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Dimensional Accuracy of Alginate Impressions Using Different Methods of

Disinfection With Varying Concentrations

Article · January 2018

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Dimensional Accuracy of Alginate Impressions Using Different
Methods of Disinfection with Varying Concentrations
Ghada Hassan Babiker, BDS, MSc; Nadia Khalifa, BDS, MSc, PhD; and Mohammed Nasser
Alhajj, BDS, MSc

Abstract
This study investigated the effect of 1% and 5.25% of sodium hypochlorite (NaOCl) as spray and
immersion solutions on the dimensional accuracy of an irreversible hydrocolloid impression
material. Impressions of master models were taken using irreversible hydrocolloid impression
material, which was then treated with NaOCl 1% or 5.25% solution, either by spaying or immersion,
for 5 minutes, or not treated to act as control. The impressions were then poured with stone, and
the dimensional accuracy was determined from the mean of six measurements taken between
fixed points using a digital caliper. No significant dimensional changes of gypsum casts obtained
from irreversible hydrocolloid impression material sprayed with NaOCl solution were observed,
whereas significant change in dimensional accuracy occurred when the casts were immersed in
NaOCl solution. Based on dimensional stability alone it would be more appropriate to disinfect
irreversible hydrocolloid impression material by spraying it with NaOCl solution rather than
immersing it.

A dental impression is a negative imprint of impression material must be limited to an

an oral structure used to produce a positive allowable range of up to only
replica of the structure for use as a 0.15%. Although the hydrophilic nature of
7

permanent record or in the production of a irreversible hydrocolloid is valuable for

dental restoration or prosthesis.1 Alginate is
one of the most widely used dental
impression materials due to its ease of
mixing, the flexibility of the set impression, its
accuracy when properly handled, and low
cost. The accuracy of an impression material
is vital to the production of a well-fitting
restoration and, thus, to its
longevity. However, alginate is affected by
2
the reactions of syneresis and imbibition after
removal from the mouth, as has been
observed in several studies; therefore, stone
casts must be fabricated as soon as possible
to avoid dimensional changes.3,4
The dimensional stability of an impression
material reflects its ability to maintain the
accuracy of the impression over time.4-
6
Maintaining dimensional stability of dental
impression materials is critical if the
impression cannot be cast (in stone) soon
after removal from the mouth. Therefore, the
dimensional changes in the alginate
making impressions in a moist environment,
this attribute limits its use, as microorganisms
present in blood and saliva tend to become
embedded in alginate impression material
posing a risk to dental practitioners, patients,
and laboratory personnel.8,9 This necessitates
the disinfection of impression materials to
avoid cross infection while maintaining the
accuracy of the impression material.
Disinfectants must be effective as
antimicrobial agents without adversely
affecting the dimensional accuracy of the
impression material and the resulting gypsum
cast on which the denture will be
fabricated.9 The comparison of different
methods of disinfection of irreversible
hydrocolloid material and their dimensional
accuracy is worth studying. Several types of
disinfectant have been suggested for use in
dental practice, such as sodium hypochlorite
(NaOCl), iodophor, phenol, and
glutaraldehyde. Sodium hypochlorite is the

COMPENDIUM January 2018 Volume 39, Number 1

most widely used disinfectant despite the
increasing availability of other disinfectants
due to its effectiveness, cost efficiency, and
abundance. It fulfills most of the requirements
of an ideal disinfectant and has a powerful
cleaning action, performing as a broad-range
antimicrobial agent that is effective against
gram-positive bacteria, gram-negative
bacteria, fungi, spores, and virus (including
HIV). Many studies have examined sodium
hypochlorite as a disinfectant solution but no
consensus has been found for its
recommendation.9-15 The present study,
therefore, aimed to evaluate and compare
the dimensional stability of alginate
impressions disinfected with sodium
hypochlorite using spray and immersion
methods.
Materials and Methods
An edentulous acrylic maxillary master model
was constructed. Reference points (A, B, C,
and D) for cast measurement were made
using posts with grooves scored onto the
occlusal surfaces in the shape of an “x.” The
posts were placed in the approximate
position of the incisal papilla, left and right
second molars, and center of the hard palate
(Figure 1). Measurements were recorded
using digital calipers. Three readings were
taken for each linear measurement (A–B, A–
C, A–D, B–C, B–D, and C–D). The
measurements were done between
intersects of the “x” on the posts of each
model. Eighteen measurements were done
for each model. The mean of the three linear
measurements was taken from the gypsum
plaster casts and compared to those
recorded from the master model.10
Five custom-made trays were constructed
using light-cure acrylic (Vertex™ Light Curing
Trayplate, Vertex Dental, vertex-dental.com).
The trays were made by uniformly covering
the model with 3 mm of wax with “stops” cut
out in the approximate locations of the
palatine fovea and left and right premolar
COMPENDIUM January 2018
positions. This would enable accurate
positioning of the tray and allow a uniform
thickness of the impression material.
Impressions of the master model were taken
and allowed to set for 5 minutes after which
they were removed. A total of 200
impressions of the master model were taken
using an irreversible hydrocolloid impression
material. The impressions were divided into
five groups of 40.10,11The impressions were
retained on the tray mechanically by the
excess alginate engaging the tray
holes.11 After impressions were taken from
the master model, they were rinsed with tap
water and treated as follows:
• First group (n = 40) of impressions:
sprayed with 1% NaOCl solution (10 puffs
for 15 seconds), then sealed in plastic bags
for 5 minutes
• Second group (n = 40): immersed in
solution of 1% NaOCl for 5 minutes
• Third group (n = 40): sprayed with 5.25%
NaOCl solution (10 puffs for 15 seconds),
then sealed in plastic bags for 5 minutes
• Fourth group (n = 40): immersed in
solution of 5.25% NaOCl for 5 minutes
• Fifth and final group (n = 40): received no
disinfection procedure acting as control
group10,12-14
Fig 1. Diagram showing positions of
posts
Alginate impression material (Italgin –
Chromatic Alginate, BMS Dental,
bmsdental.it) was portioned, mixed, and
manipulated according to the manufacturer's
instructions. In this study, commercially
Volume 39, Number 1
available Clorox® bleach was used. The
chemical solution contains 5.25% NaOCl.
The brand name “Clorox” is derived from
combining the names of the ingredients that
form sodium hypochlorite (NaOCl), chlorine
(Cl), and sodium hydroxide (NaOH). To
obtain a 1% solution, the 5.25% NaOCl
solution was diluted with distilled water.10 The
dilution of the solution was done in the
following manner: 190.5 ml of the
concentrated solution was measured using a
cylindrical measure and poured into a
volumetric flask (1000 ml), and the distilled
water was added until the demarcating line
was reached on the flask. The dilution
process was done on the same day the study
was conducted.
All the impressions were rinsed under tap
water for 10 seconds and then sealed in
plastic bags to prevent water evaporation,
and all of them were casted immediately. A
type III gypsum product was used to pour the
impressions. The gypsum product was
portioned, mixed, and manipulated according
to the manufacturer's instructions, then hand-
COMPENDIUM January 2018
spatulated for 10 seconds and poured into
the impressions with the aid of a vibrator. The
casts were allowed to set for 45 minutes
before being removed from the impressions.
The casts were ready for measurement after
the setting of the gypsum. One operator
recorded the measurements using digital
calipers. The mean of the three linear
measurements taken from the gypsum
plaster casts was obtained from impressions
that were disinfected, and this was compared
to the control, which was not disinfected.10
For descriptive statistics, the mean, standard
deviation, percentages, and graphs were
achieved. For analytical statistics, repeated
analysis of variance (ANOVA) was used to
test the significant differences between the
control group and the four methods of
disinfection. Post hoc test using least square
difference (LSD) was carried out if there were
any overall significant differences after
ANOVA; this was done to compare means of
the control group and the four methods of
disinfection. The level of significance for all
tests was α = 0.05.
Volume 39, Number 1
Results Significant differences were seen in the
means of distances A–B, A–C, and A–D by
Table 1 shows that the highest means of
the four different methods of disinfection
distances were obtained from casts retrieved
when compared to control, while no
from impressions immersed in 5.25% NaOCl
significant differences in means of distances
solution, indicating that the most dimensional
B–C and B–D were observed; hence, no LSD
changes occurred at this concentration. The
was calculated. Significant difference,
mean distances from casts obtained from
however, was found in the mean of distance
impressions that were sprayed with NaOCl
C–D by the four different methods of
(1% and 5.25%) solution showed similar
disinfection when compared to control (Table
values to the control group. The means in A–
2).
B, A–C, and B–D distances in all disinfection
As shown in Table 3, a significant difference
methods were approximately equal to the
was seen in the distances A–B and A–D
mean of the control group. However, the
between control and disinfection by
means of distances A–D (5.25% and 1%), B–
immersion of both 1% and 5.25% NaOCl
C (5.25%), and C–D (5.25% and 1%) by
solution. However, significant differences
immersion method showed higher values
were observed in distances A–C and C–D
than control.
between control and immersion in 5.25%
NaOCl solution.

COMPENDIUM January 2018 Volume 39, Number 1

 reported that there were significant changes
in alginate after immersion with more
Discussion concentrated 5.25% NaOCl
solution. 15,16
Conversely, numerous other
In this study, the dimensional accuracy of
authors found that the mean dimensions
alginate was not affected after disinfection
measured between points did not differ
using the spraying method with 1% and
significantly compared with the control
5.25% NaOCl solution. These observations
group.10,12,18-21
were in agreement with studies conducted by
Some studies concluded that dimensional
Guiraldo et al,9 Oderinu et al,11 Rueggeberg et
changes observed after disinfection of
al,15 Hamedi et al,16 and Suprono et al.17 In the
irreversible hydrocolloid impressions
case of immersion of alginate impressions in
materials were not clinically significant.22-
both 1% and 5.25% NaOCl solution there 25
However, as was found in this study, the
were significant changes in dimensional
most accurate casts were retrieved from
accuracy of the alginate material. As
impressions disinfected by spray method
expected, less dimensional changes
rather than immersion.22,25 The dimensional
occurred in the alginate impression after
changes of alginate impressions disinfected
immersion in the less concentrated solution
by either spraying or immersion using
after disinfection with 1% NaOCl. Oderinu et
different concentrations of NaOCl solution
al similarly reported that the immersion
could be attributed to either a reaction
method caused dimensional variability using
between the hypochlorite absorbed into the
1% of NaOCl for disinfection.11 As in this
impression and dental stone or a direct effect
study, Rueggeberg et al and Hamedi et al

COMPENDIUM January 2018 Volume 39, Number 1

of the hypochlorite on the alginate in relation Faculty of Dentistry
to surface quality. Khartoum University
A limitation of this study could be the Khartoum, Sudan
accuracy of measurement of distance Department of General and Specialist
between reference points, even though the Dental Practice
type of digital caliper used in this study has College of Dental Medicine
been shown to produce good reproducibility University of Sharjah
between repeat readings for each linear Sharjah, United Arab Emirates
measurement.10 Additional tools such as
measuring microscopes, micrometers, and Mohammed Nasser Alhajj, BDS, MSc
dial gauges also could be used to verify Department of Oral Rehabilitation
results. Another limitation is that direct Faculty of Dentistry
comparison of results with other studies was Khartoum University
difficult due to a variety of brands of alginate Khartoum, Sudan
materials used, the type of disinfection Department of Prosthodontics
protocols applied, and the measuring Faculty of Dentistry
techniques employed. Further research to Thamar University
evaluate the effect of NaOCl on the physical Dhamar, Yemen\
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Ghada Hassan Babiker, BDS, MSc
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COMPENDIUM January 2018 Volume 39, Number 1

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