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Influence of Ozone and Paracetic Acid Disinfection On Adhesion of Resilient Liners To Acrylic Resin
Influence of Ozone and Paracetic Acid Disinfection On Adhesion of Resilient Liners To Acrylic Resin
290
PURPOSE. The aim of this study was to evaluate the effect of paracetic acid (PAA) and ozone disinfection on the
tensile bond strength (TBS) of silicone-based resilient liners to acrylic resins. MATERIALS AND METHODS. One
hundred and twenty dumbbell shaped heat-polymerized acrylic resins were prepared. From the mid segment of
the specimens, 3 mm of acrylic were grinded off and separated parts were reattached by resilient liners. The
specimens were divided into 2 control (control1, control7) and 4 test groups of PAA and ozone disinfection
(PAA1, PAA7, ozone1 and ozone7; n=10). While control groups were immersed in distilled water for 10 min
(control1) and 7 days (control7), test groups were subjected to PAA (16 g/L) or ozone rich water (4 mg/L) for 1
cycle (10 min for PAA and 60 min for ozone) per day for 7 days prior to tensile tests. Measurements of the TBS
were analyzed using 3-way ANOVA and Tukey’s HSD test. RESULTS. Adhesive strength of Mollosil decreased
significantly by application of ozone disinfection. PAA disinfection had no negative effect on the TBS values of
Mollosil and Molloplast B to acrylic resin. Single application of ozone disinfection did not have any negative
effect on TBS values of Molloplast B, but prolonged exposure to ozone decreased its adhesive strength.
CONCLUSION. The adhesion of resilient liners to acrylic was not adversely affected by PAA disinfection.
Immersion in ozonated water significantly decreased TBS of Mollosil. Prolonged exposure to ozone negatively
affects adhesion of Molloplast B to denture base materials. [ J Adv Prosthodont 2016;8:290-5]
species.5 Sodium hypochlorite solutions are very effective in Materials and Methods
various concentrations against microorganism. However,
prolonged application may cause bleaching of the denture A dumbbell shaped master model was produced according
base and denture liners.6 Microwave irradiation can also be to ASTM D-412 standards for tensile test of elastic materi-
used to disinfect dentures. However, microwave disinfec- als. A silicone mold was produced by embedding a master
tion might negatively affect the physical properties of the model into the type A silicone impression material (Panasil,
denture base materials.7 154081, Kettenbach GmbH & Co KG, Eschenburg,
Ozone is a naturally occurring compound consisting of Germany). Modeling wax was melted and poured into the
three oxygen atoms (triatomic oxygen or trioxygen). It can silicone mold. Having been set and reached to room tem-
be found in the form of gas in the stratosphere in concen- perature, wax patterns were demolded and inspected for
tration of 1-10 ppm or it can be produced by ozone gener- any defects and voids. Wax patterns were invested in dental
ators. Ozone, in the gaseous and aqueous phase, has been stone (Triastone Type 4, 1302055, Triadent, Istanbul,
shown to be a powerful and reliable antimicrobial agent Turkey) in a stainless steel metal flask to construct the
against bacteria, fungi, protozoa, and viruses. These proper- molds. Following the setting of the dental stone, boil-out
ties make ozone an important therapeutic agent in infec- procedure was performed. (Fig. 1) The heat-polymerized
tious and inflammatory diseases. 8 Furthermore, ozone (Meliodent, 10JAN051, Heraeus Kulzer, Hanau, Germany)
decomposes rapidly to O2 and OH radicals in water solu- dumbbell shape specimens were polymerized according to
tions.9,10 the manufacturer’s instructions in a manner similar to that
PAA is generated by the reaction of tetraacetylethylene- used in conventional denture construction. Two different
diamine in the presence of an alkaline hydrogen peroxide resilient denture liners from the same manufacturer were
solution. It has broad antimicrobial efficacy against bacteria, selected: Mollosil (Mollosil, 150401, Detax, Ettlingen,
fungi, protozoa, and viruses and it is not affected by protein Germany) auto-polymerized and Molloplast B (Molloplast
residues. PAA solution decomposes to acetic acid and oxy- B, 140731, Detax, Ettlingen, Germany) heat-polymerized
gen in 24 hours and is drained to sewage after use with little silicone-based resilient liner. From the mid segment of the
to no effect on the environment.11,12 Peracetic acid-based dumbbell shaped resin specimens, 3 mm of acrylic were
disinfectants have been widely used in food industry and grinded off. The segments to be grinded off were marked
water treatment facilities, as well as for decontamination and with a digital caliper (Mitutoyo Corp, Kanogawa, Japan) and
sterilization of thermosensitive medical and hospital equip- removed with a diamond bur. The grinded surfaces were
ment and devices such as endoscopes and UV lenses.11,13 conditioned according to the manufacturer recommenda-
The research about PAA and Ozone disinfection is tions for proper adhesion between acrylic resin and liner.
mainly focused on their antimicrobial efficacy. The effects The sectioned acrylic specimens were relocated in the flask
of their use on dental materials have rarely been studied. To where they were previously polymerized. The resilient liners
date, there are no studies in the literature regarding their were prepared according to manufacturer instructions, and
effect on adhesion of resilient liners to the acrylic resins. the upper portions of the flasks were closed after applica-
Therefore, the aim of this study was to evaluate the effect tion of the resilient liner. (Fig. 2) For the Molloplast B
of PAA and ozone disinfection on the tensile bond specimens, the adhesive was applied 2 times over the grind-
strength (TBS) of heat and self-polymerized silicone-based ed acrylic surfaces and left to bench dry for 60 minutes.
resilient denture liners to denture base acrylic resins. The ready-to-use resilient liner was applied over the acrylic
A B C
Fig. 1. (A) Master model and embedded wax patterns in flask before and after boil-out, (B) Master model and embedded
wax patterns in flask before and after boil-out, (C) Master model and embedded wax patterns in flask before and after
boil-out.
Fig. 2. Dumb-bell shaped test specimen reattached with Fig. 3. Tensile testing procedure of test specimens.
silicone soft liner.
surfaces with a clean spatula. The resilient liner and acrylic Germany) and ozone disinfection (PAA1, PAA7, ozone1
resin assembly was covered with thin foil and the flask was and ozone7; n = 10) (Table 1). Tensile tests were per-
closed and placed under the hydraulic press for 4 minutes. formed after immersion in distilled water (37 oC) for 10
The flask was opened and the foil and excess material were minutes (control1) and seven days (control7) for the con-
removed with a sharp scalpel. The flask was closed and trol groups. The specimens of PAA and ozone test groups
relocated under the hydraulic press during 15 minutes. The were subjected to PAA (16 g/L) or ozone rich water (4 mg/
flask was located in cold water and heated slowly up to L). The exposure cycle was 10 minutes for PAA and 60
100°C and boiled for 2 hours. After bench cooling, the minutes for ozone. Following each cycle, test specimens
specimens were removed from the flasks. For the Mollosil were rinsed under running water and stored in distilled
specimens, the adhesive was applied over the grinded acrylic water until the next cycle. Immediately after one cycle of
surfaces and left to bench dry for 1 minute. Equal amount PAA1 and Ozone1 and seven cycles (just one cycle per day)
of base material and catalyst were mixed for 30 seconds of PAA7 and Ozone7, test specimens were subjected to
and applied over the acrylic surfaces with a clean spatula. tensile test using an universal testing machine (M500 25kN;
The flask was closed and placed under the hydraulic press Testometric Co., Rochdale, UK) with a crosshead speed of
for 30 minutes. The excess material was removed with a 5 mm/sec until debonding or rupture occurred. (Fig. 3)
sharp scalpel and the specimens were removed from the The tested specimens were observed with a magnifying
flasks. loupe (× 4) (Eyemag Pro S; Carl Zeiss AG, Germany) and
One hundred and twenty dumbbell shaped heat-polymer- the type of failure and TBS values were recorded. The fail-
ized denture base resin were prepared: 60 for Mollosil and 60 ure types were classified as: adhesive (no liner remnant on
for Molloplast B. They were reattached in mid-segment with the acrylic surface), cohesive (both acrylic surfaces covered
a 3 mm long resilient liner. The specimens were divided into with liner) and mixed (acrylic surfaces partially covered with
2 control groups (control1, control7) and 4 test groups of liner). Measurements of the TBS were analyzed using
PAA (Actosed, 0910026, Acto GmbH, Braunschweig, ANOVA and Tukey’s HSD test.
Results
Table 1. Distribution of test specimens (n = 10) The mean TBS values of the control and test groups are
presented in Table 2. Molloplast B showed greater adhesive
Mollosil Molloplast B
strengths compared to Mollosil for all test conditions. PAA
Control
Control1 - 10 min. Control1 - 10 min. disinfection had no negative effect on the TBS values of
Control7 - 7 days Control7 - 7 days Mollosil and Molloplast B. No statistically significant differ-
PAA1 - 10 min. PAA1 - 10 min. ences were detected between the mean TBS values of the
PAA PAA7 - 10 min/day for PAA7 - 10 min/day for control and PAA tests groups for both materials.
7 days 7 days On the other hand, adhesive strength of Mollosil
Ozone1 - 60 min. Ozone1 - 60 min. decreased significantly by application of ozone disinfectant.
Ozone Ozone7 - 60 min/day for Ozone7 - 60 min/day for A statistically significant decrease was found between the
7 days 7 days control and both Ozone test groups. Also, a further decrease
292
Influence of ozone and paracetic acid disinfection on adhesion of resilient liners to acrylic resin
Mollosil 1.28 (0.21)Aa 1.18 (0.13)Aa 1.22 (0.14)Aa 1.11 (0.19)Aa 1.02 (0.15)Ab 0.90 (0.09)Ac
Molloplast B 1.76 (0.23) Ba
2.37 (0.27) Bb
1.85 (0.16) Ba
2.15 (0.25)Bb
1.78 (0.30) Ba
1.82 (0.25)Ba
Different superscripted lowercase letters indicate statistically different means within each row (P < .05).
Different superscripted uppercase letters indicate statistically different means within each column (P < .05).
Control1 2 1 7 Control1 1 1 8
Control7 1 1 8 Control7 1 3 6
PAA1 1 1 8 PAA1 3 3 4
PAA7 1 1 8 PAA7 3 3 4
Ozone1 3 2 5 Ozone1 4 3 3
Ozone 1 2 7 Ozone7 3 4 3
was detected by prolonged exposure of Mollosil to ozone. to lower tear strengths of silicone based resilient liners, the
Single application of ozone disinfectant (Ozone1) did not use of tensile bond strength test method to evaluate their
have any negative effect on TBS values of Molloplast B; adhesion to acrylic resins is recommended.19
however, prolonged exposure to ozone (Ozone7) decreased In order to achieve bond between silicone liners and
its adhesive strength. denture for a reasonable clinical life, surface conditioning
The types of failures are represented in Table 3 and of the denture base is mandatory. Although adequate bond
Table 4. Mollosil mostly had a cohesive type of failure in strength can be achieved with surface treatments, oral envi-
test and control groups. Even distribution was seen in ronment with pH, temperature changes and use of various
terms of failure type for Molloplast B, except control chemicals for cleaning and disinfecting dentures further
groups in which cohesive type of failure dominated. diminish bond strength and can cause bond failure eventu-
ally.20 Therefore, disinfectants with little or no effect to the
Discussion bonding properties of resilient liners to the acrylic are
important for long term clinical use. Oxidizing agents are
There are mainly two types of resilient denture liners used usually very effective disinfectants and act by oxidizing the
in dental practice: acrylic and silicone based liners. Acrylic cell membrane of microorganisms, which results in a loss
liners have similar composition to acrylic base resin and can of structure and leads to cell lysis and death.12 A large num-
create a chemical bond with denture base. After a certain ber of disinfectants operate in this way, including Ozone,
amount of time, softening agents in acrylic liners wash off Peracetic acid, and sodium hypochlorite. Paracetic acid and
and harden the liner. On the other hand, silicone based ozone, despite their effective disinfecting capabilities, are
resilient liners cannot create a chemical bond with denture safe materials for the patient and environment. They are
base due to their different chemical composition; yet their non-toxic and non-allergenic at low concentrations and
softness remains long.14,15 Despite its relatively weak bond- decompose to water, oxygen, carbon, and OH, which are
ing strength, silicone resilient liner’s greater long term biocompatible products present in nature.12 The PAA has
structural stability over acrylic liners made them the materi- been considered an effective and safe alternative to glutaral-
al of choice in the current study. dehyde by international reference institutions, such as the
Various test methods have been used for testing the US Food and Drug Administration (FDA), Centers for
adhesion between resilient liners and denture base resins Disease Control and Prevention (CDC) and the Association
including tensile, peel and shear tests.16 The tensile bond for Professionals in Infection Control and Epidemiology
strength test has been widely used by researchers.17,18 Due (APIC).11
Different concentrations of ozone solutions were tested cantly higher than those of Control1. It is possible that the
for eradication of different microorganisms in litera- polymerization process of Molloplast B might have contin-
tures.8,21-23 Generally, as the concentration of ozone increas- ued after deflasking and increased its bonding strength.
es, the antimicrobial efficacy increases as well. According to There are few studies investigating the effect of disin-
studies of Arita et al. and Nagayoshi et al. concentration of fection techniques on the bond strength of resilient liners
4 mg/L ozonated water was effective for killing gram-posi- to denture base resins.20,29,30 Garcia et al.29 and Pisani et al.20
tive and gram-negative oral microorganisms and oral evaluated the influence of denture cleansers on resilient lin-
Candida albicans in 60 minutes.8,21 Ozonated water can be er adhesion to denture bases by tensile test method and
generated by various ozone generators. Hyper Medozon reported no adverse effects. Also, Machado et al.30 found no
comfort (Herrmann Apparateau GmbH, Germany) ozone negative effects on the peel bond strength of resilient liner
generator was used in the current study for preparation of to denture base resins when disinfected by microwave irra-
ozonated water. The concentration was controlled by diation.
device and in this study it was adjusted to 4 mg/L. On the There are various TBS values in the literature for proper
other hand, different concentrations of paracetic acid solu- adhesion between resilient liners and acrylic base. It has
tions have been used in dental and medical fields depending been reported by different researchers that this value should
on the application. In the current study, the paracetic acid be between 0.45-0.9 MPa.31-33 Considering these threshold
concentration was determined by the manufacturers’ values, all test and controls groups had satisfactory TBS
instructions. results. Nevertheless, prolonged exposure of Mollosil to
Before testing procedure, a pilot study was performed. Ozone (Mollosil-ozone7; 0.9 MPa) had high risk of decreased
It was calculated that bond strength test procedure was TBS to clinically unacceptable values.
extended to 60 minutes for each group. During test proce- Ozone generators are relatively expensive and they
dure of control groups, the specimens were left in distilled could be massive. Their use can be objected due to their
water to prevent drying, which extended the duration of cost-effectiveness in terms of everyday use for home-care.
the specimens in water from 10 minutes to 60 minutes. It Using ozone generators in dental laboratories or dental
has been shown that storing Molloplast B and Mollosil clinics seems to be more suitable for disinfection of den-
resilient liners in water one day to one week has no effect tures instead of home-care for now. However, their price
on bond strength to acrylic resins.24 Therefore, the authors and dimensions will decrease and in time they will be more
decided not to have two separate control1 (10 minutes for affordable and suitable for daily use.
PAA and 60 minutes for Ozone) groups for Mollosil and Within the limitations of this in vitro study, it has been
Molloplast B. shown that PAA and Ozone can be an alternative to disin-
In the current study, Mollosil had lower bond strength fection of dentures with resilient liners. While PAA disin-
than Molloplast B, which is in accordance with the previous fection is safe in terms of bonding strength of silicone to
studies.25 Due to uncontrolled polymerization process and acrylic base, multiple disinfection of Mollosil with ozone
cross-link density, self-polymerized polymers generally have has high risk of de-bonding. Further studies are needed for
weaker mechanical properties.26 Besides the differences in investigation of the longer-term effect of PAA and Ozone
the type of polymerization, the compositional differences on TBS values of resilient liners to acrylic resins.
might alter the characteristics of the resilient liners. The ratio
of the matrix to the filler particles of the silicone-based resil- Conclusion
ient liners directly affects the physical and mechanical prop-
erties of the materials. The increase in filler content The adhesion of resilient liner materials being tested is not
improves the strength.26 Mollosil showed mostly cohesive influenced by PAA disinfection. Prolonged Ozone expo-
failures in test and control groups. The inherent lower sure might adversely affect the adhesion of self-curing and
mechanical properties of the self-polymerized Mollosil may heat-curing resilient liners to denture base material.
be related to the material’s failure.
PAA disinfection showed no effect on bond strength of ORCID
resilient liners being tested in the current study. On the other
hand, the ozone disinfection affected the bonding strength Orhun Ekren http://orcid.org/0000-0002-3237-8003
of resilient liners differently. TBS values of Mollosil decreased Ahmet Ozkomur http://orcid.org/0000-0003-4900-3731
significantly after exposure to Ozone in both test groups.
However, single exposure of Molloplast B to Ozone solu- References
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