Effect of Chemical Disinfection and Accelerated Aging on Color Stability of Maxillofacial Silicone with Opacifiers

Frequently used extraoral maxillofacial prosthetic materials and their longevity - A comprehensive review

The longevity of an extraoral prosthesis depends on its physical and mechanical properties and user maintenance. Faced with multiple outcome measures, researchers find it difficult to determine the most appropriate extraoral prosthetic material. This comprehensive review evaluates the most used extraoral prosthesis materials and qualitatively assesses their longevity and function. The study aims to identify and interpret the results of current updates on the factors that affect longevity and functionality. This comprehensive review summarizes and evaluates differences in the properties of commonly used extraoral maxillofacial prosthetic materials. The review was planned to focus on all factors related to the longevity and function of the extraoral maxillofacial prosthetics. An electronic search covered English articles in PubMed, Scopus, Google Scholar, Web of Science, and grey literature. Manual searching was also performed. Six authors participated in the screening. Search engines extracted 1107 records, and 88 studies were included for qualitative and bias assessments. Silicones are the most frequently used extraoral maxillofacial prosthetic materials. Heat-cured silicones are more color-stable than those cured at room temperature. Additional ingredients and processing techniques affect prosthesis longevity.

In situ study of the effect of endogenous and exogenous agents on color stability, hardness, and surface roughness of an elastomer for facial prostheses

PURPOSE

To evaluate in situ the influence of sweat, oil, sunscreen, and disinfectant solution on the color stability, hardness, and roughness of elastomer for facial prostheses.

MATERIALS AND METHODS

Standardized and intrinsically pigmented specimens remained in contact with human skin from the same person for 30 days, considering exposures (n = 36 per group), absent of exposition (Control, C); sweat and oiliness contact (SO); sweat and oiliness associated with sunscreen (SOS); 0.12% chlorhexidine digluconate immersion (CD0.12%); and all agents exposed (SOSCD). The main variables were color change (CIELab and National Standard Bureau system, NBS), Shore A hardness, and surface roughness, measured at baseline and 30 days. Qualitative analyses were performed by atomic force microscopy (AFM) and scanning electron microscopy (SEM). The data were analyzed by Kruskal-Wallis tests (color) and two-way ANOVA (hardness and roughness) with Sidak post-test (α = 0.05).

RESULTS

CD0.12% (1.54 ± 0.49) and SOSCD (2.10 ± 1.03) had similar effects and caused the smallest color changes, considered mild and noticeable (NBS), respectively. SOS promoted the greatest color change (6.99 ± 1.43, NBS: large) and hardness (17.97 ± 0.56); SOS promoted intermediate roughness (3.48 ± 1.05) between SOSCD (2.25 ± 0.53), and two similar groups: C (4.46 ± 0.95), and CD0.12% (4.39 ± 1.26). The qualitative analysis showed an irregular, dense, dry, and whitish layer on the surface of the specimens exposed to sunscreen, which was reduced when in contact with 0.12% chlorhexidine digluconate.

CONCLUSIONS

Endogenous and exogenous factors are capable of altering elastomer properties. The 0.12% chlorhexidine digluconate minimized the changes caused by sweat, oil, and sunscreen.

Microwave disinfection of facial silicone prostheses, Part 1: Color stability

STATEMENT OF PROBLEM

The choice of cleaning method is an important consideration for lengthening the serviceable time of facial prostheses as microbial organisms and biofilms could degrade facial prostheses and cause skin irritation. Whether microwave disinfection is a suitable cleaning method without degradation of the properties of a prosthesis is unclear.

PURPOSE

The purpose of this in vitro study was to measure the color stability of 6 commonly used facial silicone elastomers after microwave disinfection over a simulated 1.5-year period.

MATERIAL AND METHODS

Six different facial silicone elastomers: MDX4-4210, MDX4-4210/Type A, M511, A-2186, VST-50, and A-2000 were mixed with intrinsic silicone white opacifier (except for the control group) and subsequently combined with 4 silicone intrinsic pigment color groups: red (R), yellow (Y), burnt sienna (B), and a mixture of R+Y+B (M). The control group was a silicone elastomer without opacifier or pigment. Each of the 30 experimental groups consisted of 5 specimens (N=150). Five specimens were placed in a 250-mL Erlenmeyer flask filled with 160 mL of tap water. Seven flasks were then placed in a 660-W microwave oven. An exposure of 6 minutes was used according to the antimicrobial efficacy of microwave disinfection protocol on facial silicone prostheses with a final water temperature of 60 °C for 18 times (simulating 1.5 years of microwave disinfection with one 6-minute exposure monthly). A spectrophotometer was used to measure reflectance color change values (∆E). Color differences were calculated following CIELab (∆E*ab) and CIEDE2000 (∆E00) formulae. ∆E*ab and ∆E00 were statistically analyzed by a linear mixed effects model with 3 factors (silicone type, color shade, and time) using the R Statistical software program (α=.05).

RESULTS

Both ∆E*ab and ∆E00 of all silicone elastomers studied were less than the visual perceptibility thresholds (∆E*ab<1.1 and E00<0.7) and were considered clinically acceptable (∆E*ab<3.0 and E00<2.1) after the 1.5-year simulation of microwave disinfection. Yellow and blue pigments had more effect on MDX4-4210 and M511, while red pigment had more effect on MDX4-4210, MDX4-4210/Type A, and M511 (P<.05). Nevertheless, the values were still below the perceptibility threshold (∆E*ab≤1.0 and E00<0.6).

CONCLUSIONS

All 6 facial silicone elastomers maintained clinically acceptable color after 18 months of exposure to microwave disinfection.

Evaluation of the color stability of three maxillofacial silicone materials after exposure to beverages: An in vitro study

Purpose

Oral cancer often requires treatments like surgical intervention, involving surgical resection of lips and other facial parts. For those patients, prosthetic rehabilitation following surgery promotes social reintegration. This study explores the color stability of various commercially available silicone materials for facial prostheses when exposed to everyday beverages like coffee and tea. The hypothesis is that these beverages can induce color changes in silicones, simulating conditions of daily use.

Material and methods

A total of 90 specimens were fabricated. There were 30 specimens deefor each of 3 nonpigmented silicone elastomers: Silfy, A-2186-F and VST-50 and were immersed in tea or coffee at drinking temperature and evaluated for color changes at time points of 0 h, 1 h, and 6 h. The color was measured with a colorimeter that used the CIE L*a*b* system and the color change ΔΕ was calculated to quantify the color change. Statistical analysis was performed by using the Kruskal-Wallis test, the Mann-Whitney U test, and the Wilcoxon signed-rank Test. The threshold for statistical significance was P < .05.

Results

Color change was observed for each of the silicones exposed to the beverages (P < .05). The value of ΔE was significantly higher for A-2186-F compared with VST-50 and Silfy (P < .05 in all beverages at 6 h). The color of the elastomers progressively changed while immersed in the beverages over 6 h. The change in color was significantly greater for coffee compared with tea (P < .05).

Conclusions

The color stability of nonpigmented silicone elastomers is inherently low, which contributes to the overall color change of silicone prostheses when they are exposed to beverages that contain pigments. The elastomer A-2186-F had greatest values of ΔE among the materials tested. Color changes of silicone prostheses can be lessened by selecting materials with consideration of color stability to improve their longevity and extend their period of use.

Microwave disinfection of facial silicone prostheses, part 2: Mechanical properties

STATEMENT OF PROBLEM

Part 1 of this 2-part study determined that microwave disinfection did not degrade the color stability of facial silicone prostheses. However, investigations on the effects of microwave disinfection on the mechanical properties of different silicone elastomers are lacking.

PURPOSE

The purpose of this in vitro study was to examine the mechanical properties of commonly used colored facial silicone elastomers before and after microwave disinfection over a simulated 1.5-year period.

MATERIAL AND METHODS

Six commonly used facial silicone elastomers: MDX4-4210, MDX4-4210/Type A, M511, A-2186, VST-50, and A-2000 were combined with functional intrinsic silicone pigments and opacifier (red, yellow, blue, and white). A total of 288 specimens were fabricated (n=12). Half of the specimens were tested for mechanical properties as the baseline, while the other specimens were tested after microwave disinfection. Microwave disinfection was performed with 660 W, 6 minutes of exposure time, and microwaved for 18 cycles to simulate 1.5 years of usage (one 6-minute exposure monthly). For mechanical property testing, all specimens were tested for tensile strength and percentage elongation (ASTM D412), tear strength (ASTM D624), and hardness (ASTM D2240). For each property, a 2-way ANOVA (silicone type and microwave disinfection factors) and Tukey multiple comparison test were performed using the R statistical software program (α=.05).

RESULTS

Following microwave disinfection, tensile strength and percentage elongation of A-2000 increased significantly (P<.05). MDX4-4210, MDX4-4210/Type A, and A-2000 showed significant increases in their hardness (P<.001). Tear strength also increased significantly for MDX4-4210 and VST-50 (P<.05). Among the materials tested (ranked from highest to lowest value,=not statistically significant different), for tensile strength, VST-50>A-2186=A-2000>MDX4-4210/Type A=M511=MDX4-4210 (P<.05). For percentage elongation, VST-50>MDX4-4210/Type A>A-2186>M511=A-2000=MDX4-4210=M511 (P<.05). For hardness, A-2000=A-2186>M511=VST-50>MDX4-4210>MDX4-4210/Type A (P<.05). For tear strength, VST-50>A-2186>A-2000>M511>MDX4-4210/Type A=MDX4-4210 (P<.05).

CONCLUSIONS

Overall, the mechanical properties of all the silicones tested were not adversely affected by microwave disinfection. VST-50 showed the best mechanical properties among the materials tested both before and after microwave disinfection. Microwave energy is a safe method of disinfecting the silicone elastomers tested in this study.

Ultraviolet C as a method of disinfecting medical silicone used in facial prostheses: An in vitro study - Part 2

STATEMENT OF PROBLEM

Disinfection is an important factor in preserving facial prostheses and maintaining tissue health. However, whether disinfection with ultraviolet C is an effective disinfection method is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effectiveness of irradiation with different exposure durations of an ultraviolet-C light-emitting diode in the disinfection of the silicone (A-588-1; Factor II) used in facial prostheses.

MATERIAL AND METHODS

A total of 216 specimens were prepared, contaminated by multispecies biofilm, and divided into 9 groups (n=24) for different treatments: chlorhexidine 0.12% (G CHG), ultraviolet-C light-emitting diode for 5 minutes (G UVC5), ultraviolet-C light-emitting diode for 10 minutes (G UVC10), ultraviolet-C light-emitting diode for 20 minutes (G UVC20), their respective untreated controls (Gcontrol CHG, Gcontrol UVC5, Gcontrol UVC10, Gcontrol UVC20), and dimethyl sulfoxide (G DMSO) as the negative control. Cell viability was measured by using the methyl tetrazolium salt (MTT) method. Two statistical analyses were performed. First, a 2×3 ANOVA was carried out to compare the control groups (Gcontrol UVC5, Gcontrol UVC10, and Gcontrol UVC20) and the experimental groups of UV-C LED light with different exposure durations (G UVC5, G UVC10, and G UVC20). The second analysis was performed using generalized linear models to compare the optical density of the groups (G UVC5, G UVC10, G UVC20, G CHG, and G DMSO).

RESULTS

Cell viability results demonstrated a microbial reduction after exposure to the ultraviolet-C light-emitting diode for 20 minutes (G UVC20) compared with untreated controls (P<.05). The 5- and 10-minute exposures were statistically similar to their respective control groups (P>.05). The 20 minutes exposure had the lowest average optical density value, being statistically different from the 5-minute exposure (P<.05). A 20-minute exposure to the ultraviolet-C light-emitting diode (G UVC20) was similarly effective when compared with the standard disinfection treatment (G CHG) and dimethyl sulfoxide (G DMSO) (P>.05).

CONCLUSIONS

Irradiation with an ultraviolet-C light-emitting diode for 20 minutes decreased the in vitro microbial cell viability on the medical silicone used in facial prostheses.

The impact of zirconium dioxide nanoparticles on the color stability of artificially aged heat-polymerized maxillofacial silicone elastomer

The limited service life of craniofacial prostheses due to degradation and color instability is a significant challenge. This in vitro study aimed to determine how zirconium dioxide (ZrO2) nanoparticles affect the color stability of M511 heat temperature vulcanizing (HTV) maxillofacial silicone elastomers after artificial aging. ZrO2 nanoparticles were added at concentrations of 1, 2, and 3 wt% to M511 HTV silicone elastomer. Two intrinsic silicone pigments were used (red and mocha). Silicone with pigment and without ZrO2 nanoparticles were used as the control. Eighty disk-shaped specimens were fabricated and divided into eight experimental groups, each containing ten specimens (n = 10). All specimens were subjected to artificial aging, and color changes were recorded at 252, 504, and 1008 h intervals. The L*a *b * values were measured using a colorimeter and the CIE-Lab system. To interpret the recorded color differences, a 50:50 percent perceptibility threshold (ΔE* = 1.1) and acceptability threshold (ΔE* = 3.0) were implemented. A one-way analysis of variance and Tukey's post hoc test at a significance level of 0.05 were used for the statistical analysis. We found that every evaluated specimen group exhibited a chromatic change (ΔE* > 0). The ΔE* values for the mocha pigments with and without ZrO2 nanoparticles were below the perceptible threshold (1.1 units). The ΔE* values of the red pigment with and without ZrO2 nanoparticles were significantly higher than the acceptable threshold (P < 0.000). According to the findings of this in vitro study, all the specimens underwent color changes (ΔE* > 0). The red pigment exhibited highly significant chromatic alterations. In contrast, mocha pigments with and without ZrO2 nanoparticles exhibited the least color change and were below the perceptible threshold. ZrO2 nanoparticles provided important protection and showed a reduction in color change.

Coloring Effects of Disinfectants on Pure or Nano-TiO2-Incorporated Maxillofacial Silicone Prostheses

Silicone elastomers play a crucial role in the field of maxillofacial prosthodontics. To maintain optimal hygiene, various disinfectants have been reported to clean silicone prostheses. Nevertheless, when selecting a disinfectant, it is important to consider not only its antimicrobial efficacy, but also its compatibility with the materials, to minimize any potential impact on the physical properties of the material surfaces. The coloring effect of such disinfectants on different types of silicone is of interest. A total of 144 silicone specimens (72 pure silicones, 72 nano-TiO2-incorporated silicones, from A-2000 and A-2006 silicones) were fabricated in this study. The spectrophotometric analysis was carried out, and the initial CIE L*a*b* color values were measured prior to disinfection. Specimens in each silicone group (with or without nano-TiO2) were subjected to a 30-h disinfection period simulating 1 year of disinfection with the following disinfectants: Control (tap water), 0.2% chlorhexidine gluconate, 4% chlorhexidine gluconate, 1% NaOCl, neutral soap, and effervescent. After the second color values were recorded, the color change (∆E*) was calculated. Significant differences were observed among the disinfectants for both the A-2000 and A-2006 silicone groups. Nano-TiO2 did not show a color protection effect in A-2000 silicone. In contrast, nano-TiO2 incorporation provided color protection against CHG 0.2%, CHG 4%, and NaOCl in A-2006 silicone. Most of the disinfectants did not show acceptable color stability over time. In pure A-2000 silicone, except for 0.2% chlorhexidine, all disinfectant groups demonstrated a color change within the acceptability threshold of 50:50% (∆E* = 3.0). On the other hand, in nano-TiO2-incorporated A-2006 silicone, only 0.2% and 4% chlorhexidine demonstrated an acceptable color change. Overall, chlorhexidine could be used as a suitable disinfectant in maxillofacial silicone prostheses.

Effect of Extrinsic Pigmentation on Dimensional Stability, Hardness, Detail Reproduction, and Color of a Silicone

OBJECTIVE

 The aim of the study is to evaluate the effect of extrinsic pigmentation on the dimensional stability, hardness, detail reproduction, and color of a silicone after thermocycling.

MATERIALS AND METHODS

 Sixty samples of MDX4-4210 silicone (Dow Corning Corporation Medical Products) with intrinsic pink pigment (H-109-P, Factor II) and intrinsic opacifier (TiO) were fabricated. Two groups were created: Group 1-only intrinsic pigmentation (H-109P, Factor II + TiO) (Control); and Group 2-intrinsic (H-109P, Factor II + TiO) and extrinsic (Tan FE - 215, Factor II) pigmentation. The following tests were performed for each group: dimensional stability, Shore A hardness, detail reproduction, and color. Readings for the tests were taken before and after thermocycling (2,000 cycles). For dimensional stability and hardness, two-way analysis of variance (ANOVA) was used. One-way ANOVA was used for the color test. In case of significant statistical difference, the Tukey test was applied (p <0.05). All samples achieved the same detail reproduction score, therefore, no statistical evaluation was performed.

RESULTS

 For the dimensional stability test, comparing the initial time with the final time, there was a significant contraction in both groups after thermocycling. For the hardness test, comparing the time points, only group 1 showed a significant reduction in hardness after thermocycling. Groups 1 and 2 scored 2 for the detail reproduction test, before and after thermocycling. Comparing group 1 with group 2, there was no significant difference for color change.

CONCLUSION

 Based on the tests performed, extrinsic pigmentation did not show a negative effect on silicone, and therefore it can be indicated. The results of the dimensional, hardness, detail reproduction and color evaluations of the MDX4-4210 silicone were clinically acceptable in all cases in the groups with and without extrinsic pigmentation.

Antimicrobial effects of nano titanium dioxide and disinfectants on maxillofacial silicones

STATEMENT OF PROBLEM

Deficient hygiene of maxillofacial prostheses can be a source of infection, and various disinfectants, including nano-oxides, have been suggested for the disinfection of silicone prostheses. While maxillofacial silicones involving nano-oxides at different sizes and concentrations have been evaluated in terms of their mechanical and physical properties, reports are lacking on the antimicrobial effect of nano titanium dioxide (TiO₂) incorporated into maxillofacial silicones contaminated by different biofilms.

PURPOSE

The purpose of this in vitro study was to evaluate the antimicrobial effects of 6 different disinfectants and nano TiO₂ incorporation into maxillofacial silicone contaminated with Staphylococcus aureus, Escherichia coli, and Candida albicans biofilms.

MATERIAL AND METHODS

A total of 258 silicone specimens (129 pure silicones and 129 nano TiO₂-incorporated silicones) were fabricated. Specimens in each silicone group (with or without nano TiO₂) were divided into 7 disinfectant groups (control, 0.2% chlorhexidine gluconate, 4% chlorhexidine gluconate, 1% sodium hypochlorite, neutral soap, 100% white vinegar, and effervescent) in each biofilm group. Contaminated specimens were disinfected, and the suspension of each specimen was incubated at 37 °C for 24 hours. Proliferated colonies were recorded in colony-forming units per mL (CFU/mL). The differences in microbial levels among specimens were evaluated to test the effect of the type of silicone and the disinfectant (α=.05).

RESULTS

Significant difference was found among disinfectants regardless of the silicone type (P<.05). Nano TiO₂ incorporation showed an antimicrobial effect on S aureus, E coli, and C albicans biofilms. Nano TiO₂ incorporated silicone cleaned with 4% chlorhexidine gluconate had statistically less C albicans than pure silicone. Using white vinegar or 4% chlorhexidine gluconate led to no E coli on either silicone. Nano TiO₂ incorporated silicone cleaned with effervescent had fewer S aureus or C albicans biofilms.

CONCLUSIONS

The tested disinfectants and nano TiO₂ incorporation into silicone were effective against most of the microorganisms used in this study.

Effects of Disinfection Methods on the Color Stability of Precolored and Hand-Colored Maxillofacial Silicone: An In Vitro Study

Maxillofacial prostheses are used in rehabilitation of patients with facial defects. Typically, these prostheses are fabricated with medical grade silicone and are tinted corresponding to the patients' natural skin color. However, exposure to environment and disinfectants can result in color changes. This study aimed to evaluate the effects of four different disinfection methods on the color stability of precolored and hand-colored maxillofacial silicones. Forty specimens each of precolored and hand-colored silicone were prepared. The specimens were randomly divided into eight groups (n = 10) and cleansed with four different disinfection methods. Disinfection was carried out six times/day for 60 days, simulating once-a-day disinfection for a year. Color evaluation was carried out at day 0 and day 60 using a UV-vis spectrophotometer. Color alterations were calculated by the CIE L ^∗ a ^∗ b ^∗ system. Data were analyzed by two-way ANOVA with post hoc Tukey HSD and t-tests (α = 0.05). Disinfectants can affect the color stability of maxillofacial silicone. In our study, chlorhexidine solution and liquid soap resulted in the highest color change. Precolored silicone showed higher color stability than its hand-colored counterpart.

Fungicidal Effect of Lemongrass Essential Oil on Candida albicans Biofilm Pre-established on Maxillofacial Silicone Specimens

Aims:

This in-vitro study aimed to evaluate the efficacy of lemongrass (Cymbopogon citratus) essential oil in eradicating Candida albicans biofilm pre-established on the maxillofacial silicone specimens.

Materials and Methods:

Two maxillofacial silicones, namely, MDX4-4210 and Multisil Epithetik, were used for the fabrication of 6 mm diameter disks (n = 21 for each brand of silicone). A 48-h mature C. albicans ATCC 10231 biofilm was pre-established on sterile silicone specimen. These disks were then exposed to various concentrations of lemongrass essential oil ranging from 0.31% to 5% (v/v), 20% (v/v) nystatin, and RPMI-1640 medium for 18–20 h. After exposure, the remaining viable fungal biofilm was examined by the XTT [2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide]-reduction assay. All data were analyzed by using a regression coefficient and a post hoc Tukey HSD multiple comparisons test (α = 0.05).

Results:

Different brands of silicone used for fabrication did not significantly affect the formation of mature C. albicans biofilm (P =0.302). A 5% (v/v) lemongrass essential oil significantly eliminated fungal biofilm by approximately 95% (P =0.031). However, less than 50% of the fungal biofilm was eliminated by the tested oil at a concentration as low as 0.31% (v/v). Furthermore, the fungicidal efficacy against C. albicans biofilm of lemongrass essential oil at 2.5% (v/v) was as potent as that of 20% (v/v) nystatin suspension (P = 0.99).

Conclusion:

Lemongrass essential oil expressed fungicidal effect on C. albicans biofilm pre-established on the disks fabricated from different brands of silicone. Additionally, the fungicidal effectiveness of the oil against the mature fungal biofilm was dose-dependent.

Opacifiers on color stability of maxillofacial silicone under aging and Indian weathering conditions: An in vitro study

STATEMENT OF PROBLEM

Resistance to long-term color change is a desirable property for facial prosthetic elastomers. Evidence for the color stability of maxillofacial silicones under aging and hot and humid Indian weathering conditions is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of adding opacifiers on the color stability of maxillofacial silicone under human aging and Indian weather conditions.

MATERIAL AND METHODS

A total of 93 specimen disks were obtained from the A-2186, platinum-based, room-temperature vulcanized, maxillofacial silicone elastomer by using a Ø30×6-mm stainless-steel die. The specimens were divided into 3 main groups (n=30), C (control), T (titanium dioxide), and B (barium sulfate), and 1 additional specimen (n=1) from each group was stored in a closed box and further subgrouped as outdoor weathering (COut, TOut, BOut), acidic perspiration (CAcid, TAcid, BAcid), sebum (CSebum, TSebum, BSebum) (n=10), and visual comparison (CVis, TVis, BVis) (n=1). Baseline L∗, a∗, b∗ values were recorded by using a spectrophotometer and visual perception. The specimens were subjected to human and extraoral aging conditions, and the values were recorded again after 6 months. Data were analyzed statistically by using analysis of variance (ANOVA) and post hoc analysis with the Tukey post hoc test.

RESULTS

In group C, the mean color change for COut was 3.69 ±0.49; CAcid, 3.58 ±0.68; and CSebum, 7.53 ±0.22 (P<.001). In group T, the mean color change for TOut was 2.60 ±0.24; TAcid, 2.35 ±0.13; and TSebum, 4.91 ±0.44 (P<.001). In group B, BOut was 1.59 ±0.28, BAcid was 1.46 ±0.28, and BSebum was 4.03 ±0.71 (P<.001). The specimens containing barium sulfate showed the maximum color stability. The least color stability was observed in all specimens exposed to sebum solution and was significantly different (P<.001) from the outdoor weather and acidic perspiration specimens. Visually perceivable color changes were observed in specimens exposed to the sebum solution.

CONCLUSIONS

The addition of titanium dioxide and barium sulfate as opacifiers resulted in clinically acceptable color change when exposed to outdoor weathering and acidic perspiration but not in sebum solution.

Ultraviolet C as a method of disinfecting medical silicone used in facial prostheses: An in vitro study

STATEMENT OF PROBLEM

Hygiene and disinfection are important factors for preserving facial prostheses and supporting tissue health. However, a method that does not accelerate degradation or color change is necessary.

PURPOSE

The purpose of this in vitro study was to evaluate the effectiveness of irradiation with ultraviolet C light-emitting diode (UV-C LED) light in the disinfection and initial color stability of the silicone (A-588-1; Factor II) used in facial prostheses.

MATERIAL AND METHODS

One hundred and twenty specimens were made, contaminated by multispecies biofilm, and divided into 5 groups (n = 24) with different treatments: control, distilled water, 0.12% chlorhexidine, UV-C LED light, and dimethyl sulfoxide (DMSO) as the negative control. Cell viability was measured by the methyl tetrazolium salt method. Statistical analysis was performed by generalized linear models. Additional descriptive analysis was performed for color analysis by using 16 silicone specimens made with light and dark intrinsic coloring in 4 groups (controls and treatments n=4) submitted to UV-C LED light. The ΔE of the specimens was obtained by CIEDE200.

RESULTS

The results of cell viability demonstrated a statistically significant difference among the groups (P<.001), with a microbial reduction after UVC-LED exposure compared with the control group. Regarding the color, the groups presented an average ΔE (light 0.205 and dark 0.308) compatible with visually imperceptible changes (light < 0.7 and dark < 1.2).

CONCLUSIONS

Irradiation with UV-C LED light decreased the in vitro microbial cell viability of the medical silicone used in facial prostheses, demonstrating initial color stability.

The color stability of maxillofacial silicones: A systematic review and meta analysis

Aim

This systematic review aims to identify and interpret results of studies that evaluated the changes in the color stability of maxillofacial prosthetic materials due to chemical instability of silicones and pigments and the effect of exposure to environmental conditions and aging factors on the same.

Settings and Design

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA).

Materials and Methods

Relevant articles written in English only, before November 15, 2019, were identified using an electronic search in the PubMed/Medline conducted to identify pertinent articles. The relevancy of the articles was verified by screening the title, abstract, and full text, if they met the inclusion criteria. A total of 42 articles satisfied the criteria, from which data were extracted for qualitative synthesis. This review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42019124562).

Statistical Analysis Used

Since considerable data heterogenicity was present in all studies except the ones on incorporation of TiO2 for which meta-analysis using random effects model was performed.

Results

The database search resulted in 234 studies, of which 202 articles were excluded due to lack of relevance, duplication, and unavailability of data. The remaining 32 fulltext articles were assessed for eligibility, out of which 2 articles were excluded. Twelve articles were yielded by manual search. A total of 42 studies were included in the present systematic review. Due to heterogeneous data, meta-analysis could be only carried out with the effect of TiO2 nano particle on color stability.

Conclusions

Although there has been extensive amount of research in this field, an ideal maxillofacial silicone exhibiting good color stability in various human and environmental aging conditions is yet to be identified. Human and environmental aging conditions have an adverse effect on the color stability and addition of TiO2 nano particle seems to improve the same.

Tear Strength Analysis of MDX4-4210 and A-2186 Silicones with Different Intrinsic Pigments Incorporated by Mechanical and Industrial Methods

Objective

The aim of this study was to evaluate the tear strength of MDX4-4210 and A-2186 silicones with different intrinsic pigments incorporated by mechanical and industrial methods, comparing nonaged and aged groups.

Materials and Methods

Twenty-four groups were created according to the American Society for Testing and Materials D-624/type C, half nonaged and half aged (n = 10): bronze mechanical MDX4-4210, bronze industrial MDX4-4210, black mechanical MDX4-4210, black industrial MDX4-4210, pink mechanical MDX4-4210, pink industrial MDX4-4210, bronze mechanical A-2186, bronze industrial A-2186, black mechanical A-2186, black industrial A-2186, pink mechanical A-2186, and pink industrial A-2186. All specimens were submitted to tear strength analysis. Data were submitted to the ANOVA and Tukey test (p < 0.05).

Results

An increase in the tear strength values was observed only for the bronze and black MDX4-4210, comparing nonaged and aged silicones (p < 0.05), regardless of the manufacturing method. There was a difference in all comparisons between MDX4-4210 and A-2186 silicones with the same pigment type (p < 0.05), regardless of the manufacturing method. In all cases, there was no difference in the manufacturing method comparing the MDX4-4210 or A-2186 groups with the same pigment.

Conclusion

Accelerated aging did not influence the tear strength in all aged A-2186 silicones and in aged pink industrial and mechanical MDX4-4210 silicones. The other MDX4-4210 groups had an increase in the results after aging. In all cases compared, the A-2186 groups had higher tear strength values than the MDX4-4210 groups. Mechanical and industrial methods can be used for silicone preparation, without changing the tear strength.

In vitro study of effects of aging and processing conditions on colour change in maxillofacial silicone elastomers

Background

The inherent colour change in maxillofacial silicone elastomers becomes perceptible 6–12 months after fabrication. Determining the factors that accelerate the degradation of the prosthesis can help the clinicians increase its life span. Therefore, the aim of the study was to investigate the effect of time passage, processing temperature, and molding-stone colour on the colour change of maxillofacial silicone elastomers after darkroom storage for 6000 h.

Methods

A total of ten study molds, each incorporating ten specimen gaps were fabricated using five different colors of dental stones. The gaps were filled with coloured Cosmesil M511 maxillofacial silicone elastomer. Five of the study molds, one of each stone color, were processed at room temperature (25 °C) for 24 h while the remainder were vulcanized at 100 °C for 1 h. Two stainless-steel molds were also fabricated to obtain a total of twenty control-group specimens of the same dimensions that were processed under the same conditions as the study molds. Colour measurements of the vulcanized silicone samples were performed using a Konica Minolta spectrophotometer. Initial measurements were obtained after the blocks were removed from the molds and the final measurements were recorded 6000 h after storage in the dark at 25 °C and 40% relative humidity. The CIEDE2000 colour-difference formula was used to measure the changes in the colour. One-way and two-way ANOVA, and an independent-sample t-test were used for statistical assessments.

Results

For every group, the colour change exceeded the perceptible thresholds. Thus, either the vulcanization temperature or the colour of the molding stone has a significant effect on the colour change over time. Those samples vulcanized in green and white molding stones at 100 °C exhibited a significantly higher ∆L*, ∆a*, and ∆b* values relative to the samples vulcanized at room temperature.

Conclusion

The molding-stone colour and vulcanization temperature both affect the degree of colour change after storage in a dark environment. The L*, a*, and b* values for the maxillofacial silicone elastomers are influenced by the direction of the increase or decrease according to the selected colour. This effect varies as the temperature increases.

Effect of the simulated Indian and Mediterranean climates on the Shore A hardness of maxillofacial silicone

Purpose:

The purpose of this study was to assess and compare the effect of the simulated Indian and Mediterranean climates on the Shore A hardness of a commercially available nonpigmented room temperature vulcanizing maxillofacial silicone.

Materials and Methods:

Sixty specimens were fabricated from A-2000 silicone material (Factor II), using a stainless steel mold of dimension 20 mm × 2 mm. The initial Shore A hardness was noted using a digital durometer. Thirty samples were subjected to the simulated Mediterranean climate (Group I), and the remaining thirty samples were subjected to the Indian tropical climate (Group II) in an accelerated weather chamber to simulate 1 year of clinical use. Final Shore A hardness was noted. A one-way ANOVA and Bonferroni post hoc tests were performed for the Shore A hardness at P < 0.05.

Results:

The mean initial Shore A hardness for both the groups was 24.9833. After accelerated weathering, Group I showed mean Shore A hardness of 33.0000 whereas Group II showed mean Shore A hardness of 38.0000.

Conclusions:

The Shore A hardness of Factor II, before and after accelerated artificial weathering, was statistically significant at 0.05 level (P < 0.05). The change in Shore A hardness was greater in the simulated tropical climate group (Group II) as compared to the simulated Mediterranean climate group (Group I) but within clinical limits.

Effect of vulcanization temperature and dental stone colour on colour degradation of maxillofacial silicone elastomers

Background

Colour degradation is a major problem in maxillofacial silicone elastomers. Recent studies have focused on colour stability and the mechanical properties of the silicone elastomers. A colour match is also essential for the acceptance of the prosthesis by the patient. The aim of this study is to assess the colour degradation of the silicone elastomer after being moulded in different colours of dental stones at two different vulcanization temperatures.

Methods

Five different colours of dental stones were used to fabricate a total of 120 silicone blocks using a Cosmesil M511 maxillofacial silicone elastomer. Vulcanization was completed at two different temperatures (25 and 100° Celsius). Colour measurements were obtained with a Conica Minolta spectrophotometer. The CIEDE2000 formula was used to calculate the colour differences (∆E00). Two-way ANOVA, one-way ANOVA with Bonferroni corrected post-hoc p values and independent samples t-test were used for the statistical analyses.

Results

High temperature vulcanization causes lightening of the maxillofacial silicone elastomers without regard to the dental stone colour (p = 0.001). Specimens moulded in green stone lightened least at room temperature (p = 0.999). Compared to the control group, at high temperature, all specimens moulded in coloured dental stones darkened significantly (p < 0.001 for white, blue and yellow; p = 0.006 for green; p = 0.045 for reddish-brown). In the high temperature group, the shift to a green chroma was significant in the white, yellow and green dental stones groups (p = 0.001, p = 0.002, p < 0.001, respectively). The mean b* of the high temperature control group was higher than that of the room temperature control group (p < 0.001). The only ∆E00 score lower than the perceptibility threshold for dental materials (∆E00 = 1.30) was between the room temperature control group and the room temperature green dental stone group (∆E00 = 0.96).

Conclusions

Green and blue dental stones cause less colour degradation in silicone elastomers. Reddish-brown dental stones cause the most colour degradation in silicone elastomers. At 100 °C, the colour of the silicone elastomer lightens and yellows even if the elastomer is vulcanized in a stainless steel mould. White, yellow and reddish-brown dental stones make the silicone elastomer appear more yellow even if the elastomer is vulcanized at room temperature.

Influence of adding nanoparticles on the hardness, tear strength, and permanent deformation of facial silicone subjected to accelerated aging

STATEMENT OF PROBLEM

The efficiency of adding nanoparticles to silicone protection has proven to prevent color degradation. However, reports of other physical property changes in facial silicone are scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of adding nanoparticles on the hardness, tear strength, and permanent deformation of a facial silicone.

MATERIAL AND METHODS

Specimens were made for each test, with 140 for the hardness test, 140 for the permanent deformation test, but 280 for the rupture test. This higher number was due to the fact that the first 140 specimens were ruptured and unusable after the initial reading. ZnO, BaSO₄, and TiO₂ nanoparticles at concentrations of 1% and 2% of silicone were used, as well as specimens without nanoparticles that consisted of only oil paint and of only silicone. Outcomes were measured before and after 1008 hours of accelerated aging. Data were analyzed by nested analysis of variance (ANOVA) and Tukey honest significant differences test (α=.05).

RESULTS

Results showed that the presence of nanoparticles influenced the properties of the assessed groups. The nanoparticles decreased hardness values. The highest values of tear strength were observed for the groups with addition of BaSO₄. The 1% ZnO group without oil paint showed the lowest values of permanent deformation.

CONCLUSIONS

Based on the findings of this in vitro study, the use of ZnO nanoparticles is recommended, since they did not negatively affect the properties of the materials evaluated.

Antimicrobial activity of conventional and plant-extract disinfectant solutions on microbial biofilms on a maxillofacial polymer surface

STATEMENT OF PROBLEM

Dentists often note problems with infection in patients with maxillofacial prostheses. Conventional disinfection protocols are not always effective and may alter the properties of the polymer used in the prosthesis. Thus, the search for improved disinfection methods is important.

PURPOSE

The purpose of this in vitro study was to evaluate and compare the antimicrobial activity of conventional disinfectant solutions (water and neutral soap and 4% chlorhexidine) and plant extracts (Cymbopogon nardus and Hydrastis canadensis) on specimens of maxillofacial silicone contaminated with Candida albicans and Staphylococcus aureus biofilms.

MATERIAL AND METHODS

Seventy-two silicone (MDX4-4210) specimens were fabricated (5×2 mm) and sterilized. Thirty-six were contaminated with C albicans (10(6) cells/mL) and 36 with S aureus (10(8) cells/mL) to evaluate the antimicrobial activity of the cleaning protocols. After incubation (37°C/72 hours), the specimens were divided into 5 groups: not disinfected (positive control), soaking in saline solution for 10 minutes, soaking in 4% chlorhexidine for 10 minutes, soaking in C nardus for 10 minutes, soaking in H canadensis for 10 minutes, and washing by hand with water and neutral soap for 30 seconds. The viability of cells was evaluated by XTT (2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) assay and by scanning electron microscope analysis. The results were analyzed by ANOVA and the Tukey HSD test (α=.05).

RESULTS

All disinfection solutions provided a statistically significant reduction in biofilm viability compared with the control group for both microorganisms (P<.05). Washing with water and neutral soap was significantly more effective in reducing biofilm viability than immersion in the disinfection solutions, with persistence of viable microorganisms between 1.05% for C albicans and 0.62% for S aureus after this cleaning protocol. Photomicrographs revealed that 4% chlorhexidine altered the surface of the polymer.

CONCLUSIONS

Within the limitations of this in vitro study, it was concluded that the cleaning protocols with different disinfectant solutions produced a significant reduction in the viability of C albicans and S aureus biofilms on the silicone polymer. Washing with water and neutral soap was the most effective protocol against both microorganisms.

Efficacy of cleansing agents in killing microorganisms in mixed species biofilms present on silicone facial prostheses--an in vitro study

OBJECTIVES

The purpose of this study was to assess the efficacy of different cleansing agents in killing mixed species biofilms on silicone facial prostheses.

MATERIALS AND METHODS

Two bacterial and three yeast strains, isolated from silicone facial prostheses, were selected for the mixed species biofilms. A variety of agents used to clean facial prostheses were employed, viz., antibacterial soap, essential-oil-containing mouth rinse, ethanol 27 %, chlorhexidine mouth rinse, and buttermilk. Colony forming units (CFUs) and live/dead staining were analyzed to assess the efficacy of these cleansing agents against 24-h and 2-week biofilms and regrown biofilms on silicone samples.

RESULTS

Chlorhexidine was the most effective cleansing agent. Chlorhexidine killed 8 log unit CFUs (>99.99 % killing) in a 24-h biofilm and 5 log unit CFUs (>99.99 % killing) in 2-week biofilms. Also, after regrowth and repeated treatment of the biofilm, chlorhexidine was the most effective cleansing agent showing no detectable CFUs. The essential-oil-containing mouth rinse (containing 26.9 % ethanol) showed a similar efficacy as ethanol (27 %) alone. Antibacterial soap and buttermilk were the least effective agents tested.

CONCLUSIONS

Chlorhexidine showed the highest reduction in CFUs in 24-h, 2-week, and regrown mixed species biofilm of microorganisms isolated from silicone facial prostheses.

CLINICAL RELEVANCE

Chlorhexidine mouth rinse (easy obtainable and relatively cheap) is very effective in killing bacteria and yeast present in biofilms on silicone facial prostheses. When applied on a regular basis, cleansing a facial prosthesis with chlorhexidine will presumably increase its lifetime and reduce skin irritations.

Influence of nanoparticles on color stability, microhardness, and flexural strength of acrylic resins specific for ocular prosthesis

The aim of this study was to assess the effect of adding nanoparticles to N1 acrylic resin intended for artificial sclera, in terms of the color stability, microhardness, and flexural strength of the resin. Three hundred samples of N1 acrylic resin were used: 100 samples for color stability and microhardness tests (each test was performed on the opposite side of each sample), and 200 samples for flexural strength testing (100 samples before and after 1,008 hours of accelerated aging). Samples for each test were separated into ten groups (n=10), ie, without nanoparticles (control group) or with nanoparticles of zinc oxide, titanium dioxide (TiO₂), and barium sulfate at weight concentrations of 1%, 2%, and 2.5% (nanoparticle groups). Data were subjected to statistical analysis with nested analysis of variance and Tukey’s test (P<0.05 significance level). Among the nanoparticle groups, the TiO₂ groups showed better color stability at all concentrations. Microhardness values increased after artificial aging, except for the control and zinc oxide groups. After aging, the 1%–2% TiO₂ groups had significantly higher microhardness values compared with the other nanoparticle groups. Before aging, there was a significant difference in flexural strength between the control and nanoparticle groups. After aging, the control and TiO₂ groups, regardless of concentration, showed the lowest flexural strength values. Incorporation of nanoparticles directly influenced the acrylic resin properties, with TiO₂ being the most influential nanoparticle in terms of the evaluated properties.