Introduction

Definitions

Factors Affecting need for relining & rebasing

Indications

Armamentarium Required

Impression Materials used for relining & rebasing

Pre-treatment procedures

Relining / Rebasing Procedures

(A) Clinical Procedures

1. Static impression technique

- Open mouth

- Closed mouth

2. Functional impression technique

3. Chair side impression technique

[B] Laboratory Procedures

1. Articulator Method

2. Jig Method

3. Flask Method

Conclusion

References
RELINING REBASING IN COMPLETE DENTRUE

INTRODUCTION

_ It would be difficult & tedious for both patient & dentist to

start from beginning & undergo a repeat of all the previous
procedure.

- Relining the denture can be considered as it would require just

one additional appointment.

- Similarly a patient might not want his denture changed for

financial or other reasons.

Some of the services a dentist can provide are -

Denture Relining Denture Rebasing Denture Repair

Definitions

DENTRUE RELINING

A Procedure to resurface the tissue surface of the denture new base

material to make a denture fit more accurately

OR

Relining is the process of adding some material to the tissue side of

the denture to fill the space b/w the affected tissue & original
denture base.

DENTRUE REBASING

The process or replacing entire denture base without changing

occlusal relationship (winkler)

OR

A process of refitting a denture by the replacement of entire base

with a new material on an existing prosthesis/denture.
Why denture become loose after some time ?

A patient who have worn dentures successfully for a period of time

may return for further service because of looseness, soreness,
chewing inefficiency or esthetic changes.

Causes

I.Incorrect or unbalanced II. Changes in the one of

occlusion that existed both of the structures

at the time of denture were inserted that support the

dentures.

OR I + II

for

I) Not require relining After keeping denture out

Only occlusion is corrected. of mouth for 1 to 2 days

OR

using tissue conditions.

Test

Stability & retention of denture have not been lost but patient
complaining loose denture (Looseness is due to uneven occlusion
contacts)

Sign

Supporting tissue may show more irritation or inflammation an one

side than on the other.

II) A number of changes can occur in the tissue that

support the c.D.

-More common in mandible than maxilla.

- Also common in maxillary dentures opposing natural teeth.

signs

- loss of retention & stability.

- loss of V.D.O.

-Loss of facial support

-Horizontal shift of denture

- Reorientation of occlusal plane.

Symptoms

Soreness

Looseness

Chewing inefficiently

Change in patient's appearance.

Minimal to moderate changes Moderate to maximal

changes

Relining Rebasing

FACTORS AFFECTING NEED FOR RELINING & REBASING

(1) RESIDUAL RIDGE RESORPTION (RRR)

- More rapid in Female > males

- More rapid in first 6 months after extraction of teeth & slower

pace till 12 months.

- Only to again as the patient reaches as 65 years.

- RRR precipitated by certain systemic disease so in an ideal

situation the systemic ds should be eliminated or controlled
first.

(2) EFFECTS OF ROTARY MOVEMENTS OF MANDIBLE

(a) Mandibular rotation -

 May cause change in structure that support the upper
denture.

Upper denture may be forced forward on the upper ridge

instead of backward as would be expected.

This would result from heavy inclined plane contacts b/w the
mesial inclines of cusps of lower teeth & distal inclines of
cusps of upper teeth.

Direction of such occlusal forces could cause destruction of

the anterior maxillary part.

(b) Effects of mandibular rotation on anterior part of

mandibular residual ridge when V.D.O. is decreased

(A) Cross section shape of ridge when denture was made.

(B) Inclined planes of cusps of teeth forces mandibular denture

posteriorly & cause destruction of labial side of ridge .

(C) Direction of force is changed when lower denture has moved

forward for enough to develop contact b/w distal side of
lower cusps & distal side of upper cusps.

INDICATION FOR RELINING & REBASING

1) Immediate dentures after 3-6 months of extraction where
maximum residual ridge resorption would have occurred.

2) When the adaptation of the denture to the ridge is poor due to

residual ridge resorption.

3) Poor Socio-economic condition where patient can't afford a

new denture.

4) Geriatric or chronically ill-patient's who can't withstand

physical & mental stress of construction of new denture.

Note - 1. When tissue damage is excessive the treatment shift from

Relining Rebasing

2. If the vertical dimension of patient is changed than relining

is not sufficient for the cases so that rebasing should be done.

3. Rebasing should be done in dentures with porcelain teeth.

ARMENTARIUM REQUIRED

1) Existing dentures.

2) Border moulding material

3) Impression material.

4) Utility wax.

5) Facebow, Semiadjastable articulator for, Hooper's duplicator

or jectron Jig.

6) Dental Flask.

7) Denture base material of choice.

IMPRESSION MATERIALS USED FOR RELINING AND REBASING

1) ZOE paste.

2) Composition & tracing sticks.

3) Elastomers.
4) Tissue conditioners.

5) Black gutta Purcha.

6) Cold cure acrylics.

Note:- Alginate is not suitable as an impression material because it

is dimensionally unreliable in thin section.

PRE TREATMENT PROCEDURE

A) Preparation of tissue for impression

i) Hyper plastic tissue should be surgically excised

ii) Oral mucosa should be free of irritation.

iii) Denture should not be worn during sleep.

iv) Denture should not be worn for at least 2-3 days prior to
final impression appointment.

B) Preparation of the denture for impression

i) Pressure areas on the tissue surface of the denture should

be relieved.

ii) Minor occlusal disharmony should be corrected by selective

grinding.

iii) Border inadequacies should be corrected

iv) Border should be shortened by 1mm to allow space for new

impression material

v) PPS should be established using green stick compound or

cold cure- resin

vi) All large undercuts should be removed.

RELINING/REBASING PROCEDURES

(A) CLINICAL PROCEDURES (B) LAB PROCEDURES

1. Static impression technique I. Articulator method

 ii. Jig method

1. open mouth b) closed mouth iii. Flask Method

Technique Technique

ii. Functional impression technique

iii. chair side impression technique

I. Static impression Technique

a) OPEN MOUTN TECHNIQUE

Boucher 1973

- It is the method for relining both maxillary & mandibular

dentures at the same appointment

- Existing C.D. not used.

- Dentures are used as a special tray for making the sec.

impression.

- ZOE is the material of choice.

- After making bath impression a new centric relation is

recorded.

Note - It is a demanding & laborious technique but quite a good one.

b) CLOSED MOUTH TECHNIQUE

- Both maxillary & mandibular relining/ rebasing should be done

separately

- We prefer the closed mouth technique when we use the static

impression tech.

Various Techniques

Technique -A - New centric relation is recorded using

modelling wax of compound.

}
Technique - B
Technique - C Use the existing C.R.
Technique - D
Technique - A

1. C.R. - New C.R. is Recorded before making impression.

2. Denture Preparation

-All undercuts are relieved

- Tissues surface of denture is relieved 1.5-2mm.

Special Suggestion

Palatal relief for better visibility in positioning the max denture

druign impression making.

Border Moulding

Low fusing modelling compound (Green stick)

Impression

ZOE is the impression material of choice.

If palatal portion is cut than quick setting plaster is used as an
impression material .

Advantages

1) Palatae relied for better visibility.

2) Pre made interocclusal record helps to position the denture

during impression making.

Disadvantages

1) The wax inter occusal record is not an accurare & safe record
because several times, the patient can't close c out possibility
of damaging the record.

2) This technique cannot be used to reline/ rebase booth the

dentures at the same time.

Technique - B

1) C.R. - Existing C.O. & intercuspation are used as a means to

seat the denture.

2) Denture preparation

Same as technique- A

3) Border Moulding

Green stick compound

4) Impression material

Kerr's Impression wax (Iowa wax)

(material of choice)

Flows at mouth temp.

2 steps

The impression of the labial flange & crest of the alveolar

ridge b/w the canine is made as a second step.
5) Advantages

2 step impression technique will reduce the possibility of

extreme forward movement of the maxillary denture

6) Disadvantages

- If the existing CR record is wrong then the impression become

in accurate.

- wax can distract.

Technique - C

1) C.R.- Existing Centric relation is used

2) Denture preparation

Same as Technique A & B

3) Special suggestion

Relief holes in labial & palatal flange decreasing the pressure

inside the denture there by preventing displacement of
maxillary denture.

4) Border moulding

Same as tech. A & B

5) Impression

No specific material

6) Advantages Same as Tech. A& B because This tech

7) Disadvantages is a combination of both A & B.

Technique- D

1. C.R.- existing C.D. is used to seat the denture

2. Denture Preparation

Same as in other techniques

3. Special suggestion

- Denture periphery should be shortened to create a flat border.

- A large opening should be proposed in the Palatal portion of

the maxillary denture.

Adhesive tape is attached over the buccal & labial surfaces of both
dentures.

Grooving in region b/w the reline impression & adhesive tape &
filling it with molten wax.
Border moulding

Using molten wax.

Impression

ZPE for first step

P.O.P. for second step ( for palatal portion)

(II) FUNCTIONAL IMPRESSION TECHNIQUE

Suggested by Winkler.

- Here the patient need not be c out dentures unlike previous

techniques (e.g. the dentures are not required for Lab.
Producres).

- It is simple & practical method & is more popular.

- Fluid resins (Tissue conditioners) are used as an impression

material.

Tissue conditioners are Temporary soft liners c the following

characteristics

i) Easy to use

ii) Excellent for refilling complete denture.

iii) Capable of retaining for many weeks.

iv) Good in dimensional stability.

v) Good in bonding to resin denture bases.

Procedure

Patient is advised to avoid night wear of dentures

Occlusal errors in the dentures are corrected to obtain c.o. that

coincides c the C.R.
Flange over-extensions, under extensions & PPS should be
corrected.

Tissue surface should be reduced to accommodate the tissue

conditions material

Tissue surface of denture is dried & tissue conditioning material is

placed

Next, the denture is inserted & the Patient's mandible is guided to

CR in order to stabilize the denture & material is allowed to set.

After setting, impression is removed & excess material is trimmed.

Overextensions & Voids are corrected.

Then dentures are inserted C the material.

After 3-5 days, dentures are examined

Depressed (Denuded) areas should be relieved.
Areas of under extension are corrected by adding more material.

Material should be renewed periodically (one's a week) till the tissue

heals completely.

Than once the tissue are normal impression made with ZOE or a
light bodied elastomer over the tissue conditioner material & a cast
is poured immediately.

DIFFERENT PHYSICAL STAGES OF TISSUE CONDITIONER/

TREATMENT LINERS

(a) Plastic Stage

Respond to functional &
parafunctional stresses
(Tissue Conditioner)

fit is improved.

(b) Elastic Stage

(Tissue Conditioner) Stress is cutioned
Tissue recovery takes place.

(c) Firm Stage

(Reline impression) Surface is similar to polymerized
resin surface, except it is vulnerable
to deterioration.
(III) CHAIR-SIDE IMRESSION TECHNIQUE

- Acrylic is added to the denture & allowed to set in the mouth

to produce instand relining or rebasing.

Disadvantages
- Material produces a chemical burn in oral mucosa.
- Material is porous & develops a bad odour.
- Poor colour stability.
- Material is not easy to remove if not placed correctly.

Note-
1- Recently VLC (Visible light cure) resin has been developed
which is similar to tissue conditioners.

2- Both the static impression technique & functional impression

techniques are well accepted choice B/w the 2 methods is
based on dentists & patient's convenience.

(B) LABORATORY PROCEDURES

I- Articulator method II Jig method III flash method

(I) ARTICULATOR METHOD
Once the impression is received cast is poured
Maxillary cast is mounted on an Semiadjastable articulator C
the help of face bow transfer
Mandibular denture is mounted using an interocclual record.
(Procedure is common for both relining & rebasing upto this
stage)

(For relining For rebasing

Tissue surface of denture Denture base should be
is trimmed. trimmed to just leave2mm of
acrylic around the existing teeth.

After trimming the dentures are placed in the articulator & waxed
up.

Articulating the denture (c impression) & cast against a plaster

template.

(II) JIG METHOD

2 types of riling Jig are used

Hooper's Duplicator Jectron Jig

2 triangular parts only 2 pillers
3 pillers in each corner

A plaster index is made on the lower platform with the denture teeth
penetrating the depth of about 2 mm.
When the plaster set, indentations made by denture teeth acts as
key into which denture teeth can be repeatedly positioned to
maintain a fixed distance b/w Cast & the occlusal surfaces.

Top & bottom of the Jig are separated & denture is removed from
the cast.

Impression material is removed from the denture.

For relining For rebasing

Tissue surface of denture
is trimmed.

For porcelain teeth For acrylic

teeth

entire denture base is removed Denture base is

from teeth. trimmed to just
leave 2 mm of
acrylic around
the existing
teeth.

wax-up

curing

(III) Flask Method :

Poured impression along with denture is inverted into the base

of the flask.
Silicone mould material is painted over the denture prior to
investing the body. This is done to create a Flexible mould so
denture can be removed carefully after opening the flask.

Trimming of denture

for relining for rebasing

Relining

With self cure resin With Heat cure acrylic resin

Disadvantages Disadvantages

Irritation of tissue Excessive heat which is

required for heat curing
may war the original
denture base
material
(resoftening)

May cause change in

occlusion & fit of the
denture over basal seat.
 CONCLUSION

Relining and rebasing reduces discomfort specially in case of

geriatric, chronically ill patients and decreases expense for poor
socio-economic conditions & increases adaptations of loose fitting
dentures

But they are not adequate substitute for new denture.

However relined/rebased denture should be given same care

as new denture.
 REFERENCES

1. Boucher's Prosthodontic Treatment for Edentulous Patients

- George A. Zarb, Charles L. Bolender, Gunnar E. Carlsson

2. Essentials of Complete Denture Prosthodontics

- Sheldon Winkler

3. Prosthodontic for Elderly

- Ejvind Budtz, Jorgensen, Dr. Odont

4. Clinical Dental Prosthetics

- H.R.B. Fenn, K.P. Liddelow, A.P. Gimson