Loyola University Chicago Loyola University Chicago
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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
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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
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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
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
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
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
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.
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57
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58
Fettes, E.M. and Jorczak, J.S. "Polysulfide Polymers," Ind. Eng. Chern. 42:2217-2223, 1950.
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"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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Jorczak, J.S. and Fettes, E.M. "Polysulfide Liquid Polymers," Ind. Eng. Chern. 43:324-328, 1951.
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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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Status report on polyether impression materials. J.A.D.A. p. 126, July 1977.
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
ALL COMPfu.'liSONS MADE BY USE OF "T" TEST THO-TAIL PROBABILITY AT .05
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* refers to the computer sheet identification of materials
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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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-~-~------------------------------------------------------------------------------------------·------------------------------------01 E • • • 992.0000 o.o o,o • • •
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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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ST~TISTICAL PACKA0[ FOR THE SOCIAL SCIENCES 03/]417'' PAGE I< FiLE NUNAME !CREATION OATE • 03/lo/IHJ
• • - - - • • • • • - - - - - • • - - • - - - T • T ' S T • • - • • - • • • • • - • • • • • • • • • • - - - - • • • •
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1.114 . .
COMPARISON BETWEEN PRESIDENT WITH A CUSTOM TRAY AND THE DIE AT .05 LEVEL OF SIGNIFICANCE
4 o.ooo
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- - - - - - - - - - - - - - - - - - - - - - - - - - - T • T ~ ~ T - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
VARJA~LE NUM~r R OF CAC;E ~ ~'''.A~
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T A B L E 2C
COMPARISON BETWEEN OMNIFLEX WITHOUT A CUSTOM TRAY AND THE DIE AT .05 LEVEL OF SIGNIFICANCE
~
N r--.
S!ft115TICAL PACKAGt fON THE SOCIAL SCIF~CES O.l/14/1~ PI1G( 1 ~
fiLE NON~ME tCN[ATION ~ATE = 03/I6/7HI
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vA'll~l'l.E NtJ,_,~lH~
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T A B L E 2D
COMPARISON BETWEEN OMNIFLEX WITH A CUSTOM TRAY AND THE DIE AT .05 LEVEL OF SIGNIFICANCE
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M r--. ~TIT1S!llAL ~ACKIGt fO~ T~E SOCIIL SC![NCES 0)/14/IM PfiGE 1 B
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• • • • • • • • - • - • - - - - - • - • - • - I • I F ~ I • - • • • - • - - • - - • - • - • - - • - -
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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