Effect of Chemical Disinfectants on the Color Stability

of Maxillofacial Silicones: An In Vitro Study

Ankita Chamaria, BDS, MDS, Meena A. Aras, BDS, MDS, Vidya Chitre, BDS, MDS, &
Praveen Rajagopal, BDS, MDS
Department of Prosthodontics and Crown & Bridge, Goa Dental College and Hospital, Bambolim, Goa, India

Keywords
Chlorhexidine; color alteration; distilled water;
soap.
Correspondence
Ankita Chamaria, flat no 305, block-D, Suncity
Complex. 105/1, Bidhan nagar road.
Ultadanga Kolkata-700067, West Bengal.
India. E-mail: ankita.chamaria12@gmail.com
The authors declare no conflict of interest
related to this study.
Accepted November 11, 2017
doi: 10.1111/jopr.12768
Abstract
Purpose: To evaluate the effect of chemical disinfection on the color stability of room
temperature vulcanizing (RTV) maxillofacial silicone elastomer with and without
pigment addition.
Materials and Methods: Sixty specimens were obtained from a RTV maxillofacial
silicone. The specimens were randomly divided into 6 groups according to pigments
and disinfectant to be used (n = 10). NP-DW-nonpigmented silicone specimens to
be immersed in distilled water (control). NP-S- nonpigmented silicone specimens to
be rubbed with an anti-bacterial soap. NP-CHX-nonpigmented silicone specimens
to be immersed in chlorhexidine gluconate solution (2%). P-DW-pigmented silicone
specimens to be immersed in distilled water (control). P-S-pigmented silicone spec-
imens to be rubbed with antibacterial soap. P-CHX-pigmented silicone specimens to
be immersed in chlorhexidine gluconate solution (2%). Disinfection was conducted
6 times a day for 60 days simulating 1 year of usage. Color was evaluated after
60 days (disinfection period) using a reflectance spectrophotometer. Color alterations
were calculated by the CIE Lࢩ aࢩ bࢩ system. Data were analyzed by t-test, one-way
ANOVA, and Tukey test (α = 0.05).
Results: NP-S and P-S exhibited the highest color alterations, whereas NP-DW and
P-DW the lowest color alterations.
Conclusion: Disinfection procedures affect the color stability of maxillofacial sili-
cone. Chlorhexidine gluconate solution (2%) can be effectively used as a chemical
disinfectant for maxillofacial prostheses. Antibacterial soap produced clinically un-
acceptable color changes in the silicone, hence is not advisable as a disinfectant.

The disruption of structural integrity of the maxillofacial region
due to trauma, surgical removal of diseased tissue, or congenital
deformities is very common. Advancements in plastic recon-
struction have been a boon in the correction of such deformities;
however, surgical contraindications and the extensive nature of
the defects often result in the use of maxillofacial prostheses.1
Silicone elastomer has been the material of choice for the
fabrication of facial prostheses since its introduction in 1960
by Barnhart.2,3 The material is known for its chemical inert-
ness, durability, strength, and ease of manipulation.4 However,
silicone elastomer has certain inherent deficiencies, including
rapid deterioration of physical properties, color instability, and
difficulty to repair.
Most silicone prostheses must be replaced frequently due to
discoloration, and color fading has been found to be the most
common reason for nonacceptance of prostheses by patients.5,6
Maxillofacial elastomers undergo major alterations in their
structure and appearance during their lifetime, mainly due
to aging caused by exposure to solar irradiation, temperature
changes, humidity, etc.7 Changes in properties can also occur
due to skin secretions and various disinfection procedures.1,8-11
Maintenance of hygiene of a maxillofacial prosthesis is of
paramount importance in retaining the health of the underlying
tissues. The facial prosthesis has been found to be colonized
by mixed microbial flora including bacteria and yeast. Hence,
disinfection of the prosthesis on a daily basis for a period of
3 to 5 minutes is necessary.12
Various methods of cleaning and disinfecting the prosthesis
are used. For example, use of a soft brush, chemical disinfec-
tion, or microwave exposure. Brushing alone is an insufficient
method to remove the microbial load, and therefore chemical
disinfection is the method of choice for cleaning the facial pros-
thesis. The chemical solution used should be tolerable to human
tissues and must preserve the properties of silicone.13
Commonly used disinfectants such as antibacterial soap and
chlorhexidine are economical and easily available for patient

Journal of Prosthodontics 00 (2018) 1–4 

C 2018 by the American College of Prosthodontists 1
Color Stability of Maxillofacial Silicones Chamaria et al

use, but investigations comparing their effects on the color sta- Table 1 Descriptive statistics of color change for different groups
bility of maxillofacial silicone are limited. Thus, the aim of
NP-DW NP-S NP-CHX P-DW P-S P-CHX
this study was to evaluate and compare the effect of two com-
monly used disinfectants: 2% chlorhexidine gluconate (Am- Mean 1.82 3.92 2.63 1.76 4.86 2.42
mdent Dental Products, Mohali, India), and antibacterial soap Standard deviation 0.33 1.01 0.80 0.33 0.42 0.55
(Dettol; Reckitt Benckiser Pvt. Ltd., Berkshire, UK) on the Minimum 1.23 2.22 1.06 1.31 4.16 1.66
color stability of pigmented and nonpigmented maxillofacial Maximum 2.26 5.49 3.56 2.48 5.36 3.21
silicone. The null hypothesis was there would be no difference
in the color stability outcomes following disinfection by the
different solutions. Table 2 Comparison of color change based on groups

Post hoc test (Tukey HSD test)

Materials and methods
Group Mean SD N Pair Mean difference p Value
A-2000 silicone elastomer (Factor II Inc., Lakeside, AZ) was
used to fabricate the specimens. Pigmented silicone speci- NP-DW 1.82 0.33 10 NP-DW/S 2.10 <0.001
mens were fabricated by incorporation of Functional Intrinsic NP-S 3.92 1.01 10 NP-DW/CHX 0.80 0.06
II Cream pigment (Factor II Inc.). NP-CHX 2.63 0.80 10 NP-S/CHX 1.29 <0.001
A metallic cylindrical matrix (20 mm diameter, 2 mm thick) P-DW 1.76 0.33 10 P-DW/S 3.09 <0.001
was used to obtain the specimens.14 A-2000 silicone elastomer P-S 4.86 0.42 10 P-DW/CHX 0.65 0.19
is available as a base (part A) and a catalyst (part B), which are P-CHX 2.42 0.55 10 P-S/CHX 2.44 <0.001
to be mixed in a ratio of 1:1 by weight. The base and catalyst
were measured in a digital precision scale using a plastic spoon
to maintain 1:1 by weight ratio. For the nonpigmented group,
The specimens were immersed completely for 5 minutes in
base and catalyst were taken in the manufacturer-recommended
distilled water (groups NP-DW and P-DW) and 2% chlorhex-
ratio. For the pigmented group, the intrinsic pigment was also
idine gluconate solution (groups NP-CHX and P-CHX). For
measured in a digital precision scale at a rate of 0.2% of weight
specimens in groups NP-S and P-S, the antibacterial soap was
of silicone in addition to the base and catalyst.15,16 These com-
rubbed on the silicone specimens with fingers for 5 minutes.
ponents were mixed on a glass slab using a stainless steel spat-
Following disinfection, each specimen was rinsed in running
ula to obtain a homogeneous mixture. The mix was poured in
water. After disinfection was complete, chromatic analysis of
a dappen dish, followed by vacuum de-aeration at 0.9 bars for
all the specimens was repeated using the UV visible reflectance
5 minutes as per manufacturer instructions to eliminate small
spectrophotometer (SS 5100H), and the color alterations were
air inclusions. The mix was then inserted in the matrices and
measured. The color alterations were calculated using the CIE
was kept undisturbed overnight to set. The specimens were
Lࢩ aࢩ bࢩ system, established by the Commission Internationale
retrieved carefully. A total of 60 specimens were fabricated
de l’Eclairage. It allows calculation of mean value of E (color
and divided into six groups based on the pigmentation and the
variation) between two readings by the following formula:18,19
disinfectants to be used.
E = [(L)2 + (a)2 + (b)2 ]1/2
Distribution of specimens
The chromatic change values were analyzed by:
NP-DW - Ten nonpigmented silicone specimens immersed in
distilled water (control).
r Student’s t-test to determine if there was a difference be-
NP-S - Ten nonpigmented silicone specimens rubbed with an- tween the L*, a*, and b* coordinates following disinfec-
tibacterial soap. tion. The same test compared the color change between
NP-CHX - Ten nonpigmented silicone specimens immersed in nonpigmented and pigmented groups with respect to a
particular disinfectant
2% chlorhexidine gluconate solution.
P-DW - Ten pigmented silicone specimens immersed in dis-
r One-way ANOVA test to compare the mean color change
tilled water (control). among the different groups in pigmented and nonpig-
mented groups
P-S - Ten pigmented silicone specimens rubbed with antibac-
terial soap.
r Tukey HSD test (post-hoc test) to compare the mean
P-CHX - Ten pigmented silicone specimens immersed in color change within the pigmented and nonpigmented
2% chlorhexidine gluconate solution. groups taken two at a time (pairwise) to assess where a
significant mean difference exists.
All test specimens obtained were submitted to initial chro-
matic analysis by means of an ultraviolet (UV) visible re- Results
flectance spectrophotometer (SS 5100H; Premier Colorscan,
Mumbai, India). A-2000 silicone elastomer mean color alteration values are
After the initial color test, all specimens were stored in a shown in Tables 1 to 3 and in Figure 1. The average color
black plastic box to rule out the ambient light affecting the change was found highest in NP-S, followed by NP-CHX,
color change parameter.17 The specimens were disinfected six and least in NP-DW in the nonpigmented groups. The av-
times a day for 60 days, simulating 1 year of use by patients. erage colour change was found highest in P-S, followed by

2 Journal of Prosthodontics 00 (2018) 1–4 

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Chamaria et al
Table 3 Comparison of color change based on disinfectants
Group Disinfectant Mean E t p Value
NP-DW Distilled water 1.82 0.40
P-DW 1.76
NP-S Antibacterial soap 3.92 −2.70
P-S 4.86
NP-CHX 2% chlorhexidine gluconate 2.63 0.67
P-CHX 2.42
P-CHX, and least in P-DW in the pigmented groups. Tukey
HSD test showed that the color changes were statistically
significant at 0.05 level, except between NP-DW/CHX and
P-DW/CHX. In general, groups disinfected with distilled wa-
ter and 2% chlorhexidine gluconate solution presented lowest
color alterations whereas the groups disinfected with antibac-
terial soap exhibited the highest color change.
Discussion
The present study rejects the null hypothesis that there would be
no difference in the color stability outcomes following disinfec-
tion by the different solutions. The highest color changes were
produced by antibacterial soap followed by 2% chlorhexidine.20
Color changes >1.1 are considered detectable by the hu-
man eye, and ࣙ3 as clinically unacceptable. Antibacterial soap
showed clinically unacceptable changes, whereas 2% chlorhex-
idine gluconate showed clinically perceptible but acceptable
color changes in the specimens.20
The mean color difference observed between the nonpig-
mented and pigmented silicone specimens disinfected with
distilled water was found to be statistically insignificant
(p = 0.69) Similar results were found for nonpigmented and
pigmented groups disinfected with chlorhexidine gluconate
(p = 0.24). The mean color difference between the
nonpigmented and pigmented groups disinfected with antibac-
Figure 1 Graphical comparison of color change.
Journal of Prosthodontics 00 (2018) 1–4 
C 2018 by the American College of Prosthodontists
Color Stability of Maxillofacial Silicones
terial soap was statistically significant (p = 0.01). This obser-
vation can be attributed to the repeated disinfection procedure
by digital friction removing the pigments from the superficial
0.69 layer of the pigmented silicone.
The results found in the study were in contrast to the ob-
0.01 servations by Goiato et al, in which chlorhexidine gluconate
produced the greatest color alterations followed by neutral
0.24 soap and Efferdent.17 They had disinfected the specimens with
chlorhexidine gluconate for 10 minutes, thrice a week for
2 months. This equals approximately 240 minutes. Neutral soap
was used for around 1 minute thrice a week for 2 months, which
equals 24 minutes. The suggested daily treatment is 3 to 5 min-
utes, which when done for a year corresponds to approximately
1800 minutes.21
Ariani et al studied and proved the efficacy of antibacterial
soap containing triclosan and 0.2% chlorhexidine gluconate
against microorganisms in biofilms present on silicone facial
prostheses.22 The present study used antibacterial soap contain-
ing chloroxylenol instead of neutral soap and 2% chlorhexidine
gluconate.10,17,23 Chlorhexidine (2%) is easily available and
has no coloring agents. Chlorhexidine is effective against gram
positive and negative microbes and yeasts. The chloroxylenol
used in this study is particularly effective against bacteria.
Many other factors, including time, affect color stability.
Maxillofacial silicones exhibit increased cross-linking with
time, presumably increasing resistance to fatty acid degener-
ation and decreasing water sorption; however, this effect has
been poorly investigated. It is always advisable to use mild
detergents for cleaning facial prostheses.12
Visual determination has been found to be subjective and
dependent on the observer’s responses to radiant energy
stimulation. Instrumental evaluations are objective and can be
promptly obtained. Color measurement by spectrophotometry
is a reliable, sensitive, and repeatable method. The color
changes were measured in the study by using SS 5100H,
which is a UV-visible reflectance spectrophotometer incorpo-
rating complementary metal–oxide–semiconductor (CMOS)
3
Color Stability of Maxillofacial Silicones
integrated circuit technology. It is a dual-beam d/8° spectropho-
tometer with pulsed xenon filtered to approximate D65 as
the illuminating source. The color changes detected by visual
method can be detected only if the E values are higher than
3. Therefore, only groups NP-S and P-S can be detected by the
human eye.
The intrinsic pigments incorporated in the silicone specimens
were examined. Further studies to evaluate the effect of extrinsic
coloration on the color stability of maxillofacial silicone are
required. The study presents with a limitation that rubbing of the
specimens does affect the color more. For futher investigations,
an appropriate soap solution with proper concentration should
be evaluated.
Conclusions
Within the limitations of the present study, the following con-
clusions may be drawn:
1. Antibacterial soap promoted the greatest color alterations
of the maxillofacial silicones.
2. Chlorhexidine gluconate showed clinically acceptable
color changes. Hence, it is appropriate for its usage as a
disinfectant.
Clinical Significance: For hygiene maintenance and minimal
color change, chlorhexidine in 2% concentration is an appro-
priate disinfectant.
Acknowledgments
The authors convey sincere thanks to Premier Colorscan Instru-
ments Pvt Ltd, Mumbai, for their cooperation during the color
alteration readings.
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