Introduction Definitions Factors Affecting need for relining & rebasing Indications Armamentarium Required Impression Materials used for

relining & rebasing Pre-treatment procedures Relining / Rebasing Procedures (A) Clinical Procedures

1. Static impression technique - Open mouth - Closed mouth 2. Functional impression technique 3. Chair side impression technique [B] 1. 2. 3. Laboratory Procedures Articulator Method Jig Method Flask Method

Conclusion References

RELINING REBASING IN COMPLETE DENTRUE INTRODUCTION _ It would be difficult & tedious for both patient & dentist to start from beginning & undergo a repeat of all the previous procedure. Relining the denture can be considered as it would require just one additional appointment. Similarly a patient might not want his denture changed for financial or other reasons.

Some of the services a dentist can provide are -

Denture Relining Definitions DENTRUE RELINING

Denture Rebasing

Denture Repair

A Procedure to resurface the tissue surface of the denture new base material to make a denture fit more accurately OR Relining is the process of adding some material to the tissue side of the denture to fill the space b/w the affected tissue & original denture base. DENTRUE REBASING The process or replacing entire denture base without changing occlusal relationship (winkler) OR A process of refitting a denture by the replacement of entire base with a new material on an existing prosthesis/denture.

Why denture become loose after some time ? A patient who have worn dentures successfully for a period of time may return for further service because of looseness, soreness, chewing inefficiency or esthetic changes. Causes

I.Incorrect or unbalanced occlusion that existed at the time of denture were inserted dentures. OR I + II for I) Not require relining Only occlusion is corrected.

II. Changes in the one of both of the structures that support the

After keeping denture out of mouth for 1 to 2 days OR using tissue conditions.

Test Stability & retention of denture have not been lost but patient complaining loose denture (Looseness is due to uneven occlusion contacts) Sign Supporting tissue may show more irritation or inflammation an one side than on the other. II) A number of changes can occur in the tissue that support the c.D.

-More common in mandible than maxilla. - Also common in maxillary dentures opposing natural teeth.

signs - loss of retention & stability. - loss of V.D.O. -Loss of facial support -Horizontal shift of denture - Reorientation of occlusal plane. Symptoms Soreness Looseness Chewing inefficiently Change in patient's appearance.

Minimal to moderate changes changes

Moderate

to

maximal

Relining

Rebasing

FACTORS AFFECTING NEED FOR RELINING & REBASING (1) RESIDUAL RIDGE RESORPTION (RRR) More rapid in Female > males More rapid in first 6 months after extraction of teeth & slower pace till 12 months. Only to again as the patient reaches as 65 years. RRR precipitated by certain systemic disease so in an ideal situation the systemic ds should be eliminated or controlled first.

(2) (a)

EFFECTS OF ROTARY MOVEMENTS OF MANDIBLE Mandibular rotation -

May cause change in structure that support the upper denture. Upper denture may be forced forward on the upper ridge instead of backward as would be expected. This would result from heavy inclined plane contacts b/w the mesial inclines of cusps of lower teeth & distal inclines of cusps of upper teeth.

Direction of such occlusal forces could cause destruction of the anterior maxillary part. (b) Effects of mandibular rotation on anterior part of mandibular residual ridge when V.D.O. is decreased

(A) (B)

Cross section shape of ridge when denture was made. Inclined planes of cusps of teeth forces mandibular denture posteriorly & cause destruction of labial side of ridge .

(C)

Direction of force is changed when lower denture has moved forward for enough to develop contact b/w distal side of lower cusps & distal side of upper cusps.

INDICATION FOR RELINING & REBASING

1)

Immediate dentures after 3-6 months of extraction where maximum residual ridge resorption would have occurred.

2)

When the adaptation of the denture to the ridge is poor due to residual ridge resorption.

3)

Poor Socio-economic condition where patient can't afford a new denture.

4)

Geriatric or chronically ill-patient's who can't withstand physical & mental stress of construction of new denture.

Note - 1. When tissue damage is excessive the treatment shift from Relining Rebasing

2. If the vertical dimension of patient is changed than relining is not sufficient for the cases so that rebasing should be done. 3. Rebasing should be done in dentures with porcelain teeth.

ARMENTARIUM REQUIRED 1) 2) 3) 4) 5) Existing dentures. Border moulding material Impression material. Utility wax. Facebow, Semiadjastable articulator for, Hooper's duplicator or jectron Jig. 6) 7) Dental Flask. Denture base material of choice.

IMPRESSION MATERIALS USED FOR RELINING AND REBASING 1) 2) 3) ZOE paste. Composition & tracing sticks. Elastomers.

4) 5) 6)

Tissue conditioners. Black gutta Purcha. Cold cure acrylics.

Note:- Alginate is not suitable as an impression material because it is dimensionally unreliable in thin section. PRE TREATMENT PROCEDURE A) Preparation of tissue for impression i) Hyper plastic tissue should be surgically excised ii) Oral mucosa should be free of irritation. iii) Denture should not be worn during sleep. iv) Denture should not be worn for at least 2-3 days prior to final impression appointment. B) Preparation of the denture for impression i) Pressure areas on the tissue surface of the denture should be relieved. ii) Minor occlusal disharmony should be corrected by selective grinding. iii) Border inadequacies should be corrected iv) Border should be shortened by 1mm to allow space for new impression material v) PPS should be established using green stick compound or cold cure- resin vi) All large undercuts should be removed.

RELINING/REBASING PROCEDURES

(A)

CLINICAL PROCEDURES

(B) LAB PROCEDURES I. Articulator method

1. Static impression technique

ii. Jig method 1. open mouth Technique b) closed mouth Technique iii. Flask Method

ii. Functional impression technique iii. chair side impression technique I. Static impression Technique a) OPEN MOUTN TECHNIQUE Boucher 1973 It is the method for relining both maxillary & mandibular dentures at the same appointment Existing C.D. not used. Dentures are used as a special tray for making the sec. impression. ZOE is the material of choice. After making bath impression a new centric relation is recorded. Note - It is a demanding & laborious technique but quite a good one. b) CLOSED MOUTH TECHNIQUE Both maxillary & mandibular relining/ rebasing should be done separately We prefer the closed mouth technique when we use the static impression tech.

Various Techniques Technique -A Technique - B New centric relation is recorded using

}

modelling wax of compound.

Technique - C Technique - D Technique - A

Use the existing C.R.

1. C.R. - New C.R. is Recorded before making impression. 2. Denture Preparation -All undercuts are relieved - Tissues surface of denture is relieved 1.5-2mm.

Special Suggestion Palatal relief for better visibility in positioning the max denture druign impression making.

Border Moulding Low fusing modelling compound (Green stick) Impression ZOE is the impression material of choice.

If palatal portion is cut than quick setting plaster is used as an impression material . Advantages 1) 2) Palatae relied for better visibility. Pre made interocclusal record helps to position the denture during impression making. Disadvantages 1) The wax inter occusal record is not an accurare & safe record because several times, the patient can't close c out possibility of damaging the record. 2) This technique cannot be used to reline/ rebase booth the dentures at the same time. Technique - B 1) C.R. - Existing C.O. & intercuspation are used as a means to seat the denture. 2) Denture preparation Same as technique- A 3) Border Moulding Green stick compound 4) Impression material Kerr's Impression wax (Iowa wax) (material of choice)

Flows at mouth temp. 2 steps The impression of the labial flange & crest of the alveolar ridge b/w the canine is made as a second step.

5)

Advantages 2 step impression technique will reduce the possibility of extreme forward movement of the maxillary denture

6) -

Disadvantages If the existing CR record is wrong then the impression become in accurate.

-

wax can distract.

Technique - C 1) 2) C.R.- Existing Centric relation is used Denture preparation Same as Technique A & B 3) Special suggestion Relief holes in labial & palatal flange decreasing the pressure inside the denture there by preventing displacement of maxillary denture.

4)

Border moulding Same as tech. A & B

5)

Impression No specific material

6) 7)

Advantages Disadvantages

Same as Tech. A& B because This tech is a combination of both A & B.

Technique- D 1. 2. C.R.- existing C.D. is used to seat the denture Denture Preparation Same as in other techniques 3. Special suggestion Denture periphery should be shortened to create a flat border. A large opening should be proposed in the Palatal portion of the maxillary denture.

Adhesive tape is attached over the buccal & labial surfaces of both dentures. Grooving in region b/w the reline impression & adhesive tape & filling it with molten wax.

Border moulding Using molten wax. Impression ZPE for first step P.O.P. for second step ( for palatal portion) (II) FUNCTIONAL IMPRESSION TECHNIQUE Suggested by Winkler. Here the patient need not be c out dentures unlike previous techniques (e.g. the dentures are not required for Lab. Producres). It is simple & practical method & is more popular. Fluid resins (Tissue conditioners) are used as an impression material. Tissue conditioners are Temporary soft liners c the following characteristics i) ii) iii) iv) v) Easy to use Excellent for refilling complete denture. Capable of retaining for many weeks. Good in dimensional stability. Good in bonding to resin denture bases.

Procedure Patient is advised to avoid night wear of dentures

Occlusal errors in the dentures are corrected to obtain c.o. that coincides c the C.R.

Flange

over-extensions,

under

extensions

&

PPS

should

be

corrected.

Tissue surface should be reduced to accommodate the tissue conditions material Tissue surface of denture is dried & tissue conditioning material is placed

Next, the denture is inserted & the Patient's mandible is guided to CR in order to stabilize the denture & material is allowed to set.

After setting, impression is removed & excess material is trimmed. Overextensions & Voids are corrected. Then dentures are inserted C the material.

After 3-5 days, dentures are examined

Depressed (Denuded) areas should be relieved. Areas of under extension are corrected by adding more material.

Material should be renewed periodically (one's a week) till the tissue heals completely. Than once the tissue are normal impression made with ZOE or a light bodied elastomer over the tissue conditioner material & a cast is poured immediately.

DIFFERENT PHYSICAL STAGES OF TISSUE CONDITIONER/ TREATMENT LINERS (a) Plastic Stage Respond to functional & parafunctional stresses (Tissue Conditioner) fit is improved. (b) Elastic Stage (Tissue Conditioner) Firm Stage (Reline impression) Stress is cutioned Tissue recovery takes place. Surface is similar to polymerized resin surface, except it is vulnerable to deterioration.

(c)

(III) -

CHAIR-SIDE IMRESSION TECHNIQUE Acrylic is added to the denture & allowed to set in the mouth to produce instand relining or rebasing.

Disadvantages Material produces a chemical burn in oral mucosa. Material is porous & develops a bad odour. Poor colour stability. Material is not easy to remove if not placed correctly.

Note1Recently VLC (Visible light cure) resin has been developed which is similar to tissue conditioners. 2Both the static impression technique & functional impression techniques are well accepted choice B/w the 2 methods is based on dentists & patient's convenience.

(B)

LABORATORY PROCEDURES I- Articulator method II Jig method III flash method

(I)

ARTICULATOR METHOD Once the impression is received cast is poured Maxillary cast is mounted on an Semiadjastable articulator C the help of face bow transfer Mandibular denture is mounted using an interocclual record. (Procedure is common for both relining & rebasing upto this stage)

(For relining Tissue surface of denture

For rebasing Denture base should be

is trimmed.

trimmed to just leave2mm of acrylic around the existing teeth.

After trimming the dentures are placed in the articulator & waxed up. Articulating the denture (c impression) & cast against a plaster template.

(II) JIG METHOD 2 types of riling Jig are used

Hooper's Duplicator 2 triangular parts 3 pillers in each corner

Jectron Jig only 2 pillers

A plaster index is made on the lower platform with the denture teeth penetrating the depth of about 2 mm.

When the plaster set, indentations made by denture teeth acts as key into which denture teeth can be repeatedly positioned to maintain a fixed distance b/w Cast & the occlusal surfaces. Top & bottom of the Jig are separated & denture is removed from the cast. Impression material is removed from the denture.

For relining Tissue surface of denture is trimmed. For porcelain teeth teeth

For rebasing

For acrylic Denture base is trimmed to just 2 mm of around existing

entire denture base is removed from teeth. leave acrylic the teeth. wax-up curing

(III) Flask Method : Poured impression along with denture is inverted into the base of the flask.

Silicone mould material is painted over the denture prior to investing the body. This is done to create a Flexible mould so denture can be removed carefully after opening the flask. Trimming of denture for relining for rebasing

Relining

With self cure resin Disadvantages Irritation of tissue

With Heat cure acrylic resin Disadvantages Excessive heat which is required for heat curing may war the original denture base (resoftening) May cause change in occlusion & fit of the denture over basal seat.

material

CONCLUSION
Relining and rebasing reduces discomfort specially in case of geriatric, chronically ill patients and decreases expense for poor socio-economic conditions & increases adaptations of loose fitting dentures But they are not adequate substitute for new denture. However relined/rebased denture should be given same care as new denture.

REFERENCES
1. Boucher's Prosthodontic Treatment for Edentulous Patients - George A. Zarb, Charles L. Bolender, Gunnar E. Carlsson 2. Essentials of Complete Denture Prosthodontics - Sheldon Winkler 3. Prosthodontic for Elderly - Ejvind Budtz, Jorgensen, Dr. Odont 4. Clinical Dental Prosthetics - H.R.B. Fenn, K.P. Liddelow, A.P. Gimson

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