COMPETITIVE STRATEGY MODEL AND ITS IMPACT ON MICRO BUSINESS UNITOF LOCAL DEVELOPMENT BANKSIN JAWA PJAEE, 17 (7)

7) (2020)

ROLE OF DISINFECTANTS ON ALGINATE IMPRESSION MATERIALS

DIVYA DHARSHINI A 1, JAYALAKSHMI SOMASUNDARAM 2*, MURALIDHARA.N.P3

1
Saveetha Dental College,Saveetha Institute of Medical And Technical Sciences,Saveetha
University,Chennai,Tamil Nadu.600077
2
Chief scientist,White Lab- Material research centre,Saveetha Dental College,
Saveetha Institute of Medical And Technical Sciences,Saveetha University,Chennai, Tamil
Nadu.600077
3
Professor,Department of Microbiology ,Saveetha Dental College,Saveetha Institute of
Medical And Technical Sciences,Saveetha University,Chennai, Tamil Nadu.600077
1
151801049.sdc@saveetha.com,2jayalakshmisomasundaram@saveetha.com,3muralidharan@
saveetha.com

DIVYA DHARSHINI A, JAYALAKSHMI SOMASUNDARAM*, MURALIDHARA

N.P. ROLE OF DISINFECTANTS ON ALGINATE IMPRESSION MATERIALS--
Palarch’s Journal Of Archaeology Of Egypt/Egyptology 17(7), 397-409. ISSN 1567-
214x

Keywords: Alginate; Impressions; cross contamination; Disinfection;Disinfectants

ABSTRACT
Alginate is classified as elastic aqueous irreversible impression materials. Alginate is referred
to as irreversible due to the fact that once set in a semi-solid form, it cannot get converted
back. They are widely used in contemporary dentistry for impression making particularly in
partially edentulous subjects. Primary reasons for its wide usage is that it is economical
compared to other impression materials. In addition to it, a minimum armamentarium is
needed for its manipulation. Disinfection of alginate impression materials is necessary for
prevention of cross-contamination. In alginate impressions, microbial load is transferred from
three to five times than other impression materials. Pre wash of the impression under running
water is advocated primarily to cast off all particles including blood and saliva prior to active
disinfection procedure.It should be mandatory to disinfect alginate impressions. Alginate also
undergoes dimension changes if it is kept in a disinfectant for an extended period of time.But
still there is no routine method of disinfection of dental impressions that is accepted by dental
professionals. It is the responsibility of the dentist to make appropriate choices of disinfection

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methods for different impression materials.This review primarily focuses on the effects on
disinfection on alginate impression material.

INTRODUCTION
A dental impression is a negative imprint of hard and soft tissues in the mouth
from which a positive reproduction(cast or model) can be formed.It is made by
placing an appropriate material in a stock or custom dental impression tray
which is designed to roughly fit over the dental arches.Impression materials is
of liquid or semi-solid nature when first mixed and placed in the mouth,it then
sets to become an elastic solid after few minutes.However,the impression after
taking from the patient’s mouth invariably contaminated with patient saliva or
blood,such fluids can contain viral and bacterial pathogens.This would
become a common source of transmission of infection to those handling , to
the dental clinics or labs and which then cross-infect the dental casts poured
from the impressions[1].The importance of cross-infection control cannot be
exaggerated. Disinfection and sterilization methods are used to attain
disinfection and sterility of materials and instruments in order to avoid the
spread of pathogens from patients to patient, patient to health care personnel
and health care personnel to patient, it is the duty of the health care policies
makers to allocate the appropriate methods of cleaning, disinfection.Cleaning
is the removal of all foreign material while decontamination is the removal of
pathogenic microorganisms from objects. Disinfection is the process of
elimination of many pathogenic microorganisms on inanimate objects except
bacterial spores[2,3].Disinfection is divided into three groups according to
their potency. High level disinfection involves bacterial spore destruction
along with other microbial forms. Intermediate level disinfection involves
killing microorganisms but not able to kill spores. Low level disinfection has
narrow antimicrobial activity.

Dental impressions are classified under semi-critical objects and require high
level disinfection or sterilization[4].However,Sterilization in an autoclave will
bargain the dimensional accuracy of the impression hence it is not
accomplishable.Until 1991, the only advocated procedure for disinfection of
impressions was rinsing under running water where only 40% of
microorganisms were removed and potential for transmission of
microorganisms remains[5].Now a days, a pre wash of the impression under
running water is advocated primarily to cast off all particles including blood
and saliva prior to active disinfection procedure[6,7].Alginate is the one of the
most widely used dental impression material but it has reported that the
microorganisms present in alginate are three to five times more than any other
impression materials. Disinfection of Alginate Should be done as a routine
procedure. By knowing all the methods and techniques, dental professionals in
private clinics, hospitals, dental schools and prosthetic laboratories are advised
to follow the required procedures of disinfection regularly. However ,most of
them are not following the required protocols for impression disinfection[8]. It
is of most importance to raise the level of awareness in dental professionals
and dental students involved in any process of handling, transportation,
processing and storage of dental impressions. Different techniques of

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disinfecting impressions and control of cross-infection must be a part of the

undergraduate modules of dental universities and dental technician
schools[9]. The aim of this review is to make an update on the various
techniques and types of Alginate disinfection along with their criteria and
protocols to be remembered for disinfection.

MATERIALS AND METHODS

A review of scientific literature was done in preparation of the manuscript.
The relevant articles were collected from databases such as pubmed, google
scholar, MESH etc .The time frame of the articles was between the year 2000
to 2020. Around 25 articles were collected on the basis of containing
keywords, further analysed and reviewed.

METHODS OF DISINFECTION
Impressions should be rinsed fully under tap running water before disinfection
as to remove as much as bioburden as possible. Both immersion method and
spraying method has been recommended for disinfection of alginate.

SprayMethod:
Spraying uses less solution, and often the same disinfectant can be used
.Spraying does increase the chances for staff exposure to hazardous chemicals.
Using stream spray can minimize aerosolization[10].
When using impression materials that cause distortion by immersion method,
spraying may provide an acceptable alternative to immersion. Impressions can
be sprayed thoroughly and placed in airtight plastic bags[11]. After the
appropriate contact time the impression can be removed, rinsed thoroughly
with tap water, shaken gently to remove adherent water, and poured[12].

Sterilization:
For sterilization of Alginate,e.g. exposure to UV light, steam autoclave, and
radiofrequency flow discharge etc.[13]

Microwaveirradiation:
Microwaves are easy to use, low cost and provide good disinfection for
alginate thus effective tool for Alginate disinfection[14].It could also lead
disinfection with no changes in physical properties of Alginate.

Immersionmethod:
It is the most reliable method because all the surfaces of impressions and trays
come in contact with disinfection solution.But this method is not suitable or
the best method for alginate because hydrocolloids materials are extremely
hydrophilic[15].

UV rays:
It is also a disinfecting method for impressions.In one study when comparing
UV rays disinfection with Glutaraldehyde,NaOcl,UV rays exhibited maximum
efficacy[16].This method also depends on various factors.

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Othermethods:
Sealing in a bag and spraying with a Hydrojet system is effective to remove
the microbes . All the disinfection systems would be effective with
ultraviolet[[17].

CRITERIA AND PROTOCOLS FOR ALGINATE DISINFECTION

Optimally, impressions should be decontaminated through chairside
disinfection immediately after removal from the patient's mouth. Personal
protective equipment must be utilized with adequate ventilation when
disinfecting[18].For adequate inactivation of microbial contaminants,
appropriate application (time of contact) is needed,after the appropriate
contact time the impression can be removed, rinsed thoroughly with tap water,
shaken gently to remove adherent water, and poured.Rinsing after impression
disinfection also is essential to remove residual stone, soap, or disinfectant
from the impression surface[19].

The most suitable method for Alginate disinfection to be selected.eg-spray

method. There should be a Periodic check for efficacy[20].Factors such as
effectiveness,chemical stability ,compatibility of the disinfection solution
should be considered as the disinfection procedure should not change the
dimensions and significant details of the alginate impression. Disinfectant with
appropriate life, P.H,and temperature should be considered[21].It should be
noted that no single disinfectant is compatible with all impression
materials.Therefore,the compatibility of disinfectant solution with impression
material should be assessed prior to disinfection procedure,Any compatible
disinfectant solution should not cause any alteration on the surface detail
reproduction[22].

DIFFERENT TYPES OF DISINFECTANTS AND DISINFECTION

TECHNIQUES

Glutaraldehyde:
Glutaraldehyde is a high level disinfectant solution.It is a broad spectrum
chemical agent which has fast killing capability. Glutaraldehyde is also called
chemo sterilizer. If it is used correctly with proper concentration and
specialized equipment, it can destroy all types of microorganisms including
bacterial and fungal spores, tubercle bacilli and viruses[23]. Usually it is a
colorless liquid and has pungent odour. Even though it is classified as the best
disinfectant,it would cause any drawbacks if not used properly.Hence
precautions should be proceeded while using it e.g. wearing nitrile
gloves,handling in a closed system, exhaust ventilation and with a low
temperature of the solution as it will reduce the soaring concentration of the
solution[24].

Sodium hypochlorite:
This provides intermediate level disinfection and has a broad spectrum
antimicrobial activity. The advantages of sodium hypochlorite includes fast
bactericidal activity, easily soluble in water, stable, nontoxic at use

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concentrations, low in cost, non-staining, non inflammable and colorless.

Disadvantages is less. It has been reported that the alginate impression
disinfected with spray method using 1% sodium hypochlorite has not shown
any severe dimensional changes or surface roughness of stone cast when
fabricated from that impression [25]However, in another study Alginate
disinfection by immersion method with 0.5% NaOCl for 15 min exhibited
small dimensional change [26].

Iodophors:
Iodophors are categorised as low to intermediate levels of disinfection.
Iodophors are bactericidal, mycobactericidal and virucidal[27].It needs more
frequent application for complete disinfection in case of Alginate.It could also
cause little dimensional stability or changes[28].

Alcohols:
These provide intermediate level disinfection. Alcohols like isopropyl alcohol
and ethyl alcohol are commonly used disinfectants. Ethyl alcohol is more
effective in bactericidal than bacteriostatic activity. It also has tuberculocidal,
fungicidal and virucidal[29].These Alcohol are contraindicated for alginate
impressions because they can cause surface changes of impressions
utmost[30].

Phenols:
Phenols are categorised as intermediate level disinfectants. Phenols are also
known as protoplasmic poisons. When used at very low concentration, they
cause lysis of antifungal and antiviral properties as well. These are commonly
used as surface disinfectants. Ideally not recommended for alginate
disinfection as some phenols are low level disinfectants .They are
incompatible and cause acute toxicity as well[31][32].

Chlorhexidine:
Chlorhexidine is an intermediate level disinfectant. It has a broad spectrum of
activity.It is commonly used in oral products. It is bactericidal, virucidal and
myco bacteriostatic and its activity depends on specific pH. The 2%
chlorhexidine disinfectant solution has shown activity against s.aureus,e.coli.
It can also be effective when used as a water substitute in alginate mixing.
Impression can also be immersed in chlorhexidine solution and it causes
successful disinfection[33].According to one study, 1.0 g/L of the solution has
efficacy in self-disinfecting alginate impression material as it has shown
antimicrobial activity and did not cause any alter in dimensional accuracy,
flow ability and setting time of alginate impression materials[34].

Ozonated water:
Ozone is an inorganic gaseous molecule.It has antimicrobial, antihypoxic
activities[35].Ozonated water can also be used as a disinfectant for
impressions. According to one study, aqueous ozone is more biocompatible
compared to other disinfectant solutions such as chlorhexidine, NaOCl, H2O2.
This disinfectant reduces the number of microorganisms on the surface of
alginate and by increasing the time of immersion much more effective
disinfection can be achieved[36,37].

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POSSIBLE DRAWBACKS OF ALGINATE DISINFECTION

A number of studies have evaluated and reported the effects of disinfection of
different disinfectants on irreversible hydrocolloid (alginate) impressions.
Results have varied greatly depending on the techniques and materials
evaluated. Generally, however, distortion has been found to be minimal and
not clinically significant[38].Based on these findings, disinfection via
immersion in dilute hypochlorite or iodophor is recommended as its ability to
maintain the accuracy of impressions. However, studies have reported
significant adverse effects on specific materials with disinfectants that do not
react with alginates[39]. Improper amount, concentration, time of contact ,
compatibility would result in faulty disinfection along with changes in
dimensional stability, accuracy, surface details and inferior properties[40].
Surface details may also be changed. These are the possible drawbacks of
disinfecting alginate.

Dimensional stability of alginate:

The accuracy of an impression material is the key for the production of a well-
fitting restoration and longevity[41]. But, alginate is affected by the reactions
namely syneresis and imbibition after removal from the patients mouth,
therefore stone casts must be soon fabricated as possible to avoid dimensional
changes[42].The dimensional stability of an impression material reflects its
ability to maintain the accuracy of the impression but maintaining the stability
is critical if the impression was not casted soon after removal from the mouth.
Therefore, the dimensional changes of the alginate impression must be limited
only upto an allowable range of 0.15%. Although the hydrophilic nature of
irreversible hydrocolloid material is valuable for making impressions in a
moist environment,the microorganisms present in blood and saliva tend to get
embedded in alginate impression material which would become a serious risk
in clinical use. This necessitates the disinfection of impression materials to
avoid cross infection with maintaining the accuracy of the
impression.[43][44].

ALTERNATIVE DISINFECTANTS FOR ALGINATE

Alternative modes of disinfection includes traditional sources like aloe Vera,
Neem, Turmeric, Lemon can also be used to treat alginate impressions due to
its low cost, non toxic nature, biocompatible and effective which will overall
work effectively in impression.
A study by (Sumanti and Maulida et al 2018) reported the efficacy of Aloe
vera as a disinfectant by immersion and spray method on alginate impression
material and its effect on the dimensional stability of the resultant gypsum
cast. The efficacy of the disinfection procedures against Staphylococcus
aureus, Pseudomonas aeruginosa, and Candida albicans was evaluated by
determining the number of colony-forming units (CFU) recovered after
disinfection of alginate discs inoculated with 1x106 CFU for defined intervals
with aloe vera solution (99.96%). Dimensional stability was determined. It
was identified that there is a mean percentage reduction in colony count of S.
aureus, P. aeruginosa, and C. albicans after 3 minutes of immersion in aloe
vera and after 3 minutes spray disinfection. Complete elimination of all the
microorganism cells after 7 min immersion and spray disinfection. There was

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a statistically significant difference in the increase of the mean anteroposterior

(AP) and cross arch (CA) dimension after 3 and 7 minutes immersion in aloe
vera. Spraying with aloe vera for 7 minutes was proved to be the most
effective disinfection procedure without altering dimensional stability[45].

Table:0-LEVELS OF DISINFECTANTS [46,47]

TYPES OF DISINFECTA TYPES OF TIME OF
DISINFECTI NTS IMPRESSION EXPOSURE
ON MATERIALS

HIGH LEVEL Glutaraldehyde Irreversible 10mins

OF hydrocolloid
DISINFECTI
ON Zinc-oxide 10mins
eugenol

Polysulfide 10mins
Polyether

Addition 10mins
Silicon

INTERMEDI Sodium Irreversible 10mins

ATE Hypochlorite hydrocolloid
LEVEL OF
DISINFECTI Complex Zinc Oxide 10mins
ON Iodophors zugenol

Phenols Polysulfide 10mins

Polyether
Chlorhexidine
Addition 10mins
Alcohols Silicon

Impression 10mins
compound

LOW LEVEL Quaternary Not Not

OF ammonium recommended recommended for
DISINFECTI compounds. for impression impression
ON disinfection disinfection
Simple phenols
detergents.

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TABLE:1-TYPES OF DISINFECTANTS [48]

Class of Type of Recommen MOA Commerc
disinfectant Disinfecta ded (Primary) ial
nt Concentrati preparati
on ons
available

Glutaraldehy Non 2% Alkaline agent for Cidex

de oxidizing proteins. Mainly
amines, amides
and sulfhydryl
groups

Sodium Oxidizing 0.5% or Disrupts cell Clorox

Hydrochlori 200- membrane Purex
de 50000PPM transport chain by Chloramin
causing inhibition. e

Iodophors Oxidizing 1-2% Proteins and Betadine

enzymes are a3333
inactivated Isoprep
Hy-Sine

Alcohols Non 60-90% Cell membrane Isopropyl/

oxidizing lipid content is Ethyl
solutilized and alcohol
proteins are
inactivated or
precipitated.

Chlorhexidin Non 2-4% Intracellular Savlon

e oxidizing contents are
coagulated and
cell membrane is
damaged.

Phenolic Non 1-3% Protoplasmic Lysol

oxidizing poison causes Dettol
damage to cell H-Pheno
membranes.

CONCLUSION
Cross infection control is a very important aspect of patients safety. In alginate
impression microbial load is transferred from three to five times than other
impression materials. Hence it is customary to rinse alginate impressions as a
routine work in dental offices and laboratories . It is the responsibility of the
dentist to make appropriate choices of disinfection methods for different
impression materials in order to avoid changes in accuracy and details and to

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get best results for impression disinfection. It is also important to create

awareness regarding impression disinfection. The disinfectant should be
effectively clean, thereby removing dirt, effective against a broad spectrum of
microorganisms and should have ultimately realistic contact time and the
product's chemistry profile should be sustainable. Disinfectants should be used
in impressions prior to cast pouring and also it should be used before taking
impressions in some cases. It has been reported that the most effective method
of reducing the burden of microorganisms from alginate without any changes
in accuracy is chlorhexidine, when it is used as liquid for alginate preparation
and post-setting disinfection solution.Hence, it is mandatory to do disinfection
of alginate and any other impressionable materials.

AUTHOR CONTRIBUTION
Divya Dharshini.A has contributed for execution of the work, data collection
and drafting of manuscript. Dr.Jayalakshmi Somasundaram has contributed for
concept and design of the study, validation of the data collection, revision and
proof-reading of the review. Dr.Muralidharan has contributed for validation of
the data collection, revision and proof-reading of the review

CONFLICT OF INTEREST
NIL.

ACKNOWLEDGEMENTS
The authors are thankful to Saveetha Dental College for providing a platform
to express our knowledge.

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