Relining, rebasing partial and complete dentures GJ Christensen J Am Dent Assoc 1995;126;503-506

The following resources related to this article are available online at jada.ada.org ( this information is current as of March 6, 2011 ):
Downloaded from jada.ada.org on March 6, 2011 This article appears in the following subject collections: Implants http://jada.ada.org/cgi/collection/implants Information about obtaining reprints of this article or about permission to reproduce this article in whole or in part can be found at:
http://www.ada.org/prof/resources/pubs/jada/permissions.asp

2011 American Dental Association. The sponsor and its products are not endorsed by the ADA.

RELINING

REBASING PARTIAL AND COMPLETE DENTURES

shown a remarkable increase in retention of natural teeth in all age ranges. As a result, fewer complete dentures are needed now than 50 years ago. However, the need for removable partial dentures has risen in relation to patients' inability to pay for more expensive fixed prostheses. Removable partial and complete dentures require constant upkeep, repair and eventual relining or rebasing to provide long-term optimum service. Unfortunately, dentists could use more education in this area. Also, patient satisfaction could be improved by upgrading patient education about the need for continuing oral care after denture placement.
LONGEVIlY OF ADEQUATE FIT FOR PARTIAL OR COMPLETE

Ohe past few decades have

Some patients have almost no observable changes in the alveolar ridges over many years, while most show changes relatively soon. Patients typically feel most comfortable if relining-rebasing is accomplished about five to eight years after the initial fitting of dentures on healed alveolar ridges and soft tissue.
WHEN TO RELINE OR REBASE A PARTIAL OR COMPLETE DENTURE

Most removable partial dentures, or RPDs, in the United States are made from casts

DENTURES

Quantifying longevity of adequate denture fit is difficult, because large variations occur in bone and soft tissue shrinkage. After placement of immediate dentures, relining to improve denture fit is needed within weeks. Several months later, additional tissue changes will have occurred, and refitting will be necessary again. Eventually, more bone healing takes place and oral anatomy stabilizes. Dentures fit relatively well for a while. But for how long?

Patient satisfaction could be improved by upgrading patient education about the needfor continuing oral care after denture placement.
poured from alginate impressions. (A future article will explore better RPD impressions.) These partial dentures fit remaining teeth relatively well, but they almost never fit soft tissues. Freshly mixed alginate places only slight load on soft tissues when an impression is made. Natural teeth do not move appreciably during an impression, but soft tissues over

ridges do move under load. Therefore, most removable partial dentures that are soft tissue and tooth borne (Kennedy Class 1, 2 and 4) fit soft tissue poorly as they are finished by laboratories. These RPDs are essentially tooth-borne frames that rock significantly toward soft tissue spaces until resin bases place enough load on soft tissue to halt the frame's rotation. Most of these RPDs fit so poorly that they could use a reline at first placement. I suggest that if a new RPD rocks toward a soft tissue space on initial placement, a reline should be accomplished on the day of RPD placement. The easiest, fastest and most effective products for such relines are chairside use products such as Triad light curing reline material (Dentsply); and auto cure reline materials with relatively low exothermic activity and good color retention, such as Tokuso reline material (Tokuyama America). There are others. Dentists will find that patients accept RPDs more readily if reline is done on illfitting prostheses when they are placed. Over years of use, RPDs become ill-fitting because of continued bone and soft tissue changes. When an RPD rocks toward soft tissue edentulous
JADA, Vol. 126, April 1995 503

Downloaded from jada.ada.org on March 6, 2011

CHRISTENSEN
spaces and/or prosthesis occlusion does not touch opposing arch teeth, a reline is needed. Either a chairside reline, described above, or a laboratory reline is indicated. When making an impression for a laboratory reline of an RPD, relatively viscous impression materials should be used to displace tissues in a manner like chewing. Permadyne High Viscosity (ESPE-Premier) has an excellent success record for this procedure. It is especially useful for relining because it - can be ground away with a bur; - allows subsequent layers of the same material to bond without adhesive; - is hydrophilic. Soft tissue areas of the RPD should be relieved of undercuts. The denture containing Permadyne should be seated, border molded and held in correct position by having the patient close the teeth together in a
of occlusion; - lack of display of teeth during speech, indicating collapse of dentures toward alveolar ridges; - degeneration of denture bases; - lack of proper denture extension into mucobuccal fold areas. These criteria also are indications for totally remaking the dentures. The determined magnitude of the clinical problem is related directly to the decision to reline, rebase or remake the complete prosthesis. Usually laboratory relines-rebases are indicated for complete dentures. That is because of the ease of making impressions inside old dentures and the relative strength and color stability of laboratory reline-rebase ma-

Successful chairside relining ofcomplete

dentures can be accomplished by taking special care to avoid moving the dentures off the alveolar base during the reline impression.

comfortable, moderate-load, centric-occlusion position. Such impressions place load on edentulous areas and provide nearoptimum fit for relined RPDs if proper border molding has been done. Rebasing should be accomplished when resin bases do not extend well into soft tissue reflection areas or when resin bases have degenerated. Relining or rebasing complete
dentures becomes necessary

mainly because of tissue changes related to bone resorption. Usually, mandibular dentures require more frequent relining than maxillary dentures. Criteria for relining or rebasing are - poor retention or stability; - collapse of vertical dimension
504 JADA, Vol. 126, April 1995

terials when compared to chairside materials. Impressions for complete denture relinesrebases can be made in any of many categories of materials. A simple, easy and effective impression technique for these procedures using Permadyne (ESPE-Premier) follows. 1. Remove undercuts from the denture internal areas, allowing a technician to remove the denture from the set stone cast later. 2. Place adhesive on the

internal areas of the denture. Permadyne adhesive dries well in about 90 seconds. 3. If the old denture is poorly extended peripherally, make a primary impression in Permadyne High Viscosity, border molding as soon as the material reaches the correct viscosity. After the impression material sets, remove the impression and relieve any pressure spots (indicated by denture base color showing through the impression material). Place new adhesive on any internal denture base areas where the impression material was removed and rapidly make a final wash impression, using Permadyne Low Viscosity. Do the border molding immediately to reduce the chance of increased viscosity of the material due to the beginning setting reaction and overextension of the impression. If the denture fit was relatively good, only Permadyne Low Viscosity should be used, instead of making a primary impression in Permadyne High Viscosity first. 4. Post-dam areas can be placed either by adding wax or other favorite materials on the impression clinically, Dr. ChrHitensen Is or by placing a co-founder and currently senior post-dam on consultant of the cast. Clinical Research Associates, 3707 N. Successful Canyon Rd., Sulto chairside reno 6, Provo, Utah, lining of com84604, and Is a member of JADA's plete dentures editorial board. He can be accomhas a master's degree In restorative plished by dntistry and a taking special doctorate In care to avoid education and psychology. He Is moving the board certified In dentures off prosthodontics

Downloaded from jada.ada.org on March 6, 2011

CHNISIENS[N
the alveolar base during the impression. Typically, maxillary dentures tend to move forward when relined directly, because of the relatively low resistance of the soft tissue base to forward loading. Mandibular dentures relined directly can move anywhere if the alveolar ridges are moderately to severely resorbed. However, if alveolar support is adequate, direct chairside relining
reline

with light curing material (Dentsply Triad) or auto cure material (Tokuso and others) can be successful if proper care is taken and correct materials are used. Many chairside reline materials have very high exothermic reactions, unacceptable taste and poor color retention over the service period. They should be avoided. Periodically relining and rebasing removable partial and

complete dentures is necessary

to ensure acceptable long-term

denture function and esthetics. Many products and techniques exist, and dentists must select those most appropriate for their practices. .
Information about the products mentioned in this article is available from the author. Neither the author nor the ADA has any commercial interest in the products mentioned. The opinions expressed or implied are strictly those ofthe author and do not nesarily reflect the opinions or policies of the American Dental Association or its subsidiaries.

Downloaded from jada.ada.org on March 6, 2011

506 JADA, Vol. 126, April 1995