Relines

Relines and
and Rebases
Rebases
Improving
Improving the
the Adaptation
Adaptation of
of Existing
Existing
Dentures
Dentures

Dr. M. Dubais
 Denture
Denture Relining
Relining &
& Rebasing
Rebasing

Denture Relining:
Addition of relining material to the tissue side of a
denture, to improve its adaptation to the supporting
mucosa (resurfacing the tissue surface).
 Relining indications
1.
1. Loss
Loss ofof retention
retention
2.
2. Instability
Instability
3.
3. Food
Food under
under denture
denture
4.
4. Abused
Abused mucosa
mucosa (use
(use conditioning
conditioning material)
material)
5.
5. In
In addition
addition to
to improve
improve lack
lack ofof fit
fit to
to the
the supporting
supporting tissue
tissue
6.
6. Relining
Relining maymay be
be combined
combined with:
with:
7.
7. Improving
Improving border
border extension
extension (depth
(depth and and /or
/or width)
width) or
or provision
provision
of
of aa post
post dam.
dam.
8.
8. ItIt cannot
cannot correct
correct errors
errors in
in tooth
tooth positioning
positioning OR
OR JR
JR
 Rebasing
Rebasing Indications:
Indications:

1)
1) Porous
Porous or
or artifact
artifact of
of the
the denture
denture base
base
2)
2) Loss
Loss of
of retention
retention && stability
stability
3)
3) Should
Should have
have correct
correct jaw
jaw relations
relations
 Relining / General Considerations:
[Link]
[Link] tissue
tissue health
health
2.
2. Reasonable
Reasonable CR/CO
CR/CO
3.
3. Adequate
Adequate vertical
vertical dimension
dimension
4.
4. Adequate
Adequate peripheral
peripheral extensions
extensions
5.
5. Also
Also relining
relining cannot
cannot be
be used
used when
when
A.
A. No
No free
free way
way space.
space.
B.
B. Lack
Lack of
of balanced
balanced occlusion
occlusion and
and articulation.
articulation.
C.
C. Non-alignment
Non-alignment with
with optimal
optimal denture
denture space.
space.
D.
D. Incorrect
Incorrect contour
contour for
for neuromuscular
neuromuscular control.
control.
 Rationale for use
-- Contours
Contours of of soft
soft tissues
tissues change
change continuously.
continuously.
-- Underlying
Underlying bone
bone resorb
resorb results
results in
in inferior
inferior
retention.
retention. (Especially
(Especially for
for immediate
immediate dentures)
dentures)
-- If
If occlusal
occlusal relationship
relationship and
and vertical
vertical dimension
dimension
of
of occlusion
occlusion are
are acceptable,
acceptable, relining
relining or
or
rebasing
rebasing might
might be be the
the options.
options.
-- Also
Also indicated
indicated sometimes
sometimes forfor geriatric
geriatric patients,
patients,
for
for lower
lower costs,
costs, for
for porous
porous dentures,
dentures,
 Relining
Relining
Relining isis aa process
process in
in which
which aa film
film of
of relining
relining
material
material isis added
added to
to the
the inside
inside ofof the
the denture
denture to
to
obtain
obtain an
an improved
improved fitfit with
with the
the denture-bearing
denture-bearing
mucosa,
mucosa, and
and restoring
restoring stability
stability and
and retention.
retention.
This
This is
is accomplished
accomplished by: by:
1-
1- making
making anan impression
impression of of the
the denture
denture bearing
bearing
mucosa
mucosa using
using thethe denture
denture as as aa tray,
tray, reflasking
reflasking
the
the denture,
denture, removing
removing the the impression
impression material,
material,
and
and packing
packing andand curing
curing thethe new
new liner.
liner.
2-
2- making
making aa chairside
chairside reline
reline where
where the the reline
reline
material
material isis used
used to
to make
make the the impression.
impression.
-- Two
Two different
different types
types of
of reline
reline materials
materials may may bebe
used:
used: permanent
permanent oror temporary.
temporary.
-- Permanent
Permanent relining
relining material
material may
may be be either
either aa heat-
heat-
cured,
cured, chemically
chemically cured,
cured, or
or light-activated
light-activated
acrylic.
acrylic. The
The relining
relining process
process isis carried
carried outout either
either
by
by aa flasking
flasking procedure
procedure oror curing
curing in in aa light
light
chamber,
chamber, depending
depending onon the
the type
type ofof material.
material.
Permanent
Permanent reline
reline materials
materials may
may bebe identical
identical to to
those
those from
from which
which permanent
permanent denture
denture bases
bases are
are
made.
made.
 Rebase
Rebase
•• Replacing
Replacing entire
entire denture
denture base
base
•• Flasking,
Flasking, heat-cured
heat-cured acrylic
acrylic
•• Usually
Usually porcelain
porcelain teeth
teeth
 Reline
Reline
•• Resurfacing
Resurfacing the
the tissue
tissue surface
surface
•• Jig
Jig used
used to
to maintain
maintain vertical
vertical
dimension
dimension & & occlusal
occlusal contacts
contacts with
with
cold-cure
cold-cure acrylic
acrylic
Or
Or
•• Reprocessing
Reprocessing with
with heat
heat cure
cure
 Indications
Indications
Denture
Denture no
no longer
longer fits
fits residual
residual ridge
ridge
Retention,
Retention, stability
stability are
are lacking
lacking
PLUS
PLUS
•• Occlusion
Occlusion is
is acceptable
acceptable
•• Vertical
Vertical dimension
dimension isis acceptable
acceptable
•• Denture
Denture teeth/gingival
teeth/gingival contours
contours acceptable
acceptable
 Contraindications
Contraindications
Complaints
Complaints of of aa loose
loose denture
denture
DOES
DOES NOT,NOT,
in
in itself,
itself, constitute
constitute evidence
evidence of
of
aa lack
lack of
of fit
fit and
and stability
stability
Determine
Determine Cause
Cause of
of Looseness
Looseness
•• Pivoting
Pivoting on
on bony
bony structures
structures
-- PIP
PIP
•• Occlusal
Occlusal interferences
interferences
-- Tactile,
Tactile, articulating
articulating paper,
paper, remount
remount
•• Inadequate
Inadequate posterior
posterior palatal
palatal seal
seal
-- Pull
Pull upward
upward &
& outward
outward on
on lingual
lingual of
of
canines
canines
 Evaluate
Evaluate Cause
Cause of
of Looseness
Looseness
•• Coronoid
Coronoid interferences
interferences
–– Side
Side to
to side
side movements,
movements,
•• Flanges
Flanges overextensions
overextensions
–– Pull
Pull on
on the
the cheeks,
cheeks, lips,
lips, patient
patient move
move
tongue
tongue
•• Tight
Tight pterygomandibular
pterygomandibular raphe
raphe
 Patient
Patient and
and denture
denture pre-requisites
pre-requisites for
for relining:
relining:
1. Tissues must be in normal healthy state.
2. The denture must be able to be stabilized by
border refining.
3. There must be reasonable centric occlusion in
harmony with centric relation.
4. There must be at least correctable rest vertical
dimension and occluding vertical dimension.
5. Absence of speech defects (possibly whistling can
be corrected).
 Types of relinig
••Can
Can be
be classified
classified as…
as…
1.
1. Processed
Processed oror chair-side
chair-side
2.
2. Static
Static impression
impression oror functional
functional technique
technique
3.
3. Hard
Hard acrylic
acrylic or
or resilient
resilient
4.
4. Permanent,
Permanent, temporary
temporary
5.
5. Complete
Complete oror partial
partial dentures
dentures
 Relining
Relining techniques:
techniques: Mainly:
Mainly:

1.
1. Direct
Direct method
method (chair-side
(chair-side relining
relining material):
material):
2.
2. Indirect
Indirect method
method // Conventional
Conventional (processed
(processed relining
relining
material),
material), which
which is
is subdivided
subdivided to
to ::

Static
Static impression.
impression.

Functional
Functional impression.
impression.

 Direct
Direct method
method (chair-side
(chair-side relining
relining material):
material):
•• Made
Made by….
by…. cold
cold cure
cure Or
Or conditioning
conditioning
materials. Indications:
materials. Indications:
1.1. Where
Where no
no longer
longer than
than 66 weeks
weeks is
is required.
required.
2.2. Around
Around over-denture
over-denture abutments.
abutments.
3.3. Border
Border additions.
additions.
4.4. For
For RPD
RPD base
base areas.
areas.
Direct method (chair-side relining material)
Cold cure resin
 Technique:
••Clean
Clean the
the denture
denture
••Reduce
Reduce denture
denture base
base and
and border
border
••Remove
Remove undercuts
undercuts
••Mix
Mix relining
relining material
material and
and apply
apply itit into
into denture
denture base
base
••Insert
Insert the
the denture
denture and
and instruct
instruct patient
patient toto bite
bite gently
gently
••Ensure
Ensure that
that occlusion
occlusion is
is not
not altered
altered
••Leave
Leave denture
denture for
for about
about 55 minutes
minutes
••Remove
Remove denture
denture and
and carefully
carefully examined
examined
••If
If cold
cold cure
cure acrylic
acrylic resin
resin is
is used,
used, denture
denture should
should
be
be placed
placed in
in hydroflask
hydroflask toto complete
complete curing
curing and
and
to
to reduce
reduce porosity
porosity
••If
If tissue
tissue conditioner
conditioner waswas used
used the
the excess
excess
material
material should
should bebe trimmed
trimmed and and then
then reinserted
reinserted
again
again to
to make
make sure
sure excess
excess material
material isis removed
removed
 disadvantages
1.
1. As
As itit deteriorates
deteriorates in in oral
oral environment,
environment, so so itit can’t
can’t be
be
used
used forfor long
long term
term service.
service.
2.
2. The
The material
material is is difficult
difficult in
in adhering
adhering toto denture
denture base.
base.
3.
3. Tissue
Tissue surface
surface is is rough
rough and
and presents
presents porosity
porosity & & cause
cause
bad
bad odor.
odor.
4.
4. Color
Color stability
stability isis of
of short
short duration.
duration.
5.
5. If
If denture
denture is is not
not properly
properly positioned,
positioned, correction
correction
is
is difficult.
difficult.
6.
6. Tissue
Tissue irritation
irritation maymay bebe caused
caused by
by lysis
lysis of
of the
the
local
local monomer,
monomer, or or burn
burn mucosa
mucosa during
during polymerization.
polymerization.
7.
7. Exhibits
Exhibits more
more dimensional
dimensional changes
changes
 Indirect method/ Conventional
(processed relining material)

 The
The ZOE,
ZOE, light
light body
body silicone
silicone and
and
polyvinylsiloxane
polyvinylsiloxane used
used mostly
mostly with
with this
this
procedure…
procedure…
 Technique:
••Clean
Clean the the denture
denture forfor maximum
maximum bond bond strength,
strength, even
even
use
use ultrasound
ultrasound device.
device.
.. Take
Take VD VD atat rest
rest and
and atat occlusion:
occlusion: to
to avoid
avoid changing
changing
the
the smile
smile line
line and
and && lengthening
lengthening thethe incisors
incisors
or
or showing
showing acrylic
acrylic (esthetic
(esthetic considerations),
considerations), as as well
well
as
as prevent
prevent alteration
alteration ofof the
the vertical
vertical measurements
measurements of of
the
the patient
patient (functional
(functional considerations).
considerations).
.. Check
Check the the centric
centric occlusion
occlusion before
before && after
after the
the
lining
lining impression
impression would
would bebe taken.
taken.
•• Remove
Remove the the tissue
tissue undercuts
undercuts to to allow
allow impression
impression to to
be
be removed
removed fromfrom cast
cast without
without breaking
breaking castcast or
or denture
denture
 ••Shorten
Shorten the
the denture
denture flanges
flanges to to provide
provide roomroom forfor the
the impression
impression material;
material;
special
special burs
burs can
can be be used
used toto ensure
ensure aa uniform
uniform reduction
reduction of of flanges.
flanges. Also
Also put
put
vent
vent holes
holes at
at internal
internal surface
surface to to ensure
ensure the
the perfect
perfect positioning
positioning of of impression,
impression,
and
and to
to prevent
prevent separation
separation of of impression
impression material
material fromfrom thethe denture.
denture.
••Load
Load thethe impression
impression material,
material, aa thinthin layer
layer ofof impression
impression material
material isis
spreads
spreads inin all
all around
around thethe fitting
fitting surface
surface onon the
the denture.
denture. (Avoid
(Avoid voids)
voids)
••Ensure
Ensure the
the uniform
uniform thickness
thickness of of impression
impression material
material & & correct
correct position
position to
to
prevent
prevent alteration
alteration of of VD
VD oror occlusion.
occlusion.
••Remove
Remove thethe excess
excess impression
impression material
material to to improve
improve the the impression
impression borders
borders
and
and to
to decrease
decrease needing
needing for
for trimming
trimming & & finishing
finishing thethe borders.
borders. Then
Then aa right
right
positioning
positioning for
for the
the opposite
opposite prosthesis
prosthesis is is ensured
ensured {to {to ensure
ensure maximum
maximum interinter
cuspation
cuspation youyou can can ask
ask the
the patient
patient toto close
close hishis mouth
mouth at at correct
correct COCO atat
correct
correct VD,
VD, byby this
this the
the impression
impression converted
converted to to close
close mouth
mouth technique}.
technique}.
Relines
Relines Will
Will Only
Only Solve
Solve Retention
Retention
Problems
Problems Related
Related to
to Denture
Denture Base
Base
Adaptation
Adaptation
Retention
Retention problems
problems must
must be
be diagnosed
diagnosed
as
as to
to their
their cause
cause
 Types
Types of
of Relines
Relines
•• Processed
Processed or
or chairside
chairside
•• Impression
Impression or
or functional
functional technique
technique
•• Hard
Hard acrylic
acrylic or
or resilient
resilient
•• Permanent,
Permanent, temporary
temporary
•• Complete
Complete or
or partial
partial dentures
dentures
 Processed
Processed Acrylic
Acrylic Permanent
Permanent
Complete
Complete Denture
Denture Relines
Relines

•• Make
Make impression
impression forfor least
least stable
stable
denture
denture first
first
•• Easier
Easier to
to stabilize
stabilize the
the other
other denture
denture
–– Reference
Reference for
for occlusion
occlusion &
& vertical
vertical
dimension
dimension
Impression
Impression Technique
Technique
Difficult
Difficult to
to reline
reline without:
without:
•• Encroaching
Encroaching onon interocclusal
interocclusal space
space
•• Displacing
Displacing the
the supporting
supporting tissues
tissues
•• Altering
Altering occlusal
occlusal contacts
contacts

USE
USE CARE
CARE
Positioning
Positioning the
the Denture
Denture
OVD
OVD &
& Occlusion
Occlusion
 Adjust
Adjust Occlusion
Occlusion
•• Obtain
Obtain stable
stable occlusal
occlusal contacts
contacts
•• Remount
Remount & & adjustment
adjustment maymay be
be required
required
•• Assess
Assess need
need for
for tissue
tissue conditioning
conditioning
Remove
Remove Tissue
Tissue Undercuts
Undercuts

Allows
Allows impression
impression to
to be
be removed
removed from
from
cast
cast without
without breaking
breaking cast
cast or
or denture
denture
Clean
Clean the
the Denture
Denture
 Border
Border Mold
Mold
•• Relieve
Relieve borders
borders 22 mm
mm short
short of
of vestibule
vestibule
•• Border
Border mold
mold with
with compound
compound
•• Maxillary
Maxillary posterior
posterior border
border at
at vibrating
vibrating
line
line (indelible
(indelible stick)
stick)
 Reduce
Reduce Tissue
Tissue Base
Base
•• 11 mm
mm ifif acceptable
acceptable interocclusal
interocclusal distance
distance
–– Use
Use guide
guide grooves
grooves
•• If
If interocclusal
interocclusal distance
distance is
is excessive,
excessive, relief
relief
may
may not
not be
be required
required
•• Perforate
Perforate denture
denture with
with #4
#4 round
round bur
bur
 Impression
Impression Material
Material
Polyvinylsiloxane
Polyvinylsiloxane

•• Ease
Ease of
of use
use
•• Cleaning,
Cleaning, removal
removal from
from undercuts
undercuts
•• Requires
Requires adhesive
adhesive carried
carried to
to the
the external
external
surface
surface of
of denture
denture borders
borders
 Impression
Impression Procedure
Procedure

•• Load
Load carefully
carefully
•• Excessive
Excessive material
material can
can
reduce
reduce freeway
freeway space
space
•• Dry
Dry tissues
tissues
 Impression
Impression Procedure
Procedure
•• Seat
Seat denture
denture anteriorly
anteriorly
•• Slowly
Slowly rotate
rotate posterior
posterior into
into place
place
•• Ensure
Ensure denture
denture is
is not
not too
too far
far forward
forward
 Verifying
Verifying Position
Position
•• Patient
Patient closes
closes lightly
lightly until
until first
first contact
contact
•• If
If occlusal
occlusal interdigitation
interdigitation isis poor,
poor,
physically
physically move
move denture
denture
•• Maintain
Maintain position
position until
until set
set
 Evaluate
Evaluate Impression
Impression
•• Trim
Trim impression
impression toto posterior
posterior border
border
•• Place
Place // mark
mark the
the posterior
posterior palatal
palatal seal
seal
•• Check
Check retention,
retention, extension,
extension, periphery
periphery
•• Remove
Remove excess
excess (occlusal,
(occlusal, facial
facial etc.)
etc.)
Check relations intraorally
Send to lab for processing
 Deliver, usually next clinic
Same day in practice, if possible
Remount
Remount Adjust
Adjust Occlusion
Occlusion
 Impression
Impression Technique
Technique
Advantages
Advantages
•• Only
Only two
two appointments
appointments needed
needed
•• Tissues
Tissues are
are captured
captured atat rest
rest
(less
(less possibility
possibility of
of distortion)
distortion)
•• Allows
Allows for
for greater
greater extension
extension of
of peripheries
peripheries
•• Allows
Allows placement
placement ofof functional
functional posterior
posterior
palatal
palatal seal
seal
 Impression
Impression Technique
Technique
Disadvantages
Disadvantages
•• Possible
Possible alteration
alteration inin VDO,
VDO, occlusion,
occlusion,
facial
facial support
support
•• No
No chance
chance toto test
test retention
retention and
and comfort
comfort
under
under function
function
Functional
Functional Relines
Relines
(Lynal,
(Lynal, Visco-gel)
Visco-gel)
•• Similar
Similar procedure
procedure
•• Minor
Minor variations
variations
 Functional
Functional Relines
Relines
•• Cannot
Cannot extend
extend borders
borders greater
greater
than
than 44 mm
mm
•• Distorts
Distorts too
too easily
easily
•• Grossly
Grossly under
under extended,
extended, use
use
impression
impression technique
technique
 Functional
Functional Relines
Relines
•• Material
Material requires
requires greater
greater thickness
thickness
for
for accuracy
accuracy
•• Usually
Usually need
need to
to reduce
reduce denture
denture to
to
allow
allow for
for thickness
thickness
Variation
Variation in
in Accuracy
Accuracy of
of Materials
Materials

(Visco-gel>
(Visco-gel> Coe-Comfort)
Coe-Comfort)
 Lynal
Lynal
•• 10
10 mlml powder
powder :: 22 ml
ml liquid,
liquid, mix
mix 30
30 sec
sec
•• If
If borders
borders short
short or
or too
too thin,
thin, add
add more
more
powder
powder for for increased
increased viscosity
viscosity
•• Thicker
Thicker consistency
consistency cancan be
be formed
formed into
into aa
33 -- 44 mm
mm rope
rope and
and placed
placed around
around borders
borders
 Lynal
Lynal
•• For
For tissue
tissue base,
base, mix
mix as
as per
per instructions
instructions
•• Place
Place intraorally
intraorally
•• Remove
Remove excess
excess with
with cotton
cotton swab
swab prior
prior
to
to set
set
Set
Set time:
time: 8-10
8-10 minute
minute
•• Lightly
Lightly border
border mold
mold
•• During
During setting,
setting, allow
allow patient
patient to:
to:
–– Talk
Talk
–– Swallow
Swallow
–– Lightly
Lightly occlude
occlude
 Remove
Remove Excess
Excess
•• Reduce
Reduce material
material on
on flanges
flanges with
with
HOT
HOT scalpel
scalpel or
or knife
knife
•• Remove
Remove from
from teeth,
teeth, oral
oral surfaces
surfaces
•• Patient
Patient wears
wears reline
reline home
home
Patient
Patient Returns
Returns in
in 24-48
24-48 Hours
Hours
•• A
A cast
cast is
is poured
poured within
within 22 hours
hours
•• Otherwise,
Otherwise, accuracy
accuracy compromised
compromised
 Functional
Functional Impression
Impression
Advantages
Advantages
•• Functionally
Functionally molds
molds peripheries
peripheries
•• Ability
Ability to
to assess
assess patient
patient comfort
comfort and
and
retention
retention prior
prior to
to reline
reline proper
proper
 Functional
Functional Impression
Impression
Disadvantages
Disadvantages
•• Variability
Variability of
of materials,
materials, handling
handling
characteristics
characteristics
•• Resiliency
Resiliency masks
masks overextensions
overextensions which
which
can
can subsequently
subsequently irritate,
irritate, when
when
converted
converted to
to acrylic
acrylic resin
resin
 Functional
Functional Impression
Impression
Disadvantages
Disadvantages
•• Dimensional
Dimensional stability
stability variable
variable
–– Patient
Patient care
care
–– Pouring
Pouring of
of casts
casts
•• Can'
Can' tt significantly
significantly increase
increase borders
borders
•• Do
Do not
not use
use simultaneously
simultaneously as
as aa tissue
tissue
conditioner
conditioner
RPD
RPD Relines
Relines (Open
(Open mouth
mouth technique
technique for
for relining):
relining):

1.1. Similar
Similar to to an
an altered
altered cast
cast impression.
impression.
2.2. Materials
Materials of of choice
choice are
are ZOE
ZOE wash,
wash, oror impression
impression
wax
wax wash.
wash.
3.3. It
It preferred
preferred to to take
take over-all
over-all impression
impression with
with reline
reline
in
in its
its place
place inin mouth
mouth and
and the
the cast
cast is
is poured,
poured, put
put
your
your fingers
fingers on on main
main occlusal
occlusal rests
rests and
and indirect
indirect
retainer.
retainer.
4.4. Note
Note that
that the
the teeth
teeth relation
relation to
to opposite
opposite ones
ones not
not
altered.
altered.
 Partial
Partial Denture
Denture Relines
Relines
•• Similar
Similar procedures
procedures
•• Ensure
Ensure rests,
rests, direct
direct and
and indirect
indirect
retainers
retainers are
are fully
fully seated
seated
•• Seat
Seat with
with pressure
pressure over
over the
the rests,
rests,
NOT
NOT the
the distal
distal extension
extension bases
bases
 Partial
Partial Denture
Denture Relines
Relines
•• Allow
Allow nono impression
impression material
material under
under
rests
rests or
or guiding
guiding planes
planes
•• If
If so,
so, remake
remake impression
impression
 Partial
Partial Denture
Denture
Clinical
Clinical Remount
Remount
•• If
If required,
required, aa new
new cast
cast must
must be
be made
made
•• Make
Make anan alginate
alginate impression
impression with
with
the
the RPD
RPD in
in place
place
 Partial
Partial Denture
Denture
Clinical
Clinical Remount
Remount
•• Block
Block out
out undercuts
undercuts onon the
the
framework
framework while
while RPD
RPD isis in
in the
the
impression
impression
•• Pour
Pour the
the model
model with
with the
the partial
partial
denture
denture in
in place
place
 Thank you for lessening
• Any question ?