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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 14
| Issue : 2 | Page : 141-148 |
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A Study to Evaluate and Compare the Dimensional Stability of Aluwax upon Moist Heat and Dry Heat Treatment at Different Time Intervals
Vinita Rajesh Sippy, Chethan Hegde
Department of Prosthodontics and Crown & Bridge, AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India
| Date of Submission | 01-Oct-2022 |
| Date of Decision | 17-Nov-2022 |
| Date of Acceptance | 28-Nov-2022 |
| Date of Web Publication | 10-Jan-2023 |
Correspondence Address:
Dr. Vinita Rajesh Sippy
Department of Prosthodontics and Crown & Bridge, AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Deralakatte, Mangaluru, Karnataka, 575018
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jofs.jofs_241_22
Introduction: The key to a successful prosthesis is the accurate transfer of the maxillo–mandibular relationship to an articulator.Evaluating and comparing the dimensional stability of Aluwax upon moist heat and dry heat treatment at different time intervals. In vitro study. Materials and methods: A total of 26 samples were included and were divided into two groups based on the heat treatment of Aluwax. Thirteen Aluwax bite wafers were manipulated using moist heat treatment and 13 with dry heat treatment. Dimensional changes were recorded using stereomicroscope at intervals of 0, 24, and 48 hours. The level of significance was fixed at 5%, and P ≤ 0.05 was considered statistically significant. Kolmogorov–Smirnov test was employed to test the normality of data. Kruskal Wallis test, post hoc analysis, and independent sample t test were performed for the quantitative variables. Results: The dimensional changes upon moist heat treatment at 0, 24, and 48 hours were 0.043 ± 0.011, 0.036 ± 0.009, and 0.0320 ± 0.008, respectively and upon dry heat treatment were 0.027 ± 0.010, 0.023 ± 0.009, and 0.0165 ± 0.009, respectively. Conclusion: Within the limitations of the present study, dry heat treatment of Aluwax showed less dimensional changes as compared to moist heat treatment. Maximum change was noted immediately following moist heat manipulation; storage up to 48 hours did not induce any further increase in distortion.
Keywords: Aluwax, dimensional changes, dimensional stability, interocclusal
How to cite this article:
Sippy VR, Hegde C. A Study to Evaluate and Compare the Dimensional Stability of Aluwax upon Moist Heat and Dry Heat Treatment at Different Time Intervals. J Orofac Sci 2022;14:141-8 |
How to cite this URL:
Sippy VR, Hegde C. A Study to Evaluate and Compare the Dimensional Stability of Aluwax upon Moist Heat and Dry Heat Treatment at Different Time Intervals. J Orofac Sci [serial online] 2022 [cited 2023 Jun 9];14:141-8. Available from: https://www.jofs.in/text.asp?2022/14/2/141/367444 |
| Introduction | |  |
The key to a successful prosthesis is the accurate transfer of the maxillo–mandibular relationship to an articulator. Patients willing for prosthetic rehabilitation may have improper intercuspation with no stability in rest of the dentition.[1] So it becomes difficult for the operator to transfer a reproducible relation onto the articulator. The use of interocclusal records helps to achieve horizontal stability while transferring casts onto the articulator. Errors in recording the same may lead to discrepancies in fabrication of the final prosthesis.[2]
According to Warren and Capp, the principal approach is to make an interocclusal record at correct occlusal vertical dimension and choosing an accurate dimensionally stable recording material.[3] Interocclusal recording material is basically an impression material with altered properties to improve the handling and manipulation characteristics. Incorporation of plasticizers and catalyst to these impression materials improves the dimensional stability and accuracy of the record.[4]
The ideal properties of interocclusal record includes biocompatibility to oral tissues, easy manipulation, accurate recording, ease of verification, resistance to compression, dimensional stability, and reduced initial resistance to closure.[5] The clinician also should have correct knowledge about interocclusal materials available and the techniques of manipulation of material to achieve a high-quality final restoration with reduced intraoral occlusal discrepancy.[6]
An important characteristic of an interocclusal record is the viscoelasticity and flow properties of the material as it plays an important role in reproducing accurate surface detail.[7]
Over the years, several recording materials and techniques have been known to clinicians, of which, the first and the oldest material was impression plaster introduced by Philip Pfaff in 1956. Other materials include modeling compound, wax, acrylic resin, zinc oxide-eugenol pastes, and silicone material. Recent materials include polyether and polyvinyl siloxane.[8] Inaccuracy of the record leading to distortion of the registration is very common due to release of internal stresses.[9]
To overcome this inaccuracy, the use of metalized wax, namely, Aluwax became popularized which comprised of impregnated aluminum particles added to wax, thereby reducing the thermal coefficient of expansion. It helps in uniform distribution of heat and also prevents excessive contraction on cooling.[10]
The two techniques most commonly used for manipulation of Aluwax are moist heat, which involves using a water bath and dry heat, which involves heating of wax using micro torch. Because there is no evidence in literature comparing the dimensional changes based on different manipulation techniques of Aluwax, this study was conducted to evaluate any variations in dimensional stability upon being subjected to different manipulation techniques.
To evaluate and compare the dimensional stability of Aluwax upon moist and dry heat treatment at different time intervals.
The objectives of the study are: (1) To evaluate and compare the dimensional changes of Aluwax at intervals of 0, 24, and 48 hours, respectively using moist heat. (2) To evaluate and compare the dimensional changes of Aluwax at intervals of 0, 24, and 48 hours, respectively using dry heat. (3) To compare the dimensional changes of Aluwax using moist and dry heat at intervals of 0, 24, and 48 hours, respectively.
Null hypothesis
There are no significant dimensional changes of Aluwax upon moist and dry heat treatment at different time intervals.
Alternate hypothesis
There is significant dimensional changes and variation of Aluwax upon moist and dry heat treatment at different time intervals.
| Materials and Methods | | |
Armamentarium used [Figure 1]
Stereomicroscope − Lawrence and Mayo.
Coslab camera.
Typhodont models (iDENTical Nissin type typhodont jaw set M8012).
Thermoplastic wax (Aluwax Dental Products Co., USA).
Semiadjustable articulator (Arcon Artex AP Articulator, Amann Girrbach AG).
Micro torch.
Applications used
Scope Image 9.0.
Miotic 2.0.
Methodology
Ethical approval of the study (protocol no. ABSM/EC/37/2020) was provided by Ethics committee of A B shetty dental college and hospital, Mangalore on 3rd march 2020. A total number of 26 samples were to be included in this study. These samples were split into two groups based on the type of heat treatment: Group 1–13 Aluwax bite wafers subjected to moist heat treatment and Group 2–13 Aluwax bite wafers subjected to dry heat treatment. The sample size for this study was calculated using G* Power sample size calculator at 95% confidence level and 90% power.
A typhodont model was mounted on a semiadjustable articulator to facilitate accurate recording of jaw relations. Reference points were made on the mesiobuccal and mesiopalatal cusps tips of maxillary first molar [Figure 2] using a yellow band needle tapered bur (Mani Burs; TR-11EF; ISO 199/016). Under stereomicroscope [Figure 3], the original distance between the two reference points was measured as 7.39 mm (L1). Lucia jig was fabricated on the maxillary central incisors to provide anterior stop and create 3-mm interocclusal space to facilitate making of interocclusal bite record of Aluwax and to record the jaw relations [Figure 4]. | Figure 2 Reference points made on the cusp tips of maxillary molar typhodont tooth model.
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 | Figure 3 Distance between the reference points measured using the stereomicroscope.
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 | Figure 4 Fabrication of lucia jig on the maxillary central incisors to create a complete disocclusion of 3 mm.
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For recording the jaw relations with Aluwax using moist heat, the bite wafers were manipulated by immersing in water bath at 42 to 45 °C for 3 to 5 minutes. On removal from the water bath, bite wafers were precisely positioned over the maxillary arch of the typhodont model and the articulator was completely closed till the Lucia jig fabricated on maxillary central incisors touch the lower anterior teeth [Figure 5]. Similar technique of recording Aluwax with dry heat treatment was followed. In case of dry heat manipulation technique, the wax was warmed using butane torch. The torch enabled to efficiently heat the wax in and around the areas needed to record the teeth, thus reducing volumetric shrinkage and contraction. The technique of dry heat manipulation using butane torch required application of heat gradually in multiple additions to prevent the surface wax from melting too rapidly. The wax bite was flamed on both the sides till a slight shine on the wax record was achieved. | Figure 5 U-shaped bite wafers are precisely positioned over the maxillary arch of the typhodont model and the articulator is completely closed till the lucia jig fabricated on maxillary central incisors touch the lower anterior teeth, thereby creating a uniform amount of disocclusion throughout (3 mm).
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Following this, the entire articulator assembly along with bite wafers was placed in a water bath of 36 °C to stimulate the exact oral environment till the wax hardened. Upon removal of the Aluwax record from the articulator, the linear distance between the reference points on the record was measured using a stereomicroscope. The images were captured using Coslab camera and Scope Image 9.0 software, and the distance between the reference points was measured using the Miotic 2.0 software [Figure 6]. For each sample, three readings were noted, and the mean of these readings was calculated (L2). | Figure 6 Distance between the reference points on the Aluwax bite record measured using the stereomicroscope after a particular heat treatment.
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Dimensional change was calculated by the formula:
where, ΔL= dimensional change of Aluwax bite wafer.
L1 = the original distance between the reference points, that is, 7.39 mm
L2 = final distance between the reference points on the Aluwax bite wafer following heat treatment.
Dimensional changes of Aluwax were measured at 0, 24, and 48-hour intervals. In between the days of observation, the Aluwax records were stored in an air sealed containers at room temperature. Following this, the data were formulated and statistical analysis was performed.
Statistical analysis
The data collected were entered in Microsoft Excel and subjected to statistical analysis using Statistical Package for Social Sciences (SPSS, IBM version 20.0). The level of significance was fixed at 5% and P ≤ 0.05 was considered statistically significant. Kolmogorov–Smirnov test was employed to test the normality of data. Kruskal Wallis test, post hoc analysis, and independent sample t test were performed for the quantitative variables.
| Results | | |
The dimensional changes of Aluwax upon moist heat treatment showed immediate expansion of 0.043 ± 0.011 upon making of bite records; however, after 24 and 48 hours, this change in dimension reduced to 0.036 ± 0.009 and 0.032 ± 0.008. These variations in dimensions were statistically significant compared to original dimension (P value 0.017) [Table 1]. | Table 1 Evaluation and comparison of dimensional changes of Aluwax at intervals of 0, 24, and 48 hours using moist heat
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Post hoc analysis revealed statistically significant shrinkage in the dimensions of Aluwax upon moist heat treatment after 48 hours as compared to dimension immediately following making of wax record (P value 0.026) [Table 1a]. | Table 1a The variations in dimensional changes of Aluwax upon moist heat treatment was done using Post hoc analysis
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Immediately following the making of bite records, an expansion of 0.027 ± 0.010 was noted; however, after 24 and 48 hours the change in the dimension reduced to 0.023 ± 0.009 and 0.0165 ± 0.009. These changes in dimensions were found to be statistically significant compared to original dimension (P value 0.033) [Table 2]. | Table 2 Evaluation and comparison of dimensional changes of Aluwax at intervals of 0, 24, and 48 hours using dry heat
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Post hoc analysis revealed statistically significant shrinkage in the dimensions of Aluwax upon dry heat treatment after 48 hours compared to dimension recorded immediately following making of record (P value 0.025) [Table 2a]. | Table 2a The variations in dimensional changes of Aluwax upon dry heat treatment was done using Post hoc analysis
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Aluwax upon moist heat manipulation showed significantly higher dimensional change compared to dry heat at various time.
| Discussion | | |
The main objectives of oral rehabilitation include achieving optimum functional efficiency, basic oral health, comfort, and appropriate esthetics. For fabrication of a prosthetic restoration, it is necessary to accurately and precisely record, transfer, and articulate the preliminary or working casts onto the articulator to avoid any discrepancies of the final restoration.[8]
In certain conditions, the teeth are unable to achieve vertical and horizontal stability between the arches. It is a routine practice to make centric relation record without opposing teeth contact in order to prevent the influence of any tooth interference affecting closure of mandible to centric occlusion. Hence, there is a need for interocclusal recording material with good dimensional stability to precisely record the existing jaw relationship of the stomatognathic system and transfer the same to articulator.[1]
According to GPT-9, an interocclusal record is defined as "registration of the positional relationship of the opposing teeth or arches; a record of the positional relationship of teeth and jaws to each other."[11] Several recent advancements in interocclusal recording materials with varying characteristics and properties have put the clinician in dilemma with regards to choice of material to be used.[4] Other than operator’s clinical ability and the choice of interocclusal recording material, the technique followed for recording and manipulation also plays an important role in determining the final outcome of the prosthesis.[4]
Pagano et al., in their study, stated that interocclusal record should have certain functions: providing stability of the casts during articulation, reduce the chairside time of final prosthesis, avoid chances of fabrication of prosthesis with hyper occlusion or infra occlusion, and prevent possibility of perforation or those needing excessive occlusal adjustment.[12]
Aluwax is a low-viscosity wax consisting of impregnated aluminum particles that act as a good conductor of heat. Thus, heat is uniformly distributed throughout the record preventing excessive contraction on cooling. According to the survey conducted by Maru et al., it has been concluded that practitioner’s attitude toward the use of interocclusal recording materials is found to be deviated from well-acknowledged prosthodontic quality guidelines. Most of the practitioners preferred Aluwax (54.6%) as an interocclusal recording material over polyvinylsiloxane and polyether. This may be attributed to the fact that Aluwax is easier to manipulate, commercially available, and has an adequate working time and low cost as compared to other materials.[13]
Because Aluwax is the most commonly preferred interocclusal recording material by the clinicians, a thorough knowledge of its manipulation and handling techniques should be available to reduce the chances of errors in fabrication of prosthesis.[4] The two most commonly known techniques used for manipulation of Aluwax is moist heat technique using a water bath and dry heat technique using a micro torch. Because there are no studies in literature focusing on the superior nature of either technique, our study was conducted to evaluate the dimensional changes of Aluwax between both the techniques.
Aluwax is thermoplastic in nature with high coefficient of thermal expansion and is susceptible to dimensional changes under constant pressure due to its high flow rate.[7] As there are no in vitro studies in literature considering the dimensional changes of Aluwax based on replicating oral condition and environment of the patient, our study focused on carrying out the dimensional changes of Aluwax based on two commonly used manipulation techniques stimulating the oral conditions similar to closure of mandibular arch against maxillary under pressure.
The studies done by other authors till date on dimensional changes of Aluwax have used the die moulds for making of Aluwax records using moist heat treatment. This predimensioned Aluwax mould was used as a reference to calculate the dimensional changes and amount of shrinkage on further storage. Our study focused on simulating and replicating the intraoral conditions of the patient to a great extent.
It is very interesting to note that an initial expansion in the linear dimension of the bite records was noted as compared to the original distance between the reference points of 7.39 mm irrespective of the manipulation techniques used. This expansion is a result of thermal coefficient of wax and pressure or force applied. The dimensional change of Aluwax in our study immediately after moist heat and dry heat treatment was noted as 0.043 ± 0.011 and 0.027 ± 0.010, respectively. In studies done by several authors Anup et al.[14] and Gurav et al.,[8] the dimensional change of Aluwax was measured using a specific die mould (ADA Specification No. 19) as reference followed by calculation of the linear dimensional change at different time intervals. In their study, the dimensional change of Aluwax immediately after making of records, which is influenced by thermal expansion and closing pressure was not considered. Further, all the studies conducted used linear or circular block of wax, whereas in our study, U-shaped wax wafer is used as in clinical condition.
Numerous factors play a role in determining the dimensional changes of the interocclusal record, of which the major ones include loss of volatile substance over time. In a study done by Michalakis et al., existence of a positive correlation was noted between the linear changes and weight of the record due to loss of volatile substances over a period of time.[15] In the current study, shrinkage was noted only after 24 and 48 hours of storage upon moist heat treatment (P value 0.017) and dry heat treatment (P value 0.033) [Tables 1 and 2].{Table 2}
Another factor which might be attributed for the amount of dimensional change of Aluwax is distortion due to release of internal stresses.[22] In our study, a statistically significant shrinkage in the dimension of Aluwax was noted upon moist heat and dry heat treatment up to 48 hours as compared to dimension immediately following making of wax record (P value 0.026, 0.025). Our results were found to be in correlation with a study done by Anup et al., where greatest distortion or shrinkage of Aluwax was noted at 72 hours, followed by 48, 24, and 1 hour with dimensional changes of 0.79 ± 0.08, 0.67 ± 0.09, 0.49 ± 0.06, and 0.23 ± 0.11, respectively. The difference in the values as compared to our study may be due to the difference in methodologies performed.
The time intervals used in this study were 0 (immediately), 24, and 48 hours which were based on the time needed to transfer the record to a distant lab or due to delay in articulation of the casts. In the present study, the dimensional change of Aluwax on moist heat treatment immediately after making of the record and at 48-hour interval was noted as 0.043 ± 0.011 and 0.0320 ± 0.008, respectively (P value 0.017), whereas dimensional change of Aluwax on dry heat treatment immediately after making of the record and at 48-hour interval was noted as 0.027 ± 0.010 and 0.0165 ± 0.009, respectively (P value 0.033) [Tables 1 and 2] which were found to be statistically significant. This result is in agreement with the studies performed by Shrunik, Millstein et al., Vergos et al., Michalakis et al., Karthikeyan et al., Ghazal, Pipko et al., Anup, Gupta.[14],[15],[16],[17],[18],[19],[20],[21],[22]
There are several studies in literature discussing the effect of storage time and influence of storage media on the dimensional stability and accuracy of interocclusal material. Millstein et al.[17] in their study concluded that water storage of wax records showed greater dimensional change as compared to air-cooled records. Hence, in our study the Aluwax records were stored in airtight sealed containers at room temperature to incorporate least amount of dimensional change. Exact reproduction of original wax recording was never achieved.
Significantly higher distortion was also noted with moist heat treatment when compared with dry heat treatment at 0 hour (immediately after making of record) 0.043 ± 0.011 and 0.027 ± 0.010 (P value 0.001), at 24 hours 0.036 ± 0.009 and 0.023 ± 0.009 (P value 0.002), and at 48 hours 0.0320 ± 0.008 and 0.0165 ± 0.009, respectively (P value 0.001) ([Table 3]). Increased dimensional change in moist heat as compared to dry heat manipulation is likely due to leaching out of ingredients into water in moist heat manipulation.[15] However, the above-mentioned discrepancy of less was very marginal and did not influence clinical outcome of indirectly fabricated restoration. | Table 3 Comparison of dimensional changes of Aluwax using moist and dry heat at intervals of 0, 24, and 48 hours
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The values obtained from this study indicate that moist heat treatment shows more amount of dimensional changes as compared to dry heat treatment [Graph 1]. Immediately following making of interocclusal record, there is marginal expansion followed by shrinkage. So based on our results, it is noted that dry heat manipulation shows reduced dimensional change compared to moist heat. But as these discrepancies may not induce any significant clinical error, both the techniques can be used for making interocclusal records. Dry heat manipulation is faster but needs good clinical skill; however, moist heat manipulation is easy to perform but more time consuming.
It is worthwhile to note that even though distortions with Aluwax is higher when compared to Polyvinyl Silicone interocclusal materials, it was very much within the allowed distortion limits as per ADA specification.[23] Hence, Aluwax can be successfully used as an effective interocclusal material of choice with advantages of both technique: moist and dry heat manipulation.
Limitations of the study
Standardization for applying force to the Aluwax bite record was not done. Comparison for various media for storage of bite records was not done in the present study.
Moreover, more clinical studies to evaluate its effects on final restorations are needed.
| Conclusions | | |
Within the limitations of the current study, dry heat treatment of Aluwax showed significant decreased dimensional changes as compared to moist heat treatment. Immediately following the manipulation, distortion was noticed in the form of expansion whereas on storage over a period of time up to 48 hours, a considerable amount of shrinkage was noticed.
Financial support and sponsorship
Nil.
Conflicts of interest
The authors report no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 1a], [Table 2], [Table 2a], [Table 3]
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