Comprehensive Review and Comparison of the Disinfection

Techniques Currently Available in the Literature

Ahila S. Chidambaranathan, MDS & Muthukumar Balasubramanium, MDS
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India

Keywords
Cross-infection; disinfection; dental
impression.
Correspondence
Dr.S.C.Ahila, Associate Professor,
Department of Prosthodontics,SRM Dental
College,Ramapuram,Chennai-78, Tamil Nadu
600089, India. E-mail: ahilasc@yahoo.co.in.
The authors deny any conflicts of interest.
Accepted January 6, 2017
Abstract
The goal of disinfection in the dental office is to prevent the spread of infection from
one patient to another and maintain the safety of the dental care providers. Prevention
of cross infection has significant effect on infection control. The standard procedure
of rinsing impressions under tap water immediately after removal from the mouth
eliminates microorganisms along with saliva and blood. A broad search on published
literature was done using the keywords impression materials, disinfection method, and
sterilization of dental impression from 1980 to 2016 in Medline, Google Scholar, the
internet, and textbooks. This article critically analyzes the various published methods
of dental impression disinfection in dentistry.

doi: 10.1111/jopr.12597

Public awareness of the spread of microorganisms and infec-
tious diseases in the dental office among the dentist,1 aux-
illiaries and laboratory personnel has increased significantly.
Some microorganisms may cause opportunistic infections in
immuno-compromised persons such as those with hepatitis,
tuberculosis, herpes, and AIDS.2,3
Dental impressions contaminated with a patient’s saliva or
blood can cross-contaminate stone casts4 and serve as a source
of infection to dental personnel who handle the impression or
cast.5-7 Until 1991, rinsing the dental impressions under running
tap water was the recommended procedure for disinfection.8
However, washing the impressions with running tap water elim-
inates only 40% of bacteria, viruses, and fungi, hence there is
more potential for infection.9
Disinfection aims to remove microorganisms from the
impression surface without affecting accuracy and surface
quality.10 Disinfection of an impression is a routine procedure
in dental offices and laboratories. Spray and immersion disin-
fection using solutions and the incorporation of antibacterial
chemicals into the gypsum or die stone during mixing may
influence the mechanical properties including setting time and
dimensional accuracy.11
Immersion disinfection ensures that all surfaces of the den-
tal impression are exposed to the disinfectant; however, hy-
drocolloids and polyether materials cannot be immersed in
disinfectants due to the imbibition phenomenon. Immersion
disinfectants should be discarded after every use (except for
glutaraldehydes).12
The spray method of disinfection reduces the chance of dis-
tortion, especially in hydrocolloids and polyether, and also
uses less disinfectant solution, but it may not reach the ar-
eas of undercuts and also releases air, leading to occupational
exposure.13 Antimicrobial agents have been incorporated into
impression materials by the manufacturer, increasing the risk
of dermal and mucosal irritation of the patient when multiple
impressions are made.14
Immersion disinfection is time consuming and expensive.
Additionally, chemical disinfectants must be freshly prepared
and have a limited shelf life.15 Casts that were once properly
disinfected can become contaminated during later procedures.
Many methods have been tested for disinfection of casts.
These methods include incorporation of disinfectants into den-
tal casts16 and disinfection of casts using a microwave oven
in controlled settings.1 Microwave disinfection is an effec-
tive, quick, easy, inexpensive and versatile method, which can
be done by dentists, assistants, and technicians.17 Autoclav-
ing of the dental cast damages the surface of the dental cast,
and immersion of the cast in chemical disinfectant dissolves
gypsum, thereby decreasing the compressive strength. Mi-
crowave oven disinfection is therefore a potentially convenient
solution.
The purpose of this article is to critically analyze the various
techniques of disinfection of dental impression and their effect
on dental casts and impression materials.
Impression disinfection revolution
M. tuberculosis has been found in patient casts,11 and M. pneu-
moniae has been transmitted to laboratory technicians when
they performed finishing of dentures. Infectious diseases like

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C 2017 by the American College of Prosthodontists 1
Disinfection of Dental Impressions Chidambaranathan and Balasubramanium

AIDS, hepatitis, tuberculosis, pneumonia, and herpes have Table 1 Impression materials and disinfection choices
been transmitted from patients to dentists and dental labora-
Impression material Disinfectant agent Duration
tory technicians.18
In 1978, the Council on Dental Materials and Devices de- Alginate Iodophors and diluted 10 min
scribed infection control in the dental office. Microwave dis- sodium hypochlorite
infection of gypsum casts was suggested.19,20 It has been ob- Compound Iodophors and diluted 10 min
served that 67% of the materials received in laboratories were sodium hypochlorite
contaminated with Streptococci, Staphylococci, Candida. spp, Polyether Iodophors and diluted 10 min
methicillin-resistant S. aureus (MRSA), or P. aeruginosa.20-22 sodium hypochlorite,
The Centers for Disease Control and Prevention23 recom- complex phenolics
mended that sterilization and disinfection procedures should Polysulphide Iodophors and diluted 10 min
provide a guarantee to the safety of dental treatment.10 sodium hypochlorite,
complex phenolics
Silicone Iodophors and diluted 10 min
Levels of disinfection sodium hypochlorite,
Chemical disinfectants can be classified into three categories24 complex phenolics
based on their efficiency against vegetative bacteria, tubercle Agar Iodophors and diluted 10 min
sodium hypochlorite
bacilli, fungal spores, and viruses. High-level disinfectants are
Zinc-oxide eugenol Iodophors 10 min
capable of inactivating bacterial spores and all other micro-
bial forms, an essential criteria for high-level disinfectants like
ethylene oxide gas or glutaraldehyde solutions. Intermediate-
level disinfectants, namely formaldehyde, chlorine compounds,
iodophors, alcohols, and phenolic compounds, destroy mi- Sodium hypochlorite
crobes like tubercle bacilli, but they do not inactivate spores.
Low-level disinfectants are chemical agents with narrow an- Sodium hypochlorite is a chemical with the formula of NaOCl.
tibacterial activity namely, quaternary ammonium compounds, It is composed of sodium cation and hypochlorite anion. It is
simple phenols, and detergents, which are unacceptable for im- soluble in water. NaOCl is a compound that can be used for
pressions disinfection25-27 (Table 1). purification. It is used for surface purification, bleaching, odor
removal, and water disinfection in industry. Hypochlorite re-
ADA specification for evaluation moves stains from clothes at room temperature. In households,
of dental impression materials hypochlorite is used for purification and disinfection. By adding
hypochlorite to water, NaOCl + H2 O → HOCl + NaOH− is
ANSI/ADA Specification 18/1928 was recommended for eval- formed. Hypochlorous acid is further divided into hydrochloric
uation of accuracy and dimensional stability of impression ma- acid (HCl) and oxygen (O). The oxygen atom is a very strong
terials. oxidator.29

Disinfection solutions used in dentistry

Iodophor
Iodophor, discovered by H. A. Shelanski and M. V. Shelanski,is
a complex of polyvinyl pyrolidone (povidone, PVP) and ele-
mental iodine. These compounds are bactericidal, sporicidal,
virucidal, and fungicidal but require more disinfection time.
They also have been used for the disinfection of blood culture
bottles, hydrotherapy tanks, thermometers, and endoscopes.
The disinfective ability of iodine is neutralized in the pres-
ence of organic material, and hence frequent applications are
needed for thorough disinfection.29
0.25% Benzalkonium chloride (BC)
This is a quaternary ammonium (QA) chloride salt in which the
nitrogen is substituted by a benzyl group, two methyl groups,
and even alkyl chains. It has antibacterial, antiseptic, detergent,
and surfactant action. BC is not effective against viruses, fungi,
and bacterial spores. QA disinfectants have a strong positive
charge that makes good contact with negatively charged sur-
faces. Hence, they are good cleaning agents. QA compounds
are low toxicity, but prolonged contact may irritate the tissues.
Usually they are used for environmental sanitation like floors,
furniture, and walls.29

Glutaraldehyde
Glutaraldehyde is a pungent colorless oil used to sterilize med-
ical and dental instruments. It is used as preservative in indus-
tries. Glutaraldehydes are bactericidal, virucidal, fungicidal,
sporicidal, and parasiticidal and can be highly toxic. They are
used as disinfectant in both liquid and gas forms. They are
more effective in the presence of lower amounts of organic ma-
terial, and hence should be used as a last resort under trained
supervision in a ventilated setting with appropriate protective
equipment.29
Alcohols
Isopropyl alcohol
Isopropyl alcohol is a 2-propanol with the formula of C3 H8 O
or C3 H7 OH. It is a colorless chemical compound with strong
odor. It is commonly used as a topical antiseptic. It is also
used to disinfect the surface of medical equipment. Alcohols
are flammable, hence must be stored in a cool, well-ventilated
area. Alcohol irritates the tissues and evaporates rapidly. It is
very expensive for general use as a surface disinfectant.29

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Chidambaranathan and Balasubramanium
Ethyl alcohol
Ethyl alcohol is more bactericidal than bacteriostatic, also
tuberculocidal, fungicidal, and virucidal against enveloped
viruses. Alcohols are not effective against bacterial spores and
non-enveloped viruses. They denature the bacterial proteins,
thereby inactivating the microorganisms. The optimum bacte-
ricidal concentration in water is 60% to 90%, and the cidal
activity drops when diluted below 50% concentration. Ethyl
alcohol also can be used for hand washing. The drying effect
of alcohols on the hands can be blocked by the addition of
emollients and skin-conditioning agents. Ethanol has shown
clear bacterial growth inhibition, especially when used in high
concentrations against S. mutans and S. aureus.30
Chlorhexidine
Chlorhexidine (CHX) is a positively charged molecule that
binds with the negatively charged sites of the cell wall and
destabilizes. Hence, it interferes with osmosis of the cell wall.
The CHX then attacks the cytoplasmic membrane and leaks
the components that lead to cell death. In high concentrations,
CHX causes the cytoplasm to congeal or solidify. The bacterial
intake of CHX is very rapid (<20 seconds).31 No antifungal
activity of CHX has been observed in the agar diffusion test
in low concentrations,32-34 but 2% CHX showed antimicrobial
activity against S. aureus, E. coli, and B. subtilis, but not C.
albicans.35
Ozone water
Ozone, or trioxygen, is a gaseous inorganic molecule with the
chemical formula of O3 . It is less stable than O2 and easily
breaks down to normal dioxygen in the lower atmosphere.
Ozone is formed by the action of atmospheric electrical dis-
charges and ultraviolet (UV) light from dioxygen. It is present
in low concentrations (0.6 ppm) in the atmosphere.36 It is a
potent oxidizing and antimicrobial agent37 and has been used
as a disinfecting agent since the 19th century.38,39 Ozone is
an unstable compound that decomposes very quickly (half-life
40 minutes at 20°C).40 It derives from ozone generators, ei-
ther corona discharge technology, UV light, or electrolysis.41,42
Ozone affects the cell membrane, vital proteins, unsaturated
lipids, and the intracellular enzymes of microorganisms.43-45
The DNA degradation effect of ozone had been reported in
many studies.46,47
Analysis of sterilization methods
Sterilization
Sterilization means complete elimination of microorganisms
and spores, and requires an immersion period of 6 to 10 hours.
Sterilization of elastomers by autoclave and microwave is as-
sociated with mild linear dimensional changes.48
UV light on impression
The effectiveness of UV49 rays in disinfection depends upon
the time, intensity, humidity, and access to the microorganism.
Since dental prostheses provide a number of sites for housing
microorganisms, UV light must be reflected from many direc-
Journal of Prosthodontics 00 (2017) 1–8 
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Disinfection of Dental Impressions
tions. UV light exposure has been shown to drastically reduce C.
albicans colonies as compared to direct-current glow discharge.
It has been observed that a higher-watt UV light tube decreases
the colony count in less time.50,51 The maximum killing ef-
ficiency with UV light exposure has been obtained with 24
watts (3750 µw/cm 2 ). The higher wattage required less time
to decrease the colony count of C. albicans to zero.50,51
Direct current glow discharge
A glow discharge is plasma formed by passing electric cur-
rent between two metal electrodes in a glass tube containing
low pressure gas at 1 to 10 torr (argon). When the voltage
exceeds the striking voltage, the gas in the tube ionizes, and
becomes plasma, which begins to conduct electricity. Direct-
current glow discharge is the simple type of glow discharge. A
small population of atoms within the cell is initially ionized,
and the positively charged ions are driven towards the cathode
by the electric potential, and the electrons are driven towards
the anode by the same potential. As long as the potential is
maintained, a population of ions and electrons remains. The
glow discharges can be ignited and sustained in both continu-
ous and pulsed modes, and can be run with plasma gases like
argon, helium, nitrogen, and air. Depending on the gas flow
rate, glow discharges can be created and sustained between the
two planar electrodes to form low-temperature plasma brushes.
The direct-current glow discharge sustains the discharges in the
range of milliamps to tens of milliamps. Direct-current glow
discharge has been shown to decrease the count of C. albicans
colonies, but UV light could be a better disinfection method
than direct-current glow discharge.52
Steam autoclave
An autoclave is a device used to sterilize equipment by subject-
ing them to high saturated steam pressure at 121°C or more for
15 to 20 minutes. An autoclave also works at 115°C/10 p.s.i,
121°C/15 p.s.i., and 134°C/30 p.s.i. The standard settings can
kill most bacteria, spores, viruses, and fungi at 134°C, which
can be achieved in 3 minutes. The color change indicates that
the object inside the package, or under the tape, has been au-
toclaved. Digitalized autoclaves use an F0 (F-nought) value
to monitor the sterilization cycle.53 Addition or condensation
silicone materials could be sterilized without any significant
dimensional changes using stock metal trays at 132°C54 and
producing less than 0.5% dimensional change at 134°C55 with-
out producing clinically relevant changes in tear strength.
Ethylene oxide gas autoclave
Holtan et al56 noted that ethylene oxide gas sterilization allowed
gas inclusions into the poly(vinyl siloxane) (PVS) impression
material, which produced bubbles in dies poured immediately.
This kind can be avoided by pouring the dies after 24 hours.
They also stated that steam autoclaving was a suitable method
if the impressions were used for removable prostheses. Olin
et al57 reported that the use of ethylene oxide gas autoclaving
of heavy- and light-body addition silicone impression material
in custom trays showed significant structural changes (>0.5%
3
Disinfection of Dental Impressions
change) due to the distortion of the trays or incapability of
preventing expansion of the impression material.
Argon radio frequency glow discharge
Plasma glow discharge is created by evacuating a reaction
chamber, then refilling with a low-pressure gas. The gas is
then energized by radio frequency microwaves using alternating
current or direct current. Argon radiofrequency glow discharge
(RGD) improves the wettability of impression materials. Re-
cently, RGD has been advocated for disinfecting procedure for
PVS impressions, but it is not clear if glow discharging results
in sterilization.58
Microwave sterilization
Microwave irradiation improves the strength and hardness of
the cast,59-61 but cracks or porosities in the surface have been
noted to occur when type III gypsum is exposed to irradiation
with 1450 W59 and 5 minutes of microwave oven irradiation in
a household microwave oven set at 900 W.62 Studies have also
demonstrated that the exposure of bacterial suspensions to mi-
crowave irradiation caused reduction of viable cell counts and
increased leaching of DNA and protein.63 These results suggest
that microwaves affect cell membrane integrity and permeabil-
ity and cell metabolism, which leads to cell death.64 Microwave
irradiation releases more electrolytes (K+ , Ca++ ) and nucleic
acids than non-irradiated specimens.65 Microwave irradiation
(10 minutes/720 W) has been noted to have little effect
on impression accuracy of impressions, and hence has been
recommended as a suitable technique for sterilizing rubber
impressions.66
Alternative methods of impression
disinfection to prevent cross
contamination in prosthodontics
Incorporation of disinfectant into the alginate
powder
The disinfectant material added to the alginate must be ef-
ficient without affecting the properties, accuracy, stability,
and the castability of the impression.67 Water soluble an-
timicrobial compounds such as quaternary ammonium com-
pounds, bisquanidine compounds, dialkyl quaternary com-
pounds, quinoline compounds, substituted phenols, chlorhex-
idine, didecyldimethyl ammonium chloride, and a mixture of
these materials are generally employed.68 Disinfectants that
are either physically blended or coated onto the alginate pow-
der have been made in the form of microcapsules, which will
release the disinfectant on mixing with the liquid. Similarly,
disinfectants can also be added to the mixing liquid. Among
these, CHX was the most widely used and efficient disinfectant
without affecting handling of alginates.67
The addition of 0%, 0.25%, 0.5%,1%, 2%, 3%, or 4% NaF
to alginate powder produced a significant reduction of contam-
ination and non-significant effect on dimensional stability and
detail reproduction and a significant increase in tear strength.
This was due to the effect of NaF on the consistency and quality
of the alginate. Also, NaF may decrease the wettability of the
impression. Among these methods, NaF can be considered as a
4 Journal of Prosthodontics 00 (2017) 1–8 
Chidambaranathan and Balasubramanium
suitable disinfectant liquid for mixing with alginate impression
material, as it did not significantly affect the properties of the
material. NaF at high concentration had altered the properties
of alginate. Hence, 2% NaF was the optimum concentration
with minimum effect.69
Nanotechnology
Nanotechnology has been used for dental applications in sev-
eral forms.70 Jafari et al71 compared solutions containing nano-
silver colloid 1000 ppm and 500 ppm with 2% chlorhexidine
solution and sterile distilled water. The 500 ppm nano-silver
showed the widest range of zone of inhibition (ZOI) around
S. aureus (23.33 mm) and the narrowest ZOI around Lacto-
bacillus acidophilus, Actinomyces viscosus, and Pseudomonas
aeruginosa (7 mm) Other microorganisms had no signifi-
cant effect, and the widest ZOI was seen around S. aureus
(mean 30 mm), in which the solutant was 1000 ppm nanocid.71
Disinfection or sterilization of dental cast
The effect of microwave irradiation on the properties of gyp-
sum casts has been investigated.56-58,72 The results indicated
that there is an improvement in the mechanical properties,
but a negative effect on compressive strength. Also, cracks or
porosities formed in the surface of the gypsum casts when they
were exposed to microwave irradiation with very high power
(1450 W).
Disinfectant incorporated into the gypsum
product
Chlorhexidine, iodine, and ethanol disinfectants revealed more
antibacterial activities, especially at the higher concentrations,
against S. mutans and S. aureus. Antifungal growth inhibition
was not noticed with the selected concentrations of the disin-
fectants. The mechanism of action of CHX is due to binding
of a positively charged molecule to the negatively charged sites
on the cell wall, destabilizing the cell wall, and thereby inter-
fering with osmosis. The bacterial uptake of CHX is very rapid
(<20 seconds). In low concentrations CHX affects the integrity
of the cell wall and in high concentrations, it causes the cyto-
plasm to congeal or solidify.30
Addition of 0.5% sodium hypochlorite to distilled water
for disinfection of dental stone casts can decrease the setting
time, increase the compressive strength, and have no significant
effect on setting expansion of stone models. Considering the
shrinkage of cast alloys, this expansion is overall favorable
for compensation of metal shrinkage. The mean compressive
strength has been shown to be higher when sodium hypochlo-
rite was used for flasking and processing of acrylic resin den-
ture base materials.73 The setting expansion of type V gypsum
mixed with 0.5% calcium hypochlorite has proven to be higher
than that of type V gypsum mixed with distilled water. Surface
hardness of type V gypsum stone mixed with 0.5% calcium
hypochlorite was less than that of type V gypsum mixed with
distilled water.74
Sodium hypochlorite is not recommended for type IV gyp-
sum disinfection in a concentration more than 0.5%. Io-
dine is not suitable for type IV gypsum disinfection in any
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Chidambaranathan and Balasubramanium
concentration equal or more than 2%. Compressive strength is
directly proportional to drying time of type IV gypsum, regard-
less of type of disinfectant solution used.75
Dental stones mixed with chemical disinfectant agents have
shown high average roughness (Ra); however, the additions of
gum arabic and calcium hydroxide to the hemihydrate powders
before mixing maintain the roughness values to the level of
the control. The setting time of die stone increased and the
surface detail reproduction capacity of die stone was similar
when 2% glutaraldehyde was used compared to 5% sodium
hypochlorite.76
The addition of 1.0% undiluted sodium hypochlorite was
shown to lead to contraction during setting, but 50% diluted
sodium hypochlorite and undiluted chlorhexidine 2.0% resulted
in intermediate values compared to the other groups.77 The
reductions in mean compressive strength value of both types of
dental stones remain close to ANSI/ADA standards, which are
21 MPa for Type III dental stone and 34 MPa for Type IV dental
stone. Therefore, slurry with 0.525% sodium hypochlorite has
been recommended for immersion disinfection of Type III and
IV stone casts.78
Sadananda et al reduced the consistency of the gypsum mix
by the presence of gum arabic and calcium hydroxide additives.
The additives and disinfectants incorporated into the gypsum
had no positive effect on the wetting of an untreated or treated
silicone surface with surfactant. The contact angle values and
number of voids in gypsum casts increased on disinfection, but
decreased on application of topical surfactant. However, the
affinity of the impression material was relatively unchanged on
disinfection and decreased on application of topical surfactant.
Hence, there is a positive correlation between the contact angle
and resultant number of voids in gypsum casts.79
Discussion
The important factors considered in disinfection of dental im-
pressions include the effectiveness, chemical stability of the
disinfecting solution, and the influence of the disinfectant pro-
cedure on the dimensional stability and surface reproduction of
the impression and the resultant casts.80 Impressions must be
treated with disinfectants that do not affect their dimensional
stability.81 The most effective means of minimizing infection
risks is chemical disinfection of impressions.8,82
Spray disinfection of dental casts is a reliable but imprac-
tical method of preventing cross contamination within the
dental team.55 It is a very convenient and popular method
of disinfection.83 However, immersion is the most reliable
method4 because all surfaces of the impression and tray will
come into contact with the disinfectant solution. The quality of
the stone casts obtained from irreversible hydrocolloid impres-
sions disinfected by the immersion method has improved.84
Chemical disinfection and autoclave sterilization do not signif-
icantly increase surface roughness. Autoclave and microwave
sterilization of elastomeric impression materials may be con-
sidered when the impressions are made for diagnostic casts
because the significant increase in roughness may produce a
rougher cast, resulting in rougher tissue surfaces for denture
and cast restorations.85
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Disinfection of Dental Impressions
Surface roughness of gypsum casts was adversely affected
when the disinfectant solution was incorporated with the water
substitutes.86 Chemical agents suitable for the disinfection of
dental impressions, like chlorine compounds, glutaraldehydes,
phenols, and iodophors, have been effective against viruses,
spores, and bacteria.25,26,87 The incorporation of quaternary am-
monium compound into an alginate impression material leads
to dermal and mucosal irritation.13
The ADA recommended using at minimum a medium-level
disinfectant for dental impressions.88 The surface quality of
gypsum casts retrieved from any impression has been an indi-
cator of the compatibility of the impression material and dental
stone.89 If the smooth surface was rapidly degraded by the
disinfecting solutions, it resulted in an irregular surface and
increased roughness (Ra) at an early stage (90 seconds), indi-
cating a chemical reaction of the solution with the impression
material or the dental stone. It may be due to additional reaction
between the dental stone and the residual disinfecting solution
in the irregularities of the impression surface after rinsing with
water.
Taylor et al26 reported that irreversible hydrocolloid impres-
sion material showed the least penetration of disinfecting so-
lution into the surface. Hence, it exhibited superior surface
reproduction; however, impression materials that do not ab-
sorb disinfecting solutions may not be adequately disinfected
if microorganisms are entrapped within the material.90
Sodium hypochlorite23-26 is effective against bacteria,
viruses, and fungi. Sodium hypochlorite should not come in
contact with air, because it will easily disintegrate. It also pro-
duces residue that is a dangerous and corrosive substance. Both
sodium hypochlorite and chlorine do not inactivate G. lambia
or Cryptosporidium. Negative findings were due to either reac-
tion between the hypochlorite absorbed into the impression and
the dental stone or the direct effect of the hypochlorite on the
alginate to surface.91 Gypsum combined with iodophor, neu-
tral glutaraldehyde, phenol, or sodium hypochlorite solutions
reduced the number of colonies to negative within 1 hour,92 but
the incorporation of sodium hypochlorite to the stone decreases
the compressive strength.93
Glutaraldehyde and formaldehyde solutions fix the cell mem-
brane, thereby blocking the release of cellular components
and consequently killing the microorganisms. Chlorhexidine,
phenols, alcohols, and ammonium quaternary compounds are
protoplasmic poison, acting on the cell membrane and caus-
ing loss of nucleic acids and potassium, vital cell components.
Halogen disinfectant performance is based on cell oxidation.83
Alcohols are contraindicated for disinfection of impression
materials, because their action depends on friction of the sur-
face. Formaldehyde should be avoided because of its carcino-
genic action. The quaternary ammonium compounds have a low
level of disinfection and also require friction,94 even though
they have a small effect on the dimensional stability of con-
densation silicone.95 The synthetic phenols act better under
friction, display acute toxicity, and are incompatible with latex,
acrylic, and rubber.94
Sodium hypochlorite has a medium level of action. So the
surface has to be exposed to a concentration of 1% active chlo-
rine (10,000 ppm) for 10 minutes, but it corrodes the metal
trays. Glutaraldehyde is a high-level disinfectant and is not as
5
Disinfection of Dental Impressions
corrosive as hypochlorite. Neutral and alkaline glutaraldehy-
des are less corrosive than the acidic glutaraldehyde. They are
suitable for use in a concentration of 2% for 10 minutes.6
Iodophor diluted 1:213, 5.25% sodium hypochlorite with a
dilution 1:10, 2% acid glutaraldehyde with dilution of 1:4 and
glutaraldehyde with phenolic buffer diluted 1:16 had no ef-
fect on dimensional accuracy of impressions immersed in the
solutions. Silicone impression materials can be disinfected by
immersion in iodophor, diluted chlorine solution, glutaralde-
hyde, or complex phenols’ tuberculocidal activity.96 Studies97
have shown that hydrophilic polyether impressions can be dis-
infected by immersion, but exposure time should be a minimum
of 10 minutes. Disinfectants requiring exposure time more than
10 minutes for tuberculocidal disinfection should be avoided
with polyethers. Immersion in acid glutaraldehyde improves
the surface detail reproduction of elastomeric impressions,4 but
limited data are available on disinfection of ZOE and compound
impressions.
Addition of glutaraldehydes, iodophores, and phenols into
the alginate impression causes throat and lung irritation, asthma
and difficulty breathing, contact and allergic dermatitis, nasal
irritation, sneezing, wheezing, burning eyes, and conjunctivitis.
Organic matter inactivates iodophores. Phenol is toxic, corro-
sive, and a skin irritant. Anionic soaps inactivate chlorhexidine.
Chloroxylenol is inactivated by hard water.98,99
Ten minutes of irradiation at high power can sterilize the im-
pressions made from PVS impression materials.86 Microwave
irradiation can be used for gypsum cast disinfection.53 There-
fore, a certain frequency of microwave energy may be absorbed
by the nucleic acids. Moreover, the level of molecular response
to the quantity of thermal energy explains the nonthermal effect
of microwaves.100
Research supports the use of silver ion or metallic silver and
silver nanoparticles for disinfection of dental materials, coating
of stainless steel materials, textile fabrics, water treatment, and
sunscreen lotions. Silver nanoparticles possess low toxicity to
human cells, high thermal stability, and low volatility.
Conclusion
Impression sterilization is expensive and time consuming, and
potentially damaging to the dental materials, since surface
disinfection with chemical solution is an alternative method
of disinfecting hydrocolloid and silicone impression materials.
Iodophor is a recommended disinfectant for all types of im-
pression materials. The dentist should realize the importance
of disinfection to prevent the cross contamination of microor-
ganisms via impression to patients, dental auxiliaries, and the
laboratory technician.
References
1. Leung RL, Schonfield SE: Gypsum casts as a potential source
of microbial cross contamination. J Prosthet Dent
1983;49:210-211
2. Council on dental materials: instrument and equipment
disinfection impressions. J Am Dent Assoc 1991;122:110
3. Council on scientific affairs and council on dental practice:
infection control recommendations for the dental practice and
the dental laboratory. J Am Dent Assoc 1996;127:672-680
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