Effect of Hand Gloves on Setting Time and Dimensional Stability of Vinyl Polysiloxane Putty Impression Material

INTRODUCTION
For restoration of esthetics as well as occlusion, conservation of tooth and tooth structure are the primary objectives in dental practice. Several types of dental works have been performed by the dental practitioners, for instance, dental impression and so on. Impression is taken for different prosthodontic procedures. And this is the preliminary stage for the fabrication of any prosthesis as well as the first step of microbial contamination.

In the light of current concept regarding the spread of infectious diseases, the dental professional have become more aware of various routes of cross contamination. It might happen in dental operatory , facilitated by the dentist and dental auxiliary personal (Runnells RR. 1988). Since dentistry is considered as an important issue for cross contamination, infection control should be an integral part of dentistry. In standard guide lines of infection control wearing gloves is one of the most important one/method.

The ADA Council on scientific Affairs evaluates the latex examination gloves for safety and efficacy. According to the ADA Acceptance Program Guideline for Infection Control Products (October 1998) and American National Standards Institute/ADA Specification no. 76 for Non Sterile Natural Rubber Latex Gloves for Dentistry (January 1999).

The use of gloves in dentistry is essential for proper infection control. There are so many advantages to using latex gloves and latex examination gloves remain the best choice for protecting dentists without overly compromising tactile sensitivity. However, it has been reported that wearing latex rubber gloves while mixing vinyl polysiloxane putty retards or inhibits their setting.

JUSTIFICATION
In dentistry, using hand gloves is a vital method to control contamination or cross infection via saliva and blood. Although several types of gloves are available in the market but most researchers have recommended to use the latex disposable surgical gloves to reduce the transmission of infectious diseases in the dental office.

Since the present investigator have noticed by his personal observation, the disposable latex gloves often affect the setting time as well as dimensional stability of the impression material, he is interested to study about the effects of different disposable gloves particularly between the latex and vinyl disposable gloves on vinyl polysiloxane (addition silicone) putty impression materials .

HYPOTHESIS
Latex hand gloves may have some effect on the setting time and dimensional stability of vinyl polysiloxane putty impression material during their manipulation.

OBJECTIVES
General :

To evaluate the influence of hand gloves on setting time and dimensional stability of vinyl polysiloxane putty impression materials.
Specific :

To assess the setting time of vinyl polysiloxane impression materials during manipulation with ungloved hands. To measure the dimensional stability of vinyl polysiloxane impression materials during manipulation with ungloved hands. To assess the setting time of vinyl polysiloxane impression materials during manipulation wearing latex and vinyl gloves. To measure the dimensional stability of vinyl polysiloxane impression materials during manipulation wearing latex and vinyl gloves. To utilize the results obtained from the present study in our daily dental practice in terms of better prognosis.

METHODS
Type of study : It was a prospective comparative study. Place of study : This study was carried out in the Department of Prosthodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University, Dhaka. Period of study : The total duration of the study was from January 2009 to December 2010.

Study subject :
Patients attended in the outpatient department of Prosthodontics, BSMMU for the treatment of fixed prosthesis on maxillary arch, were included in this study.

Sampling technique:
Simple random sampling was followed to select the subject of the study.

Study sample:
Vinyl polysiloxane maxillary impressions of dentulous patient and their casts were used as the sample of the study.

Sample size :
Twenty patients were selected to collect three maxillary impressions from each. So (20 x 3)= 60 vinyl polysiloxane impressions followed by their 60 gypsum cast were taken as sample size.

Grouping of the sample

Total 60 maxillary impressions of vinyl polysiloxane were made according to the grouping of sample and divided into three groups (A, B and C)-

Group-A(Control group): Twenty (20) maxillary vinyl polysiloxane impressions were divided intoGroup A1: Twenty maxillary impressions were made with ungloved hands. Group A2: Gypsum cast were prepared from the twenty impressions which were made with ungloved hands.
Group-B: Twenty (20) maxillary vinyl polysiloxane impressions were divided intoGroup-B1: Twenty maxillary impressions were made wearing latex gloves. Group-B2: Gypsum cast were prepared from the twenty impressions which were made wearing latex gloves.

Group-C: Twenty (20) maxillary vinyl polysiloxane impressions were divided intoGroup-C1: Twenty maxillary impressions were made wearing vinyl gloves. Group-C2: Gypsum cast were prepared from the twenty impressions which were made wearing vinyl gloves

Inclusion criteria
Dentulous patients of both sexes were included. Patients with good oral hygiene were included. Patients with both intact maxillary canines were included. Impressions taking from maxillary arch were included. Only intact, clean as well as exact sized gloves were used. Equal amount of impression material were used for every impression. Recommended working time(1.30min) were followed for every impression. Only properly mixed impression materials were used.

Exclusion criteria
Patients with infectious diseases were excluded. Patients with missing maxillary canine were excluded. Patients wearing prosthesis were excluded. Defective, torn gloves were excluded. Improperly mixed impression materials were excluded. Defective impressions were excluded. Defective casts were excluded.

Research instrument :
The devices which were used to record and measure the setting time and dimensional stability of the impression is a SS China brand blunt probe or Opso brand 10cc disposable syringe, a Apple brand (China) stop watch and a digital calipers.

Fig: Vinyl Polysiloxane Putty Impression

Material

Fig: Disposable syringe and stop watch

Fig: Magnifying Glass and Digital Calipers

Fig: Latex (Comfit) Hand Gloves

Fig: Vinyl (Life) Hand Gloves

STUDY PROCEDURE
With all aseptic measures the impression materials will be mixed by hand according to the manufacturers recommendation. Then the materials will be placed in the patients mouth to take impressions with stainless steel stock tray (perforated) and setting time will be noted. Penetrometer tests have been used to assess both the working time and the setting time.

Total 60 impressions will be made with vinyl polysiloxane and the material will be mixed once in latex gloves, vinyl gloves and again with washed ungloved hands subsequently. Setting times will be recorded in every steps of the mixing of impression materials. The setting times of these putties will be tested and compared to control group (mixing with washed ungloved hand).

Then the impressions will be checked and gypsum product (Die stone, Dentamerica, USA) will be poured into the impressions and allowed to set. After removing the casts from the impressions, dimensional stability will be measured with a digital caliper according to the reference point.

Fig: Putty Impression Material in Ungloved Hand

Fig: Kneading of Vinyl Polysiloxane Putty Impression Material

Fig: Vinyl Polysiloxane Impression with stock tray

Fig: Impression taking with Vinyl

Polysiloxane putty material in ungloved hand

Fig: Checking of setting of Vinyl

Polysiloxane with blunt needle

Fig: Kneading of Vinyl Polysiloxane

Putty Impression Material wearing latex gloves

Fig: Impression taking with Vinyl

Polysiloxane putty wearing latex hand gloves

Fig: Recording of setting time of Vinyl

Polysiloxane with stop watch

Fig: Impression taking with Vinyl Fig: Kneading of Vinyl Polysiloxane Putty
Material wearing Polysiloxane putty wearing vinyl hand gloves

Fig: Set of Vinyl Polysiloxane impression

after labeling

Fig: Gypsum cast preparation

Fig: Prepared gypsum cast after labeling

Fig: Measurement of reference

distance with digital calipers

Study parameter :
Setting time : Method used for scoring setting time
Grade 0: No significant delay of setting time.* Grade I: Setting time delayed within 6-8minutes.* Grade II: Setting time delayed within 8-10 minutes.* Grade III: Setting time delayed for more than 10 minutes.* (*From the setting time of the manufacturer i.e. 6 minutes)

Dimensional stability
It is the ability of a material to retain its size and form. Dimensional stability was checked by measuring the distance between the tips of the canines of maxillary cast which was found following different technique of impression procedures. The tip of the canine was serving as a reference point. To take the distance between the reference points a digital caliper was used and values were placed on the data sheet. The difference of the distance in between control group and study groups was consider as dimensional change.

Data Collection
Data were collected according to the predesigned data collection sheet on the basis of the setting time and dimensional stability of the putty impression materials.

Data Analysis
Data were entered into the computer by using the statistical soft ware and statistical package for social science (SPSS) for windows version 16. Statistical significant was done according to the objective of the study. Data were checked, cleaned and edited properly before analysis. Chisquare test and t-test (unpaired) were done for statistical significance. Analysis of variance (ANOVA) was applied to compare the data among the groups. The results were presented in tables and figures. p-value (<0.05) was considered as significant.

Result
Table I: Distribution of impression materials according to setting time in between Group-A1 and Group-B1 (n=20)
Group A1 Setting Time n Grade 0 Grade I Grade II Grade III MeanSD 19 1 0 0 0.050.22 (n=20) % 95.0 5.0 0.0 0.0 n 2 17 1 0 0.950.39 Group B1 (n=20) % 10.0 85.0 5.0 0.0 0.001s P value

P- value reached from unpaired t-test. S=Significant n= number of samples. Group A1- Impression taken with Un-gloved hands (control group) Group B1- Impression taken wearing Latex hand-glove Grade 0: No significant delay of setting time.* Grade I: Setting time delayed within 6-8 minutes.* Grade II: Setting time delayed within 8-10 minutes.* Grade III: Setting time delayed for more than 10 minutes.* (*From the setting time according to instruction of the manufacturer i.e. 6 minutes)

Grade 0
95

Grade I

Grade II
100 90 80 70 Percentage of grading 60 50 85

Grade III

40
30 20 10 0 Group A1 Group B1 5 0 0 10 5 0

Fig 1: Bar diagram of impression materials showing the setting time of Group-A1 and Group-B1.

 Table I and Figure1 show the distribution of impression materials according to setting time. It is evident that in group A1, 19(95%) impression material sets within normal limit (6 minutes= Grade 0) whereas 1(5%) sets delayed for within 6-8 minutes (Grade I) and nothing is observed in Grade II & III. In group B1 2(10.0%) shows normal setting time (Grade 0) while 17(85.0%) falls Grade I (within 6-8 minutes) and 1(5.0%) fall in Grade II (within 8-10 minutes) and in Grade III nothing is observed. The mean setting time was 0.050.22 and 0.950.39 in group A1 and group B1 respectively. The mean setting time was significantly higher in group-B1 (p value = 0.001) than the Group A1.

Table II: Distribution of impression materials according to setting time in between Group-A1 and Group-C1 (n=20)
Group A1 Setting Time n Grade 0 Grade I Grade II 19 1 0 (n=20) % 95.0 5.0 0.0 n 18 2 0 Group C1 (n=20) % 90.0 10.0 0.0 P value

Grade III MeanSD

0 0.050.22

0.0

0 0.100.31

0.0 0.560 ns

P value reached from unpaired t-test. NS=Not significant n= number of samples. Group A1- Impression taken with Un-gloved hands (control group) Group C1- Impression taken wearing Vinyl hand-glove Grade 0: No significant delay of setting time.* Grade I: Setting time delayed within 6-8 minutes.* Grade II: Setting time delayed within 8-10 minutes.* Grade III: Setting time delayed for more than 10 minutes.* (*From the setting time according to instruction of the manufacturer i.e. 6 minutes)

Grade 0
95 90

Grade I Grade III

Grade II

100 90 80 70 Percentage of grading 60 50 40 30 20 10 10 5 0 0 0 0

0
Group A1 Group C1

Fig 2: Bar diagram of impression materials showing the setting time of Group-A1 and Group-C1.

 The table II and Figure 2 show the distribution of impression materials according to setting time. In group A1 Grade 0 were 19(95.0%), Grade I 1(5.0%) but there were no difference observed in Grade II & III . In group C1 Grade 0 were 18(90.0%), Grade I 2(10.0%), Grade II & Grade III not observed. The mean sitting time was 0.050.22 in group A1 and 0.100.31 in group C1. The mean setting time was almost similar between group-A1 and group-C1 (p value = 0.560), which indicates that the mean sitting time was almost similar between two groups (not significant).

Fig 3: Bar diagram of impression materials showing the setting time of Group-B1 and Group-C1.
Group B1 Setting Time (n=20) n Grade 0 Grade I Grade II Grade III MeanSD 2 17 1 0 0.950.39 10.0 85.0 5.0 0.0 18 2 0 0 0.100.31 Group C1 (n=20) % 90.0 10.0 0.0 0.0 0.001s P value

P value reached from unpaired t-test. S=Significant n= number of samples. Group B1- Impression taken wearing Latex hand-glove Group C1- Impression taken wearing Vinyl hand-glove Grade 0: No significant delay of setting time.* Grade I: Setting time delayed within 6-8 minutes.* Grade II: Setting time delayed within 8-10 minutes.* Grade III: Setting time delayed for more than 10 minutes.* (*From the setting time according to instruction of the manufacturer i.e. 6 minutes)

85

90

Grade 0
90 80 70 60 Percentage of grading 50

Grade I

Grade II

Grade III

40
30 10 20 10 0 Group B1 Group C1 5 0 10 0 0

Fig 3: Bar diagram of impression materials showing the setting time of Group-B1 and Group-C1.

The table III and Figure 3 show the distribution of impression materials according to setting time between group B1 and group C1. In group B1 Grade 0 were 2(10.0%), Grade I 17(85.0%), Grade II 1(5.0%) and Grade III not observed. In group C1 Grade 0 were 18(90.0%), Grade I 2(10.0%), Grade II & Grade III not observed. The mean setting time was 0.950.39 in group B1 and 0.100.31 in group C1. The mean setting time was significantly higher in groupB1 (p value=0.001) than the Group C1.

Table IV: Distribution of impression materials according to setting time among the Group-A1, Group-B1 and Group-C1 (n=20)
Group A1 Setting Time n Grade 0 Grade I Grade II Grade III MeanSD 19 1 0 0 (n=20) % 95.0 5.0 0.0 0.0 0.050.22 n 2 17 1 0 Group B1 (n=20) % 10.0 85.0 5.0 0.0 0.950.39 n 18 2 0 0 Group C1 (n=20) % 90.0 10.0 0.0 0.0 0.100.31 0.001s P value

S=Significant n= number of samples. P value reached from ANOVA test. Group A1- Impression taken with Un-gloved hands (control group) Group B1- Impression taken wearing Latex hand-glove Group C1- Impression taken wearing Vinyl hand-glove Grade 0: No significant delay of setting time.* Grade I: Setting time delayed within 6-8 minutes.* Grade II: Setting time delayed within 8-10 minutes.* Grade III: Setting time delayed for more than 10 minutes.* (*From the setting time according to instruction of the manufacturer i.e. 6 minutes)

Grade 0

Grade I Grade III

95 85 100 90 80 70 60 50 40 30 20 10 0

90

Grade II

Percentage of grading

10

10 0 0 0

Group A1

Group B1

Group C1

Fig 4: Bar diagram of impression materials showing the setting time among the Group-A1, Group-B1 and Group-C1

Table IV and Figure 4 show the distribution of impression materials according to setting time among group A1, group B1 and group C1. In group A1 Grade 0 were 19(95.0%), Grade I 1(5.0%) and Grade II & III not observed. In group B1 Grade 0 were 2(10.0%), Grade I 17(85.0%), Grade II 1(5.0%) and Grade III not observed. In group C1 Grade 0 were 18(90.0%), Grade I 2(10.0%), Grade II & Grade III not observed. The mean setting time was 0.050.22 in group A1, 0.950.39 in group B1, and 0.100.31 in group C1. The mean setting time was significantly higher in group-B1 (p value = 0.001) than the Group A1 and Group C1.

Table V: Distribution of gypsum cast according to dimensional stability in between Group-A2 and Group-B2 (n=20)
Groups (MeanSD) Group- A2 34.964 Group- B2 34.982 2.842 31.29 41.49 2.901 Min 31.34 Max 41.54 0.906ns P Value

Group A2- Measurement of distance between the reference point from the gypsum cast made from the impression manipulated with ungloved hands (control group) Group B2- Measurement of distance between the reference point from the gypsum cast made from the impression wearing Latex hand gloves (case group) Reference Point= Distance between the tips of both canines of the maxillary cast NS= Not significant n= number of samples. P value reached from unpaired t-test.

34.964

34.982

35 34.5

34
33.5 33 Mean 32.5 32 31.5 31 30.5 30 Group- A2 Group- B2

FIG 5: Bar diagram of gypsum cast showing the dimensional stability of Group-A2 and Group-B2

 Table V and Figure 5 show distribution of gypsum cast according to dimensional stability. The mean measurement of distance between the reference point from cast is 34.9642.901 and within the range from 31.34 to 41.54 in group A2. In group B2, the mean measurement of distance between the reference point from cast is 34.9822.842 and within range from 21.29 to 41.49. The mean reduction of measurements of distance between the reference points from cast is 0.09% between group A2 and group B2 which is not statistically significant (p>0.05) between two groups.

Table VI: Distribution of gypsum cast according to dimensional stability in between Group-A2 and Group-C2 (n=20)
Groups Group-A2 Group-C2 MeanSD 34.9642.901 34.9612.898 Min 31.34 31.32 Max 41.54 41.52 P Value 0. 541ns

Group A2- Measurement of distance between the reference point from the gypsum cast made from the impression manipulated with ungloved hands (control group) Group C2- Measurement of distance between the reference point from the gypsum cast made from the impression wearing Vinyl hand gloves Reference Point= Distance between the tips of both canines of the maxillary cast NS=not Significant n= number of samples. P value reached from unpaired t-test.

34.964

34.961

35
34.5 34 33.5 33 Mean 32.5 32 31.5 31

30.5
30 Group-A2 Group-C2

Fig 6: Bar diagram of gypsum cast showing the dimensional stability of Group-A2 and Group-C2

 Table VI and Figure 6 show distribution of gypsum cast according to dimensional stability. The mean measurements of distance between the reference points from cast was 34.9642.901 with ranged from 31.34 to 41.54 in group A2. In group C2, the mean measurements of distance between the reference points from cast was 34.9612.898 with ranged from 31.32 to 41.52. The mean difference of measurements of distance between the reference points from cast was not statistically significant (p>0.05) between two groups. The mean reduction of measurements of distance between the reference points from cast was 0.008% between group A2 and group C2.

Table VII: Distribution of gypsum cast according to dimensional stability in between Group-B2 and Group-C2 (n=20)
Groups Group-B2 Group-C2 MeanSD 34.9822.842 34.9612.898 Min 31.29 31.32 Max 41.49 41.52 P Value 0.891ns

Group B2- Measurement of distance between the reference point from the gypsum cast made from the impression wearing Latex hand gloves (case group) Group C2- Measurement of distance between the reference point from the gypsum cast made from the impression wearing Vinyl hand gloves Reference Point= Distance between the tips of both canines of the maxillary cast NS=Not significant n= number of samples. P value reached from unpaired t-test.

34.982

34.961

35 34.5 34 33.5 33 Mean 32.5 32 31.5 31 30.5 30 Group-B2 Group-C2

Fig 7: Bar diagram of gypsum cast showing the dimensional stability of Group-B2 and Group-C2

 Table VII and Figure 7 show distribution of gypsum cast according to dimensional stability. The mean measurements of distance between the reference points from cast was 34.9822.842 with ranged from 31.29 to 41.49 in group B2. In group C2, the mean measurements of distance between the reference points from cast was 34.9612.898 with ranged from 31.32 to 41.52. The mean difference of measurements of distance between the reference points from cast was not statistically significant (p>0.05) between two groups. The mean reduction of measurements of distance between the reference points from cast was 0.08% between group-B2 and group-C2.

Table VIII: Distribution of gypsum cast according to dimensional stability among three groups.

Groups Group-A2 Group-B2 Group-C2

MeanSD 34.9642.901 34.9822.842 34.9612.898

Min 31.34 31.29 31.32

Max 41.54 41.49 41.52

P Value

0.999ns

Group A2- Measurement of distance between the reference point from the gypsum cast made from the impression manipulated with ungloved hands (control group) Group B2- Measurement of distance between the reference point from the gypsum cast made from the impression wearing Latex hand gloves (case group) Group C2- Measurement of distance between the reference point from the gypsum cast made from the impression wearing Vinyl hand gloves Reference Point= Distance between the tips of both canines of the maxillary cast NS=Not significant P value reached from ANOVA-test

34.964

34.982

34.961

35

34.5
34 33.5 33 Mean 32.5 32 31.5 31 30.5 30 Group-A2 Group-B2 Group-C2

Fig 8: Bar diagram of gypsum cast showing the dimensional stability among three groups.

 Table VIII and Figure 8 show distribution of gypsum cast according to dimensional stability. The mean measurements of distance between the reference points from cast was 34.9642.901 with ranged from 31.34 to 41.54 in group A2. The mean measurements of distance between the reference points from cast was 34.9822.842 with ranged from 31.29 to 41.49 in group B2. In group C2, the mean measurements of distance between the reference points from cast was 34.9612.898 with ranged from 31.32 to 41.52. The mean difference of measurements of distance between the reference points from cast were not statistically significant (p>0.05) among three groups.

DISCUSSION
From the present study result it is evident that the vinyl gloves (Life) shows no significant difference in comparison to un-gloved hand in terms of the setting time (p-value=0.560ns) as well as dimensional stability (p-value=0.541ns) with Reprosil polyvinylsiloxane putty impression materials that were tested. On the other hand, Reprosil putty impression material show significantly delayed setting time (p-value=0.001s) when comparing with the latex gloves (comfit) from un-gloved hand. In the present, during accuracy test (dimensional stability), the same accuracy of impression is achieved when high viscosity impression materials (putty impression material) were used.

CONCLUSION
At the end of the study it is concluded that latex gloves delayed or interfered the setting time of vinyl polysiloxane (addition silicone) putties. Sulfur compound which is present in the latex gloves acts as a retarder causing inhibition of setting of vinyl polysiloxane but it does not change any dimensional stability. It is also concluded that the vinyl gloves has no effect on setting time or dimensional stability of vinyl polysiloxane. Clean, ungloved hands or fingers could be used for kneading of vinyl polysiloxane putty impression materials.

RECOMMENDATIONS
The following recommendations can be made Latex gloves should not be worn while dispensing, mixing or handling vinyl polysiloxane putties because it interferes the setting time. Vinyl gloves can be used during taking impression with vinyl polysiloxane materials because it does not interfere the setting time or changes the dimensional stability. Clean and ungloved hands or fingers may be an alternative option for kneading of vinyl polysiloxane putty impression materials. As the sample size was small, the further research could be done with a greater sample size and variety to obtain more valid conclusion.

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