CLINICAL REPORT

Consequences of relining on a maxillary complete

denture: A clinical report
Yung-tsung Hsu, DDS, MS

Relining a complete denture

is often mistakenly assumed to ABSTRACT
1
be a simple procedure ; The position of a complete denture may change after relining, especially in the maxillary arch. This
however, problems such as report reviews relining techniques and presents a situation with anterior displacement after the
incorrect ve- rtical dimension relining of a maxillary complete denture. Instead of providing a new denture, the displaced denture
of occlusion and errors in was repaired and the original tooth arrangement maintained. (J Prosthet Dent 2015; )
centric occlusion
can occur when the procedure is poorly performed.2 relining impression, a relined denture may still be dis-
By definition, relining is resurfacing the intaglio placed.15-17 This article presents a patient whose
3
surface of a complete denture with new material. This maxillary denture was relined previously, but the
procedure is indicated after ridge resorption, position was altered after the relining. The diagnosis
abrasion, or over- adjustment of the intaglio surface of and procedures for correcting the displaced denture
the denture base,4 or after a recent extraction.5 Before are also presented.
relining a denture, the clinician should verify whether
the jaw relationship, ver- tical dimension of occlusion,
CLINICAL REPORT
and esthetics are acceptable on the existing dentures.
If not, remaking the dentures should be the treatment A 73-year-old white man who had been edentulous
option. for more than 15 years came to the University of
A denture can be relined with an open-mouth or Alabama at Birmingham School of Dentistry
closed-mouth technique.6,7 Many clinicians prefer the Comprehensive Care Clinic with the chief complaints
closed-mouth technique to minimize the change in of a bulky maxillary denture and the inability to
occlusal relationship.8 Both techniques emphasize the masticate well. This patient stated that he had
importance of removing the undercut and relief on received 2 implants (Tapered Internal Ø3.8×12 mm;
the intaglio surface of the denture to provide a space BioHorizons) in the mandibular arch and had new
for the impression material. Some clinicians suggest complete dentures made after the implants were
creating holes on the palatal area or removing part of uncovered 3 years previously. A review of his medical
the palatal portion of the denture to improve the history revealed that the patient was taking hy-
seating of the den- ture during impression, especially drochlorothiazide for hypertension and had been a
on the maxillary den- ture.2,9-11 To improve the border smoker for more than 10 years before stopping 4 years
seal of the dentures, the extension of the flange may be previously. He had regular follow-up appointments with
reduced and remolded with different materials.2,9,11 To his physician. An intraoral examination revealed healthy
avoid displacement of the denture, different low mucosa and plaque around the implant abutments
viscosity impression materials have been (Figs. 1, 2). No pain or inflammation was found on
suggested.6,8,9,12-14 Even by using the above tech- niques palpation of the mucosa.
to minimize the change in the vertical dimension of His mandibular denture was retained by 2 Locator
occlusion or the displacement of the denture during abutments (Zest Anchors) with the blue inserts in the
the

Associate Professor, Department of Restorative Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Ala.

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Figure 1. Maxillary arch.
Figure 3. Significant horizontal overlap of anterior teeth.
metal housings. He returned to the clinic every 6
months after the delivery of the dentures. Eighteen
months after the delivery of the dentures, he started
to feel loosening in both dentures. The blue inserts of
the attachments were replaced, and the maxillary
denture was relined with the closed-mouth
impression technique and polyvinyl siloxane (PVS)
impression material (Aquasil Ultra Mono- phase;
Dentsply Caulk). The impression material was
replaced with heat-polymerizing acrylic resin (Lucitone
199 Denture Resin; Dentsply International). He
returned for a follow-up visit the next day. Six months
after the delivery of the relined denture, he came to the
clinic for the follow-up appointment with the
previously mentioned chief complaints. An intraoral
examination revealed a significant horizontal overlap
on the anterior teeth (Fig. 3). He stated that after the
delivery of the relined denture, he felt the denture to
be bulky and that the thickness on the border had
been trimmed at the 24-hour follow-up appointment.
He expected the bulky feeling would grad- ually go
away; however, he still felt the border was too thick at
the 6-month follow-up appointment. The vertical
dimension of occlusion was acceptable as verified with
the phonetics and physiologic rest position
techniques. The
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DENTISTRY
Figure 2. Mandibular arch.
Figure 4. Closed-mouth technique with occlusal record.
diagnosis was anterior displacement of the maxillary
denture after relining. Because the patient was
satisfied with the size and tooth arrangement before
the relining, the treatment plan was to reposition the
teeth to the original positions and to perform occlusal
adjustment. A centric relation (CR) occlusal record
was made with PVS material (Regisil PB; Dentsply
Caulk). The undercut on the intaglio surface was
relieved, and the border of the denture was reduced by
2 mm. Border molding procedures were performed
with green modeling plastic impression com- pound.
Two holes were created at the middle anterior palatal
part of the denture. The relining impression was made
with low-viscosity PVS impression material (Aquasil
Ultra LV; Dentsply Caulk) and the closed-mouth tech-
nique with an occlusal record (Fig. 4). The vibrating
line was marked at the junction of the movable and
immovable soft palate and transferred to the impression.
The midline of the face was marked on the mandibular
denture. The maxillary denture with the impression
was boxed and poured with a Type 3 dental stone
(Microstone; Whip Mix Corp). After the stone had set,
the maxillary denture with the stone cast was mounted
in a semiadjustable articulator (Hanau Wide-Vue;
Whip Mix Corp) with a facebow
Hsu
- 2015
Figure 5. Separate denture teeth from base.
Figure 7. Denture teeth with silicone matrix and maxillary cast.
transfer (Spring-Bow; Whip Mix Corp). A remount
cast was fabricated for the mandibular denture, and
this den- ture was oriented to the maxillary denture
with the CR record. The maxillary denture was removed
from the stone cast, and the postpalatal seal area was
carved in the cast according to the vibrating line
transferred from the impression. The impression
material and modeling plastic impression compound
were removed from the denture. The denture teeth
with acrylic resin were cut from the denture (Fig. 5).
The teeth block was centered with the midline mark
and oriented to the mandibular denture to a maximum
intercuspation position and secured with sticky wax
(Fig. 6). The horizontal overlap for the anterior teeth
decreased from 4.5 mm to 2 mm. An index was
fabricated with PVS putty (Splash; DenMat Holdings,
LLC) on the facial and buccal surfaces of the denture
teeth. The intaglio surface of the teeth block was
adjusted until there was no contact between the stone
cast and acrylic resin when the upper member of the
articulator closed (Fig. 7). Two layers of baseplate wax
were added to cover the stone cast and to connect the
teeth block (Fig. 8). The thickness of wax was
measured with a periodontal probe to avoid a bulky
den- ture base. The denture was processed with the
Hsu
3
Figure 6. Maxillary teeth oriented and secured to mandibular denture.
Figure 8. Wax added to seal tooth block and stone cast.
conventional technique. At the delivery appointment, the
intaglio surfaces were evaluated by a pressure-indicating
paste (Pressure Indicating Paste (PIP); Keystone In-
dustries), and the dentures were remounted with a new
CR record for occlusal adjustment. The patient returned
to the clinic for a 24-hour follow-up, and no sore spot
was noticed. At the 6-month follow-up, he was
satisfied with the retention and comfort of the maxillary
and mandibular dentures.
DISCUSSION
The fit of a denture decreases with use because of
ridge resorption or the wear of the acrylic resin base
by daily brushing. However, no guidelines exist to assist
clinicians in determining when a denture should be
relined.18 Patients may not be aware of the change and
have no regular postdelivery appointments with
clinicians until improved retention is needed.19 In this
report, the patient returned to the clinic for regular
follow-up appointments every 6 months, and the
relining request was initiated by the patient 2 years
after the delivery because of the lack of retention on
the maxillary arch.
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When a displaced relined denture is identified, a
clinician may either remake or repair the denture.
Remaking a denture usually requires more appointments
and additional costs. Using this presented technique
will decrease the number of appointments. Although
the intaglio surface of a denture is relieved before
making the relining impression, the amount of relief is
an estimate and will be uneven in different locations.
The denture may be seated at an unstable position if
the intaglio surface is relieved aggressively. When the
denture is loaded with an impression material, even
with a low viscosity one, the material still may push
the denture away from the original position. The
displacement may be more significant when a soft
liner type of material is used because of the viscosity
of liner material. The den- ture is easily displaced
forward, and the vertical dimen- sion of occlusion is
increased if too much material is used. 2 Using an
occlusal record may not ensure the original position
because the mandible could move to a different
position to fit the record. Removing the palatal portion
of a denture will minimize the hydraulic pressure from
the impression material but will also decrease the
stability of the denture during the impression
procedure and create another challenge to record the
palatal area accurately through the impression. In this
report, only holes were created on the palatal area to
prevent voids on the impression. Because the denture
was displaced for- ward, the border of the denture
was no longer accurately adapted to the range of
muscle movements. The border extension was
reduced and remolded with modeling plastic
impression compound. When making the impression,
the denture was seated in the anterior part of the
ridge first and the posterior part rotated up to the
ridge to avoid displacement from the undercut of the
anterior ridge. After the impression, a clinician can
examine the thickness of impression material,
especially at the anterior ridge area. To evaluate
whether the den- ture has been displaced anteriorly, a
clinician can mea- sure the distance between the
center of incisive papilla to the anterior teeth with a
Boley gauge or an Alma gauge (Dentsply Intl) before
and after the relining impression. In addition, the
thickness of impression material at the distal buccal
corner should be similar to the dimension of the
molded modeling plastic impression compound. If the
polymerized impression material on this area be-
comes thinner than the dimension of modeling plastic
impression compound, or becomes unsupported from
the modeling plastic impression compound, the
denture was not seated to the position where the
border molding procedure was performed and the
impression will not be accurate.
If cusped denture teeth are used, the 2 opposing
dentures may be oriented with the existing cusp-to-
fossa relationship without an occlusal record. For
nonanatomic teeth, the dentures should be placed
according to the
THE JOURNAL OF PROSTHETIC
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horizontal relationship of the posterior teeth to avoid
the cheek-biting problem. The thickness of the
baseplate wax has to be measured with a sharp
instrument or a periodontal probe to ensure the ideal
thickness of the denture base. In this report, the
maxillary denture was placed according to the cusp-
fossa relationship and the midline mark on the
mandibular denture. A relined denture must be
mounted on an articulator for occlusal equilibration
because of the discrepancy of position.15-17 The
limitation of this reported technique is that if the
occlusal surfaces of the denture have been ground too
aggressively after the initial relining, a new denture is
indicated.
CONCLUSIONS
Relining impression may result in a displaced
denture. If a displaced denture is identified, a clinician
could use the presented technique to avoid remaking
the denture.
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Corresponding author:
Dr Yung-tsung Hsu
1919 7th Avenue South, Rm 534
Birmingham, AL 35294
Email: ythsu@uab.edu
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Hsu