21

Relining and rebasing the removable partial

denture
Relining Tooth-Supported Denture Bases Relining
Distal Extension Denture Bases Method!i of Ree!
itllbli_hing Ocdu_ion
on a Relined Partial Denture Self.Assessment
Aid_

ifferentiation between relining and rebasing halO tissue conditioning material5, with an activated acrylic
D been di5cu55ed previously in resin used as an impression material, or with a mouth-
Chapter 1. Briefly, relining is the resurfacing of the temperature wax:
tissue surface of a denture base with new In deciding between a closed-mouth and an open-
material to make it fit the underlying tisSUQS mouth impression method for relining, one must first
more accurately, whereas rebasing is the replacement of consider the reasons for doing so and the objectives to be
the entire denture base with new material while obtained. Again, it is necessary to differentiate between
preserving the occlusal relationship. The artificial teeth the two basic types of partial dentures, one being the all
may need to be replaced in a rebase procedure. tooth-supported restoration and the other the tooth- and
Relining removable restorations is 11 common tissue-supported restoration.
occurrence in many dental practices; however, rebasing Before relining or rebasing is undertaken, the oral
is not indicated as often. tissues must be returned to an acceptable state of health.
In either situation a new impreSSion regis_ tration is For murt: information refer to the Chapter 16 discussion
necessary and uses the existing denture base as an about conditioning abused and irritated tissues.
impression tray for either a dosed-mouth or an open-
mouth impression procedure. One of several types of
impression materials may be used. The impression may
be made with a metallic oxide impression paste, with
one of the rubber-base or silicone impression materials, 'From An impression made while the mouth is closed and
with one of the with the patient's muscular activity molding the borders.
In Zwemer TJ, ed: Boucher's clinical dental terminology,
ed 3, St Louis, 1982, Mosby.
451
452 McCracken's removable partial prosthodontics

supported area in which early tissue changes are

RELINING TOOTH-SUPPORTED DENTURE anticipated. A metal base should not be used after recent
extractions or other surgery or for a long span when
BASES relining to provide secondary tissue support is
When total abutment support is available but for one anticipated. (A distal extension metal base is ordinarily
reason or another a removable partial denture has been used only when a partial denture is made over tissues
the restoration of choice, support for that restoration is that have become conditioned to supporting a previous
derived entirely from the abutment teeth at each end of denture base.)
each edentulous span. This support may be effective Because the tooth-supported denture base cannot be
through the use of occlusal rests, boxlike internal rests, depressed beyond its terminal position with the occlusal
internal attachments, or supporting ledges on abutment rests seated and the teeth in occlusion, and because it
restorations. Except for intrusion of abutment teeth under cannot rotate about d fulcrum, d closed-mouth
functional stress, settling of the restoration toward the impression method is used. Virtually any impression
tissues of the ri:'gidual ridgl" is prl"vl"ntl"d by thl" material may be used, provided sufficient space is
supporting abutments. Tissue changes that occur beneath allowed beneath the denture base to permit the excess
tooth-supported denture bases do not affect the support material to flow to the borders, where it is either turned
of thl" denture, and therefore relining or rebMing is by the bordering tissues Of, as in the palate, allowed to
usually donI" for rl"asons that include (1) unhygienic escape through venting holes without unduly displaclfig
conditions and the trapping of debris between the thl' undl'rlying tissues. The qualities of each type of
denture and the residual ridge; (2) an unsightly conaition impression matl'rial must hI' kept in mind when onl" is
that results from tnespace that has developed; or (3) selecting the material to be used. Ordinarily an
patient discomfort associated with lack of tissue contact impression material is used that will record the anatomic
that arises from open spaces between the denture base form of the oral tissues.
and the ti:5:5ue:5. Anteriorly, 10:5:5 of support beneath a A word of caution 5hould be mentioned when
denture base may lead to some denture movement, relining a tooth-:5upported acrylic resin base with
despite occlusal support and direct retainers located autopolymerizing acrylic resin as an intraoral procedure.
posteriorly. Ri:'basing would bl" the trl"atment of choice When one or more relatively short spans are to be
if the artificial teeth are to be replaced or rearrangi:'d, or relined, making an impression for rl"lining purpOSl"S
if the denture base needs to be replaced for esthetic rl"quirl"s that the denture be flasked and processed. The
reasons or because it has become defective. po55ibility that thr vrrtiml di11lW5ion of OCclU5ioll
To accomplish either relining or rebasing, the original may be increased and that the denture may be
denture base must have been made of an acrylic resin dibtuTtnl eluTing luuuTutunj prucraurr5 mu5l be;
material that can be relim!d or rQplaCQd. Commonly, weighed against the disadvantages of the use of a direct
tooth-!;upportQd partial dQnture bases are made of reline material. Fortunately thQ!;Q material!; are
metal as part of the cast framework. These generally constantly improved with greater predictability and color
cannot be satisfactorily relined, although they may stability. The possibility that the original denture base
sometimes be altered by drastic grinding to provide will become crazed or distorted by the action of the ac-
mechanical retention for the attachment of an entirely tivated monomer is minimal when the base is made of
new acrylic resin base, or some of the new acrylic resin modern cross-linked acrylic resin. However, caution
bonding agents, such as Four-meta, Silicoating, or should be exercised to be sure that the older types of
Rocatec, may be used. Ordinarily a metal base, with its acrylic resin bases are compatible when relining with
several advantages, is not used in a tooth direct reline acrylic resins.
When relining in the mouth with an acrylic
 Chapter Relining and rebasing the removable partial denture 453
21
resin reline material is done with a definite technique, terminal position with finger pressure on the occlusal
the results can be quite satisfactory, with complete surfaces while border molding is in progress.
bonding to the existing denture base, good color 6. Immediately remove the denture from the mouth and
stability, permanence, and accuracy. The procedure for with fine curved iris scissors, trim away gross excess
applying a direct reline of an existing acrylic resin base material and any material that has flowed onto
is as follow:5; proximal tooth surfaces and other components of the
L Gf'nf'rously rf'lieve the tissue side of the denture framework. While doing this, have the patient
denture base. Lightly relieve the borders. This not again rinse the mouth with cold water. Then replace
only provides space for an adequate thickness of new the denture in its terminal position to bring the teeth
material but also eliminates the possibility of tissue into occlusion. Then l-epeat the border movements
impingement because oi coniinement of the material. with the patient' s mouth open. By this hme, or soon
2. Apply lubricant or tape over the polished surfaces thereafter, the material will have become firm enough
from the relieved border to the occlusal surfaces of to maintain it:5 form out of the mouth.
the teeth to prevent new resin from adh_rinB to th(:,\ 7. Remove the denture, quickly rin_e it in water, and dry
Pf(:,\S(:,\fV(:,\d bases find teeth. the relined surface with compressed air. Apply a
3. Mix th(:,\ POWd(:'\f and liquid in a suitable generous coat of glycerine or Teet-ol with a brush or
container according to the proportions recom- cotton peJ1et to prevent frosting of the surface caused
mEndEd by the manufacturer. by evaporation of monomer- Allow the material to
4. While the material is. reaching the desired bench cure in a container of cold waterThis will
consistency, have the patient rinse the mouth with eliminate any patient discomfort and tissue damage
cold water. At the same time, wipe the fresh surfaces that could have resulted
of the dried dentur_ bas(:,\ with a cotton p_ll,;>t or from exothermic heat or prolonged contact of the
small brm:h saturated with some of the reline acrylic tissues with raw monomer. Allhough it is
resin monomer. This facilitates bondinsand ensures preferablQ that 20 to 30 minutes elapse before
that the surface is free of any contamination. trimming and polishing, it may be don(:,\ as
5. When the material has first begun to thicken, but soon as the material hardens- Polymerization
while it is still quite fluid, apply it to the tissue side may be expedited and condensed by placing the
of the denture base and over the denture in warm water in a pressure pot for 15 minutes
borders. Immediately place the denture in the mouth at 20 psi. The masking tape must be removed before
in it:5 terminal po:5ition, and have trimming is done but :5hould be replaced over the
the patient close into occlusion. Be sure no teeth and polished surfaces below the junction of the
malerial floW:5 over the occlu:ml :mrfaces or new and old materials to protect those surfaces during
alLer:5 the establi:5hed vertical dimension of final polishing
occlusion. Then, with the patient's mouth open, Properly done, a direct reline is entirely acceptable
manipulate the cheeks to turn the exce"" at the border for mO:5t tooth-:5upported pelrtiell denlure bll.:5e:5
and establish harmony with bordering attachments. If llUtde of an acrylic resin material, except when some
a mandibular partial denture is being relined, have tissue support may be obtained for long spans between
the patient move the tongue into each cheek and then abutment teeth. In the latter situation, a reline impression
against the anterior teeth to establish i'! functional in tissue-conditionins material or other suitable elastic
lingual border. It i5 necessary that the direct retainers impression material may be accomplished, the denture
be effective to prevent displacement of the denture may then be flasked, and a processed reline may be
while molding of the borders is accomplished. added for optimum tissue contact and support.
Otherwise the denture must be held in its
454 McCracken's removable partial prosthodontics

pressure is applied on either side of the fulcrum

RELINING DISTAL EXTENSION DENTURE BASES line (see Fig. 9-16). Although checking for occlusal
contact alone may be misleading, such rotation is positive
proof that relining is necessary. If occlusal inadequacy is
A distal extension partial denture, whkh derives its major detected without any evidence of denture rotation toward
support from the tissues of the residual ridge, requires the resldual ridge, all that needs to be done is to
relining much more often than does a tooth-supported reestablish occlusal contact by rearranging the teeth or by
denture. Because of this, distal extension bases are adding to the occlusal surfaces with resin or cast gold
usually made of an acrylic resin material that can be onlays. On the other hand, if occlusal contact is adequate
relined to compensate for loss of support caused by but denture rotation can be demonstrated, it is usually a
tissue changes. Although tooth-supported areas are result of migration or extrusion of opp05in_ teeth or CI
relined for other reasons, the primary reason for rl'lining _hift in position of an opposing maxillary denture, thus
a distal extl'nsion base is to reestablish tissue support for maintaining occlusal contact at the expense of the
that base. stability and tissue support of that denture. This is often
The need for relining a distal extension base is the situation when a partial denture is opposed by a
determined by evaluating thl-' st<ibility and occlusion at maxillary complete denture. It is not unusual for a
reasonable intervals after initial placement of the patient to complain of looseness of the maxillary com-
denture. Before initial placement of the denture the plete denture and request relining of that denture when
patient must be advised that (1) periodic examination dctudlly it is the pdrtidl denture that needs relining.
and also relining, when it becomes necessflry, are Relining and thus repositioning the partial denture results
imperative; (2) the success of the partial denture and the in repositioning of the maxillary complete denture with
health of the remaining tissues and abutment teeth CI return of stability and retention in that denture.
depend on periodic examination and servicing of both Therefore evidence of rotation of a distal extension
the denture and the abutment teeth; and (3) a charge will partial denture about the fulcrum line must be the
be made for these visits in proportion to the treatment deciding factor as to whether relining needs to be done.
required. Rotation tis:meward about the fulcrum line always
There arc two indications of the need for relining a results in a lifting of the indirect retainer(s). The
distal extension partial denture base. Fir1it, a lo:s:s of framework of any distal extension partial denture must be
occlu:sal contact between oppo:sins dentures or between in its original terminal position with indired retainers
the denture and opposing natural dentition may be fully seated during and at the end of any relining
evident (see Fig. 9-15). This is determined by having procedure. Any p05sibility of rotation about the fulcrum
the ?ati_mt close on ,two strips of 2S-gauge soft green or line because of occlusal influence must be prevented, and
blue (casting) wax or Mylar matrix strips. If occlusal therefore the frdmework must bc held in its original
contact between artificial dentition is weak or lacking terminal position during the time the impression is being
while the remaining natural teeth in opposition are made. This all but eliminate:; the practicality of the use
making £inn contact, the distal extension denture needs of a do:sed-mouth impres:sion procedure effectively
to have occlusion reestablished on the present base by when relining unilateral or bilateral distal extension
altering the occlusion reestablishing the original position bases.
of the denture framework and ba:se, or, :sometimes, Therefore the only sure method of making a reline
both. In most instances, reestablishing the original impression for a distal extension partial denture is with
relationship of the denture is necessary, and the an open-mouth procedure done in exactly the same
occlusion will automatically be reestablished. manner as the original secondary impression (see Fig.
Second, a loss of tissue support that causes rotation 16-13). The
and settling of the distal extension base or bases is
obvious when alternate finger
 455
Chapter Relining and rebasing the removable partial denture
21
denture to be relined is first relieved generously on the ration not only of the original denture relationship and
tissue side and then is treated the same as the original tissue support but also of the original occlusal
impression base for a functional impression. The step- relationship (Fig. 21-1).
by-step procedure is the same, with the dentist's three
fingers placed on the two principal occlusal rests and at
a third point between, preferably at an indirect retainer METHODS OF REESTABLISHING OCCLUSION
farthest from the axis of rotation. The framework is thus ON A RELINED PARTIAL DENTURE
returned to its original terminal position, with all tooth-
Occlusion on a relined partial denture may be
supported components fully seated. The tissues beneath
reestablished by several methods and depends on whether
the distal extension base are then registered in a
the relining results in an increase in the vertical
relationship to the original position of the denture that
dimension of occlusion or in a lack of opposing occlusal
will ensure (1) the denture framework will be returned
to its intended relationship with the supporting teeth; contacts Tn either instance, it is usually necessary to
(2) thl" rl"l"stablishment of optimum tissue support for make a remounting cast for the relined partial denture so
the distal extension base; and (3) the restoration of the that the denture can be correctly related to an opposing
original occlusal relationship with the opposing teeth. cast in an articulator as described in Chapter 20 (see Fig.
Although it is true that the teeth are not 20-2).
allowed to come into occluBion during an open-mouth In rare instances, after the relining of a distal
impression procedure, the original position of the extension partial denture by the method previously
denture is ptJ5itively determined by its relation:ship described, the occlusion is found to be negative rather
with the Bupporting abutment teeth. Becau:se thi5 i5 than positive, or the same as it was before relining. This
the relationship on which may be a result of wear of occlusal surfaces over a period
the orit;inal occlusion was established, returning the of time, the
denture to that position should bring about a rerurn to original occlusion being high with resulting
the original occlusal relationship if two conditions are depression of opposing teeth, or other reasons. In such a
sati"fied. Fir5t of theBe iB that the laboratory _ituation, occlu5ion on the denture must be restored to
procedure::; durin!'; relining must be done accurately reeshblish an even distribution of occlusal loading over
without any increase in vertical dimension of occlusion. both natural and artificial dentition. Otherwise, the natural
This is essential to any reline procedure, but it is a dentition must carry the burden of ma::;tication
partiLuhu nece__ity with a partial dl'nture because any unaided, and the denture becomes only a space-filling or
change in occlusal v_rtil!a.l dim_ngion will prevent cosmetic device.
occlusal rests from sedting dnd will reBult in over- If the artificial teeth to be corrected arc acrylic
loading and. trauma to th{\ und{\rlying tissues. The resin, the occlusion can be reestablished either by adding
second condition is that the opposing teeth have not autopolymerizing or light-activated acrylic resin to
extruded or mi15rated or that the position of an occlusal surfaces or by fabricatinB Bold occlusal surfaces,
oppoSing denture has not become irrcver_ibly altered. In which can be attached to the original repillced teeth. The
the latter situation some oribinal h!Qth may also be removed from the denture base
adjustment of the occlusion will be necessary, but and replaced by new teeth anang,ed to harmonize with the
lhi:> :>hould be deferred until the opposing teeth or opposing occlusal surfaces. Baseplate _ax may be used to
denture and the structures lI:>:>ocillted with the support the tQQth as they are arranged. The wax should
temporomandibular joint have had a chance to return to be carved to restore the lingual anatomy of the teeth and
their original position before denture settling occurred. the portion of the denture base that was
One of the greatest satisfactions of a job well done is in eliminated when the original teeth were removed. A stone
the execution of an open-mouth reline procedure as matrix is made that covers the occlusal and lingual
described previously, which results in the resto surfaces of the teeth and
456 McCracken's removable partial prosthodontics

A B

c D

Fig. 21-1 Because of potential for occlusal distortion, alternative procedure for relining _hould be
considered. Metal reline jig may be used effectively to preserve vertical and occ1wml rdalion;:!hip_
of partial denture. Procedure firBt requircB that suitable impression be "ccompli"hQd, following
guidelines discu""ed in text. A, Stone cast 1S made to record impression portion and also to contact
but not entrap, sufficient parts of framework to ensure stable cast base. I}, Cast is then affixed to
upper or lower member of reline jib' C, OcclUBaJ BurfaceB are isolMp.1 in blackout and stone
opposing cast is poured and secured to other member of jig. V, When stone has thoroughly set, jig is
separated, partial denture i" removed from cast and
ti"sue surface(,,) and border" are relieved

Contmuect
denture flange. Then wax may bc rcmovcd from the acrylic resin is then used to attach the teeth. If an
denture base and teeth and the tissuebea.rinlJ tmrfa.ce autopolymerizing material is used it can be conveniently
coated with a bondino aocnt. Those areas on the stone sprinkled on by a buccal approach. The buccal surface of
matrix, intimate to the new acrylic resin to be added, the denture base adjacent Lo Lhe Leeth _hould be
should be painted with a tinfoil substitute or an air _li15htly overfilled BO the cuned :shape nmy be re_tored
barrier coating material if a visible light-cured (VLC) to thiB portion of the base during finishing and polishing
material is to be used. The new teeth are placed in the procedures. Occlusal discrepancies caused by this
stone matrix, and the matrix is accurately attached to the procedure should be corrected on the articulator by new
denture base with sticky wax or a hot glue gun. VLC jaw relation records if the denture has a distal extension
material or an autopolymerizing base.
 Chapter Relining and rebasing the removable partial denture 457
21

E f

FiS' :1:1-1, c:ont'd. E, A1.1.toFolymorizins acrylic rQsin is mixQd to thick, runny consistency and
carefully placed into base and into any deep llrell1\ of Cll1\t. F, Framework io replaced on Ci1ot, and
membcm of jig Qre realigned. and. tisht...nQd to complete closure, covered with warm water, and
placQd in a pmssure pot at 20 psi for 15 minutes G, Re'<toration is finished and polished. Became of
secure positioning of base to cast this mf'thod virtually ensures that no changes will occur in occlusal
vertical dimension or in occlusal relationship.

A second method i1\ to remove the original teeth and adjuBtment in the mouth and should exhibit the occlusal
replace them '-\lith a hard inlay '-\laX occlusion rim vn harmony that is possible by this method.
which a functional ret;iBtmtion of occlusal pathways is
then established (see Chapter 17). Either the original
teeth or new teeth may then be arranged to occlude with
the templ:at._ thus obtained and subsequently attached SJ:,LF- A:):)J:,sSMBNT
to the denture base with processed VLC material or AIDS
alltopolymerizing acrylic resin. If the latter is used, the
need for flasking may be eliminated by securing the 1. What is the difference between relining and
teeth to a stone matrix while the acrylic resin attachment rebaBin15 an acrylic reBin denture base?
is applied with a brush technique. Regardless of the 2. On occasion, tissue changes beneath toothsupported
method used for reattaching the teeth, the occlusion thus denture bases require correction of the bases to
established should require little reestablish intimate contact of the base and residual
ridge. List three indications that would lead one to
believe that intimate contact must be restored.
458 McCracken's removable partial prosthodontics

3. In any relining procedure, it is necessary to relieve 9. There is little difference in relining a distal extension
the borders and tissue surface of the denture base denture base and making a secondary impression
before making an impression. Why b thb required? with a tray attached to the framework. Describe the
4. Tooth-supported removable partial denture bases procedures, both clinical and laboratory, that must
may often be relined with a colormatching, be performed in relining a distal extension base.
autopolymerizing, or VLC acrylic resin as a 10. After completion of the reline procedure and
chairside procedure. Describe such a procedure, and finishing of the restoration, occlusal dbcrepancil's
include preparation of the invariably occur. ThI'Y must bl' cor
bases as well as the precautions that must be rected before the patient IS given possessIOn of the
observed for patient comfort. restoration. How are occlusal discrepancies for a relined
5. When relining a tooth-supported base, why should the distal extension denture corrected?
anatomic or functional form of the ridge be used? 11. Should the same adjustment procedures of the
6. Suppose that rests are not correctly seated in their denture ba_e to re_idual ridge be undertaken for a
prepared _eat_ when a chair_ide reline procedure is relined base as was performed for initial placement
accomplished. What mu_t be done? of a new denture? Why or why not?
7. Suppose a Class III, modification I, type of 12. Dues adjustment of the denture base to the basal
removable restoration must be relined: the seat precede or follow correction of occlusal
edentulous areas of the residual ridge are from discrepancies? Why?
canine to third molar on each side, and some 13. Suppose that after relining a distal extension denture
support of the _ases by the residual ridges is base one finds occlusal contacts of opposing
desired. What procedure should be undertaken to posterior artificial teeth are minimal or nonexistent
acceptably reline the restoration? Include What then?14. Before relining or reba"ing i"
impression procedure, impression material, undertaken, the oral tissues should be returned to a
processing, and correction of any occlusal state of health. True or falsl'? Rationalizl' your
discrepancies encountered. answer.
8. There are two indications of the need for relining a
distal extension removable partial denture. State
the"e two indications.