). Five copings per temperature were coated with a glass infiltrate and ground back to a standard thickness. Finished copings were bonded to a duplicate die with an adhesive resin luting system, placed on an Instron testing machine and loaded to fracture. The fractured copings were examined with a SEM, and results were analyzed with ANOVA and Student-Newman-Keuls tests. Results. ANOVA and Student-Newman-Keuls tests revealed significant differences among the various treatments and temperatures. A significant increase in fracture strength was noted after glass infiltration of the magnesia-core porcelain as compared with noninfiltrated samples. Sintering the copings to 871C or 899C before glass infiltration resulted in the highest fracture loads. Conclusion. Glass infiltration significantly increased fracture strength of the magnesia-core porcelain. 27 References. RP Renner

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