J Interdiscip Dentistry
Home | About JID | Editors | Search | Ahead of print | Current Issue | Archives | Instructions |
Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 309  | Login  | Contact us | Advertise | Subscribe  


 
Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 105-110

Comparison of tensile and tear strength of three silicone materials for maxillofacial prosthesis in Indian climatic condition


Department of Prosthodontics and Crown and Bridge, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

Date of Submission05-Jun-2020
Date of Acceptance14-Sep-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Anoop Sharma
Department of Prosthodontics and Crown and Bridge, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru - 560 054, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jid.jid_41_20

Rights and Permissions
   Abstract 


Aims: The aim of the study was to evaluate and compare physical properties such as tensile strength and tear strength of three commonly used silicone maxillofacial materials in Indian climatic condition. Settings and Design: An in vitro study was conducted to compare the tensile and tear strength using a universal testing machine with 100 N load at a speed of 20 mm/min. Specimens were prepared from three commercially available silicones, i.e., medical grade silicone (control group), prosthetic grade silicone (test Group 1), and a locally available medical grade silicone (test Group 2). One-way analysis of variance was carried out to test any significant difference between the mean values of tensile and tear strength between the tested materials. Post hoc test of Tukey was used to find which of the two groups' means shows a significant difference. Results: Prosthetic grade silicone showed the highest tensile strength with a P< 0.001* among the two tested materials. Tear strength and mean elongation was highest in control showing statistically significant results (<0.001*). Locally available medical grade silicone showed the least favorable properties among all the tested materials, though tensile strength was within acceptable range. Conclusions: Tensile strength of prosthetic silicone was highest followed by medical grade, whereas tear strength and elongation were maximum in medical grade silicone. Locally available medical grade silicone showed the least favorable properties.

Keywords: Maxillofacial material, mechanical properties, room temperature vulcanized silicones


How to cite this article:
Shetty V, Sharma A, Mishra S. Comparison of tensile and tear strength of three silicone materials for maxillofacial prosthesis in Indian climatic condition. J Interdiscip Dentistry 2020;10:105-10

How to cite this URL:
Shetty V, Sharma A, Mishra S. Comparison of tensile and tear strength of three silicone materials for maxillofacial prosthesis in Indian climatic condition. J Interdiscip Dentistry [serial online] 2020 [cited 2021 Jul 24];10:105-10. Available from: https://www.jidonline.com/text.asp?2020/10/3/105/304154




   Clinical Relevance to Interdisciplinary Dentistry Top


Silicone being the mostly commonly used material in the field of maxillofacial prosthesis, orthopedics and cosmetics does require modification as per indian climatic conditions


   Introduction Top


The face is the identity of an individual; therefore, a facial deformity has an extreme psychosocial impact. Maxillofacial prostheses are the prosthesis used to replace part or all of any stomatognathic and/or craniofacial structures.[1] Mimicking facial structure is challenging in terms of comfort, color, and function. Earlier prostheses were made using wood, wax, and metal, but in 1901, Upham used vulcanite rubber to replace nasal and auricular defects. Later, latex rubber and glycerin-gelatin were introduced for the same.[2]

Since 25 years, room temperature vulcanized (RTV) silicones have taken a commonplace in the fabrication of maxillofacial prosthesis but have certain limitations.[3] Literature shows that frequent re-fabrication of prosthesis is required, especially in tropical climatic conditions. Therefore, this study was targeted at identifying changes in the material that could happen in tropical climates and serve as a guide for possible modifications.

Settings and Design

An in vitro study was conducted in the Department of Prosthodontics and Crown and Bridge, Faculty of Dental Sciences, Bangalore (Karnataka, India). Based on literature, a sample size of ten in each group was chosen to get a 95% power of the study.

The samples were fabricated from the most common three commercially available silicone elastomers being medical grade (Technovent limited, UK) – control group, prosthetic grade (Link Composites, India) – test Group 1 and locally available medical grade silicone (M P SAI enterprise Pvt Ltd., India) – test Group 2 [Figure 1]. The type of chemical reaction and processing conditions of each material is shown in [Table 1]. According to ASTM No. D4123 and D624 specifications, the dumbbell samples and unnicked 90° angle samples were made, and for standardization, metal mold was used for fabrication of the samples [Figure 2] and [Figure 3].
Figure 1: Three silicones used in this study

Click here to view
Figure 2: Dimensions of dumbbell tensile test specimen. (a) 75mm, (b) 12.5 ± 1, (c) 25 ± 1, (d) 4 ± 0.1, (e) 8 ± 0.5, (f) 12.5 ± 1.0

Click here to view
Figure 3: Dimension of unnicked 90° angle specimen for tear strength. (a) 102 mm, (b) 19 mm, (c) 19 mm, (d) 12.7 mm, (e) 25 mm, (f) 27 mm, (g) 28 mm, (h) 51 mm

Click here to view
Table 1: Material used in the study

Click here to view


Sample preparation

  • Control group – Using a 300 g weighing machine (Tangent KP 104), base and catalyst were mixed in a ratio of 10:1 according to manufacturer's instructions on a ceramic tile with stainless steel spatula, in a sweeping motion until no air bubble was seen. Subsequently, it was packed into the dumbbell and unnicked 90° stainless steel mold, load of 1 kg was applied to remove any excess material, and the molds were kept for 1 h at 100°C for polymerization
  • Test Group 1 – Similar to the fabrication of a previous sample, prosthetic grade silicone was mixed and packed into the mold, which was kept at room temperature for 24 h for polymerization of the material
  • Test Group 2 – As it is a premixed material which is supplied in a tube, the material was squeezed out of the tube and spread on a ceramic tile with stainless steel spatula. After packing, the excess material was removed from the stainless steel mold and was kept at room temperature for 24 h for complete polymerization.


Parameters measured

  • Tensile strength – According to ASTM, specimens of dumbbell shape with dimension 100 mm × 80 mm and 2 mm and thickness 1.8 mm was used for evaluating tensile strength
  • Tear strength was evaluated with 90° angle-shaped specimens free of nicks with a thickness of 1.8 mm, which is a modification of the test specimen described by ASTM D624 (standard test method for rubber property–tear resistance)
  • Elongation – above specimens were also used to check stretchability in tensile and tear stress.


All the thirty samples were subjected to Universal Testing Machine with a loading cell of 100 N at a speed of 20 mm/min for the evaluation of the above parameters [Figure 4].
Figure 4: (a) Dumbbell-shaped samples mounted on UTM machine for tensile strength evaluation. (b) Broken samples showing maximum stretch. (c) 90° angle-shaped specimens free of nicks mounted on UTM machine for tear strength evaluation. (d) Teared sample showing maximum stretch

Click here to view



   Results Top


Tensile strength

Among all the materials tested, the test Group 1 showed the highest tensile strength of 55.06Mpa, whereas test Group 2 had the least tensile strength of 12.06Mpa as shown in [Figure 5]. Tukey's HSD post hoc test showed a significant (P ≤ 0.001*), the mean difference in tensile strength between three groups. The control group had a mean difference of −17.50 Mpa when compared to test group 1, whereas when the control group was compared with test Group 2, the mean difference 25.50 Mpa was noticed. Mean elongation in tensile strength of the control group was the highest (102.7 mm) followed by test Group 2 (80.02 mm), as shown in [Figure 6], which was statistically significant (P ≤ 0.001*).
Figure 5: Comparison of mean in tensile strength between three groups

Click here to view
Figure 6: Comparison of mean elongation in tensile strength between three groups

Click here to view


Tear strength

Group 1 showed the largest mean difference of 13.80 Mpa and mean elongation of 155.64 Mpa as compared to the entire tested group [Figure 7] and [Figure 8]. Tukey's HSD post hoc test revealed that mean difference among the control group and Group 1 was 114.65 Mpa, whereas in control group and Group 2 was 108.22 Mpa. This mean difference was found to be statically significant (P ≤ 0.001*).
Figure 7: Comparison of mean in tear strength between three groups

Click here to view
Figure 8: Comparison of mean elongation in tear strength between three groups

Click here to view



   Discussion Top


The main objective of maxillofacial prosthesis is to reduce morbidity and suffering of the patient by improving his quality of life.[4] The prosthetic substitute must replace the lost anatomy that looks normal, both topographically and optically and should become a part of the adjacent tissue. Considerable skill and experience are required to create such a prosthesis. To achieve all these requirements, choice of material for the fabrication of prosthesis plays a critical role. Barnhart in 1960 demonstrated the use of silicone elastomers for facial prostheses.[5] Literature quotes many advances in the field of maxillofacial material such as polymethylmethacrylate, polyvinyl chloride and copolymers, polyurethane elastomers, silicone elastomers, silicone block copolymers, and polyphosphazene.[3] Unfortunately, all these maxillofacial prosthetic materials come with some or the other disadvantages, till now no material has been found that can fulfill all the ideal requirements.[6] This is further exaggerated in the tropical climatic conditions. Little is known about the physical properties of the materials under the above circumstances. A systematic review and meta-analysis done by Rahman AM et al. in 2018 concluded that the scientific evidence on the physical properties of maxillofacial material in Asian countries is very limited, where climatic conditions are very different than the climatic condition where these materials are manufactured.[7]

This study evaluated conventionally used medical grade silicone, prosthetic grade, and locally available medical grade silicones. Medical grade silicone (Technovent M51) is imported from the United Kingdom was used as a control group as it is widely used maxillofacial material in India.[8] The climatic condition between India and the UK differs, the average climatic condition in a temperate control environment like the United Kingdom is 18°C–20°C with a humidity level of 73%, whereas in India, the average temperature is 32°C–40°C with a humidity of 65%–70%. Therefore, patients show a failed MFP due to loss of color matching and tear along the edges. This tear along the edges could be due to repeated insertion and removal of the prosthesis causing fatigue or it could be due to change in the properties of the material due to the weather condition. This not only requires a frequent refabrication of the prosthesis but also adds as a financial burden for the patient. Thus, it is imperative for the maxillofacial material to not only fulfill the physical and mechanical requirements suited to our climate but also be economical so that more patients can be rehabilitated.

Prosthetic grade silicone (Platanisil 40tt) is a locally available RTV silicone which is used successfully for making limb prosthesis. Yet, very limited data are available on prosthetic grade silicone as a maxillofacial prosthesis material, so it was included as test Group 1.

Third material evaluated in this study was a locally available RTV medical grade silicone material. There are many case reports, in which this material is used as a maxillofacial material, but there is hardly any literature evaluating the properties of this material.[9],[10],[11] Therefore, this material was chosen as test Group 2.

The parameters chosen for evaluation were tensile strength, tear strength, and elongation. According to the ISO, standard tensile strength must be 2.0–7 MPa (300–1000 psi) and tear strength 53–175 N/cm (30–100 psi).[3] Studies have shown that a high percentage elongation and good tear strength is one of the most desirable properties for maxillofacial material.[12]

Tensile strength indicates stretch ability that a material can withstand without failure.[13] Clinically, it implies, its ability to withstand facial movement as well as strain incorporated during insertion and removal of the prosthesis.[14] The above property was assessed using dumbbell-shaped specimen fabricated according to ASTM guideline.[4] Another important property evaluated was tear strength, which is indicative of marginal integrity of feather edge of the prosthesis.[15] This property was evaluated using unnicked 90° angled specimen, which is a modification of the test specimen described by ASTM D624: (standard test method for rubber property).[6]

The findings of our study showed that test Group 1 had the best tensile strength. However, both control group and test Group 2 medical grade silicones showed tensile strength within the prescribed range and were good enough to be used as a maxillofacial material, though less than prosthetic grade silicone. The high tensile strength displayed by test Group 1 is a useful property for fabrication of finger prosthesis where more tensile loads are directed, and biocompatibility issues are not critical. With respect to tear strength, our study showed that the control group had the best tear strength, followed by test Group 1 and test Group 2, respectively. The average tear strength of the control samples was in the range of 130 N/cm, which is well within the required tear strength range for maxillofacial materials. Test Group 1 prosthetic grade silicone showed about 100 N/cm, which is within the stated range. The medical grade silicone made locally (test Group 2) showed quite low strength of 30 N/cm, which is below the recommended range. The elongation test showed best results with the control group over test Group 1. This is because the material was rigid and showed poorer ultimate tensile strength as compared to the control. Test Group 2 showed better elongation than test group 1 but less than the control. A high ultimate tensile strength is important for maxillofacial materials. Similarly, for tear strength, the ultimate tear strength was least for test Group 1, followed by test Group 2, and control showed the highest. This can be interpreted as locally available medical grade silicone had better ultimate tear strength but lower tear strength than test Group 1. However, in maxillofacial materials, tear strength is a critical factor as the edge of the prosthesis is kept very thin to be flush with the margins of the face. This study reveals that improvement in the tear strength of locally made medical grade material (test Group 2) is essential before it can be an acceptable maxillofacial material.

The findings of this study are in line with the findings of a study conducted by Mitra et al., in which RTV and HTV silicones were compared with the latter showing better tear strength over the former[3] and not in agreement with the study by Gregory L. Polyzois in 1994 where he stated that RTV silicone showed better physical properties over HTV silicone.[13]

Our study is also in agreement with that of Kheur et al. who evaluated the effect of tropical climatic conditions on M511 and Z004 (Principality Medical, Technovent, UK) maxillofacial material.[12] In his experiment, the samples within the group were prepared using HTV and RTV technique and authors concluded that, though HTV had superior properties over RTV, there was no statistically significant difference.[16] Our control group too showed no statistical significant difference in tensile and tear strength in a tropical climate as compared to accepted standards. However, further research is required for improving the properties of locally available medical grade material such that it can meet the economic needs of our patients. Additional research is also required on color stability of both experimental materials in simulated tropical climates.[17],[18],[19],[20] Prosthetic grade silicone needs to be assessed for biocompatibility with facial keratinized tissues as it's tensile and tear strength made it acceptable as a maxillofacial material. The limitations of our study included the climate in Bangalore, which is unlike some extreme weather conditions of India. Further color stability and shelf life of these can be compared, and in vivo study will aid in the better clinical assessment of material properties.


   Conclusions Top


Within the limitation of the study, the following conclusions can be drawn:

  • Tensile and tear strength of control group does not alter much in tropical climates
  • Locally available medical grade silicone has comparable tensile strength but inadequate tear strength
  • Locally made prosthetic grade silicone showed adequate tensile and tear strength for maxillofacial material and can be considered subject to its fulfilling color stability and biocompatibility criteria.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
The glossary of prosthodontic terms 9th edition. J Prosthet Dent 2017;117:e70.  Back to cited text no. 1
    
2.
Harsh M, Kshiliz G. Maxillofacial prosthetic material: A literature review. J Orofac Res 2012;2:87-90.  Back to cited text no. 2
    
3.
Mitra A, Choudhary S, Garg H, H G J. Maxillofacial prosthetic materials - An inclination towards silicones. J Clin Diagn Res 2014;8:ZE08-13.  Back to cited text no. 3
    
4.
Goiato MC, Pesqueira AA, Ramos da Silva C, Gennari Filho H, Micheline Dos Santos D. Patient satisfaction with maxillofacial prosthesis. Literature review. J Plast Reconstr Aesthet Surg 2009;62:175-80.  Back to cited text no. 4
    
5.
Aziz T, Waters M, Jagger R. Analysis of the properties of silicone rubber maxillofacial prosthetic materials. J Dent 2003;31:67-74.  Back to cited text no. 5
    
6.
Haug SP, Andres CJ, Munoz CA, Okamura M. Effects of environmental factors on maxillofacial elastomers: Part III — physical properties. J Prosthet Dent 1992;68:644-51.  Back to cited text no. 6
    
7.
Rahman AM, Jamayet NB, Nizami MM, Johari Y, Husein A, Alam MK. Effect of aging and weathering on the physical properties of maxillofacial silicone elastomers: A systematic review and meta-analysis. J Prosthodontics 2019;28:36-48.  Back to cited text no. 7
    
8.
Barnhart GW. A new material and technic in the art of somato-prosthesis. J Dent Res 1960;39:836-44.  Back to cited text no. 8
    
9.
Polyzois GL, Hensten-Pettersen A, Kullmann A. An assessment of the physical properties and biocompatibility of three silicone elastomers. J Prosthet Dent 1994;71:500-4.  Back to cited text no. 9
    
10.
Polyzois GL, Eleni PN, Krokida MK. Effect of time passage on some physical properties of silicone maxillofacial elastomers. J Craniofac Surg 2011;22:1617-21.  Back to cited text no. 10
    
11.
Begum Z, Kola MZ, Joshi P. Analysis of the properties of commercially available silicone elastomers for maxillofacial prostheses. J Contemp Dent Pract. 2011;1:2.  Back to cited text no. 11
    
12.
Kheur MG, Sethi T, Coward T, Jambhekar SS. A comparative evaluation of the change in hardness, of two commonly used maxillofacial prosthetic silicone elastomers, as subjected to simulated weathering in tropical climatic conditions. Eur J Prosthodont Restor Dent 2012;20:146-50.  Back to cited text no. 12
    
13.
Eleni PN, Katsavou I, Krokida MK, Polyzois GL, Gettleman L. Mechanical behavior of facial prosthetic elastomers after outdoor weathering. Dent Mater 2009;25:1493-502.  Back to cited text no. 13
    
14.
Al-Harbi FA, Ayad NM, Saber MA, ArRejaie AS, Morgano SM. Mechanical behavior and color change of facial prosthetic elastomers after outdoor weathering in a hot and humid climate. J Prosthet Dent 2015;113:146-51.  Back to cited text no. 14
    
15.
Polyzois GL. Evaluation of a new silicone elastomer for maxillofacial prostheses. J Prosthodont 1995;4:38-41.  Back to cited text no. 15
    
16.
Haug SP, Moore BK, Andres CJ. Color stability and colorant effect on maxillofacial elastomers. Part II: weathering effect on physical properties. J Prosthet Dent 1999;81:423-30.  Back to cited text no. 16
    
17.
Hatamleh MM, Polyzois GL, Silikas N, Watts DC. Effect of extraoral aging conditions on mechanical properties of maxillofacial silicone elastomer. J Prosthodont 2011;20:439-46.  Back to cited text no. 17
    
18.
Gary JJ, Huget EF, Powell LD. Accelerated color change in a maxillofacial elastomer with and without pigmentation. J Prosthet Dent 2001;85:614-20.  Back to cited text no. 18
    
19.
Han Y, Zhao Y, Xie C, Powers JM, Kiat-amnuay S. Color stability of pigmented maxillofacial silicone elastomer: effects of nano-oxides as opacifiers. J Dent 2010;38 Suppl 2:e100-5.  Back to cited text no. 19
    
20.
Eleni PN, Krokida MK, Frangou MJ, Polyzois GL, Maroulis ZB, Marinos-Kouris D. Structural damages of maxillofacial biopolymers under solar aging. J Mater Sci Mater Med 2007;18:1675-81.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Clinical Relevan...
   Introduction
   Results
   Discussion
   Conclusions
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1072    
    Printed36    
    Emailed0    
    PDF Downloaded126    
    Comments [Add]    

Recommend this journal