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Relines and Rebases
 

Relines and Rebases

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    Relines and Rebases Relines and Rebases Presentation Transcript

    • Relines and Rebases
      • Improving the Adaptation of Existing Dentures
    • Rebase
      • Replacing entire denture base
      • Flasking, heat-cured acrylic
      • Usually porcelain teeth
    • Reline
      • Resurfacing the tissue surface
      • Jig used to maintain vertical dimension & occlusal contacts with cold-cure acrylic
      • Or
      • Reprocessing with heat cure
    • Indications
        • Denture no longer fits residual ridge
        • Retention, stability are lacking
        • PLUS
            • Occlusion is acceptable
            • Vertical dimension is acceptable
            • Denture teeth/gingival contours acceptable
    • Contraindications
      • Complaints of a loose denture
      • DOES NOT,
      • in itself, constitute evidence of
      • a lack of fit and stability
    • Determine Cause of Looseness
        • Pivoting on bony structures
          • PIP
        • Occlusal interferences
          • Tactile, articulating paper, remount
        • Inadequate posterior palatal seal
          • Pull upward & outward on lingual of canines
    • Evaluate Cause of Looseness
      • Coronoid interferences
        • Side to side movements, PI{P
      • Flanges overextensions
        • Pull on the cheeks, lips, patient move tongue
      • Tight pterygomandibular raphe
    • Relines Will Only Solve Retention Problems Related to Denture Base Adaptation
      • Retention problems must be diagnosed as to their cause
        • Processed or chairside
        • Impression or functional technique
        • Hard acrylic or resilient
        • Permanent, temporary
        • Complete or partial dentures
      Types of Relines
    • Processed Acrylic Permanent Complete Denture Relines
      • Make impression for least stable denture first
      • Easier to stabilize the other denture
        • Reference for occlusion & vertical dimension
    • Impression Technique
        • Difficult to reline without:
          • Encroaching on interocclusal space
          • Displacing the supporting tissues
          • Altering occlusal contacts
          • USE CARE
    • Positioning the Denture OVD & Occlusion
    • Adjust Occlusion
      • Obtain stable occlusal contacts
      • Remount & adjustment may be required
      • Assess need for tissue conditioning
    • Remove Tissue Undercuts
      • Allows impression to be removed from cast without breaking cast or denture
    • Clean the Denture
    • Border Mold
      • Relieve borders 2 mm short of vestibule
      • Border mold with compound
      • Maxillary posterior border at vibrating line (indelible stick)
    • Reduce Tissue Base
      • 1 mm if acceptable interocclusal distance
        • Use guide grooves
      • If interocclusal distance is excessive, relief may not be required
      • Perforate denture with #4 round bur
    • Impression Material Polyvinylsiloxane
      • Ease of use
      • Cleaning, removal from undercuts
      • Requires adhesive carried to the external surface of denture borders
    • Impression Procedure
      • Load carefully
      • Excessive material can reduce freeway space
      • Dry tissues
    • Impression Procedure
      • Seat denture anteriorly
      • Slowly rotate posterior into place
      • Ensure denture is not too far forward
    • Verifying Position
      • Patient closes lightly until first contact
      • If occlusal interdigitation is poor, physically move denture
      • Maintain position until set
    • Evaluate Impression
      • Trim impression to posterior border
      • Place / mark the posterior palatal seal
      • Check retention, extension, periphery
      • Remove excess (occlusal, facial etc.)
    • Check relations intraorally Send to lab for processing
    • Deliver ASAP, usually next clinic Same day in practice, if possible
    •  
    • Remount Adjust Occlusion
    • Impression Technique Advantages
        • Only two appointments needed
        • Tissues are captured at rest (less possibility of distortion)
        • Allows for greater extension of peripheries
        • Allows placement of functional posterior palatal seal
    • Impression Technique Disadvantages
        • Possible alteration in VDO, occlusion, facial support
        • No chance to test retention and comfort under function
    • Functional Relines (Lynal, Visco-gel)
        • Similar procedure
        • Minor variations
    • Functional Relines
      • Cannot extend borders greater than 4 mm
      • Distorts too easily
      • Grossly under extended, use impression technique
    • Functional Relines
      • Material requires greater thickness for accuracy
      • Usually need to reduce denture to allow for thickness
    • Variation in Accuracy of Materials
      • (Visco-gel> Coe-Comfort)
    • Lynal
      • 10 ml powder : 2 ml liquid, mix 30 sec
      • If borders short or too thin, add more powder for increased viscosity
      • Thicker consistency can be formed into a 3 - 4 mm rope and placed around borders
    • Lynal
      • For tissue base, mix as per instructions
      • Place intraorally
      • Remove excess with cotton swab prior to set
    • Set time: 8-10 minute
      • Lightly border mold
      • During setting, allow patient to:
        • Talk
        • Swallow
        • Lightly occlude
    • Remove Excess
      • Reduce material on flanges with HOT scalpel or knife
      • Remove from teeth, oral surfaces
      • Patient wears reline home
    • Patient Returns in 24-48 Hours
      • A cast is poured within 2 hours
      • Otherwise, accuracy compromised
    • Functional Impression Advantages
      • Functionally molds peripheries
      • Ability to assess patient comfort and retention prior to reline proper
    • Functional Impression Disadvantages
      • Variability of materials, handling characteristics
      • Resiliency masks overextensions which can subsequently irritate, when converted to acrylic resin
    • Functional Impression Disadvantages
      • Dimensional stability variable
        • Patient care
        • Pouring of casts
      • Can' t significantly increase borders
      • Do not use simultaneously as a tissue conditioner
    • Partial Denture Relines
      • Similar procedures
      • Ensure rests, direct and indirect retainers are fully seated
      • Seat with pressure over the rests, NOT the distal extension bases
    • Partial Denture Relines
      • Allow no impression material under rests or guiding planes
      • If so, remake impression
    • Partial Denture Clinical Remount
      • If required, a new cast must be made
      • Make an alginate impression with the RPD in place
    • Partial Denture Clinical Remount
      • Block out undercuts on the framework while RPD is in the impression
      • Pour the model with the partial denture in place