Tissue Conditioners and Soft Liners

SOFT LINERS
AND TISSUE
CONDITIONERS
PRESENTED BY:
SUGANDHI PIDAPARTHI
1ST YEAR POST GRADUATE
DEPARTMENT OF PROSTHODONTICS
SIBAR INSTITUTE OF DENTAL SCIENCES
CONTENTS
Introduction
Definitions
History
Ideal requirements
Classification
Composition
Properties
Clinical uses of tissue conditioners and soft
liners
Indications
Contraindications
Manipulation of abused tissues
Limitations
Storage
Recent advances
Conclusion
References
26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 2

• The sequelae of removable denture is that
both the biological supporting tissues and
denture material are vulnerable to changes
• Denture relining materials are used to refit the
removable dentures and tissue conditioners
help to condition the traumatized tissues .
• Sometimes it is necessary to apply a very soft
material to the fitting surface of a denture in
Introduction order to act as a ‘cushion’ which will enable
traumatized soft tissues to recover before
recording an impression for a new denture.
• Some patients are unable to tolerate a ‘hard’
denture base and must be provided with a
‘permanent’ soft cushion on the fitting
surface of the denture.

Definitions
Liner : The polymeric material used to replace the tissue-

contacting surface of an existing denture.
Soft denture liner :Polymeric material placed on the

tissue-contacting surface of a denture base to absorb
some of the energy produced by masticatory impact and
to act as a type of shock absorber between the occlusal
surfaces of a denture and the underlying oral tissues .
Anusavice KJ. phillips science of dental materials,11th edition pg 721

• Tissue Conditioner: a resilient denture
liner resin placed into a removable
prosthesis for a short duration to allow time
for tissue healing; used in functional
removable relining procedures to evaluate
denture function and patient acceptance
prior to laboratory reline processing.
(GPT9)
• Tissue conditioner : a soft liner used to

treat traumatized mucosa.
(William J
O’Brein)

History
Resilient liners - natural rubbers.
The earliest soft lining material recorded (soft rubber) was used by Twitchell in 1869.
“Velum” a soft natural rubber was used in 1940 with vulcanite in conjunction with obturators and as a
soft lining for mandibular complete dentures.
This material had high water absorption, and it became foul and ill fitting over a period of time.
In the year 1945,the first synthetic resin made of plasticized poly vinyl resins were developed
The silicone rubbers were developed in 1958.
Garcia LT, Jones JD. Soft liners. Dent Clin N Am 48 (2004) 709–20

Schultz relines the denture with wax and allows
the patient to wear it a few hours before
rebasing.
Skinner reduced hypertrophic tissue by having

patients
Chase WW.Tissuechew anutilizing
conditioning inflated plastic
dynamic adaptive bag1961;11(3);804-13
stress.JPD with the
edentulous ridges.
Ideal Requirements
Ease of processing and minimal

dimensional change during
processing
Water absorption should be

minimal
Minimal solubility in saliva
Long term Resilience

Bonding to poly(methyl
methacrylate)
Adequate tear resistance
Easy cleanability and maintenance
Nontoxic, odourless, and tasteless
Aesthetically acceptable

Classification
•International Organization for Standardization (ISO)
•1. Resilient lining materials for removable dentures–
• Part 1: short-term materials and
•2. Resilient lining materials for removable dentures–
• Part 2: materials for long-term use.
• AND
•1.Mouth cured or chair side soft liners
•2.Processed soft liners

Based on composition :
• Silicone elastomers
• Soft acrylic compounds
Based on curing :
• Self cure- eg.,soften,viscogel
• Heat cure- eg. supersoft,
molloplast B,Lucisoft, Flexor, Permaflex
• Light cure resins-eg.Clearfit LC
Based on durability
• Short term liner
• Intermediate liner
• Long term liners
Based on water sorption property

• Hydrophilic- eg.,kooliner(polymethyl/ethyl
methacrylate polymer)
• Hydrophobic- eg.,Elite soft(silicone polymer)

Based on the availability
• Home reliners
• Tissue conditioners / functional
impression material
• Denture liners
Based on consistency
1. Hard denture liners Eg-Ufigel hard C
2. Soft denture liners Eg-Silastic 390
• Soft denture liners are further
classified as
a) silicone based and resin based
b) Auto cured and heat cured
TISSUE CONDITIONERS : A REVIEW NUJHS Vol. 4, No.2, June 2014

Commercially available tissue conditioners
06/26/2023
15
TISSUE CONDITIONERS AND SOFT LINERS - 71
Commercially
available Soft
Liners

Composition of tissue conditioners
Tissue conditioner
Powder polyethyl methacrylate (PEMA)
Liquid Aromatic Esters -(plasticizers)

In ethyl alcohol solution
No acrylic monomer
Initiator Not present

Plasticizer
• Contains aromatic esters
dibutyl phthalate
butyl phthalyl butyl glycolate,
butyl benzyl phthalate, and
benzyl benzoate
Ethyl alcohol
• Penetrates PEMA
• Easy penetration by plasticizer

Setting :
PEMA+ aromatic esters alcohol swelling of polymer beads
entanglement of polymer chains forming a gel
Set material :-
High cohesiveness
Viscoelastic and elastic

SELF CURE HEAT CURE

Composition Powder polyethyl methacrylate Polyethyl
of soft liners (PEMA) methacrylate (PEMA)
liquid liquid containing an liquid containing an

acrylic monomer and acrylic monomer and
plasticizers plasticizers
Initiator Not present Benzoyl peroxide
Activator Peroxide tertiary amine Not present
26/06/2023 20
• Silicone liners
1)Room temperature curing – chair side
Polymer Polydimethylsiloxane
The crosslinking alkyl-silane

agent
Catalyst an organometal salt
Plasticizer Not present

2)Heat cured silicones
Paste
Polymer Poly (dimethyl
siloxane)
filler Silica
Initiator Benzoyl peroxide
Catalyst Heat

• Plasticized vinyl resins
Poly vinyl chloride
Polyvinyl acetate
• Polyurethane soft liners
• Vinyl polysiloxane
Eg: GC RELINE II

Properties of soft liners :
Properties Silicone liners Plasticized

acrylic
Bonding to denture Less adhesive better capacity
base
Adhesive Required Not required
Water sorption Comparatively less
more
Plasticizer Not present Present
Resiliency High Low
tear resistance Low Acceptable
abrasion resistance low Better
susceptibility to More Less

microorganism
growth
resistance to damage Less more
by denture cleansers
HEAT ACTIVATED:
acrylic resins silicones
Advantages Advantages
High peel strength to acrylic Good and long lasting resiliency

denture base Ease of application
Can be polished
Disadvantages Disadvantages
Warpage of dentures Candida growth is favoured

Poor abrasion resistance

CHEMICALLY ACTIVATED:
acrylic resins silicones
Advantages Advantages
Ease of application Good strength and

Dimensionally stable Low polymerization shrinkage
Minimum warpage
Disadvantages Disadvantages
Have only 60% of its original Do not bond effectively due to

strength high water sorption
Chances of porosity

Comparative study of water sorption, solubility, and tensile
bond strength of two soft lining materials
El-Hadary Et al evaluated and compared the water sorption,

solubility, and tensile bond strength of a silicone-based soft
liner (Luci-sof) and a plasticized acrylic resin soft liner
(Permasoft) using 2 processing techniques, laboratory-
processed and autopolymerized at chairside, for the latter.
It was concluded that on the basis of lower water sorption and
solubility and higher tensile bond strength, Luci-sof may
provide better clinical success
El-Hadary A, Drummond JL. Comparative study of water sorption,

solubility, and tensile bond strength of two soft lining materials. The
Journal of prosthetic dentistry. 2000 Mar 1;83(3):356-61.

Properties of tissue conditioners
Visco-elastic and elastic properties-
The set gel has viscous behavior allows adaptation of the gel to the
inflammed mucosa underlying the denture, which greatly improves the
fit of the denture.
• Elastic behavior helps to recover initial deformation during chewing.

• Hong G et al conducted a study to determine the dynamic
viscoelasticity and plasticizer leachability of commercial
tissue conditioners using a dynamic mechanical analyzer and
high performance liquid chromatography.
• They suggested that the dynamic viscoelasticity of

commercial tissue conditioners is affected by plasticizer
leaching.
Hong G et al.The dynamic viscoelasticity and plasticizer leachability of tissue

conditioners. Gerodontology 2012;29;284-91 .

Hardness : 13-49 shore

hardness units 24hrs
mixing.
Other
properties of Weight loss: 4.9% to
tissue 9.3% after 24hrs
conditioners
Deformation : these
materials deform easily
Murata et al conducted a study in which the masticatory functions of ten

subjects were evaluated in terms of maximum bite forces, chewing time and
frequencies of 2 food samples, and by the use of visual analogue scales.
 The acrylic materials exhibited viscoelastic behavior, while the silicones
exhibited elastic behavior.
 The improvement in masticatory function was found to be in the order:
acrylic permanent soft liner >silicone permanent soft liner > tissue
conditioner > hard resin.
 Thus, plasticized acrylics may best meet the requirements of a resilient
denture liner but they significantly lag behind silicone elastomers in terms of
durability due to the presence of leachable plasticizers.
Murata H, Taguchi N, Hamada T, Kawamura M, McCabe JF. Dynamic viscoelasticity of soft liners and
masticatory function. J Dent Res. 2002; 81(2):123-8 .
26/06/2023 32
Mechanical Chemical
Adhesion roughness of acrylic Chemical
with the aid of etch
• Lassila et al found enhanced lasers, alumina Silane
adhesion using ethyl acetate as abrasion coating
bonding agent.
• Kimet et al found better results
using a primer or adhesive to adhere
silicone liners to PMMA surfaces Oxygen plasma
since they reduce the bubbles’ treatment
formation during relining.

THE EFFECT OF DENTURE BASE SURFACE
PRETREATMENTS ON BOND STRENGTHS OF TWO
LONG TERM RESILIENT LINERS
Kulkarni et al evaluated the effect of two surface treatments, sandblasting and monomer
treatment, on tensile bond strength between two long term resilient liners and poly (methyl
methacrylate) denture base resin
It was concluded that surface pretreatment of the acrylic resin with monomer prior to
resilient liner application is an effective method to increase bond strength between the base
and soft liner. Sandblasting, on the contrary, is not recommended as it weakens the bond
between the two.
Kulkarni RS, Parkhedkar R. The effect of denture base surface

pretreatments on bond strengths of two long term resilient liners. The
journal of advanced prosthodontics. 2011 Mar 1;3(1):16-9.
26/06/2023 34
Uses of tissue conditioners
• Tissue treatment
Papillary hyperplasia
Depression due to suction cups
Avitaminosis or general debilitating diseases

• Temporary obturator
36 TISSUE CONDITIONERS AND SOFT LINERS - 71 26/06/2023

Functional impression material or as an adjunct in
impression making
Tissue conditioners are used when it is difficult to determine the extent of the
denture base due to presence of movable oral structures.
26/06/2023 37
• Stabilization of
Baseplates & Surgical
Splints or Stents

• Liners in surgical splints
• Trial denture base
• Tissue conditioning during implant healing.

Powder
Uses liquid ratio Time of use Use of flow control
Adjunct in tissue 1.25 3-4days ½ cc in liquid coat the set
conditioning material with it
Temporary obturators 1.5/1 7-10 days ½ cc in liquid coat the set

material with it
Stabilize baseplates and 1.75/1 1-10 days Not used for base plates
surgical splints Coat the surgical splint with it
Adjunct in impression 1.5/1 1-3weeks ½ cc in liquid coat the set

making material with it
Adjunct as a tool for 1.5/1 4-8 weeks ½ cc in liquid coat the set
resilient liners material with it

Indications for soft liners:
1.Thin, non-resilient mucosal coverage or Persistent
denture sore mouth
2. Poor ridge morphology where the mental nerve is at

the crest of the ridge

3.Acquired or congenital oral defects
4.Xerostomia
5. Single denture opposing natural teeth

6. In cases with severe undercuts

Contraindications
• Loss of vertical
dimension
• Altered plane of
occlusion
26/06/2023 43
• Short denture borders,
• Poor quality of denture base

• Dissatisfying original esthetics.
• Poor teeth arrangement
• Speech problem
• Improper jaw relations

• Dramatically changed
tissues, or traumatic oral
tissues
• TMJ problems

Conditioning of
abused tissues
• First: Diagnose and institute the
treatment plans for correction of
any systemic diseases
• Second: diagnose and eliminate

or minimize mechanical factors
causing tissue abuse.

This includes the following six steps :
• Correcting faulty occlusion
• Correcting the impression surface of the denture.
• Placing a temporary relining in the dentures
• Soft diet and removal of the dentures at night.
• Stimulate the soft tissues by massage.
• Dentures out of the mouth 48-72 hrs before
making the impression

Prerequisites
• Adequate coverage of the
Technique denture bearing area.
for use of • Good centric relation
tissue • Adequate occlusal vertical
conditioner dimension
• No gross interferences in centric
jaw position

• Remove all the

undercuts
Preparation • Remove 1mm of the

area immediately on
of denture the ridge
• Retain the flanges and
hard palate area
26/06/2023 50
Preparation and Placement of
Tissue Conditioner
06/26/2023 51
• Denture placed slowly and firmly

when the material ceases to flow.
• Use opposing dentition as guide to
centric.
• Hold the dentures in position for at
the desired vertical dimension for
3-7 minutes.
26/06/2023 52
• Denture is removed and the excess is trimmed.
• Pressure areas are relieved, and a fresh mix of
the material is added and placed in the mouth.
• Repeated until a thickness of 1mm or better
conditioning material is obtained.

• Cover the sharp edges with plasticizer to allow

conditioner to flow and contour itself as the tissue
recovers.
• This is repeated every 3-4 days till the tissue
recovers.
• If both maxillary and mandibular arches are
involved each to be treated separately.
26/06/2023 54
Indirect or laboratory method

Kunwarjeet singh and Nidhi Gupta conducted a study in which they
suggested a technique to improve the retention of the prosthesis in grossly
resorbed ridge and minimize the trauma of thin, atrophic knife edge ridge with
severe undercuts.
This study described the successful functional rehabilitation of three completely

edentulous patients with grossly resorbed, thin knife edge, and severe undercut
mandibular ridges with permanent silicone soft liner.
Singh K, Gupta N. Fabrication and relining of dentures with permanent silicone soft liner: A novel
way to increase retention in grossly resorbed ridge and minimize trauma of knife edge and severe
undercuts ridges. Dentistry and Medical Research. 2016 Jan 1;4(1):24.

Self administered
home reliners
• Home reliners consist of polyvinyl acetate, ethyl
alcohol, calcium carbonate, polypropylene
glycol, white bees wax and alkyl methacrylate
copolymers.
• Liquid consists of acrylic, triacetyl citrate, tri-
methoxyethoxyvinylsilane
E.g.: Acryline, Denturite, Snug denture cushions.
The Council on Dental Research and Therapeutics’
concluded that these home reline materials are in
no way a good substitute for professional care.

Maximum benefit maybe
obtained by:
1). Eliminating interfering
occlusal contacts
2). Extending denture base to
proper form
3) Relieving the tissue side of
denture base sufficiently(2mm)
4) Applying the material in
sufficient amounts
5) Following the manufacturer’s
directions

• Reduction of the
denture base strength.
Limitations:
• Loss of softness and
resilience.
26/06/2023 60
• Colonization by
Candida albicans.
• Failure of adhesion
• Dimensional instability
26/06/2023 61
How to maintain ?
Instructions to be given to the

patient
Do’s Dont’s
Cleaning with Hard bristle
soft brush or brush
cotton
Nonabrasive Soaking in
dentifrice denture
cleansers

Studies have shown that rougher surface of the resilient liners favours the
adhesion of micro-organisms and allow fungal growth.
Kang et al reported that acrylic based soft liners exhibited greater Candida
adhesion compared to silicon liners
According to Ohkubo et al dentures used for an extended period of time are
difficult to reline because microorganisms produce methyl mercaptan, which
causes liner detachment . Since bacteria penetrate to approximately 3 mm deep
more efficacy is obtained by reducing the base thickness and applying a high
penetration primer, such as those based on dichloromethane.
Kang SH, Lee HJ, Hong SH, Kim KH, Kwon TY. Influence of surface characteristics on the
adhesion of Candida albicans to various denture lining materials. Acta Odontologica
Scandinavica. 2013 Jan 1;71(1):241-8.

Storage: Storing dentures lined with tissue
conditioners under dry conditions and
those lined with ethanol in humidifier may
be justified to extend serviceability by
minimizing the loss of the component
most relevant to viscoelasticity.
Aloul RK Shen C.The influence of plasticizer loss on the

viscoelasticity of temporary soft liners.J Prosthodont 2002;11;254-62
TISSUE CONDITIONERS AND SOFT LINERS - 71 06/26/2023 64

Recent advances:
MATERIAL COMPOSITION ADVANTAGES
Light cured soft Polyisoprene no leaching
liners elastomers less water sorption
superior stain resistance
adequate working time
Fluorinated fluorinated copolymer Excellent viscoelastic properties

Adheres well to denture base
Modified Silicone Gamma No adhesive required

soft liner methacryloxypropyl
Molloplast b trimethoxysilane

Surface coated tissue monopoly-coating Prevents leaching
conditioners agent
Alternative plasticisers So replaced by phthalates: cytotoxic

dibutyl citrates or
sebacate
Anti bacterial zeomic (crystalline To decrease colonizing

aluminium citrate) of bacteria
Anti fungal agents 5% itraconazole Inhibit candidal growth

myconazole

FLUORINATED SOFT LINING
MATERIALS
•Polyphosphazene is a fluorinated nitrogen-
phosphate elastomer distinctly different
from plastiols and silicones
• It quickly deforms under load converting
the deformation energy into a small amount
of heat before returning to its original shape
OLEFINIC SOFT LINING MATERIAL
• Have good elastic properties
• But these require a special apparatus for
lining and the lining procedures are
complicated
Eg: MOLTENO
Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

• Iqbal, Z., & Zafar, M. S.
investigated the current state of
knowledge on the incorporation of
antifungal agents into the tissue
conditioners for the treatment of
denture induced stomatitis.
• The review literature reported that

incorporation of antifungal agents
into tissue conditioners is effective
with minimal or no effects on
physical and mechanical properties
Iqbal, Z., & Zafar, M. S. (2016). Role of antifungal medicaments added to tissue conditioners: A
of tissue
systematic review. Journal of Prosthodontic conditioners.
Research, 60(4), 231–239.

69
Conclusion
06/26/2023
• Sheldon winkler text book on essentials of

complete denture prosthodontics 2nd edition chapter
6 page no. 81-87
• Anusavice Text Book On Science Of Dental
Materials 11th Edition Chapter 22 Page No. 750-751
• William J O’brein Text Book On Dental Materials
And Their Selection 3rd Edition Chapter 6 Page 85-
88
• Craig’s Book On Restorative Dental Material
Chapter 22 Page No 540-543
REFERENCES • Murata H, Taguchi N, Hamada T, Kawamura M,
McCabe JF. Dynamic viscoelasticity of soft liners
and masticatory function. J Dent Res. 2002;
81(2):123-8.
26/06/2023 70
• El-Hadary A, Drummond JL. Comparative study of

water sorption, solubility, and tensile bond strength
of two soft lining materials. The Journal of
prosthetic dentistry. 2000 Mar 1;83(3):356-61
• Hong G et al.The dynamic viscoelasticity and
plasticizer leachability of tissue conditioners.
Gerodontology 2012;29;284-91.
• Kulkarni RS, Parkhedkar R. The effect of denture
base surface pretreatments on bond strengths of two
long term resilient liners. The journal of advanced
prosthodontics. 2011 Mar 1;3(1):16-9.
• Aloul RK Shen C.The influence of plasticizer loss
on the viscoelasticity of temporary soft liners.J
Prosthodont 2002;11;254-62
26/06/2023 71

Tissue Conditioners and Soft Liners

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SOFT LINERS

Manipulation of abused tissues

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 2

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 3

Liner : The polymeric material used to replace the tissue-

Soft denture liner :Polymeric material placed on the

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 4

• Tissue conditioner : a soft liner used to

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 5

The silicone rubbers were developed in 1958.

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 6

Skinner reduced hypertrophic tissue by having

Ease of processing and minimal

Water absorption should be

Minimal solubility in saliva

Long term Resilience

Adequate tear resistance

Easy cleanability and maintenance

Nontoxic, odourless, and tasteless

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 9

06/26/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 10

Based on water sorption property

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 12

TISSUE CONDITIONERS : A REVIEW NUJHS Vol. 4, No.2, June 2014

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 13

06/26/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 16

Liquid Aromatic Esters -(plasticizers)

06/26/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 17

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 18

PEMA+ aromatic esters alcohol swelling of polymer beads

entanglement of polymer chains forming a gel

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 19

SELF CURE HEAT CURE

liquid liquid containing an liquid containing an

Initiator Not present Benzoyl peroxide

Activator Peroxide tertiary amine Not present

The crosslinking alkyl-silane

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 21

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 22

• Polyurethane soft liners

06/26/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 23

Properties Silicone liners Plasticized

abrasion resistance low Better

susceptibility to More Less

acrylic resins silicones

High peel strength to acrylic Good and long lasting resiliency

Warpage of dentures Candida growth is favoured

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 26

acrylic resins silicones

Ease of application Good strength and

Have only 60% of its original Do not bond effectively due to

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 27

El-Hadary Et al evaluated and compared the water sorption,

El-Hadary A, Drummond JL. Comparative study of water sorption,

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 28

Visco-elastic and elastic properties-

• Elastic behavior helps to recover initial deformation during chewing.

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 29

• They suggested that the dynamic viscoelasticity of

Hong G et al.The dynamic viscoelasticity and plasticizer leachability of tissue

26/06/2023 TISSUE CONDITIONERS AND SOFT LINERS - 71 30

Hardness : 13-49 shore

Murata et al conducted a study in which the masticatory functions of ten