presentation on soft tissue liners and tissue conditioners .

1. SOFT TISSUE LINERS AND TISSUE
CONDITIONERS
Presented by-Dr. Vaishali
Shrivastava.
Pg 2nd year student.
Dept. of prosthodontics ,crown &
bridge & implantology.
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2. CONTENTS-  INTRODUCTION
 DEFINITIONS
 INDICATIONS, CONTRAINDICATIONS
FOR RELINING AND REBASING
 CLASSIFICATIONS
 REQUIREMENTS FOR DENTURE LINERS
 HARD LINERS
 SOFT LINERS
 TISSUE CONDITIONERS
 CONCLUSION
 REFERENCES
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3. INTRODUCTION
• Maintenance of the adaptation of the denture bases to the mucosa that
covers the residual ridges is a critical part of a complete denture service.
• The residual ridges have been described as plastic in nature, always
changing in topography and morphologically.
• resorption occurs most rapidly in the first six months following
extraction of the teeth and seems to level off at about 12 months.
Essentials of complete denture prosthodontics, Sheldon winkler 3rd edition 3

4. definitions
Relining is the process of adding some
material to the tissue side of a denture to fill
the space between the tissue and the
denture base - (Sheldon winkler)
reline(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 ( GPT9)
Reline
4

5. Rebasing is a process of replacing all
the base material of a denture. The
purpose of such a process is to fill the
space between the tissue and the
denture base without changing the
position of the teeth and the relation of
the dentures (Sheldon winkler)
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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 (GPT9)
definitions

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Tissue conditioner: 1. a resilient denture liner resin placed into a removable
prosthesis for a short duration to allow time for tissue healing(GPT9)
2. used in functional removable relining procedures to evaluate denture function
and patient acceptance prior to laboratory reline processing (GPT9)

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INDICATIONS FOR RELINING AND REBASING
1.Immediate dentures at three to six months after their original construction
2. When the residual alveolar ridges have resorbed and the adaptation of the denture bases to the ridges
is poor.
3. When the patient cannot afford the cost of having new dentures constructed.
4.When the construction of new dentures with the accompanying series of appointments can cause
physical or mental stress, such as for geriatric or chronically ill patients
Essentials of complete denture prosthodontics, Sheldon winkler 3rd edition

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CONTRAINDICATIONS
1. Excessive amount of resorption has taken place.
2. When patients complain about TMJ problems.
3. If denture have poor esthetics.
4. If denture create major speech problem.
Essentials of complete denture prosthodontics, Sheldon winkler 3rd edition

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TISSUE
PREPARATION
1. Excessive
hypertrophic
tissue should
be surgically
removed. 2.The oral
mucosa should
be free of areas
of irritation.
3.The dentures should
be left out of the
mouth at least two to
three days before
making the final
impression
4.Daily massage of
the soft tissues is
helpful to stimulate
their blood supply

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DENTURE
PREPARATION
1)Minor occlusal
disharmony is
corrected by
selective grinding.
2)Pressure areas on
the tissue surface of
the dentures should
be relieved.
3)Small border
inadequacies are
corrected.
4)A correct posterior
palatal seal area
should be
established before
the final impression

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RELINING
METHODS
CLINICAL
1)STATIC
2) FUNCTIONAL
3) CHAIRSIDE
LABORATORY
1) FLASK METHOD
2) ARTICULATOR
METHOD
3) JIG METHOD
Open mouth
technique
Closed mouth
technique

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• Proposed by Boucher in 1973.
• Dentures are used as special tray
for making the final impression.
• After impression a New Centric
Relation is recorded.
Open mouth technique

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Closed mouth technique
Integral Step for a Closed-Mouth Reline
Technique—
• Centric Relation Existing correct
intercuspation (CRO) used to stabilize
dentures

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Denture Preparations
1.Large undercuts relieved
2.Hard resin surfaces relieved 1.5 to 2 mm
3.Tissue conditioner removed or relieved”
4.Escape” holes drilled, particularly in maxillary base; this
will also assist easy removal of palatal portion during
laboratory rebase
5.Denture periphery shortened to create flat border
Impression Procedure
1) Border molding achieved with preferred material
(i.e., low-fusing compound)
2) Border molding retained from polymerized
tissue-conditioning material
3) Posterior palatal seal achieved with low-fusing
compound
4) Border molding achieved by choosing
impression material that is soft and yet viscous
enough to support and register peripheral detail
(one of the polyether impression materials
Prolonging the Useful Life of Complete Dentures: The Relining Procedure George A. Zarb, Rhonda F. Jacob

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FUNCTIONAL TECHNIQUE

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Disadvantages-
(1) the materials often have
produced a chemical burn on the
mucosa
(2) the result often was porous and
subsequently developed a bad odor
(3) color stability was poor
(4) if the denture was not positioned
correctly, the material could not be
removed easily to start again.
CHAIRSIDE TECHNIQUE
acrylic or other plastic material that
could be added to the denture and
allowed to set in the mouth to
produce an instant chairside
reline/rebase

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RELINING AND REBASING KENNETH D. RUDD, ROBERT M. MORROW, R. NEAL EDWARDS, and AMBROCIO V. ESPINOZA
LABORATORY TECHNIQUES
ARTICULATOR METHOD

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RELINING AND REBASING KENNETH D. RUDD, ROBERT M. MORROW, R. NEAL EDWARDS, and AMBROCIO V. ESPINOZA

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RELINING AND REBASING KENNETH D. RUDD, ROBERT M. MORROW, R. NEAL EDWARDS, and AMBROCIO V. ESPINOZA

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JIG METHOD

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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
classification

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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

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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

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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)

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Basic
requirements
nontoxic,
odourless, and
tasteless to
encourage
long-term wear
of the denture
by the patient.
Insoluble in
oral fluids
They should be
easily
processed
using
conventional
laboratory
equipment.
Dimensionally
stable
Ease to
manipulate
Should
maintain bond
to denture base

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Powder
1) Polymer beads- polymethylmethacrylate
2) Initiator- benzoyl peroxide
Liquid
1) Monomer – methylmethacrylate
2) Plasticizer – Di-n-butylphtalate
3) Chemical activator- tertiary amine
HARD RELINE MATERIALS

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Soft lining
materials
Natural
rubber
Vinyl
copolymer
Silicone
elastomers
Soft
acrylics
Polyelastomeric
system
fluoropolymer
Complete denture prosthodontic treatment and problem solving Yasemin k ozkan

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Natural Rubber
Natural rubbers have been used as soft lining materials since the 1860s
DISADVANTAGES
• quick absorbance of intraoral liquids
• difficulty in preparation
• low quality of connection to base material,

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• Available in powder liquid form
• Polymer is methyl or ethyl-methacrylate
• They are divided into two groups, based on their preparation
methods:
1. Acrylic-based soft lining materials that polymerize in room
temperature
2. Acrylic-based soft lining materials that polymerize with heat
SOFT ACRYLICS
Composition
polyethyl methacrylate in
powder
n-butyl methacrylate
liquid
amine activator.

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• Silicone Elastomers
• The most widely used soft lining materials are silicone-based
materials.
• No need to add plasticizing agent
• Material retain its rubbery consistency for longer period
Silicone-Based Soft Lining Materials that Polymerize in Room
Temperature
Silicone-Based Soft Lining Materials that Polymerize with Heat

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Olefinic Soft Lining Materials
• having good elastic properties
• these require a special apparatus for lining
• need an adhesive.
• Water absorption is minimal
• since the lining material can be stained by nutrients, a coating agent must be used. E.G.
Molteno (Molten) (indirect method)

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TISSUE CONDITIONERS
-Short term denture liners are also called tissue conditioners
-Intraorally these materials are used one week to 15 days at most
Complete denture prosthodontic treatment and problem solving Yasemin k ozkan

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Composition
Powder
polyethylmethacrylate Liquid
ethyl alcohol-solvent
aromatic ester mixture (benzyl salicylate, butyl
phthalate, butyl glycolate- plasticizer
sweeteners.
Complete denture prosthodontic treatment and problem solving Yasemin k ozkan

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Gelation reaction:
When the powder and liquid are
mixed, polymeris dissolvedby
plasticizer.This reaction is
responsible for chain
entanglementand thus formation
of gel.
Reaction- 15-20 min

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Uses Their main use is to treat chronic soreness due to
dentures.
Adjunct uses
• conditioning the tissues during fabrication of new complete
dentures
• Temporary obturator
• Stabilize surgical splints or stents

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IN TEMPORARY OBTURATORS

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Conclusion-
Soft liners have important place in dental prosthesis
but requires improved strength, improves adhesion ,
inhibit fungal growth
Greatest virtue of tissue conditioners is versitality and
ease to use

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References-
• Complete denture prosthodontic treatment and problem
solving Yasemin k ozkan
• Essentials of complete denture prosthodontics, Sheldon
winkler 3rd edition
• Phillips science of dental materials 12th ed
• Applied dental materials john f MC cabe 9th ed

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THANKYOU