TISSUE CONDITIONER/SOFT RELINER

INTRODUCTION

 Denture liner use in dentistry is not new and is known for many years now .
 Resilient liners which were used previously were natural rubbers.
 In the year 1945, the first synthetic resin made of plasticized poly vinyl res ins were
developed and the silicone rubbers followed in 1958.

DEFINITIONS

 Denture soft liner—A polymeric material that is placed on the tissue-contacting

surface of a denture base to absorb some of the mastication impact energy by acting
as a type of “shock absorber” between the occlusal surfaces of a denture and the
underlying oral tissues. A denture soft liner also may be used to engage natural or
prosthetic undercuts so as to provide retention, stability,and support.
 Long-term soft liner—A resilient polymeric material that is bonded to the tissue-
contacting surface of a denture for cushioning and/or improved retention. Intended for
up to a year of service, they are typically heat-processed, and thus, they are more
durable than chemically cured, short-term soft liners and tissue conditioners.
 Short-term soft liner (tissue conditioner)—A resilient polymeric material that is
employed for brief periods (up to 14 days) to absorb masticatory impact and adapt to
changing ridge contours (e.g., following the extraction of teeth or surgical alteration
of an edentulous or partially edentulous ridge.) Such materials are typically
chemically activated polymers that contain plasticizers.

REVIEW OF LITERATURE

1. Ward J.E., Effect of time lapse between mixing and loading on the flow of tissue
conditioning materials. J Prosthet Dent 1978; 499-508.
 Purpose: To determine how the time lapse between mixing and loading affects
the flow of some tissue conditioning materials over a 30 minute test period
and with a compressive pressure similar to the pressure of deglutition on
dentures.
 Results: Increase in delay between mixing and loading the material resulted in
less total flow of the material at each time after loading for all products.

USES OF DENTURE RELINERS:

 Denture reliners find several uses in the specialty of prosthodontics.

 They are used to improve fit of ill fitting dentures
 To prevent traumatic damage to the mucosa
 As a cushion between denture bearing mucosa and denture
 To retain over denture bar attachments
 To retain extra oral prosthesis
  To distribute occlusal forces, to increase serviceable life of prosthesis
 To replace the fitting surface of conventional hard dentures
 To relieve mucosal pain under hard dentures
 Improves the rhythm of chewing strokes
 It also compensates for the volumetric shrinkage of acrylic resin.

DESIRABLE PROPERTIES OF LINING MATERIALS:

 Long term viscoelastic behaviour which is stable

 Low water sorption
 Improved colour stability
INDICATIONS FOR THE USE OF TISSUE
 Resistance to staining
CONDITIONERS:
 Tear resistance
 Good bond strength to denture base  Thin atrophic mucosa underlying denture
 Dimensional stability base
 Resistance to fungal and bacterial growth  Ridge atrophy or resorption
 Ease of processing  Presence of deep anatomical undercuts
 Good shelf life,  Chronic bruxers or patients with bruxing
 Biocompatibility tendencies,
 High magnitude of energy dissipation,  Reduced tolerance level of the mucosa for
 Good resiliency occlusal loads under denture
 Low elastic modulus,  Acquired or congenital defects which
 Heat resistance, require obturation
 Low glass transition temperature,  Presence of bony protruberances
 Resistance to radiation,
 Special rheological properties
 Outstanding electrical isolation.

Classification:

I. Based on curing:

 Self cure- eg.,soften,viscogel

 Heat cure-eg.,supersoft,molloplast B, Lucisoft, Flexor, Permaflex
 Light cure resins-eg.,clearfitLC(polyisoprene based material)

II .Based on composition:

 Silicone elastomers
 Soft acrylic compounds
 Pthalate ester free compounds-eg.,di-n butyl sebacate,
 Benzyl benzoate,acetyl tributyl citrate,tri-n-butyl phosphate
 Polyolefin liners
 Fluoride containing liners(fluoroalkyl methacrylate)-eg.,
 Maxfit
III. Based on durability

 Temporary/Short term liners-eg., soft comfort

 Definitive/long term liners

IV. Based on consistency

 Hard denture liners-eg.,Ufigel hard C

 Soft denture liners-eg.,Silastic 390
 Soft denture liners are further classified as a) silicone based and resin based b)Auto
cured and heat cured

V. Based on the availability

 Home reliners
 Tissue conditioners

VI. Based on water sorption property

 Hydrophilic- eg.,kooliner(polymethyl/ethyl methacrylate polymer)

 Hydrophobic- eg.,Elite soft(silicone polymer)

COMPOSITION:

1. COLD CURE ACRYLIC BASED MATERIAL

Powder consists of- Liquid contains of-

 polymethyl  methyl methacrylate

methacrylate/copolymer,  ethylene glycol dimethacrylate
 Polymethyl  ester plasticizer mixture like dibutyl
methacrylate/copolymer, phthalate
 benzoyl peroxide  butyl pthalylbutylglycolate
 pthalyl butyl glyconate,  benzyl butyl phthalate,
 pigments,fillers  ibutylsebacate, ethyl alcohol

2. HEAT CURE LIQUID

 Has in addition benzoyl peroxide initiator.
3. HOME RELINERS CONSIST OF

Powder- Liquid consists of

 polyvinyl acetate  acrylic, triacetyl citrate,

 ethyl alcohol trismethoxyethoxyvinylsilane
 calcium carbonate  Silica consists of MDX (silastic MDX-
 polypropylene glycol 4210) RTV silicone
 white bees wax  vinyl terminated polydimethylsiloxane,
 alkyl methacrylate copolymers  adhesive like 3-methacryloxypropyl
trimethoxysilane
 4. SILICIC ACID LIGHT CURED MATERIAL CONSISTS OF
 urethane acrylate oligomers
 benzoylperoxide
 camphoroquinone

GELATION REACTION

 When the powder and liquid are mixed, polymer is dissolved by plasticizer.
 This reaction is responsible for chain entanglement and thus formation of gel.
 Since monomer is abscent, it is made of a non cross linked amorphous polymer.

LOSS OF RESILIENCY

 When tissue conditioners are in continuous contact of liquids such as oral fluids, the
plasticizer and alcohol contents leach out and water or saliva occupies these lacunae.
 The absorbed liquid acts like a plasticizer, lowering mechanical property of the
polymer network, thus lowering the dynamic viscoelastic property.
 Silicone materials remain resilient for longer time because they are devoid of
plasticizers. In addition they have greater cross linking and higher bonding capacity to
the fillers.

PROPERTIES OF TISSUE CONDTIONERS

HOW TO USE ?

 The conditioning procedure should be repeated until the supporting tissues display an
undistorted and healthy appearance.
 Literature cites 4-7 days as clinically acceptable for achieving better results.
 Usually 3-4 changes of the tissue conditioning material is required .
 If positive results are not seen within 3-4 weeks , one should suspect serious health
issues and request physician consultation .
 The length of the denture base, followed by the occlusion should be checked and
corrected if necessary.
 The tissue surface of the denture also should be examined, and pressure areas
eliminated.
 The occlusal vertical dimension must be re-established.
 The lining of the tissue conditioning material must be approximately 1.5 mm thick .
 If the occlusal vertical dimension is too short, it will get corrected by the thickness of
the lining material.
However, if the occlusal vertical dimension is correct, we must avoid further increase of VD
contributed by the thickness of the lining. This problem has three possible solutions

 Remove 1.5 mm. from the tissue surface of the denture

 Remove the same amount from the occlusal surface
 When simultaneously treating both upper and lower ridges, it might be necessary to
remake the lower denture, taking into consideration material on both dentures.

STEPS

 Mix the material to a smooth creamy mix avoiding incorporation of air bubbles and
apply it on to the tissue surface of the denture.
 The patient is trained to close in the centric relation.
 This position is maintained for 5-7 minutes following which functional border
molding is performed.
 Once the moulding is over, the denture is removed from the mouth, the excess
material is trimmed and the tissue surface of the denture is examined.
 If the denture base shows through the tissue conditioner in some areas, it means that,
at this point, an excessive amount of pressure is still being exerted.
 The pressure spots identified should be selectively trimmed to attain a relief of 1.5mm
and a new lining must be placed to correct these errors19.
 The patient must be instructed not to brush the tissue surface of the denture, but only
to rinse it with water.
 Patient is advised to take a soft- diet and should remove the dentures at night if
possible.
 The patient is asked to return in three days. At the next appointment, the tissue surface
of the denture as well as the residual ridge is examined.
 Any pressure spots should be identified and corrected.

RECENT ADVANCES

SELF-ADMINISTERED RELINING MATERIALS:

 Several types of lining materials are available which enable the patient to attempt
to improve the fit of ill-fitting dentures or to provide a soft cushioning effect to the
fitting surface.
 Such products are generally available for purchase at many retail outlets such as
supermarkets or chemists shops.
 The products normally contain methacrylate or vinyl polymers such as
polymethyl-, polyethyl-, or polybutylmethacrylate or vinyl acetate along with a
plasticizer such as butyl phthalate and a solvent such as acetone, ethanol or
toluene.
 The claim for such products is that they improve the fit or comfort of a denture
without having to visit the dentist.
 Most authorities agree however that the use of these products should be firmly
discouraged, for all but short term emergency use.
  Long term use of these products can lead to harmful effects on the hard and soft
oral tissues.
 Cases of irritation, severe bone loss and tumors, related to the use of self-
administered denture lining materials, have been documented.

References:

1) Prosthodontic Treatment for Edentulous Patients, 12th edition, Zarb Bolender.

2) Boucher’s Prosthodontic Treatment for Edentulous Patients, 10th edition, Zarb,

Bolender, Hickey, Carlson.

3) Phillip’s Science of Dental Materials, 11st Edition, Annusavice.

4) Anupama Prasad D. , B. Rajendra Prasad², Veena Shetty³, C.S. Shastry & Krishna
Prasad D Tissue Conditioners : A Review Nujhs, June 2014, Vol. 4, No.2