Complete dentures
Both biological supporting tissues and materials used
in complete denture fabrication are vulnerable to time-
dependent changes.
Thus the need for “servicing” complete dentures to keep
pace with the changing surrounding and supporting
tissues becomes mandatory.
The clinical efforts involve a refitting of the impression
surface of the denture.
Two techniques are available:
1- Relining
2- Rebasing
Definitions
Relining: a procedure used to resurface the tissue
side of a denture with new base material that
provides accurate adaptation to the changed
denture-foundation area.
Rebasing: the laboratory process of replacing the
entire denture base material in an existing
prostheses.
TREATMENT RATIONALE
The foundation that supports a denture changes adversely as a
result of varying degrees and rates of residual ridge resorption
(RRR).
These changes may be insidious or rapid, but they are progressive
and inevitable, and they usually are accompanied with the
following clinical changes:
Loss of retention and stability
Loss of vertical dimension of occlusion
Loss of support for facial tissues
Horizontal shift of dentures: incorrect occlusal relationship
Reorientation of occlusal plane
Indications for relining
Immediate dentures at 3 to 6 months
The adaptation of the dentures to the ridges is poor
The cost of new dentures
Physical or mental stress such as for geriatric or
chronically ill patients.
Rebasing is also indicated when:
The denture base is distorted, porous or discoloured
The denture base is severely damaged
Contraindications
Excessive amount of resorption
Abused soft tissues are present
TMJ problems
Poor aesthetics
Unsatisfactory jaw relationships
Speech problems
Severe osseous undercuts
Diagnosis
A thorough examination of the patient and the denture must be
accomplished. The following points should receive special
consideration:-
Vertical dimension, centric relation, centric occlusion
The size, shape, shade, and arrangement of the teeth must be
satisfactory.
The oral tissues should be in optimum health.
The posterior limit of the maxillary denture is correct and
adequate denture base extension.
The inter-occlusal distance is correct
Speech is satisfactory
Redundant tissue or severe osseous undercuts
Preliminary
❖ Tissue preparation
Treatment
➢ Tissues should be healed completely, & if not healed then as the case
indicate, will be the preparation; ex – tissue conditioner, preprosthetic
surgery.
➢ In case of Hypertrophic tissues for example:
✓ The oral mucosa should be free of areas of irritation.
✓ Removal of the dentures from the mouth during sleep is a must for
several weeks.
✓ The dentures should be left out of the mouth at least two to three
days before making final impression.
✓ Daily massage of the soft tissue.
Preliminary Treatment
❖Denture preparations
➢ Occlusion
➢ Extensions
➢ post. palatal seal
➢ Fitting surfaces relieved 1.5 to 2 mm
➢ Tissue conditioner removed or relieved
➢ Escape holes drilled, particularly in maxillary base; this will
also assist easy removal of palatal portion during laboratory
rebase
➢ Denture periphery shortened to create flat border
In any technique to refit a complete
denture :-
1. Do not increase the VDO.
2. Do not permit the maxillary denture to move forward during
impression making.
3. Ensure that CR and CO are identical.
4. Ensure that an accurate posterior palatal seal has been
established.
5. An equal thickness of final impression material should be
used.
❖ Clean the Denture
Clean the denture before impression making:
➢ - To ensure the ideal cleanliness, put the denture in an
ultrasonic cleaner.
➢ - In addition to brushing the denture by toothbrush & soap.
Border Mold
Relieve borders 2 mm short of vestibule
Border mold with compound
Maxillary posterior border at vibrating
line (indelible stick) to ensure making
sufficient posterior seal.
RELINING MATERIALS
Hard relining materials
Tissue conditioners
Soft relining materials
Relining Procedures
❖ CLINICAL PROCEDURES LABORATORY PROCEDURES
1. Static Method 1. Articulator Method
a. Closed mouth technique 2. Jig Method
b. Open mouth technique 3. Flask Method
2. Functional Method
3. Chair Side
LABORATORY
1. Static impression / a. closed
mouth technique
The dentures are used as impression trays and either the
existing CRO is used to seat the dentures with lining impression
material or the CR is recorded before the impressions are made.
Why?
To maintain the VDO
Make impression for the least stable denture first first, which is
usually the mandibular.
VDO maintained by asking the patient to close on teeth while
taking the impression.
Impression Material
Polyvinylsiloxane
Ease of use
Cleaning, removal from undercuts
Requires adhesive material carried to the external
surface of denture borders before the application of
polyvinylsiloxane.
It is a light body silicone impression material.
Impression Procedure
Load carefully
Excessive material can
reduce freeway space
Dry tissues
Impression Procedure
Seat denture anteriorly
Slowly rotate posterior into place
Ensure denture is not too far forward
Verifying Position
Patient closes lightly until first contact
If occlusal interdigitation is poor,
physically move denture
Maintain position until set
1. Static impression/ b. open
mouth technique
Used in some certain cases where VDO or CR need
some minimal changes as they are not in the
perfect position; thus they are recorded after
applying the relining impression.
Relining/rebasing of both dentures can be done at the
same appointment.
The existing CO is not used, and a new CRO record is
obtained after the impressions are made.
1. Static impression/ b. open
mouth technique
Since the dentures, that are intended to do for them relapse or reline, are not in
contact (not in interdigitation); thus at the time of impression making there is a
high chance for the dentures to move in place during the impression & this will
change the vertical & horizontal relationship in an unwanted way; thus the
occlusal relationships should be in control during taking impression.
This is done by applying tissue stops on the fitting surface of the denture before
making the impression.
Tissue stops could be made of compound (green stick).
After applying tissue stops, put the impression material & insert the denture in a
way that decided for the occlusal relationships to be, without asking the patient
to close his mouth because this will affect the decided occlusal relationships.
After the material is set, reinsert into the patient mouth & record the new vertical
& horizontal relationships.
Evaluate Impression
Trim impression to posterior border
Place / mark the posterior palatal seal
Check retention, extension, periphery
Remove excess (occlusal, facial etc.)
2. Functional impression
It is a simple and practical procedure.
It depends on a thorough understanding of the properties of
tissue conditioners as functional impression material.
Procedure:
▪ Dentures are examined
▪ In case of extensive resorption three compound stops may
be required on the fitting surface ……..
▪ A liner is placed inside the denture
▪ Guidance to CR helps stabilization
▪ Excess material is trimmed away with a hot sharp scalpel
▪ Instructions given to patient on the care of the lined prosthesis
▪ 10-14 days should elapse before the material is firm enough to
proceed with the clinical relining sequence.
▪ At the next appointment, the under extentions, pressure spots
are corrected by trimming and/or by adding new material.
▪ The material is changed periodically till the tissues return to a
state of health and then the patient is scheduled for final
impressions
Functional Relines
Functional Relines Disadvantages
Cannot extend borders greater
than 4 mm
Distorts too easily
Grossly under extended, use
impression technique
Functional Relines
Material requires greater thickness
for accuracy
Usually need to reduce denture to
allow for thickness
3. Chairside technique
These techniques have met with failure for several reasons:
1. The materials produce a chemical burn on the mucosa
2. The materials are porous and subsequently developed a
bad odor
3. color stability was poor; and
4. if the denture was not positioned correctly, the material
could not be removed easily to start again.
At this stage, the chairside technique has been of very limited
use in clinical practice because of these difficulties, and it is
not recommended.
Both the static technique and the functional impression
technique are well accepted procedures.
They can be used for simple situations and complicated
situations.
The choice between the two methods is based on the
dentist’s skill in manipulating the materials and the
patient’s convenience.
Laboratory techniques
1. Articulator Method 3. Jig method
2. Flask Method
Thank you