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Repair, relining and rebasingRepair, relining and rebasing
Dr. Amal Fathy KaddahDr. Amal Fathy KaddahProfessor of Prosthodontic,Professor of Prosthodontic,
Faculty of Oral &Dental Medicine,Faculty of Oral &Dental Medicine,Cairo UniversityCairo University
www.egydental.comwww.egydental.com
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First Steps In Making A Denture
Primary impression
Diagnostic cast
Custom tray
Final impression
Master cast
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Impression TechniquesImpression TechniquesPrimary impressionsPrimary impressions
Conventional techniquesConventional techniques
Template techniquesTemplate techniques
Definitive impressionsDefinitive impressionsII-- Conventional techniquesConventional techniques
IIII-- Selective pressure techniquesSelective pressure techniques
IIIIII-- Functional techniquesFunctional techniques
IVIV-- Reline and rebase techniquesReline and rebase techniques
(including secondary template impressions).(including secondary template impressions).
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Complete DenturesComplete Dentures
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Repair of Complete
Dentures
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Dentures may fracture
during function dropped on hard
surface
Key of repair = accurate reassembling
& alignment of the broken parts in theiroriginal position.
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Classification of fractured dentures
I) According to location of fracture
Midline fracture Any part fracture
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II) According to extent of fracture
With broken ormissing part &/or
teeth
Without broken ormissing part &/or
teeth
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IV) According to cause of fracture
Operator Patient
III) According to timing of fracture
Early fracture Delayed fracture
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Midline fracture(mainly in maxillary dentures)
Causes:
1) No or insufficient relief in the midline. (M.P.R.)(Early fracture)
2) Ridge resorption with loss of relief effect. (Delayedfracture)
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Procedures for repair of midline fracture:
Broken parts areassembled & fixed
together with stickywax on the polishedsurface.
Assembled parts maybe strengthened withburs or plastic sticks.
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Any undercut on the
fitting surface is blocked
out with wax or clay.
The fitting surface is
painted with separating
medium.
Procedures for repair of midline fracture:
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Stone plaster is pouredinto the fitting surface.
After stone setting, thedenture is removed fromthe cast and cleaned fromany traces of sticky wax.
Fractured edges arereduced, widened (8-10mm) along the fractureline and beveled towardsthe polished surface to
increase bonding surfacearea. Dove tail cuts may bemade to strengthen therepair joint.
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The cast is painted with separating
medium and the denture is secured to
the cast with rubber bands. Self cure A.R. is applied to the
modified fracture area until the area is
overfilled.
N.B. An alternate method is to waxand contour the fracture line to the
desired form using base plate wax,
followed by flasking, wax elimination,packing with self cure A.R. and placing
in the flask under press for 2 hrs.
Deflasking, finishing and polishing is
then done in the usual manner.
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Relief of the median palatineRelief of the median palatine
raphea.raphea.
Reline if needed.Reline if needed.
Remake in some cases.Remake in some cases.
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Main cause is falling on the ground or the sinkduring cleaning.
Types:
I- Fracture with no missing part
Repaired as mentioned.
Any part fracture
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II- Fracture with missing or lost part
Procedures:
An impression is madewith the denture placed
in patient mouth. After pouring the cast,either self cure A.R. isapplied to replace themissing part, or wax is
added and carved toresemble the brokendenture part, followed byflasking, packing, curing,
finishing & polishing.
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Fractured teeth are
cut away with burs. On the lingual side,enough acrylic isremoved and dovetailed.
Teeth of same size,shape & shade arepositioned in properalignment and waxedwith base plate wax.
III- Fracture with broken or missingteeth
Procedures:
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A plaster index (key) is madeto record & secure the positionof waxed teeth. Teeth to be repaired areremoved together with all waxaround them.
Teeth are then put back exactlyin their original position aided byplaster key. Self cure acrylic resin is addedfrom the lingual side until repair
area is over built. It is thencovered with tin foil. After curing, the index isremoved and the denture is
finished and polished.
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Def: Resurfacing or correction of dentureadaptation to underlying tissues by the addition ofa new resin material to its fitting surface withoutchanging its occlusal relation.
Relining of Complete Dentures
AdditionAddition ofMaterial to the tissue side of aofMaterial to the tissue side of a
denture to improve its adaptation to thedenture to improve its adaptation to thesupporting mucosa.supporting mucosa.
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Reline IndicationsReline Indications
Loss of retentionLoss of retention
InstabilityInstability
Food under dentureFood under denture
Abused mucosaAbused mucosa
Whenever the denture loses or has poor adaptation to theunderlying tissues, while all other factors as occlusion,esthetics, centric relation, V.D.O. and denture base
material are satisfactory.
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Reline: General ConsiderationsReline: General Considerations
Optimal tissue healthOptimal tissue health
Reasonable CR/COReasonable CR/CO
Adequate vertical dimensionAdequate vertical dimension
Adequate peripheral extensionsAdequate peripheral extensions
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Denture preparation: Any undercuts are removedfrom the denture base. Peripheral extensions are
checked and adjusted. Borders are reduced andsquared to provide a definiteedge for addition of newresin material.
Procedures: Patient is instructed to leave his denture out ofhis mouth at least 48 hrs to allow for recovery oftissues and reduce irritation caused by ill-fitteddenture.
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A hole is made in the palatalsurface to allow escape of
excess impression material.Slight reduction in the fittingsurface may be done to createsome space for the impression
material.
Border tracing & newimpressions are made undercentric occlusion to maintain
occlusal relationship.
The denture with impressionmaterial is boxed and pouredinto stone.
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. The denture is flasked, and the old resin material isthoroughly cleaned and roughened.
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. New acrylic resin material is packed, and the
denture is cured in pressure curing unit containingwater at 45c for 20 min. to prevent porosity of newresin material and warpage of the old resin material(release of internal stresses).
. Finishing and polishing is done in the usual manner.
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N.B.
When both upper and lower dentures need relining,lower denture should be completed first. The upper
may be relined against a stable lower denture.The denture should be clinically remounted toperfect the occlusion.
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Evaluate DenturesEvaluate Dentures
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Is Reline necessary????Is Reline necessary????
If after modifications, theIf after modifications, the fit and bitefit and biteseem improved, let the patient try theseem improved, let the patient try the
denture for one weekdenture for one weekif there is noif there is noimprovement, then reline.improvement, then reline.
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Is reline Necessary?Is reline Necessary?
Irritation of Peripheral Borders
Overextension
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Is reline Necessary?Is reline Necessary?
Overextended borders
Borders corrected
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Is reline necessary?Is reline necessary?
Error in CO on oneError in CO on oneside, will break theside, will break the
seal on the oppositeseal on the oppositesideside
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Is reline necessary?Is reline necessary?
Correct eccentric excursions
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DiagnosisDiagnosis--OcclusalOcclusal
disharmonydisharmony
1.1. Loss of stability and retentionLoss of stability and retention2.2. Irritation and inflammation on oneIrritation and inflammation on one
sideside
3.3. Teeth stained on one sideTeeth stained on one side
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Reline ContraindicationsReline Contraindications
1.1. Worn out denturesWorn out dentures
2.2. Vertical dimension loss greater thanVertical dimension loss greater than 77mmmm
3.3. Significant mucosal inflammationSignificant mucosal inflammation
4.4. Poor denture estheticsPoor denture esthetics
5.5. Denture related speech problemsDenture related speech problems
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ContraindicationsContraindications
Severe tooth wear
Severe vertical overlap
with tooth wear (posterior
tooth concept)Severe occlusal wear (CD
evaluation)
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PrePre--requisites for reliningrequisites for relining
Recognition of abused tissues, withsuperimposed candidiasis.
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Initiate Tissue RecoveryInitiate Tissue Recovery
ProgramProgram Intermittent hot and cold rinsesIntermittent hot and cold rinses
Massage tissuesMassage tissues
Relieve pressure areasRelieve pressure areas
Correct faulty occlusions and dentureCorrect faulty occlusions and denturebordersborders
Minimize stress byMinimize stress by Soft dietSoft diet
Removal of denture at nightRemoval of denture at night
Use tissue conditionersUse tissue conditioners
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Complete Denture ExamComplete Denture Exam
Healthy Tissues!!Healthy Tissues!!
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CUDRelineCUDReline
1. Check extensions 2. Indicate amount of
peripheral reduction required
3. BorderReduction 4. Tissue Conditioner preparation:
Peripheral reduction + Tissue surface
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CUDRelineCUDReline
5. Border Molding
Completed6. Palatal surface vented
after B. M.
7. Seat denture until wash
comes through vents8. Final Impression
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CUDRelineCUDReline
Incorrect seating.Incorrect seating.Improper plane ofImproper plane of
orientation:orientation:Not contacting teethNot contacting teeth
Excess materialExcess material
No ventsNo vents
Place ZnO washPlace ZnO wash
Have patient closeHave patient closein CR.in CR.
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CUDRelineCUDReline
ZnO wash. Posterior
palatal seal area
using impression
wax
Trim
excess wax
beyond
anteriorline
Reline final
impression
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Final Impression with PVS Final Impression with Rubber base
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post palatal sealpost palatal seal
combinationcombinationIdentify inIdentify in
impression, beforeimpression, before
pouring it up.pouring it up.
Identify onIdentify onimpression soimpression sotechnician cantechnician can
scribe the sealscribe the seal
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CLDRelineCLDReline
Border
molding
completed
Complete
Denture method-
ZnO
Rubber Base
Reline
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RelineReline
Relined cast: Donot separate
Roughened
border to blend
new acrylic with
old. Wont show
finishing line
After
processing:Note junction
line
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RelineReline
Trimmed and polished
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Delivery of RelineDelivery of Reline
Examine:
Peripheral extensions
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Delivery of RelineDelivery of Reline
Pressure IndicatorPressure IndicatorPaste (PIP)Paste (PIP)
Ask the patient toAsk the patient tobite on cotton rollsbite on cotton rolls
forfor 55 min.min.
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LABORATORYREMOUNTINGLABORATORYREMOUNTING
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CLINICALREMOUNTINGCLINICALREMOUNTING
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Perfection of occlusionPerfection of occlusion
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Def: It is a process of readaptation of a denture tothe underlying tissues by replacing the denture
base material with a new one without changing itsocclusal relation.
Rebasing of Complete Dentures
Indications:
When the existing denture base is unsatisfactorye.g. stained, crazed or porous.
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Procedures: An impression is made withthe denture and a cast isobtained.
An occlusal and incisal index
of the teeth is made in plasterusing Hooper duplicator Theposts of the lower part of theduplicator are seated in theupper part to maintain the
relationship of the casts to theplaster index.
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The denture with the impression material are
removed from the cast.
Artificial plastic teeth are sectioned from thedenture and all base material around the teeth isremoved. (porcelain teeth are removed by
flaming)
Teeth are placed and held in position in the indexusing sticky wax on the labial and buccal surface.
A layer of base plate wax is placed over the ridgeof the cast.
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The upper part of the duplicator is closed and
denture teeth are waxed to the proper thicknessand contour to the cast.
The cast is removed, flasked and processed inthe usual manner.
After deflasking, the cast is reattached to theupper part of the duplicator to adjust any occlusalerrors.
Occlusion of rebased denture is furtherperfected by clinical remount.
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THANK YOUTHANK YOU
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