European Journal of Molecular & Clinical Medicine

ISSN 2515-8260 Volume 07, Issue 01, 2020

DISINFECTION OF IMPRESSION MATERIAL

- A REVIEW
1
Sree lakshmi S.B, 2Jayalakshmi Somasundram, 3R.V Geetha
1
Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha
University, Chennai 77.
2Chief Scientist, White Lab- Material Research Centre, Saveetha Dental College and Hospitals, Saveetha
Institute of Medical and Technical Sciences, saveetha University, Saveetha university, Chennai 77
3Associate professor, Department of Microbiology, Saveetha Dental College and Hospitals, Saveetha
Institute of Medical and Technical Sciences, Saveetha university, Chennai 77
1
[email protected]
2
[email protected]
3
[email protected]

ABSTRACT:
Dental impressions are categorized under semi-critical objects in dental practice and require high level
disinfection or sterilization. Sterilization in an autoclave will compromise the dimensional accuracy of the
impression hence it is not feasible. Until 1991, the recommended procedure for disinfection of impression
was rinsing under running water with which only 40% of bacteria, viruses and fungi were removed and
potential for transmission of microorganisms remained there. In recent times, a pre wash of the impression
with running water is advocated first to cast off all particles, blood and saliva prior to active disinfection
procedure. Disinfection of dental impression should be a routine procedure in the dental office and dental
laboratory. However, most of the dental professionals in private clinics, hospitals, dental schools and
prosthetic laboratories are not following the required protocols for impression disinfection. Keeping in
view the above findings, it is of utmost importance to raise the level of awareness in dental professionals
involved in any process of handling, transportation, processing and storage of the dental impressions.
With this background ,the aim of this review is to generate an update on the various techniques of
impression disinfection along with their mechanism of action , dimensional stability ,cause of infection on
impression material and effects of disinfectant on impression materials.

KEYWORDS: cross infection; dimensional stability ; disinfection ; impression materials

INTRODUCTION:
One of the primary functions of dental surgeons as health professionals is to prevent diseases in their field
or when diseases are set in to treat it. The actual worrying about the cross infection strongly increased
after the rapid evolution of AIDS and hepatitis B, leading the American dental Association(ADA) to
publish guidelines about the control of infection in dental offices and laboratories(Badrian et al., 2012) .
Among these instructions, such as the use of gloves , caps, makes, eyeglasses, protective over wear
garment and sterilisation of all dental materials, there is also concern about impression, which along with
trays, are important ways of transmission between patient and dental laboratories. The impression
materials differ widely in terms of absorption and retention of viruses (Bergman, Bergman and Olsson,
1985) . Even the occupational safety health agency (OSHA) have made some protocols to prevent
infection in the laboratories (Rueggeberg et al., 1992). Specific disinfectant procedures should be followed
for each material and the stone cast are potential sources of cross infection in dentistry (Pratten, 1987) .
Soganci et al emphasised the importance of cross infection in his study (Soganci et al., 2018). The control
978
 European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 01, 2020

of cross infection is a process that consist of various stages such as identification of high-risk population,
use of technical barriers both professional and the assistance, technique of disinfectant and sterilisation of
instruments, surfaces, materials using 2% glutaraldehyde,NAOCL, ammonium compounds, autoclaving
etc(Ramer, Gerhardt and McNally, 1993) . The elastic recovery of impression material without any
deformation is important on removal of material from the mouth (Silva and Salvador, 2004).Moreover the
material should be dimensionally stable during disinfectant and also during storage, because it takes some
time to pour the cast . Therefore it is essential that the dimensional changes in the impression material are
limited to permitted changes of 0 to 0.15% (Thouati et al., 1996). The varying combinations of both
disinfectant and impression material produce different results in the dimensional changes of the
impression materials (Pasini, Boscarioli and Pinto, 2010). Disinfection and sterilization methods are used
to free microorganisms on the medical and surgical instruments. The primary duty of the healthcare
professionals is to provide the appropriate methods of cleaning, disinfection and sterilization for various
surfaces and instruments and materials to avoid the spread of pathogens . The cleaning is the
elimination of all foreign material (e.g. blood, saliva, debris) from materials and decontamination is the
complete removal of pathogenic microorganisms from objects. Disinfection is the destruction of all
pathogenic organisms on inanimate objects. While sterilization is the complete elimination of all
microorganisms including spores.The nature of the disinfection varies according to the product used . On
this basis disinfectant can be divided into three categories namely low level ,intermediate and high level
disinfection. High level disinfectants such as glutaraldehyde and hydrogen peroxide destroy the
vegetative bacteria, mycobacteria, fungi and enveloped (lipid) and non enveloped (non lipid) viruses, but
not necessarily bacterial spores (Chakraborthy et al., 2014). Intermediate level disinfectants such as
alcohols, iodine and iodophors involve destruction of microorganisms like tubercle bacilli but are not able
to kill spore. Low level disinfectants such as phenolic and quaternary ammonium compounds used to clean
the environmental surfaces.

The clinical items can be classified into three categories namely critical ,semi critical and non critical
according to CDC . Dental impressions come under semi-critical objects which tend to come in contact
with the mucosal membrane but not penetrate bone. They are usually handled with gloves because they
are usually coated with blood and saliva which require high level disinfection or sterilization. The
Sterilization in an autoclave will compromise the dimensional accuracy of the impression material so it's
not recommended (Premkumar et al., 2014).The only means of disinfection is washing the impression
materials directly under running water which only removes 40% of microorganism and all the potential
pathogens causing the diseases are present . Nowadays the particles contaminated with blood and saliva
are washed with running water before performing the actual disinfection (Shree et al., 2019). The
complete disinfection of the dental impression and the materials should be a regular process followed in
the dental hospitals and laboratories. The majority of private clinics, hospitals, dental schools and even
prosthetic laboratories are not following the required guidelines for disinfecting the impression which
leads to cross infection . (G. Jayaraj et al., 2015). It is significantly important to create awareness
to dental professionals about the handling, transportation, processing and storage of dental
impressions(Sridharan et al., 2019). Different techniques of impression disinfection and other methods of
cross-infection control must be a part of the undergraduate curriculum of dental universities and dental
technician schools(Kumar and Gheena, 2015). With this background the aim of the review is to
concentrate on the various techniques of impression disinfection along with their mechanism of action ,
dimensional stability ,cause of infection on impression material and effects of disinfectant on impression
materials.

MATERIALS AND METHOD:

979
 European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 01, 2020

The articles, journals and documents related to the topic were searched and collected from Search
engines like PUBMED, google scholar, semantic scholar, MESHCORE , elsevier and medline. The
period of collection of articles from 1980 till date were considered. The inclusion criteria taken into
consideration were articles related to the impression material and its effects by disinfectant. The exclusion
criteria includes that the article is not related to the topic and article published before 1980.
IMPRESSION MATERIAL AND DISINFECTANT:
A dental impression material is defined as the negative record of the tissues of the mouth. It is used to
produce the form of the teeth and the surrounding tissues (Johnson et al., 1998). The ideal characteristics
of dental materials are pleasant odour, taste and esthetic colour, doesn’t contain any toxic or irritating
ingredients and economical, exhibits dimensional stability, adequate tear strength possess elastic
property, shelflife (Martin, Martin and Jedynakiewicz, 2007). The impression materials are classified into
rigid and elastic based on the properties . So the commonly used impression material is alginate which is
an irreversible elastic hydrocolloid material. It is used for making impressions for preparation models and
cast for primary impression. The most dimensional stable impression material is additional silicon because
it doesn’t release any byproducts (Birnbaum, 1995) . So talking about impressions they are highly
contaminated with patient saliva or blood. Such fluids can have viral and bacterial pathogens. To avoid
cross infection, impression material should be rinsed thoroughly under the running tap water before
disinfection to remove as much by a burden as possible (Peutzfeldt and Asmussen, 1990). For adequate
inactivation of microbial contaminants, the contact time between impression and disinfectant should be at
least equal to the time for tuberculoid activity as recommended by manufacture of germicide (Rai,
Easwaran and Dhivya, 2017). Rinsing after impression disinfection is also essential to remove residual
Stone, soap or disinfectant from impressions surface.
CAUSE OF INFECTION ON IMPRESSION MATERIALS:
Dental impression after taking out the patient mouth, the material contained saliva and blood , which is the
source of infection. Even the presence of caries have microorganisms in them which is seen in the
impression material after removal(Sherlin et al., 2015) . Most of the impression materials used have a
feature of retaining microorganism on their surfaces (Leung and Schonfeld, 1983) . Impression procedure
frequently causes bleeding from oral tissues. So when there is a rupture of skin happens , the blood which
has a potential to culture microorganism and also acts a microbial transportation which leads to the entry
of pathogenic microorganism and spreads to the intimate places . Materials like irreversible hydrocolloids
are often positioned against mucous membranes, when used and could potentially result in inoculation of
the microorganism on the impression material from the patient (Savabi et al., 2018) . So to avoid this kind
of contamination proper disinfection techniques and methods should be followed in dental laboratories and
hospitals.Various non elastic and elastic impression materials are used for making impressions(Swathy,
Gheena and Varsha, 2015). Before disinfecting the impression material there are key elements to be
understood such as presence or absence of surfactants and their tolerance to immersion on water or other
chemical fluids based on the hydrophilic nature of the materials (Milward and Waters, 2001). For example
, polyether impression material is hydrophilic in nature, which absorbs water and other chemical liquids
during disinfection causing dimensional changes and the loss of surfactants affects the wettability of the
impression. Despite alginates are susceptible to both wet and dry environments

The different methods used for disinfecting the impressions are more technique sensitive and time
consuming. Some disinfectant solutions may cause notable changes in impression material , particularly
when exposed for a long period of time. Disinfection depending on the solutions used , produces irritating
vapours which are major drawbacks (Anusavice, 2003) . Considering all these drawbacks , UV rays can
be used as an alternative method for disinfection . Uv chambers are now readily available in all dental
980
 European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 01, 2020

clinics and are also used for storing the sterilized instruments. Ultraviolet rays have long been recognized
as an effective method for killing microbes without requiring chemicals or heat(Gheena and Ezhilarasan,
2019). The working principle of these uv rays are , when microorganisms exposed to a particular
wavelength ( ie 200-280 nm) , the reproduction capacity of micro organisms are inhibited and inactivation
occurs at a faster rate ,which leads to the safety use of the materials without any threats .
METHODS OF DISINFECTION:
Destruction or inactivation of pathogenic microorganisms results in stopping their reproduction and
growth. Chlorine is a greenish-yellow gas and by providing a high pressure, the gas turns into liquid
which is toxic. Chlorine gas is widely used as a water disinfectant. Introducing chlorine to water plays a
very effective role for removing almost all pathogenic microorganisms(Gupta and Ramani, 2016). It is
effective for both primary and a secondary disinfection of impression materials . The gas cannot be
used for household disinfection because of its toxicity and its danger . It is lethal at concentrations as low
as 0.1% air by volume. Sodium hypochlorite, a commonly used disinfectant , used as a bleaching agent for
papers and textiles. The solution generally contains 10–15% of the available chlorine, but rapidly loses its
force in the storing process. Regular controlled environment is needed as the solution is affected greatly by
the pH, light, heat, and heavy metals (Dong and Liang, 2009). Chlorination ,Ca(OCl)2 (calcium
hypochlorite) is an essential solid that can be used in replacement of NaOCl (liquid). When compared it
has a similar property of NaOCl as a disinfectant but it is much safer to handle. Almost 70% of chlorine is
available in commercial grades of Ca(OCl)2. It has applications in both wastewater and drinking water.

When free chlorine reacts with ammonia , chloramines are formed . Chloramines have a significant role
and they are very stable. When comparing chlorine and chloramines , chlorine releases certain byproducts
. When three molecules of oxygen are combined there lead to the formation of ozone which is an
allotropic structure . It quickly decomposes to generate highly reactive free radicals(Craig, 2006) . The
ozone’s oxidation potential (−2.7 V) (that is the ability of chemical species to gain or lose electron) is
more than that of the chlorine (−1.36 V) and hypochlorite ion (−1.49 V) and these substances are
extensively used in wastewater treatment as an oxidants. Ozone is surpassed only by the hydroxyl radical
(•OH) and fluoride in its oxidation capacity.UV treatment can be used for treating waste water, drinking
water, and aquaculture(Johansen and Stackhouse, 1987). The UV light causes disinfection by changing the
biological components of microorganisms specifically breaking the chemical bonds in DNA, RNA, and
proteins(Sridharan, Ramani and Patankar, 2017). The acceleration of a photoreaction in the presence of a
catalyst is referred to as photocatalysis. The adsorbed substrates such as H2O are used to absorb light in
the catalyst photolysis process . In photogenerated catalysis, electron–hole pairs are created by the
photocatalytic activity (PCA) generating free radicals (e.g., hydroxyl radicals: •OH) that have the ability to
undergo secondary reactions. Its practical application was made possible by the discovery of the
electrolysis of water by using titanium dioxide (Gifrina Jayaraj et al., 2015).
MECHANISM OF ACTION OF DISINFECTANT:
Disinfectant or chemical biocides to use a more general term differ from antibiotic agents in their relative
lack of selecting toxicity and often implied lack of target specificity. Disinfectant acts on microorganisms
in two different ways, growth inhibition (statis) or lethal action (cidal)(Poulis, 2016). The disinfectant has
its action on bacterial wall, cytoplasmic membrane, energy metabolism, cytoplasm and nucleus, bacterial
spores . Acidic and alkaline compounds are linked to the H +and OH -concentration. H + ions destroy the
amino acid, precipitating proteins ,whereas OH- ions saponify the lipids in the enveloping membrane
(Varghese, 2008). Chlorine derivative acts by oxidising peptide linkage and the natural proteins, since
chlorine is electronegative. The quaternary ammonium compound irreversibly binds to phospholipids and
proteins of the membrane, thereby impairing permeability (Davies and Porra, 1994). Phenolic compounds
981
 European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 01, 2020

act specifically on cell membranes and inactivate intra cytoplasmic enzymes and form unstable
complexes. Aldehyde compounds act by protein denaturation and on nucleic acid by alkylation
(Nespraydko et al., 2015). Peracetic acid and hydrogen peroxide denatured proteins and lipids of
microorganisms, leading to this organisation of the membrane.

Whereas several alcohols such as ethyl alcohol (ethanol, alcohol), isopropyl alcohol (isopropanol,
propan-2-ol) and n-propanol are effective antimicrobials and are commonly used. Alcohols exhibit rapid
broad-spectrum antimicrobial activity against vegetative bacteria (including mycobacteria), viruses, and
fungi but are not sporicidal(Jangid et al., 2015) . Alcohol works on the principle of inhibiting sporulation
and spore germination , but this effect is reversible . They have wide applications as hard-surface
disinfection , skin antiseptics and in lower concentrations used as preservatives and since there is a lack of
sporicidal activity, alcohols are not suggested for sterilization . Many alcohol products have other biocides
mostly chlorhexidine in combination, which remain on the skin ,leading to evaporation of the alcohol, or
excipients (including emollients). These biocides decrease the evaporation time of the alcohol and can
significantly increase product efficacy(Thangaraj et al., 2016) . In general, isopropyl alcohol is considered
slightly more efficacious against bacteria and ethyl alcohol is more potent against viruses .
EFFECT OF DISINFECTANT ON NON-ELASTIC AND ELASTIC IMPRESSION
MATERIALS:
Publications examining the interaction between impression material and disinfectant began to appear in
dental literature in about 1980 and that quite frequently found for one or two decades. The research was
readily oriented towards two main areas which comprises the main requirement for a disinfectant, the
efficiency of disinfecting solution in eliminating the pathogens and influence of disinfection treatment on
the properties of impression material (Look et al., 1990). The critical qualities affected by disinfectant are
surface properties such as dental reproduction, surface roughness and dimensional alteration, (Melilli et
al., 2008). Hydrocolloids should be disinfected for a limited time period. Immersions are more secure than
spraying and self disinfecting materials are efficacious but better accompanied by immersion . Polyether
can be effectively disinfected by spraying. Long-term immersion of hydrophilic silicon may enhance their
absorption potential (Nandini, Vinitha and Smitha, 2013). Hydrophobic elastomerics materials can be
safely immersed in disinfectant and left for a long period. The possibility of unpredictable interaction
between various constituencies dictates that each newly marketed impression material must be tested for
compatibility with common disinfectant(Viveka et al., 2016). Investigation exploring the dimensional
changes of new material should be and some of them do, include a chemical disinfectant method in
experimental protocol, contributing to the establishment of disinfection process as a standard clinical
routine and promoting professional awareness of its necessity (Wood, 1992).
LIMITATIONS OF DISINFECTION
Some factors that limit the accuracy of impression material are different storage time, effect of
disinfectant, proportion of inorganic filler on the impression material. The disinfectant has toxicity,
handling problems, dimensional changes and alters the surface texture. Impression materials have a
limitation in flowing , hydrophilicity, short working time, poor tear strength and high cost.

FUTURE SCOPE:
1. Further more focus on dimensional alteration after long term (overnight) disinfection, which is
more conveniently incorporated in the clinical practice.
2. explores the effects of disinfection procedure on the dimensions of the tray, especially in relation
with the long term contact.
982
 European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 01, 2020

3. Specify the role of gypsum products used to make the cast on the final dimensional differentiation
which actually is the combined effect of impression material setting, disinfectant and gypsum
product setting .
CONCLUSION :
The disinfectant acts by destroying the bacteria present on the surface, suppresses their growth and the
ability to reproduce. The application of disinfectant on impression materials prevents the infection ,
contamination of laboratories and prevents cross infection to the dentist and other employees. Disinfectant
efficacy depends on the impression material used and microorganism present on the surface. The
disinfectant solution applied on impression material has the tendency to affect both the microorganism
and the accuracy, surface structure and stability.

AUTHORS CONTRIBUTIONS :
All authors have contributed equally to the study .
CONFLICT OF INTEREST :
The authors declare that there is no conflict of interest.

REFERENCES :

[1] Anusavice, K. J. (2003) Phillips’ Science of Dental Materials - eBook. Elsevier Health Sciences.
[2] Badrian, H. et al. (2012) ‘The effect of three different disinfection materials on alginate impression by
spray method’, ISRN dentistry. downloads.hindawi.com, 2012, p. 695151.
[3] Bergman, B., Bergman, M. and Olsson, S. (1985) ‘Alginate impression materials, dimensional
stability and surface detail sharpness following treatment with disinfectant solutions’, Swedish dental
journal. europepmc.org, 9(6), pp. 255–262.
[4] Birnbaum, D. (1995) ‘Cross Infection Control in Dentistry, a Practical Illustrated Guide PR Wood’,
Infection Control and Hospital Epidemiology, pp. 114–114. doi: 10.2307/30140953.
[5] Chakraborthy, A. et al. (2014) ‘Antioxidant and pro-oxidant activity of Vitamin C in oral
environment’, Indian journal of dental research: official publication of Indian Society for Dental Research,
25(4), pp. 499–504.
[6] Craig, R. G. (2006) Craig’s Restorative Dental Materials. Mosby.
[7] Davies, G. R. and Porra, M. (1994) ‘The need for post-vaccination serology and the timing of booster
vaccinations against hepatitis B in dental health care workers’, Australian Dental Journal, pp. 238–241.
doi: 10.1111/j.1834-7819.1994.tb04784.x.
[8] Dong, J. and Liang, X. (2009) Cross Infections: Types, Causes and Prevention. Nova Science Pub
Incorporated.
[9] Gheena, S. and Ezhilarasan, D. (2019) ‘Syringic acid triggers reactive oxygen species–mediated
cytotoxicity in HepG2 cells’, Human & Experimental Toxicology, pp. 694–702. doi:
10.1177/0960327119839173.
[10] Gupta, V. and Ramani, P. (2016) ‘Histologic and immunohistochemical evaluation of mirror image
biopsies in oral squamous cell carcinoma’, Journal of oral biology and craniofacial research, 6(3), pp.
194–197.
[11] Jangid, K. et al. (2015) ‘Ankyloglossia with cleft lip: A rare case report’, Journal of Indian Society of
Periodontology, p. 690. doi: 10.4103/0972-124x.162207.
[12] Jayaraj, G. et al. (2015) ‘Inter-observer agreement in grading oral epithelial dysplasia – A systematic
review’, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, pp. 112–116. doi:
10.1016/j.ajoms.2014.01.006.
983
 European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 01, 2020

[13] Jayaraj, G. et al. (2015) ‘Stromal myofibroblasts in oral squamous cell carcinoma and potentially
malignant disorders’, Indian Journal of Cancer, p. 87. doi: 10.4103/0019-509x.175580.
[14] Johansen, R. E. and Stackhouse, J. A., Jr (1987) ‘Dimensional changes of elastomers during cold
sterilization’, The Journal of prosthetic dentistry, 57(2), pp. 233–236.
[15] Johnson, G. H. et al. (1998) ‘Dimensional stability and detail reproduction of irreversible
hydrocolloid and elastomeric impressions disinfected by immersion’, The Journal of Prosthetic Dentistry,
pp. 446–453. doi: 10.1016/s0022-3913(98)70160-x.
[16] Kumar, M. D. A. and Gheena, S. (2015) ‘Incidence of dry socket after third molar extraction’,
Research journal of pharmaceutical, biological and chemical sciences. Journal of Pharmaceutical Sciences
and Research, 7(7), p. 451.
[17] Leung, R. L. and Schonfeld, S. E. (1983) ‘Gypsum casts as a potential source of microbial cross-
contamination’, The Journal of Prosthetic Dentistry, pp. 210–211. doi: 10.1016/0022-3913(83)90503-6.
[18] Look, J. O. et al. (1990) ‘Preliminary results from disinfection of irreversible hydrocolloid
impressions’, The Journal of Prosthetic Dentistry, pp. 701–707. doi: 10.1016/0022-3913(90)90329-b.
[19] Martin, N., Martin, M. V. and Jedynakiewicz, N. M. (2007) ‘The dimensional stability of dental
impression materials following immersion in disinfecting solutions’, Dental Materials, pp. 760–768. doi:
10.1016/j.dental.2007.01.004.
[20] Melilli, D. et al. (2008) ‘The effect of immersion disinfection procedures on dimensional stability of
two elastomeric impression materials’, Journal of Oral Science, pp. 441–446. doi: 10.2334/josnusd.50.441.
[21] Milward, P. J. and Waters, M. G. (2001) ‘The effect of disinfection and a wetting agent on the
wettability of addition-polymerized silicone impression materials’, The Journal of Prosthetic Dentistry, pp.
165–167. doi: 10.1067/mpr.2001.116774.
[22] Nandini, Y., Vinitha, K. B. and Smitha, M. (2013) ‘Comparison of Dimensional Accuracy of Four
Different Die Materials before and after Disinfection of the Impression: An in vitro Study’, The Journal of
Contemporary Dental Practice, pp. 668–674. doi: 10.5005/jp-journals-10024-1383.
[23] Nespraydko, V. P. Et Al. (2015) ‘[Evaluation Of Changes Of Geometrical Parameters Of Alginate
Dental Impressions Due To The Influence Of Chemical And Microwave Disinfection Method Using 3d
Technologies]’, Likars’ka Sprava / Ministerstvo Okhorony Zdorov'ia Ukrainy, (7-8), Pp. 117–123.
[24] Pasini, G., Boscarioli, A. P. T. and Pinto, P. G. (2010) ‘The influence of disinfectant agents on the
dimensional stability of elastomeric impression materials and surface durability of odontological
Gypsum’, Brazilian Dental Science. doi: 10.14295/bds.2002.v5i1.139.
[25] Peutzfeldt, A. and Asmussen, E. (1990) ‘Effect of disinfecting solutions on surface texture of
alginate and elastomeric impressions’, Scandinavian journal of dental research, 98(1), pp. 74–81.
[26] Poulis, N. (2016) ‘Preliminary SEM Observations on the Surface of Elastomeric Impression
Materials after Immersion or Ozone Disinfection’, JOURNAL OF CLINICAL AND DIAGNOSTIC
RESEARCH. doi: 10.7860/jcdr/2016/20330.8949.
[27] Pratten, D. H. (1987) Wettability and Wetting Behavior of Elastomeric Impression Materials: A
Thesis Submitted in Partial Fulfillment ... Biomaterials ..
[28] Premkumar, J. et al. (2014) ‘Detection of species diversity in oral candida colonization and anti-
fungal susceptibility among non-oral habit adult diabetic patients’, Journal of natural science, biology, and
medicine, 5(1), pp. 148–154.
[29] Rai, R., Easwaran, M. A. and Dhivya, K. T. (2017) ‘Comparative Study to Evaluate the Surface
Detail Reproduction of Dental Stone after Immersion in Various Different Disinfectant Solutions, Under
Stereomicroscope 10 X Magnification –An In-Vitro Study’, International Journal of Pharmaceutical and
Clinical Research. doi: 10.25258/ijpcr.v9i3.8316.

984
 European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 01, 2020

[30] Ramer, M. S., Gerhardt, D. E. and McNally, K. (1993) ‘Accuracy of irreversible hydrocolloid
impression material mixed with disinfectant solutions’, Journal of prosthodontics: official journal of the
American College of Prosthodontists, 2(3), pp. 156–158.
[31] Rueggeberg, F. A. et al. (1992) ‘Sodium hypochlorite disinfection of irreversible hydrocolloid
impression material’, The Journal of Prosthetic Dentistry, pp. 628–631. doi: 10.1016/0022-
3913(92)90160-c.
[32] Savabi, G. et al. (2018) ‘Prevention of cross-contamination risk by disinfection of irreversible
hydrocolloid impression materials with ozonated water’, International Journal of Preventive Medicine, p.
37. doi: 10.4103/ijpvm.ijpvm_143_16.
[33] Sherlin, H. et al. (2015) ‘Expression of CD 68, CD 45 and human leukocyte antigen-DR in central
and peripheral giant cell granuloma, giant cell tumor of long bones, and tuberculous granuloma: An
immunohistochemical study’, Indian Journal of Dental Research, p. 295. doi: 10.4103/0970-9290.162872.
[34] Shree, K. H. et al. (2019) ‘Saliva as a Diagnostic Tool in Oral Squamous Cell Carcinoma – a
Systematic Review with Meta Analysis’, Pathology & Oncology Research, pp. 447–453. doi:
10.1007/s12253-019-00588-2.
[35] Silva, S. M. L. M. da and Salvador, M. C. G. (2004) ‘Effect of the disinfection technique on the
linear dimensional stability of dental impression materials’, Journal of applied oral science: revista FOB,
12(3), pp. 244–249.
[36] Soganci, G. et al. (2018) ‘3D evaluation of the effect of disinfectants on dimensional accuracy and
stability of two elastomeric impression materials’, Dental materials journal, 37(4), pp. 675–684.
[37] Sridharan, G. et al. (2019) ‘Evaluation of salivary metabolomics in oral leukoplakia and oral
squamous cell carcinoma’, Journal of Oral Pathology & Medicine, pp. 299–306. doi: 10.1111/jop.12835.
[38] Sridharan, G., Ramani, P. and Patankar, S. (2017) ‘Serum metabolomics in oral leukoplakia and oral
squamous cell carcinoma’, Journal of Cancer Research and Therapeutics, p. 0. doi:
10.4103/jcrt.jcrt_1233_16.
[39] Swathy, S., Gheena, S. and Varsha, S. L. (2015) ‘Prevalence of pulp stones in patients with history of
cardiac diseases’, Research Journal of Pharmacy and Technology, p. 1625. doi: 10.5958/0974-
360x.2015.00291.7.
[40] Thangaraj, S. V. et al. (2016) ‘Molecular Portrait of Oral Tongue Squamous Cell Carcinoma Shown
by Integrative Meta-Analysis of Expression Profiles with Validations’, PloS one, 11(6), p. e0156582.
[41] Thouati, A. et al. (1996) ‘Dimensional stability of seven elastomeric impression materials immersed
in disinfectants’, The Journal of Prosthetic Dentistry, pp. 8–14. doi: 10.1016/s0022-3913(96)90338-8.
[42] Varghese, K. (2008) ‘Infection Control in Dental Practice’, A Practical Guide to Hospital Dentistry,
pp. 111–111. doi: 10.5005/jp/books/10018_8.
[43] Viveka, T. S. et al. (2016) ‘p53 Expression Helps Identify High Risk Oral Tongue Premalignant
Lesions and Correlates with Patterns of Invasive Tumour Front and Tumour Depth in Oral Tongue
Squamous Cell Carcinoma Cases’, Asian Pacific Journal of Cancer Prevention, pp. 189–195. doi:
10.7314/apjcp.2016.17.1.189.
[44] Wood, P. R. (1992) Cross Infection Control in Dentistry: A Practical Illustrated Guide. Mosby.

985