L8 Maintenance Relines and repairs

Complete Denture Maintenance¹²

Procedures³

• Recall Examination – Annual
• Occlusal Correction
  • • To address minor to moderate errors in the maxillomandibular relationship (MMR). This can be done chairside or in a laboratory.
  • • Chairside adjustment
  • • Laboratory adjustment
• Denture Reline
  • • To compensate for the continuous resorption of supporting structures, which affects stability, retention, and facial height. This involves adding new denture base material to the fitting surface.
  • • Chairside, soft
  • • Chairside, hard
  • • Laboratory, soft
  • • Laboratory, hard
    • • Reline
    • • Rebase
• Denture Repair
  • • Fractured denture base
  • • Broken or missing tooth

Recall Examination⁴

NOTE

A full recall examination should be conducted every 12 months. This process begins with updating the patient’s history before proceeding to a physical examination of the dentures and the oral cavity.

1. Update Medical and Dental History
2. Extra-oral Examination of Dentures
3. Intra-oral Examination
4. Reinforce Instructions to the Patient

1. Update Medical and Dental History⁵

Common Complaints

• Mandibular denture
  • • Discomfort
  • • Poor retention and stability
  • • Lack of support
• Maxillary denture
  • • Poor retention and stability
  • • Pain on chewing
  • • Aesthetics and phonetics
  • • Gagging

Factors under control of Dentist

Discomfort may be secondary to:

• Open occlusal vertical dimension
• Inaccurate centric relation record
• Lack of occlusal balance
• Poor denture base adaptation
• Inappropriate denture base extensions

Retention and stability compromised by:

• Occlusal discrepancies
• Poor denture base adaptation
• Inadequate denture base extensions

Factors beyond control of Dentist

Retention and stability also affected by:

• Moderate to severe resorption
• Unfavourable floor of mouth posture
• Retruded tongue position
• Reduced salivary flow
• Poor neuromuscular control

2. Extra-oral Examination of Dentures⁶

• Chips, cracks, or fractures.
• Worn, broken, or loose teeth.
• Adherent plaque on the intaglio (fitting) surface.
• Abrasion on the polished surfaces.

1. Sharp projections and acrylic nodules
2. Sharp edges
3. Over-extension into bony undercuts
4. Hand relate dentures to confirm stable occlusion

3. Intra-oral Examination⁷⁸⁹¹⁰

A. Check denture bearing area¹¹¹²

Tissue Health

The mucosa should appear pink, smooth, moist, and resilient. Look for hyperaemic (red) areas indicating impingement from acrylic nodules or sharp edges.

• Sharp projections & acrylic nodules

• Sharp edges

• Stomatitis, fungal infections

• ==Papillary Hyperplasia: An inflammatory condition characterized by pebble-like growths, affecting only the palatal mucosa.==

• ==Causes of Inflammation: These conditions can be caused by wearing dentures at night, poor oral hygiene, or an ill-fitting denture.==

B. Check extension, retention and stability

• ==Retention: Test by gripping the anterior teeth and pulling the denture in the direction opposite to its path of insertion.==

• ==Stability: Test by applying sequential pressure on the biting surfaces of the anterior teeth, followed by alternating pressure on the posterior teeth on each side.==

• Adequate clearance for frena (1 – 2 mm)

• Decubitus

  • an ulcer due to local interference with circulation

• Overextension into bony undercuts

C. Evaluate aesthetics

NOTE

Continuing alveolar resorption can reduce denture support, affecting the patient’s appearance. Evaluate:

• ==Tooth Display: The amount of tooth visible during speech and smiling.==
• ==Lip and Cheek Support: The fullness of the lips and cheeks.==
• ==Face Height: The vertical dimension of the face.==
• ==Natural Appearance: The overall harmony of the dentures with the patient’s face.==

D. Evaluate phonetics

NOTE

Speech difficulties are most common shortly after denture insertion but can also develop over time due to resorption.

• Whistle on “S” Sound: This issue is caused by the absence of sufficient space for the tongue between upper bicuspids. The solution is to remove and relocate the denture bicuspids toward the buccal or, if there is adequate room, grind out more area for the tongue.

• Lisping on “S” Sound: This concern is essentially the opposite of the whistling “S” in that its cause is too much room for the tongue between the upper bicuspids. To test for this, add a piece of wax palatal to the bicuspids and check phonetics.

• Indistinct “Th” and “T” sounds can be corrected by thinning out the palatal area of the anterior.

• ==Looseness: Denture looseness resulting from alveolar resorption can also negatively impact speech clarity.==

E. Evaluate occlusion

NOTE

Alveolar resorption over time directly affects occlusion. The occlusion must be carefully checked at every annual review.

• ==Reduced OVD: A reduction in the occlusal vertical dimension leads to an increase in the interocclusal clearance (freeway space).==

• ==Occlusal Interferences: Premature contacts may develop in the intercuspal position (centric occlusion) or during eccentric movements (lateral excursions, protrusion).==

• Occlusal vertical dimension

• Centric occlusion

• Eccentric movements

4. Instructions to Patient¹³

• Careful daily removal of biofilm in oral cavity and on dentures
  • • Mechanical (non-abrasive)
  • • Chemical
• Annual professional ultrasonic cleaning
• Never place dentures in boiling water
• Do not place in sodium hypochlorite for periods longer 10 minutes
• Whilst out of mouth, store dentures in clean water to avoid warping
• Denture adhesives, properly used, can improve retention and stability and help seal even well-fitting dentures
• Dentures should not be worn 24/7
• Patients who wear dentures should be checked annually for fit & function, evaluation for oral lesions and bone loss, and for assessment of oral health status

Occlusal Correction¹⁴

NOTE

If the recall examination reveals occlusal discrepancies, they can be corrected either at the chairside or in the laboratory. The goal is to achieve balanced contacts in the retruded jaw relationship and in all eccentric movements without cuspal interferences, while maintaining the correct OVD.

Chairside Adjustment¹⁵¹⁶

• Only possible for minor occlusal discrepancies
• Articulating paper used to identify areas of heavy contact
• Occlusal Adjustments for Intercuspal Position

Selective Grinding Rules

1. Marking: Use thin articulating paper to mark premature contacts intraorally.
2. Centric Stops: The primary vertical dimension is maintained by the buccal cusps of the lower teeth and the palatal cusps of the upper teeth. These centric stops should not be adjusted once the OVD is correct.
3. Retruded Position Only: If a premature contact exists only in the retruded position and not in lateral excursions, reduce the opposing fossa.
4. Retruded and Lateral Positions: If a cusp is premature in both the retruded position and lateral excursions, the cusp itself may require reduction.

• Occlusal Adjustments for Excursive movements

Adjusting Lateral Excursions

• Working Side:
  • If there is an interference between the upper and lower buccal cusps (working side), adjust the upper buccal cusp (BULL Rule: Buccal Upper, Lingual Lower). The lower buccal cusp is a centric stop.
  • If there is an interference between the upper and lower lingual cusps, adjust the lower lingual cusp. The upper lingual cusp is a centric stop.
• Balancing Side:
  • If there is a balancing side interference between the upper lingual cusp and the lower buccal cusp (both are centric stops), one must be chosen for adjustment.
  • Preferably, reduce the lower buccal cusp. This reduces the mandibular cusp height, which aids the stability of the inherently less stable lower denture.

Laboratory Adjustment¹⁷¹⁸

Incorrect MMR

NOTE

1. New MMR Record: A new maxillomandibular relationship record is made at the retruded contact position.

• Apply PVS adhesive to the occlusal surfaces of the lower denture teeth.
• Inject a PVS bite registration paste (e.g., from a Garant dispenser) to fill the occlusal gap, slightly overlapping the buccal and incisal edges.
• Allow the material to set undisturbed in the mouth.

2. Mounting and Resetting:

• Use the new record to mount the dentures on an articulator.
• Separate the teeth of the lower denture from the base.
• Adjust the articulator to the correct OVD and relate the lower tooth section to the upper teeth with the best possible interdigitation. Minor discrepancies (e.g., a slight centerline mismatch) may be accepted to avoid a full remake.

3. Processing:

• Reattach the lower tooth section to the base with wax.
• Contour the wax and flask the denture in a split cast flask.
• Process with new acrylic resin in the normal way.

4. Result: The denture retains its original tissue-contact surface and teeth, but the occlusal relationship is corrected. The repaired area is imperceptible if the acrylic is well-matched.

• Anterior primary contact
• Premature posterior contact
• Anterior open bite
• Centrelines do not coincide

Denture Reline^{1920212223242526}

NOTE

A reline is a procedure to resurface the intaglio (fitting) surface of a denture with new base material, improving its fit.

Indications²⁷

• lack of stability
• lack of retention

Timing Within Treatment Plan

• denture insert (e.g. corrective)
• after short-term (e.g. post-extraction)
• after long-term (e.g. resorption)

Areas

• ==Localized: To correct specific defects, such as in the posterior palatal seal area or a peripheral border.==

• ==Global: Covering the entire intaglio surface of a loose denture.==

• posterior extension / seal

• peripheral extension

• alveolar changes

Assessment²⁸

NOTE

The fit of a denture can be assessed using a fast-setting PVS material like Fit Checker.

• A thin, even layer of the material indicates a good fit.
• A combination of excessively thick and extremely thin sections indicates a poor fit.

Chairside, Soft²⁹

• Usually a self-curing plasticised acrylic
• Often used immediately after surgery
• Can be used to improve stability and promote healing under an ill-fitting denture prior to impression-making
• Difficult to attain an even thickness
• Short service life (~ 6 weeks)
• Short term use only

Materials³⁰

• ==Examples: Ufi Gel Soft, GC ReLine Soft (cartridge dispensers), CoSoft (powder/liquid).==

Ufi Gel³¹

NOTE

1. Preparation: The intaglio surface of the denture is cleaned and dried.
2. Adhesive: An adhesive is applied to the intaglio surface and allowed to become tacky.
3. Application: The soft liner material is extruded from the mixing nozzle directly onto the denture.
4. Seating: The denture is seated in the mouth, and the patient applies light biting force to ensure correct occlusion until the material sets.
5. Finishing: Excess material is trimmed away after setting.

Chairside, Hard³²³³

• Usually a self-curing acrylic resin
• Has no cushioning effect
• Provides a longer service life than the chairside soft reline material (~6 months)

Materials³⁰

• ==Examples: Ufi Gel Hard, GC Reline Material, Co-rect (all powder/liquid).==

Base Reduction³⁴

Procedure

1. Base Reduction: A thin layer of the intaglio surface is ground away with an acrylic bur to create a fresh bonding surface.
2. Preparation: Teflon tape can be applied to the polished surfaces to make cleanup easier.
3. Application: The material is mixed to a creamy consistency and applied in an even layer to the intaglio surface.
4. Seating: The denture is seated, and the patient closes into even occlusal contact under light pressure.
5. Molding: The peripheries are gently muscle-molded while the material sets, ensuring the denture remains in occlusion.
6. Curing: The setting reaction is exothermic. The denture should be removed from the mouth once the material becomes rubbery and allowed to finish setting on the bench.
7. Finishing: Gross excess can be trimmed with curved scissors while rubbery. Once fully set, it is smoothed with an acrylic bur and polished with a rubber point.

Potential problems^3536373839

• Bony undercuts
• Separation of materials
• Bubbles/porosities
• Long-term outcome

Laboratory, Soft⁴⁰

NOTE

This provides a durable, resilient lining, most often used for mandibular dentures where the denture-bearing area is reduced and chewing is uncomfortable.

• Usually a heat cured silicone
• Correct laboratory process results in a more even thickness of material
• Generally requires a two stage cure
• Costs more
• Has a longer service life (~3 years)
• May suffer from adhesion problems
• Staining is often an issue

Molloplast B⁴¹

• ==Material: A heat-cured silicone.==
• ==Thickness: Processed to an even layer of about 2-3 mm.==
• ==Process: Requires a more sophisticated, two-stage curing technique.==
• ==Cost: More expensive due to material and time.==
• ==Service Life: Longer, approximately three years.==
• ==Issues:==
  • • May suffer from adhesion problems if technique is not followed precisely.
  • • Prone to staining over time (though it handles hypochlorite better than hard liners).
  • • Trimming is difficult; excess material can expose the hard denture base in critical areas.

Laboratory, Hard⁴²

Reline

• Usually a heat-cured polymethyl methacrylate
• Applied as a thin lining to the intaglio surface of the denture
• Costs more, lasts longer
• The bulk of the denture base is the original acrylic and is subjected to a second heat-curing cycle and possible distortion

Procedure

1. Impression: An impression is made using the denture as a tray (materials like CoSoft, Polyether, or PVS can be used).
2. Processing:

• A Type IV stone cast is poured into the impression.
• The denture and cast are flasked.
• The flask is opened, separating medium is applied to the cast, and PMMA dough is applied to the cleaned intaglio surface of the denture.
• The denture is heat-processed, deflasked, trimmed, and polished.

Base reduction⁴³⁴⁴

Covering teeth

NOTE

To facilitate cleanup, a layer of Teflon tape is applied to the buccal and labial surfaces of the teeth before making the impression.

Vaseline

NOTE

A layer of Vaseline can help the Teflon tape adhere to the denture surface.

Rebase^4546474849

• Usually a heat-cured polymethyl methacrylate
• Replaces most of the denture base material
• Costs even more but lasts even longer
• Less likely to undergo dimensional change during processing

Laboratory, Hard Rebase⁵⁰

Procedure

1. Preparation and Impression: The intaglio surface is reduced, and a tissue surface impression is made in the denture. A stone cast is poured.
2. Flasking:

• The denture and cast are placed in a split flask.
• A layer of laboratory putty is adapted to the labial and buccal surfaces of the teeth, but not the occlusal or incisal surfaces. This is critical to maintain the OVD record, as it prevents the teeth from being displaced during packing.
• The flask is assembled and poured.

3. Base Removal: After the stone sets, the flask is opened, and the denture is removed. All of the old denture base is cut away, except for a small horseshoe of material retaining the teeth in their correct relationship.
4. Processing: The cast is cleaned, and the denture is packed with new PMMA and processed in the usual way.
5. Advantages: This method is less likely to undergo dimensional change during processing and results in a stronger, more durable prosthesis. It is the most expensive but longest-lasting option.

Denture Repair⁵¹⁵²

Fractured Denture Base

NOTE

This repair is possible if the denture has a clean break with no missing pieces.

Method 1^53545556

Quick Repair

1. Assembly: The broken pieces are precisely reassembled and held together with cyanoacrylate glue.
2. Reinforcement: The polished surface over the fracture is roughened, and self-curing repair resin is applied over the area.
3. Intaglio Groove: Once set, the denture is inverted, and a deep trough is cut along the fracture line on the intaglio surface with a bur.
4. Curing: Acrylic repair resin is flowed into the trough and the denture is cured in a pressure pot.
5. Finishing: The repaired surfaces are trimmed and polished.

Method 2⁵⁷

Cast-Based Repair

This method is more time-consuming but may result in a stronger repair and a better fit.

1. Assembly: The pieces are assembled with cyanoacrylate glue or sticky wax (reinforced with metal burrs).
2. Cast Pouring: Undercuts on the fitting surface are blocked out with wax, and a stone cast is poured into the denture.
3. Preparation: The denture is removed from the cast, and the edges of the fracture line are tapered and roughened to increase the bonding surface area.
4. Curing: The cast is painted with a separating medium, self-curing acrylic is applied to the fracture area, and the denture is cured on the cast in a pressure pot.
5. Finishing: The denture is trimmed and polished.

Broken or missing tooth³

Procedure

1. Preparation: Use a bur to cut away the denture base from behind and below the tooth position. Retain as much of the labial

Thank You^58596061

Any questions? Contact me

Dr Ian Lander
ian.lander@uwa.edu.au

Complete Denture Maintenance¹²

NOTE

This document outlines the procedures for the ongoing maintenance of complete dentures, ensuring their long-term function in terms of mastication, aesthetics, phonetics, and comfort. Maintenance involves regular recall examinations, occlusal corrections, relining or rebasing procedures, and repairs for mechanical damage.

Procedures³

• Recall Examination – Annual

• • To assess the functional status of the prosthesis and the health of the supporting oral structures.

• Occlusal Correction

  • • ✓ Chairside adjustment
  • • ✓ Laboratory adjustment

• Denture Reline

  • • ✓ Chairside, soft
  • • ✓ Chairside, hard
  • • ✓ Laboratory, soft
  • • ✓ Laboratory, hard
    • • ○ Reline
    • • ○ Rebase

• Denture Repair

• • To conservatively fix mechanical damage, such as a fractured base or a broken tooth.

  • • ✓ Fractured denture base
  • • ✓ Broken or missing tooth

Denture Repair⁸

Fractured Denture Base⁵⁸

Method 2

Broken or Missing Tooth⁵⁹⁶⁰⁶¹

Thank You^58596061

Any questions? Contact me

Dr Ian Lander
ian.lander@uwa.edu.au

Footnotes

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