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SUMMARY In 21 complete denture wearers, six before and 03 mm after reline; hence, the
upper and 15 lower denture relines were performed measured condylar displacement after reline could
with the open-mouth technique. The centric not attribute to a methodological bias. This clinical-
relation (CR) was recorded with the Central- experimental study demonstrates that relining
Bearing-Point (CBP) method three times before and complete dentures with the open-mouth technique
three times after the reline. For each registration, may lead to a substantial denture shift and thus
the right and left condylar position was recorded in imply inevitably clinically relevant occlusal
three dimensions using a custom-made measuring discrepancies. It is therefore important to carefully
device. The average denture displacement from an check the occlusion at denture delivery and
initial reference position (CR) was calculated for remount the prostheses if necessary.
each registration. An upper denture reline leads to KEYWORDS: occlusion, relining, open-mouth reline,
a mean displacement of 25 mm, both in the right closed-mouth reline, remounting complete
and left condylar area. With an average of 20 mm, dentures, complete dentures
this displacement was smaller following a lower
denture reline (right and left mean, 16 mm). The Accepted for publication 13 June 2012
precision of the CBP-registrations proved 05 mm
Measuring device
Table 2. Displacements (mm) of right and left condyles following reline of the upper complete dentures
Spatial
Right Left displacement
n=6
Upper dentures Sagittal Vertical Transversal Sagittal Vertical Transversal Right Left
4
3·5 Max
75%
3 75%
[mm]
2·5 Median
2 Median
1·5 Fig. 5. Box-plot of the denture
25% Max
25% displacement following open-mouth
1
reline of upper dentures in the
0·5 Min condylar area, the precision of the
Median Min
0 Min Central-Bearing-Point (CBP)-
Displacement [mm] Reproducibility [mm] Displacement minus registration method as well as the
Reproducibility [mm] displacement minus the precision.
articulator and the occlusion was adjusted before the (04–51 mm) and on the left side with 20 ± 14 mm
dentures were delivered‡‡§§. (06–51 mm) slightly smaller than the one following
the upper denture reline (Table 3, Fig. 6).
The directions of all shifts of the upper comparing
Results
with all shifts of the lower dentures following the
A total of 21 patients (16 men and five women) took reline were statistically significantly different (Pillai’s
part in the experiments. Their average age was Trace, right P = 0.0045; left P = 0.027).
674 ± 97 years (56–84 years), and they had been The precision of the CBP-registrations was 05 ±
wearing their current complete dentures for 04 mm (008–12 mm) before and 034 ± 022 mm
55 ± 49 years (05–18 years). Relines were per- (010–093 mm) after the reline. There was a ten-
formed six times on the upper and 15 times on the dency towards a higher interindividual variability
lower complete dentures. after reline (Pillai’s Trace, P < 0097), although this
Relining the upper dentures leads to a mean condy- difference was not significant (n.s.).
lar displacement for the right side of 25 ± 11 mm
(05–40 mm) and for the left side of 25 ± 16 mm
Discussion
(05–47 mm) (Table 2, Fig. 5).
The condylar displacement following reline of the Although denture displacement in this study was
lower denture was on the right side with 20 ± 1.2 mm measured in the condylar area, the corresponding
occlusal interferences have been shown to be of a sim-
ilar magnitude (18); hence, the results are clinically
‡‡
PalaXpress®; Heraeus Kulzer GmbH & Co. KG, Hanau, Germany. relevant. Measuring the occlusal interferences directly
§§
Bite Compound®; GC Germany GmbH, Bad Homburg, Germany.
Table 3. Displacements (mm) of right and left condyles following reline of the lower complete dentures.
Spatial
Right Left displacement
n = 15
Lower dentures Sagittal Vertical Transversal Sagittal Vertical Transversal Right Left
5 Max
Max
4
[mm]
3
75%
is difficult, as no stable reference points can be identi- condylar position only allowed for 2-dimensional mea-
fied on the denture bearing tissues. surements. Consequently, the reported displacements
Whilst relining is a routine procedure in clinical proofed with 335 mm (2–5 mm) for the upper and
practice, little is known on the denture displacement 39 mm (18–8 mm) for the lower denture larger than
at insertion. In a study on 16 patients, Sassen used a those in the present study. These early findings confirm
method similar to ours to evaluate the condylar shift nevertheless a considerable denture displacement fol-
following denture reline, but he performed only one lowing reline procedures. Sassen could not evince dif-
single measurement before and after reline, so that ferences between the impressions whilst chewing
the precision of the methods remains unknown (19). (mouth-closed) and the other ones (most likely mouth-
His experiments also took place at various time points open, but not precisely described).
following reline, not taking into account that the occlu- Javid et al. (22) performed a three-dimensional anal-
sion of complete denture wearers changes over the ysis of maxillary denture displacement following reline
wearing period (20, 21). He also used different reline procedure by means of a mechanical contourmeter in
techniques and materials for the lower dentures (8 9 six patients. The authors performed relines in three
reline with X3N® whilst chewing, 5 9 Xantopren®, one patients using an open-mouth technique, and three
further technique without precise description). Sassen’s further patients were treated by means of a closed-
measurements therefore confound the denture shift mouth technique. They used four different reline mate-
because of reline and denture settling; in addition, they rials and measured differences immediately after reline
comprise methodological imprecisions of unknown on the fitting surface of the upper dentures. Their
extent. Furthermore, his mechanical registration of the smallest displacement was in the lateral direction (042
–077 mm) followed by a forward displacement interesting, as the patients in this study all presented
between 056 and 123 mm and finally a vertical dis- for a reline, meaning that the denture fit was compro-
placement between 125 and 192 mm. Compared with mised. It can therefore be assumed that central load-
the present results, their displacements were smaller, ing of the dentures via the CBP plates stabilises the
but they investigated only the reline impressions, denture base independently of discrepancies between
which were subsequently not transformed and deliv- the denture-bearing tissues and the denture base. The
ered to the patient, hence technical deformations CBP thus proves a robust and precise way to register
owing to plaster expansion or resin contraction as well the CR. Nevertheless, it has to be considered that the
as denture settling after delivery was not considered. In patient sample was with an average age of 67 years
their experiments, Javid et al. could not evince statisti- rather young for an edentulous cohort, so they are
cally different discrepancies between open-mouth and likely to have a better muscle coordination, more
closed-mouth techniques. favourable anatomical conditions and less flabby
The lack of relevant literature may also be caused ridges than an older cohort.
by the methodological difficulties of establishing a Adding a layer of impression material on the hori-
reference position to measure the displacement of the zontal surfaces of the denture base such as the pal-
prostheses. Javid et al. (22) added reference ate or the ridges may be expected to raise the
depressions with a rose bur to the denture base. Their vertical dimension. In contrast, adding a layer of
reference position was given by a fixed tripod on the impression material to a vertical surface like the ves-
table, whereas the denture was placed on an occlusal tibular flanges might rather displace the denture in
key. In the present study, we used the mean of three an anterior direction. However, in this study, no sys-
CBP-registrations before reline as reference position tematic anterior displacement for the dentures could
and compared those to the mean of three subsequent be evinced. Looking at the individual shifts in the
CBP-registrations when the relined denture was six upper relines, it can be noted that only in one
inserted 1 day later. Our reference position was the patient occurred a bilateral dorsal displacement of
CR. Thus, the reported denture displacement relates the condylar balls of the non-arcon measuring device
only to the reline procedure and is independent of (corresponding to an anterior displacement of the
the initial intercuspation, denture settling during the upper denture). The other five upper relines created
wearing period as well as the vertical opening during a ventral displacement of the condylar balls on one
registration of the gothic arch. The latter is negligible side and a dorsal displacement on the other side,
for two reasons, first because an arbitrary face-bow indicating a rotational component. If all these rota-
transfer had been performed and second because tions were in the same direction, an influence from
measurements were taken with the plaster-keys in the right-handedness of the operator or his position
place, so the vertical dimension remained virtually during the clinical procedures may be suspected, but
unchanged between the clinical situation and the in the present six upper denture relines, no system-
bench measurements (23). atic direction of denture displacement could be
The precision of the CBP-registration method in this evinced. A possible explanation might be related to
study corresponded to the 05 ± 03 mm (0–15 mm) the patient’s demand for denture reline. Bone
reported in previous independent publications, resorption in the upper ridge occurs in a centripetal
although the clinical procedures were performed by a direction, hence creating a space between the bony
different operator (24, 25). This precision is only ridge and the vestibular denture flange. As all
slightly larger than the one found in the CBP-registra- patients perceived a need for reline, this space might
tion of fully dentate volunteers (03 mm (26)), a have been already sufficiently large to preclude den-
remarkable finding considering the resiliency of the ture displacement by the additional layer of reline
denture-bearing tissues. However, the precision material. Another reason for the absence of any par-
increased slightly after reline, which might be due to ticular direction of upper denture displacement fol-
a better adaptation of the denture base, but may lowing upper denture reline might be the use of the
equally include a certain training effect of the patients open-mouth technique, which allows loading the
in carrying out the movements necessary to write a denture centrally whilst the impression material is
gothic arch. The initial high precision is particularly setting. The central hard palate is usually less
affected by bone resorption than the alveolar ridges, occlusal relationships in immediate complete denture wear-
so it provides an excellent reference for placing the ers. J Oral Rehabil. 1980;7:77–94.
6. Brigante RF. A cephalometric study of the settling and
denture during the reline procedure. This ‘ideal den-
migration of dentures. J Prosthet Dent. 1965;15:277–284.
ture placement’ has to be considered one of the 7. Tallgren A. The reduction in face height of edentulous and
main advantages of the open-mouth technique com- partially edentulous subjects during long-term denture wear.
pared with the closed-mouth technique where den- Acta Odontol Scand. 1966;24:195–239.
ture placement is ‘uncontrolled’ and guided by a 8. Tallgren A. Positional changes of complete dentures – a
given intercuspation. Although Javid et al. (22) 7-year longitudinal study. Acta Odontol Scand. 1969;27:539–
561.
found with their mechanical measurements no signifi-
9. Tuncay OC, Thomson S, Abadi B, Ellinger C. Cephalometric
cant difference between open- and closed-mouth evaluation of the changes in patients wearing complete
techniques, it would be interesting to verify their dentures. A ten-year longitudinal study. J Prosthet Dent.
results with nowadays more sophisticated methodol- 1984;51:169–180.
ogy. 10. Woelfel JB, Winter CM, Igarashi T. Five-year cephalometric
study of mandibular ridge resorption with different posterior
The present clinical-experimental study confirms
occlusal forms. Part I. Denture construction and initial com-
and quantifies the displacement of complete dentures parison. J Prosthet Dent. 1976;36:602–623.
following an open-mouth reline. It seems reasonable 11. Brehm TW, Abadi BJ. Patient response to variations in com-
to assume that the resulting occlusal changes are sub- plete denture technique. Part IV: residual ridge resorption –
stantial and will be detected by the patient (27, 28). cast evaluation. J Prosthet Dent. 1980;44:491–494.
They might also challenge denture retention, stability 12. Nicol BR, Somes GW, Ellinger CW, Unger JW, Furhmann J.
Patient response to variations in denture technique. Part II:
and patient comfort and even the TMJ function.
five-year cephalometric evaluation. J Prosthet Dent. 1979;
In conclusion, it is very important to carefully 41:368–372.
check the occlusion of a relined denture at delivery 13. Utz K-H. Unterfütterungsverfahren für Totalprothesen. In:
and remount the prostheses if necessary! Koeck B. Totalprothesen. 4th ed. München: Urban &
Fischer; 2005.
14. Schwickerath H. Über die Kraft bei der Abformung und
Acknowledgments über das Fließverhalten von Zinkoxid-Eugenol-Pasten.
Dtsch Zahnärztl Z. 1975;30:527–530.
The dental technician Gabi Reppert produced the 15. Bollmann F, Schulte-Kramer F. Zur labortechnischen Prob-
CBP-registration plates, performed all relines and lematik von Unterfütterungen. Dtsch Zahnärztl Z. 1977;
adjusted the occlusion after denture remounting. 32:965–967.
16. Utz K-H, Swoboda R, Duvenbeck H, Oettershagen K. Para-
Dr. Vera Klein and Dr. Sabine Linsen helped in
okklusale Axiographie: Zur Lage der individuellen terminalen
recruiting patients. Dr. Oliver Lottner constructed the Scharnierachse bei Vollbezahnten – eine klinisch-experimen-
program of the connection between condylar and telle Untersuchung. Zahnärztl Welt. 1987;96:706–712.
occlusal displacement. 17. Posselt U. An analyzer for mandibular positions. J Prosthet
Dent. 1957;7:368–374.
18. Hellmann D, Etz E, Giannakopoulos NN, Rammelsberg P,
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