Accuracy of polyether and addition silicone after long-term immersion disin-

fection
Xavier Lepe, DDS, MS, ~ and Glen H. Johnson, DDS, MS b
University of Washington, Seattle, Wash.

Statement o f p r o b l e m . Some studies have demonstrated that short-term immersion disinfection does
not affect the accuracy of polyether or addition silicone materials. Impressions are often disinfected for
longer than recommended time periods.
P u r p o s e . This study evaluated these materials after simulating overnight disinfection.
Material and m e t h o d s . Impressions were made of a master model with Extrude Extra material with
Extrude Wash addition silicone and Impregum F material in combination with Permadyne Garant
polyether material. Nondisinfected impressions served as controls, whereas the disinfected samples were
immersed for 18 hours in a full strength 2% acid glutaraldehyde solution. Anteroposterior and cross arch
dimensions of the working cast and occlusogingival, mesiodistal, and buccolingual dimensions of working
die were assessed. The data were analyzed with one-way analysis of variance at "alpha" = 0.05.
Results. No significant differences were observed for anteroposterior and cross arch dimension when
compared with the master model. However, significant differences were found for occlusogingival dimen-
sion at 18 hours of disinfection for both materials. The addition silicone 18-hour disinfection group was
significantly less accurate in the mesiodistal dimension.
C o n c l u s i o n . Accuracy of both impression materials was adversely affected with 18 hours of immersion
disinfection. Long-term (18 hours) immersion disinfection will affect the fit of fixed partial prostheses. (J
Prosthet Dent 1997;78:245-9.)

I t is well-lcnown that all impressions should be dis-
infected to avoid possible transmission o f infectious dis-
eases such as hepatitis B, tuberculosis, herpes, and
AIDS. >7 I m m e r s i o n and spray disinfection as well as
various disinfection solutions have been tested and
proven to be effective for this purpose. 7-1° Certain com-
binations o f method/disinfectant are more effective than
others, and their effect on the impression material be-
ing disinfected can vary. 11 It is important to weigh the
effectiveness o f the method/disinfectant used against the
possible negative side effects on the material. O f par-
ticular importance are the dimensional accuracy, 12-19sur-
face detail, 19,2° and wettability5123
Surface detail o f the gypsum cast has been shown to
improve after immersion disinfection, especially when
an acid glutaraldehyde solution is used that contains non-
ionic ethoxylate molecules which serve as a surfactant.14
This investigation was supported in part by NIH grant no. RR-05346.
~Assistant Professor, Department of Restorative Dentistry.
bProfessor, Department of Restorative Dentistry.
It has also been demonstrated that there is no signifi-
cant effect on wettability even after 18 hours o f immer-
sion. 2~ Therefore surface detail and wettability are not
o f great concern even after long periods o f disinfection.
Reversible and irreversible hydrocolloids, polyethers,
and some newer addition silicone materials are more hy-
drophilic in nature. Because o f this property, an alterna-
tive m e t h o d to disinfecting the impression is disinfec-
tion o f the gypsum cast by immersion or spray atomiza-
tion. 24 A l t h o u g h these m e t h o d s have been p r o v e n
effective, they are not practical and they may not pre-
vent cross-contamination a m o n g the dental team.
The most reliable method o f disinfection, and there-
fore the most popular, is immersion o f the impression. 2s
With this method, there is assurance that the disinfectant
solution will come into contact with all surfaces of the
impression material and tray. The effect o f immersion on
the dimensional accuracy o f an impression is a critical fac-
tor and the main reason why one may chose an alternate
method. Immersion is not the m e t h o d o f choice for the
hydrocolloid materials because they are highly hydro-

SEPTEMBER 1997 THE JOURNALOF PROSTHETICDENTISTRY 245

THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 1. Occlusal view of master model with stainless steel pre-
molar complete veneer crown preparation die and occiusa[
inserts. Occlusal inserts were used for cross arch and antero-
posterior measurements. Stainless steel die was used for as-
sessment of occlusogingival, mesiodistal, and buccolingual
dimensions.
philic 7'1s'16'19 and controversy exists whether this method
should be used with the polyether materials./4,19
Because of results of more recent studies on dimen-
sional accuracy, the American Dental Association Council
on Dental Materials has changed their position on ac-
ceptable methods of disinfection for polyether. In 1988
polysulfide and addition silicone were recommended to
be disinfected by immersion in any accepted product,
whereas polyether only by spray with a chlorine com-
pound for 2 to 3 minutes. 7 In a 1991 ADA Report Up-
date, immersion was also recommended as an accept-
able technique for use with the polyether materials.9
Impressions are often disinfected for longer than rec-
ommended time periods--sometimes in-bctween patients,
other times twice by both dentist and laboratory, and
sometimes overnight. The purpose of this study was to
simulate overnight (18 hours) immersion disinfection in
a full-strength 2% acid glutaraldehyde solution and evalu-
ate its effect on the dimensional stability ofpolyether (PE)
and hydrophilic addition silicone (PVS) materials.
MATERIAL AND METHODS
A customized mandibular arch of a Columbia
dentoform was used for the master model. This model
consisted of a stainless steel premolar complete veneer
crown preparation on the mandibular right first premo-
lar with occlnsal and gingival shoulders and vertical fi-
duciary lines used for occlusogingival (O-G), mesiodis-
tal (M-D), and buccolingual (B-L) measurements. In
addition to this, stainless steel inserts with fiduciary
points located on the occlusal surface of the mandibular
left and right first molars and the lingual surface of the
mandibular left and right central incisors were used for
cross arch (C-A) and anterior-posterior (A-P) measure-
ments (Fig. 1). All dimensions were measured on casts
retrieved from impressions made on the master model.
Both polyether and addition silicone impression ma-
246
LEPE A N D J O H N S O N
Fig. 2. Premolar die on stainless steel jig used for measuring
occlusogingival, mesiodistal, and bucco[ingual dimensions.
terials were used. Polyether impressions were made with
I m p r e g u m F tray material in c o n j u n c t i o n with
Permadyne Garant light body (Espe, Seefeld, Germany),
and Extrude Extra tray material with Extrude wash was
used for the addition silicone materials (Kerr Mfg.,
Romulus, Mich.). Ten impressions were made with each
material. Of each group, 5 of the 10 impressions were
disinfected, while the other 5 impressions in the group
served as the nondisinfected control group. As recom-
mended by the manufacturer, a full-strength solution of
2% acid glutaraldehyde (Banicide) was used as the disin-
fectant (Pascal, Bellevue, Wash.). Impressions were
poured with Prima-Rock type V gypsum for the initial
pour and Microstone type III gypsum (Whip Mix Corp.,
Louisville, Ky.) for the base pour.
Disposable Spacer trays (Coe Laboratories, Inc., Chi-
cago, Ill.) were used for the impressions. Uniform seat-
ing was ensured by using acrylic resin anterior and lin-
gual indexes. Tray adhesives and impression materials
were used following the manufacturer's instructions.
Impregum F material was dispensed by weight and hand
mixed, whereas all other materials were automixed and
dispensed by volume.
A 1.2 ml disposable syringe (Ultradent Products, Inc.,
South Jordan, Utah) was used to inject the light body
materials after which the impression tray was centered and
fullyseated. Impressions were left to set on the master model
for twice the recommended time in the mouth. The im-
pressions were then removed and rinsed under cold tap
water for 10 seconds to simulate rinsing of blood and sa-
liva after a clinical impression. The nondisinfected impres-
sions were air-dried and left to bench sit for 1 hour while
the 18-hour disinfection groups were disinfected, rinsed
again for 10 seconds, and air dried.
Impressions were boxed and poured with a 70 gm pack-
age of type V gypsum, gypsum retention knobs were made,
VOLUME 78 NUMBER 3
LEPE AND JOHNSON
Deviation from Master Model
I
CA OG
Fig. 3. Results show percent dimensional change of polyether and addition silicone for
nondisinfection and 18-hour immersion disinfection groups (PE = polyether, PVS = addition
silicone, Ap = anteroposterior, CA = cross arch, OG = occlusogingival, MD = mesiodistal and
BL = buccolingual).
and the gypsum was left to set for 1 hour. COE-sep sepa-
rating medium (Coe Laboratories Inc.) was painted over
the premolar die section, the base poured with a 70 gm
packagc o f type I I I gypsum and the base was left to set
undisturbed for 1 hour. For ease o f measurement, casts
were later leveled by using a plastic piece, which rested
on the stainless steel inserts, onto which a bubble bull's-
eye level could be seated. Plaster was then added to the
base o f the cast to level occlusal plane to countertop.
Anteroposterior and cross arch measurements were
assessed o n a N i k o n M e a s u r e s c o p e 20 i n s t r u m e n t
(Nippon Kogaku K.K., Tokyo, Japan) capable o f mea-
suring up to 1 pm. After these two dimensions were
measured on the solid cast, the premolar die was sec-
tioned and positioned on a stainless steel jig (Fig. 2) to
assess occlusogingival, mesiodistal, and buccolingual
dimensions. Each dimension was measured three times
and an average was taken. A two-factor analysis o f vari-
ance (A_NOVA) was used to analyze the data with pres-
ence or absence o f disinfection as one factor and type o f
impression material as the other. W h e n significant inter-
actions occurred between the two-factors, a one-factor
A N O V A was conducted to test for main effects. Given
significant main effects, the Student Newman-Keul's
procedure for multiple pairwise comparison o f means
was used. All hypothesis testing was conducted at "al-
pha" = 0.05. The sample size was five.
RESULTS
Results are expressed in pcrcentage deviation from the
master model. The equation used to arrive at this was as
follows:
SEPTEMBER 1997
THE JOURNAL OF PROSTHETIC DENTISTRY
[] PVS - - N o
disinfection
I I P E - - No
disinfection
H P E - - 1 8 hrs
disinfection
El PVS - - 18 hrs
disinfection
MD BL ~ Simitar Groups
percentage deviation = 100 x (sample cast dimension
-master cast dimension) / master cast dimension
The nondisinfection groups served as controls. N o
significant differences were seen a m o n g anteroposterior
and cross arch dimensions (Fig. 3).
The statistical power to detect differences between means
( main effects) greater than 1.333 standard deviations was
greater than 80%, which equates to 0.04% for anteroposte-
rior measurements, 0.14% for cross arch dimensions, 0.08%
for occlusogingival dimensions, 0.24% for mesiodistal di-
mensions, and 0.34% for buccolingual dimensions.
Two-factor -&NOVA revealed that interactions were
not significant in analyzing the occlusogingival dimen-
sion; thus factor-level means were compared. Significant
differences were found for the occlusogingival dimen-
sion when comparing the control and disinfected samples
(p = 0.000) and between the two impression materials
(p = 0.019). With 18 hours o f disinfection, polyether
(PE) and addition silicone (PVS) demonstrated an overall
mean deviation o f 0.34% compared with 0.18% for the
nondisinfected state. The two impression materials also
differed overall with PE and exhibited a 0.23% increase
in occlusogingival height compared with 0.30% for PVS.
Cross product interactions were significant (p < 0.05 )
for the two-factor ANOVA of mesiodistal and
buccolingual dimensions. Thus a one-factor ANOVA was
conducted to test for differences. After disinfection for
18 hours, PVS produced -0.54% smaller dies in the
mesiodistal dimension and -0.70% in the buccolingual
dimension compared with the master model; the corre-
sponding values for the nondisinfected state was 0.08%
and -0.17%, respectively. There was a small increase in
247
THE J O U R N A l OF PROSTHETIC DENTISTRY
Table I. Dimensional change in micrometers
Mean deviation in pm from master model
Material Group AP CA OG MD
Addition No 37 150 14 6 -12
silicone disinfection
Polyether No 37 137 9 9
disinfection
Polyether 18-hour 30 154 19 13
disinfection
Addition 18-hour 24 205 24 -38
silicone disinfection
the PE m e s i o d i s t a l d i m e n s i o n s , 0.13% for the
nondisinfected group and 0.19% for the 18-hour disin-
fection group. A statistical significant difference was
found between PVS nondisinfection and PVS 18-hour
disinfection groups and also when comparing PE and
PVS 18-hour disinfection groups.
A decrease in the buccolingual dimension was ob-
served for both materials with and without disinfection
(PE, -0.35% no disinfection, -0.36% at 18 hours;
PVS, -0.17% no disinfection and-0.70% at 18 hours).
The PVS nondisinfection and the 18-hour disinfection
groups differed from each other.
DISCUSSION
Mean deviations from the master model in microme-
ters are listed in Table I. Even though no significant
differences were found in the anteroposterior and cross
arch dimensions, some mean values especially in the cross
arch dimension are relatively large.
The anteroposterior dimensional changes will play a
role in the fabrication of both removable and fixed par-
tial dentures. The anteroposterior dimensional changes,
which ranged from 24 to 37 pm, were small enough
that, with adequate use of die spacer and investment
setting and thermal expansion, they would not be of
concern. The cross arch measurements indicated larger
dimensions on the cast that ranged from 137 to
205 pm. These larger dimensions may be beneficial when
fabricating a removable partial denture by allowing com-
pensation for casting shrinkage. Casting shrinkage of
cobalt-chromium and other nonprecious alloys was
higher than gold. Compensation by investment thermal
expansion alone may not be enough. 26
The occlusogingival, mesiodistal, and buccolingual
dimensions were assessed on the premolar die. When
the occlusogingival dimensional changes were evaluated,
the two 18-hour disinfection groups were significantly
different from the master die. These changes may not
translate into any clinically significant changes, because
the dies were larger and would provide for a larger cast-
ing, this being a goal in providing adequate cement space
and also compensating for casting shrinkage. 27 The di-
mension was larger by only 24 pro, which is the equiva-
248
LEPE A N D J O H N S O N
lent of two layers of die spacer. This dimensional change
was likely due to polymerization shrinkage of the im-
BL pression material toward the impression tray} 2
The negative values in the mesiodistal dimension of
the PVS 18-hour group and all four groups in the
-25
buccolingual dimension indicated smaller dies. This de-
crease in dimension may be caused by imbibition of water
-25 from the freshly mixed gypsum, as described in a previ-
ous study.14 Although imbibition is a viable explanation
-49 for the negative values, the 18-hour disinfection group
dies were more difficult to read. This was possibly due
to some degree of distortion of the gingival portion of
the impression during the disinfection process. The
smaller die dimensions can have a big impact on most
fixed partial denture procedures and result in castings
that are too small or tight, if compensation can not be
accomplished with die spacer and investment expansion.
CONCLUSIONS
Accuracy of both polyether and addition silicone im-
pressions were adversely affected with 18-hour disinfec-
tion by immersion in a full-strength 2% acid glutaralde-
hyde solution. The 18-hour disinfection groups revealed
that there were significant differences from the master
model. Both products tended to be affected, but more
so for the addition silicone. An increase in the cross arch
d i m e n s i o n was seen w i t h b o t h materials in the
nondisinfection and disinfection groups. This may have
a favorable effect when fabricating removable partial
dentures by compensating for casting shrinkage. This is
especially true when base metal alloys are used.
Differences in mesiodistal and buccolingual dimen-
sions between nondisinfected groups and 18-hour dis-
infection groups are of concern. The negative values for
these groups would suggest smaller die dimensions than
the master die, an inconsistency that may be too large to
compensate with die spacer. This may result in a smaller
casting with enough discrepancy to seriously affect the
clinical fit of a prosthesis.
Materials donated by the Kerr Corporation, theWhip Mix Corpo-
ration, and ESPEAmerica, Inc.
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LEPE A N D J O H N S O N THE JOURNAL OF PROSTHETIC DENTISTRY

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SEPTEMBER 1997 249