PALATAL SALIVA RESERVOIR BY USING RESILIENT LINER IN COMPLETE DENTURE

1. Good Morning

2. Fabrication of a Functional Palatal Saliva
Reservoir using a Resilient Liner during
processing of a Complete Denture
( J Prosthet Dent 2012;108:332-335).
Presented by : Dr Siddhant Dandawate
( 2nd year PG )
Guide : Dr S. C. Nagaral
(HOD and Professor)

3. Contents
 Purpose
 Introduction
 Review of Literature
 Fabrication Technique
 Discussion
 Conclusion
 References

4. Purpose
 The purpose of this study is to describe a novel
technique for the fabrication of a functional palatal
saliva reservoir in edentulous xerostomic patients.

5. Introduction
 One of the major problems associated with xerostomic
patients is the poor tolerance and retention of removable
dental prostheses because of thin atrophic mucosa and
lack of a saliva film.
 The use of salivary substitutes can improve lubrication,
provide irrigation for dry mucosa, provide significant
relief from symptoms, and also improve the retention of
removable prostheses.

6.  These substitutes can be delivered over prolonged
periods by using saliva reservoir in the prostheses itself.
 This technique uses a resilient liner in the floor of the
reservoir.

7. Review of Literature
 Branchi in the year 2003 had suggested a particular
method for prosthetic rehabilitation, the so-called
"reservoir" denture.
 A complete denture is produced with conventional
techniques but has a small container for artificial saliva.

8.  For mandibular dentures, the container is sub-divided into
3 inter-communicating chambers and is situated in the
lingual flange; for maxillary dentures, a single chamber is
situated in the palatine concavity.

9.  The essential role of saliva substitutes is to provide
lubrication, hydration, and protection of the oral
mucosa, providing symptomatic relief to sufferers of
xerostomia.
 However, saliva substitutes should also be of neutral or
near neutral pH, to prevent demineralization of the oral
hard tissues.

10. Fabrication Technique
 Complete all the steps for complete denture fabrication
in a conventional manner up to trial placement
appointment.
 At the trial placement appointment, add modeling wax
to the palatal surface of the denture base and evaluate
speech, adjusting the palatal contours as necessary.
Palatogram can also be made, if needed.

11. Modeling wax added to adjust palatal contours

12.  After adding modeling wax, make an index of the
palatal surface with type 3 dental stone, since this index
serves as a guide when fabricating the floor of the
reservoir.
 After this procedure, remove the modeling wax and
process the dentures.

13. Palatal index for fabrication of floor of reservoir

14.  Adapt a sheet of modeling wax over the surface of the
stone index. Flask and process it in clear heat-polymerized
acrylic resin to form the floor of the reservoir.
 In order to make it functional, make a hole with roughened
borders in the anterior part of the floor and line it with a
resilient liner. Note that this completes the fabrication of
floor of the reservoir.

15. Flasked palatal index with waxed floor of reservoir

16. Floor of reservoir with space for resilient liner

17. Addition of resilient liner

18. Floor of reservoir

19.  Attach the floor to the palatal surface of the reservoir
with auto-polymerizing acrylic resin.
 Drill a 1 mm diameter hole in the most anterior part of
the floor. Note that this will be the lowest point of the
floor of the reservoir.

20. Floor of reservoir attached to palatal surface of
maxillary denture

21. Reservoir filled with povidone-iodine

22.  Demonstrate to the patient regarding how to inject
saliva substitute through the hole by using a 5 ml
disposable syringe and needle. Select a needle with a
diameter slightly smaller than that of the hole.
 Tell the patient to practice this procedure till they are
able to inject the saliva substitute easily.

23.  Provide a treatment record card and ask the patient to
note every time the reservoir is filled, the quantity of
substitute, and the time till the reservoir is empty. After
this, make a 1-week recall appointment.
 After 1-week, evaluate the patient record and calculate
the average duration of flow. Note that the duration of
flow provided by artificial saliva reservoirs should
range from 2 to 5 hours. Accordingly, adjust the
increase or reduce the size of the hole to adjust the flow
rate.

24. Discussion
 This technique is used to fabricate a prosthesis that
makes swallowing a control mechanism for the flow of
saliva substitute.
 During swallowing procedure, tongue creates pressure
on the anterior part of the hard palate, which, in turn
releases the substitute.

26.  On releasing the pressure, the liner reverts to its
position due to its resiliency and creates negative
pressure inside the reservoir space that sucks air inside.
 The air collects at the top of the reservoir.

27.  Increased palatal thickness in the regions of the contact
areas of the tongue while pronouncing /ch/ and /j/
(tongue contacts anteriorly), /s/ and /sh/ of the patient
significantly (tongue contacts laterally) and /k/ (tongue
contacts posteriorly) affects the speech significantly.

28.  The thickness of the denture was 7 mm at the mid-
palatine raphae area on the line connecting the contact
area between the second premolar and the first molar on
one side of the arch to the respective contact area on the
contralateral side of the arch.
 The volume of the reservoir was 4.7 ml and its working
duration was 2 to 2.5 hours.

29.  As the mean number of swallowing cycles is
approximately 600 cycles per day or approximately 25
cycles per hour, the amount of substitute released per
functional cycle of the reservoir was calculated to be
0.19 ml.

30. Advantages
 Advantages of this functional saliva reservoir design
include the swallowing cycle controlling the flow of
saliva, less outlet clogging, ease of fabrication, and
low cost.

31. Limitations
 It can not be used for patients with shallow palatal
forms, there is loss of resiliency of the liner, and the
patient must be advised to clean the reservoir
thoroughly with 2 % sodium hypochlorite.

32. Other Methods
 Mechanical interlocking
 Magnets
 Double tooth lego blocks
 Stainless steel press on buttons
 Metal rods
 Precision attachments

33. Conclusion
 Saliva reservoirs significantly improve the quality of
life of xerostomic patients.
 This study describes a novel technique for the
fabrication of a functional saliva reservoir.
 Although this technique is simple, easy and successful,
further improvements are required to overcome the loss
of resiliency and the need to replace the entire floor of
the reservoir.

34. References
 Upadhyay S R, Kumar L, Rao J: Fabrication of a functional palatal
saliva reservoir by using a resilient liner during processing of a complete
denture J Prosthet Dent 2012;108:332-335.
 Prem B, Meena A, Vidya C, Ivy C, Aradhana N, Mysore A: SALIVARY
RESERVOIR DESIGNS FOR PATIENTS WITH XEROSTOMIA: A
REVIEW Journal of Research in Dentistry 2016, 4(2):51-57
 Joseph A M, Joseph S, Nicholas M , Ashwin T K: Functional
salivary reservoir in maxillary complete denture – technique
redefined

35. THANK
YOU