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| Figure 1. The patient, with healing implants. |
INTRODUCTION
As the number of partially or completely edentate adults increases, many patients will require replacement of missing teeth. Dentures are custom-made replacements for missing teeth and are one option for our aging society. While dentures take some getting used to and will never feel exactly the same as natural teeth, today’s dentures are more natural looking and comfortable than ever. Replacing missing teeth will help to improve the patient’s appearance and smile. Without support from the denture, facial muscles sag, making a person look older. Dentures can also help with eating and speaking more comfortably. In addition to the current treatment options of fixed partial dentures and implants, removable dentures have many advantages and are widely used in clinical practice. Aside from daily usage, there can be many needs for removable partial and complete dentures, including being used as temporaries while implants are healing.
Partial and complete dentures can become ill-fitting and worn. This may be due to numerous reasons, including damage to the denture base and the alveolar ridge resorbing. Correcting these denture problems can be done in the dental laboratory as well as in the dental office. Chairside denture relines provide immediate resolution to patient problems while the patient waits in the office, avoiding the edentulous time of laboratory relines. There are 2 main options for correction of an ill-fitting denture: the hard or soft reline. Selecting the correct material is based on various conditions, such as the state of the alveolar ridge, the presence of teeth and/or implants, and whether the denture base is acrylic or metal.1 These materials are used for repairs, relines, border extensions, and immediate dentures.
Brief History of Soft Reline Materials and Causes of Denture Failures
Soft liner material has been available since the days of vulcanite dentures. The liner material at the time, velum rubber, comprised a sponge-rubber that had many limitations related to the porosity of the material and its ability for adjustment and polishability.2 In the late 1950s through the early 1960s, tissue conditioners were introduced for use in tissue treatment, for lining surgical splints, and as functional impression materials. By the late 1960s, more durable and resilient soft liners were used, and more would come in the later years.3
There are many common causes for denture failure. The most frequent was lack of stability. Mandibular removable partial dentures typically had retention problems. Meanwhile, maxillary removable partial dentures had issues with the integrity of the reline material itself. Vertical dimension of occlusion changes can also cause denture failure. These changes can be caused by denture-tooth wear, resulting in worn surfaces. Denture bases can also be damaged and in need of repair. Another cause for failure is that denture wearers have continued bone loss over the years. Occlusal forces on the gingival tissues irritate the bone that resorbs. This results in a decrease in bone volume and density.4
Overcoming the Challenges Found With Soft Reline Materials
One of the challenges of soft reline materials is finding a sturdy yet comfortable material that resists odor buildup, is easy to apply, and can be cleaned by the patient without damage to the lining material. These materials should accurately adapt to the denture surface, be highly polishable, and exhibit low heat generation during the intraoral curing stage.5 Denture reline materials should cure quickly and have enough strength to last in long-term applications. A dental product’s affordability is also a factor when deciding to implement a new material into an office’s armamentarium. Sofreliner Tough (Tokuyama Dental America) is one such material. It is a dependable, easy-to-use, and hygienically friendly soft reline material. It is available in Soft and Medium consistencies, depending on what type of case it is indicated for. Sofreliner Tough is excellent for relief and comfort from sharp sections of alveolar bone that have not been smoothed out or where there are undercuts in the ridge that make the hard acrylic of a denture uncomfortable and painful to some patients. The Soft paste can be used with immediate dentures, while the Medium paste gives patients plenty of support and comfort for most other relines.
Another excellent product that goes hand in hand with soft reline materials is Silicone Remover (Tokuyama Dental America). This is a silicone denture reline removing solution that saves a great deal of time and effort. Silicone Remover allows for easy peeling away of old reline materials, completing the denture reline removal process with less grinding and mess. This material can also be used for removing silicone-based impression materials from custom impression trays.
The following clinical case report will describe the proper protocol, using the above-mentioned materials, to ensure predictable and reliable denture relines.
CASE REPORT
A 71-year-old male patient presented for a denture reline while in the midst of implant treatment on his maxillary dentition (Figure 1). His chief complaint was a loose denture. He stated that he wanted a reline until his fixed maxillary denture could be inserted after implants were integrated. The goal was for increased comfort and chewing ability and a better fit for his upper denture.
Following a comprehensive examination, it was determined that the tissue surface of the maxilla was sore to palpation in various areas. The remainder of the findings of the examination were within normal limits. The patient had 5 previously placed implants and was in the healing stage in preparation for his final prosthesis. He presented with a maxillary full denture that had a soft-tissue reliner placed in it (Figure 2).
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| Figure 2. The patient’s existing full maxillary denture. | Figure 3. The use of a sharp blade to cut into the existing material. |
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| Figure 4. Silicone Remover was dripped into the slit. | Figure 5. The reline material was peeled, starting from the center to the border. |
Before a new soft reline was used, the prosthesis was evaluated and deemed clinically acceptable, as the liner should not be used to compensate for a poorly made denture. Upon evaluation of the denture, it was established that the soft-tissue reline material needed to be removed, the denture needed to be sandblasted and cleaned, and a new reline material needed to be placed. A simple and effective method of removing reline material from existing dentures is by using a sharp, new scalpel blade and cutting a slit in the center of the material (Figure 3). Next, a few drops of a reline material remover (Silicone Remover) were placed in the slit and allowed to penetrate under the old soft reline material (Figure 4). This material is great at separating soft reline material from the denture without using a bur. A spatula was then used to begin peeling the reline material from the center outward to the borders (Figure 5). Extra care was taken to not force the material with too much pressure in any direction, as extreme pressure can cause multiple rips in the material. When areas of material are difficult to remove, a few more drops of reline remover can be used to speed up the process. This short and rapid process allows for the quick removal of the previously placed denture reline material.
Next, an acrylic bur was used to create a lip around the denture border. This is an important step in that it provides enough space for a bulk of material to prevent peeling and loss of reline material over time (Figure 6). This step was then followed by air abrading the intaglio surface of the denture using a 50-µm aluminum oxide powder. This step leaves the denture with a far more retentive surface. The denture was rinsed thoroughly and dried with air for a completely clean surface in preparation for the bonding agent. Several coats of Sofreliner Tough Primer (Figure 7) were applied as the adhesive layer between the denture and reline material. This bonding agent was dried, and the soft denture liner, Sofreliner Tough Paste (Medium), was dispensed from an automix gun. The borders of the denture were covered first, followed by the internal surface of the denture base (Figure 8). This paste was placed into the denture in a similar fashion to a final impression material being placed into a tray, keeping the tip of the material dispenser fully inside the material to prevent the introduction of air bubbles into the mix. The denture was then inserted into the patient’s mouth, and border movements were quickly captured. Complete setting was achieved in 5 minutes; then the denture was removed from the patient’s mouth. A sharp blade was then used to remove excess material from the border areas of the denture. Using the lab burs provided in the Sofreliner Tough kit (Figures 9 and 10), the denture was adjusted and polished to a smooth finish and shine (Figure 11). The patient’s occlusion was then adjusted for comfort and function. Subsequently, the patient was instructed to insert and remove the denture a few times to make sure of the fit and retention. A final evaluation was completed, which included aesthetics, phonetics, stability, and occlusion.
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| Figure 6. An acrylic bur was used to create a lip around the denture border. | Figure 7. Sofreliner Tough primer (Tokuyama Dental America) was used before the reline material. |
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| Figure 8. The reline material was placed in the denture. | Figure 9. Lab burs were used to adjust and polish the material. |
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| Figure 10. The Sofreliner Tough kit (Tokuyama Dental America). | Figure 11. The final denture, with new reline material in place. |
The patient was then given home care instructions and seen a week later. No postoperative complications were reported, and the patient was very happy with the results of the reline procedure.
CLOSING COMMENTS
Dentists are currently faced with a wide selection of soft reline materials for a variety of uses. With the increased number of products available, the dentist must understand these materials and use the product best suited to meet the challenges a patient may present clinically. The use of a soft reline may make the difference between a patient being able to function with a removable prosthesis, such as a complete denture, and not being able to function properly. It is a part of our profession to provide our patients with the care to function and thrive with removable appliances. Chairside denture relining, when used correctly and with proper materials, is a highly effective treatment option for our growing edentulous population.
References
- Hummel SK, Wilson MA, Marker VA, et al. Quality of removable partial dentures worn by the adult U.S. population. J Prosthet Dent. 2002;88:37-43.
- O’Brien WJ. Dental Materials and Their Selection. 3rd ed. Chicago, IL: Quintessence Publishing; 2002:78, 85-87.
- Schmidt WF Jr, Smith DE. A six-year retrospective study of Molloplast-B-lined dentures. Part I: patient response. J Prosthet Dent. 1983;50:308-313.
- Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years. J Prosthet Dent. 2003;89:427-435.
- Braden M, Wright PS, Parker S. Soft lining materials—a review. Eur J Prosthodont Restor Dent. 1995;3:163-174.
Dr. Halabo graduated from Boston University’s Goldman School of Graduate Dentistry and earned his bachelor’s degree at the University of California (UC), Santa Barbara in microbiology. He completed a general practice residency at the Loma Linda Veterans Hospital. For more than 20 years, he has run a state-of-the-art practice in San Diego. Dr. Halabo is an adjunct faculty member at UC San Diego (UCSD) and an accomplished national and international speaker, author, and product evaluator. He served as the director of dental care at the UCSD homeless clinic in Pacific Beach, Calif. Dr. Halabo lectures on a variety of topics with an emphasis on improving patient care and dentists’ enjoyment of their profession by combining technological and clinical advancements with the use of simple practice management tools. He can be reached via email at sam@samhalabodmd.com or by visiting the website smilesbydrsam.com.
Disclosure: Dr. Halabo reports no disclosures.
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