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23. Relines.ppt

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  • 1. Relines and Rebases
    • Improving the Adaptation of Existing Dentures
  • 2. Rebase
    • Replacing entire denture base
    • Flasking, heat-cured acrylic
    • Usually porcelain teeth
  • 3. Reline
    • Resurfacing the tissue surface
    • Jig used to maintain vertical dimension & occlusal contacts with cold-cure acrylic
    • Or
    • Reprocessing with heat cure
  • 4. Indications
      • Denture no longer fits residual ridge
      • Retention, stability are lacking
      • PLUS
          • Occlusion is acceptable
          • Vertical dimension is acceptable
          • Denture teeth/gingival contours acceptable
  • 5. Contraindications
    • Complaints of a loose denture
    • DOES NOT,
    • in itself, constitute evidence of
    • a lack of fit and stability
  • 6. 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
  • 7. 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
  • 8. Relines Will Only Solve Retention Problems Related to Denture Base Adaptation
    • Retention problems must be diagnosed as to their cause
  • 9.
      • Processed or chairside
      • Impression or functional technique
      • Hard acrylic or resilient
      • Permanent, temporary
      • Complete or partial dentures
    Types of Relines
  • 10. Processed Acrylic Permanent Complete Denture Relines
    • Make impression for least stable denture first
    • Easier to stabilize the other denture
      • Reference for occlusion & vertical dimension
  • 11. Impression Technique
      • Difficult to reline without:
        • Encroaching on interocclusal space
        • Displacing the supporting tissues
        • Altering occlusal contacts
        • USE CARE
  • 12. Positioning the Denture OVD & Occlusion
  • 13. Adjust Occlusion
    • Obtain stable occlusal contacts
    • Remount & adjustment may be required
    • Assess need for tissue conditioning
  • 14. Remove Tissue Undercuts
    • Allows impression to be removed from cast without breaking cast or denture
  • 15. Clean the Denture
  • 16. Border Mold
    • Relieve borders 2 mm short of vestibule
    • Border mold with compound
    • Maxillary posterior border at vibrating line (indelible stick)
  • 17. 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
  • 18. Impression Material Polyvinylsiloxane
    • Ease of use
    • Cleaning, removal from undercuts
    • Requires adhesive carried to the external surface of denture borders
  • 19. Impression Procedure
    • Load carefully
    • Excessive material can reduce freeway space
    • Dry tissues
  • 20. Impression Procedure
    • Seat denture anteriorly
    • Slowly rotate posterior into place
    • Ensure denture is not too far forward
  • 21. Verifying Position
    • Patient closes lightly until first contact
    • If occlusal interdigitation is poor, physically move denture
    • Maintain position until set
  • 22. Evaluate Impression
    • Trim impression to posterior border
    • Place / mark the posterior palatal seal
    • Check retention, extension, periphery
    • Remove excess (occlusal, facial etc.)
  • 23. Check relations intraorally Send to lab for processing
  • 24. Deliver ASAP, usually next clinic Same day in practice, if possible
  • 25.  
  • 26. Remount Adjust Occlusion
  • 27. 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
  • 28. Impression Technique Disadvantages
      • Possible alteration in VDO, occlusion, facial support
      • No chance to test retention and comfort under function
  • 29. Functional Relines (Lynal, Visco-gel)
      • Similar procedure
      • Minor variations
  • 30. Functional Relines
    • Cannot extend borders greater than 4 mm
    • Distorts too easily
    • Grossly under extended, use impression technique
  • 31. Functional Relines
    • Material requires greater thickness for accuracy
    • Usually need to reduce denture to allow for thickness
  • 32. Variation in Accuracy of Materials
    • (Visco-gel> Coe-Comfort)
  • 33. 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
  • 34. Lynal
    • For tissue base, mix as per instructions
    • Place intraorally
    • Remove excess with cotton swab prior to set
  • 35. Set time: 8-10 minute
    • Lightly border mold
    • During setting, allow patient to:
      • Talk
      • Swallow
      • Lightly occlude
  • 36. Remove Excess
    • Reduce material on flanges with HOT scalpel or knife
    • Remove from teeth, oral surfaces
    • Patient wears reline home
  • 37. Patient Returns in 24-48 Hours
    • A cast is poured within 2 hours
    • Otherwise, accuracy compromised
  • 38. Functional Impression Advantages
    • Functionally molds peripheries
    • Ability to assess patient comfort and retention prior to reline proper
  • 39. Functional Impression Disadvantages
    • Variability of materials, handling characteristics
    • Resiliency masks overextensions which can subsequently irritate, when converted to acrylic resin
  • 40. Functional Impression Disadvantages
    • Dimensional stability variable
      • Patient care
      • Pouring of casts
    • Can' t significantly increase borders
    • Do not use simultaneously as a tissue conditioner
  • 41. 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
  • 42. Partial Denture Relines
    • Allow no impression material under rests or guiding planes
    • If so, remake impression
  • 43. Partial Denture Clinical Remount
    • If required, a new cast must be made
    • Make an alginate impression with the RPD in place
  • 44. 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