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Relines and Rebases Improving the Adaptation of Existing Dentures.

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Presentation on theme: "Relines and Rebases Improving the Adaptation of Existing Dentures."— Presentation transcript:

1 Relines and Rebases Improving the Adaptation of Existing Dentures

2 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

3 RelineReline Resurfacing the tissue surfaceResurfacing the tissue surface Jig used to maintain vertical dimension & occlusal contacts with cold-cure acrylicJig used to maintain vertical dimension & occlusal contacts with cold-cure acrylicOr Reprocessing with heat cureReprocessing with heat cure Resurfacing the tissue surfaceResurfacing the tissue surface Jig used to maintain vertical dimension & occlusal contacts with cold-cure acrylicJig used to maintain vertical dimension & occlusal contacts with cold-cure acrylicOr Reprocessing with heat cureReprocessing with heat cure

4 IndicationsIndications Denture no longer fits residual ridge Retention, stability are lacking PLUS PLUS 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 Retention, stability are lacking PLUS PLUS Occlusion is acceptableOcclusion is acceptable Vertical dimension is acceptableVertical dimension is acceptable Denture teeth/gingival contours acceptableDenture teeth/gingival contours acceptable

5 ContraindicationsContraindications Complaints of a loose denture DOES NOT, in itself, constitute evidence of a lack of fit and stability Complaints of a loose denture DOES NOT, in itself, constitute evidence of a lack of fit and stability

6 Determine Cause of Looseness Pivoting on bony structuresPivoting on bony structures -PIP Occlusal interferencesOcclusal interferences -Tactile, articulating paper, remount Inadequate posterior palatal sealInadequate posterior palatal seal -Pull upward & outward on lingual of canines Pivoting on bony structuresPivoting on bony structures -PIP Occlusal interferencesOcclusal interferences -Tactile, articulating paper, remount Inadequate posterior palatal sealInadequate posterior palatal seal -Pull upward & outward on lingual of canines

7 Evaluate Cause of Looseness Coronoid interferencesCoronoid interferences –Side to side movements, PI{P Flanges overextensionsFlanges overextensions –Pull on the cheeks, lips, patient move tongue Tight pterygomandibular rapheTight pterygomandibular raphe Coronoid interferencesCoronoid interferences –Side to side movements, PI{P Flanges overextensionsFlanges overextensions –Pull on the cheeks, lips, patient move tongue Tight pterygomandibular rapheTight pterygomandibular raphe

8 Relines Will Only Solve Retention Problems Related to Denture Base Adaptation Retention problems must be diagnosed as to their cause

9 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 Relines

10 Processed Acrylic Permanent Complete Denture Relines Make impression for least stable denture firstMake impression for least stable denture first Easier to stabilize the other dentureEasier to stabilize the other denture –Reference for occlusion & vertical dimension Make impression for least stable denture firstMake impression for least stable denture first Easier to stabilize the other dentureEasier to stabilize the other denture –Reference for occlusion & vertical dimension

11 Impression Technique Difficult to reline without: Encroaching on interocclusal spaceEncroaching on interocclusal space Displacing the supporting tissuesDisplacing the supporting tissues Altering occlusal contactsAltering occlusal contacts USE CARE USE CARE Difficult to reline without: Encroaching on interocclusal spaceEncroaching on interocclusal space Displacing the supporting tissuesDisplacing the supporting tissues Altering occlusal contactsAltering occlusal contacts USE CARE USE CARE

12 Positioning the Denture OVD & Occlusion

13 Adjust Occlusion Obtain stable occlusal contactsObtain stable occlusal contacts Remount & adjustment may be requiredRemount & adjustment may be required Assess need for tissue conditioningAssess need for tissue conditioning Obtain stable occlusal contactsObtain stable occlusal contacts Remount & adjustment may be requiredRemount & adjustment may be required Assess need for tissue conditioningAssess need for tissue conditioning

14 Remove Tissue Undercuts Allows impression to be removed from cast without breaking cast or denture

15 Clean the Denture

16 Border 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 line (indelible stick)Maxillary posterior border at vibrating line (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 line (indelible stick)Maxillary posterior border at vibrating line (indelible stick)

17 Reduce Tissue Base 1 mm if acceptable interocclusal distance1 mm if acceptable interocclusal distance –Use guide grooves If interocclusal distance is excessive, relief may not be requiredIf interocclusal distance is excessive, relief may not be required Perforate denture with #4 round burPerforate denture with #4 round bur 1 mm if acceptable interocclusal distance1 mm if acceptable interocclusal distance –Use guide grooves If interocclusal distance is excessive, relief may not be requiredIf interocclusal distance is excessive, relief may not be required Perforate denture with #4 round burPerforate denture with #4 round bur

18 Impression Material Polyvinylsiloxane Ease of useEase of use Cleaning, removal from undercutsCleaning, removal from undercuts Requires adhesive carried to the external surface of denture bordersRequires adhesive carried to the external surface of denture borders Ease of useEase of use Cleaning, removal from undercutsCleaning, removal from undercuts Requires adhesive carried to the external surface of denture bordersRequires adhesive carried to the external surface of denture borders

19 Impression Procedure Load carefullyLoad carefully Excessive material can reduce freeway spaceExcessive material can reduce freeway space Dry tissuesDry tissues Load carefullyLoad carefully Excessive material can reduce freeway spaceExcessive material can reduce freeway space Dry tissuesDry tissues

20 Impression Procedure Seat denture anteriorlySeat denture anteriorly Slowly rotate posterior into placeSlowly 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 placeSlowly rotate posterior into place Ensure denture is not too far forwardEnsure denture is not too far forward

21 Verifying Position Patient closes lightly until first contactPatient closes lightly until first contact If occlusal interdigitation is poor, physically move dentureIf occlusal interdigitation is poor, physically move denture Maintain position until setMaintain position until set Patient closes lightly until first contactPatient closes lightly until first contact If occlusal interdigitation is poor, physically move dentureIf occlusal interdigitation is poor, physically move denture Maintain position until setMaintain position until set

22 Evaluate 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.)

23 Check relations intraorally Send to lab for processing

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

25

26 Remount Adjust Occlusion

27 Impression Technique Advantages Only two appointments neededOnly two appointments needed Tissues are captured at rest (less possibility of distortion)Tissues are captured at rest (less possibility of distortion) Allows for greater extension of peripheriesAllows for greater extension of peripheries Allows placement of functional posterior palatal sealAllows placement of functional posterior palatal seal Only two appointments neededOnly two appointments needed Tissues are captured at rest (less possibility of distortion)Tissues are captured at rest (less possibility of distortion) Allows for greater extension of peripheriesAllows for greater extension of peripheries Allows placement of functional posterior palatal sealAllows placement of functional posterior palatal seal

28 Impression Technique Disadvantages Possible alteration in VDO, occlusion, facial supportPossible alteration in VDO, occlusion, facial support No chance to test retention and comfort under functionNo chance to test retention and comfort under function Possible alteration in VDO, occlusion, facial supportPossible alteration in VDO, occlusion, facial support No chance to test retention and comfort under functionNo chance to test retention and comfort under function

29 Functional Relines (Lynal, Visco-gel) Similar procedureSimilar procedure Minor variationsMinor variations Similar procedureSimilar procedure Minor variationsMinor variations

30 Functional Relines Cannot extend borders greater than 4 mmCannot extend borders greater than 4 mm Distorts too easilyDistorts too easily Grossly under extended, use impression techniqueGrossly under extended, use impression technique Cannot extend borders greater than 4 mmCannot extend borders greater than 4 mm Distorts too easilyDistorts too easily Grossly under extended, use impression techniqueGrossly under extended, use impression technique

31 Functional Relines Material requires greater thickness for accuracyMaterial requires greater thickness for accuracy Usually need to reduce denture to allow for thicknessUsually need to reduce denture to allow for thickness Material requires greater thickness for accuracyMaterial requires greater thickness for accuracy Usually need to reduce denture to allow for thicknessUsually need to reduce denture to allow for thickness

32 Variation in Accuracy of Materials (Visco-gel> Coe-Comfort)

33 Lynal Lynal 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 powder for increased viscosityIf borders short or too thin, add more powder for increased viscosity Thicker consistency can be formed into a mm rope and placed around bordersThicker consistency can be formed into a 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 powder for increased viscosityIf borders short or too thin, add more powder for increased viscosity Thicker consistency can be formed into a mm rope and placed around bordersThicker consistency can be formed into a mm rope and placed around borders

34 Lynal Lynal For tissue base, mix as per instructionsFor tissue base, mix as per instructions Place intraorallyPlace intraorally Remove excess with cotton swab prior to setRemove excess with cotton swab prior to set For tissue base, mix as per instructionsFor tissue base, mix as per instructions Place intraorallyPlace intraorally Remove excess with cotton swab prior to setRemove excess with cotton swab prior to set

35 Set time: 8-10 minute Lightly border moldLightly border mold During setting, allow patient to:During setting, allow patient to: –Talk –Swallow –Lightly occlude Lightly border moldLightly border mold During setting, allow patient to:During setting, allow patient to: –Talk –Swallow –Lightly occlude

36 Remove Excess Reduce material on flanges with HOT scalpel or knifeReduce material on flanges with HOT scalpel or knife Remove from teeth, oral surfacesRemove from teeth, oral surfaces Patient wears reline homePatient wears reline home Reduce material on flanges with HOT scalpel or knifeReduce material on flanges with HOT scalpel or knife Remove from teeth, oral surfacesRemove from teeth, oral surfaces Patient wears reline homePatient wears reline home

37 Patient Returns in 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

38 Functional Impression Advantages Functionally molds peripheriesFunctionally molds peripheries Ability to assess patient comfort and retention prior to reline properAbility to assess patient comfort and retention prior to reline proper Functionally molds peripheriesFunctionally molds peripheries Ability to assess patient comfort and retention prior to reline properAbility to assess patient comfort and retention prior to reline proper

39 Functional Impression Disadvantages Variability of materials, handling characteristicsVariability of materials, handling characteristics Resiliency masks overextensions which can subsequently irritate, when converted to acrylic resinResiliency masks overextensions which can subsequently irritate, when converted to acrylic resin Variability of materials, handling characteristicsVariability of materials, handling characteristics Resiliency masks overextensions which can subsequently irritate, when converted to acrylic resinResiliency masks overextensions which can subsequently irritate, when converted to acrylic resin

40 Functional Impression Disadvantages Dimensional stability variableDimensional stability variable –Patient care –Pouring of casts Can' t significantly increase bordersCan' t significantly increase borders Do not use simultaneously as a tissue conditionerDo not use simultaneously as a tissue conditioner Dimensional stability variableDimensional stability variable –Patient care –Pouring of casts Can' t significantly increase bordersCan' t significantly increase borders Do not use simultaneously as a tissue conditionerDo not use simultaneously as a tissue conditioner

41 Partial Denture Relines Similar proceduresSimilar procedures Ensure rests, direct and indirect retainers are fully seatedEnsure rests, direct and indirect retainers are fully seated Seat with pressure over the rests, NOT the distal extension basesSeat with pressure over the rests, NOT the distal extension bases Similar proceduresSimilar procedures Ensure rests, direct and indirect retainers are fully seatedEnsure rests, direct and indirect retainers are fully seated Seat with pressure over the rests, NOT the distal extension basesSeat with pressure over the rests, NOT the distal extension bases

42 Partial Denture Relines Allow no impression material under rests or guiding planesAllow no impression material under rests or guiding planes If so, remake impressionIf so, remake impression Allow no impression material under rests or guiding planesAllow no impression material under rests or guiding planes If so, remake impressionIf so, remake impression

43 Partial Denture Clinical Remount If required, a new cast must be madeIf required, a new cast must be made Make an alginate impression with the RPD in placeMake an alginate impression with the RPD in place If required, a new cast must be madeIf required, a new cast must be made Make an alginate impression with the RPD in placeMake an alginate impression with the RPD in place

44 Partial Denture Clinical Remount Block out undercuts on the framework while RPD is in the impressionBlock out undercuts on the framework while RPD is in the impression Pour the model with the partial denture in placePour the model with the partial denture in place Block out undercuts on the framework while RPD is in the impressionBlock out undercuts on the framework while RPD is in the impression Pour the model with the partial denture in placePour the model with the partial denture in place


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