DISCUSSION

DISCUSSION

Impression making is a critical step in the process of producing successful crowns and

fixed partial dentures in oral rehabilitation, and the properties of impression materials

play an important role in the clinical success. Inaccurate impression may lead to failure

in recording of fine details, incomplete impression records and insufficient details of

hard and soft tissues.

Since the introduction of hydrocolloids in the mid-1930s, the impression of undercuts

became possible and until the 1950s and 1960s, hydrocolloids were the preferred

impression materials. Polysulfides and condensation silicones were later reliably used in

fixed prosthodontics. More evident loss observed in all these materials was mainly the

shrinkage noticed during prolonged duration of few or more hours. While hydrocolloid

shrinkage of impression material was due to the evaporation of water, in condensation

cured elastomers, it was the evaporation of low molecular by-products like ethyl alcohol.

In the late 1960s, polyether, a hydrophilic product cured by cationic ring opening

polymerization reaction, was introduced due to its good mechanical properties, reduced

shrinkage and good esthetic recovery which made it superior to hydrocolloids and

Condensation silicone materials.

The hydrophobic addition-cured silicones (polyvinyl siloxane, PVS) were introduced ten

years later in 1970s. The level of hydrophobicity of PVS was reduced by addition of

surfactants. PVS has a very high dimensional stability over time and temperature, even in

a moist environment, it is known for its superior elastic recovery. In 1997, three

categories of impression materials dominated fixed, removable and implant

prosthodontics use: addition reaction silicone, polyether and reversible hydrocolloid,

listed in order of decreasing use.

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 DISCUSSION

In order to take advantage of the properties of both poly vinyl siloxane and polyether

impression materials, a new generation of impression material, called vinyl poly ether

siloxane (VPES) has being developed. The potential advantages of VPES include

intrinsic hydrophilicity without using surfactant, handling characteristics similar to PVS,

high tear strength with flexibility, predictable subgingival flow ability.

Elastomers primarily referred to as rubber base polymers which physically or chemically

are interlinked, showing property of relapsing to original shape when indicated pressure

is released. Impression materials should reproduce hard and soft tissue in order to obtain

biologically, mechanically, functionally and esthetically acceptable restorations.

However, dimensional changes in the mold inherent to the impression material can

occur, because of changes in wettability, handling properties, viscosity and thickness of

the material existing between the oral structure and tray, fixation method of impression

material on tray, time elapsed for cast pouring, material’s hydrophilicity, byproduct loss,

polymerization shrinkage, thermal shrinkage due to temperature change (from the mouth

to room temperature), incomplete elastic recovery and in some cases, soak. Impression

quality is influenced by tray selection impression technique and preparation design.

The elastic impression materials made with a silicone base are found in four different

viscosities: putty (type 0), heavy body (type 1), regular or medium body (type 2) and

light body (type 3). According to ADA specification No. 19 for elastomeric impression

materials, the contraction should not exceed 0.5% for Type I and Type III materials or

1.0% for a type II elastomer at the end of 24 hours. According to Hung, accuracy of

addition silicone impression material is affected more by material than technique.

After Covid-19 pandemic the use of disinfectant solutions increased so, it is compulsory

for the dentist to clean the impression with the help of disinfectant solution and protect

53
 DISCUSSION

doctors and lab personnels from the infectious diseases. Dental patients are the most

common source of micro-organisms which causes dental practitioners to encounter

potentially harmful micro-organism. It has been noticed that the outer surface of the

impressions when retrieved from the mouth is usually contaminated with bacteria.

Micro-organisms are eradicated by chemical disinfection as impressions and occlusal

records cannot be sterilized by heat. The ADA recommends soaking impression

materials in disinfectant solutions for < 30 minute.

There are many disinfectant solutions use in dental field such as Iodophors, Quaternary

ammonium compound, Phenol compound, Ethyl alchohol, Gluteraldehyde, Sodium

hypochloride, O benzyl p-chlorophenol, Chitosan 1% etc17,20. Out of these disinfectant

solutions we used gluteraldehyde, Sodium hypochloride and Chitosan because these are

commercially used in clinics.

In this study, we assessed linear dimensional stability and surface details of two

commonly used elastomeric impression materials i.e. PVS and Polyether, by immersing

samples in three disinfectant solutions i.e. Gluteraldehyde 2.45% (Cidex), Sodium

Hypochloride 5.25% (Hypo) and Chitosan 1% at three time intervals T1 (15 min),T2 (6

h) and T3 (12 h) after fabrication. This would simulate the disinfection performed by the

dental technician when they receive an impression previously disinfected by the dental

office personnel. The control group taken was chosen so as to evaluate the detailed

changes and differences when impressions were not subjected to form of disinfection.

In this study Gluteraldehyde 2.45% was used as a disinfectant solution which was

advocated by Monika Khatri et. al.50 2.45% glutaraldehyde significantly reduced

microbial count from alginate impression surface.36

54
 DISCUSSION

Sodium hypochloride 5.25% was used as a disinfectant solution which was advocated by

Gelson Luis Adabo et. al11. 5.25% NaOCl was found to be sufficient to control the

virulent effect of Candida species.35

Chitosan 1% was also used as a disinfectant solution as it is a natural, non-toxic

biopolymer produced by the deacetylation of chitin. Chitin is the main component of the

cell walls of fungi and the exoskeleton of arthropods such as Crustaceans (lobsters and

shrimps). It is very resourceful hydrophilic polysaccharide inclusive of unique anti-

microbial and anti-viral activity with broad spectrum and increased fatality rate and

decreased perniciousness towards mammalian cells. Chitosan is being used in dentistry

as an implant surface modifier, as a component in dental adhesives, dental composite

resins and in combination with dentifrices and mouthwashes to reduce plaque. Chitosan

1% was advocated by Yenumula J. B. Manikyamba et. al.49

In this study, the dimensions of the stainless steel mold were according to ADA

specification number 19 which was advocated by Monika Khatri et. al 50, and Maria Del

Pilar Rios et. al.17 The stainless steel die mold which was used in this study contained

three horizontal and two vertical script lines.

Savion Marcelo Leite Moreira da Silva et. al.23 used a stainless steel mold which

comprised a roulette block and an impression tray divided into two parts: a ring and a

perforated base. Dario Melilli, Antonio et. al.29 used an acrylic resin custom tray

fabricated with Formatray acrylic resin which was perforated and non-perforated. James

N. Ciesco et. al.30 used a stainless steel die which was fabricated according to ADA

specification no 19.Three horizontal lines namely X,Y,Z were included for surface detail

reproduction and determination of dimensional stability of impression materials because

these lines are easily assessed and better reproduced, and have less chance of error.

55
 DISCUSSION

The comparison of dimensional stability of Polyvinyl Siloxane (PVS) and Polyether

dental impression materials without the use of any disinfectant, focusing on intergroup

and intragroup comparisons across three different time points, T1 (15 minutes), T2 (6

hours), and T3 (12 hours), in table 1 and graph 1, shows significant differences between

the two materials at each time point.

At T1, the mean dimensional stability for PVS was 25.63 (SD=0.01), while for

Polyether, it was 25.15 (SD=0.06). The unpaired t-test revealed a substantial t-value of

32.99 (p<0.001), signifying a significant difference in dimensional stability between PVS

and Polyether at this early time point.

Similar trends were observed At T2 (6 hours) and T3 (12 hours). At T2, the t-value was

43.43 (p<0.001), and at T3, the t-value further increased to 59.46 (p<0.001), indicating a

widening gap in dimensional stability between the two materials over time. This showed

that PVS consistently exhibited greater dimensional stability compared to Polyether. This

study was in accordance with the study of Maria del Pilar Rios et. al17 and Barry S.

Rubel et. al4

The intragroup comparisons were performed using repeated-measures ANOVA (RM

ANOVA) for both PVS and Polyether. The results demonstrated significant changes

within each group over time. For PVS, F=50.1 (p<0.001), and for Polyether, F=155.1

(p<0.001), reinforcing the notion that both materials experienced notable alterations in

dimensional stability across the assessed time points.

Thus, this investigation underscores the substantial differences in dimensional stability

between PVS and Polyether dental impression materials when used without disinfectant,

highlighting the importance of material selection and time considerations in dental

impression procedures.

56
 DISCUSSION

The comparison of dimensional stability of Polyvinyl Siloxane (PVS) and Polyether

dental impression materials with Glutaraldehyde 2.45% disinfectant at three different

time points, that is T1 (15 minutes), T2 (6 hours), and T3 (12 hours) has been depicted in

table 2 and graph 2. The results showed that, at each time point, PVS exhibited superior

dimensional stability compared to Polyether.

At T1, the mean dimensional stability for PVS was 25.63 (SD=0.01), while for

Polyether, it was 25.19 (SD=0.05). The unpaired t-test revealed a substantial t-value of

34.60 (p<0.001), indicating a significant difference in dimensional stability between PVS

and Polyether when subjected to Glutaraldehyde 2.45% at this early time point.

Similar trends were observed at T2 (6 hours) and T3 (12 hours), with PVS consistently

outperforming Polyether. At T2, the t-value was 34.56 (p<0.001), and at T3, the t-value

further increased to 64.52 (p<0.001), emphasizing the robust advantage of PVS in

maintaining dimensional stability over time in the presence of the disinfectant.

The intragroup comparisons using repeated-measures ANOVA (RM ANOVA) were

performed for both PVS and Polyether. The results demonstrated significant changes

within each group over time. For PVS, F=175.3 (p<0.001), and for Polyether, F=385.7

(p<0.001), indicating substantial alterations in dimensional stability for both materials

across the assessed time points when exposed to Glutaraldehyde 2.45%. These findings

were in agreement with the study that was conducted by Monika Khatri et. al.2 which

showed that PVS is more dimensionally stable as compared with polyether when

immersed in Gluteraldehyde 2.45%.

This investigation underscores the significant impact of Glutaraldehyde 2.45% on the

dimensional stability of dental impression materials, with PVS consistently exhibiting

better performance compared to Polyether. These findings contribute valuable insights

57
 DISCUSSION

for dental professionals in selecting appropriate materials for impression procedures

involving disinfectants.

With respect to the comparison of dimensional stability of Polyvinyl Siloxane (PVS) and

Polyether dental impression materials with Sodium Hypochlorite 5.25% disinfectant,

both intergroup and intragroup comparisons across three different time intervals, at T1

(15 minutes), T2 (6 hours), and T3 (12 hours), as shown in table 3 and graph 3.The

results indicated that, at each time point, PVS consistently displayed superior

dimensional stability compared to Polyether. For instance, at T1, the mean dimensional

stability for PVS was 25.60 (SD=0.13), while for Polyether, it was 25.13 (SD=0.03). The

unpaired t-test unveiled a substantial t-value of 14.22 (p<0.001), signifying a significant

difference in dimensional stability between PVS and Polyether when exposed to Sodium

Hypochlorite 5.25% at this initial time point.

Similar trends were observed at T2 (6 hours) and T3 (12 hours), with PVS consistently

outperforming Polyether. At T2, the t-value was 14.96 (p<0.001), and at T3, the t-value

further increased to 17.37 (p<0.001), highlighting the robust advantage of PVS in

maintaining dimensional stability over time in the presence of the disinfectant. This was

in accordance to the study ‘the effect of dimensional stability of impression material

when disinfected by different disinfectant solutions’ that was conducted by Gelson Luis

Adabo et. al 20

Intragroup comparisons using repeated-measures ANOVA (RM ANOVA) were

performed for both PVS and Polyether. The results demonstrated significant changes

within each group over time. For PVS, F=75.9 (p<0.001), and for Polyether, F=730.3

(p<0.001), indicating substantial alterations in dimensional stability for both materials

across the assessed time points when exposed to Sodium Hypochlorite 5.25%.

58
 DISCUSSION

Hence, this research underscores the significant impact of Sodium Hypochlorite 5.25%

on the dimensional stability of dental impression materials, with PVS consistently

exhibiting better performance compared to Polyether. These findings contribute valuable

insights for dental professionals in selecting appropriate materials for impression

procedures involving disinfectants.

In the study of the comparison of dimensional stability of Polyvinyl Siloxane (PVS) and

Polyether dental impression materials with Chitosan 1% disinfectant, both intergroup and

intragroup comparisons were conducted across three different time intervals. At T1 (15

minutes), T2 (6 hours), and T3 (12 hours) shown in table 4 and graph 4, the

measurements were taken for both PVS and Polyether with Chitosan 1%. The results

revealed that, at each time point, PVS consistently demonstrated superior dimensional

stability compared to Polyether. For instance, at T1, the mean dimensional stability for

PVS was 25.69 (SD=0.12), while for Polyether, it was 25.12 (SD=0.02). The unpaired t-

test showed a significant t-value of 18.99 (p<0.001), indicating a substantial difference in

dimensional stability between PVS and Polyether when exposed to Chitosan 1% at this

initial time point.

Similar trends were observed at T2 (6 hours) and T3 (12 hours), with PVS consistently

outperforming Polyether. At T2, the t-value was 20.16 (p<0.001), and at T3, the t-value

further increased to 20.89 (p<0.001), emphasizing the advantage of PVS in maintaining

dimensional stability over time in the presence of Chitosan 1%.

In addition, intragroup comparisons using repeated-measures ANOVA (RM ANOVA)

were performed for both PVS and Polyether. The results demonstrated significant

changes within each group over time. For PVS, F=155.9 (p<0.001), and for Polyether,

59
 DISCUSSION

F=241.4 (p<0.001), indicating substantial alterations in dimensional stability for both

materials across the assessed time points when exposed to Chitosan 1%.

Therefore, this research underscores the significant impact of Chitosan 1% on the

dimensional stability of dental impression materials, with PVS consistently exhibiting

superior performance compared to Polyether. These findings provide valuable insights

for dental professionals in choosing suitable materials for impression procedures

involving Chitosan 1% as a disinfectant.

The scores obtained under the stereomicroscope for PVS and Polyether materials were

analyzed, resulting in mean scores and standard deviations (SD). On analysis of table 5,

7 and graph 5, 7, the PVS exhibited a mean score of 1.70 with an SD of 0.93, while

Polyether had a mean score of 2.02 with an SD of 0.81. The Mann-Whitney test was

employed for intergroup comparison, revealing a significant difference between the two

materials. The calculated z-value was 2.36, and the associated p-value was 0.018,

indicating a statistically significant distinction in scores between PVS and Polyether

materials. Hence the surface details reproduction of polyether is more as compared to

PVS.

In the present study, PVS disinfected with glutaraldehyde and NaOCl at T1 and T2 and

T3 time intervals showed no significant difference in dimensional stability. This result

was in accordance with the studies conducted by Dario Melilli, Antonio Rallo et. al.17

Monika Khatri et. al. 2and Aalaei Sh, Rezaei Adli A et. al.33. Polyether disinfected with

glutaraldehyde and NaOCl at T1 and T2 and T3 time intervals showed no significant

difference in dimensional stability. This result was in accordance with the studies

conducted by and Monika Khatri et. al50. So, the dimensions of impressions by addition

silicone were closer to the control as compared to polyether. But, no significant

60
 DISCUSSION

differences were found for all the three dimensions measured for control, polyether and

addition silicone. Therefore, it was concluded that there were no significant changes in

dimensional stability of elastomeric impression material that was immersed in different

disinfectant solutions.

The study of the comparisons of the dimensional stability between PVS and Polyther

materials was compared in both intergroup and intragroup across three different time

points T1 (15 minutes), T2 (6 hours), and T3 (12 hours) shown in table 6 graph 6. The

mean dimensional stability, along with standard deviations (SD), for both materials at

each time point was analyzed.

At T1 (15 minutes), PVS exhibited a mean stability of 25.64 (SD = 0.09), while Polyther

had a mean stability of 25.15 (SD = 0.05). The intergroup comparison using an

independent t-test showed a significant difference between the two materials, with t=37.4

and p<0.001.

Similarly, at T2 (6 hours), PVS had a mean stability of 25.61 (SD = 0.09), and Polyther

had a mean stability of 25.08 (SD = 0.04). The intergroup comparison yielded a

significant difference with t=42.2 and p<0.001.

At T3 (12 hours), PVS showed a mean stability of 25.59 (SD = 0.10), while Polyther had

a mean stability of 24.96 (SD = 0.02). Once again, the intergroup comparison was highly

significant, with t=49.4 and p<0.001.

For intragroup comparisons within each material over the three time points, repeated

measures ANOVA (RM ANOVA) were conducted. For PVS, the F-statistic was 280.1

with p<0.001, indicating a significant difference across time points. Similarly, for

Polyther, the F-statistic was 599.9 with p<0.001, signifying a significant difference in

dimensional stability over time.

61
 DISCUSSION

The following studies have shown significant differences between addition silicone and

polyeter, addition silicone being more accurate .Peutzfeldt A and Asmussen E15

measured and compared the accuracy of a number of alginates (irreversible

hydrocolloids) and elastomeric impression materials. They found that alginate was less

accurate than the elastomeric materials. Within elastomeric materials, addition-curing

silicones were more accurate than polyether. Thongthammachat et al21 evaluated the

influence on dimensional accuracy of dental casts made with different types of trays and

impression materials (addition silicone and polyether) and found that silicone impression

material has better dimensional stability than polyether.

The following studies have shown significant differences between addition silicone and
30
polyether, polyether being more accurate.James N. Ciesco, Willium F.P. Malone

compared the dimensional stability and accuracy of selected elastomeric impression

materials at various time intervals and found that polyether material consistently yielded

superior results with or without a custom tray when compared to the other impression

materials.

Dimensional accuracy of impressions is very essential for precise fitting of prosthesis. In

this study, since there were no significant differences on the dimensional accuracy of

resultant impression made by monophase polyether and addition silicone, which implies

that both the materials can be used optimally in fixed prosthodontics. The accuracy of

both the materials falls within the clinically acceptable limits.

62