Inhibition

of polymerization
of polyvinyl
medicaments
used on gingival retraction
Luciano
M. de Camargo,
DDS, MEd,a Winston
W. L. Chee, BDS,b
Terry E. Donovan,
DDSC
University of Southern California, School of Dentistry, Los Angeles, Calif.

siloxanes
cords

by

and

Inhibition
of polymerization
of polyvinyl
siloxane
materials
by latex products
is
well documented.
It is thought
to be caused by contamination
of the chloroplatinic
acid catalyst
by sulfur compounds.
Many medicaments,
such as aluminum
sulfate
and ferric
sulfate,
used on gingival
retraction
cords have been accused of causing
inhibition
of set of polyvinyl
siloxane
materials.
Several
of these medicaments
were
tested with two polyvinyl
siloxanes
and found not to cause any inhibition
of set. (J

PROSTHETDENT i99>;70;114-7.)

P.

olyvmyl siloxane impressions have become popular in recent years because of their accuracy, ease of
manipulation,
excellent elastic recovery, and dimensional
stabi1ity.l Inhibition
of polymerization
of these materials
by chemical agents in latex rubber has been well documented.2-4 This can occur when putty materials are mixed
with latex gloves, when the impression material is in contact with a rubber dam, and even by indirect intraoral contact of teeth and soft tissue structures with latex gloves before impression making. 5,6 The mechanism of inhibition of
polymerization
is thought to be contamination
of the chloroplatinic acid catalyst by sulfur compounds in the latex
products.7
Many different medicaments are used on gingival retraction cords to attempt to minimize hemorrhage from the
gingival sulcus during impression making.8 This is especially critical in using hydrophobic
impression materials
such as polyvinyl siloxanes. Manufacturers
claims to the
contrary, these materials are not truly hydrophilic and they
require an absolutely dry sulcus if impressions are to be
predictably successful.g It has been suggested that certain
of these medicaments may inhibit the polymerization
of
polyvinyl siloxanes in a manner similar to that of latex
rubber.lO Clinicians have reported such occurrences anecdotally in the clinical setting to one of the authors on numerous occasions.
Concern with some of the medicaments, especially those
containing aluminum sulfate or ferric sulfate, seems valid.
It is also possible that the inhibition reported anecdotally

aGraduate student, Advanced Education in Prosthodontics.

bAssistant Professor, Director of Implant Dentistry.
CAssociateProfessor, Chairman, Department of Biomaterials Science.
Copyright 9 1993 by The Editorial Council of THE JOURNAL OF
PROSTHETIC DENTISTRY.
0022-3913/93/$1.00 + .lO. 10/l/47313

114

was caused by contact of the intraoral soft .and hard tissues

with latex gloves, and had nothing to do wit.h the medicament used. This study was done to determine whether any
of the commonly used gingival retraction medicaments
could inhibit the polymerization
of polyvinyl siloxane impression materials when they are in direct contact with the
setting material.
Inhibited polymerization
of polyvinyl siioxanes is manifested by the appearance of a rippled surface on the set
impression material (Fig. 1). The material on the surface of
the impression in the areas that were contaminated will be
slippery to the touch. This inhibition is limited and superficial, not unlike the oxygen-inhibited
layer encountered
with resin composites. This rippling is duplicated in the
gypsum cast, and the cast may appear wet. wrinkled, or
poorly defined. Often, unpolymerized
impression material
will be adherent to the prepared teeth or to the cast when
the impression is separated (Fig. 2). Regardless, the surface
detail of the cast will be compromised and unsuitable for
use in the fabrication of cast restorations.

METHODS

AND MATERIAL

A number of commercially available gingival retraction

medicaments were purchased from dental supply houses.
The active agents in these materials included racemic epinephrine, aluminum chloride, aluminum sulfate, alumi
num potassium sulfate, and ferric sulfate. The products
tested, along with the active agents and manufacturers, are
listed in Table I.
In phase one of this investigation, l-inch length segments
of plain retraction cord (Ultrapack Cord, size 1, Ultradent
Products, Salt Lake City, Utah) were soaked in the various
medicaments for 10 minutes and blotted dry on a sterile
cotton towel. Additional l-inch segments of cords impregnated with various medicaments by manufacturers
were
also tested along with untreated cord, which was used as the
control. Three cords in each category were tested. Low-

\'OI,ti,1IE 70 NPMBER 2

DE CAMARGO,

CHEE,

AND

THE

DONOVAN

JOURNAL

OF PROSTHETIC

DENTISTRY

Fig. 1. The rippled surface of the impression material opposing the labial surfaces of the
teeth is characteristic of inhibited polymerization.
Fig. 2. Often unpolymerized
impression material will remain adherent to the teeth if
contamination
has occurred.
Fig. 3. This is representative of the surface of impression material allowed to set against
a gauze sponge impregnated with one of the medicaments tested. No evidence of inhibition of polymerization
is present.
Fig. 4. The surface of the impression material allowed to set against a sample of latex
demonstrates the rippling characteristic of inhibited polymerization.
viscosity polyvinyl siloxane impression materials (Reprosil, L. D. Caulk Co., Milford, Del.; and Extrude, Kerr Dental Mfg., Romulus, Mich.) were mixed and injected by use
of the automix system over all of the cords. The impression
material was allowed to set for 10 minutes. The surface of
the set impression material was independently
examined
by the naked eye and under X10 magnification
for the
presence or absence of inhibited polymerization.
The criteria used to determine whether polymerization
was inhibited were (1) the presence of an oily, slippery
substance on the surface of the impression material; (2) a
rippled appearance on the surface of the impression material; or (3) an obvious lack of detail reproduction on the
surface of the impression material.
In phase two of the study, squares of cotton sheets, 1
cm x 1 cm, were soaked in the medicaments (solutions 6
through 9 listed in Table I) for 10 minutes and blotted dry
on a cotton towel. Similar squares of latex rubber cut from
gloves known to inhibit polymerization
of the impression

AUGUST

1993

materials tested (Alpine Latex Gloves, Redondo Beach,

Calif.) were used as controls. Three samples in each category were tested. Impressions of the squares were made in
a manner identical to those made in phase one. The set impression materials were evaluated for inhibited polymerization also in the same manner, with the same criteria as
in phase one.

RESULTS
In phase one of the investigation, none of the materials
tested appeared to have any inhibitory effect on the polymerization of either of the polyvinyl siloxane impression
materials used. However, the small surface area afforded by
use of retraction cords per se made it somewhat problematic to evaluate the samples, especially when it came to an
attempt to feel the nature of the surface of the set
impression. Phase two was initiated with a larger surface
generated so this evaluation would be more meaningful.
None of the medicaments
tested demonstrated
any

115

Table

I. Products

tested

Product

Active

1. Iiltrapak nonimpregrated
cord

None

2. Gingi-Pak
impregnated
cord
3. Hemodent
gingival
retraction
cord
4. Pascord 8

5. Racord Two
9

6. Ultrapak
nonimpregnated
cord
7. Ultrapak
nonimpregnated
cord

8. Astringedent
9. Hemodent

DISCUSSION
agent

Racemic
epinephrine
0.5 mg/inch
Buffered
aluminum
chloride
0.8 mg/inch
Aluminum
sulphate
0.48 mg/inch
Racemic
epinephrine
0.30 mg/inch
plus zinc
phenolsulfonate
0.70 mg/inch
Aluminum
sulphate
saturated
solution
Aluminum
potassium
sulphate
saturated
solution
Ferric sulphate
Aluminum
chloride
(buffered)

Manufacturer

Ultradent
Products
Salt Lake City,
Utah
Gingi-Pak
Camarillo, Calif.
Premier Dental
Products
Norristown, Pa.
Pascal Co. Inc.
Bellevue, Wash.
Pascal Co. Inc.

U.S.C.
Pharmacy
Los Angeles,
Calif.
U.S.C.
Pharmacy

Ultradent
Products
Premier Dental
Products

inhibitory effect on the setting of the two polyvinyl siloxanes studied in phase two of the investigation. The surfaces
of the set impression materials appeared completely normal (Fig. 3). The impression materials setting against the
control samples of latex rubber displayed the classic
rippling characteristic of inhibited polymerization
(Fig. 4).
Although the samples in phase two were easier to evaluate than those in phase one, the apparent lack of inhibition of polymerization
by aluminum sulfate and aluminum
chloride in both groups would lend credence to the validity
of the data in phase one. The potential inhibitory effect of
epinephrine was not tested in phase two, but the likelihood
that it would cause a problem is extremely small in any
case. Epinephrine-impregnated
cord was only included in
phase one for the sake of completeness because it is a commonly used agent.
Because no inhibitory
effect on polymerization
of the
polyvinyl siloxane impression materials tested was apparent, no statistical analysis was done.

116

The concern that certain medicaments used with gmg:ival retraction procedures may interi+
:vil h p~,l:Vmeriz;~tion of polyvinyl siloxane is undersiantiabie.
Ihi5 inhitii
tory effect has been clearly demonstrated iii lhe cuse of IX
tex rubber products, likely because oi :tnre;-rct,ed sulfur that
remained from the manufacturing
procehs. However, OFi
the basis of data from this study, it does not appear t.hat :iri~
of the materials commonly used in gingivai ret racl ion procedures have an inhibitory effect.
A likely explanation for the clinical situations in which
inhibited polymerization
was reported is that the leetb
and/or the surrounding soft tissues were contammated i-r)
latex gloves before the impression making. This contarnnation, which is difficult to remove, was likely the cause ok
the inhibited set. In this regard, it is interesting to note that
all of the reports of inhibition have surfaced in recent years
since improved infection control and barrier techniques
have become widespread. Before this. polyvinyl siloxanes
had been used successfully for many years in conjunction
with all of the medicaments tested. The evidence point;; to
the latex gloves and not the medicamrnts

SUMMARY

AND

CONCLUSIONS

In light of the finding that the polymerization

of polyvinyl siloxane impression materials can be inhibited by sulfur in latex rubber products, and because many gingival
retraction medicaments contain chemically act.ive agents,
a study was conducted to determine whether tiny of the
commonly used gingival retract,ion medicaments inhibited
the set of these materials. The following cclnclusions appear
to be valid:
I. Latex rubber can inhibit the set oi polyvinyl siloxane
impression materials.
2. The inhibition of set seen with latex rubber is limited
to the most superficial layer of the impression material.
3. None of the medicaments tested had an>- inhibitor)
effect whatsoever on polymerization.
4. The inhibited polymerization
mentioned in anecdotal
reports is more likely caused by inadvertent contamination
by latex rubber gloves than by the gingival retraction medicaments.

REFERENCES
1.
2.

3.
4.

5.

Craig RG. Kestorative

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1988;116:371-5.
Noonan dE, Goldfogel MH, Lambert RL. Inhibited Sethof the surfaw of
addition silicones in contact with rubber dam. Oper Dent 1986;10:3B-8.
Chee WWL, Donovan TE, Kahn RL. Indirect inhibition ofpolymerizn
t ion of a polyvinyl siloxane impression material: a case report. Quint Tnt
1991;22:1:13--5.
Kahn RL, Donovan TE, Chee WWL. A pilut study of polymerization
inhibition
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1989;2:128-30.

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1)~: CAMARGO,

CHEE,

AND

DONOVAN

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AUGUST

1993

THE

10. Phillips RW. Skinners

Saunders, 1991;154.

JOURNAL

OF PROSTHETIC

science of dental materials,

DENTISTRY

Philadelphia:

WB

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