Master of Science (Dentistry) / Dimensional stability was defined by Nicholls (1977) as “the ability (of a material) to maintain accuracy over time”, and the result of loss of accuracy, “distortion”, as “the relative movement of a single point, or group of points, away from some originally specified reference position such that permanent deformation is apparent”. Maintaining dimensional stability of dental impression materials is vital if the impression cannot be cast (in stone) soon after removal from the mouth. Dental irreversible hydrocolloid (alginate) is a major dental impression material used worldwide in many clinical procedures. However, alginate is dimensionally unstable and changes its dimensions (suffers “distortion”) after removal from the mouth. With storage times of more than ten minutes, alginate begins to distort, and after one to three hours (depending on the product and storage conditions) cannot be used for many clinical purposes, especially fixed prosthodontics such as crowns and bridges (Hampson 1955, Skinner & Hoblit 1956, Wilson & Smith 1963, Rudd et al. 1969, Miller 1975, Inohara 1977, Schoen et al. 1978, Coleman et al. 1979, Linke et al. 1985, Habu et al. 1986, Peutfeldt & Asmussen 1989, Mathilde & Peters 1992, Khan & Aziz Sahu 1995, Eriksson et al. 1998, Schleier et al. 2001, and Donovan & Chee 2004). This loss of accuracy, due to dimensional instability, manifests as a time-dependent distortion of the poured stone cast, and thus any prosthesis fabricated will not fit in the mouth. With the introduction of the more stable elastomers in the 1950s (Stackhouse 1970, Glenner 1997, Brown 2003) that could be stored for days if necessary, without loss of accuracy, the alginates fell out of favour for fixed prosthodontics. Recently, there has been a resurgence of interest in alginate for use in dental procedures where dimensional stability is critical (Peutzfeldt and Asmussen 1989, Eriksson et al. 1998). This in part is due to the favourable properties of alginate not found in the elastomers. Of greatest significance is that alginate hydrocolloid is hydrophilic, whereas elastomers are hydrophobic (Phillips & Ito 1958, Glenner 2004). Thus, alginate materials are able to reproduce wet oral areas with greater precision and to produce a superior "fit" of, say, a gold casting produced by the Lost Wax technique (Skinner and Phillips 1982). A number of reports have been published which investigate newer alginate materials that are claimed to be more dimensionally stable than older formulations. Puetzfeldt and Asmussen (1989) found that a newer alginate , if stored at 100% relative humidity, retained accuracy over 24 hours that was equivalent to that of the elastomers. More recently, the manufacturer of another alginate has claimed equivalent dimensional stability to the elastomers for up to 100 hours, and, whilst this claim has not been reported on in the literature, the present thesis will show that, under favourable conditions of storage, the material maintained clinically useful accuracy for up to 100 hours. Another approach to improving the accuracy of alginate impressions has been to combine reversible hydrocolloid with alginate (the “Bilaminar” technique). Frederick and Caputo (1997) confirmed that the new agar reversible hydrocolloids are just as accurate (at the time of removal from the mouth) as the new elastomers. Mathilde et al. (1992) and Eriksson et al. (1998) have shown that several of the “bilaminar” impression techniques for fixed prosthodontics, where alginate is used as a tray material supporting a reversible hydrocolloid (agar) wash, are as accurate and dimensionally stable as elastomers for up to three hours. However, these studies are difficult to interpret due to lack of uniformity in the testing methods, and the fact that there is no regulatory standard available to measure dimensional stability for dental alginates. The International Standard (IS) for alginate impression materials (ISO 1563:1990E) contains no specification for dimensional stability, and thus places no requirement for manufacturers to state dimensional stability properties on their labels. In contrast, ISO 4823:1992(E) specifies the IS for elastomeric dental impression materials, and it does specify a requirement for dimensional stability (less than 1.5% distortion after 24 hours). Further, the IS sets a method for determination of dimensional stability. Briefly, this method (the Optical Method) uses a travelling optical microscope to measure the accuracy of the distance between score lines on an impression of a test grid, at various time periods. The American Dental Association Specification No. 19 for dental elastomeric impression materials is identical to the IS. There is currently no specific Australian Standard (AS) for the dimensional stability of any dental impression material. Overview of Experimental Methods A. The Optical Method The aim of Part A of this investigation was to: 1. Adapt the Optical Method of the IS for elastomers to be reproducible for dental alginates. This was achieved by using a perforated test tray (to simulate clinical conditions), and measuring the grid pattern on a dental stone button after casting the test impression, rather than direct measurement of the impression, as for the IS. 2. To measure and rank the dimensional stability of a number of locally available dental alginates. Measurements of the test stone buttons proved reproducible, and the results were different for each sample, allowing them to be ranked according to dimensional stability after 50 and 100 hours of storage. The results show that the traditional optical method for measuring dimensional stability, as specified in the IS for dental elastomers, can be adapted to measure the dimensional stability of dental alginates However, the Optical Method of measuring dimensional stability of dental alginates is cumbersome and time-consuming. It was hypothesised that dimensional stability of dental alginates could be measured more conveniently by finding a thermal property that is directly proportional to dimensional stability. This method could be useful for the rapid determination of relative performance, and allow comparison with a determined benchmark. B. The Thermal Method Recently, modern methods of Thermal Analysis, Thermal Gravimetric Analysis (TGA) and Differential Scanning Calorimetry (DSC) have been used to rapidly age various polymers, including food alginates (Chinachoti 1996), in order to measure thermal stability. This thesis shows that thermal stability is an indicator of dimensional stability. The aim of Part B of this investigation was therefore to adapt thermal analysis techniques to dental alginates, and develop a method to measure their thermal stability. These results were then compared with those for dimensional stability measured by the Optical Method to determine the relationship between thermal and dimensional stability for dental alginates. The results show that current thermal analysis methods of TGA and DSC can be adapted to measure relative dental alginate dimensional stability, and are both rapid and convenient. This study also provides evidence that commercial products differ as regards the property of dimensional stability, and can be ranked accordingly. C. Practical Application of the Methods The aim of part C of this thesis was to validate the methods (both optical and thermal) developed in this study by using them to investigate the effect of varying the water/powder ratio on the dimensional stability of dental alginates. It was shown that dimensional stability is affected by changes to the recommended water/powder ratio, that both the methods detected and measured the changes, and that the results were proportional, in that any percentage change detected by the optical method, was mirrored by the thermal method, confirming that the more convenient thermal methods can be used to measure dimensional stability.

Master of Science (Dentistry) / Dimensional stability was defined by Nicholls (1977) as “the ability (of a material) to maintain accuracy over time”, and the result of loss of accuracy, “distortion”, as “the relative movement of a single point, or group of points, away from some originally specified reference position such that permanent deformation is apparent”. Maintaining dimensional stability of dental impression materials is vital if the impression cannot be cast (in stone) soon after removal from the mouth. Dental irreversible hydrocolloid (alginate) is a major dental impression material used worldwide in many clinical procedures. However, alginate is dimensionally unstable and changes its dimensions (suffers “distortion”) after removal from the mouth. With storage times of more than ten minutes, alginate begins to distort, and after one to three hours (depending on the product and storage conditions) cannot be used for many clinical purposes, especially fixed prosthodontics such as crowns and bridges (Hampson 1955, Skinner & Hoblit 1956, Wilson & Smith 1963, Rudd et al. 1969, Miller 1975, Inohara 1977, Schoen et al. 1978, Coleman et al. 1979, Linke et al. 1985, Habu et al. 1986, Peutfeldt & Asmussen 1989, Mathilde & Peters 1992, Khan & Aziz Sahu 1995, Eriksson et al. 1998, Schleier et al. 2001, and Donovan & Chee 2004). This loss of accuracy, due to dimensional instability, manifests as a time-dependent distortion of the poured stone cast, and thus any prosthesis fabricated will not fit in the mouth. With the introduction of the more stable elastomers in the 1950s (Stackhouse 1970, Glenner 1997, Brown 2003) that could be stored for days if necessary, without loss of accuracy, the alginates fell out of favour for fixed prosthodontics. Recently, there has been a resurgence of interest in alginate for use in dental procedures where dimensional stability is critical (Peutzfeldt and Asmussen 1989, Eriksson et al. 1998). This in part is due to the favourable properties of alginate not found in the elastomers. Of greatest significance is that alginate hydrocolloid is hydrophilic, whereas elastomers are hydrophobic (Phillips & Ito 1958, Glenner 2004). Thus, alginate materials are able to reproduce wet oral areas with greater precision and to produce a superior "fit" of, say, a gold casting produced by the Lost Wax technique (Skinner and Phillips 1982). A number of reports have been published which investigate newer alginate materials that are claimed to be more dimensionally stable than older formulations. Puetzfeldt and Asmussen (1989) found that a newer alginate , if stored at 100% relative humidity, retained accuracy over 24 hours that was equivalent to that of the elastomers. More recently, the manufacturer of another alginate has claimed equivalent dimensional stability to the elastomers for up to 100 hours, and, whilst this claim has not been reported on in the literature, the present thesis will show that, under favourable conditions of storage, the material maintained clinically useful accuracy for up to 100 hours. Another approach to improving the accuracy of alginate impressions has been to combine reversible hydrocolloid with alginate (the “Bilaminar” technique). Frederick and Caputo (1997) confirmed that the new agar reversible hydrocolloids are just as accurate (at the time of removal from the mouth) as the new elastomers. Mathilde et al. (1992) and Eriksson et al. (1998) have shown that several of the “bilaminar” impression techniques for fixed prosthodontics, where alginate is used as a tray material supporting a reversible hydrocolloid (agar) wash, are as accurate and dimensionally stable as elastomers for up to three hours. However, these studies are difficult to interpret due to lack of uniformity in the testing methods, and the fact that there is no regulatory standard available to measure dimensional stability for dental alginates. The International Standard (IS) for alginate impression materials (ISO 1563:1990E) contains no specification for dimensional stability, and thus places no requirement for manufacturers to state dimensional stability properties on their labels. In contrast, ISO 4823:1992(E) specifies the IS for elastomeric dental impression materials, and it does specify a requirement for dimensional stability (less than 1.5% distortion after 24 hours). Further, the IS sets a method for determination of dimensional stability. Briefly, this method (the Optical Method) uses a travelling optical microscope to measure the accuracy of the distance between score lines on an impression of a test grid, at various time periods. The American Dental Association Specification No. 19 for dental elastomeric impression materials is identical to the IS. There is currently no specific Australian Standard (AS) for the dimensional stability of any dental impression material. Overview of Experimental Methods A. The Optical Method The aim of Part A of this investigation was to: 1. Adapt the Optical Method of the IS for elastomers to be reproducible for dental alginates. This was achieved by using a perforated test tray (to simulate clinical conditions), and measuring the grid pattern on a dental stone button after casting the test impression, rather than direct measurement of the impression, as for the IS. 2. To measure and rank the dimensional stability of a number of locally available dental alginates. Measurements of the test stone buttons proved reproducible, and the results were different for each sample, allowing them to be ranked according to dimensional stability after 50 and 100 hours of storage. The results show that the traditional optical method for measuring dimensional stability, as specified in the IS for dental elastomers, can be adapted to measure the dimensional stability of dental alginates However, the Optical Method of measuring dimensional stability of dental alginates is cumbersome and time-consuming. It was hypothesised that dimensional stability of dental alginates could be measured more conveniently by finding a thermal property that is directly proportional to dimensional stability. This method could be useful for the rapid determination of relative performance, and allow comparison with a determined benchmark. B. The Thermal Method Recently, modern methods of Thermal Analysis, Thermal Gravimetric Analysis (TGA) and Differential Scanning Calorimetry (DSC) have been used to rapidly age various polymers, including food alginates (Chinachoti 1996), in order to measure thermal stability. This thesis shows that thermal stability is an indicator of dimensional stability. The aim of Part B of this investigation was therefore to adapt thermal analysis techniques to dental alginates, and develop a method to measure their thermal stability. These results were then compared with those for dimensional stability measured by the Optical Method to determine the relationship between thermal and dimensional stability for dental alginates. The results show that current thermal analysis methods of TGA and DSC can be adapted to measure relative dental alginate dimensional stability, and are both rapid and convenient. This study also provides evidence that commercial products differ as regards the property of dimensional stability, and can be ranked accordingly. C. Practical Application of the Methods The aim of part C of this thesis was to validate the methods (both optical and thermal) developed in this study by using them to investigate the effect of varying the water/powder ratio on the dimensional stability of dental alginates. It was shown that dimensional stability is affected by changes to the recommended water/powder ratio, that both the methods detected and measured the changes, and that the results were proportional, in that any percentage change detected by the optical method, was mirrored by the thermal method, confirming that the more convenient thermal methods can be used to measure dimensional stability.

Made available in DSpace on 2014-08-20T14:30:13Z (GMT). No. of bitstreams: 1 Tese_Gloria_Beatriz_Azevedo_Cubas.pdf: 1660996 bytes, checksum: 8bb44113acc263526d63d6f5e7e47e2b (MD5) Previous issue date: 2012-12-07 / The aims of this randomised controlled trial were to evaluate the influence of a preprocedural 0.12% chlorhexidine mouthrinse on the microbial contamination of dental impressions, subsequently disinfected with sodium hypoclorite or water (control). The second objective was to evaluate if aqueous solution of 0.12% chlorhexidine mixed with irreversible hydrocolloid powder would decrease microbial contamination of dental impressions. Forty subjects underwent maxillary dental impressions with irreversible hydrocolloid and were randomly divided into two groups (n=20) according to the preprocedural mouthrinse (0.12% chlorhexidine or placebo).The dental impressions were then divided into two subgroups and disinfected with sodium hypochlorite or water (control). In the second part, 20 subjects underwent maxillary dental impressions with irreversible hydrocolloid and randomly assigned into two groups according to the mixed agent used (0.12% chlorhexidine or water). Saliva and alginate samples were assessed for microbiological counts of total micro-organisms, total streptococci and Candida species. Surface roughness of the impressions and dimensional stability of the casts were also evaluated. Chlorhexidine preprocedural mouthrinse significantly reduced (p<0.05) microbial contamination. Small but significant alterations were produced on dimensional stability and surface quality when sodium hypochlorite was used as disinfectant after the impression (p=0.005). The results also showed that the use of aqueous 0.12% chlorhexidine mixed with the powder of irreversible hydrocolloid decreased the percentage of total micro-organisms and total Streptococci counts (p<0.001), without producing alterations in surface quality and dimensional stability. It can be concluded that 0.12% chlorhexidine used as preprocedural mouthrinse, or mixed with irreversible hydrocolloid powder, are effective methods in reducing microbial contamination of alginate impressions, without causing damage to the physical and mechanical properties of the material / Os objetivos deste ensaio clínico randomizado foram (I) avaliar a influência de um bochecho, com solução de clorexidina 0,12% e placebo, previamente a realização de moldagens bucais, posteriormente desinfetadas com hipoclorito de sódio ou água (controle) na contaminação de moldagens de alginato; e (II) avaliar se solução aquosa de clorexidina 0,12% misturada com o pó de hidrocolóide irreversível reduziria a contaminação microbiana de moldagens bucais.Quarenta voluntários foram submetidos a moldagens bucais com hidrocolóide irreversível e foram divididos de forma randomizada em 2 grupos (n=20) de acordo com a solução bucal (0,12% clorexidina ou placebo). As moldagens bucais foram divididas em 2 grupos e desinfetadas com hipoclorito de sódio ou água (controle). Na segunda parte do ensaio clinico, 20 voluntários foram submetidos a moldagens bucais com hidrocolóide irreversível e foram divididos em 2 grupos de acordo com a solução usada no preparo do alginato (0,12% clorexidina ou água).Amostras de saliva e alginato foram avaliados quanto a contagem microbiana de microrganismos totais, estreptococos totais e espécies de Candida. Rugosidade de superfície e estabilidade dimensional de modelos de gesso também foram avaliados. Bochecho com solução bucal de clorexidina reduziu de forma significativamente (p<0,005) a contaminação microbiana. Pequenas mais significativas alterações dimensionais e de rugosidade de superfície foram produzidas quando hipoclorito de sódio foi utilizado como agente desinfetante pós-moldagem (p=0,005). Os resultados também demonstraram que o uso de solução de clorexidina 0,12% misturada ao pó de hidrocolóide irreversível reduziu a percentagem de microrganismos totais e estreptococos (p<0.001), sem causar alterações de rugosidade de superfície e estabilidade dimensional. Pode ser concluído que o uso de solução de clorexidina 0,12% usada como bochecho bucal ou misturada ao pó de hidrocolóide irreversível são métodos eficientes na redução microbiana de moldagens de alginato, sem causarem danos as propriedades físicas e mecânicas do material