complete presentation including all information on tissue conditioners and soft liners

1. DR. DHANANJAY D SHETH
1ST YEAR MDS
DEPARTMENT OF PROSTHODONTICS

3. Tissue conditioner: 1. a resilient denture liner resin placed
into a removable prosthesis for a short duration to allow
time for tissue healing;
2. used in functional removable relining procedures to
evaluate denture function and patient acceptance prior to
laboratory reline processing.
Tissue conditioning: a procedure in prosthodontics usually
performed by relining a removable complete denture,
removable partial denture, or a maxillofacial prosthesis with
a resilient resin and allowing a short duration of time for the
patient’s soft tissue to heal.

4. Reline re-lın΄ vt (1851): the procedures used to resurface the
intaglio of a removable dental prosthesis with new base material, thus
producing an accurate adaptation to the denture foundation area.
Resilient denture liner/ soft liner: an interim (ethyl methacrylate with
phthalate plasticizers) or definitive (processed silicone) liner of the
intaglio surface of a removable complete denture, removable partial
denture, or intraoral maxillofacial prosthesis

5. *
Dentures can apply excessive forces to the supporting tissues
because of poor fit or occlusal errors.
These loads may be localized or generalized and can cause
accelerated bone resorption, inflammation, and hyperplasia.
The latter soft tissue conditions must be treated before denture
construction and can often be improved significantly by nonsurgical
procedures.
Rest for the denture-supporting tissues can be achieved by
removal of the dentures from the mouth for an extended period or
the use of temporary soft liners inside the old dentures. Both
procedures allow deformed tissue of the residual ridges to return
to normal form

8. Tissue abuse caused by improper occlusion can be corrected by
(1) withholding the faulty dentures from the patient,
(2) adjusting/correcting the occlusion and refitting the denture by
means of a tissue conditioner, and
(3) substituting properly made dentures once the denture-bearing
tissues have recovered.
This usually can be readily achieved by removing the dentures for 48
to 72 hours before the impressions are made for the construction of
new dentures.
Treatment with so-called “tissue treatment or conditioning
materials”is usually employed.
These temporary lining materials consist of a polymer powder and an
aromatic ester ethanol mixture and are both elastic and plastic..

9. Consequently they provide an interim cushioning stage and allow the
tissues to recover their unstressed shape.
Their softness is maintained for several days while the tissues
recover, and they have been widely used in dentistry for many years.

11. • They are generally manufactured as powder and liquid.
The powder is mainly an acrylic resin.
• It is mixed with a somewhat oily liquid plasticizer
(generally an alcoholic solvent) in a proportion of 1.25 to
1.5 of powder to 1 of liquid.6-10 The result is the formation
of a soft and elastic gel with a high percentage of flow
under compression.
• Tissue conditioners maintain their optimum
characteristics under conditions in the mouth for
approximately 3 days. The material adheres to itself (when
dry), to dry acrylic resin (without molecular union), and to
dry skin.°
• These materials act as soft cushions that allow the
deformed mucosa to push against them and gradually
recover their normal form.

12. • Once the lining has been placed in the denture, inserted,
and removed, 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 either
because of a faulty denture base or because of
malocclusion.
• The pressure spots must be ground away, and a new lining
must be placed to correct these errors. The patient must
be instructed not to brush the tissue surface of the
denture, but only to rinse it with water. He must use a
soft-food diet and should remove the dentures at night if
possible. The patient is asked to return in three days.

14. SOFT LINERS
INTRODUCTION
Relining is a process of resurfacing of a denture with new base
materials to make it fit more accurately. While rebasing is a process
of replacing the entire denture base material with new material.
Relining is indicated when there is resorption of the ridge and
denture lack retention and stability. It is for refitting of the impression
surface.
DEFINITIONS
Reline (1851): The procedure used to resurface the tissue
side of a denture with new base material, thus producing an
accurate adaptation to the denture foundation (GPT-7).

15. WHAT IS A SOFT LINER?
They are elastomer polymers used in the prevention of chronic
soreness from denture and preservation of supporting structures.
They are made resilient by addition of alcohol type plasticizers
or by co-polymerisation with the monomer unit. The hydrophilic
polymer is a mixture of polyethylene glycol with diacetins.
RESILIENT DENTURE BASE LINERS:
The indications for use of a resilient liner are:
 existence of thin, non-resilient mucosal coverage of the residual
ridge,
 poor ridge morphology,
 persistent denture-sore mouth,
 and acquired or congenital oral defects.

16. Stoner (1962) stated that the rational for using a soft lining material
is that part of the energy transferred from it to the denture aids in
deforming the denture elastically and consequently reduces the direct
load of mastication on the atrophied area. In addition, the soft lining
procedures as equal amount of pressure over the bone of the ridge
and thereby avoids resistance from the prominent spicules to a larger
amount of applied force.
Ortman and Ortman (1975) have described the ideal properties of a
resilient liner and recommended that these liners serve merely as aids
in solving the problems and not as the total solution.
Materials and Brand name:
Silicone rubber materials
• Flexibase
• Simpa
• Cardex-Stabon
• Molloplast-B

17. • Primasoft
• Prolastic
• Silastic 382
Soft acrylic materials
• Coe-soft
• Soft Oryl
• Coe-Super Soft
• Palasiv 62
• Soft Nobiltone
• Softic 49
• Virina
• Verno soft
Other materials
• Hydrocryl Soft Liner
• Cole polymers
• Natural rubber

18. GC RELINE SOFT
DETAX MOLLOSIL PERMANENT
SOFT LINER

19. GC SOFT LINER
MAJESTIC DRUG RELINE-IT
DENTURE RELINER

20. PERMA SOFT DENTURE RELINER
REVIVER SILICON DENTURE RELINING
MATERIAL

21. • Materials available for use as resilient liners are natural
rubber, soft acrylic materials, vinyls, and silicone rubbers.
• Natural rubber has only a limited service period because
of deterioration, fouling, and poor dimensional stability.
• Plasticized resin materials are the largest group of
resilient liners; they are either cold-cure or heat-cure
systems, and frequently they depend on the addition of
plasticizer for their resilience.
• A plasticizer eventually leaches out, leaving the material
hard and often fissured, thereby promoting staining.
Vinyls have short-comings similar to those of resins
because they may harden in service gradually.
• Lower resistance to abrasion also is a problem and may
contribute to the poor fit of dentures.

22. • Silicone rubbers probably are closest to being the ideal material.
Achieving a satisfactory bond strength between the silicone lining
and denture base resin for a reasonable service life has been a
problem.
• Use of newer bonding agents seems to have increased the service
life.
• Although silicone rubber is a suitable medium for the growth of
fungus, proper denture hygiene minimizes this problem.
Silicone rubber materials:
Having no natural adhesion to polymethyl methacrylate,
silicone rubbers depend on an adhesive or a bonding agent, such as a
silicone polymer in a volatile solvent, for adherence of the lining to
the denture base. The molecules of the polymer penetrate the acrylic
of the denture base and anchor in it after evaporation of the solvent.
As the resilient lining material cures, it adheres to the denture base
by cross-linkage with the silicone polymer.

23. TEMPORARY SOFT LINERS OR TISSUE CONDITIONERS
Tissue conditioners as temporary soft liners are materials
whose useful function is very short, generally a matter of a few days.
Kydd and Mandley (1967) stated that tissue lining materials permit
wider dispersion of forces and hence, aid to decrease the force per
unit area transmitted to the supporting tissues. Such soft liners could
serve as an analog of the mucoperiosteum with its relatively low
elastic modulus.
Currently for practical purposes, denture base materials are
made of rigid materials. The dentist must recognize that the
prolonged contact of these bases with the underlying tissues is bound
to elicit changes of the tissues. Mucosal health may be promoted by
hygienic and therapeutic measures and tissue-conditioning techniques
may be applied when appropriate.

24. Tissue conditioners are indicated to condition the abused tissue,
whereas soft liners are indicated to give a cushioning effect to relieve
and protect vulnerable tissues.
COMPOSITION:
Tissue conditioners are composed of polyethyl-methacrylate
and a mixture of aromatic ester and ethyl alcohol. Tissue conditioners
are available as three component systems.
• Polymer (Powder)
• Monomer (Liquid)
• Liquid plasticizer (Flow control) Butylphthalyl butylglycolate
Other polymers used: Polymethyl methacrylate, Silicone rubber, Poly
‘n’ propyl-methacrylate, poly ‘n’ butyl methacrylate.
A gel is formed when these materials are mixed, with the ethyl alcohol
having a greater affinity for the polymer.

25. Ideal properties:-
• Flow under constant force
• Resilient at high rates of deformation
• Remain viscous for several days
• Have a high adhesion to aid retention to denture base.
• Permanent resiliency
• Dimensional stability
• Adherence to denture base
• Dimensional stability
• Adherence to denture base
• Color stability
• Biocompatibility
• Intertness to fungus and bacteria
• Absence of odor, taste, irritation, toxicity.
• Ease of processing and repair
• Wettability
• Slow fluid absorption
• Abrasion resistance

26. • Long shelf life
• Economical
DISADVANTAGES:-
• Low cohesive strength
• Affected by cleaners
• Alcohol can sting inflamed
mucosa
ADVANTAGES:-
• Rheological and viscoelastic
properties almost ideal
• Can be applied chairside
• Dentures fit well
• Can record freeway space

27. Indications:
• Ridge atrophy/ resorption
• Bruxers
• Surgery
Contraindications:
• Relief areas
• Xerostomia
• Obturators to enhance
retention
• Denture opposing natural
dentition

28. POINTS TO REMEMBER:-
• They survive only few weeks in mouth – although some are so
well formulated as to remain resilient and in place for many
months.
• However, it is their viscoelastic properties that are important,
specifically their ability to flow under mastication and occlusal
forces, spreading the load on the mucosa evenly.
• When first mixed they flow easily recording such voids as
means of free space.
• They soon becomes highly viscous.
• After than they respond to changes in shape of mucosa.
• In this way swollen mucosa traumatized by ill-fitting dentures
can recover.

29. Uses of Tissue Conditioners:
The major uses of these tissue conditioning materials include:
• Tissue treatment
• Temporary obturator
• Baseplate stabilization
• To diagnose the outcome of resilient liners
• Liners in surgical splints
• Trial denture base
• Functional impression material
Adjuncts for Tissue Healing:
The merit of using a tissue conditioner is that they
prepare the selected oral structures to withstand all the stress
from the prosthesis. Tissue conditioners are generally used to
preserve the residual ridge. They are also used to heal irritated
hyperemic tissues prior to denture fabrication.

30. • Temporary Obturator:
Tissue conditioners may be added as a temporary obturator
over the existing complete or partial denture; this may be done
directly in the mouth or indirectly after an impression of the surgical
areas has been made.
• Stabilization of Baseplates and Surgical Splints or Stents:
When undercuts are present on an edentulous cast, an acrylic
temporary denture base cannot be used as it may get locked into the
undercut and break the cast during removal. In these cases tissue
conditioners of a stiffer consistency may be used to stabilize the
record bases and prevent breakage of the cast.

31. • Adjunct to an Impression or as a Final Impression Material:
These materials are used when it is difficult to determine the
extent of the denture base due to the presence of movable oral
structures. These materials record the extensions of the denture in a
dynamic form that will later help in preparing an impression tray for
the final impression.
• Adjunct to Determine the Potential Benefits of a Treatment
Modality:
Sometimes patients with well-constructed dentures develop
chronic soreness and find it difficult to wear the dentures
comfortably. Tissue conditioners can be used to determine if this
problem can be resolved with the use of a resilient liner.

32. Procedure for Applying Tissue Conditioners:
The following steps should be considered while applying a
tissue conditioner on a denture.
Preparation of the dentures:
• The tissue part of the denture base, which crosses an undercut,
should be reduced.
• The tissue surface of the denture, which covers the crest of the
ridge, should be reduced by 1 mm.
• It should be remembered that the dentures should allow sufficient
room for the placement of the tissue conditioner in order to
promote the recovery of displaced and traumatized tissues.
Mixing and Placement of the Tissue Conditioner:- Tissue conditioners
are available as three component systems.
• Polymer (Powder)
• Monomer (Liquid)
• Liquid plasticizer (Flow control).
• The mixing ratio can be changed according to the consistency
required.

33. • A ratio of 1.25 parts of polymer, 1 part monomer an d0.5cc
plasticizer is usually recommended.
• The plasticizer should be added to the monomer.
• The ingredients are mixed to form a gel, which is applied in
sufficient thickness to the tissue surface of the denture.
• The denture is inserted and border movements are carried out to
mould the setting material.
• This method is similar to functional relining.
Care and Maintenance:
• Tissue conditioners should not be cleaned by scrubbing with a
hard brush in order to prevent tearing of the material. The use of
soft brush under running water is recommended.
• The greatest virtue of tissue conditioners is their versatility
and ease of use. Their biggest flaw is that they are so easily
misused. Their longevity against wear is very limited and they tend
to harden and roughen within 4 to 8 weeks due to the loss of
plasticizer. Hence, they require close observation.

34. Properties:
• Viscous properties, which allow excellent adaptation to the
irritated denture-bearing mucosa over a period of several days.
• Elastic behavior, which cushions the cyclic forces of
mastication and bruxism.
• It should not be cleansed by scrubbing with a hard bristle brush.
• Cleansed with soft bristle brush under cold running water.
• Soaking denture in cleanser is not recommended since they can
adversely affect the physical properties of tissue conditioners
and cause premature deterioration. Most of denture cleansers
are acidic and are absorbed by tissue conditioners and retained
even after rinsing with water, mild acid can later be released
when it places denture in the mouth and can cause irritation.

35. Requirements of Resilient Denture Base Liners:
• The requirements of soft liners are as follows:-
• They should be of a biologically inert material that is compatible
with the oral tissues and does not support bacterial or fungal
growth.
• They should be resilient and capable of maintaining this
characteristic. Dentists agree that the average period of
satisfactory service for a denture is 7 years; however, patients that
need this resilient lining have special problems that often require
more frequent service. For them, a reasonable period of service
expected from such a material may be 2 years.
• After curing, they should be dimensionally stable and insoluble in
oral fluids to maintain proper tissue contact.
• They should be color stable throughout their useful life, resistant
to staining, and impervious to odors.

36. • Even though flexible, they should resist abrasion and thereby allow
the practice of proper hygiene of the surface.
• On curing, they should maintain their bond to the denture base
without damaging it.
• It should be relatively easy to work with them, including during
fabrication of the lining and its subsequent adjustment. However it
is not essential for the liner to be a chairside material.

37. Resilient Liner Materials:
• Hard reline material
• Tissue conditioners
• Soft lining material
Heat cured Lining Denture Bases:
A silicone rubber liner can be added to a previously processed
denture base as a reline procedure or, more conveniently, can be
included in the process of initial fabrication of the denture base.

38. Reline Procedure: According to Rudd and Morrow.
Denture with soft tissue-conditioner is
ready to be flasked
Stone-plaster mix is spatulated onto outer surface of denture so
as to avoid trapping air and to assure filling interproximal spaces
Denture is inverted into lower half of denture flask filled with
Stone-plastermix.
No. 320 grit wet or dry sandpaper is used to put smooth
Finish on stone-plaster surface and to facilitate seperation
Of halves of flask before removal of tissue conditioner.

39. When stone-plaster mix has reached its final set, thin coat of
Seperating medium is painted on surface to act as seperator.
Second half of flask has been placed in position.
Upper half of flask is positioned, and flask is filled with water at
Room temperature to wet surface of tissue conditioner and to
Prevent air bubbles from clinging to material during second pour.
Vacum spatulated mix of dental stone is vibrated carefully into
Upper half of flask to complete flasking. After flask is filled, lid
Is positioned.
After stone of second pour of denture flask has reached its final set,
Flask is immersed in hot water, 130F, for approx 5min for easy seperation
And seperated.

40. After stone of second pour of denture flask has reached its final set,
Flask is immersed in hot water, 130F, for approx 5min for easy seperation
And seperated.
Tissue conditioner is removed and resin denture base is roughened
With carbide base
Seperating medium is applied to all gypsum surfaces of both halves of flask
to facilitate seperation after processing.
Bonding agent is applied to all exposed surfaces of resin denture base.
Putty-like soft liner is formed into roll and placed on denture base and cured

41. Bring the temperature of the water to 1600F (710C) within 30 minutes,
and maintain this temperature for 30 minutes.
During the next 30 minutes bring the water to a boil, and then boil it
for 2 hours. The total curing time is 3 ½ hours.

53. INITIAL PROCESSING PROCEDURE
• Flask denture in a Hanau flask in conventional manner.
• Boil out and apply tinfoil substitute to all gypsum surfaces of both
halves of flask, and allow them to dry thoroughly (approximately 5
minutes).
• To control the thickness of the Molloplast-B liner, a silicone putty
spacer is constructed on the master cast in the lower half of the
flask. Mix putty following manufacturer’s directions and mold onto
master cast maintaining at least a 3 mm thickness. When set, trim
borders with scissors. Reduce excess thickness with a coarse
stone mounted in a high-speed lathe.
• Trial pack high-impact denture base resin in flask with silicone
putty spacer.

54. • Place flask in cold water in a Hanau curing unit, and set curing
cycle and temperatures according to manufacturer’s
recommendations.
• Bench cool and open flask. Halves of the flask will separate easily,
as soft spacer does not engage undercuts in master cast.
• Remove spacer and flatten resin borders with a carbide bur to
provide a butt joint.
• Reapply tinfoil substitute to gypsum surfaces of master cast and
lower half of flask. Coat all exposed surfaces of resin with bonding
agent. Trial pack, process, and finish Molloplast-B liner.

55. Problem Probable cause Solution
Subsurface
voids during
initial flasking
stages
Improper
application of
stone-plaster
mix to surface
of denture
Carefully apply stone-
plaster mix to assure
filling interproximal
areas and avoid
trapping air
Vacuum spatulate
stone-plaster mix in
mechanical spatulator
Inadequate
duplication of
denture
border rolls
Improper flasking Flask so as to assure
inclusion of border
rolls of impression in
top half of the flask
Fully expose border
rolls prior to final set
of stone-plaster mix
Problem Areas:
Resilient denture base liners (silicone):

56. Adherence of
tissue
conditioner to
stone surface
Too much free
liquid remaining
in tissue
conditioner
Alter powder-liquid
ratio
Prolong wearing time of
tissue conditioner
until flasking
Chalky, rough,
pitited stone
surface
See above See above
Voids in top
half of flask
Dry surface of
tissue
conditioner
Wet surface of tissue
conditioner with water
before pouring second
half of flask
Improper flasking Use mechanical
vibration to avoid
entrapment of air
bubbles
Use vacuum-mixed
dental stone

57. Denture base
visible
through
resilient liner
on adjustment
Resilient liner too
thin
Inadequate
removal of
denture base
material
Remove adequate
amount of denture
base material to
assure resilient liner 2
to 3 mm thick prior to
packing and
processing
Fracture of
denture base
during usage
Weak denture
base material
Denture base
material too
thin
Use high-impact resin
Leave minimum of 3mm
of denture base
material over crest of
ridge
Separation of
resilient liner
from denture
base material
No bonding agent
used
All surfaces not
coated with
bonding agent
Use bonding agent
recommended by
manufacturer
Apply bonding agent
thoroughly to all
surfaces to be
covered with resilient
liner

58. Small yellowish
plaques on
resilient liner
surface
Yeast organisms Soak for 30 minutes in
solution of 1½ oz of
Zephiran and 8 oz of
water; scrub well with
mild soap and water

59. Problem Probable
cause
Solution
Surface voids Improper
application of
tinfoil
substitute
Flush mold surface with boiling water to eliminate
any traces of wax.
Packing in
cold mold
Warm mold under heat lamp
Subsurface
voids
(bubbles)
Packaging Precompress soft liner in specially prepared flask.
Trial pack three times
Underpacking Trial pack three times
Rapid
monomer
volatilization
Reduce temperature and increase time of initial
stage of cure cycle (1500F, 6 hours)
Completely cure resin against silicone putty spacer
before packing and processing soft liner
Problems associated with silicone rubber liners:

60. SUMMARY
Since 1942, dentistry has sought to find a resilient denture
lining material that would exhibit ideal clinical and laboratory qualities.
To date, silicone materials have been considered the material of
choice.
CONCLUSION:
The greatest virtue of tissue conditioners lies in their
versatility and ease of use. Their biggest flow is that they are so
easily misused. Because the conditioner-lined dentures provide
immediate relief and comfort, there is a danger that the patient will
wear them too long and so cause trauma to the supporting tissue –
thereby producing the very situation that their use is intended to
prevent or correct. Their longevity in wear is very limited. They
harden and roughen within four to eight weeks because of loss of the
plasticizer. This requires close observation of the patient by the
dentist.

61. REFERENCES:
• Prosthodontic Treatment for Edentulous Patients, 12th edition, Zarb Bolender.
• Boucher’s Prosthodontic Treatment for Edentulous Patients, 10th edition, Zarb,
Bolender, Hickey, Carlson.
• Phillip’s Science of Dental Materials, 11st Edition, Annusavice.
• Restorative Dental Materials, 11th Edition, Craig.
• Dental Lab Procedures – Fixed Partial Dentures, 2nd edition, Vol.2, Roads, Rudd,
Marrow.
• Essential of Complete Denture Prosthodontics, 2nd edition, Sheldon Winkler.
• Diagnosis and Treatment Planning for Edentulous Patients, Lancy, Philadelphia,
1983.
• J Prosthet Dent 1978; 40 : 89-97.
• J Prosthet Dent 1978; 40 : 334-342.
• J Prosthet Dent 1978; 40 : 499-508.
• J Prosthet Dent 1980; 43 : 348-351.
• J Prosthet Dent 1991; 65 : 413-418.

62. THANK YOU