CLINICAL REPORT

Associate Pro

THE JOURNA

Consequences of relining on a maxillary complete denture:A clinical report

Yung-tsung Hsu, DDS, MS

ABSTRACTThe position of a complete denture may change after relining, especially in the maxillary arch. Thisreport reviews relining techniques and presents a situation with anterior displacement after therelining of a maxillary complete denture. Instead of providing a new denture, the displaced denturewas repaired and the original tooth arrangement maintained. (J Prosthet Dent 2015;114:13-16)

Relining a complete denture isoften mistakenly assumed to bea simple procedure1; however,problems such as incorrect ver-tical dimension of occlusionand errors in centric occlusion

can occur when the procedure is poorly performed.2 Bydefinition, relining is resurfacing the intaglio surface of acomplete denture with new material.3 This procedureis indicated after ridge resorption, abrasion, or over-adjustment of the intaglio surface of the denture base,4 orafter a recent extraction.5 Before relining a denture, theclinician should verify whether the jaw relationship, ver-tical dimension of occlusion, and esthetics are acceptableon the existing dentures. If not, remaking the denturesshould be the treatment option.

A denture can be relined with an open-mouth orclosed-mouth technique.6,7 Many clinicians prefer theclosed-mouth technique to minimize the change inocclusal relationship.8 Both techniques emphasize theimportance of removing the undercut and relief on theintaglio surface of the denture to provide a space for theimpression material. Some clinicians suggest creatingholes on the palatal area or removing part of the palatalportion of the denture to improve the seating of the den-ture during impression, especially on the maxillary den-ture.2,9-11 To improve the border seal of the dentures, theextension of the flangemay be reduced and remoldedwithdifferent materials.2,9,11 To avoid displacement of thedenture, different low viscosity impression materials havebeen suggested.6,8,9,12-14 Even by using the above tech-niques tominimize the change in the vertical dimension ofocclusion or the displacement of the denture during the

fessor, Department of Restorative Sciences, School of Dentistry, Universit

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relining impression, a relined denture may still be dis-placed.15-17 This article presents a patient whose maxillarydenture was relined previously, but the position wasaltered after the relining. The diagnosis and procedures forcorrecting the displaced denture are also presented.

CLINICAL REPORT

A 73-year-old white man who had been edentulous formore than 15 years came to the University of Alabama atBirmingham School of Dentistry Comprehensive CareClinic with the chief complaints of a bulky maxillarydenture and the inability to masticate well. This patientstated that he had received 2 implants (Tapered InternalØ3.8×12 mm; BioHorizons) in the mandibular arch andhad new complete dentures made after the implantswere uncovered 3 years previously. A review of hismedical history revealed that the patient was taking hy-drochlorothiazide for hypertension and had been asmoker for more than 10 years before stopping 4 yearspreviously. He had regular follow-up appointments withhis physician. An intraoral examination revealed healthymucosa and plaque around the implant abutments(Figs. 1, 2). No pain or inflammation was found onpalpation of the mucosa.

His mandibular denture was retained by 2 Locatorabutments (Zest Anchors) with the blue inserts in the

y of Alabama at Birmingham, Birmingham, Ala.

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Figure 1. Maxillary arch. Figure 2. Mandibular arch.

Figure 3. Significant horizontal overlap of anterior teeth. Figure 4. Closed-mouth technique with occlusal record.

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metal housings. He returned to the clinic every 6 monthsafter the delivery of the dentures. Eighteen months afterthe delivery of the dentures, he started to feel loosening inboth dentures. The blue inserts of the attachments werereplaced, and the maxillary denture was relined with theclosed-mouth impression technique and polyvinylsiloxane (PVS) impression material (Aquasil Ultra Mono-phase; Dentsply Caulk). The impression material wasreplaced with heat-polymerizing acrylic resin (Lucitone199 Denture Resin; Dentsply Intl). He returned for afollow-up visit the next day.

Six months after the delivery of the relined denture, hecame to the clinic for the follow-up appointment with thepreviously mentioned chief complaints. An intraoral ex-amination revealed a significant horizontal overlap on theanterior teeth (Fig. 3). He stated that after the delivery ofthe relined denture, he felt the denture to be bulky andthat the thickness on the border had been trimmed at the24-hour follow-up appointment. He expected the bulkyfeeling would gradually go away; however, he still felt theborder was too thick at the 6-month follow-up appoint-ment. The vertical dimension of occlusion was acceptableas verified with the phonetics and physiologic rest position

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techniques. The diagnosis was anterior displacement ofthe maxillary denture after relining.

Because the patient was satisfied with the size andtooth arrangement before the relining, the treatmentplan was to reposition the teeth to the original positionsand to perform occlusal adjustment. A centric relation(CR) occlusal record was made with PVS material (RegisilPB; Dentsply Caulk). The undercut on the intaglio surfacewas relieved, and the border of the denture was reducedby 2 mm. Border molding procedures were performedwith green modeling plastic impression compound. Twoholes were created at the middle anterior palatal part ofthe denture. The relining impression was made with low-viscosity PVS impression material (Aquasil Ultra LV;Dentsply Caulk) and the closed-mouth technique withan occlusal record (Fig. 4). The vibrating line was markedat the junction of the movable and immovable soft palateand transferred to the impression. The midline of the facewas marked on the mandibular denture.

The maxillary denture with the impression was boxedand poured with a Type 3 dental stone (Microstone;Whip Mix Corp). After the stone had set, the maxillarydenture with the stone cast was mounted in a

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Figure 5. Separate denture teeth from base. Figure 6. Maxillary teeth oriented and secured to mandibular denture.

Figure 7. Denture teeth with silicone matrix and maxillary cast. Figure 8. Wax added to seal tooth block and stone cast.

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semiadjustable articulator (Hanau Wide-Vue; Whip MixCorp) with a facebow transfer (Spring-Bow; Whip MixCorp). A remount cast was fabricated for the mandibulardenture, and this denture was oriented to the maxillarydenture with the CR record. The maxillary denture wasremoved from the stone cast, and the postpalatal sealarea was carved in the cast according to the vibrating linetransferred from the impression.

The impression material and modeling plasticimpression compound were removed from the denture.The denture teeth with acrylic resin were cut from thedenture (Fig. 5). The teeth block was centered with themidline mark and oriented to the mandibular denture to amaximum intercuspation position and secured with stickywax (Fig. 6). The horizontal overlap for the anterior teethdecreased from 4.5 mm to 2 mm. An index was fabricatedwith PVS putty (Splash; DenMat Holdings, LLC) on thefacial and buccal surfaces of the denture teeth. The intagliosurface of the teeth block was adjusted until there wasno contact between the stone cast and acrylic resin whenthe upper member of the articulator closed (Fig. 7).

Two layers of baseplate wax were added to cover thestone cast and to connect the teeth block (Fig. 8). The

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thickness of wax was measured with a periodontal probeto avoid a bulky denture base. The denture was pro-cessed with the conventional technique. At the deliveryappointment, the intaglio surfaces were evaluated by apressure-indicating paste (Pressure Indicating Paste(PIP); Keystone Industries), and the dentures wereremounted with a new CR record for occlusal adjust-ment. The patient returned to the clinic for a 24-hourfollow-up, and no sore spot was noticed. At the6-month follow-up, he was satisfied with the retentionand comfort of the maxillary and mandibular dentures.

DISCUSSION

The fit of a denture decreases with use because of ridgeresorption or the wear of the acrylic resin base by dailybrushing. However, no guidelines exist to assist cliniciansin determining when a denture should be relined.18

Patients may not be aware of the change and have noregular postdelivery appointments with clinicians untilimproved retention is needed.19 In this report, the patientreturned to the clinic for regular follow-up appointmentsevery 6 months, and the relining request was initiated by

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the patient 2 years after the delivery because of the lackof retention on the maxillary arch.

When a displaced relined denture is identified, aclinician may either remake or repair the denture.Remaking a denture usually requires more appointmentsand additional costs. Using this presented technique willdecrease the number of appointments. Although theintaglio surface of a denture is relieved before making therelining impression, the amount of relief is an estimateand will be uneven in different locations. The denturemay be seated at an unstable position if the intagliosurface is relieved aggressively. When the denture isloaded with an impression material, even with a lowviscosity one, the material still may push the dentureaway from the original position. The displacement maybe more significant when a soft liner type of material isused because of the viscosity of liner material.

The denture is easily displaced forward, and the ver-tical dimension of occlusion is increased if too muchmaterial is used.2 Using an occlusal record may notensure the original position because the mandible couldmove to a different position to fit the record. Removingthe palatal portion of a denture will minimize the hy-draulic pressure from the impression material but willalso decrease the stability of the denture during theimpression procedure and create another challenge torecord the palatal area accurately through the impression.

In this report, only holes were created on the palatalarea to prevent voids on the impression. Because thedenture was displaced forward, the border of the denturewas no longer accurately adapted to the range of musclemovements. The border extension was reduced andremolded with modeling plastic impression compound.When making the impression, the denture was seated inthe anterior part of the ridge first and the posterior partrotated up to the ridge to avoid displacement from theundercut of the anterior ridge. To evaluate whether thedenture has been displaced anteriorly, a clinician canmeasure the distance between the center of incisivepapilla to the anterior teeth with a Boley gauge or anAlma gauge (Dentsply Intl) before and after the reliningimpression. In addition, the thickness of impressionmaterial at the distal buccal corner should be similar tothe dimension of the molded modeling plastic impres-sion compound. If the polymerized impression materialon this area becomes thinner than the dimension ofmodeling plastic impression compound, or becomesunsupported from the modeling plastic impressioncompound, the denture was not seated to the positionwhere the border molding procedure was performed andthe impression will not be accurate.

If cusped denture teeth are used, the 2 opposingdentures may be oriented with the existing cusp-to-fossarelationship without an occlusal record. For nonanatomicteeth, the dentures should be placed according to the

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horizontal relationship of the posterior teeth to avoid thecheek-biting problem. The thickness of the baseplatewax has to be measured with a sharp instrument or aperiodontal probe to ensure the ideal thickness of thedenture base. In this report, the maxillary denture wasplaced according to the cusp-fossa relationship and themidline mark on the mandibular denture. A relineddenture must be mounted on an articulator for occlusalequilibration because of the discrepancy of position.15-17

The limitation of this reported technique is that if theocclusal surfaces of the denture have been ground tooaggressively after the initial relining, a new denture isindicated.

CONCLUSIONS

Relining impression may result in a displaced denture. Ifa displaced denture is identified, a clinician could use thepresented technique to avoid remaking the denture.

REFERENCES

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2. Levin B. A reliable reline-rebase technique. J Prosthet Dent 1976;36:219-25.3. The Academy of Prosthodontics. The glossary of prosthodontic terms, 8th ed.

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Weight loss and changes in surface roughness of denture base and reline ma-terials after simulated toothbrushing in vitro. Gerodontology 2012;29:e121-7.

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17. Utz KH, Schneider D, Feyen J, Gruner M, Bayer S, Fimmers R, et al. Com-plete denture displacement following open-mouth reline. J Oral Rehab2012;39:838-46.

18. Felton D, Cooper L, Duqum I, Minsley G, Guckes A, Haug S, et al. Evidence-based guidelines for the case and maintenance of complete dentures: Apublication of the American College of Prosthodontists. J Prosthodont2011;20:S1-12.

19. Marchini L, Tamashiro E, Nascimento DF, Cunha VP. Self-reported denturehygiene of a sample of edentulous attendees at a university dental clinic and therelationship to the condition of oral tissues. Gerodontology 2004;21:226-8.

Corresponding author:Dr Yung-tsung Hsu1919 7th Avenue South, Rm 534Birmingham, AL 35294Email: ythsu@uab.edu

Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.

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