8

Reline and rebase

Aya Shahrouri & Baraah Alsalamt Khaled Alhamad

Prosthodontics lec. 8 relining and rebasing of complete dentures References : 1.Boucher's Prosthodontic treatment for Edentulous Patients( Zarb & Bolender) Chapter: Prolonging the useful life of complete dentures: the relining procedures 2. Applied Dental Materials ( JF McCabe & AW Walls) Chapter: Denture lining material

** Relining and rebasing Is about maintenance of complete denture why we need relining or rebasing ?? bone resorption will happen over time and the pt will feel that the denture is wide , pt will express that to you and tell you that he feels denture is loose, so you'll check the denture if it needs relining or rebasing or total remake so it's mandatory to keep recall visits for your CD pt after bone resorption pt wearing CD will experience: loss of retention and stability and he could end up losing vertical dimensions of occlusion and loss of support as well as centric relations and this can affect the whole orientation of the occlusal plan, so a lot of things can happen from bone resorption - so in this case I can do reline or rebase or remake. first lets differentiate btw them Reline: when just minimal resorption happened so you just add the fitting surface, so I'll use a special technique In the clinic (I have over time resorption in the ridges and denture is a bit loose and you just add on fitting surface) Rebase: if changes were moderate to severe and I had changes in the occlusal plan and vertical dimension and CR , as a result the thickness of the layer that I'm adding is increased and by that the pink part of the denture will become thick so I'll produce pressure on fitting surface then my technician will decrease thickness from the polished surface (in this technique you're dealing with the base). diagnosis How to decide wither you need reline or rebase or a total remake ??

you start with the Complaints: Looseness ,Soreness, Chewing inefficiency, Aesthetic changes. And cause should be determined because these complaints could be similar to problems with the occlusal surfaces so we might have nothing wrong with the base nothing wrong to the fitting surface it could be just problems with the occlusal surfaces and manifests as looseness ,Soreness, Chewing inefficiency, Aesthetic changes, so you have to differentiate if it is an occlusal problem, or sth to do with the fitting surface Q: how to reveal if changes are related to fitting surface?? A: you can check retention and stability of the denture one by one (upper alone and lower alone), and check general soreness and inflammation is it related to the occlusal surface or poor fit of the denture , and check VDO and VDR, is the freeway space too much increased so I have lost the VD , and how is esthetics and then occlusal surfaces problems and interferences and then you can conclude that it was a problem in the fitting surface or in the occlusal surface if you imagine, over time bone resorption occur, and the space btw the teeth increases, mandible will travel further up, and as it is travelling far the mandibular position will be slightly forward, but the centric relation won't change only the position of the man. , and you can imagine that now while you're working in the clinics, that most of pts are class 3 because most of them worn the denture for a long time so there will be loss in vertical dimension and mand. Will go forward and thats why you see lots of class 3 Now when you are working on a CD in the third visit you will not make the VDO probably, so you'll ask the pt to move his mand. Further up so it will forwards and you check the free way space 8mm which is increased means VDO is very small, and if you increase the VDO the man. Will go a little bit backward into normal position *sometimes even without changing the CR, if VDO is wrong (decreased) the mand. Will occupy a class 3 position NOTE: mandible move around the terminal hinge access (imaginary line passes btw condyles ) which the hinge access that the mandible closes and open on. Sometimes one of them could be a problem so rotation will take place if the seat of the denture has changed ; bone resorption

occurred then position of CD differs and we'll have rotation and it will not only affect retention and stability, it can affect the whole occlusal scheme, imagine when the position of CD changes because of the base seats changed so all special relations will change due to the base seats changes. you can check the VDO , the statics , fitting surface , size of the residual ridge and by that you can determine the cause of the problem then reline or rebase the denture. If too much to do the remake is the choice and by EXPERIENCE you'll be able to decide when to reline or rebase or remake. To SUMMERIZE : * if the problems are only related to the fitting surface then change the fitting surface wither it's a minimal thickness reline or large thickness , but in large thickness you have to check when I change the fitting surface is the occlusion and esthetics changing?? And you have to do that before remake as we'll see now in the techniques. What would you do in the clinic ?? we have 3 techniques : 1. Static impression technique 2. Functional impression technique. 3. Chair-side technique. In the 1st two tech. >> you take imp. In the clinic and then you send it to the lab, and in the lab according to your imp. They will add the layer either reline or rebase but the third >> you make and finish everything in the clinic

1. Static impression technique now I need a new impression but not with special tray, because I want to make changes in the denture itself so I take impression with same denture A. Closed mouth technique : when you do the impression for upper and lower together and make the pt closes on them. Remember when I'm taking an impression for the upper, I'm adding thickness (imp. Thickness) and occlusal relation will change, because any material you are adding to the fitting surface will change special relations how minimal it was, so I prefer to check the occlusion first; before doing this technique, if any

correction is needed for the occlusion, do it then mark CR and if I need border molding I prepare it for upper and lower (I'll treat the denture as a secondary imp. ) and check the extension of the denture and post dam and then I check the occlusion at this position. If the CR is okay I just add imp. Material inside the denture without border molding -- border molding I did it in the tracing compound * so make sure you put imp. Material inside and make the pt bites on them and according the CR (no change in the occlusion here because the mouth is closed) *Dentures are used as impression trays. B. Open mouth technique: here you take the impression for the upper alone and the lower alone then you change the occlusion ( by that you did the 2nd and 3rd visit together) then send them to the lab A little bit harder dentures are used as impression trays. **I prefer closed mouth technique
** this slide just telling you what you have to prepare in the clinic if you're doing closed mouth tech.**

This will help the technician in removing the material( holes will make it easier)

** If the centric relation is not correct you can take >> Wax iter- occlusal record or by adding acrylic resin as you did in the tray make shorter than the sulcus and make sure that the tray is flat and have flat border You can do border molding in many ways ;one of them By tracing compound , most of American schools use polyether( viscous material we take It all at once ) It is believed that strains inherent in the processed denture base would be released by subsequent processing causing warpage (1.33%). Use low heat in the processing or auto-polymerizing resin. so be aware to tell the technician to use one of them.

Functional impression technique.

notice that in the static impression we used the denture itself to take an impression then sent it to the lab to replace the impression material into acrylic for both reline and rebase. but here in the functional impression is done in a different way : Impression is made with a material called tissue conditioners. we palce it on the denture itself. Retaining compliance for many weeks , we keep it with the patient up to 2 weeks.

this tissue conditioner material is acrylic in origin , it starts acting as visco- elastic (which permanently deforms) within the first 2 to three days , then it becomes elastic (which will absorb the pressure on the residual ridge) then after up to 2 weeks reaches the final set without any deformity. it is the same concept of the impression taking but with longer duration of impression taking (2 weeks) not (5-10 min.s). because it is not silicone it is acrylic which can adhere to the fitting surface, and cured inside the patient's mouth without making border molding step. after 2 weeks we send the denture to the lab , then they do rebasing to the denture. we named it functional impression because the patient has used it for 2 weeks while he is functioning. Good dimensional stability

Excellent bonding to resin base.

The denture is observed intra-orally, and any under or over-extensions is corrected. Tissue stops using compound is used to re-establish the a proper occlusal relationship.

A treatment liner is placed on the fitting surface. The patient manidble is guided into RCP and maintained while the material is setting. Excess material is trimmed with a hot scalpel. slide #22 : Tissue conditioner :

an acrylic impression material contains plasticizer (which means the acryl will not be fully set it stay as a dough so it take a longer time in the visco-elastic stage up to 36 hours) so when the patient is functioning chewing and mastication it works as we are molding the border of the denture. so it differ from the impression materials like silicones which needs a border molding step.

** we can use this material in other situation ex. : a patient has extracted his teeth or a patient with fresh implants, and made a denture and he has pain on the ridge areas, if we use the hard acrylic , it will cause complications so we use the tissue conditioner it won't make pressure or trauma. until the tissues heals we change the tissue conditioner into hard material. As you see in the pic above : materialistic point of view about the tissue conditioner , it has stages to reach the full set:

1- Plastic stage : few hours to few days : or visco-elastic when it receives pressure from the tongue or cheeks in permanently deforms like molding, during few hours to few weeks the patient is molding his own fitting surface. 2- Elastic stage : 1-2 weeks : this stage is sufficient if the patient has injuries or thin mucosa , then the material will absorb the stress and will not transform it on the ridges. 3- Firm stage : after 2 weeks: once it reaches the firm stage we have it change the material because if it becomes firm we will not get the purpose of

using it as a tissue relief or decrease the stress, but as an impression material we should take the denture out and send it to the lab.

Chair-side technique.

the material used is a hand mixed acrylic to add to the denture in the clinic , you mix it directly put in on the fitting surface and use it as an impression material , do border molding then ask the patient to close and add the acrylic on the wanted areas wait it to set then Jahez 3ammy Rawe7 :P. Used with acrylic material that is added to the denture and allowed to set in the mouth to produce an instant chair-side reline/rebase. Problems: Chemical burn and sensitivity. Porous, developing bad odor. will cause Candidal infections and food accumulation . Poor color stability. over time there will be discoloration

If the denture was not positioned correctly, the material would not be removed easily to start again.

it gives very poor quality So Chair side technique is not used at all ,just in one situation if the prosthesis is temporary then you have to replace it with the other techniques; you will see over time that there is some dentists use it as a final technique :/

Material Science
Hard Reline
as a revision typical reline material which you can use it chair side. ** you have to memorize the table beside.

Allergy more with type I( monomer: methyl methacrylate). Liquid in type II is far less irritant. Both I & II have low (Tg) glass transition temperature . Why ? you should read it but for now clinically : type II Tg = 60 means that this material remain hard when the

temperature is below 60 and above 60 becomes soft. so it depend on our usage , we want the acrylic to stay soft so we should use the one which has the lower Tg. but the transition acrylic is above 100 Both types result in porous Air inclusion during mixing Rapid increase in viscosity Often colonized by Candida. No control over the thickness and the occlusal plane. Increase in the thickness of the palatal part of the upper denture. Because of all that direct reline is considered temporary solution.

Tissue Conditioners
Soft denture liners applied to the fitting surface providing a temporary cushion. It undergo a plastic flow for 24-36 hours after mixing to allow for soft tissue changes after healing. Applications: When the soft tissues are traumatized allowing it to heal before making the new impression. In cases of immediate dentures. Functional impression technique. Composition The softness of the material is a function of the use of the higher methacrylate, coupled with considerable quantities of plasticizer and solvent. No initiator or monomer in the composition. It is purely physical process. The final set material is a gel-like with swollen plasticized spheres being cemented together with a matrix of saturated solution of polymer in a solvent/ plasticized mixture

Soft Lining Materials

Temporary Soft Lining Materials Similar to tissue conditioner in composition but less soft initially and retain softness for longer. Not to be used with peroxide. Use water or soak denture in hypochlorite.

Permanent soft lining material Indication: For patients who cannot tolerate a hard base- irregular mandibular alveolar ridge covered by a thin non-resilient mucosa. Expected to function for a much longer period of time- permanently soft for the life time of the denture.

Self cure(cold cure) are in fact temporary soft lining material- requires replacement. Heat cured acrylic rely on softness on the use higher methacrylate (poly ethel /poly butyl methacrylate), and a plasticizer.

the end : Aya Shahrouri Baraa'h Alsalamat