Relining

Finn Tengs

techniques
Christensen,

for complete
L.D.S.*

dentures

University of Bergen, School of Dentistry, Bergen, Norway

1 he term reline is defined as, To resurface the tissue side of a denture with new base material to make it fit more accurately. The term rebase is defined as, A process of refitting a denture by the replacement of the denture base material without changing the occlusal relation of the teeth.l Commonly used relining techniques will be discussed in this article. In addition, a reliable laboratory relining technique for complete and removable partial dentures which is simple to execute and offers a high degree of precision will be described. RELINE, REBASE, OR NEW DENTURES

The main purpose for either relining or rebasing is to re-establish adequate adaptation of the denture base to the bearing area and to re-establish the original jaw relations. Lack of knowledge and technical skill regarding relining and rebasing have caused disappointments, and consequently, these procedures have often been omitted where indicated. Some dentists recommend making new dentures, others reline, and still others prefer to reprocess the old denture on a cast from a new impression.3l New dentures are indicated when the residual ridges have resorbed extensively with great loss of vertical height or when proper occlusion is difficult to establish.3 When only one jaw has resorbed extensively, the rebasing method described by Swenson5 may be used if the occlusion is acceptable. The thickness of the layer of impression material is not increased, but the intermaxillar distance is established by means of an interoccusal record; and the vertical change is accomplished by reoccluding the teeth after the dentures have been mounted on the articulator. Nagle and Sear9 recommend filling the alveolar groove of the denture with softened wax to determine the new vertical dimension of occlusion prior to making the impression. Van den Berg7 prefers to increase the vertical dimension of occlusion without *Head of the Prosthetic Department.

373

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findings indicate that balance GIII changing the fit of the denture base. Histologic occur between the denture base and the ridge which should not bc disturb(sd. lhis method may be advantageous when an increase of the vertical height is t~cccssar! and the patient is satisficcl M.ith the fit of the dcxnturc*. TIME FOR RELINING

The best time for and the frequency of relining depend on the amount and rapidity of resorption of thcb residual ridges. Disharmony of fit and occlusion a~ important factors in the degree and rapidity of the resorption. AccordinK to Schiile, the resorption is Icast ivhen the dentures arcs relined within a short time. Immediate dentures usually must br relined about three months following surgery. If thr patient has difficulties M.ith retention prior to this time. the denture should be relined earlier. DIAGNOSIS AND PREPARATION OF THE ORAL CAVITY

The tissue underlying the dentures JnUSt br examined carefully, and irritation caused by the denture must be eliminated beforc relining procedures can be initirelines with tissue conated. According to Lytlc, I1 frequent consfhcutivr temporary ditioning material ha\se to be made until complete tissue recovery is achieved. Supporting therapy includes massage of soft tissues with a soft toothbrush or finger, removal of dentures during the night, and use of soft food during the healing period. In addition, the dentures must be removed from thr mouth for 48 hours before the final impressions are made. If the supporting bone is badly drstroycd, surgicai corrections may be necessary. Plastic surgery to drepcn the sulcus or surgical treatment of the mylohyoid ridg-c may also bc nrcrssary. EXAMINING THE OCCLUSION

When dentures are relined, it must be assumed that the occlusion was satisfactory when they were made. With cusp teeth, the rock test (Wipp-probe) may bt used.12 The occlusal surfaces of opposing teeth are put against each othrr with th(* dentures in the hand, and where there is disharmony of the occlusion, thcl dentur-th will rock on the high spots. A relining in connection with faulty occlusion will only give tcnjporary ill]provemcnt. The occlusal disharmony will cause resorption, and the fit of the denture wii1 again be fadty. No rclinin g can bc accurate or complete without a IIVM InollntinF: of the dentures on the articulator and ;1 regrindin,g of the occlusion. PREPARING THE DENTURE BASE FOR RELINING

All undercuts on the denture base must be eliminated before impression procedures are started to avoid locking the denture to the cast. The bordrrs of the denture may be cut down if too long or built up with a suitable n~atrrial if too short to make theul harmonious with the surrounding tissues. The vibratinSg line is checked, and the posterior border of the denturr is corrected, if necessary. to develop the posttarior palatal seal.

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The palatal and labial flange of the upper denture should be perforated to decrease pressure inside the denture during the impression-making procedure which might displace soft tissue. The perforations also prevent air bubbles from forming on the surface of the impression and may prevent anterior displacement of the denture. A moderate pressure with a balancing finger against the labial surface of the upper denture as the jaws are closed will assist in maintaining the denture in its proper position. When the vertical relation has been established, the lips and cheeks are constricted to mold the borders. Nagle and Sears? recommend boiling the dentures for 5 minutes before relining them to minimize the internal strains in the base material.
IMPRESSION MATERIALS AND IMPRESSION METHODS

A thin layer of impression material usually causes more pressure on the tissues than a thick layer and a low degree of flow. Therefore, to avoid tissue distortion, the impression material should possess a certain thickness and a high degree of flow and have sufficient time to flow at mouth temperature.r3 ChaseI uses a thin layer of rubber-base impression material with a closed-mouth technique, making the impression with little pressure. Escape holes are made through the labial flange to prevent the forward displacement of the maxillary denture. The occlusal relationship is preserved by relining and finishing the maxillary denture first so that it will control the position of the mandibular denture. The patient is cautioned to use slight force and only tap the teeth together again. Increased occlusal pressure may squeeze too much of the impression material out of the dentures resulting in sore points from the completed dentures. Buchmanl recommends using a central bearing point and a needlepoint (Gothic arch) tracing in connection with the relining procedure. Impression materials for relines must reproduce fine surface detail, If tissueconditioning impression materials are used, they can be used for the final impression. However, each dentist should use the material which is most suitable for his technique and his experience.
RELINING Soft-base materials in relining

Usually a cold-curing acrylic resin is used as the relining material. However, elastic-base materials may have advantages for patients with extremely resorbed tissue residual ridges when the interarch distance is great* or where the underlying is especially tender and sensitive.17 According to Sauer,ls the denture lined with a soft material may be especially desirable when mechanical shock to the supporting areas should be reduced. The indications for this reduction include ( 1) ridges with mucosal coverage, multiple osseous undercuts, (2) ridges with thin, nonresilient, (3) persistent denture sore mouth, (4) knife-edge mandibular ridges, (5) relief for the median palatine suture or torus palatinus, and (6) prosthodontic restorations for congenital or acquired oral defects. Most patients seem to be very comfortable with the soft acrylic resins. AS occlusal pressures are distributed over the entire underlying area, retention seems to be in-

1 I

I,/TC WEH M/TC K/EB J/TC B/TC H/TC O/TC H/TC EiTC H/TC S/TC

DH ss DH GI GI DH DH DH GI GI DH DH DH DH DH DH

DH (hl) TC f,h_,i SS (ht)

DH (hYj :io.so 30.6.i "7,:io 27.?0

SS (hll DH (h,) 1E (111 j DH (h?)

4 5 6 7 8 9 10 11

29.10 29.00 :i t .o:, :i 1 10 ss (hl) DH (hl) DH (hl) GI (h?) L4.20

'4.Yl

NH (hl) DH (hL) SY 011) DH ih) DH ihl) SS rh) SS (hi) DH (11)

"2.00 21.95

33.10 :i:i.10 3 I .io 31.60

26.50 26.50

13 14 13 16

N/PR H/AH P/TC S/B

DH (hl) NH (h2) Three measurements were made before (L-M-R) and after (LI-Ml-R,) cold-curing resin during relining.

the relining

procedure

creased and problems with food accumulatin,c underneath the denture are reduced. The reduction of mechanical shock resulting from occlusal pressure tends to reduce. destructive changes in the supporting tissues.! Soft acrylic resin may cover the whole base or may be surrounded by rigid

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during

relining
FfOTU Difference M-MI +0.15 +0.05 0 to.05 -0.05 0 0 0 +0.10 to.10 +0.05 +0.05 to.10 to.05 -0.05 to.05 +0.05 to.05 -0.10 -0.10 -0.05 -0.10 to.05 +0.10 +0.05 0 +0.15 to.15 to.05 0 -0.05 0 the difference Before R 36.00 36.10 27.50 27.50 32.35 32.35 27.30 27.30 26.40 26.35 29.60 29.65 28.90 28.90 24.80 24.80 33.45 33.50 31.10 31.10 25.75 25.70 33.60 33.60 32.05 32.10 26.30 6.3.5 35.50 35.50 23.30 23.30 in measurements before Right After side DiBerence R-RI 0 -0.10 to.10 +O.O.i to. 1:i to.05 0 -0.10 -0.20 -0.15 +O.lO to.05 to.10 +O.lO 0 0 0 -0.05 to.05 0 -0.05 -0.05 to.05 0 -0.0.5 -0.10 +O.lO to.05 0 0 0 0 the curing of the -

Before M 38.65 38.73 30.05 30.05 32.40 32.40 26.90 26.90 36.50 36.60 37.35 37.35 30.50 30.45 28.40 28.35 31.70 31.75 34.30 34.20 29.1.5 29.15 34.40 34.40 31.10 31.20 30.10 30.15 34.80 34.80 25.30 25.30 L-L,, M-M,,

After Ml 38.80 38.80 30.05 30.10 32.35 32.40 26.90 26.90 36.60 36.70 37.40 37.40 30.60 30.50 28.35 28.40 31.70 31.80 34.20 34.10 29.10 29.05 34.45 34.50 31.15 31.20 30.25 30.30 34.85 34.80 25.23 25.30 and R-R,, indicate

Ri
36.00 36.00 25.60 27.55 32.50 32.40 27.30 27.20 26.20 26.20 29.70 29.70 29.00 29.00 24.80 24.80 33.45 33.45 31.15 31.10 25.70 25.6. 33.65 33.60 32.00 32.00 26.40 26.40 35.50 35.50 23.30 23.30 and after

acrylic resin which forms the border of the denture. The soft resins will only be satisfactory for a limited time (up to three years), 3p16, *O because they harden and stain and white nodules appear in the silicone rubber materialszl Therefore, patients should be informed that relining must be repeated periodically.

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Christensen

Fig. 1. Thr impression material has been removed from the denture. and the t,rrtl of cac,h resin wing (A. B, and C) has been rut flush with thr surrounding plaster in order to form a definite border between the resin and plaster. The junction between the ~Y~CIVC~and thl, wings is marked with ink (B) for visual control of the relining material.

Disadvantage

of the relining

procedures

The greatest disadvantage of all relining methods has been the problem of increasing the vertical dimension of occlusion during thr laboratory procedures. Often, this problem can be corrected by intraoral occlusal grinding or by remounting the dentures on the articulator and correcting the processing changes. However, the problem may be eliminated or minimized by means of the wing relining laboratory procedure.
Wing relining laboratory technique

technique *2 incorporates The wing relining a. simple but effective control for alterations in the vertical dimension of occlusion during laboratory procedures by the use of resin wings Lvhich are added to the denture. The resin wings fit into corresponding grooves in the land of the cast (Fig. 1 ) and allow the denture to btb accurately repositioned and maintained following rclnoval of the impression material. The vertical dimension is controlled by clamps during the addition of coldcuring acrylic resin to replace the impression material.
Accuracy of the wing relining laboratory technique

Changes in the vertical dimension of occlusion during relinings were investigated before and after laboratory procedures using the wing technique. Measurements were made from the occlusal surfaces of the teeth to the base of the cast with ii sliding caliper. One measurement was made in the anterior region and the others on either side in the molar region. The sliding caliper was developed by soldering a plate to a Boley gauge (Fig. 2 j . The plate functions as a supporting plane and must fit the base of the cast without

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plane added to the sliding caliper. The supporting plane fits the base of the cast without rocking. (A) The tracing of the supporting plane to permit its replacement for subsequent measurements after the curing process is complete.

Fig. 2. (P) The supporting

rocking. Consequently, the base of the cast must be made even by means of a cast trimmer. When measuring, the upper arm of the sliding gauge is placed on one of the selected points, and the supporting plane is placed on the base of the cast (Fig. 2). The border of the supporting plane is marked on the base of the cast with a sharp pencil. and the lines are accentuated with a sharp instrument. In this way, the supporting plane can be accurately replaced for repeated measurements after the curing process. The denture with the impression material and with the resin wings added was first measured on the cast at the three selected locations before the denture was separated from the cast (Table 1). The measurements at the same three locations were repeated after curing the autopolymerizing (cold-curing) resin but before the denture and cast were separated. Altogether, at least six measurements were made for each denture during the relining procedure, and each of the measurements was repeated by another person for a total of twelve measurements for each relining procedure. The measurements with the impression material in the denture before its separation from the cast are listed in the cdumns Iabeled L, M, and R in Table I. The measurements after curing but before the denture was separated from the cast are listed in columns L,, MI, and R,. Differences between the first and second measurements indicate the alterations in the vertical height before and after processing (Differences L-L,, M-M,, R-R,). STATISTICAL EVALUATION OF MEASUREMENTS dimension
to z

The change in vertical

the vertical dimension

is equal to d (Table
n is equal

I) ; the mean change of

is equal

to 96 measurements.

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Christensen

The standard Consequently,

deviation

(Sd) dimension

changes in thr vertical

of occlusion N~FII dining

dyll-

tures using the xving relining laboratory twhniyue varies with x-i- Sd -m 0.01 ? 0.7 1nIn. That is, fi8 per cent of the variation in vertical changes during the laboratol.! relining procedure lie between -0.06 and 4-0.08 mm.. c\.hilf: 9.5 per cent art situated hetmwn -0.13 and +O. 15 IIIIII. According to Swenson, the relining prowdurr is time consm~iing when using an exacting technique. Hr states that thf. work involved requires about half of tht time necessary to construct new dentures. Hol\.cver. cvhcrl using the \\.ing rchinc! technique. an a\craSye dcnturr can bc rplillcd in Ir~ss than t\vo hol~r.~ including ~111 procedures. Measurements rnadc in this stud!. indicate that dirrlcnsion may be dcweascd drtl-ing the laboratory proccduI-es of rclininc. IIlereforc*. only n gcntlt: prwsurc should r&J, w,ings GUI 1~5 I)rcssyd into be used during the c,uring procedure or t1w ;rryIir the plaster. Prcssurc: on the dcnturc itself should be nvoidcd durin,g processing. The pressuw causrs the denture base to act as a spring, and too much of the new relining material may be squwzcd out. Whcu the pressure i\ rcGe,ml bcforr the c,llring process ha5 been conlplcted. air will be drawn bot\t.c~c~nthe drnturc and the cast resultinK in aii bubbles in the acrylic resin. If the prc~ssurc on thtx occlusal surfaw is milintainrd until the acrylic resin is cur&. chan,qcs Illa!- occur irr the oc~clusion. Pol~rr~rrizatio~~ quality of c111w1 resin ;ih of cold-curing acrylic twin in a pressl~re box improws compared with resin cured without prcssuw. Howm.fI. correctly treatc~l cold-curin? acrvlic resins procmscd without a prcssurc box also qi\.fs good results. SUMMARY AND CONCLUSION

I>ifferent relining techniques for rcnm~ablc dentures have beer1 discussc*tl. 1%~. wing relining method for wrnplete clcntures is an rrtcctivc laboratory wlining pro-. cedure that permits control of thr I-ertical dirlrension of occlusion during prows+ ing. Statistical analysis indicates that the wing relinin% laboratory proccdurcss reflected a variation in changes in th(. \.crtical dimension or owlusion that IILIX less th;tll iO.l mm. in 68 per cent of the dentures relined. References

2. Hardy, 3. Rehm, Hiithig

I. R.: Rebasing the Maxillary H.: Erfolgr und Miswrfolge

Detlturc. Dent. Dig. 55: 23, 1949. bei Tot&n Protbespn, Heidelberg,

196.5, Dr. ,4]frczr(

Verlag.

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Number 4 4. 5. 6. 7. 8. 9.

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10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22.

Coburn, W. il.: Century of Standard Maxillary and Mandibular Impressions With Refinements, J. PROSTHET. DENT. 3: 29, 1953. Swenson, M.: Improving Immediate Dentures in General Practice, J. Am. Dent. Assoc. 47: 550, 1953. Nagle, R. J., and Sears, V. H.: Remodeling and Refitting Dentures, St. Louis, 1962, The C. V. Mosby Company. van den Berg, E. J.: Partial Dentures as Seen by a General Practitioner. IX. Internationalen Zahnarztekongrez der F.D.I., Wien, 1936, Urban und Schwarzenberg, p. 1133. Van Thiel, H.: Alteration in Tissue Underlying Complete Dentures, Int. Dent. J. 10: 518, 1960. Schiile, H.: Untersuchungen tiber den Einfluss van Alveolarkammplastik und Immtdiatprothese auf Form und Beschaffenkeit des Prohtesenlagers, Dtsch. Zahnaerztl. Z. 12: 1451, 1957. Frohlich, E.: Gewebsveranderungen als Folge Schleimhautgetragener Prosthesen. Dtsrh. Zahnaerztl. Z. 7: 107, 1952. Lytle, R. B.: The Management of Abused Oral Tissues in Complete Denture Construction, J. PROSTHET. DENT. 7: 27, 1957. Kiihler, L.: Die Vollprothese, in Scheff und Pichler, editors: Handbuck der Zahnheilkunder, Band IV, Berlin and Wien, 1929, Urban und Schwarzenberg. Sandermann-Olsen, Th.: Karakteristik af Dentale Aftrykspastaer, Tandlaegebladet 57: 333,1953. Chase, W. W.: Adaptation of Rubber-base Impression Materials to Removable Denture Prosthetics, J. PROSTHET. DENT. 10: 1043, 1960 . Buchman, J.: Relining Full Upper and Lower Dentures, J. PROSTHET. DENT. 2: 703, 1952. Kuck, M.: Die Physiologische Protheses im Zahnlosen Unterkiefer, Dtsch. Zahnaerztl. Z. 9: 1352, 1954. Langer, H.: Die Unterfiitterung van Kunstoffplatten als Prothetische Aufgabe, dsterr. Z. Stomatol. 55: 244, 1958, Sauer, J. L., Jr.: A Clinical Evaluation of Silastic 390 as a Lining Material for Dentures, J. PROSTHET.DENT. 16:650, 1966. Voss, R.: Die Theoretischen Grundlagen der Verwendung van Weichbleibender Kunstoffen, Stoma 15: 153, 1962. Hildestad, P.: Anvendelse af Blodtblivende Protesematerialer, Tandlaegebladet 71: 1189, 1967. Bascom, P. W.: Resilient Denture Base Materials, J. PROSTHET. DENT. 16: 646, 1966. Christensen, F. T.: The Wing Relining Technique, J. PROSTHET. DENT. 22: 268, 1969. IXSTITUTE OF ODONTOLOCY UNIVERSITY OF BERGEN 5000 BERGES,NORWAY