Tissue conditioners

TISSUE CONDITIONERS
AND LINERS
Presented by,
Dr. Chaithra Prabhu B
1st year post graduate
Department of Prosthodontics
175

2
CONTENTS
• Introduction
• Definitions
• Reliningandrebasing
• Classifications
• Requirementsof dentureliners
• Hardliners
• Softliners
types,indications,procedurefor applicationofsoftliners
• Tissueconditioners
composition, uses,procedure forapplicationoftissue
conditioners&careandmaintenance
• Conclusion
• Reference 75

INTRODUCTION
• Maintenance of the adaptation of denture bases to the
mucosa that covers the ridges is a critical part of complete
denture service.
• Residual ridges have been described as plastic in nature,
always changing in topography and morphology because
of alteration in the contour of soft tissues and resorption of
underlying bone.
• Resorption occurs most rapidly in first 6 months
following extraction of teeth and levels at about 12
months, and increases again as the patient reaches age of
about 65. 3/75Essentials of complete denture
prosthodontics Sheldon Winkler 2nd ed

INTRODUCTION
• Every edentulous patient among with other things should
be examined on an annual basis to determine the rate of
resorption of the residual ridges.
• More rapidly in females than in males.
• More rapidly in Caucasians than in Negroes.
4/75Essentials of complete denture

• In such a case a replacement of the denture can be done, or
we can reline or rebase the denture
• Further the Denture soreness, pain, presence of abused,
hypertrophic, irritated, hyperaemic and displaced oral
mucosa, once very difficult to treat can now with the
advent of soft liners can be conditioned to a healthy state
5/75
Essentials of complete denture

DEFINITIONS
• RELINE
The procedure used to resurface the intaglio of a removable
dental prosthesis with new base material thus producing an
accurate adaptation to the denture foundation
GPT 9
The process of replacing the tissue contacting surface of an
existing denture
PHILIPS
6/75

7
• REBASE
The laboratory process of replacing the entire denture base
material on an existing prosthesis
GPT 9
The process of replacing the entire denture base of an
existing complete or partial denture
PHILIPS
• TISSUE CONDITIONER:
A resilient denture liner resin placed into a removable
prosthesis for a short duration to allow time for tissue healing
-GPT 9
A soft liner used to treat traumatized mucosa
-0’BRIEN

INDICATION FOR RELINING
OR REBASING
1. Immediate dentures at 3 to 6 months after their original
construction
2. When the residual alveolar ridge have resorbed and the
adaption of the denture base to the ridge 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 chronically ill patients
8/75

CONTRAINDICATIONS
1. Excessive amount of resorption
2. Presence of abused soft tissues
3. When patients complain about TMJ problems
4. If the denture have poor esthetics
5. If the denture create major speech problem
6. When severe osseous undercuts exist
9/75

RELINING OR REBASING
10/75
Boucher's prosthodontic treatment for
edentulous patients 131h ed

GENERAL CONSIDERATIONS
1. The occlusal vertical dimension should be satisfactory
2. CO should coincide with CR
3. The size shape shade and arrangement of the artificial
teeth must be satisfactory
4. The oral tissue should be in optimum health
5. The posterior limit of the maxillary denture should be
correct
6. The denture base extensions should be adequate and
should distribute masticatory load over large surface area
7. Inter-occlusal distance should be correct
8. Satisfactory speech
11/75Essentials of complete denture

RELINING
TISSUE
PREPARATION
• Excessive hypertrophic
tissue should be surgically
removed.
• The oral mucosa should be
free of areas of irritation.
• Dentures should not be
worn at least 2-3 days
before the final
impression.
• Daily message is helpful
to stimulate their blood
supply.
DENTURE
PREPARATION
• Pressure areas on the tissue
surface of the dentures
should be removed.
• Minor occlusal
disharmony is corrected by
selective grinding.
• Small border inadequacies
are corrected.
• A correct posterior palatal
seal area should be
established.
12/75

RELINING TECHNIQUES
13/75
1. Closed mouth technique
2. Open mouth technique
(Boucher’s technique)
1. Articulator method
2. Jig method
Boucher's prosthodontic treatment for
edentulous patients 9th ed

14/75
CLOSED MOUTH
TECHNIQUE
• Is preferred when the static
impression technique is used.
• Several variations have been
suggested, all based on using the
denture as an impression tray and
the actions of the patient to mold
the peripheries.
• The prosthesis is held in position by
the patient occluding on the
opposing denture before which the
occlusion should be corrected either
in the preliminary treatment or by
modification with hard wax or
compound

OPEN MOUTH TECHNIQUE
• Given by Boucher.
• Reining of both upper & lower dentures at the same time.
• Dentures are used as special trays for making secondary
impression. ZnOE is the material of choice
• After impression a new Centric Relation is recorded.
DISADVANTAGES:
• Difficult procedure because more clinical and lab work is
involved.
15/75

CHAIR SIDE RELINE
TECHNIQUE
Several attempts had been made to produce an 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.
These are not recommended because of following
drawbacks:
• Chemical burns (from the monomer)
• Porosity and poor odor
• Poor color stability
• Material cannot be removed easily if there is any mistake
16/75
Recent introduction of VLC resin systems
These materials can be partly polymerized at the chairside
using handheld curing lights, but require a more powerful
light chamber device for complete curing.
USE
• temporary modification of dentures
• corrections to the posterior border seal on the upper
denture & the extension of flanges, and
• may be employed for relining dentures.
The technique is not, however, suited to situations where
there are undercut areas
REASON: can be distorted during removal and becomes
rigid once cured

LABORATORY METHOD
• ARTICULATOR METHOD
17/75
Dental laboratory procedure for
complete denture Rudd and Morrow vol
1

18/75Dental laboratory procedure for complete
denture Rudd and Morrow vol 1

19/75
JIG METHOD
Dental laboratory procedure for
complete denture Rudd and Morrow vol
1

CLASSIFICATION
20/75
Science of dental materials V Shama
Bhat 2nd ed

CLASSIFICATION
• BASED ON CURING
1. Self cure
Eg-soften, viscogel
2. Heat cure
Eg-supersoft,
molloplast B, Lucisoft,
Flexor, Permaflex
3. Light cure
Eg-clearfitLC
(polyisoprene based
material)
• BASED ON
COMPOSITION
1. Silicone elastomers
2. Soft acrylic compounds
3. Pthalate ester free
compounds
4. Polyolefin liners
5. Fluoride containing
liners
21/75
TISSUE CONDITIONERS : A REVIEW
NUJHS Vol. 4, No.2, June 2014

CLASSIFICATION Cntd
• BASED ON
DURABILITY
1. Temporary/Short term
liners-eg., soft comfort
2. Definitive/long term
liners
• BASED ON
CONSISTENCY
1. Hard denture liners
Eg-Ufigel hard C
2. 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 22/75TISSUE CONDITIONERS : A REVIEW

CLASSIFICATION cntd
• BASED ON THE
AVAILABILITY
1. Home reliners
2. Tissue conditioners
• BASED ON WATER
SORPTION PROPERTY
1. Hydrophilic
Eg-kooliner
(polymethyl/ethyl
methacrylate polymer)
2. Hydrophobic
Eg-Elite soft(silicone
polymer)
23/75
TISSUE CONDITIONERS : A REVIEW

REQUIREMENTS OF RESILIENT
DENTURE BASE LINERS
They should be biologically inert material
They should be resilient and capable of maintaining
this characteristics
Should be dimensionally stable & insoluble in oral
fluids to maintain proper tissue contacts
Should be color stable throughout their use
Even though flexible, they should resist abrasion &
thereby allow the practice of proper hygiene of surface
Should maintain their bond to denture base without
damaging it
Ease while working with them 24/75
Dental laboratory procedure for complete
denture Rudd and Morrow vol 1

HARD LINERS
Due to resorption and
shrinkage of the tissues,
after the teeth
extraction, the denture
prepared gradually
becomes lose or mis-
fitting. This requires an
additional layer on the
tissue side of denture
for better fit
25/75

HARD LINERS
TYPE 1
• Powder
PMMA----Polymer beads
Benzoyl
Peroxide-----initiator
• Liquid
MMA-------monomer
Di-n-butyl
phthalate-----plasticizer
Tertiary amine----Chemical
activator
TYPE 2
• Powder
PMMA----Polymer beads
Benzoyl
Peroxide-----initiator
• Liquid
Butyl/ iso-butyl/ higher
methacrylates-----monomer
Di-methacrylate ----CLA
Tertiary amine----Chemical
activator
26
Applied Dental Materials John F.
McCabe 9th ed
 Disadvantage is
that it is irritant to
the soft tissues
 May cause allergic
reaction
Less irritant
comparitively

COLD CURE IS
PREFERRED
Simpler curing procedure
Less distortion or warpage of denture
Strength of cold cure is adequate for liner
27/75
Science of dental materials V Shama
Bhat 2nd ed

SOFT LINING
MATERIALS
• Permanent soft lining materials are most commonly used
for patients who cannot tolerate a hard base.
• This problem generally arises if the patient has an irregular
mandibular alveolar ridge covered by a thin and relatively
non-resilient mucosa.
• It may be very painful when a masticatory load is applied
through a hard base on to this type of supporting tissue.
• In such cases, a soft lining on the denture will help to
relieve the pain and increase patient acceptance of the
denture. 28/75
McCabe 9th ed

29/75
Soft lining
materials
Natural rubber
Vinyl co-
polymers
Soft acrylics
Silicone
elastomers
Fluoropolymers
Poly-elastomeric
systems
Complete denture prosthodontics
treatment and problem solving Yasemin
K ozkan

NATURAL RUBBERS
• Have been used as soft lining materials since 1860s
• Not a material of choice because of
 Quick absorbance of intraoral liquids
 Difficulty in preparation
 Low quality of connection to base materials
30/75
K ozkan

SOFT ACRYLICS
Plasticized acrylic resins
chemically cured heat cured
• Available in powder and liquid forms
• Polymer is either methyl or ethyl-methacrylate
• Primary difference between conventional PMMA and
these is that liquid contains large amount of plasticizers
• Plasticizers limits the tangling of the polymer chains
31/75

SILICONES
• One of the more successful soft lining materials
• There is no need for addition of plasticizing agents
• The material retains its rubbery consistency for long period
of time
• Available as
Chemical cure
Supplied as two components
Setting is by condensation reaction
Heat cure
Supplied as one-component pastes
Applied using compression moulding technique
32/75
K ozkan

DISADVANTAGES
1. They generally do not bond to the denture base and
require some form of adhesive
2. The material is also unsuitable for polishing and has to
be left in the finished state. Thus they are prone to
bacterial contamination and growth of C. albicans ( GC
reline modifier which removes surface roughness and
manufacturing defects when added )
3. They occupy space and as their thickness increases, the
thickness of the denture itself is reduced. Affects the
strength of denture base
33/75
A Clinical guide to applied dental
materials Stephen J Bonsor

FLUORINATED SOFT LINING
MATERIALS
• Polyphosphazene is a fluorinated nitrogen- phosphate
elastomers distinctly different from plastiols and silicones
• It quickly deforms under load converting the deformation
energy into a small amount of heat before returning to its
original shape
34/75
K ozkan

OLEFINIC SOFT
LINING MATERIAL
• Have good elastic properties
• But these require a special apparatus for lining and the
lining procedures are complicated
• Eg MOLTENO
35/75
K ozkan

36/75
•INDICATIONS OF SOFT LINING
•Aging & pathological changes
•Atropy and resorption
•Decreasing the pressure locally
•Reducing the pressure locally
•Reducing occlusal irritation
•Providing retention in presence of undercuts
•Rehabilitation of congenital/acquired defects
•Following radiation therapy
•Some systemic disease or excessive usage of alcohol or
cigarate
K ozkan

DISADVANTAGES
1. Hardening of materials by loosing its softness
2. Bonding problems to the denture base
3. Fracture of denture base
4. Cost application problems
5. Color stability
6. Candidal growth
37/75
K ozkan

38/75
CLINICAL APPLICATION OF SOFT LINING
MATERIALS
DIRECT METHOD INDIRECT METHOD
Soft lining materials are applied
on the tissue surface of
Acrylic base and left to
polymerize intraorally
Lining procedure is
carried out in
laboratory after the
impression is made

APPLICATION
OF
SOFT LINING
MATERIAL BY
DIRECT
METHOD
39/75

APPLICATION
OF
SOFT LINING
MATERIAL
BY INDIRECT
METHOD
44/75

48/75
Application of liner to
already processed
dentures

51/75
This study evaluated the effect of two commonly used methods
of processing permanent soft liner on tensile bond strength
between denture base and silicone based soft liner
Group 1: Specimens which were relined at the time of processing
denture base resin.
Group 2: Specimens relined after the denture base resin
specimens were fabricated.
Conclusion
Bond strength of soft liner relined directly to the denture
base resin during processing was significantly higher than
the bond strength of the soft liner applied to already
processed denture base resin.

TISSUE
CONDITIONERS
• Tissue conditioners are also known as temporary soft
lining materials
• Intraorally these materials can be used 1 week to 10 days
at most
52/75
K ozkan

COMPOSITION
POWDER
Polyethylmethacrylate--
-- Polymer beads
LIQUID
Ethyl alcohol---Solvent
Butylphthalyl
Butylglycolate------
Plasticizer 60 -80%
DOES NOT CONTAIN
MONOMER 53/75
TISSUE
CONDITIONER
McCabe 9th ed

• Setting reaction is by gelation ----------15-20 min
• In tissue conditioners, polymerization starts with mixing
the powder with plasticizer and penetrant involving liquid
mixture and letting the liquid penetrating into powder
monomers. This procedure is accelerated by the presence
of ethyl alcohol.
54/75
K ozkan

USE OF TISSUE
CONDITIONERS
Adjuncts in tissue conditioning
Temporary obturators
Stabilizers of baseplates and surgical splints or
stents
Adjunct in the impression making procedure or as a
final impression material
55/75

ADJUNCTS IN TISSUE
CONDITIONING
 These materials provide an excellent medium to aid in the
conditioning of traumatized denture bearing tissues
because of their flow consistency permits the tissue
recovery and prevents further breakdown
 Specific situations like
• hyperemic and traumatized oral mucosa
• Poorly occluding dentures
• Bruxism
• Papillary hyperplasia
• Patients with avitaminosis or general debilitating disease
56/75

ADJUNCT IN TEMPORARY
OBTURATORS
• Temporary obturation is usually accomplished 7 to 10 days
after surgery, and so it is important that minimal pressure
and no irritation be produced by obturators
• The use of these materials protects the tissue and thereby
enhances the healing process
57/75

STABILIZERS OF
BASEPLATES AND SURGICAL
SPLINTS
• When undercuts are present on an edentulous cast,
tissue conditioners of a stiffer consistency may be
used to stabilize recording base and prevent
breakage of the cast
enhances the stability, retention and comfort of the
recording base
58/75

• They are used to line surgical stents or splints when
performing maxillary or mandibular vestibuloplasties
• Their use provide closer adaption to the healing tissues and
so protects them from trauma
59/75

IN IMPRESSION MAKING
PROCEDURE
• Can be used when it is difficult to determine the extent of
the denture base by means of the movable oral structures.
• The materials will record the extension in a dynamic form
that will later help in preparing an impression tray for the
final impression.
60/75

PROCEDURE
FOR APPLICATION
OF TISSUE
CONDITIONER
61

66/75
This in vitro study evaluated and compared the tensile bond
strength of two commercial brands of temporary soft liners to
different types of denture base resins.
Soft liners Denture
resin base
Viscogel DPI
GC tissue
conditioner
TREVELON
TREVELON
HI
Conclusion
Viscogel showed better
bond compared to GC tissue
conditioner with all type of
denture base
Trevelon exhibited better
bond with both the liners
compared to other type of
denture base resins
The bond failures were classified as
• Adhesive,
• Cohesive, and
• Mixed types.
Tensile strength > than bond strength ADHESIVE FAILURE
Tensile strength < bond strength COHESIVE FAILURE
Tensile strength = bond strength MIXED

67/75
Purpose of this study was to evaluate effect of two surface
treatments, sandblasting and monomer treatment, on tensile
bond strength between two long term resilient liners and poly
(methyl methacrylate) denture base resin.
Conclusion
Surface pretreatment of the acrylic resin with monomer
prior to resilient liner application is an effective method to
increase bond strength between the base and soft liner.
Sandblasting, on the contrary, is not recommended as it
weakens the bond between the two.

CARE & MAINTENANCE
• Soft brush is recommended to clean the material
under cold running water.
• Soaking in denture cleansers - not recommended –
adversely affects physical properties & causes
premature deterioration.
68/75

69/75
Conclusion
Silicone-based soft liners showed better compatibility with
cleansing solutions and maintained their resiliency better
thereby, proving to be more promising for long term
usage.
This study was aimed to determine the effect of two chemically
distinct denture cleansers (0.2% sodium hypochlorite & sodium
perborate) and water on the surface hardness of acrylic and
silicone based soft denture liners at various time intervals.

70/75
This study evaluated the effect of denture cleansers on C.
albicans biofilm formation over resilient liners and to evaluate
compatibility between resilient liners and denture cleansers.
Conclusion
Based on the C. albicans binding levels results, it is not
recommended to immerse COE-SOFT in denture
cleansers, and GC RELINE and SOFRELINER
TOUGH should be immersed in Cleadent

CONCLUSION
• Soft liners have an important place in denture prosthetics
but require improved strength, improved adhesion to the
denture base and the ability to inhibit the growth of
microorganisms.
• The greatest virtue of tissue conditioners is their
versatility and ease of use.
• However they’re temporary materials and are not
adequate substitute for new dentures.
72/75

REFERENCES
1. Science of dental materials V Shama Bhat 2nd ed
2. Phillips science of dental materials 12th ed
3. Applied dental materials John f McCabe 9th ed
4. Dental materials and their selection William O’brien
3rd ed
5. Clinical guide to applied dental materials Stephen J
Bonsor
6. Essentials of complete denture prosthodontics
Sheldon Winkler 2nd ed
7. Complete denture prosthodontics treatment and
problem solving Yasemin k Ozkan
73/75

CROSS REFERENCES
• An In vitro Evaluation of Tensile Bond Strength of Commercially
Available Temporary Soft Liners to Different Types of Denture Base
Resins 2018 Journal of Natural Science, Biology and Medicine
• Tensile Bond Strength of Soft Liner to denture Base Resin Processed
by two Commonly used Processing Techniques Int J Sci Res Sci
Technol . March-April-2019
• Effect of denture cleansers on surface hardness of resilient denture
liners at various time intervals- an in vitro study J Adv Prosthodont
2013
• Effect of denture cleansers on Candida albicans biofilm formation
over resilient liners J Adv Prosthodont 2014
• The effect of denture base surface pretreatments on bond strengths of
two long term resilient liners J Adv Prosthodont 2011
74/75

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