RELINING AND REBASING OF COMPLETE DENTURES

Khaled Q Al Hamad BDS MSc MRD RCSEd 4th year/removable Prosthodontics 441-442

References
1. Boucher's Prosthodontic treatment for Edentulous Patients( Zarb & Bolender) Chapter: Prolonging the useful life of complete dentures: the relining procedures 2. Applied Dental Materials ( JF McCabe & AW Walls) Chapter: Denture lining material

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Biological supporting structures & materials used in complete dentures are both vulnerable to deterioration. Meticulous attention in the construction of complete denture can minimize changes in the edentulous state but cannot preclude them. The need for servicing in the form of annual recall & patient education is mandatory to keep up with the changes. The clinical efforts aiming at prolonging the useful life of complete dentures involve:

Refitting of the impression surfaces Occlusal correction Minor spatial reorientation of the prosthesis.

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Bone resorption is progressive & inevitable resulting in

Loss of retention & stability. Loss of VDO Loss of support Horizontal shift of dentures. Re-orientation of occlusal plane

From Cawood. Howell 1991 Reconstructive pre-prosthetic surgery I. Anatomical considerations. Int J Oral Maxillofac Surg 20:75-82

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Clinical techniques
Reline: a procedure used to resurface the tissue side of the denture with new base material that provides accurate adaptation to the changed denture foundation area. Rebase: the laboratory process of replacing the entire denture base material in an existing prosthesis. The other alternative to the above is to : Remake.

Reline:

When the minimal or moderate changes are evident. A thin layer of impression material is added to compensate for resorptive changes that occurred in the basal seat. In the laboratory, the material is replaced by new layer of acrylic resin that bond to the original fitting surface of the denture. This will result in a slightly thicker acrylic denture base.

Rebase:

If extensive changes are encountered, the dentist must compensate not only for the reduced supportive tissue but also for the reorientation of the dentures, and this necessitates a simultaneous refitting of the impression surface with a reorientation of its vertical and horizontal position in the mouth.

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Diagnosis

Complaints:

Looseness Soreness Chewing inefficiency Aesthetic changes.

The cause should be determined: occlusal or related to resorption?

Denture with built-in errors in occlusion may not need relining. Changes in the base seat is revealed by:

Looseness & movement of the dentures on examination. General soreness and inflammation. Loss of VDO Compromised aesthetics Disharmonies occlusal contacts.

The amount of change in the VD that has resulted from loss of the supporting structures is not only simply in the vertical direction, it can also be evident in the horizontal relation as the mandible rotates around the hinge axis taking a more forward position. This rotation may be associated with :

Maintenance or loss of CR. Changing the structures that support the denture. Forcing the lower denture backward or forward and the upper forward

One or both dentures may have rotated in relation to the supporting structures, the occlusion in the mouth cannot be used as a guide to the horizontal repositioning of either dentures.

New determination of the VD. Examination of aesthetic profile-lip support. Relation of the teeth to the ridge. Degree of shrinkage in both ridges: greater shrinkage in one arch will change the orientation of the occlusal plane.

If the changes is not too dramatic, the aesthetics is only compromised by few mm, and the teeth are still in place over the mandibular ridge: a reline procedures will be successfully achieved. If greater errors in fit, occlusion, occlusal plane, aesthetics, over-extensions, the dentist may be wise to tell the patient the new dentures are necessary. Changing too many variables in denture rebasing without the control of the dentition, may end up with a denture requiring major modification. Sever revision of the dentition often result in poor aesthetics.

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Static impression technique

Closed mouth technique :

Dentures are used as impression trays. RCP of the existing dentures are used to seat the dentures in place. If the RCP to changed, this is done before relining the dentures. Dentures are used as impression trays. The existing RCP is not used and a new RCP is taken after making the reline. The dentist, however, should place tissue stops in the dentures before making the reline to maintain occlusion, occlusal plane, and aesthetic position.

Open mouth technique:

It is believed that strains inherent in the processed denture base would be released by subsequent processing causing warpage (1.3-3%). Use low heat in the processing or auto-polymerizing resin.

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Functional impression technique.

Impression is made with tissue conditioners.

Retaining compliance for many weeks Good dimensional stability Excellent bonding to resin base.

The denture is observed intra-orally, and any under or over-extensions is corrected. Tissue stops using compound is used to reestablish the a proper occlusal relationship. A treatment liner is placed on the fitting surface. The patient manidble is guided into RCP and maintained while the material is setting. Excess material is trimmed with a hot scalpel.

Functional impression technique.

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Chair-side technique.

Used with acrylic material that is added to the denture and allowed to set in the mouth to produce an instant chair-side reline/rebase. Problems:

Chemical burn? Porous, developing bad odor. Poor color stability. If the denture was not positioned correctly, the material would not be removed easily to start again.

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Allergy more with type I( monomer: methyl methacrylate). Liquid in type II is far less irritant. Both I & II have low (Tg). Why ? Both types result in porous

Air inclusion during mixing Rapid increase in viscosity Often colonized by Candida.

No control over the thickness and the occlusal plane. Increase in the thickness of the palatal part of the upper denture. Because of all that direct reline is considered temporary solution.

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Soft denture liners applied to the fitting surface providing a temporary cushion. It undergo a plastic flow for 24-36 hours after mixing to allow for soft tissue changes after healing. Applications:

When the soft tissues are traumatized allowing it to heal before making the new impression. In cases of immediate dentures. Functional impression technique. The softness of the material is a function of the use of the higher methacrylate, coupled with considerable quantities of plasticizer and solvent. No initiator or monomer in the composition. It is purely physical process. The final set material is a gel-like with swollen plasticized spheres being cemented together with a matrix of saturated solution of polymer in a solvent/ plasticized mixture

Composition

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Temporary Soft Lining Material

Similar to tissue conditioner in composition but less soft initially and retain softness for longer. Not to be used with peroxide. Use water or soak denture in hypochlorite.

Introduction Need for relining & rebasing Bone resorption. Available techniques. Diagnosis Clinical Procedures Static impression technique Functional impression technique. Chair-side technique Material Science Hard Reline Tissue Conditioners Soft Lining Materials Temporary Permanent

Permanent soft lining material

Indication: For patients who cannot tolerate a hard base- irregular mandibular alveolar ridge covered by a thin non-resilient mucosa. Expected to function for a much longer period of time- permanently soft for the life time of the denture.

Self cure(cold cure) are in fact temporary soft lining material- requires replacement. Heat cured acrylic rely on softness on the use higher methacrylate (poly ethel /poly butyl methacrylate), and a plasticizer.