Tissue response to cd and preventing and treating the abused tissues

TISSUE RESPONSE TO
COMPLETE DENTURE AND
PREVENTING AND
TREATING ABUSED TISSUES
Presentation by:
Dr. Vanshree Sorathia
MDS Prosthodontist
Total slides: 154
1

Introduction
Aree Jainkittivong, Vilaiwan Aneksuk and Robert P, Langlais. Oral mucosal lesions
in denture wearers. The Gerodontology Society and John Wiley and Sons A/S,
Gerodontology 2010; 27: 26-32. 2

TISSUE REPONSE TO
PREVENTING AND TREATING
ABUSED TISSUES
3

4
Tissue
response
Treatment
Prevention

Objectives of Discussion
• Abused Tissues/ Tissue response
• Preventive Measures
• Treatment Modalities
• Review of Literature
• Conclusion
• References
5

Tissue
Response
Direct
Sequelae
Indirect
Sequelae
7

A. DIRECT CONSEQUENSES
1. Denture irritation hyperplasia
2. Epulis fissuratum
3. Denture stomatitis
4. Traumatic ulcers
5. Oral cancers in denture wearers
6. Flabby ridges
Zarb Bolender – Complete denture and implant supported prosthesis, Elsevier 2009. 8

7. Angular chelities/ Perleche
8. Burning mouth syndrome
9. Gagging
10.Residual ridge reduction
11.Overdenture abutments: caries and
periodontal disease

B. INDIRECT CONSEQUENSES
1. Atrophy of masticatory muscles
2. Nutritional deficiencies

1. Denture Irritation Hyperplasia
Clinical presentation:
• Hyperplasia.
• Elongated rolls of
tissues.
• Inflammation.
Zarb Bolender – Complete denture and implant supported prosthesis, Elsevier 2009.
(Pg.: 40) 12

Causes:
• Local irritation.
• Poor oral hygiene.
• Candida associated.
Microscopic Features:
• Pseudoepitheliomatous
hyperplasia.
(Pg.: 40) 13

Treatment:
• Removal of denture.
• Tissue conditioner + massage.
• Replacement or adjustment of denture.
• Severe- surgical excision.
Large Lesions Small Lesions
Split thickness Sharp curettes
Supra periosteal excision Mucoabrasion
Electrosurgery
Zarb Bolender – Complete denture and implant supported prosthesis, Elsevier
2009. (Pg.: 40) 14

2. Epulis Fissuratum
Clinical manifestation:
• Hyperplastic tissue
repair response.
• Female.
• Mandible.
• Slower in growth.
• Firm to palpate.
Shafer’s Oral Pathology, 7th edition. Elsevier 2014. (Pg. no. 540) 15

Etiology:
• Chronically ill fitting
dentures.
Microscopic features:
• Hyperplastic fibrous
connective tissue.

Management:
• Discontinue denture wearing.
• Tissue conditioning.
• Repair/ rebase the denture.
• New denture.
• Surgical removal.

3. Denture Stomatitis
Synonyms:
• Denture induced stomatitis
• Denture sore mouth
• Inflammatory papillary hyperplasia
• Chronic atrophic candidosis
• 25-67%- female patients.
• Prevalence increases with age.
• Asymptomatic.
Shamimul Hasan, Kuldeep. Denture Stomatitis: a Literature Review. Journal of
Orofacial and health sciences 6 (2), 2015. 18

Old age
Diabetes
mellitus
Nutritional
deficiency
Malignancies
Immune
defects
Corticosteroids
2009. (Pg. no. 38)
19
Dentures Xerostomia
Irradiation
High
carbohydrate
diet
Broad
spectrum
antibiotics
Smoking
tobacco
Predisposing factors of Candida associated Denture Stomatitis:
Systemic factors Local factors

Classification:
Newton
1962
• Punctiform hyperemia
• Diffuse hyperemia
• Granular hyperemia
Budtz-
Jorgensen &
Bertram 1970
• Simple localized inflammation
• Simple diffuse inflammation
• Granular inflammation
Bergendal &
Isacson
1983
• Localized inflammation
• Diffuse reddening
• Grandulated type

Punctiform hyperemia Diffuse hyperemia
Granular hyperemia

Diagnosis:
Karine Vitor Martins, Savio Morato de Lacerda Gontijo. Treatment of denture
stomatitis: Literature review. Rev Bras Odontol 2017; 74(3): 215-20. 22
Clinically
Histopathologically

Prevention:
• Thorough evaluation and correction of oral and
denture hygiene.
• Avoid nocturnal wearing of denture.
• Soaking of dentures in cleaning solution.

Treatment:
• Antifungal agent
• Mouthwash
• Photodynamic therapy
• Nanomaterials
• Microwave irradiation
• New dentures

4. Traumatic Ulcers/ Sore Spots
Clinical features:
• Within 1-2 days of
denture insertion.
• Small, painful.
• Covered with grey
necrotic membrane.
• Surrounded by an
inflammatory halo with
firm elevated borders.
2009. (Pg. no. 40-41)
25

Etiology:
• Sharp denture borders.
• Unbalanced occlusion.
• Sharp ridges.
• Immunocompromised patients
Treatment:
• Correction of causative factor.
• Self healing.
• If not treated- Denture irritation hyperplasia.
(Pg. no. 40-41) 26

5. Oral Cancers In Denture
Wearer
Sunil R. Panat, Ashish Aggrawal, Ankkita Chakarvarty, Denture induced squamous
cell carcinoma: A rare case report. Journal of Dental Science and Oral Rehabilitation.
April-June 2012.
27

6. Flabby Ridges
Clinical Features:
• Mobile or extremely resilient alveolar ridges.
2009. (Pg. no. 40)
28

Etiology:
• Combination syndrome (24% maxilla + 5%
edentulous mandible).
• Also known as “Anterior Hyperfunction Syndrome”.
• Ellisworth Kelly, 1972.
Ellisworth Kelly, Changes caused by a mandibular removable partial denture opposing
a maxillary complete denture. J Prosthet Dent 2003;90:213-9.
29

Ellisworth Kelly, Changes caused by a mandibular removable partial denture opposing
a maxillary complete denture. J Prosthet Dent 2003;90:213-9. 30

Microscopic feature:
• Marked fibrous
inflammation and
resorption of underlying
bone.
Ellisworth Kelly, Changes caused by a mandibular removable partial denture opposing a
maxillary complete denture. J Prosthet Dent 2003;90:213-9. 31

Management:
• Surgical removal.
• Extreme ridge resorption- preserve the tissue.
Rubina Bansal, Manjit Kumar, Rashim Garg, Rishi Saini, Shaveta Kaushala.
Prosthodontic rehabilitation of patient with flabby ridges with different impression
technique. Indian Journal of Dentistry, Jun 2014, vol 5, Issue 2.
32
Hobkirk
Technique Zafarullah Khan
Technique

i. HOBKIRK TECHNIQUE
33
1. Preliminary impression
(Irreversible hydrocolloid)
2. Primary cast

34
3. Special tray
4. Border molding

35
5. Secondary impression
(Medium body elastomeric
impression material)
6. Tertiary impression
(Light body elastomeric
impression material)

36
7. Master cast
8. Maxillary denture

ii. ZAFARULLAH KHAN TECHNIQUE /
WINDOW TECHNIQUE
37

Department of Prosthodontics, Pacific Dental College and Hospital 38
1. Diagnostic cast
2. Spacer design

3. Custom tray
4. Intraorally placed

5. Border molding
6. Impression plaster

7. Final Impression

7. Angular Chelities / Perleche
Clinical manifestations:
• Dryness and burning
sensation.
• Skin at commissure -
wrinkled and lacerated or
ulcerated, never bleeds.
• Lesion stops at the
mucocutaneous junction.
2009.
42

Causes:
• Candidial infection.
• Overextended denture flanges.
• Reduced vertical dimension at occlusion.
• Vitamin B12 deficiency.
Zarb Bolender – Complete denture and implant supported prosthesis,
Elsevier 2009. 43

Microscopic feature:
• Majority are candida associated which shows
candidal hyphae.
Management:
• Antifungal therapy
• Denture correction
• New denture
2009. 44

8. Burning Mouth Syndrome
• Burning pain in the tongue
or other oral mucous
membrane associated with
normal signs and laboratory
findings lasting at least 4-6
months.
-International
Association for the Study of
Pain.
Arvindham R., Vidyalakshmi S., Kumar MS., Satheesh C., Balasubramanium
AM., Prasad VS. Burning Mouth Syndrome: A review on its diagnostic and
therapeutic approach. J Pharm. Bioall Sci 2014; 6:S21-5.
45

• Scalded mouth syndrome
• Stomatodynia
• Sore tongue
• Burning lips syndrome
• Glossodynia
• Glossalgia
• Stomatopyrosis
• Oral dysesthesia
• Burning mouth condition
• Glosssopyrosis
• Sore mouth
Synonyms
of BMS
46

Classification:
A. Lamey and Lewis Classification:
Subtype 1 (35%)
Subtype 2 (55%)
Subtype 3 (10%)
B. Scala et al:
Primary Jaskelainer 3 Subtypes
Secondary
Arvindham R., Vidyalakshmi S., Kumar MS., Satheesh C., Balasubramanium AM.,
Prasad VS. Burning Mouth Syndrome: A review on its diagnostic and therapeutic
approach. J Pharm. Bioall Sci 2014; 6:S21-5.
47

Clinical Features:
• No inflammatory changes.
• Burning pain- chief complain.
• Altered taste sensation.
• Dry mouth.
48

Etiology: Multifactorial
49
Local
• Mechanical irritation, Allergy, Infections
• Oral habits and parafunctions
• Myofacial pain
Systemic
• Vit. Deficiency, iron deficiency anemia
• Xerostomia, menopause, diabetes,
• Parkinson’s disease, medication
Psychogenic
• Depression
• Anxiety
• Psychosocial stress

Treatment :
• Capsaicin (0.025% cream)
• Clonazepam (1mg) tds for 14 days
• 0.5 ml alovera gel tds with tongue
protector
Topical
medication
• TCA (loading dose 5-10mg,
increase gradually to 50mg)
• Antipsychotic drugs
Systemic
medication
• Cognitive behavior therapy
Behavioral
therapy
50

9. Gagging
• Normal healthy defense
mechanism.
Predisposing factors:
• Tactile stimulation.
• Psychogenic.
• Overextended denture
borders.
• Poor retention of
maxillary denture.
2009. Pg. no. 6 51

Management :
Behavioral
• Relaxation
• Distraction
• Desensitization
• Cognitive
behavior
therapy
Pharmacological
• Local anesthesia
• Inhalational
• Training Base
Simple measures
• Impression tray
• Impression
material
• Aspiration
• Upright position
• Cessation of
treatment
G.S. Basi, G.M. Humphris, L.P. Longman. The etiology and management of
gagging: A review of the literature. J Prosthet Dent, May 2004, Vol 91, No. 5.
52

Condition appliance
G.S. Basi, G.M. Humphris, L.P. Longman. The etiology and management of
gagging: A review of the literature. J Prosthet Dent, May 2004, Vol 91, No. 5.
53

10. Residual Ridge Reduction
Sheldon Winkler- Essentials of Complete Denture Prosthodontics, 3rd edition,
AITBS publisher, 2017. (Pg. no. 32-50) 54

• Pathology:
Gross
Microscopic
AITBS publisher, 2017. 55

(i)Gross pathology:
(a) Hard tissue:
DOUDLAS ALLEN ATWOOD – 6 Orders

(b) Soft tissue
(ii) Microscopic pathology:
Hard tissue
Soft tissue
• Pathophysiology
• Pathogenesis
• Epidemiology
Sheldon Winkler- Essentials of Complete Denture Prosthodontics, 3rd edition, AITBS
publisher, 2017. (Pg. no. 32-50) 57

Sheldon Winkler- Essentials of Complete Denture Prosthodontics, 3rd edition, AITBS
publisher, 2017. (Pg. no. 32-50) 58
Centripetal- Maxilla
Centrifugal- Mandible

Etiology
1. Anatomic factors:
RRR α quality and quantity of bone.
2. Metabolic factors:
RRR α bone resorptive factors
bone forming factors
3. Mechanical factors:
RRR α force factors + 1
damping forces time

Quality and quantity of bone × Bone
RRR α resorptive factors × Force factors
Bone forming factors × Damping force
× Time
RRR – Mandible > Maxilla ????

Prevention :
Ajay Gupta et al. Residual Ridge Resorption: A review. Indian journal of dental
sciences, March 2010 Vol 2 Iss 2 61
Retaining natural teeth Implant supported overdenture

sciences, March 2010 Vol 2 Iss 2 62
Tooth supported overdenture

2
Objectives
Increasing
denture
bearing area
Reducing
occlusal
table
sciences, March 2010 Vol 2 Iss 2
63

1. Impression technique- Winkler
Overextended primary alginate
impression
Wax occlusal rim
3 applications of tissue conditioner
Wash Impression- light bodied
material
sciences, March 2010 Vol 2 Iss 2
64

2. Neutral Zone Technique:
Pooja Asnani, Chandu GS, Sunit Kumar Mishra, Neutral Zone Technique in CD – Case
report. Journal of Applied Dental and Medical Sciences. Vol 1, Iss-1, Apr-Jun 2015.
65
1. Edentulous Mandible
2. Diagnostic impression
3. Diagnostic cast

report. Journal of Applied Dental and Medical Sciences. Vol 1, Iss-1, Apr-Jun 2015.
66
4. Final impression
5. Master cast
6. Retentive wire

Swatantra Agrawal, Praveen Gangadhar. A simplified Approach for Recording
Neutral Zone. J Indian Prosthodont Soc. (Apr-June 2010) 10(2); 102-104. 67
7. Impression compound
8. Putty index

report. Journal of Applied Dental and Medical Sciences. Vol 1, Iss-1, Apr-Jun 2015. 68
7. Molded occlusal rims in neutral zone
8. Putty index
9. Teeth arrangement

11. Overdenture Abutments: Caries
and Periodontal Disease
Elsevier 2009. 69

1. Atrophy of Masticatory Muscles
• Masticatory function of a muscle depends on
the skeletal muscle force and co-ordination of
orofunctional movements.
• Skeletal or biting force decreases with age.
2009. Pg. no. 8) 71

• Women and older age.
• Disuse atrophy-
Masseter and Medial
pterygoid.
• Chewing efficiency
decreases as the no. of
natural teeth reduces.
• CD patients- 7 times
more chewing stroke.
Pg. no. 8) 72

• Prevention and Management:
1. Preservation of teeth
2. Teeth supported overdenture
3. Implant supported overdenture.
2009. Pg. no. 8) 73

2. Nutritional Deficiency
• Healthy patients – rare
• Chronically ill patients
– factors such as
i. Ill fitting denture
ii. Salivary gland
hypofunction
iii. Altered taste
perception
2009. Pg. no. 8) 74

• Wearing of Complete Denture greatly
compromises both:
Elsevier 2009. Pg. no. 8) 75
• Individual’s own
assessment of his or her
masticatory function.
Masticatory
Ability
• The capacity to reduce
food during mastication.
Masticatory
Efficiency

Janet L. Dray, Bruce Blasberg, Michael I. MacEntee, and Robert J. Conklin. Oral
mucosal disorders in denture wearers. Journal of Prosthetic Dentistry, Feb1985, Vol
53, No. 2.
76
Review of literature

mucosal disorders in denture wearers. Journal of Prosthetic Dentistry, Feb1985,
Vol 53, No. 2.
77

mucosal disorders in denture wearers. Journal of Prosthetic Dentistry, Feb1985, Vol
53, No. 2.
78

Summary
1. Denture irritation hyperplasia
2. Epulis fissuratum
3. Denture stomatitis
4. Traumatic ulcers
5. Oral cancers in denture wearers
6. Flabby ridges
7. Angular chelities/ Perleche
8. Burning mouth syndrome
9. Gagging
10. Residual ridge reduction
11. Overdenture abutments
1. Atrophy of masticatory muscles
2. Nutritional deficiencies 79

TISSUE RESPONSE TO
PREVENTING AND
TREATING ABUSED TISSUES
Presentation by:
Dr. Vanshree Katarya
(1st year Postgraduate)
Date: 20/12/18
21/12/18
Guided by:
Dr. Sonal Pamecha
(Professor)
Seminar no.: 3
Total slides: 154
82

83
Tissue
response
Treatment
Prevention

1. Evaluation of intaglio surface
2. Evaluation of borders
3. Clinical and processing errors
4. Correcting occlusal disharmony
5. Instruction for patient
Charl M. Heartwell – Syllabus of Complete Dentures, 4th edition, K.M.Varghese
company 1992.
85

1. Evaluation of Intaglio surface
• For undercut areas and
accuracy of tissue
contact.
• Pressure disclosing
paste.
• Path of insertion.
company 1992.(Pg. no. 391)
86

• Severe bony undercut relieve – prevents
stripping.
• Exostosis or midpalatal raphe.
• Occlusal harmony
• Smoothen.
87

2. Evaluating the borders and
Cameo Surface
(i) The border extensions
and contour are
compatible with the
available space in
vestibules.
88

(ii) Frenum attachment
and hamular notch area.
(iii) Dentures are stable
during speech and
swallowing.
company 1992.(Pg. no. 393) 89

• Disclosing wax.
• Relieve overextension if
present.
company 1992.(Pg. no. 393) 90

3. Clinical errors
a. Errors in registering the Jaw Relation:
i. Inaccurately fitting record base.
ii. Shifting of record base over displaceable tissue.
iii. Excessive pressure by patient.
iv. Unequal distribution of stress.
v. Record base placed on deformed soft tissues.
vi. Patient not registering centric relation.
company 1992.(Pg. no. 394) 91

b. Errors in mounting cast:
i. Record base not properly secured to cast.
ii. Occlusion rims not definitely locked.
company 1992.(Pg. no. 395) 92

iii. Interference of cast in posterior region.
iv. Inaccurate articulator.
v. Inaccuracy by plaster.
company 1992.(Pg. no. 395) 93

4. Correcting the occlusal
disharmony
• Intraoral methods:
company 1992.(Pg. no. 395) 94
Articulating paper Central bearing device

company 1992.(Pg. no. 395) 95

company 1992.(Pg. no. 395) 96
Occlusal wax Abrasive paste

Checking the occlusal errors:
• Feather touch.
• Selective grinding intraorally - increases error.
• Accurate mounting in articulator – accurate.
company 1992.(Pg. no. 395) 97

Patient
Remount Selective
Grinding
company 1992.(Pg. no. 395) 98

A. Patient Remount:
Most accurate.
Advantages:
a. Reduces patient participation.
b. Better vision.
c. Stable working foundation.
d. Absence of saliva – accurate marking.
e. Preventing occasional observation of patient.
company 1992.(Pg. no. 395) 99

Procedure:
100
Interocclusal record- 1.5mm wax
Orient maxillary and mandibular
denture
Secure with sticky wax, Remount
mandibular cast
Condylar elements freed, rest against
stops
Selective grinding

B. Selective Grinding Procedure:
REALEFF – HANAU
CORRECTION TECHNIQUE - HANAU
Unstrained JR Strained JR
Long centric or short
protrusive occlusion
(area of freedom of occlusion with jaws in
terminal relation)
Charl M. Heartwell – Syllabus of Complete Dentures, 4th edition,
K.M.Varghese company 1992.(Pg. no. 396)
101
(no displacement of mucosa) (Displacement of mucosa)

(i) Selective grinding of anatomic teeth:
To achieve balanced occlusion, uniform contact on;
1.Centric relation.
2.Eccentric
Working side- all posterior teeth and canine.
Balancing side- only posterior teeth.
3. Protrusive balance- incisal edge contact at the
same time posterior teeth contact.
102

Procedure:
104
Adjust horizontal and condylar
inclinations
Raise the incisal pin
Evaluate in centric and eccentric
position
Grinding
Refining the occlusal anatomy

Rules:
If cusp is higher in centric and eccentric – reduce.
If cusp is higher in centric only- deepen the
fossa/marginal ridge.
More contact in incisal and no contact in posterior:
labioincisal surface of mandibular teeth + palatal
surface of maxillary teeth.
105

Working side:
BULL
(non functional cusp)
Balancing side:
company 1992.(Pg. no. 405) 106

(ii) Selective grinding of Non anatomic teeth:
107
Articulating paper tape, tapping the
teeth together
Simultaneous bilateral posterior
contact
No anterior tooth contact
Distal of PM and 1st Molar and
mesial of 2nd molar
Mounting disc, Polishing

(iii) Occlusal equilibrium of Zero degree teeth:
• Dr. Gronas 1970 –
Carborundum stripping
technique.
• Maintain flat occlusal
scheme on grinding.
• Waterproof carborundum
abrasive paper
220 grit – porcelain
320 grit - acrylic
108

5. Patient instructions
• Albino JE et al 1984 – An expectations of
patient can profoundly influence treatment
outcomes.
109

Maintaining the tissue health
Tissue rest Denture hygiene Cleaning of tissue
110
Removing
denture at
night
- Cleansers
- Brushing
- Sonic action cleansers
Gentle rubbing (wash cloth)

1. Surgical excision
2. Correction of occlusal disharmony
3. Massage
4. Correcting the pressure areas
5. Diet and nutrition
6. Drug and medication
7. Psychological counseling
8. Use of lasers
112

1. Surgical excision
• Hyperplastic,
hypertrophied and
pedunculated tissues.
• Alteration of bony
support.
• Repositioning of sulci.
company 1992.
113

2. Correction of occlusal disharmony
Charl M. Heartwell – Syllabus of Complete Dentures, 4th edition,
K.M.Varghese company 1992.
114

3. Massage
• 2-3 times a day.
• Lukewarm salt water
rinse.
• Washing with moist
cotton balls, NS rinses.
• Chewing gums.
company 1992.
115

4. Correcting the pressure areas
Tissue
conditioner
Relining or
rebasing
AITBS publisher, 2017. 116

Tissue conditioner
• Average displacement of soft tissue – 0.050 to
0.030 inches.
• Tissue conditioning is an effort to restore the
health of the tissues of the denture foundation
area before master impressions are made by
relining the dentures with temporary denture
reliners.
Lytle, R.B. Soft tissue displacement beneath removable partial and complete denture,
J Prosth Dent. 12: 34-43, 1962. 117

• Resilient liners – natural
rubbers.
• 1945 – Plasticized
polyvinyl resins.
• 1958 – Silicone rubbers.
Mese A, Guzel KG. Effect of storage duration on the hardness and tensile bond
strength of silicone and acrylic resin based resilient denture liners to a processed
denture base acrylic resin. J Prosth Dent 2008.; 99(2): 153-9.
118

Properties :
Dr. Julie Deorge Alapatt, Dr. Neenu Mary Varghese, Dr. Bennet Atlin Corrreya,
Dr. Mohmed Shaeer K. Tissue Conditioners: A review. Journal of Dental and
Medical Sciences, Vol 14, Issue 5, Ver:I (May:2015) pp 54-57.
119
Viscoelasticity
Slow fluid absorption
Color stability, dimensional stability
Tear resistance
Good adhesion
Inertness to fungal and bacterial growth
Ease of processing and repair

Long shelf life
Biocompatibility
Good resiliency
Low glass transition temperature
Adequate wettability
Absence of odor, taste irritation, toxicity
Economical
Dr. Julie Deorge Alapatt, Dr. Neenu Mary Varghese, Dr. Bennet Atlin Corrreya, Dr.
Mohmed Shaeer K. Tissue Conditioners: A review. Journal of Dental and Medical
Sciences, Vol 14, Issue 5, Ver:I (May:2015) pp 54-57.
120

Composition:
121
POWDER:
1. Polyethyl methacrylate
2. Polymethyl methacrylate
3. Silicone rubber
4. Poly ‘n’ propyl-
methacrylate
5. Poly ‘n’ butyl-methacrylate
MONOMER:
Aromatic ester +
ethyl alcohol
LIQUID
(PLASTICIZER):
Butyl phthalyl butyl
glycolate
Heat cure – benzoyl
peroxide

Home liners:
Light cured material:
Dr. Julie Deorge Alapatt, Dr. Neenu Mary Varghese, Dr. Bennet Atlin Corrreya,
Dr. Mohmed Shaeer K. Tissue Conditioners: A review. Journal of Dental and
Medical Sciences, Vol 14, Issue 5, Ver:I (May:2015) pp 54-57.
122
POWDER:
1. Polyvinyl acetate
2. Ethyl alcohol
3. Calcium carbonate
4. Polypropylene glycol
5. White bees wax
6. Alkyl methacrylate
copolymer
LIQUID:
1. Acrylic
2. Triacetyl citrate
3. Tri –methoxy
ethoxy vinyl silane
1. Urethane acrylate oligomers
2. Benzoyl peroxide
3. Camphoroquinone

Gelation reaction:
Anupama Prasad D, B Rajendra Prasad, Veena Shetty, C.S. Shastry and Krishna
Prasad D. Tissue conditioners: A review. Nitte University Journal of Health
Sciences NUJHS. Vol 4, No. June 2014 ISSN 2249-7110.
123
Polymer
Liquid
Plasticizer
Gel formation

Loss of resiliency:
Anupama Prasad D, B Rajendra Prasad, Veena Shetty, C.S. Shastry and Krishna Prasad
D. Tissue conditioners: A review. Nitte University Journal of Health Sciences NUJHS.
Vol 4, No. June 2014 ISSN 2249-7110. 124
Plasticizer
Ethyl Alcohol

Classification:
a. Based on curing:
Sciences, Vol 14, Issue 5, Ver:I (May:2015) pp 54-57. 125
Self
cure
Heat
cure
Light
cure

b. Based on composition:
Silicone
elastomers
Soft acrylic
compounds
Phthalate
ester free
compounds
Polyolefin
liners
Fluoride
containing
liners

c. Based on durability:
1. Temporary / soft term
2. Definitive/long term
d. Based on availability:
1. Home reliners
2. Tissue conditioners
e. Based on water sorption property:
1. Hydrophilic
2. Hydrophobic

f.
Consistency
Soft denture
liners
Silicone
based and
resin based
Auto cure
and heat
cured
Hard denture
liners
Ufigel hard
gel C
128

Uses:
Adjuncts in tissue conditioning
Temporary obturator
Stabilizer of baseplate and surgical splints
Adjunct in impression procedure
As a determinant of potential benefits
from treatment
129

Techniques in use of tissue conditioner:
Prerequisites.
Preparation of
denture.
Preparation
and placement
of TC
intraorally.

Care and
maintenance
Virtues
Pitfalls Advancement

Relining
The Glossary of Prosthodontic Terms, 9th edition. J. Prosthet Dent 2017 May;
117(5S):e1-e105.
132
• 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.
- Glossary of Prosthodontics Terms- 9.

Indications:
Changes in denture
bearing areas
Chronically ill
patients
Socioeconomic
condition
Immediate denture
AITBS publisher, 2017. Pg. no. 451
133

Contraindications:
Poor quality
denture
Abused oral
tissues
Poor esthetics
Too much
resorption
TMJ problems
Unsatisfactory
jaw
relationship
Severe bony
undercut
Major speech
problems
AITBS publisher, 2017. pg. no. 451
134

Sheldon Winkler- Essentials of Complete Denture Prosthodontics, 3rd
edition, AITBS publisher, 2017. Pg. no. 451 135

The laboratory process of replacing the entire
denture base material on an existing prosthesis.
- Glossary of Prosthodontics Terms- 9.
The Glossary of Prosthodontic Terms, 9th edition. J. Prosthet Dent 2017 May;
117(5S):e1-e105.
136
Rebasing

Indications:
AITBS publisher, 2017. Pg. no. 451
137
Clinical changes
are moderate
to maximal
Processing
defects
Denture teeth
in good
condition
Porcelain teeth

1. Defective denture

Department of Prosthodontics, Pacific Dental College and Hospital
139
2. Wax up
3. First pour

4. Second pour
5. Dewaxing

6. Denture retrieval
7. Trimming of denture

7. Jig
8. Teeth in position in mold

9. Packing
10. Final denture

5. Diet and nutrition.
6. Drug and medication.
7. Psychological counseling.
company 1992. 144

Conclusion
• The advanced age of average denture wearers,
and the nature of the denture bearing mucosa
appear to influence the nature of problems.
• Superimposed infections with candidal
organisms and traumatic lesions are the most
commonly encountered abnormalities.
• A thorough knowledge of factors involved in
construction of complete denture is essential
before attempting postinsertion check up.
145

References
1. Boucher’s – Prosthodont Treatment for Edentulous
Patient, 9th edition, C.V. Mosby 1982.
2. Sheldon Winkler- Essentials of Complete Denture
Prosthodontics, 3rd edition, AITBS publisher, 2017.
3. Charl M. Heartwell – Syllabus of Complete Dentures,
4th edition, K.M.Varghese company 1992.
4. John J Sharry- Complete Denture Prosthodontics, 3rd
edition, A. Blakiston.
146

5. The Glossary of Prosthodontic Terms, 9th edition. J.
Prosthet Dent 2017 May; 117(5S):e1-e105.
6. Zarb Bolender – Complete denture and implant supported
prosthesis, Elsevier 2009.
7. Arvindham R., Vidyalakshmi S., Kumar MS., Satheesh C.,
Balasubramanium AM., Prasad VS. Burning Mouth
Syndrome: A review on its diagnostic and therapeutic
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M, Milillo L, Guida A, Petruzzi M, Serpico R. Candida-
assosiated denture stomatitis. Med Oral Patol Oral Cir
Bucal. 2011 Mar 1; 16(1): e139-43.
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9. Iuliana Babiuc et al, Correct complete denture
rehabilitation, a chance for recovering abused tissue.
Romanian Journal of Morphology and Embryology 2009,
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response to complete denture by diabetic patient. Journal
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review. Jornal of Orofacial and health sciences 6 (2), 2015.
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Langlais. Oral mucosal lesions in denture wearers. The
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13. Janet L. Dray, Bruce Blasberg, Michael I. MacEntee,
and Robert J. Conklin. Oral mucosal disorders in
denture wearers. Journal of Prosthetic Dentistry,
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14. Mahesh Verma and Ankur Gupta. Post insertion
complaints in complete denture – A never ending saga.
Journal of Academy of Dental Education, vol 1(1),
jan-jun 2014.
15. Rubina Bansal, Manjit Kumar, Rashim Garg, Rishi
Saini, Shaveta Kaushala. Prosthodontic rehabilitation
of patient with flabby ridges with different impression
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16. Anupama Prasad D, B Rajendra Prasad, Veena Shetty, C.S.
Shastry and Krishna Prasad D. Tissue conditioners: A
review. Nitte University Journal of Health Sciences
NUJHS. Vol 4, No. June 2014 ISSN 2249-7110.
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Bennet Atlin Corrreya, Dr. Mohmed Shaeer K. Tissue
Conditioners: A review. Journal of Dental and Medical
18. Karine Vitor Martins, Savio Morato de Lacerda Gontijo.
Treatment of denture stomatitis: Literature review. Rev
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20. Pooja Asnani, Chandu GS, Sunit Kumar Mishra, Neutral
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Dental and Medical Sciences. Vol 1, Iss-1, Apr-Jun 2015.
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Approach for Recording Neutral Zone. J Indian
Prosthodont Soc. (Apr-June 2010) 10(2); 102-104.
22. Lytle, R.B. Soft tissue displacement beneath removable
partial and complete denture, J Prosth Dent. 12: 34-43,
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23. Mese A, Guzel KG. Effect of storage duration on the
hardness and tensile bond strength of silicone and acrylic
resin based resilient denture liners to a processed denture
base acrylic resin. J Prosth Dent 2008.; 99(2): 153-9.
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24. Ellisworth Kelly, Changes caused by a mandibular
removable partial denture opposing a maxillary complete
denture. J Prosthet Dent 2003;90:213-9.
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Denture induced squamous cell carcinoma: A rare case
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Indian journal of dental sciences, March 2010 Vol 2 Iss 2.
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152

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