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Loyola University Chicago Loyola University Chicago Loyola eCommons Loyola eCommons Master's Theses Theses and Dissertations 1978 A Comparison of the Accuracy and Dimensional Stability of Five A Comparison of the Accuracy and Dimensional Stability of Five Elastomeric Impression Materials Elastomeric Impression Materials James N. Ciesco Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_theses Part of the Oral Biology and Oral Pathology Commons Recommended Citation Recommended Citation Ciesco, James N., "A Comparison of the Accuracy and Dimensional Stability of Five Elastomeric Impression Materials" (1978). Master's Theses. 2964. https://ecommons.luc.edu/luc_theses/2964 This Thesis is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Master's Theses by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1978 James N. Ciesco

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Loyola University Chicago Loyola University Chicago

Loyola eCommons Loyola eCommons

Master's Theses Theses and Dissertations

1978

A Comparison of the Accuracy and Dimensional Stability of Five A Comparison of the Accuracy and Dimensional Stability of Five

Elastomeric Impression Materials Elastomeric Impression Materials

James N. Ciesco Loyola University Chicago

Follow this and additional works at: https://ecommons.luc.edu/luc_theses

Part of the Oral Biology and Oral Pathology Commons

Recommended Citation Recommended Citation Ciesco, James N., "A Comparison of the Accuracy and Dimensional Stability of Five Elastomeric Impression Materials" (1978). Master's Theses. 2964. https://ecommons.luc.edu/luc_theses/2964

This Thesis is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Master's Theses by an authorized administrator of Loyola eCommons. For more information, please contact [email protected].

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1978 James N. Ciesco

A COMPARISON OF THE ACCURACY AND DIMENSIONAL STABILITY

OF FIVE ELAS TOHERIC IMPRESS ION HATE RIALS

by

James N. Ciesco, D.D.S.

A Thesis Submitted to the Faculty of the Graduate School

of Loyola University in Partial Fulfillment of

the Requirements for the Degree of

Master of Science

April

1978

DEDICATION

To my mother, Olga, for offering the greatest love, support

and encouragement throughout my first rNenty-seven years of life

and making me what I am. Also to my mother and father-in-law,

Lillian and Menceslaus, for their guidance and support in my

educational and professional pursuits.

To my wife, Joyce, for her love, devotion, patience, and most

of all understanding in whatever endeavor I choose to pursue.

ii

ACKNOHLEDGEMENTS

I am especially thankful to Dr. Hilliam F. Malone who, as my

advisor, offered invaluable guidance and inspiration during the course

of this investigation, and for allowing the realization of my pro­

fessional career, not only as a clinical operator but also as a potential

researcher and a total human being.

I wish to thank Dr. James L. Sandrik whose continual guidance and

enthusiasm have provided me with a sincere appreciation of investigative

principles.

I also wish to express my appreciation to Dr. Boleslaw Mazur and

Dr. Hosea F. Sawyer for their assistance and sincere encouragement.

iii

-

VITA

James N. Ciesco was born April 18, 1950 in Chicago, Illinois to

Theodore T. and Olga Ciesco. He >vas the second of three children; having

one brother, Thomas, and one sister, Carol Lynn.

In 1968 he graduated from Taft High School. He began his formal

education at Wright Junior College in 1968, where he studied for two years.

From here he transferred to Loyola University where he received the degree

of Bachelor of Science in June 1972. He began his formal dental studies

at the University of Loyola School of Dentistry, Chicago College of Dental

Surgery in 1972 and graduated in 1976 with a Doctor of Dental Surgery

degree.

His graduate studies began in the Department of Oral Biology of Loyola

University School of Dentistry, Chicago College of Dental Surgery in 1976.

Specialty training was in the Department of Fixed Prosthodontics under the

Director of Graduate Fixed Prosthodontics, Dr. William F. Malone.

iv

TABLE OF CONTENTS

PAGE

DEDICATION · · · ii

ACK.NO\VLEDGEMENTS iii

VITA .. · • · iv

LIST OF TABLES vii

LIST OF FIGURES viii

Chapter

I. INTRODUCTION 1

II. LITERATURE REVIEW 6

A. Introduction . 6

B. Elastomeric Impression Haterials - 1950 1 s 6

C. Elastomeric Impression Materials - 1960's 9

D. Elastomeric Impression ~~terials - 1970's 12

III. METHODS AND MATERIALS 24

A. Part I • 24

B. Part II 31

IV. RESULTS . 33

V. DISCUSSION 46

A. Interpretation of Results 46

B. Comparison of Materials Used Without a Custom Tray . • . . . . . . • . • . 49

C. Comparison of Materials Used With a Custom Tray . . . • . . . • . · · • 49

v

pt

D. Comparison of Techniques

E. General Discussion and Recommendations

VI. CONCLUSIONS

BIBLIOGRAPHY

APPENDIX

vi

50

51

55

57

64

ps

Table

1.

LIST OF TABLES

Name, batch number and manufacturer of each impression elastomer ••.•••

2. To tal mean data for all samples taken. He an -Standard Deviation - Percent Shrinkage from die are calculated

3. Comparison of all materials evaluated without the use of a custom tray and adhesive at all

4.

5.

time intervals

Comparison of all materials evaluated with the use of a custom tray and adhesive at all time intervals . . • . . . . . . . • . . . • . •

Comparison of all samples made without the use of a custom tray to all samples made with the use of a custom tray at all time intervals observed

vii

Page

25

34

35

36

37

p

Figure

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

ll.

LIST OF FIGURES

Top view of the die with the ring on • • •

The die with the glass and cellophane held to­gether with the "c" clamp

Gaetner traveling microscope

The die with the glass, custom tray and cello­phane held together with the "c" clamp ••••

Graphical comparison of President w/ tray "vs" President w/o tray ••••••.

Graphical comparison of Omniflex w/ tray "vs" Omniflex w/o tray • • • . . • • • • • •

Graphical comparison of Permlastic w/ tray "vs" Permlastic w/o tray • . • • • • •

Graphical comparison of Impregum w/ tray "vs" Impregum w/ o tray • • • . . • • • • • • .

Graphical comparison of Accoe w/ tray "vs" Accoe r.v/o tray •••••.•.•.•.••

Graphical comparison of all materials evaluated without the use of a custom tray • • • • • . .

Graphical comparison of all materials evaluated with the use of a custom tray ••••••.•

viii

Page

26

28

29

32

39

40

41

42

43

44

45

p

CHAPTER I

INTRODUCTION

The requirements of dental impression materials are numerous.

Primarily, impression materials should provide an accurate reproduction

of the teeth and allied intraoral structures. The materials also must

possess an acceptable working and setting time for the comfort of the

patient and the convenience of the dentist. In addition, these materials

should have satisfactory elasticity to enable them to be withdrawn from

the undercuts of the oral cavity and return to stable form from which

accurate casts can be obtained.

Secondly, dental materials must be non-toxic and have a sufficient

shelf life to be stored without a demanding physical environment, i.e.,

heat and humidity.

Impression materials used in conjunction with fixed prosthodontics

must have inherent strength and acceptable viscosity to be placed in

critical areas of tooth preparation such as subgingival marginal extensions

and rigid axial line angles. The cost cannot be prohibitive to restrict

widespread usage.

Prior to the development of elastomeric impression materials, there

were only two materials which enjoyed widespread use in fixed prosthodontics.

They were reversible hydrocolloid and impression compound. It may be

noted that prior to the development of any elastic type impression material,

prosthesis were fabricated by direct wax patterns, impression compounds

and Dietrich's formula.

1

p

Reversible hydrocolloid has been and still is used by numerous

practitioners in the fabrication of fixed partial dentures. However,

2

it is a difficult material to manipulate because of its low tear strength

and problems associated with imbibition and syneresis on storage (Phillips

1973). In addition, hydrocolloid impressions must be poured immediately

to maintain an acceptable level of accuracy.

Impression compound is a thermoplastic material, which when set,

is extremely hard and inelastic. Thus it is not suitable in areas which

have obvious undercuts. The use of impression compound in crown and bridge

prosthodontics has generally been restricted to isolated crowns. Circum­

ferential copper bands are employed as the matrix to contain the material.

The uniform thickness of this thermoplastic material insures a measure of

success.

The dire need for a stable, accurate and elastic impression material

sponsored the introduction of elastomeric impression rubber into dentistry.

Today there are three classes of rubber impression materials available to

the dentist, namely, the polysulfides, silicones and the polyether materials

(Phillips 1973).

The polyether material was the only one of the three types which has

been developed specifically for dental use, whereas the other two have been

adapted from industrial use (Craig 1975). Polyether impression materials

were introduced in West Germany in late 1969 (JADA 1977). These are two

paste systems consisting of a base and a catalyst. A thinner paste may also

3

be added to the prime ingredients to alter some of their physical properties,

The addition does not affect the accuracy. Two polyether materials are

+ commercially available today, Impregum and Polygel. The setting reaction

is affected by reaction between aziridino rings at the end of the branched

polymer molecules. The reaction is brought about by an aromatic sulphonate

ester (Braden et al, 1972; Phillips, 1973; Braden, 1975).

The polysulfide rubbers were introduced for industrial application

in 1929 (Craig 1975). The liquid polymers were developed in 1943 by Thiokol

Laboratories, Inc. (New Jersey, USA). They were promoted for a number of

uses in the Armed Services, but were not used in general dentistry until

after the second World War (Fettes and Jorczak, 1950; Jorczak and Fettes,

1951). Polysulfides were formally introduced into dentistry in the 1950's.

Braden (1966, 1975) and Phillips (1973) reported the basic ingredient of the

liquid polymer was a polyfunctional mercaptan on polysulfide polymer with

the general formula:

HS (R-S-S) - R - SH 23

Fillers, plasticizers, pigments, deodorizers and accelerators were added

to the material to render it suitable for dental use. The addition of lead

peroxide to the polysulfide polymer resulted in both chain lengthening and

cross linking by oxidacion of the -SH groups (Braden, 1966; Phillips, 1973).

Similarly, the silicones were developed for i_ndustrial use but were

not introduced into dentistry until the late 1950's (Craig 1975). The

basic polymer is a difunctional polydimethylsiloxane with hydroxyl end

groups (Braden, 1966; Phillips, 1973). Elastomer formation occurred by

4

cross linkage between these terminal end groups of silicone polymers and

alkyl silicate. This developed into a three dimensional network. Tin

octate or other organa-tin compounds were used as the catalyst (Craig 1975):

SILICONE POLYMER + ALKYL SILICATE + TIN OCTATE = ELASTOMER + METHYL OR ETHYL ALCOHOL

It should be noted this reaction produced alcohol and the resultant

evaporation may be a contributing factor in causing shrinkage which occurred

after setting.

There are many steps involved in the fabrication of a cast prosthesis

and most of these have been researched extensively. However, the role of

the elastomeric impression materials adhesive had commonly escaped investiga-

tion. Whenever an elastomeric impression was removed from the mouth, both

the impression material and its bond to the impression tray were stressed.

Many dentists depended entirely on tray adhesives for the retention of the

impression material to the tray. It became obvious this bond played an

important role in the accuracy of the impression as well as the resultant

model and subsequent casting. The strength and properties of this bond have

been methodically studied (Davis 1976).

Many procedures have been advocated for the fabrication of custom

trays (Davis 1976). Custom trays worked well with silicones and poly-

sulfides when a uniform thickness of material was of paramount importance in

producing an accurate impression. However, custom trays initially appeared

to be too restrictive when used with polyether impression material. The

increased rigidity of the polyethers was problematic. This stiffness

necessitated increased care when removing gypsum products from the im­

pression so final casts would not be fractured in the fabrication of

5

a fixed prosthesis. To alleviate this problem, the manufacturer recommended

a greater bulk of material between the tray and surface of the impression

(Davis 1976).

These three types of elastomers are excellent, but never-the-less,

many controversies have not been resolved concerning viscosity, permanent

deformation, elasticity and dimensional stability, Although the accuracy

of elastomers has been studied by many authors, it was the purpose of this

research to compare the dimensional stability and accuracy of all three types

of elastomeric impression materials. Specifically the effect of the elasto­

meric adhesives and the use of custom trays on the dimensional stability

and accuracy of these materials will also be reported.

In conclusion, it is hoped this study will contribute to the standardi­

zation of research techniques of impression materials by simulating clinical

conditions.

p

INTRODUCTION

CHAPTER II

LITERATURE REVIEW

If an impression n~terial is to enjoy widespread use in the field

of dentistry today, it must not only be initially accurate but must also

maintain its accuracy for a reasonable period of time. Accuracy and dimen­

sional stability of impression materials has always played a paramount role

in dental practices. Facilities for pouring impressions as soon as they

are removed are usually readily available. However, because of the advent

of high patient volume type practices many practitioners do not have the

time to pour their own impressions. They send them, instead, through the

mail to a dental laboratory. Thus, impressions must be stable enough to

produce accurate casts for several days after it has been made.

This literature review will encompass an overall view of elastic im­

pression materials from their conception. The accuracy and dimensional

stability of these materials vlill be the specific concern of the review.

ELASTOMERIC IMPRESSION HATERIALS - 1950's

After World War II and prior to the 1950's, the only reliable impression

materials used in fixed prosthodontics and extensive restorative dentistry

was irreversible hydrocolloid, impression compound and, i.e., Dietrich's

impression materials. Due to the advent of high velocity instrumentation,

a need for a new elastic impression material became evident. This triggered

the initial research in dental materials to seek polymers such as the poly­

sulfide and silicone base rubbers.

6

7

Skinner (1955) compared the first seven commercially available rubber

base impression materials to reversible hydrocolloid. He found that if the

type of tray employed was disregarded, the accuracy and dimensional stability

of the rubber impression materials was acceptable. He also stated these

materials were superior when compared to the dimensional stability of

hydrocolloids.

Hollenback (1957) advocated the immediate pouring of polysulfide im­

pressions because any delay caused inaccuracies. At this time he thought

the silicones were much superior to the polysulfides. Anderson (1958) and

Skinner (1958) reported in the same year that although the silicones showed

more elasticity than the polysulfide rubbers, the latter seemed to exhibit

greater dimensional stability. Skinner suggested this shrinkage may arise

from two causes: namely; shrinkage which accompanies any polymerization, and

the volitilization of constituents. They further observed the setting

reaction of polysulfide rubbers produced water and its loss contributed to

further shrinkage. Phillips (1959), however, did not consider water absorp­

tion and/or dehydration were problems with either the silicones or the poly­

sulfides.

McGregor et al (1958) claimed the small dimensional changes that occurred

over the period of one week were not clinically significant. Lund and

Thompson (1959) and Eberle (1959) reported silicone materials to be accurate

if poured within 30 minutes of impression taking. Meyers and Peyton (1959)

reported the elastic recovery of both the silicones and polysulfides improved

if left undisturbed for 30 minutes before pouring casts.

8

Beagrie (1956) recommended an impression tray giving 2-3 mm. of im­

pression material. For reasons of economy, he recommended a tray relined

with compound to permit only a thin layer of rubber around the teeth.

Skinner and Cooper (1955) considered acrylic better material for impression

trays than the traditional impression compound. In 1958, Schnell and

Phillips reported storage of impressions in water affected acrylic bands

and trays. Further, they observed a decrease in accuracy as the material

thickness was increased.

Brass (1959) advocated the use of non-yielding special trays which were

lined with a rubber cement which was allowed to dry for at least ten minutes

before the tray is filled with the impression material. He believed the

polysulfide rubbers should not be used in conjunction with impression com­

pound. Gilmore et al (1959) suggested a uniform thickness of about 2 mm.

of silicone material in the tray so the dentist gained adequate support

from the tray.

McLean (1958) found the silicone elastomers continued to polymerize

for a considerable time after mixing. All materials tested tended to shrink

on storage. In view of this dimensional instability, silicone impressions

should be poured within the first hour.

Jorgensen (1956) noted some brands of polysulfide rubbers expanded

slightly in water and suggested this was due to hydration tendencies. lfiller

(1956) made measurements of the setting time and dimensional stability of

synthetic rubbers under different temperatures and humidities. He reported

difficulty in obtaining duplicate results. TI1e following year, Myers (1957)

9

found the increased humidity decreased the setting time of polysulfide

rubbers. Myers and Arbor (1958) also found moisture decreased the setting

time of polysulfide rubbers.

Miller et al (1960) reported the polysulfides were more stable than

the silicones. Rubenstein et al (1960) reported "although the silicones meet

the American Dental Association's Specification requirements with regard to

deformation~ deterioration and reproducibility, most failed to satisfy the

standard Specifications with regard to dimensional stability after six hours".

ELASTOMERIC IMPRESSION MATERIALS - 1960's

Shipee (1960) noted casts which were made from impressions that had

been "bench-aged" for three days differed significantly in accuracy from casts

poured after one hour. Second casts from polysulfide impressions were ob­

served to be less accurate than first casts. He also noted electroplating

polysulfide impressions did not significantly reduce their accuracy.

Hosoda and Fusayama (1961) found the thermal shrinkage of polysulfide

rubbers was much greater than the irreversible hydrocolloids. They also

believed the distortion of rubber impressions increased with storage time,

but the distortion increase was not significant during the first hour.

Myers and Stockman (1960) demonstrated more than 3 rnrn. of material in

the impression tray could produce inaccurate results. Phillips (1962 a,b,

1968) stated the accuracy of both silicone and polysulfide rubbers depended

on the use of a minimum thickness of material and of an adhesive which bonded

the material strongly to the tray. Nogowa (1969) noted the influence of

material thickness became more apparent the longer the impression was left

before casting.

By 1963, Hollenback reported the accuracy of polysulfide, silicone

and reversible hydrocolloid impression materials had improved. They had

met requirement standards quite well. Initially, the accuracy of the

silicones and polysulfides were about the same. However, as the time

interval between impression taking and pouring the models increased, the

silicones showed greater inaccuracies than the polysulfides (Bell 1975).

Custer and Updegrove (1964) found the accuracy and stability of

silicone impression material were acceptable. However, the manipulation

10

and techniques for using these materials very definitely affect the accuracy

of reproduction. The unfavorable changes and properties which existed when

the first materials became available were no longer apparent.

Ellam and Smith (1966) reported the strength of the adhesive bond

obtained with two polysulfide impression materials on a cold curing acrylic

special tray material. The strength in tension si1ear was also measured.

Scania rubber base and Kerr's Perrnlastic were chosen because their adhesives

appeared to possess different properties. The latter demonstrated superior

bonding. This was due to the lower mobility of the adhesive. They drew the

conclusion an adhesive which had set and became "tack-free" within three

minutes was found to give superior bonding. Shear properties were especially

noteworthy. The increased rate of stress increased the strength of the bond.

This fact will be illustrated hopefully in the ensuing research.

Wilson (1966) noted the silicone materials were more elastic than the

polysulfides. He recommended impressions should be left undisturbed for ten

11

minutes before pouring models so the elastic recovery could occur. He also

showed premature polymerization before the impression \vas seated, would

cause distortion.

In 1969 a patent was issued to Schmitt and co-workers. It was for

making elastomer compounds from polyethers terminated with amino groups

which are cross-linked with strong acids such as aromatic sulfonic acid

esters. The cross-linked rubber was reported to have high dimensional

accuracy after polymerization and on storage (JADA, July 1977).

Chong and Docking (1969) were the first to report on Impregum (a

polyether impression material). Chong preferred the polysulfide material

because it possessed a slightly longer working time than the silicone and

polyether products. However, the silicone and polyether obviously set much

quicker than the polysulfides. Silicone and polyether products were shown

to set in almost half the time than the polysulfides. In dimensional

stability, all the samples listed had undergone a contraction during setting

of the bulk of the materials. This was particularly true for the poly­

sulfide changes which occurred within the first 30 minutes, It was note­

worthy that while most of the contractions in polysulfide impressions had

taken place almost immediately after setting, there remained obvious

dimensional change within the first 24 hours. In addition, there was still

subtle changes after 72 hours. These latter changes were not very signifi­

cant in proportion to earlier dimensional changes. In regard to permanent

deformation, silicones and polyether materials were considered more favorable

than polysulfides. However, the dimensional stability for the polysulfides

12

and polyethers consistently exhibited less change than the silicones.

Hannah and Pearson (1969) reported the polyether material "Impregum"

gave consistently better results with regards to dimensional stability than

all other impression materials they tested. The polysulfide materials gave

satisfactory results up to and including 24 hours after the impression and

before pouring. The silicone elastomers were found to be less reliable

clinically. More satisfactory results were obtained with silicones after

standing for an hour before pouring models.

ELASTOMERIC IMPRESSION MATERIALS - 1970's

Pfannenstiel (1970) compared polysulfides, polyethers and silicones

and showed the polyether impression material (Impregum) to be superior.

However, a rigid tray must be utilized. Rohan (1970) similarly reported

the unrestrained dimensional stability of Impregum to be superior to the

polysulfides and silicones. Its permanent deformation after tension was

less than the polysulfides or silicones. Docking (1970) also reported

similar results; the polyether materials possessed the highest recovery

after deformation and the least dimensional change following removal from

the mouth.

Stackhouse (1970), with a laboratory test method, measured those dies

from four rubber elastomers (3 silicones, 1 polysulfide) used in three

clinically simulated techniques. Dies obtained at different impression

bench set times demonstrated the dimensional changes of the elastomers

during aging. The subsequently poured stone dies seemed to indicate hourly

dimensional changes of the elastomers which were greater than specified by

by the A.D.A. Spec. #19. Generally, more uniform dies were produced from

the silicones than from the mercaptan rubber.

Ferguson (1970) took 250 Thiokol impressions. They were inspected

13

under magnification. A surprising finding was none of the impressions were

entirely free of bubbles. Nevertheless, the percentage that caused demon­

strable inaccuracy was relatively small; roughly 6%. When impressions were

sectioned, bubbles were found close to the surface, which had obviously ex­

panded, displacing a thin wall of impression material inward against the die.

As a result, air bubbles were considered to be a direct factor in the

distortion of any rubber impression.

Stackhouse (1970) stated "the second pour casts are not as accurate

as the first poured casts. The margins of crowns should always be finalized

on the first casts while the second cast used only for alignment of bridges."

Schwindling (1971) stated linear changes of a silicone impression were

critical for a period of 48 hours. In addition, his investigation showed

the contraction values of the impression material which results from con­

trolled pre-heating (after various storage limits) can be reversed. Thus it

is possible to obtain more accurate models if you control and monitor the

temperature.

Wilson (1971) noted the heavy-bodied elastomers of polysulfide and

silicone impression materials were almost twice as stable as the light-bodied

materials in the unrestrained state. However, the polyether material, Impregum,

was more stable than either the silicone or polysulfide materials. He

suggested all materials be poured as soon as possible, but if there should be

a delay, then the polyether produced the most accurate dies.

The double mix technique involves the simultaneous mixing of a thin

material which is applied around the preparation and a thicker mix of

material used in a tray. Both mixes of material are thus setting at the

same time. The reline technique involves taking a preliminary impression

and then reintroducing the impression after the tooth preparations have

14

been covered with a second mix of material (Bell 1975). The double mix

technique is widely used and has been advocated by Phillips (1968). However,

Podshadley et al (1970, 1972) reported the relined rubber impressions pro~

duced more accurate dies than did the double mix technique.

Causton and Braden (1971, 1972) reported on the new polyether impression

rubber, Impregum. It differed from other impression materials in the follow­

ing important respects: 1) The rheology of the unset material was radically

different and caused clinical difficulties. 2) The elastic modulus of the

set rubber was greater than existing materials (nearly twice as great as a

heavy-bodied polysulfide), This led to problems with extensive and intricate

preparations. 3) The polymer itself is highly water absorbent. In practice,

the potentially high dimensional changes consequent on this were offset by

extraction of water-mixable material in rubber.

Sawyer (1971a, 1971b) reported an optimum time for mercaptan rubber base

to polymerize before removal of an impression. A stainless steel die was

constructed for comparative measurements of horizontal and vertical dimensions

to .0001 inch. Forty die stone casts were produced from mercaptan rubber im­

pressions which had set on the master die for various periods of time. Results

demonstrated the die stone casts produced from impressions which had set

15

15 minutes after insertion on the master die were the most accurate repro­

duction. The double mix technique was used according to manufacturer's

directions.

sawyer and others (1973, 1974) again conducted an investigation to

determine the comparative accuracy of stone cast produced from different

elastomeric impression materials. They took impressions of a stainless

steel master die simulating a preparation for a three-unit bridge, poured

stone models, and compared the vertical and horizontal changes between

the master and stone models. Another series of five impressions in a

polyether rubber were made but the dies were poured in stone one week after

the impressions were made. In all instances the most accurate casts were

produced by the silicones and polysulfides respectively. The measurements

of the casts produced from the polyether impressions which were poured one

week later varied only slightly from those poured immediately.

Phillips (1973) shmv-ed there were a number of sources of dimensional

change. All elastomers contracted slightly during curing, the silicone

rubbers lost alcohol, and this was accompanied by a shrinkage. Similarly,

the loss of volatile accelerator components caused a marked contraction in

hydroperoxide polysulfide rubbers, although both silicones and polysulfide

rubbers were water-repellant, the polyether polymers absorbed water, a process

complicated further by the simultaneous extraction of the water-soluble

plasticizer. This resulted in dimensional changes if such materials were

exposed to water for a prolonged period of time. There was usually incom-

plete recovery after deformation because of the visco-elastic nature of rubbers.

16

Reisbick (1973) stated either high or low viscosity materials pro-

duced the same degree of accuracy and stability. In hydrocolloid, poly~

sulfide or silicone, the molar crown preparation was the most sensitive to

differences between the materials. Stability after one hour storage dis­

closed that elastomers were more stable than agar-hydrocolloid and silicones.

This was because of their rapid rate of physical setting would decrease

accuracy and stability due to latent strain release.

Mansfield (1973) believed the silicones possessed a much lower tension

set value than polysulfides. Silicone materials showed less dimensional

change than polysulfides as the duration of the strain and manipulation

period was increased.

Combe (1973) believed the polysulfides, in general, could be recognized

as an accurate impression material capable of reproducing fine detail. Dimen­

sional inaccuracies occurred through polymerization and thermal shrinkage.

(Polyethers excluded),

The silicones were recognized as being less stable dimensionally than

polysulfides because the alcohol formed as a by-product of the setting

reaction was lost during evaporation. This resulted in a volumetric

shrinkage of 0.8%.

Polyethers on the other hand, had water absorbent properties. However,

the expansion associated with this absorption appeared to be offset by the

extraction of water-miscible material from the rubber. The polyether still

possessed better dimensional stability than the other elastomers.

Brown (1973) suggested if the dimensional accuracy was only observed

17

the lead~dioxide cured polysulfide impression material and the polyethers

were less effected by the strain accompanying their withdrawal from undercut

regions. They also showed if it is necessary to store an impression after

it has been taken, the lead~dioxide cured polysulfides were the least

susceptible to both water absorption and solvent loss, whereas the polyethers

must be kept dry if they are to retain their accuracy. The silicone polymers

and hydrocolloid materials did not maintain their accuracy during storage.

Hembree (1974a) reported little difference in accuracy in polyether

impressions, regardless of whether a custom or stock tray was used. He

also found the polyether impressions were not particularly susceptible to

change on storage, but the best results were noted if poured within the first

hour. Later, Hembree and Nunez (1974b) measured the effect of moisture on

the accuracy of polyether impressions of a sta~nless steel model. The most

accurate stone models were obtained when an impression was taken of a dry

surface and poured immediately. The accuracy of the stone models was de­

creased when the pouring was delayed one hour and was decreased further

when the impression was stored one hour in 100% relative humidity. The least

accurate model was prepared from an impression of a wet master model poured

immediately in stone.

The creep compliance, recovery and permanent deformation were reported

by Goldberg (1974) for nine polysulfide, silicone and polyether impression

materials. He showed the material was linearly visco-elastic. Instantaneous

elastic, retarded elastic and viscous flow all decreased with continued poly­

merization; and permanent deformation resulted from lack of recovery of elastic

18

deformation and viscous flow.

The polyether material and one silicone most closely approached ideal

elastic behavior. This characteristic was desirable for it minimized

dimensional change due to stress encountered during handling, shipping and

storage of the impression. The silicones, in general, exhibited less belated

elastic deformation than the polysulfides.

Reisbick (1975) stated little or no work has been reported to verify

the accuracy of the highly filled or putty-like silicone elastic materials.

The results of his study showed two of the three systems he studied were

very accurate under the limited conditions of his testing. He also showed

low variability. However, he found the silicone or putty-like material did

not bond well to the tray inspite of tray adhesive. It was necessary to pro­

vide mechanical locks in the tray to hold the material. Horeover, this

material tends to separate in layers during rapid removal from undercut

areas. Conversely, he also found when the material was used in a corrective

wash technique, excellent reproduction of oral tissue detail was produced.

Combe (1975) reported there ~;·;as a small contraction on setting of these

elastic materials (silicones, polysulfides and polyethers) due to polymeriza­

tion shrinkage. Contraction also occurred on cooling the impression from

mouth to room temperature. The coefficient of thermal expansion of these

materials resulted in this order: polyether )>silicone> polysulfide. The

magnitude of the thermal shrinkage was reduced by the adhesion of the material

to the tray. This was a very important aspect, since this will be reinforced

in the ensuing research. Silicones may show a slightly greater shrinkage

than the polysulfides.

craig (1975) reported the dimensional change of polyethers was

comparable to polysulfides but less than regular silicone impression

materials. The stability of polyethers in water ·1i.ras not as reliable as

19

the silicones or polysulfides. Electroplating was also not recommended for

this reason. The addition of thinner in equal lengths to the polyether

base and catalyst did not result in noteable differences of its critical

properties.

Bell (1975) believed all impression materials were more accurate if

they had an increase of 50% over the setting time recommended by the manu­

facturers. Custom trays were preferable to stock trays and should be used

wherever possible. The trays provided a uniform thickness of material;

2-4 mm. appeared to be optimum. Trays should be rigid and not susceptible

to distortion. Ideally, the impression was kept for approximately 30 minutes

to permit elastic recovery to occur before pouring. If delay was unavoidable,

the polyether material appeared to be the most stable provided that it was

stored under dry conditions.

There appeared to little demonstrable difference between the use of

double mix and the reline techniques. Second pour casts should never be used

for purposes of accuracy. They are not as accurate as the first poured casts.

High humidity or water contamination of the unset material accelerated

the setting. The effects of ambient and storage humidity on the accuracy

of the impression did effect the set material. In conditions of high

humidity, the material of choice appeared to be the lead-dioxide cured

polysulfides. Polyethers should never be stored in conditions of high

humidity. Storage of silicones in damp conditions appeared to prevent

the loss of volatile constituents and the polymerization of shrinkage was

more than compensated for by the water absorbed.

20

Further study of the effects of humidity were done by Bell and Davies

(1976) on elastic impression materials. They found the dimensional change

of these materials was markedly affected by their storage conditions. Al­

though no material was found to be completely stable, under particular

conditions, some materials were superior to others.

Comparison of materials at high humidity exhibited a weight gain, and

most showed a corresponding expansion over a period of 72 hours. Impregum

exhibited the greatest dimensional change due to water uptake. The silicone

Xanthopren/Optisil system absorbed less water than Impregum or the polysul­

fide, Mim.

Comparison of materials at medium humidity showed the polyether materials

and lead-dioxide cured polysulfides absorbed water. The silicone materials

and organic hydroperoxide cured polysulfide illustrated the most accurate

results.

At low humidity conditions, all materials lost weight and shrunk when

unrestrained. The polyethers demonstrated the most accurate results followed

by the silicones and polysulfides.

Hembree (1976) once again studied the polyether impression materials

to determine the effects of repouring, washing and using a body modifier on

the dimensional accuracy. Impressions were made from a stainless steel model

utilizing custom trays. Within the conditions of this study, it was demon-

21

strated a polyether impression could be poured three times before a

dimensional inaccuracy was produced. It was also shown the use of a body

modifier and relining or washing of the polymerized impression material had

no significant effect on the dimensional stability of the material.

Permanent deformation time relationships of 15 elastomeric impression

materials under a constant load was studied by Kaloyannides (1975). All

materials except the polyether material showed greater permanent deformation

under constant load than with tensile load. Silicone and polyether materials

exhibited less permanent deformation than mercaptan materials ten minutes

after mixing.

:1-~; !-' Lorren (1976) reported on the effect of the contact angle of die stone

on elastic impression materials. The silicones produced specimens with the

greatest contact angles and casts with the greatest number of bubbles. This

was due to the relative non-wetting characteristic of silicone materials.

Polysulfides were intermediate to the silicones and polyethers. The polyether

materials produced the best specimens.

Davis, Moser and Brinsden (1976) researched the bonding strength of

impression material adhesives, the retentive surface texture of self-curing

acrylic resin trays and the influence of drying time of the adhesive on the

bond strength of the elastomer-adhesive-resin system. Their research was

one of the best efforts of this kind. Davis et cl:1 found: 1) the tray

surface yielded by the acrylic resin formed against tin foil provided better

retention for the rubber base than surfaces yielded by wax or asbestos spacers1

2) drying times of between 15 minutes and 72 hours showed no significant change

22

in bonding strength of the elastomer to the tray, but drying times of less

than 15 minutes were found to be inadequate and decreased bond strength;

3) in the systems tested, the silicone and polyether systems showed cohesive

failure of the elastomer before the adhesive bond between the elastomer and

tray failed.

Vermilya and others evaluated the quality of silver plated dies and

the accuracy of silver plating of polyether impressions. They used a simu­

lated model of a bridge preparation. Plating made on polyether materials

was discolored, but the discoloration could be removed by wiping with

tissue. The most accurate silver plated impressions were obtained from the

polyether (+0 .005%) impressions, followed by the putty/l;vash silicone (+0 .021%),

and then the tray/syringe polysulfide rubber (+0.056%).

Herfort et al (1977) studied the viscosity characteristics of several

commercial polysulfides and silicones and one polyether. He found the

silicones produced viscosity values that were lower than those of both heavy­

bodied polysulfides and the polyether. All materials displayed shear thinning

properties. This means that viscosity decreased with increasing shear rate.

This is advantageous ~ecause it facilitates syringing and enables the

material to resist flow at low shear rates of gingival contraction and fluid

seepage present in the mouth. Omniflex, Impregum and Xantopren green ex­

hibited these properties well.

Christensen (1978) found the polyethers and polysilicones were similar

in exhibiting very little dimensional change. Observation of working charac­

teristics showed polyethers had high viscosity during short working time, high

23

rigidity causing difficulty in removal when set and difficulty in separation

of stone models. Polysiloxanes had moderate viscosities during mixing,

moderate working time, high rigidity when set, but no difficulty in removal

or separation of stone models.

Lacy (1978) recently did a study on the time-dependent accuracy of

elastomeric impression materials. Seven conventional silicones, four poly­

sulfides, one polyether and a new addition polymerization silicone were tested.

With one exception, the putty/wash methods provided a more accurate first

die (0 time) and a smaller overall change with time than custom tray/wash

systems. Most of the dies became larger with time. The addition polymeriza­

tion silicone was found to be most accurate and most stable. A putty/wash

polysulfide was least accurate and least stable. These results will be com­

pared to in the conclusion of this thesis for, in this study, an addition

polymerization silicone will be compared with other elastomeric impression

materials. Very little research, so far, has been done with this new

silicone.

CHAPTER III

HETHODS AND MATERIALS

PART I

A total of five elastomeric impression materials were evaluated:

t\-JO polysulfides, one lead cure and one non-lead cure; t\vo silicones,

one condensation polymerization and one addition polymerization; and one

polyether. (Table 1 lists brand names and manufacturers) All materials

evaluated were light-body consistency with the exception of the polyether

which is manufactured in,only one consistency. Light-body impression

material was used because all intimate reproduction is captured with this

material when impressions are being taken.

A new round die which is the A.D.A. Standard Specification die for

testing dental impression materials was utilized to compare the specimens

at room temperature and humidity. The new apparatus included only those

lines required for dental reproduction and compatability with gypsum (three

horizontal ruled lines). It provided cross lines which were used for

determination of dimensional stability of impression materials (see Fig. 1).

The horizontal ruled line widths were: line "z" = 50 ± 8 pm.; line "y"

20 ~ 4 pm.; line "x" = 50 ~ 8 pm. All lines had a 90° included angle. Line

"y" \vas the center line. The length of this line between the cross lines

was 24.992 rnrn. Also, the die has a highly polished surface. This eliminated

the need for a separator and minimized cleaning operations which could damage

the ruled surface of the die. The die also had a ring which fit around the

periphery of the ruled measuring surface. It acted as a tray or container for

the dental impression material and was considered a new research approach

24

MATERIAL

Permlastic

Omniflex

Impregum

Accoe

President

T A B L E 1

NAME, BATCH NUMBER AND MANUFACTURERS OF EACH ELASTOHER

l-1ANUF ACTURER

Kerr Romulus, Michigan

Coe Laboratories, Inc. Chicago, Illinois

Premier Dental Products Co. Philadelphia, Pennsylvania

Coe Laboratories, Inc. Chicago, Illinois

Coltene Uni/Disco Detroit, Michigan

BATCH NUMBER

Base 72041 Cat 71047

Base 0504 77 Cat 040677

Base 76173 Cat 76139

Base 040377 Cat 030277

08703

25

26

FIG. 1

Top vie1:v of the die with the ring on

27

* (Fig. 1). The die was cleaned in an ultrasonic cleaner with toluene.

The temperature and the relative humidity were recorded with a glass

thermometer and a micro-hygrometer. The setting time was regulated by the

use of a chronometer.

Manufacturers were requested to send freshly manufactured materials.

The batch #'s were recorded. The impression materials were weighed on a

centogram triple beam c± 0.05 gm) balance model 311** to control ratio

between base and catalyst. All materials were mixed according to manufacturer

instructions. The materials were put in the die and a piece of cellophane

was placed over the impression material. A glass plate was pressed against

the material and the die so excess material would be extruded. The cello-

phane acted as a separator for easy removal from the glass slab. The glass

and die were maintained together by using a "C" clamp (Fig. 2) and placed in

*** a Blue M, full visibility jar water bath filled with deionized water

and maintained at 32°C to cure for the time specified by the manufacturer

for complete polymerization in the mouth plus three minutes to insure complete

set of the material.

)~*** The readings were made with the use of a Gaetner travelling microscope

graduated in 0.01 mm. increments with a magnification of 32x (Fig. 3).

Five specimens of each material were evaluated.

* Fisher Scientific Ultrasonic Cleaner ** Ohaus Scale Corporation

**** Blue M Electric Company, Blue Island, IL The Gaetner Scientific Corporation, Chicago,

The specimens were tested

IL

FIG. 2

The die \vi th the glass and cellophane

held together with the "c" clamp

28

29

rrc. 3

Gaetner traveling microscope

30

at intervals of: immediate removal from bath, one hour, 24 hours, 48 hours,

72 hours and one week after set. Talc was placed on the base of the micro­

scope to aid in the ease of manipulation and recording of the specimens.

Between readings, all specimens were put in a clean box with talc and stored

in a dust-free cabinet.

HETHODS AND MATERlALS

PART II

The second part of this research was to determine the influence

of the manufacturer's adhesive and custom tray on the accuracy and

dimensional stability of the impression material. Plexiglass plates

~~~ thick and 2~" square were used to simulate an intraoral custom tray.

The surfaces were roughed (with sandpaper disc) to mimic the surface

of clinical custom trays. The manufacturer's adhesives were painted on

the trays and allowed to dry for 24 hours (Davis 1976). The same pro­

cedures followed in Part l were carried out in this series of evaluation.

The impression materials were carried to the die, only this time the

plexiglass custom plates were clamped to the die (Fig. 4) • A glass

slab was again used over the plexiglass plate so that distortion was

not transmitted to the plastic when the clamp was tightened.

Each material was evaluated immediately after removal from bath,

at 24 hours, 72 hours and one week.

31

FIG. 4

The die with the glass, custom tray and

cellophane held together with the "c" clamp

32

CHAPTER IV

RESULTS

All materials were mixed at approximately the same conditions of room

temperature and humidity and were allowed to set in a water bath at 32°C.

This was done to simulate as closely as possible open mouth temperatures.

The mean room conditions were 22°C and relative humidity of 59%.

The mean, standard deviation and percent shrinkage (dimensional change)

of each material. at the different time periods is presented in Table 2.

This data is the individual average of 49 samples taken, five recordings per

sample at specific time periods. It is important to note at this time, the

immediate accuracy of all materials evaluated w~e~improved significantly

when an adhesive and custom tray was employed. The dimensional change of

these materials at one week were also considerably improved.

Table 3 shows the comparison of all materials evaluated without the

use of a custom tray at various time intervals. This data was accumulated

statistically using a "T" Test, bvo tail probability at .05 level of signi­

ficance. All "T" values from which this table were prepared can be found in

the Appendix Tables 3A thru 3J.

Similarly, Table 4 indicates the comparison of all materials evaluated

with the use of a custom tray and adhesive at all time intervals. 11Tn

values from which this table was prepared can be found in the Appendix Tables

4A thru 4J.

Comparisons of all samples made without the use of a custom tray

at all time intervals observed are indicated in Table 5. As noted previously

in Table 2, there can be seen a significant improvement in the immediate

33

34

T A B L E 2

TOTAL MEAN DATA FOR ALL SAMPLES TAKEN. MEAN - STANDARD DEVIATION -PERCENT SHRINKAGE FROM DIE ARE CALCULATED

~

MATER TAT 10 min. 1 hr. 24 hr. 48 hr. 72 hr. 1 wk.

PRESIDENT 2.4946 2.4946 2.4934 2.4930 2.4919 2.4902 .0007 .0004 .0004 .0005 .0004 .0011

w/o tray 0.18% 0.18% 0.23% 0.25% 0.29% 0.36%

PRESIDENT 2. 49 76 [>( 2.4963

~ 2.4952 2.4953

.0004 .0004 .0003 .0002 w/ tray 0.06% 0.12% 0.16% 0.16%

OMNIFLEX 2.4940 2.4933 2.4903 2.4881 2.4882 2.4838 .0009 .0008 .0024 .0016 .0013 .0018

w/o tray 0.21% 0.24% 0.34% 0.44% 0.44% 0.62%

OMNIFLEX 2.4979 [>( 2.4960 [X 2. 49 29 2.4916 .0003 .0007 .0016 .0012

w/ tray 0.05% 0.13% 0.25% 0.34%

PERMLASTIC 2.4957 2.4957 2.4937 2.4919 2.4904 2.4902 .0006 .0013 .0029 .0028 .0023 .0028

w/o tray 0.14% 0.14% 0.22% 0.31% 0.35% 0.36%

PERMLASTIC 2.4971 [>( 2.4960 [X 2.4930 2.4931 .0008 .0011 .0016 .0013

w/ tray 0.08% 0.13% 0.25% 0.24%

IMPREGUM 2.4953 2.4952 2.4959 2.4953 2.4951 2.4953 .0002 .0002 .0003 .0002 .0006 .0005

w/o tray 0.16% 0.16% 0.13% 0.16% 0.16% 0.16%

IMPREGUH 2.4980 [>( 2.4964 X 2.4961 2.4962 .0011 .0008 .0012 .0009

w/ tray 0.05% 0.56% 0.12% 0.12%

ACCOE 2.4931 2.4887 2.4851 2.4843 2.4826 2.4820 .0008 .0006 .0013 ,0013 .0008 .0009

,_w/o tray 0.24% 0.42% 0.56% 0.60% 0 .66~~ 0.69%

ACCOE 2.4979 [>( 2.4929 X 2.4915 2.4929 .0004 .0003 .0009 .0005

W/ tray 0.05% 0.25% 0.30% 0.26% ,_

~ E-1

E-1 i=) 0

~ H :::::

T A B L E 3

COMPARISON OF ALL MATERIALS EVALUATED WITHOUT THE USE OF A CUSTOM TRAY AND ADHESIVE AT ALL TIME INTERVALS

WITHOUT TRAY

PRESIDENT OMNIFLEX PERMLASTIC IMPREGUM

0 hr 0 X 0

1 hr X 0 X

PRESIDENT 24 hr X 0 X 48 hr X 0 X 72 X 0 X

0 X

0 X X 1 hr X X

OMNIFLEX 24 hr X X 48 hr X X 72 hr X X

1 wk X 0 hr 0 1 hr 0

PERNLASTIC 24 hr 0 48 hr 0 72 hr X

1 wk

hr hr

IMPREGUM hr hr

X = significant difference at .05 level

0 = no significant difference at .05 level

35

ACCOE

X X X X X X

0 X X X X 0 X X X X X X X X X X X X

~ H

::z:: H

T A B L E 4

COMPARISON OF ALL MATERIALS EVALUATED WITH THE USE OF A CUSTOM TRAY AND ADHESIVE AT ALL TIME INTERVALS

WITH TRAY

PRESIDENT OMNIFLEX PERMLASTIC IMPREGUM

0 0 0

PRESIDENT 0 0 0 X X 0

0

0

OMNIFLEX 0 X X 0 0 ~ PERMLASTIC X

0

IMPREGUH

X = significant difference at .OS level

0 = no significant difference at .OS level

36

ACCOE

0 X X X

X 0 0 0 X 0 0

0 X X X

~ E-1

E-1 p 0 ::c: E-1 H :;::

PRESIDENT

OMNIFLEX

T A B L E 5

COMPARISON OF ALL SAMPLES MADE WITHOUT THE USE OF A CUSTOM TRAY TO ALL SAMPLES MADE WITH THE USE OF A

CUSTOH TRAY AT ALL TIME INTERVALS OBSERVED

WITH TRAY

PRESIDENT OMNIFLEX PERMLASTIC IMPREGUM

0 hr X X X X 24 hr X X X X 72 hr X 0 0 X

1 wk X X X X 0 hr X X X X

24 hr X X X X 72 hr X X X X

1 wk X X X X

0 hr 0 X X X

PERMLASTIC 24 hr 0 0 0 0 72 hr X 0 0 X

1 wk X 0 0 X 0 hr X X X X

IMPREGUH 24 hr 0 0 0 0 72 hr 0 X X 0

1 wk 0 X X 0 0 hr X X X X

ACCOE 24 hr X X X X 72 hr X X X X

1 wk X X X X

X = significant difference at .05 level

0 = no significant difference at .05 level

37

ACCOE

X X 0

_X

X X X X

X 0 0 0 X X X X X X X X

38

accuracy of all materials tested when the use of a custom tray was employed.

Appendix Tables SA thru SY contains all statistical data used in the

preparation of this table.

The dimensional change (% deviation from die) as a fun~tion of time

for each individual impression material have been plotted a~d are presented

in Figures 5 thru 9. Again, one can note the immediate acc~racy and dimen­

sional stability over a \veek period had improved considerabl.y when a custom

tray was employed.

Figures 10 and 11 represent a graphical comparison of &11 materials

evaluated without and with the use of a custom tray. These graphs clearly

indicate the rank of each material as compared to the other~ evaluated with

regard to accuracy and dimensional stability. Note in Figu~e 11, all

materials tested with the use of a custom tray appear to ha~e approximately

the same immediate accuracy. This would seem to indicate if the materials

are used properly, and poured immediately upon removal, all materials

would produce similar results in respect to immediate accuracy.

All materials, when compared statistically to the standard A.D.A. die,

showed a significant difference in respect to accuracy and dimensional stabil­

ity over all time periods. lmpregum, with the use of a custom tray, was

the only one which did not differ significantly from the die at time 0

(immediate accuracy). This was purely a statistical result and was due to a

high standard deviation of 11. (See Appendix Tables !A thru lC and Tables

2A thru 2J).

Oi o.o5J

I 0.10-i

I 0.15

;:>:: I

~ 0.25l

5 o. 30-j H I ~ j ::; o. 35 I ~ 0.<'.0~ E-1 z t3 0.45 ~ IJ:.l p., 0.50

0.55

0.60

0.65

I

39

FIG. 5

President w/ tray

President w/o tray

24 48 72 120 144 168

TIME (hours)

o.J 0.10

0.15

fit ~0.20

~ I

~0.25j rz..

50.30 H E-1 ~0.35 :> fit &::10.40

~0.45~ ~ ' 0.501

o.ss1 0.601 0.65l

24

40

FIG. 6

Omniflex w/o tray

48 72 96 120 144 168

TIHE (hours)

0

0.05

0.15 .

~ ~0.20

~ ~0.25 r...

80. 30-' 1-1 H ;:so.J5 :> ril r=l0.40

~ ~0.451

P..o.5o]

o.55 I

0.60'

41

FIG. 7

Permlastic w/ tray

Permlastic w/o tray

24 48 72 96 120 144 168 TH1E (hours)

r.:l

0.201 H ~

~ 0::: 0.25-l JJ:..

z 0.30 0 H H < 0.35 H :> r.:l ~ 0.40 H z r.:l 0.45 u 0::: r.:l p., 0.50

0 .55'

0.60j 0.65

I 24 48

FIG. 8

Impregum w/ tray

Impregum w/o

72 96

TUIE (hours) 120

tray

42

144 168

IJ:l H

0

0.05

0.10

0.15

e:l 0. 20

~ r:t. 0.25 z s 0.30 ~ < t;! 0. 35 rg ~ 0 .',(; z IJ:l ~ 0.45 IJ:l 1=4

0.30

o.ss

0.60

0.65

43

FIG. 9

Accoe w/ tray

Accoe w/o tray

24 48 72 96 120 144 168

TIME (hours)

0

0.05

0.10

0.15

w ::i 0. 20

t§ ..::: 0. 25

"" 13 0. 30 H H ;:S 0. 35 :> w Q 0.40 H z t5 0.45 ..::: w P-. 0 .so

0.55

0.60

0.65

24

FIG. 10

COJ:.1PARISON OF ALL MATERIALS EVALUATED WITHOUT THE USE OF A CUSTOM TRAY

Impregum

President

Permlastic

Omniflex

Accoe

48 72 96 120 Tnm (hours)

1' ' 4'+ 168

44

0

0.05

0.10'

0.15

~ 0.20 q

;:;:: ~ 0.25 >z..

:z; 0. 30 0 H E-< <: 0.35 H :> ~ 0.40 E-< :z; r3 0 .45 ~ i:il p., 0 .so

0.55

0.60

0.65

24

FIG. 11

COHPARISON OF ALL J:.1ATERIALS EVALUATED HITH THE USE OF A CUSTOH TRAY

Impregum

President

Omniflex

48 72 96 120 144 TIHE (hours)

45

168

INTERPRETATION OF RESULTS

CHAPTER V

DISCUSSION

The purpose of this research was to compare the accuracy and dimensional

stability of the five elastomeric impression materials presented in Table 1.

It would only seem logical that when discussing this type of research one

would look at the raw data first, for this is where all subsequent statistical

data and comparisons will be drawn. Table 2, representing the mean, standard

deviation and percent shrinkage from the die of all samples evaluated, re­

vealed some important general findings.

Considering the five materials evaluated without a custom tray, the lead

curing polysulfide Permlastic and the polyether Impregum, appeared to be the

most accurate materials for the first hour. Permlastic, the lead curing poly­

sulfide, was initially more accurate than the polyether Impregum. However,

no significant difference between materials was found at the .05 level.

This most probably was the result of continual polymerization following its

removal from the water bath, a phenomenon not uncommon to the polysulfide group

as a whole. This finding has been supported (Bell, 1975a; Combe, 1973; Chong,

1969; and others). This continual polymerization is accompanied by a shrink­

age of the mass material which would result in a larger model produced (Bell,

1975a).

After 24 hours, Impregurn proved to be significantly superior to all other

materials evaluated, and this was well expected, for these results appear over

and over again in the literature (Hannah and Pearson, 1969; Sawyer, et al

1973, 1974).

46

47

Of significant importance was the fact that Table 2 indicates after 24

hours, the addition polymerization silicone, President, appears to be second

in reference to accuracy and dimensional stability over the one week period.

Since this material is relatively new, comparison of this data cannot be made

with previous research findings. Although Lacy, (1978), recently researched

this new silicone and found it to be superior to the oth~r materials he evalu­

ated with respect to accuracy and dimensional stability.

Further, the findings in Table 2 revealed the lead cure polysulfide,

Permlastic; the non-lead cure polysulfide, Omniflex; and the condensation

polymerization silicone, Accoe, follow respectively with regard to accuracy

and dimensional stability when use of a custom tray was not employed.

When we compare the relative accuracy and dimensional stability of these

five materials with the use of a custom tray and adhesive, the following

findings become evident. The raw data in Table 2 indicated at least for the

first 24 hours when a custom tray was employed; all five materials seemed to

have comparably the same relative accuracy and dimensional stability with the

exception of Accoe at 24 hours. Accoe fell off sharply indicating a possible

loss of volatile constituents (alcohol), yielding inferior dimensional stabil­

ity. This would be expected of the condensation polymerization silicones, and

has plagued them throughout their existence. This is a well known phenomenon

familiar to this group of elastomers and many authors have reported this

finding.

Once again, of significant notation is the fact the polymerization

silicone, President, was extremely stable over the one week period, and

48

compared favorably to the polyether, Impregum. As will become evident

in the following discussion, there was statistically no significant differ­

ence between these two materials when a custom tray and adhesive were em-

ployed.

It appeared from the data, both polysulfides for all practical purposes,

yield similar findings with respect to the areas discussed. The least stable

and accurate material researched was the condensation polymerization silicone,

Accoe.

The data presented in Table 2 compared favorably to the findings reported

previously in the research. Sawyer et al, 1973, reported his findings for

the percentage of shrinkage for the polysulfides to be 0.15%; for the poly­

ethers, 0.12%; and for the silicones, + .015% in reference to immediate

accuracy. If these results are compared to those presented in Table 2, it

would appear there was not significant differences in the percentage of con­

traction. Sawyer's value for the silicone can be explained as an expansion

of the material and for this reason the silicone in his study appears as the

second most accurate.

Craig, 1975, found the shrinkage that occurred at 24 hours to be:

polysulfide, .25%; silicone, .58%; and polyether, .30%. Craig's data in

comparison to the present research yields slightly higher values with regard

to the polyether. All other values are within the findings he reported. All

findings reported with the use of a custom tray in this research appear to be

much lower than those reported by Craig at 24 hours. TI1is is probably due to

tne use or a custom tray which restricted the contraction of the materials

49

evaluated and also the fact Craig cured his impressions at 37°C as opposed

to 32°C in this study.

COMPARISON OF ~~TERIALS USED WITHOUT A CUSTOM TRAY

Table 3 compared all materials evaluated in the research ~vithout the

use of a custom tray. Using a two-tail "T" test at the .05 level of signifi­

cance, results yielded Impregum to be significantly better than all other

materials evaluated from immediately upon removal from the die thru one week.

The only time intervals where the polyether did not prove to be significantly

different in both respects was at the immediate recording and at 48 hours.

At time 0, no significant difference between Impregum, President, and Perm­

lastic was observed. From 0 hour to 48 hours, no significant difference

between Impregum and Permlastic was observed. It can be seen in the Appendix

Table 3H, that at 48 hours a "T" value of .062 was observed. This was very

close to approaching non-significance and the subsequent difference could be

due to chance in the researcher's recording interpretation.

TI1e lead curing polysulfide, Permlastic, and the addition polymerization

silicone, President, proved to yield about the same results with regards to

dimensional stability and accuracy. The non-lead curing polysulfide, Omniflex,

and the condensation polymerization silicone, Accoe, followed respectively.

Omniflex yielded only slightly better results than Accoe.

COMPARISON OF MATERIALS USED WITH A CUSTOM TRAY

Table 4 showed the statistical results comparing all materials evaluated

with the use of a custom tray. Once again, of significant importance was all

so

materials evaluated yielded the same results initially and up to 24 hours.

No significant difference was found between materials, From these findings

the assumption can be made, if care is taken in preparing materials to be

used in impression taking and if the manufacturer's directions are followed,

all impression materials would yield similar results if poured immediately

upon removal.

After the observed 24 hour period, Impregum and President were significant-

ly superior in regards to accuracy and dimensional stability, as indicated in

Table 4. The lead peroxide, Permlastic was slightly better than the non-lead

peroxide, Omniflex, followed by the conventional silicone, Accoe.

At this time, again, special notation must be taken that there was no

significant difference at the .05 level between the polyether, Impregum, and

the addition polymerization silicone, President.

COMPARISON OF TECHNIQUES

Table 5 compared all five elastomers with respect to the technique

used to evaluate the materials. When a custom tray and manufacturer's ad-

hesive were employed, all elastomers are superior to those evaluated when the

custom tray was not employed.

Impregum, whether used with a custom tray or without, yielded approxi-

mately the same results. TI1is material was inherently stable by itself.

And if one compared this material closely with all other materials evaluated

in Table 5, you can determine the polyether, whether employed with or with-

out a custom tray, yielded better results than all other materials evaluated.

51

clearlY this impression elastomer was a superior material.

GENERAL DISCUSSION AND RECO~lliENDATIONS

This investigation had been carried out in a manner which had as closely

as possible simulated clinical conditions. All materials under investigation

were prepared at room temperature and humidity, and were also stored under

these conditions. A temperature of 32°C was used for polymerization to take

place because it most closely simulated the open mouth temperature at which

elastomeric impressions are taken.

As for the two techniques used to evaluate the five impression materials

researched, it should be apparent the use of a custom tray was of paramount

importance if the true characteristics of an impression material were to be

considered. Ellam, 1966, and Davis et al, 1976, have already proved the

strength of the bond between the elastomer and the custom tray. Davis, 1976,

reported in his research that in the silicone and polyether systems, cohesive

failure of the material occurred before the adhesive bond between elastomer

and tray failed. This property must be of tremendous value in holding the

impression material static, thus preventing large change in the dimensional

stability of the material itself. One only need to review the data in Table

5 for this to become apparent. \\Then evaluating an impression material by it­

self, not bound to a custom tray, the environmental variables played a much

larger role in the stability of the material. This \vas true because variables

can affect the entire mass of the material circumferentially rather than merely

the material adjacent to the area being recorded in the impression.

52

It is the recommendation of this researcher that the A.D.A. modify

their technique, to use a custom tray and the mandufacturer's adhesive when

evaluating the elastomeric impression materials. The results of this research

have proved the value of this technique.

As for the relative accuracy and dimensional stability of the elastomers

evaluated, without question the polyether impression materials were superior

to all other commercially available impression materials today. Although

the new addition polymerization silicone, President, does in fact mimic

the properties possessed by the polyethers, only the material bound to the

custom tray compared favorably with the polyethers. This one study cannot

be considered conclusive for very little research has been done or reported

about the actual nature of this material. A need for further research in

this area is highly recommended. Still remains the fact this material is

very exciting, and its future in dentistry is very promising. We shall hear

much more about this new silicone in future research.

The polysulfides and conventional silicone respectively, follow in accura­

cy and dimensional stability as one would expect. All findings mentioned

above have compared well with the research of previous investigators within the

past ten years. One only need to review the literature for this to become

readily apparent.

The time advocated in this research for the complete polymerization of the

materials evaluated was the manufacturer's plus three minutes. This was in

accordance with work reported by previous investigators. Chong and Docking,

1969, and Sawyer et al, 1971. The manufacturers' setting times were found

to be insufficient, so additional time for the setting was advocated

to insure a greater measure of success and complete polymerization of all

the elastomers.

53

Taking into consideration such factors as the room temperature, relative

humidity, water absorption while taking the impression, continual poly­

merization, loss of volatile constituents, setting expansion of stone and

impression expansion, the following points can be recommended: a custom

tray with the proper adhesive (the brand recommended by the manufacturer);

uniform thickness of material (from 2- 4 mm.); mix the material as the

manufacturer recommends; and finally, the impression has to be fully set

before it is removed from the mouth.

For all three types of elastomers, it would appear the manufacturer's

recommended setting time is too short. Sawyer, 1971, found the optimum

setting time in the mouth to be 15 minutes for the polysulfides while the

silicones and polyethers were found to be seven minutes to insure all

materials were set completely.

The most important factor, however, was the impression material should

be poured immediately. If this was followed, all impressions regardless of

the material used, yielded superior results. If for any reason prolonged

storage before pouring the impression is necessary, the use of the polyether

or addition polymerization silicone materials would be the elastomers of

choice.

Lastly, it is at the discretion of this researcher to classify this

study as pilot research, with the following recommendations: the sample

54

size and the number of observations per sample be expanded.

CHAPTER VI

CONCLUSIONS

A total of five elastomeric impression materials were evaluated: two

polysulfides, one lead cure and one non-lead cure; two silicones, one conden­

sation polymerization and one addition polymerization; and one polyether.

These materials were subjected to an environment that closely simulated

clinical and oral conditions. Room temperature and humidity were relatively

constant and the materials were allowed to set in a 32°C water bath for three

minutes longer than the manufacturer recommended. Ynis additional time

insured complete set of the material.

Two techniques were evaluated. All materials were evaluated initially

with the use of a custom tray and manufacturer's adhesive. A second evalua­

tion was performed without using the tray system. Both techniques were

subjected to statistical comparison.

Conclusions of the research were:

1. A research method \-laS introduced to evaluate the effect of custom

trays on the dimensional stability and accuracy of comnercial dental im­

pression materials.

2. All impression materials evaluated using a custom tray and adhesive

consistently demonstrated superior results in comparison to those tested

without the custom tray.

3. There was no appreciable difference recorded at the ,05 level of

significance when the materials were compared immediately after initial

set using a custom tray.

55

56

4. Of the five materials evaluated without the use of a custom tray,

the polyether material consistently yielded superior results when compared

to the other impression materials. The addition polymerization silicone

was second followed by the lead cure polysulfide, the non-lead cure poly­

sulfide and the condensation polymerization silicone respectively.

5. Of the five impression materials evaluated with the use of a

custom tray and manufacturer's adhesive, the polyether along with the

addition polymerization silicone materials yielded the superior results,

followed by the polysulfides and condensation polymerization silicone

respectively. Note: no significant difference exists between the polyethers

and addition polymerization silicone at the .05 level.

REFERENCES

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Bell, J. W., Davies, E .H. , and Fraunnho fer, J .A. "The Dimensional Changes of Elastomeric Impression Materials Under Conditions of Humidity," J. Dent. 4, 2 73-82, 1976.

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Ellam, A.H. and Smith, D.C. "The Relative Effectiveness of Ad­hesives for Polysulphide Impression 1'1a terials," Br. Dent. J. 20:135-138, 1966.

58

Fettes, E.M. and Jorczak, J.S. "Polysulfide Polymers," Ind. Eng. Chern. 42:2217-2223, 1950.

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Gilmore, W.H., Schnell, R.J., and Phillips, R.W. "Factors In­fluencing the Accuracy of Silicone Impression Materials, 11

J. Pros. Dent. 9:304-314, 1959.

Goldberg, A.J. "Viscoelastic Properties of Silicone Polysulfide and Polyether Impression Materials," J. Dent. Res. 53:1033-1039, Sept-Oct 1974.

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Hembree, J.H., Jr. H.aterials,"

"Comparative Accuracy of Elastomer Impression J. Tenn. Dent. Assoc. 54:164-167, Oct 1974c.

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59

Hembree, J.H., Jr. and Andrews, J.T. "Accuracy of Polyether Impression Material," Ark. Dent. J. 47:10-11, June 1976.

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Hollenback, G.M. "A Study of the Physical Properties of Elastic Impression Materials," Parts I -IV, J. South. Calif. St. Dent. Assoc. 31:204-206, 227-230, 369-372, 403-408, 1963.

Hosoda, H. and Fusayama, T. "Distortion of Rubber Base Impression," J. Pros. Dent. 11:318-333, 1961.

Jorczak, J.S. and Fettes, E.M. "Polysulfide Liquid Polymers," Ind. Eng. Chern. 43:324-328, 1951.

Jorgensen, K.D. "Thiokol as a Dental Impression Material," ACTA Odont. Scand. 14:313-334, 1956.

Kaloyannides, T.M. "Elasticity of Elastomer Impression Materials: II Permanent Deformation," J. Dent. Res. 52:719-724, July-Aug 1973.

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''The Contact Angles J. Pros. Dent.

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60

Mansfield, M.A. and Wilson, H.J. "A New Method for Determining the Tension Set of Elastomeric Impression Materials," Br. Dent. J. 135:101-105, Aug 1973.

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61

Podshadley, A.G., Dilts, W.E., Neiman, R., and Ellison, E. "Accuracy of Relined Mercaptan Rubber Impressions," J. Pros. Dent. 24:503-511, 1970.

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62

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63

Schwindling, R. "Thermal Correction of the Volume Changes of a Silicone Impression," Quintessence International 10, 04 71, pp. 35-40, 1971.

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Vermilya, S.G., Powers, J.A., and Craig, R.G. "Polyether, Polysulfide and Silicone Rubber Impression Haterials: Part I & II Quality of Silver Plated Dies," Hich. Dent. Assoc. J. in press.

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Status report on polyether impression materials. J.A.D.A. p. 126, July 1977.

APPENDIX

64

APPENDIX

* KEY TO IDENTIFICATION OF IMPRESSION }L~TERIALS EVALUATED IN APPENDIX

ID :::: 11 President w/o tray

ID 12 President w/ tray

ID :::: 21 Omniflex w/o tray

ID 22 Omniflex w/ tray

ID 31 Permlastic w/o tray

ID 32 Permlastic w/ tray

ID 41 Impregum w/o tray

ID 42 Impregum w/ tray

ID 51 Accoe w/o tray

ID 52 Accoe w/ tray

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• • • • • • • - • - • - - - - - - r - 1 r ~ r - - -

QJ/1•11" Ph.r,t

VARIABLE Nl'~-'"f_4 SHimhQO STA~IJAQI) •CU!Frfllt'ICEI STMDA-IU ~TA'-IOAR~ • 2•TAJL • I ';toR[t~ Of ?·TAl' OF LhSES "1Ell"l OEVIATIO"' EQROR 0 "-'f.._I'PII rJEVIATl~)·~ t.P·?0R n (OoR. P~QH. 0 Vf1LtJ£. ... ,_~1)11"1 ~'~U:L

UiE·--------------------------------------------------;-----------------------------------;-------------;--------------------------992.oooo o.o o.o • •

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l f),. 57 2J 0 I 0 ()

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9Y2.oooo o.n o. 37 , 2 ~ 00 15.121 3,086 :99.onoqg,oon : 1>,o 7 ?.4 9~1.,7500 15.1?1 J,OA6

23 ('I• Q Q 'I

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o.o o.o o, n 99. 0 Ot . . . . 'l48 o.o 0. 0 o.o

----------------------------·----------------------------------------------~------------------------------------------------------~ u r E .,. ~ o

24 992• 0000 0 • 0 0 • 0 : 54,0417 zo.24A 4.113 :~9.ono~~.ono: lJ.o~ 937,9583 20.246 4,!J3 • • •

23

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COMPARISON BETWEEN ALL MATERIALS TESTED WITH A CUSTOM TRAY "vs" THE DIE USING TWO-TAIL "T" TEST AT .05 LEVEL OF SIGNIFICANCE

23

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STATISTICAL PACK•GE FOR THE SOCIAL SCIE~CES 0]/1417~ PAGE 1 0 ftLE NONAME ICREATIO~ DATE • 03/14/781

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VAR!AHLE "'UW1fR SHNI)ARIJ qA~IlAR., •!OIFFERtl·lCEl <:;J''l)A-<U STA'l~~Ril • ?.·TAIL 0 T Dl:."oifE<; 0' 2·T•I OF CA!>ES MEA~ DEVIATION ~o<RUH • MEAN OEVIAIIO~ ER~O'I • CfiRR, PqoB, • VALUE ·~~E0<) 0 PriOt!•

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T A B L E 2A

COMPARISON BETI~EEN PRESIDENT WITHOUT A CUSTOM TRAY AND THE DIE AT .05 LEVEL OF SIGNIFICANCE

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• • - - - • • • • • - - - - - • • - - • - - - T • T ' S T • • - • • - • • • • • - • • • • • • • • • • - - - - • • • •

VARIABLE NtJM8FR STAIIflM>O SIA'Jtlhlll •t91FffPEtKEl ST'NlA~Il >!A'JflARIJ • ~-TAlL 0 1 'JF.o-'fFS of" 2-TA!L OF Cr.St::S MEA~ DEVIATION EqR()~ u ~~EAI,! DFVTIIT[[Jr'.) t,LJ~r)~ u- COoR. DQQ8. t-. VALUE ~,...~.EU 1)~ ~.H.Jlld•

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VARJA~LE NUM~r R OF CAC;E ~ ~'''.A~

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COMPARISON BETWEEN OMNIFLEX WITHOUT A CUSTOM TRAY AND THE DIE AT .05 LEVEL OF SIGNIFICANCE

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APPROVAL SHEET

The thesis submitted by James N. Ciesco has been read and

approved by the following committee:

Dr. William F. Malone, Director Professor, Fixed Prosthodontics, Loyola

Dr. James L. Sandrik Associate Professor, Dental Materials, Loyola

Dr. Boleslaw Mazur Professor, Fixed Prosthodontics, Loyola

The final copies have been examined by the director of the

thesis and the signature which appears below verifies the

fact that any necessary changes have been incorporated and

that the thesis is now given final approval by the Committee

with reference to content and form.

TI1e thesis is, therefore, accepted in partial fulfillment

of the requirements for the degree of Master of Science in

Oral Biology.

Date. 1 Director's Signature