Relines and RebasesRelines and RebasesRelines and RebasesRelines and Rebases

Improving the Adaptation of Existing Improving the Adaptation of Existing DenturesDentures

Improving the Adaptation of Existing Improving the Adaptation of Existing DenturesDentures

RebaseRebase RebaseRebase

• Replacing entire denture baseReplacing entire denture base

• Flasking, heat-cured acrylicFlasking, heat-cured acrylic

• Usually porcelain teethUsually porcelain teeth

• Replacing entire denture baseReplacing entire denture base

• Flasking, heat-cured acrylicFlasking, heat-cured acrylic

• Usually porcelain teethUsually porcelain teeth

RelineReline RelineReline

• Resurfacing the tissue surface Resurfacing the tissue surface

• Jig used to maintain vertical Jig used to maintain vertical dimension & occlusal contacts with dimension & occlusal contacts with cold-cure acryliccold-cure acrylic

OrOr

• Reprocessing with heat cureReprocessing with heat cure

• Resurfacing the tissue surface Resurfacing the tissue surface

• Jig used to maintain vertical Jig used to maintain vertical dimension & occlusal contacts with dimension & occlusal contacts with cold-cure acryliccold-cure acrylic

OrOr

• Reprocessing with heat cureReprocessing with heat cure

IndicationsIndicationsIndicationsIndications

Denture no longer fits residual ridge Denture no longer fits residual ridge

Retention, stability are lackingRetention, stability are lacking

PLUSPLUS• Occlusion is acceptableOcclusion is acceptable• Vertical dimension is acceptableVertical dimension is acceptable• Denture teeth/gingival contours acceptableDenture teeth/gingival contours acceptable

Denture no longer fits residual ridge Denture no longer fits residual ridge

Retention, stability are lackingRetention, stability are lacking

PLUSPLUS• Occlusion is acceptableOcclusion is acceptable• Vertical dimension is acceptableVertical dimension is acceptable• Denture teeth/gingival contours acceptableDenture teeth/gingival contours acceptable

Contraindications Contraindications Contraindications Contraindications

Complaints of a loose dentureComplaints of a loose denture

DOES NOT,DOES NOT,

in itself, constitute evidence of in itself, constitute evidence of

a lack of fit and stabilitya lack of fit and stability

Complaints of a loose dentureComplaints of a loose denture

DOES NOT,DOES NOT,

in itself, constitute evidence of in itself, constitute evidence of

a lack of fit and stabilitya lack of fit and stability

Determine Cause of LoosenessDetermine Cause of LoosenessDetermine Cause of LoosenessDetermine Cause of Looseness

• Pivoting on bony structures Pivoting on bony structures - PIPPIP

• Occlusal interferences Occlusal interferences - Tactile, articulating paper, remountTactile, articulating paper, remount

• Inadequate posterior palatal sealInadequate posterior palatal seal- Pull upward & outward on lingual of Pull upward & outward on lingual of

caninescanines

• Pivoting on bony structures Pivoting on bony structures - PIPPIP

• Occlusal interferences Occlusal interferences - Tactile, articulating paper, remountTactile, articulating paper, remount

• Inadequate posterior palatal sealInadequate posterior palatal seal- Pull upward & outward on lingual of Pull upward & outward on lingual of

caninescanines

Evaluate Cause of LoosenessEvaluate Cause of Looseness Evaluate Cause of LoosenessEvaluate Cause of Looseness

• Coronoid interferences Coronoid interferences – Side to side movements, PI{PSide to side movements, PI{P

• Flanges overextensionsFlanges overextensions – Pull on the cheeks, lips, patient move Pull on the cheeks, lips, patient move

tonguetongue

• Tight pterygomandibular rapheTight pterygomandibular raphe

• Coronoid interferences Coronoid interferences – Side to side movements, PI{PSide to side movements, PI{P

• Flanges overextensionsFlanges overextensions – Pull on the cheeks, lips, patient move Pull on the cheeks, lips, patient move

tonguetongue

• Tight pterygomandibular rapheTight pterygomandibular raphe

Relines Will Only Solve Retention Relines Will Only Solve Retention Problems Related to Denture Base Problems Related to Denture Base

AdaptationAdaptation

Relines Will Only Solve Retention Relines Will Only Solve Retention Problems Related to Denture Base Problems Related to Denture Base

AdaptationAdaptation

Retention problems must be diagnosed Retention problems must be diagnosed as to their causeas to their cause

Retention problems must be diagnosed Retention problems must be diagnosed as to their causeas to their cause

• Processed or chairsideProcessed or chairside• Impression or functional techniqueImpression or functional technique• Hard acrylic or resilientHard acrylic or resilient• Permanent, temporaryPermanent, temporary• Complete or partial denturesComplete or partial dentures

• Processed or chairsideProcessed or chairside• Impression or functional techniqueImpression or functional technique• Hard acrylic or resilientHard acrylic or resilient• Permanent, temporaryPermanent, temporary• Complete or partial denturesComplete or partial dentures

Types of RelinesTypes of RelinesTypes of RelinesTypes of Relines

Processed Acrylic Permanent Processed Acrylic Permanent Complete Denture RelinesComplete Denture Relines

Processed Acrylic Permanent Processed Acrylic Permanent Complete Denture RelinesComplete Denture Relines

• Make impression for least stable Make impression for least stable denture first denture first

• Easier to stabilize the other denture Easier to stabilize the other denture – Reference for occlusion & vertical Reference for occlusion & vertical

dimensiondimension

• Make impression for least stable Make impression for least stable denture first denture first

• Easier to stabilize the other denture Easier to stabilize the other denture – Reference for occlusion & vertical Reference for occlusion & vertical

dimensiondimension

Impression TechniqueImpression TechniqueImpression TechniqueImpression Technique

Difficult to reline without:Difficult to reline without:• Encroaching on interocclusal space Encroaching on interocclusal space • Displacing the supporting tissuesDisplacing the supporting tissues• Altering occlusal contactsAltering occlusal contacts

USE CAREUSE CARE

Difficult to reline without:Difficult to reline without:• Encroaching on interocclusal space Encroaching on interocclusal space • Displacing the supporting tissuesDisplacing the supporting tissues• Altering occlusal contactsAltering occlusal contacts

USE CAREUSE CARE

Positioning the DenturePositioning the DentureOVD & OcclusionOVD & Occlusion

Adjust Occlusion Adjust Occlusion Adjust Occlusion Adjust Occlusion

• Obtain stable occlusal contacts Obtain stable occlusal contacts

• Remount & adjustment may be requiredRemount & adjustment may be required

• Assess need for tissue conditioningAssess need for tissue conditioning

• Obtain stable occlusal contacts Obtain stable occlusal contacts

• Remount & adjustment may be requiredRemount & adjustment may be required

• Assess need for tissue conditioningAssess need for tissue conditioning

Remove Tissue Undercuts Remove Tissue Undercuts Remove Tissue Undercuts Remove Tissue Undercuts

Allows impression to be removed from Allows impression to be removed from cast without breaking cast or denturecast without breaking cast or denture

Allows impression to be removed from Allows impression to be removed from cast without breaking cast or denturecast without breaking cast or denture

Clean the DentureClean the DentureClean the DentureClean the Denture

Border MoldBorder MoldBorder MoldBorder Mold

• Relieve borders 2 mm short of vestibuleRelieve borders 2 mm short of vestibule

• Border mold with compoundBorder mold with compound

• Maxillary posterior border at vibrating Maxillary posterior border at vibrating line line (indelible stick)(indelible stick)

• Relieve borders 2 mm short of vestibuleRelieve borders 2 mm short of vestibule

• Border mold with compoundBorder mold with compound

• Maxillary posterior border at vibrating Maxillary posterior border at vibrating line line (indelible stick)(indelible stick)

Reduce Tissue BaseReduce Tissue BaseReduce Tissue BaseReduce Tissue Base

• 1 mm if acceptable interocclusal distance 1 mm if acceptable interocclusal distance – Use guide groovesUse guide grooves

• If interocclusal distance is excessive, relief If interocclusal distance is excessive, relief may not be requiredmay not be required

• Perforate denture with #4 round burPerforate denture with #4 round bur

• 1 mm if acceptable interocclusal distance 1 mm if acceptable interocclusal distance – Use guide groovesUse guide grooves

• If interocclusal distance is excessive, relief If interocclusal distance is excessive, relief may not be requiredmay not be required

• Perforate denture with #4 round burPerforate denture with #4 round bur

Impression Material Impression Material PolyvinylsiloxanePolyvinylsiloxane

Impression Material Impression Material PolyvinylsiloxanePolyvinylsiloxane

• Ease of useEase of use

• Cleaning, removal from undercutsCleaning, removal from undercuts

• Requires adhesive carried to the external Requires adhesive carried to the external surface of denture borderssurface of denture borders

• Ease of useEase of use

• Cleaning, removal from undercutsCleaning, removal from undercuts

• Requires adhesive carried to the external Requires adhesive carried to the external surface of denture borderssurface of denture borders

Impression ProcedureImpression ProcedureImpression ProcedureImpression Procedure

• Load carefullyLoad carefully

• Excessive material can Excessive material can reduce freeway spacereduce freeway space

• Dry tissuesDry tissues

• Load carefullyLoad carefully

• Excessive material can Excessive material can reduce freeway spacereduce freeway space

• Dry tissuesDry tissues

Impression Procedure Impression Procedure Impression Procedure Impression Procedure

• Seat denture anteriorlySeat denture anteriorly

• Slowly rotate posterior into place Slowly rotate posterior into place

• Ensure denture is not too far forwardEnsure denture is not too far forward

• Seat denture anteriorlySeat denture anteriorly

• Slowly rotate posterior into place Slowly rotate posterior into place

• Ensure denture is not too far forwardEnsure denture is not too far forward

Verifying PositionVerifying PositionVerifying PositionVerifying Position

• Patient closes lightly until first contact Patient closes lightly until first contact

• If occlusal interdigitation is poor, If occlusal interdigitation is poor, physically move denturephysically move denture

• Maintain position until setMaintain position until set

• Patient closes lightly until first contact Patient closes lightly until first contact

• If occlusal interdigitation is poor, If occlusal interdigitation is poor, physically move denturephysically move denture

• Maintain position until setMaintain position until set

Evaluate ImpressionEvaluate ImpressionEvaluate ImpressionEvaluate Impression

• Trim impression to posterior borderTrim impression to posterior border• Place / mark the posterior palatal sealPlace / mark the posterior palatal seal• Check retention, extension, peripheryCheck retention, extension, periphery• Remove excess (occlusal, facial etc.)Remove excess (occlusal, facial etc.)

• Trim impression to posterior borderTrim impression to posterior border• Place / mark the posterior palatal sealPlace / mark the posterior palatal seal• Check retention, extension, peripheryCheck retention, extension, periphery• Remove excess (occlusal, facial etc.)Remove excess (occlusal, facial etc.)

Check relations intraorallyCheck relations intraorallySend to lab for processingSend to lab for processing

Check relations intraorallyCheck relations intraorallySend to lab for processingSend to lab for processing

Deliver ASAP, usually next clinic Deliver ASAP, usually next clinic Same day in practice, if possibleSame day in practice, if possible

Deliver ASAP, usually next clinic Deliver ASAP, usually next clinic Same day in practice, if possibleSame day in practice, if possible

RemountRemountAdjust OcclusionAdjust Occlusion

RemountRemountAdjust OcclusionAdjust Occlusion

Impression Technique Impression Technique AdvantagesAdvantages

Impression Technique Impression Technique AdvantagesAdvantages

• Only two appointments neededOnly two appointments needed• Tissues are captured at rest Tissues are captured at rest

(less possibility of distortion)(less possibility of distortion)• Allows for greater extension of peripheriesAllows for greater extension of peripheries• Allows placement of functional posterior Allows placement of functional posterior

palatal seal palatal seal

• Only two appointments neededOnly two appointments needed• Tissues are captured at rest Tissues are captured at rest

(less possibility of distortion)(less possibility of distortion)• Allows for greater extension of peripheriesAllows for greater extension of peripheries• Allows placement of functional posterior Allows placement of functional posterior

palatal seal palatal seal

Impression Technique Impression Technique DisadvantagesDisadvantages

Impression Technique Impression Technique DisadvantagesDisadvantages

• Possible alteration in VDO, occlusion, Possible alteration in VDO, occlusion, facial supportfacial support

• No chance to test retention and comfort No chance to test retention and comfort under functionunder function

• Possible alteration in VDO, occlusion, Possible alteration in VDO, occlusion, facial supportfacial support

• No chance to test retention and comfort No chance to test retention and comfort under functionunder function

Functional Relines Functional Relines (Lynal, Visco-gel)(Lynal, Visco-gel)

Functional Relines Functional Relines (Lynal, Visco-gel)(Lynal, Visco-gel)

• Similar procedureSimilar procedure

• Minor variationsMinor variations

• Similar procedureSimilar procedure

• Minor variationsMinor variations

Functional Relines Functional Relines Functional Relines Functional Relines

• Cannot extend borders greater Cannot extend borders greater than 4 mm than 4 mm

• Distorts too easily Distorts too easily

• Grossly under extended, use Grossly under extended, use impression techniqueimpression technique

• Cannot extend borders greater Cannot extend borders greater than 4 mm than 4 mm

• Distorts too easily Distorts too easily

• Grossly under extended, use Grossly under extended, use impression techniqueimpression technique

Functional Relines Functional Relines Functional Relines Functional Relines

• Material requires greater thickness Material requires greater thickness for accuracyfor accuracy

• Usually need to reduce denture to Usually need to reduce denture to allow for thicknessallow for thickness

• Material requires greater thickness Material requires greater thickness for accuracyfor accuracy

• Usually need to reduce denture to Usually need to reduce denture to allow for thicknessallow for thickness

Variation in Accuracy of Materials Variation in Accuracy of Materials Variation in Accuracy of Materials Variation in Accuracy of Materials

(Visco-gel> Coe-Comfort)(Visco-gel> Coe-Comfort)(Visco-gel> Coe-Comfort)(Visco-gel> Coe-Comfort)

LynalLynal LynalLynal

• 10 ml powder : 2 ml liquid, mix 30 sec10 ml powder : 2 ml liquid, mix 30 sec

• If borders short or too thin, add more If borders short or too thin, add more powder for increased viscositypowder for increased viscosity

• Thicker consistency can be formed into a Thicker consistency can be formed into a 3 - 4 mm rope and placed around borders3 - 4 mm rope and placed around borders

• 10 ml powder : 2 ml liquid, mix 30 sec10 ml powder : 2 ml liquid, mix 30 sec

• If borders short or too thin, add more If borders short or too thin, add more powder for increased viscositypowder for increased viscosity

• Thicker consistency can be formed into a Thicker consistency can be formed into a 3 - 4 mm rope and placed around borders3 - 4 mm rope and placed around borders

LynalLynal LynalLynal

• For tissue base, mix as per instructionsFor tissue base, mix as per instructions

• Place intraorallyPlace intraorally

• Remove excess with cotton swab prior Remove excess with cotton swab prior to setto set

• For tissue base, mix as per instructionsFor tissue base, mix as per instructions

• Place intraorallyPlace intraorally

• Remove excess with cotton swab prior Remove excess with cotton swab prior to setto set

Set time: 8-10 minute Set time: 8-10 minute Set time: 8-10 minute Set time: 8-10 minute

• Lightly border mold Lightly border mold

• During setting, allow patient to:During setting, allow patient to:– TalkTalk

– SwallowSwallow

– Lightly occludeLightly occlude

• Lightly border mold Lightly border mold

• During setting, allow patient to:During setting, allow patient to:– TalkTalk

– SwallowSwallow

– Lightly occludeLightly occlude

Remove ExcessRemove ExcessRemove ExcessRemove Excess

• Reduce material on flanges with Reduce material on flanges with HOTHOT scalpel or knife scalpel or knife

• Remove from teeth, oral surfacesRemove from teeth, oral surfaces

• Patient wears reline homePatient wears reline home

• Reduce material on flanges with Reduce material on flanges with HOTHOT scalpel or knife scalpel or knife

• Remove from teeth, oral surfacesRemove from teeth, oral surfaces

• Patient wears reline homePatient wears reline home

Patient Returns in 24-48 HoursPatient Returns in 24-48 HoursPatient Returns in 24-48 HoursPatient Returns in 24-48 Hours

• A cast is poured within 2 hoursA cast is poured within 2 hours

• Otherwise, accuracy compromisedOtherwise, accuracy compromised

• A cast is poured within 2 hoursA cast is poured within 2 hours

• Otherwise, accuracy compromisedOtherwise, accuracy compromised

Functional Impression Functional Impression AdvantagesAdvantages

Functional Impression Functional Impression AdvantagesAdvantages

• Functionally molds peripheriesFunctionally molds peripheries

• Ability to assess patient comfort and Ability to assess patient comfort and retention prior to reline properretention prior to reline proper

• Functionally molds peripheriesFunctionally molds peripheries

• Ability to assess patient comfort and Ability to assess patient comfort and retention prior to reline properretention prior to reline proper

Functional Impression Functional Impression DisadvantagesDisadvantages

Functional Impression Functional Impression DisadvantagesDisadvantages

• Variability of materials, handling Variability of materials, handling characteristicscharacteristics

• Resiliency masks overextensions which Resiliency masks overextensions which can subsequently irritate, when can subsequently irritate, when converted to acrylic resinconverted to acrylic resin

• Variability of materials, handling Variability of materials, handling characteristicscharacteristics

• Resiliency masks overextensions which Resiliency masks overextensions which can subsequently irritate, when can subsequently irritate, when converted to acrylic resinconverted to acrylic resin

Functional ImpressionFunctional Impression DisadvantagesDisadvantages

Functional ImpressionFunctional Impression DisadvantagesDisadvantages

• Dimensional stability variable Dimensional stability variable – Patient carePatient care– Pouring of castsPouring of casts

• Can' t significantly increase bordersCan' t significantly increase borders

• Do not use simultaneously as a tissue Do not use simultaneously as a tissue conditionerconditioner

• Dimensional stability variable Dimensional stability variable – Patient carePatient care– Pouring of castsPouring of casts

• Can' t significantly increase bordersCan' t significantly increase borders

• Do not use simultaneously as a tissue Do not use simultaneously as a tissue conditionerconditioner

Partial Denture RelinesPartial Denture RelinesPartial Denture RelinesPartial Denture Relines

• Similar proceduresSimilar procedures

• Ensure rests, direct and indirect Ensure rests, direct and indirect retainers are fully seated retainers are fully seated

• Seat with pressure over the rests, Seat with pressure over the rests, NOTNOT the distal extension bases the distal extension bases

• Similar proceduresSimilar procedures

• Ensure rests, direct and indirect Ensure rests, direct and indirect retainers are fully seated retainers are fully seated

• Seat with pressure over the rests, Seat with pressure over the rests, NOTNOT the distal extension bases the distal extension bases

Partial Denture Relines Partial Denture Relines Partial Denture Relines Partial Denture Relines

• Allow no impression material under Allow no impression material under rests or guiding planesrests or guiding planes

• If so, remake impression If so, remake impression

• Allow no impression material under Allow no impression material under rests or guiding planesrests or guiding planes

• If so, remake impression If so, remake impression

Partial Denture Partial Denture Clinical Remount Clinical Remount Partial Denture Partial Denture

Clinical Remount Clinical Remount

• If required, a new cast must be madeIf required, a new cast must be made

• Make an alginate impression with Make an alginate impression with the RPD in place the RPD in place

• If required, a new cast must be madeIf required, a new cast must be made

• Make an alginate impression with Make an alginate impression with the RPD in place the RPD in place

Partial Denture Partial Denture Clinical RemountClinical Remount Partial Denture Partial Denture

Clinical RemountClinical Remount

• Block out undercuts on the Block out undercuts on the framework while RPD is in the framework while RPD is in the impressionimpression

• Pour the model with the partial Pour the model with the partial denture in placedenture in place

• Block out undercuts on the Block out undercuts on the framework while RPD is in the framework while RPD is in the impressionimpression

• Pour the model with the partial Pour the model with the partial denture in placedenture in place