COLOUR STABILITY OF MAXILLOFACIAL SILICONE MATERIALS AFTER DISINFECTION AND AGING PROCEDURES A SYSTEMATIC REVIEW
Suji Daivasigamani1, Ahila Singaravel Chidambaranathan2*, Muthukumar Balasubramanium2
1SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India.
2Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, India. [email protected]
ABSTRACT
Maxillofacial prosthesis should restore the appearance to near normal so that the affected person should have a normal mental status as well as quality of life. The longevity of any kind of maxillofacial silicone prosthesis is determined by its color and mechanical properties. To systematically assess the current published literature on the stability of color of maxillofacial silicone materials after 10 minutes of disinfection and aging, a literature search on PubMed and Google Scholar was done from January 2000 to December 2020 on the stability of color of maxillofacial silicone materials after disinfection and aging. In addition, a hand search was performed through standard dental journals for the years 2000 to 2020 using the keywords; color stability and maxillofacial silicone, maxillofacial silicone and disinfection, maxillofacial silicone, and aging. A total of 52 studies were recognized and 6 in vitro studies were appended for this systematic review. The color stability of maxillofacial silicone materials was affected by disinfection and aging procedure.
Key words: Aging process, Colour stability, Disinfection, Maxillofacial prosthesis, Maxillofacial silicone, Nanoparticles.
Introduction
Colour is the principal feature appreciated by patients rehabilitated with maxillofacial prostheses [1, 2]. The principal objective of a maxillofacial prosthodontist is to restore the patient’s aesthetics, enhance their self-confidence, and aid to lead a regular life as possible [3]. The average clinical life of maxillofacial silicone is approximately 1 year. Patients have to clean the maxillofacial prosthesis for 3 to 5min every day with a brush to prevent contamination [4]. There are several disinfection procedures and materials were opted for disinfection of maxillofacial prosthesis. Chlorhexidine was considered the most efficacious disinfectant in dentistry [5].
Chemical disinfection give rise to changes in properties of the maxillofacial silicone materials used for fabrication of maxillofacial prosthesis, so it is important to evaluate these changes during fabrication is mandatory to use as chemical disinfection. Furthermore, these disinfectants should not elicit any reaction in human tissues and also should conserve the properties of maxillo-facial silicones [6]. Disinfectants like2% to 4% chlorhexidine, 1% sodium hypochlorite, neutral soap and cleansing tablets, were used in many types of research [1, 4, 7].
Nanomaterials such as Titanium dioxide, silaned silica, fumed silica, zinc oxide, cerium oxide, polyhedral silsesquioxane, magnesium silicate, tulle were used as reinforcement material in maxillofacial silicone. The mechanical properties of maxillofacial silicone-like tensile strength, tear strength, percentage of elongation, hardness, dimension stability, and color stability were improved by reinforcement with nanoparticles [8].
There was no systematic review on the stability of color of maxillofacial silicone after disinfection procedures to date. Hence this systematic review was aimed to analyze the color stability of maxillofacial silicone after disinfection and 252, 504, and 1004 hours of aging in the available literature. The research question on which we focused for this systematic review was “Does the disinfection solution affect the color stability of maxillofacial silicones?”
Materials and Methods
The current systematic review follows the criteria of the PRISMA statement [9]. The electronic search was done in PubMed and Google Scholar for relevant publication from January 2000 to December 2018. The search was done with the key terms color stability of maxillofacial silicone, disinfection of maxillofacial silicone WITH or AND. Also, publication in Journal of Prosthetic Dentistry, International Journal of Prosthodontics, Journal of Prosthodontics, Journal of Prosthodontic Research, Journal of Advanced Prosthodontics, Journal of Indian Prosthodontic Society, and Indian Journal of Dental Research from January 2000 to December 2020 manually.
Eligibility criteria
Studies that were included were in vitro studies on color stability published in the English language and exclusion criteria were case reports, animal studies, and review articles.
Study selection
The titles were screened independently by two reviewers SD and ASC. Studies that meet the inclusion criteria were retrieved.
Results and Discussion
Studies identified through databases were 52 that included 18 PubMed/Medline 34 Google Scholar. The identification and removal of duplicate articles by applying the inclusion/exclusion criteria reported with 12 articles. Totally 6 studies were taken for systemic review (Figure 1).
|
|
|
Figure 1. Diagram of the search strategy |
The purpose of the present systematic review was to analyze the stability of color of maxillofacial silicone materials after disinfection and aging. Recent research showed that incorporation of oil pigments, nanoparticles, and opacifiers into silicone materials increases the shelf life of maxillofacial silicone prostheses and also increased the color stability, and protects the silicone material from UV rays [10-14].
Disinfection is a process by which the microorganisms are eliminated from the surface by a chemical agent. It should not damage the human tissues and conserves the properties of silicone. The antimicrobial properties, compatibility, and retaining the properties of the materials are the important factors for the selection of disinfectants [15]. Various disinfectants like neutral soap, sodium hypochlorite solution, 4% chlorhexidine, efferdent tablet, plant extract, the commercial disinfecting solution can produce some property changes in the maxillofacial silicone materials [13, 16-18].
The device for aging helps to investigate the response of the subject in the natural atmosphere by simulating environmental factors like humidity, heat, and radiation [7]. Photooxidative potential to alter the chemical structure of any material by heat and light. The scientists have accepted that the changes in maxillofacial silicone materials are due to changes produced by the ultraviolet radiation in mechanical and optical properties of silicones which helps us to determine the acceptability of the environment by the materials [19, 20].
In the present systematic review, the color stability of the maxillofacial silicone material is analyzed by using the ultraviolet-visible reflection spectrophotometer (Table 1).
Table 1. Characteristic of studies included
|
Study |
Material |
Instrument |
Disinfectant Solution |
Duration |
Aging |
Significance |
|
Goiato et al. -20092 |
MDX 4-4210 Silastic 732 |
Visible UV Reflectance E spectrophotometer, |
Neutral Soap Efferdent |
3 days a week for 60 days |
nil |
Significant Not significant |
|
Marcelo Coelho Goiato et-al 2011 23 |
MDX4-4210
MDX4-4210 with barium sulphate
MDX4-4210 with titanium dioxide |
Visible Ultraviolet Reflection Spectrophotometer, |
Efferdent effervescent tablet neutral soap 4% chlorhexidine gluconate |
three times a week for 2 months for 15 minutes |
252, 504, and 1008 h of artificial aging |
Significant Significant Significant |
|
Haddad et al. 201122 |
MDX4-4210 Silicone
MDX4-4210 silicone pigmented with ceramic powder
MDX4-4210 silicone pigmented with BaSO4
MDX4-4210 silicone pigmented with BaSO4 and ceramic powder |
UV reflection spectrophotometer |
Neutral soap Efferdent Evervescent tablets 4% chlorexidine |
3 days a week for 60 days |
252, 504, and 1008 h of artificial aging |
Significant Significant Significant |
|
Aldie ris Alves Pesqueir et al. 20116 |
1.Silastic MDX 4-4210
2.Silastic MDX 4-4210 (Ceramic Powder) 3.Silastic MDX 4-4210 (Makeup |
Visible Ultraviolet Reflection Spectrometer |
neutral soap effervescent tablets |
3 days a week for 60 days |
252, 504, and 1008 h of artificial aging |
Significant Significant |
|
Panagiota Eleni et al. 2013 17 |
polydimethylsiloxane (PDMS) chlorinated polyethylene (CPE) |
MiniScan XE Spectrophotometer |
Microwave sodium hypochlorite, neutral soap Commercial disinfecting soap |
5 minutes per day for 1 year (30 hours) |
nil |
Significant Not clinically acceptable Not clinically acceptable Not clinically acceptable |
|
Guiotti, Aimee Maria-et al. (2016) 21 |
MDX4-4210 (polydimethylsiloxane)
Functional Intrinsic II – Silicone Coloring System( Medium-shade)
Functional Intrinsic II – Silicone Coloring System (dark shade)
Dry opacifier (Zinc oxide – ZnO) |
ultraviolet-visible reflection spectrophotometer |
Saline solution Neutral soap Chlorhexidine 4% Hydrastis canadensis (Hydrastis) Cymbopogon nardus (Cytronella |
daily for 30 days for 10 minutes |
1008 hours
|
Not clinically acceptable |
The stability of color of maxillofacial silicone material after the addition of pigment and opacifier, disinfected with conventional and plant extracted disinfected solution for 30 days, and accelerated aging for 1008 hrs. They mentioned that silicones MDX 4-4210 exhibited clinically impermissionable color change regardless of the disinfecting solution [21]. The color stability of chlorinated polyethylene (CPE) and polydimethylsiloxane (PDMS) after disinfection and microwave exposure was tested and concluded that microwave exposure was recommended for polydimethylsiloxane (PDMS) and chlorinated polyethylene (CPE) material to be disinfected with sodium hypochlorite solution [17]. Maxillofacial silicone silastic MDX 4-4210 with different pigmentations after disinfection and aging, ceramic powder showed more color stability compared with makeup and colorless after disinfection and 252, 504,1008 hrs aging period [6]. Maxillofacial elastomer mixed with an opacifier and/or a nanoparticle underwent artificial aging and disinfection. The samples with BaSO4 opacifier and ceramic nanoparticles were the most stable material on color, without intent for aging and disinfection [22]. The color stability MDX 4-4210 maxillofacial silicone after disinfection and accelerated aging was tested and mentioned that chlorhexidine showed more color change in the facial silicone compared to neutral soap and efferdent tablet. Also, they mentioned that accelerated aging had a significant effect on the color stability of all kinds of silicone materials. The barium sulfate opacifier was more stable than titanium dioxide [23]. The color stability of Silastic 732 RTV and MDX 4-4210 after disinfection with neutral soap and Efferdent tablet and concluded that neutral soap showed the least effect of color stability than efferdent tablet [24].
Conclusion
The authors concluded that the color stability of maxillofacial silicones was affected by disinfection solution and aging procedure. Among the disinfection, solution chlorhexidine produced the maximum color change in the maxillofacial silicone in the various aging period.
Acknowledgments: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed.
Conflict of interest: None
Financial support: None
Ethics statement: Ethical review and approval were obtained from the institutional review board (IRB) of SRM University, Chennai. Registration no SRMU/ M&HS/ SRMDC/ 2022/ S/003.
1. Babu AS, Manju V, Gopal VK. Effect of chemical disinfectants and accelerated aging on maxillofacial silicone elastomers: An In vitro Study. Indian J Dent Res. 2018;29(1):67-73. doi:10.4103/ijdr.IJDR27216.
2. Goiato MC, Pesqueira AA, da Silva CR, Gennari Filho H, Dos Santos DM. Patient satisfaction with maxillofacial prosthesis. Literature review. J Plast Reconstr Aesthet Surg. 2009;62(2):175-80. doi:10.1016/j.bjps.2008.06.084.
3. Sheets JL, Pinkston DJ, Yuan JC, Sukotjo C, Wee AG. US Maxillofacial Prosthetics Programs: Fellows' and Directors' Perspectives. J Dent Educ. 2018;82(12):1335-42.
4. Goiato MC, Haddad MF, C Sinhoreti MA, dos Santos DM, Pesqueira AA, Moreno A. Influence of opacifiers on dimensional stability and detail reproduction of maxillofacial silicone elastomer. Biomed Eng Online. 2010;85:1-9. doi:10.1186/1475-925X-9-85
5. Ariani N, Visser A, Teulings MR, Dijk M, Rahardjo TB, Vissink A, et al. Efficacy of cleansing agents in killing microorganisms in mixed-species biofilms present on silicone facial prostheses-an in vitro study. Clin Oral Invest. 2015;19(9):2285-93. doi:10.1007/s00784-015-1453-0.
6. Pesqueira AA, Goiato MC, dos Santos DM, Haddad MF, Ribeiro PD, Coelho Sinhoreti MA. Effect of disinfection and accelerated aging on color stability of colorless and pigmented facial silicone. J Prosthodont. 2011;20(4):305-30. doi:10.1111/j.1532-849X.2011.00693.x.
7. Mat-Rani S, Chotprasert N, Srimaneekarn N, Choonharuangdej S. Fungicidal Effect of Lemongrass Essential Oil on Candida albicans Biofilm Pre-established on Maxillofacial Silicone Specimens. J Int Soc Prev Community Dent. 2021;11(5):525-30. doi:10.4103/jispcd.JISPCD6321
8. Pinar C, Serdar P, Ayse ND. Effects of the addition of titanium dioxide and silaned silica nanoparticles on the color stability of a maxillofacial silicone elastomer submitted to artificial aging. Cumhuriyet Dent J. 2016;19(1):9-15.
9. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9. doi:10.7326/0003-4819-151-4-200908180-00135.
10. Hu X, Pan X, Johnston WM. Effects of pigments on dynamic mechanical properties of a maxillofacial prosthetic elastomer. J Prosthet Dent. 2014;112(5):1298-303. doi:10.1016/j.prosdent.2014.04.004
11. Kiat‐amnuay S, Lemon JC, Powers JM. Effect of opacifiers on color stability of pigmented maxillofacial silicone A-2186 subjected to artificial aging. J Prosthodont. 2002;11(2):109-16.
12. Kiat-Amnuay S, Mekayarajjananonth T, Powers JM, Chambers MS, Lemon JC. Interactions of pigments and opacifiers on color stability of MDX4-4210/type A maxilla-facial elastomers subjected to artificial aging. J Prosthet Dent. 2006;95(3):249-57. doi:10.1053/jopr.2002.124357
13. Pesqueira AA, Goiato MC, dos Santos DM, Haddad MF, Ribeiro PD, Coelho Sinhoreti MA, et al. Effect of disinfection and accelerated aging on color stability of colorless and pigmented facial silicone. J Prosthodont. 2011;20(4):305-9. doi:10.1111/j.1532-849X.2011.00693.x
14. Dos Santos DM, Goiato MC, Moreno A, Pesqueira AA, Haddad MF. Influence of pigments and opacifiers on color stability of an artificially aged facial silicone. J Prosthodont. 2011;20(3):205-8. doi:10.1111/j.1532-849X.2010.00657.x.
15. Abdul‑Ameer FM. Effect of plant‑extract disinfectant solutions on the specific properties of reinforced maxillofacial silicone elastomers with nanofiller and intrinsic pigment. Eur J Gen Dent. 2020;9(02):55‑61. doi:10.4103/ejgd.ejgd8619
16. Charitidis CA, Ziomas I, Gettleman L. Tensile and micro indentation properties of maxilla-facial elastomers after different disinfecting procedures. J Mech Behav Biomed Mater. 2013;28:147-55. doi:10.1016/j.jmbbm.2013.07.013
17. Eleni PN, Krokida MK, Polyzois GL, Gettleman L. Effect of different disinfecting procedures on the hardness and color stability of two maxillofacial elastomers over time. J Appl Oral Sci. 2013;21:278-83. doi:10.1590/1679-775720130112.
18. Eleni PN, Krokida MK, Polyzois GL, Gettleman L. Dynamic mechanical thermal analysis of maxillofacial prosthetic elastomers: the effect of different disinfecting aging procedures. J Craniofac Surg. 2014;25(3):e251-5. doi:10.1097/SCS.0000000000000556.
19. Bilge TB, Merve BG, Seçil KN, Cemal A, Yeliz KA. Effect of ultraviolet protective agents on maxillofacial silicone elastomer, part 1: Color stability after artificial aging. J Prosthet Dent. 2021; Article in press. doi:10.1016/j.prosdent.2021.06.033
20. Chamaria A, Aras MA, Chitre V, Rajagopal P. Effect of chemical disinfectants on the color stability of maxillofacial silicones: An in vitro study. J Prosthodont. 2019;28(2):e869-72. doi:10.1111/jopr.12768.
21. Cifter ED, Ozdemir-Karatas M, Cinarli A, Sancakli E, Balik A, Evlioglu G. In vitro study of effects of aging and processing conditions on colour change in maxillofacial silicone elastomers. BMC Oral Health 2019;19(1):122-32. doi:10.1186/s12903-019-0798-1
22. Guiotti AM, Goiato MC, Dos Santos DM, Vechiato-Filho AJ, Cunha BG, Paulini MB, et al. Comparison of conventional and plant-extract disinfectant solutions on the hardness and color stability of a maxillofacial elastomer after artificial aging. J Prosthet Dent. 2016;115(4):501-8. doi:10.1016/j.prosdent.2015.09.0092
23. Haddad MF, Goiato MC, Dos Santos DM, Moreno A, Pesqueira AA, D'almeida NF. Color stability of maxillofacial silicone with nanoparticle pigment and opacifier submitted to disinfection and artificial aging. J Biomed Opt. 2011;6(9):095004-6. doi:10.1117/1.3625401
Goiato MC, Haddad MF, Pesqueira AA, Moreno A, Dos Santos DM, Bannwart LC. Effect of chemical disinfection and accelerated aging on color stability of maxillofacial silicone with opacifiers. J Prosthodont. 2011;20(7):566-9. doi:10.1111/j.1532-849X.2011.00755.x
