Are new dentures necessary?

Daniel F. Gordon, D.D.S.*

University of Southern California, School of Dentistry, Los Angeles, Calif.

T here are many patients who would benefit more by the relining of their old
dentures than by the construction of new ones. They either cannot adapt satisfac-
torily to new dentures or, for other reasons, would be better served by relining their
old dentures.
Many dentists have been taught that it is an unwise procedure to tamper with
dentures constructed by another dentist. The reasoning has been that once the den-
tist has modified the denture he then inherits all of the problems the patient may
have had in the past in addition to all of the new ones to come. Certainly there
is some justification for such thinking.
However, such reasoning is too inflexible. The dentists primary concern should
be to adapt his form of treatment to best meet the needs of the patient.

RELINING DENTURES
The following categories of patients would be better served by relining their old
dentures.
Patients suffering from any chronic illness. These illnesses impair their ability
to master or tolerate new dentures, or they hinder the dentists ability to construct
them. Some examples are patients with: (A) C erebral hemorrhage with resultant
partial paralysis and lack of coordination (relining existing dentures may be of
tremendous value to patients as they slowly recover under very trying circum-
stances) ; (B) chronic uncontrolled diabetes; (C) blood dyscrasia; (D) chronic
kidney or liver disease; and (E) chronic alcoholism.
Extremely aged patients. As with the chronically ill, elderly patients may have
difficulty in coordination or may lack adaptability to a new environment. It may
cause physical or mental stress for them to be subjected to the series of appointments
necessary to construct new dentures.
Psychologically handicapped patients. There are some patients who insist that
the only teeth that looked like their own were the original dentures. This type of
patient may be better treated by relining the original denture, crude as it may be.

Read before the Pacific Coast Society of Prosthodontists, San Diego, Calif.
*Associate Clinical Professor.

512
2;gTr7 Are new dentures necessary 513

Economically handicapped patients. These people may be better served by re-

lining the old dentures when the other choices may be no treatment at all or falling
into the hands of licensed or unlicensed charlatans.
Patients who changed residence. In these days of ever-increasing mobility, fre-
quent changes in residence force many patients to seek out other dentists. This may
happen within a relatively short period of time following insertion of immediate
dentures. Certainly these patients are entitled to have the dentures relined rather
than have the present dentist insist upon making new dentures. Another type of
patient in this group is one who may have had complete dentures made two or three
years previously, and there have been sufficient changes in the ridges to cause gross
discomfort. Here again, relining may be the method of choice.

INADEQUACIES OF DENTURES
Relining of a denture does not mean that all of the errors attendant on that
denture need to be perpetuated. It is of the utmost importance that existing inade-
quacies be recognized and, insofar as possible, be corrected in the denture to be
relined. The same basic requirements apply to a relined denture as to a new den-
ture. Examples of common shortcomings of dentures are as listed below.
Mandibular denture short of the retromolar pad. Unless the denture rests on at
least one-half of the pad or preferably covers all of it, any benefits gained from re-
lining will be short-lived due to a settling of the denture posteriorly. A technique for
correcting this deficiency will be described.
Inadequate extensions of the peripheral borders. Unless full advantage is taken
of the available stress-bearing area within the patients limitations of adaptability,
failure will be the likely result. It is also important to attempt a valve seal wherever
possible.
Gross overclosure (reduction) of the vertical dimension of occlusion.
Lack of adaptation of the denture base to the tissues.
All of the above shortcomings are correctable to some degree. There are some
inadequacies which cannot be corrected by relining or at the least correction would
be impractical to attempt.

UNCORRECTABLE DEFICIENCIES
Some uncorrectable deficiencies which may be present in dentures are: ( 1) The
vertical dimension of occlusion is grossly in excess of patients ability to accommo-
date it; (2) the centric occlusion of the denture is in such disharmony with centric
jaw relation that there is constant soreness of the tissues and an instability of the
denture bases; (3) the tooth position is too far to the buccal or lingual side of the
position to be normal for that patient; (4) the size or color of the teeth is completely
out of harmony with the patients appearance, particularly when the patient is
aware of the discrepancy; and (5) the patients psychological condition is inade-
quate causing an inability to adapt to a changed oral condition. A corollary to the
adaptation problem is one in which the patient uses his denture problem as a means
for manipulating people and for venting his hostilities. The wary dentist who learns
to recognize such patients is well advised to postpone treatment until such problems
are resolved.
514 Gordon J. Pros. Dent.
May, 1970

Fig. 1. A plastic material is adapted to the border and to the area of the posterior palatal seal
of a denture prior to its being molded by insertion in the mouth.

Fig. 2. A roll of the plastic material is adapted to the borders of a lower denture to develop
the proper border extension.

TECHNIQUE TO CORRECT UNDEREXTENSION

There are several techniques for relining dentures which will vary according to
the particular inadequacies of the existing dentures.
One of the most common types of deficiency is that in which the denture does
not cover the available stress-bearing area. A technique described by Levin is
effective in this situation.

*Dr. Bernard Levin, Associate Professor and Chairman, Department of Removable Pros-
thodontics, School of Dentistry, University of Southern California, Los Angeles, Calif.
Volume 23 Are new dentures necessary 515
Number 5

Fig. 3. The functional impression of the border is formed in the plastic 24 hours after
-tion.
inset

Following thorough cleaning of the dentures and roughening of their borders,

moldable plastic material* is rolled by hand into a strip about 3 mm. in diameter
and is adapted entirely around the borders of the dentures (Figs. 1 and 2). The
dentures are placed in the mouth, and the patients jaws are guided into terminal
hinge closure. The patient then is dismissed until the following day with instructions
not to remove the dentures for at least three hours. When the patient does remove
the dentures for cleaning, he should avoid handling or brushing the soft material
on the borders.
The patients may eat or drink anything they wish. The plastic material has the
properties of flow and moldability for several hours, and during that time it gradu-
ally hardens. The following day, generally there will be very fine, firm, and stable
functional impressions of the border tissues (Fig. 3) .
On the upper denture, the border impression also includes the region of the pos-
terior palatal seal. At this stage, the patient already has experienced considerable
improvement in retention and stability of the denture. Any areas on the tissue side
(basal surface) of the denture where the plastic material has been extended and
compressed so that the denture-base material is showing through must be relieved.
A free-flowing zinc oxide and eugenol paste impression is made by guiding the pa-
tients jaws into terminal hinge closure and by holding the denture in position while
the patient makes the usual tongue, lip, and cheek movements as the material sets
(Figs. 4 and 5). The dentures are processed in the laboratory in the usual manner
after satisfactory impressions have been made.
For relining dentures where the retromolar pads of the lower ridge are not ade-
quately covered, the plastic border impression material will often cover the area
without any prior extension. However, it may be necessary to extend the denture
base over the retromolar pads with some cold-curing acrylic resin prior to placing the
strip of soft plastic around the denture borders.

*Denturlyne, Dental Perfection Company, Glendale, Calif.

516 Gordon J. Pros. Dent.
-May, 1970

Fip. 4. A zinc oxide and eugenol paste impression made in the denture for final adaptation.

Fig. 5. A final reline impression made in a zinc oxide and eugrenol impression paste.

If the vertical dimension of occlusion is too short, the roll of soft plastic material
can be placed somewhat inside the borders on the basal surface of the dentures. This
will have the effect of increasing the vertical dimension of occlusion as well as form-
ing the borders of the impressions. If the vertical dimension of occlusion is correct in
the existing dentures, care must be taken to see that none of the plastic material
creeps onto the basal surface of the denture.

FUNCTIONAL TECHNIQUE
Where the problem is a lack of adaptation of the denture base to the tissues, a
different technique is indicated. These dentures have adequate border extensions,
Volume 23 Are mm dentures necessary 517
Number 5

Fig. 6. The initial application of Adapt01 wax to a mandibular denture prior to inserting it
in the mouth.

Fig. 7. Distribution of the impression (Adaptol) wax after five minutes of denture function
in the mouth.

and the vertical dimension of occlusion is satisfactory. If the occlusal relationship is

also good, a functional procedure is used for relining the lower denture.
The denture is prepared for the impression by eliminating the undercuts. Where
major undercuts exist, grooves are cut into the outer aspect of the denture, and these
are filled with wax so that later the undercut part of the flange can be removed. This
is done after the cast has been poured. Impression wax* which flows at mouth
temperature is painted onto the buccal and lingual aspects of the basal surface of

+Adaptol, J. F. Jelenko and Company, Inc., New Rochelle, N. Y.

518 Gordon J. Pros. Dent.
May, 1970

the denture, and the denture is placed in the mouth (Fig. 6). No wax is placed at
this time over the crest of the ridge or on the tissue side (basal surface) of the labial
flange of the denture. Thus, the wax is allowed to flow toward the crest of the ridge,
and the danger of anterior displacement of the denture is minimized. The patient
is given a piece of chewing gum of the nonstick type or a piece of plastic foam and
is told to chew for about five minutes. The denture is then removed and examined
(Fig. 7). Areas where the denture base has completely pressed through the impres-
sion material are relieved with a bur, more wax is reapplied, and the patient re-
peats the chewing procedure. More wax is added where there is insufficient wax.
When the patient has chewed with the dentures two or three times, some of the wax

Fig. 8. Distribution of the wax after 15 minutes of function.

Fig. 9. The final reline impression of wax after four hours in the patients mouth.
 Are new dentures necessary 519

will flow onto the basal surface side of the labial flange of the denture so that very
little additional wax will be needed in this area (Fig. 8). When there is a fairly
even distribution of wax throughout, the patient is dismissed and is allowed to keep
the denture in his mouth. Refore dismissal he is given an appointment to return in
three to four hours with instructions not to eat anything solid, but he may drink
anything he wishes, hot or cold.
When the patient returns, he is instructed to rinse his mouth with ice water
and then the denture is removed. The resultant impression will have a very fine
tissue adaptation, a molded border, and a valve seal (Fig. 9). The technique tends
to compensate for any slight discrepancies in the centric occlusal relationship, be-
cause the denture reseats itself every time the patient swallows. I use this procedure

Fig. 10. The pattern of application of impression wax on a maxillary denture prior to its
initial insertion. Note that none of the wax is placed on the basal surface of the labial flange.

Fig. 11. The final functional reline impression after the denture and the wax have been it]
the mouth for several hours.
520 Gordon J. Pros. Dent.
May, 1970

routinely for all patients with new complete lower dentures. When stone is poured
in the impression, the entire denture and the mold must be placed in a water bath
as the stone begins to set. This will prevent the heat generated from the setting stone
from causing the wax to become sticky, and thus it will permit the formation of
a smoother, denser cast.
This technique may be used for relining either a maxillary or a mandibular den-
ture: However, they are never relined simultaneously. The relining of one denture
must be completed before the other is relined. Particular caution must be exercised
on the maxillary denture to allow the wax to flow into the labial section last so as to
avoid an anterior displacement of the finished denture (Figs. 10 and 11) . The same
technique can be used with Stalite wax* when a low-fusing wax which will flow
more readily is indicated, as that indicated for debilitated, aged patients.

IMPRESSION MATERIALS FOR RELINE IMPRESSIONS

When the adaptation of the palate of the maxillary denture needs improvement
and when the borders do not need correction, a free-flowing zinc oxide and eugenol
impression paste may be used. These pastes are generally preferable to the rubber-
base materials for this purpose due to the risk of anterior displacement of the den-
ture.
There are some situations in which one of the tissue-conditioning materials
(Hydrocast,? Tissuedyne,$ and others) may be used in the impression procedures
for relining. In order to give a patient immediate comfort and improved stability,
a tissue-conditioning material sometimes is placed in the old denture. It also has
the advantage of allowing distorted tissues to assume their normal shapes. It may
also serve a very useful diagnostic purpose: If the patient does not appear to
be helped at all with the conditioning material in place, the prognosis for relining
may be very poor, and a re-evaluation is indicated.
To be effective, the tissue conditioning materials must be allowed to function in
the mouth at least 24 hours. Undesirable pressure areas of the denture base which
show through the conditioning material are cut away with a bur. New conditioning
material is placed in the denture, and the patient is dismissed for another one or
two days. When the patient returns, the denture is examined for even distribution
of the material with adequate borders. A free-flowing zinc oxide and eugenol im-
pression paste is placed over the tissue-conditioning material, and a final impression
is made as described previously. Clinical experience indicates that after a patient has
worn the tissue-conditioning material for one to three days, the impression made
in it is not satisfactory. Unless a corrective impression is made in the denture lined
with the tissue-conditioning material, the result will be a loose-fitting denture.

SUMMARY
Various situations have been noted in which patients would be better served by
having their old dentures relined than by having new ones made. Dentists must

*Stalite Inc., Hialeah, Fla.

+Kaysee Dental Mfg. Company, Kansas City, MO.
$Professional Products Company, San Diego, Calif.
Volume 23 Are new dentures necessary 521
Number 5

modify their relining techniques to satisfy the requirements of each situation. Several
techniques have been described which may be used to fulfill each specific need.
Whatever technique is used, it is important that the basic minimum requirements
of a complete denture be met.

CONCLUSIONS
Unwary dentists are sometimes too hasty in committing themselves to making
new dentures for patients. When deficiencies of the previous dentures are recog-
nized, the dentist may erroneously assume that the correction of those inadequacies
will lead to successful new dentures. Failure will result unless those patients who
cannot adapt to new dentures are identified. At the time of diagnosis, there should
be a careful evaluation of the patients ability to adapt to new dentures. A decision
should then be made as to whether or not the patient might be better served by
relining his present dentures.
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