L29-Ortiz-CD Reline Rebase Repair.txt

RELINE,REBASE AND REPAIR OF COMPLETE DENTURES PROSTHODONTICS DEPARTMENT LILIANA ORTIZ CAMACHO,DDS RELINING Resurfacing of a denture base with a new material to make it fit the underlying tissues more accurately REBASING Replacement of a denture base with new material without changing the occlusal re...

RELINE,REBASE AND REPAIR OF COMPLETE DENTURES PROSTHODONTICS DEPARTMENT LILIANA ORTIZ CAMACHO,DDS RELINING Resurfacing of a denture base with a new material to make it fit the underlying tissues more accurately REBASING Replacement of a denture base with new material without changing the occlusal relations of the teeth REASONS FOR RELINING •  Loss of retention and stability •  Loss of VDO •  Esthetic Concerns •  Patient Discomfort 
 
 
 Relineß————-àRebase
 ____________________________________________________________________________________________________________________
 
 Minimal to moderate changes Moderate to maximal changes Patterns of Resorption - Mandible Denture Reline • Remove acrylic from the intaglio surface • Reduce the flanges to create a butt joint Border mold the denture with green stick compound as you would do on a custom tray Impression Materials •  Polysulphide •  Polyvinyl siloxane New Impression Registration •  Closed – Mouth Procedure Make an impression in the denture with impression material that is capable of accurately reproducing soft tissue The final cast should be neat and easy to work with. An improperly poured cast is very hard to separate because the denture is locked into place by undercuts. Lubricate both parts of the jig with petroleum jelly. Make a patty of plaster in the lower half of the jig and seat the denture teeth in it. Mount the upper half of the jig to the cast. Let it set, then separate the two halves. Separate the denture from the cast. Thoroughly clean the cast with hot water and detergent. Remove the impression material from the denture base and reduce the intaglio surface of the denture to provide room for the reline material. Reposition the denture back into the index. Paint the tooth portion and any area of the denture that is not to be bonded to by the acrylic with the lubricant supplied by the company. Cure in a pressure pot at 115 o F and 25 lbs/in 3 for 30 minutes or as the manufacturer of the relining acrylic recommends. Denture Rebasing Denture Rebasing • If the denture base is not suitable for relining, then a rebase is an option. • Complete all the preliminary steps of the impression as were done for the reline. It is necessary to have the cast mounted in a suitable jig before anything is done with the denture. Denture Rebasing Cut out the palate and trim off excess acrylic around teeth. The teeth will be left as a block Denture Rebasing After the acrylic denture base is trimmed back from the teeth, the block of teeth are fixed in place in the index. Denture Rebasing Flow wax around teeth to fix them into place. After this wax hardens, more wax can be added and contoured to the ideal denture base form. The wax-up should be tried against an opposing cast to determine suitability of occlusion. Two thicknesses baseplate was added to palate Teeth sealed in wax to cast Denture fully contoured in wax USE A DENTURE FLASK TO REBASE THE D ENTURE Place resin dough over teeth Place plastic sheet over resin Press dough to express any excess Note overfilling flash in lower part of flask After the rebased denture is completed, a remount of the casts needs to be done to ensure proper occlusion with the opposing dentition. Tissue Conditioning Tissue Conditioning Inflamed oral mucosa Healthy oral mucosa • At the first clinical appt, the patient’s existing dentures are evaluated for fit and occlusion. If they are found inadequate, they can be adapted with temporary denture liners and the occlusion re-established using tooth colored cold cure acrylic. • Soft Tissue conditioning is necessary to improve the health of the soft tissue prior to fabrication of new dentures • The procedure is repeated every 2-3 weeks until the soft tissue appears healthy. Tissue Conditioning Indications • • Discomfort Abused tissues Tissue Conditioning General Instructions for Using Tissue Conditioners • Have patient close into centric relation • Verify the Vertical Dimension of Occlusion (VDO) •  Check the midline. •  Muscle trim. Before tissue conditioning After tissue conditioning Relining a Complete Denture • Check the flange extensions and shorten as necessary. •   Resin may need to be removed from the bearing surface to make room for treatment liner. Reduce the tissue surface (intaglio) with an acrylic bur. This procedure freshens the surface to be bonded and provides space for a layer of tissue conditioner. Draw a line around the border that is about 2 mm in from the border except in the posterior palatal area, then reduce the denture borders to this line. Follow the manufacturer’s mixing instructions. Apply lubricant to the teeth and other parts of polished surface of the denture to act as a separating medium where bonding of the tissue conditioner is not desirable. The denture is inspected to ensure that the tissue surface is relatively smooth. Orally this tissue conditioner will be moldable for several hours, so a little roughness around the margin would not be uncomfortable and would soon be contoured to fit the mouth. The tissue conditioner relined denture is removed from the mouth after about 10 minutes and is inspected. A properly applied tissue conditioner will have extruded evenly around the periphery of the denture and will provide a good coverage of the tissue surface. • Life span of the material: 2-3 weeks depending upon oral hygiene and oral flora. • Instruct patient not to soak the denture in effervescent denture cleansers. This could loosen the denture to reline bond. Since the tissue conditioners absorb moisture and harden over time they must be recovered from the patient within a few weeks after they are placed. Resilient Liners Will not bond well to dentures that have been worn because the porous tissue surface of the denture has contaminants incorporated into it. Plasticized Acrylics (Lynal, Coe-Soft,Hydro-Cast,ViscoGel) • Often used as a functional impression for a reline or rebase (Left in place no more than 3 days.) • Improve the health of tissues prior to making an impression. • Temporary or short-term liners. Silicones (Molloplast-B, LUCI-SOF) • More durable. • More suitable for long-term use (3-4 years). • Will not compensate for inadequacies in either base or tooth arrangement. Denture Repair Denture Repair Midline fracture of the maxillary denture • • • • • • • Most common fracture. Ridges resorb and remodel. Palatal bone does not resorb. “High-centering” of the denture Rocking effect accelerates Bone loss. Leads to a stress fracture. Denture Repair #1 rule when repairing fractures of a complete or partial denture • Always fit the pieces of the denture together with sticky wax and place it against the opposing denture or a cast of the opposing teeth to ensure that the denture is correct for the patient. Denture Repair Repairing a Fractured Complete Denture When a midline fracture of a maxillary complete denture occurs, the cause must be determined. As with any fracture, this must be corrected if the repair is to be successful. First, assemble the pieces and try them against a cast of the opposing dentition. Remove enough acrylic from the polished surface side of the denture to allow a gap of 8-10 mm. This provides an increased surface area that affords a stronger joint between the old and new acrylic. Tooth Fracture Repairs RELINE,REBASE AND REPAIR OF COMPLETE DENTURES PROSTHODONTICS DEPARTMENT LILIANA ORTIZ CAMACHO,DDS