Relining and rebasing/endodontic courses/ dental implant courses

INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
RELINING ANDRELINING AND
REBASINGREBASING
www.indiandentalacademy.comwww.indiandentalacademy.com

Abuse of the tissue supporting denturesAbuse of the tissue supporting dentures
deforms the soft tissues and destroys bone.deforms the soft tissues and destroys bone.
When the bone has resorbed and the tissuesWhen the bone has resorbed and the tissues
are deformed so much that minorare deformed so much that minor
procedures no longer will make the denturesprocedures no longer will make the dentures
acceptable, the dentures must be relinedacceptable, the dentures must be relined
and remade.and remade.
Relining complete dentures is a serviceRelining complete dentures is a service
to patients that will reestablish adequateto patients that will reestablish adequate
adaptation of the denture base to theadaptation of the denture base to the
denture bearing surfaces.denture bearing surfaces.

Relining can be defined as a procedureRelining can be defined as a procedure
to resurface the tissue surface of the dentureto resurface the tissue surface of the denture
with new base material to make the denturewith new base material to make the denture
fit more accurately.fit more accurately.
Rebasing can be defined as a processRebasing can be defined as a process
of refitting a denture by the replacement ofof refitting a denture by the replacement of
the denture base materialthe denture base material

General Considerations for relining and rebasingGeneral Considerations for relining and rebasing
1. The occlusal vertical dimension should be satisfactory.1. The occlusal vertical dimension should be satisfactory.
2. Centric occlusion should coincide with centric relation; an2. Centric occlusion should coincide with centric relation; an
error is allowable if it is so slight as to be correctable.error is allowable if it is so slight as to be correctable.
3. The patient's appearance must be acceptable to the3. The patient's appearance must be acceptable to the
patient and dentist. The size, shape, shade, andpatient and dentist. The size, shape, shade, and
arrangement of the artificial teeth must be satisfactory.arrangement of the artificial teeth must be satisfactory.
4. The oral tissue should be in optimum health.4. The oral tissue should be in optimum health.
5. The posterior limit of the maxillary denture is correct.5. The posterior limit of the maxillary denture is correct.
6. The denture base extensions are adequate.6. The denture base extensions are adequate.
7. The denture base extensions ensure distribution of7. The denture base extensions ensure distribution of
masticatory forces over as large an area as possible.masticatory forces over as large an area as possible.

Indications for relining or rebasingIndications for relining or rebasing
1. Immediate dentures at three to six months after1. Immediate dentures at three to six months after
their original construction.their original construction.
2. When the residual alveolar ridges have resorbed2. When the residual alveolar ridges have resorbed
and the adaptation of the denture bases to theand the adaptation of the denture bases to the
ridges is poor.ridges is poor.
3. When the patient cannot afford the cost of3. When the patient cannot afford the cost of
having new dentures constructed.having new dentures constructed.
4. When the construction of new dentures with the4. When the construction of new dentures with the
accompanying series of appointments can causeaccompanying series of appointments can cause
physical or mental stress, such as for geriatric orphysical or mental stress, such as for geriatric or
chronically ill patients.chronically ill patients.

ContraindicationsContraindications
1. When an excessive amount of resorption has taken1. When an excessive amount of resorption has taken
place.place.
2. When abused soft tissue are present. The relining is not2. When abused soft tissue are present. The relining is not
indicated until the tissues recover and return as closely asindicated until the tissues recover and return as closely as
possible to normal form.possible to normal form.
3. When the patient complains of unresolved temporo3. When the patient complains of unresolved temporo
mandibular joint problems and myofacial pain. Untilmandibular joint problems and myofacial pain. Until
accurate diagnosis and treatment of the problem has beenaccurate diagnosis and treatment of the problem has been
accomplished, relining or rebasing is contraindicated.accomplished, relining or rebasing is contraindicated.
4. If the dentures have poor esthetics or unsatisfactory jaw4. If the dentures have poor esthetics or unsatisfactory jaw
relationships (and unfavourable occlusal plane).relationships (and unfavourable occlusal plane).
5. If the dentures create a major speech problem (poor5. If the dentures create a major speech problem (poor
phonetics).phonetics).
6. Multiple fractured and severely worn artificial teeth are6. Multiple fractured and severely worn artificial teeth are
present in the denture.present in the denture.
7. Artificial teeth are grossly malpositioned in relation to the7. Artificial teeth are grossly malpositioned in relation to the
residual alveolar ridge.residual alveolar ridge.

Tissue PreparationTissue Preparation
With any relining or rebasing technique, the tissues andWith any relining or rebasing technique, the tissues and
dentures should be prepared for the necessary proceduresdentures should be prepared for the necessary procedures
as follows:as follows:
1. Excessive hypertrophic tissue should be surgically1. Excessive hypertrophic tissue should be surgically
removed. The dentures can be used as a surgical splint.removed. The dentures can be used as a surgical splint.
2. The oral mucosa should be free of areas of irritation.2. The oral mucosa should be free of areas of irritation.
3. Removal of the dentures from the mouth during sleep is a3. Removal of the dentures from the mouth during sleep is a
must for several weeks before treatment commences,must for several weeks before treatment commences,
4. The dentures should be left out of the mouth at leasttwo4. The dentures should be left out of the mouth at leasttwo
to three days before making the final impression.to three days before making the final impression.
5. Daily massage of the soft tissues is helpful to stimulate5. Daily massage of the soft tissues is helpful to stimulate
their blood supply.their blood supply.

Denture PreparationDenture Preparation
1. Pressure areas on the tissue surface of1. Pressure areas on the tissue surface of
thethe dentures should be relieved.dentures should be relieved.
2. Minor occlusal disharmony is corrected by2. Minor occlusal disharmony is corrected by
selective grinding.selective grinding.
3. Small border inadequacies are corrected.3. Small border inadequacies are corrected.
4. A correct posterior palatal seal area4. A correct posterior palatal seal area
should be established before the finalshould be established before the final
impression. Stick compound andimpression. Stick compound and
autopolymerizing acrylic resin can be usedautopolymerizing acrylic resin can be used
for this purpose.for this purpose.

The clinical relining or rebasing can beThe clinical relining or rebasing can be
achieved byachieved by
(1) The static impression technique(1) The static impression technique
- Open mouth technique- Open mouth technique
- Closed mouth technique- Closed mouth technique
(2) The functional impression technique, or(2) The functional impression technique, or
(3) The so-called chairside technique.(3) The so-called chairside technique.

Closed mouth relining techniques-Closed mouth relining techniques-
Maxillary dentureMaxillary denture
In all the techniques the existing centricIn all the techniques the existing centric
occlusion and intercuspation are used as aocclusion and intercuspation are used as a
means to seat the dentures and the denturemeans to seat the dentures and the denture
is prepared before making impression byis prepared before making impression by
relieving all large undercuts and by relievingrelieving all large undercuts and by relieving
1.5 - 2 mm from the tissue surface. The1.5 - 2 mm from the tissue surface. The
borders are reduced 1-2 mm except theborders are reduced 1-2 mm except the
posterior border of maxillary dentures.posterior border of maxillary dentures.

TECHNIQUE A (Shaffer, Filler 1971)TECHNIQUE A (Shaffer, Filler 1971)..
Border Molding:Border Molding: The borders of theThe borders of the
dentures are reformed to their functionaldentures are reformed to their functional
contours by using low-fusing modelingcontours by using low-fusing modeling
compound.compound.
Impression:Impression: Zinc oxide eugenol impressionZinc oxide eugenol impression
paste is used as the impression material forpaste is used as the impression material for
this purpose. During the border molding andthis purpose. During the border molding and
impression making, the patient closes lightlyimpression making, the patient closes lightly
into the premade interocclusal record .Theinto the premade interocclusal record .The
impression of the exposed part of the palatalimpression of the exposed part of the palatal
section is made with quick setting plaster.section is made with quick setting plaster.

Advantages:Advantages:
The opening of the palatal portion will allow betterThe opening of the palatal portion will allow better
seating of the maxillary denture and alleviateseating of the maxillary denture and alleviate
the increase in vertical dimension pitfall.the increase in vertical dimension pitfall.
The premade interocclusal record helps to positionThe premade interocclusal record helps to position
the dentures during the impression making andthe dentures during the impression making and
to orient the dentures on the articulator.to orient the dentures on the articulator.
Disadavantages:Disadavantages:
The possibility of moving the maxillary denture forward isThe possibility of moving the maxillary denture forward is
still a major problem.still a major problem.
The wax interocclusal record is not accurate and safeThe wax interocclusal record is not accurate and safe
record that the patient can close or several timesrecord that the patient can close or several times
without the possibility of damaging the record.without the possibility of damaging the record.

TECHNIQUE B (Hansen 1964)TECHNIQUE B (Hansen 1964)
Border molding:Border molding: Border molding is doneBorder molding is done
with low–fusing modeling compoundwith low–fusing modeling compound
(greenstick).(greenstick).
Impression:Impression: A wax the flows at mouthA wax the flows at mouth
temperature such as Kerr’s impression waxtemperature such as Kerr’s impression wax
(Iowa wax) is the material of choice in this(Iowa wax) is the material of choice in this
technique. The impression is made in twotechnique. The impression is made in two
steps. The impression of the labial flangesteps. The impression of the labial flange
and the crest of the alveolar ridge betweenand the crest of the alveolar ridge between
the canines is made as a second step.the canines is made as a second step.

Advantages:Advantages: The two-step impressionThe two-step impression
technique will reduce the possibility oftechnique will reduce the possibility of
extreme forward movement of theextreme forward movement of the
maxillary denture.maxillary denture.
Disadvantages:Disadvantages:
Wax impression material is difficult to workWax impression material is difficult to work
with and the possibility of the distortionwith and the possibility of the distortion
exists.exists.
Errors of existing centric occlusion canErrors of existing centric occlusion can
produce an inaccurate impression.produce an inaccurate impression.

TECHNIQUE C (Christensen 1971)TECHNIQUE C (Christensen 1971)
Border Molding:Border Molding: Border molding is done with aBorder molding is done with a
low-fusing modeling compound (Green-stick).low-fusing modeling compound (Green-stick).
Impression:Impression: No specific impression materialNo specific impression material
recommended.recommended.
DisadvantagesDisadvantages
Errors of existing centric occlusion can produce anErrors of existing centric occlusion can produce an
inaccurate impression.inaccurate impression.
Wax impression material is difficult to work with andWax impression material is difficult to work with and
the possibility of distortion exists (i.e., if Kerr’sthe possibility of distortion exists (i.e., if Kerr’s
impression wax is used.)impression wax is used.)
This technique does not suggest any solution forThis technique does not suggest any solution for
difficulties of relining both dentures at the samedifficulties of relining both dentures at the same
time.time.

TECHNIQUE D (Jordan 1972)TECHNIQUE D (Jordan 1972)
Special SuggestionsSpecial Suggestions
Denture periphery should be shortened to create a flatDenture periphery should be shortened to create a flat
border.border.
A large opening should be prepared in the palatal portion ofA large opening should be prepared in the palatal portion of
the maxillary denture.the maxillary denture.
Adhesive tape is attached over the buccal and labialAdhesive tape is attached over the buccal and labial
surfaces of both dentures 2-mm away from the denturesurfaces of both dentures 2-mm away from the denture
borders.borders.
With a knife-edge stone, a fairly deep groove should be cutWith a knife-edge stone, a fairly deep groove should be cut
into the buccal and labial surfaces of the dentures atinto the buccal and labial surfaces of the dentures at
the junction of the impression material and filled withthe junction of the impression material and filled with
molten base plate wax.molten base plate wax.
Border Molding:Border Molding: Border molding has not been suggested,Border molding has not been suggested,
but during the impression making it has beenbut during the impression making it has been
emphasized that a slight amount of impression materialemphasized that a slight amount of impression material
should be left on the flattened borders.should be left on the flattened borders.

Impression:Impression: Plaster of Paris or zinc oxide eugenol isPlaster of Paris or zinc oxide eugenol is
suggested for the first step of impression making andsuggested for the first step of impression making and
plaster of Paris for the second step (the palatalplaster of Paris for the second step (the palatal
portions).portions).
AdvantagesAdvantages
The opening of the palatal portion will allow better seating ofThe opening of the palatal portion will allow better seating of
the maxillary denture and alleviate the increase inthe maxillary denture and alleviate the increase in
vertical dimension pit-fall.vertical dimension pit-fall.
The pre-made interocclusal record helps to position theThe pre-made interocclusal record helps to position the
dentures during the impression making and to orientdentures during the impression making and to orient
the dentures on the articulator.the dentures on the articulator.
The two-step impression technique will reduce theThe two-step impression technique will reduce the
possibility of moving the maxillary denture forwardpossibility of moving the maxillary denture forward
during the final impression making.during the final impression making.
Disadvantages:Disadvantages: Even though it has been suggested thatEven though it has been suggested that
the patient should not seat the denture by closing on it,the patient should not seat the denture by closing on it,
the existing errors of the centric occlusion may producethe existing errors of the centric occlusion may produce
some pressure points and a faulty impression cansome pressure points and a faulty impression can
result.result.

Closed mouth relining techniques-Closed mouth relining techniques-
Mandibular dentureMandibular denture
It is generally agreed that the hazardsIt is generally agreed that the hazards
in relining a maxillary complete denture arein relining a maxillary complete denture are
greater than relining a mandibular completegreater than relining a mandibular complete
denture. There are many factors that shoulddenture. There are many factors that should
be considered during the relining of abe considered during the relining of a
mandibular denture. Ridge relations, ridgemandibular denture. Ridge relations, ridge
form, and the characteristics of the mucousform, and the characteristics of the mucous
covering the ridges must be considered.covering the ridges must be considered.
There are many other factors with which theThere are many other factors with which the
relined denture must be in harmony.relined denture must be in harmony.

TECHNIQUE E (Gillis 1960)TECHNIQUE E (Gillis 1960)
Centric Relation:Centric Relation: The existing centricThe existing centric
occlusion (intercuspation) is used as aocclusion (intercuspation) is used as a
means to seat the mandibular denture duringmeans to seat the mandibular denture during
the secondary impression.the secondary impression.
Impression:Impression: Modeling compound at theModeling compound at the
early stage and zinc oxide-eugenol forearly stage and zinc oxide-eugenol for
making the secondary impression wasmaking the secondary impression was
suggested.suggested.

The loss of vertical dimension can be compensatedThe loss of vertical dimension can be compensated
for during the relining procedures.for during the relining procedures.
The error in centric occlusion can be reducedThe error in centric occlusion can be reduced
during the laboratory stages.during the laboratory stages.
1) This technique is very time consuming from the1) This technique is very time consuming from the
stand-point of clinical and laboratory procedure.stand-point of clinical and laboratory procedure.
2) The procedure for establishment of occlusal2) The procedure for establishment of occlusal
vertical dimension is highly questionable.vertical dimension is highly questionable.

OPEN-MOUTH RELINE TECHNIQUEOPEN-MOUTH RELINE TECHNIQUE
In the so-called open-mouth technique,In the so-called open-mouth technique,
the dentures are used essentially as trays forthe dentures are used essentially as trays for
making the new impressions.making the new impressions.
Relining/rebasing of both maxillary andRelining/rebasing of both maxillary and
mandibular dentures can be done at themandibular dentures can be done at the
same appointment. The existing CO is notsame appointment. The existing CO is not
used, and a new CRO record is obtainedused, and a new CRO record is obtained
after the impres-sions are made.after the impres-sions are made.

TECHNIQUE F (Boucher 1972)TECHNIQUE F (Boucher 1972)
Centric Relation:Centric Relation: Utilizing both dentures asUtilizing both dentures as
recording bases, the jaw relation is recorded afterrecording bases, the jaw relation is recorded after
making the secondary mandibular and maxillarymaking the secondary mandibular and maxillary
impressions.impressions.
Denture Preparation:Denture Preparation: A posterior palatal seal isA posterior palatal seal is
formed in modeling compound on the maxillaryformed in modeling compound on the maxillary
denture before any other changes are made on thedenture before any other changes are made on the
tissue side of the denture. One millimeter of spacetissue side of the denture. One millimeter of space
is provided inside the denture for the newis provided inside the denture for the new
impression material. The borders are shortened 1impression material. The borders are shortened 1
mm to allow space for the impression material tomm to allow space for the impression material to
form a new border.form a new border.
Border Molding:Border Molding: If the flanges are inadequate theIf the flanges are inadequate the
borders should be corrected with modelingborders should be corrected with modeling
compound.compound.

Impression:Impression: Zinc oxide-eugenol impression material isZinc oxide-eugenol impression material is
used with the following technique exactly 15 secondsused with the following technique exactly 15 seconds
after the denture has been placed in the mouth, theafter the denture has been placed in the mouth, the
patient is asked to pull his upper lip down and to openpatient is asked to pull his upper lip down and to open
his mouth wide. These actions mold the impressionhis mouth wide. These actions mold the impression
material over the border of the denture. The uppermaterial over the border of the denture. The upper
denture is laid aside until the lower impression hasdenture is laid aside until the lower impression has
been made.been made.
The special trimming of the denture and making room forThe special trimming of the denture and making room for
the impression material will facilitate the making of athe impression material will facilitate the making of a
reasonable impression during the selective pressurereasonable impression during the selective pressure
impression technique without any occlusal interference.impression technique without any occlusal interference.
A separate interocclusal record using already madeA separate interocclusal record using already made
impressions as the recording bases will allow theimpressions as the recording bases will allow the
operator to concentrate on recording the jaw relation.operator to concentrate on recording the jaw relation.

Although this technique seems simple, theAlthough this technique seems simple, the
performance of the procedures is notperformance of the procedures is not
easy.easy.
This technique requires more clinical andThis technique requires more clinical and
laboratory time.laboratory time.

FUNCTIONAL IMPRESSION TECHNIQUEFUNCTIONAL IMPRESSION TECHNIQUE
Functional MethodFunctional Method
It was suggested by Winkler. Here, theIt was suggested by Winkler. Here, the
patient need not be without dentures unlikepatient need not be without dentures unlike
previous techniques (i.e. dentures are notprevious techniques (i.e. dentures are not
required for laboratory procedures). Fluidrequired for laboratory procedures). Fluid
resins (tissue conditioners) are used asresins (tissue conditioners) are used as
impression material. It is a simple andimpression material. It is a simple and
practical procedure and is more popular.practical procedure and is more popular.

Tissue conditioners are temporary soft linersTissue conditioners are temporary soft liners
with the following characteristics:with the following characteristics:
Easy to use.Easy to use.
Excellent for refitting complete dentures. .Excellent for refitting complete dentures. .
Capable of retaining for many weeks.Capable of retaining for many weeks.
Good in dimensional stability.Good in dimensional stability.
Good in bonding to resin denture bases.Good in bonding to resin denture bases.

ProcedureProcedure
The tissue surface should be reduced to accomThe tissue surface should be reduced to accom
modate the tissueconditioning material. The tissuemodate the tissueconditioning material. The tissue
surface of the denture is dried and tissuesurface of the denture is dried and tissue
conditioning material is placed. It should flowconditioning material is placed. It should flow
evenly as a thin layer to cover the entire impressionevenly as a thin layer to cover the entire impression
surface of the denture and its borders.surface of the denture and its borders.
Next, the denture is inserted and the patient'sNext, the denture is inserted and the patient's
mandible is guided to centric relation in order tomandible is guided to centric relation in order to
stabilize the denture and the material is allowed tostabilize the denture and the material is allowed to
set. Once it sets, impression is removed andset. Once it sets, impression is removed and
excess material is trimmed. Overextensions andexcess material is trimmed. Overextensions and
voids are correctedvoids are corrected

Unsupported areas in the dentures will show theUnsupported areas in the dentures will show the
overflow of the liner and poor recording of theoverflow of the liner and poor recording of the
borders. This indicates the need for localizedborders. This indicates the need for localized
border moulding with green stick compound. Theborder moulding with green stick compound. The
lining material will slump during setting if notlining material will slump during setting if not
adequately supported by the denture.adequately supported by the denture.
After making the corrections, the dentures areAfter making the corrections, the dentures are
inserted with the material and the patient isinserted with the material and the patient is
dismissed. After 3 to 5 days, dentures aredismissed. After 3 to 5 days, dentures are
examined for denuded (depressed) areas,whichexamined for denuded (depressed) areas,which
should be relieved. Areas of underextension areshould be relieved. Areas of underextension are
corrected by adding more material. The materialcorrected by adding more material. The material
should be renewed periodically (once a week) tillshould be renewed periodically (once a week) till
the tissue healing is complete.the tissue healing is complete.

Once the tissues are normal, impression is madeOnce the tissues are normal, impression is made
with ZnOE or a light bodied elastomer over thewith ZnOE or a light bodied elastomer over the
tissue conditioner material and a cast is pouredtissue conditioner material and a cast is poured
immediately. During one of the previous visits, animmediately. During one of the previous visits, an
accurate orientation record of maxillary dentureaccurate orientation record of maxillary denture
should be recorded using a facebow.should be recorded using a facebow.
. The tissue conditioner material undergoes some. The tissue conditioner material undergoes some
physical changes during its use, which help thephysical changes during its use, which help the
dentist use it for different purposes. In itsdentist use it for different purposes. In its plasticplastic
andand elasticelastic stages it is used as tissue conditioner,stages it is used as tissue conditioner,
whereas in itswhereas in its firmfirm stage it is used as relinestage it is used as reline
impression material. Hence, for reliningimpression material. Hence, for relining
procedures, it should be left in place for about 10procedures, it should be left in place for about 10
14 days to allow them to become firm and then14 days to allow them to become firm and then
reline procedure is carried out.reline procedure is carried out.

Chair Side ProcedureChair Side Procedure
This method makes use of acrylic that couldThis method makes use of acrylic that could
be added to the denture and allowed to setbe added to the denture and allowed to set
in the mouth to produce instantin the mouth to produce instant
relining/rebasing.relining/rebasing.
. Material produces a chemical burn in oral. Material produces a chemical burn in oral
mucosa.mucosa.
. Material is porous and develops a bad. Material is porous and develops a bad
odour.odour.
. Poor color stability.. Poor color stability.

REBASINGREBASING
Rebasing is defined as a process of refitting aRebasing is defined as a process of refitting a
denture by the replacement of the denture basedenture by the replacement of the denture base
materialmaterial
Rebasing is similar to relining except that there isRebasing is similar to relining except that there is
extensive replacement of the denture baseextensive replacement of the denture base
material. The clinical procedure is similar to that ofmaterial. The clinical procedure is similar to that of
relining. Denture is prepared and border mouldingrelining. Denture is prepared and border moulding
is done as described in relining. A new vertical andis done as described in relining. A new vertical and
centric relation should be recorded. The impressioncentric relation should be recorded. The impression
made using the dentures are processed asmade using the dentures are processed as
described in relining. The only difference is thatdescribed in relining. The only difference is that
only a layer of acrylic is removed before waxup inonly a layer of acrylic is removed before waxup in
relining but in rebasing the entire denture base isrelining but in rebasing the entire denture base is
removed prior to waxup.removed prior to waxup.

Indications, Contraindications, Advantages andIndications, Contraindications, Advantages and
The indications and contraindications forThe indications and contraindications for
rebasing is similar to relining. Generally onerebasing is similar to relining. Generally one
must keep in mind that when tissue damagemust keep in mind that when tissue damage
is excessive the treatment shifts fromis excessive the treatment shifts from
relining to rebasing. Another thumb rule isrelining to rebasing. Another thumb rule is
that rebasing should be done if the verticalthat rebasing should be done if the vertical
dimension of the patient is changed. Reliningdimension of the patient is changed. Relining
is not sufficient for these cases. Rebasingis not sufficient for these cases. Rebasing
can be done properly only in dentures withcan be done properly only in dentures with
porcelain teeth. Rebasing has the sameporcelain teeth. Rebasing has the same
advantages and disadvantages of relining.advantages and disadvantages of relining.

Relining and rebasing/endodontic courses/ dental implant courses

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