CLINICAL REPORT

Consequences of relining on a maxillary complete denture:

A clinical report
Yung-tsung Hsu, DDS, MS

Relining a complete denture is ABSTRACT

often mistakenly assumed to be
The position of a complete denture may change after relining, especially in the maxillary arch. This
a simple procedure1; however, report reviews relining techniques and presents a situation with anterior displacement after the
problems such as incorrect ve- relining of a maxillary complete denture. Instead of providing a new denture, the displaced denture
rtical dimension of occlusion was repaired and the original tooth arrangement maintained. (J Prosthet Dent 2015;-:---)
and errors in centric occlusion
can occur when the procedure is poorly performed.2 By relining impression, a relined denture may still be dis-
definition, relining is resurfacing the intaglio surface of a placed.15-17 This article presents a patient whose maxillary
complete denture with new material.3 This procedure denture was relined previously, but the position was
is indicated after ridge resorption, abrasion, or over- altered after the relining. The diagnosis and procedures for
adjustment of the intaglio surface of the denture base,4 or correcting the displaced denture are also presented.
after a recent extraction.5 Before relining a denture, the
clinician should verify whether the jaw relationship, ver-
CLINICAL REPORT
tical dimension of occlusion, and esthetics are acceptable
on the existing dentures. If not, remaking the dentures A 73-year-old white man who had been edentulous for
should be the treatment option. more than 15 years came to the University of Alabama at
A denture can be relined with an open-mouth or Birmingham School of Dentistry Comprehensive Care
closed-mouth technique.6,7 Many clinicians prefer the Clinic with the chief complaints of a bulky maxillary
closed-mouth technique to minimize the change in denture and the inability to masticate well. This patient
occlusal relationship.8 Both techniques emphasize the stated that he had received 2 implants (Tapered Internal
importance of removing the undercut and relief on the Ø3.8×12 mm; BioHorizons) in the mandibular arch and
intaglio surface of the denture to provide a space for the had new complete dentures made after the implants
impression material. Some clinicians suggest creating were uncovered 3 years previously. A review of his
holes on the palatal area or removing part of the palatal medical history revealed that the patient was taking hy-
portion of the denture to improve the seating of the den- drochlorothiazide for hypertension and had been a
ture during impression, especially on the maxillary den- smoker for more than 10 years before stopping 4 years
ture.2,9-11 To improve the border seal of the dentures, the previously. He had regular follow-up appointments with
extension of the flange may be reduced and remolded with his physician. An intraoral examination revealed healthy
different materials.2,9,11 To avoid displacement of the mucosa and plaque around the implant abutments
denture, different low viscosity impression materials have (Figs. 1, 2). No pain or inflammation was found on
been suggested.6,8,9,12-14 Even by using the above tech- palpation of the mucosa.
niques to minimize the change in the vertical dimension of His mandibular denture was retained by 2 Locator
occlusion or the displacement of the denture during the abutments (Zest Anchors) with the blue inserts in the

Associate Professor, Department of Restorative Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Ala.

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Figure 1. Maxillary arch.
Figure 3. Significant horizontal overlap of anterior teeth.
metal housings. He returned to the clinic every 6 months
after the delivery of the dentures. Eighteen months after
the delivery of the dentures, he started to feel loosening in
both dentures. The blue inserts of the attachments were
replaced, and the maxillary denture was relined with the
closed-mouth impression technique and polyvinyl
siloxane (PVS) impression material (Aquasil Ultra Mono-
phase; Dentsply Caulk). The impression material was
replaced with heat-polymerizing acrylic resin (Lucitone
199 Denture Resin; Dentsply International). He returned
for a follow-up visit the next day. Six months after the
delivery of the relined denture, he came to the clinic for the
follow-up appointment with the previously mentioned
chief complaints. An intraoral examination revealed a
significant horizontal overlap on the anterior teeth (Fig. 3).
He stated that after the delivery of the relined denture, he
felt the denture to be bulky and that the thickness on the
border had been trimmed at the 24-hour follow-up
appointment. He expected the bulky feeling would grad-
ually go away; however, he still felt the border was too thick
at the 6-month follow-up appointment. The vertical
dimension of occlusion was acceptable as verified with the
phonetics and physiologic rest position techniques. The
THE JOURNAL OF PROSTHETIC DENTISTRY
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Figure 2. Mandibular arch.
Figure 4. Closed-mouth technique with occlusal record.
diagnosis was anterior displacement of the maxillary
denture after relining. Because the patient was satisfied
with the size and tooth arrangement before the relining,
the treatment plan was to reposition the teeth to the
original positions and to perform occlusal adjustment. A
centric relation (CR) occlusal record was made with PVS
material (Regisil PB; Dentsply Caulk). The undercut on the
intaglio surface was relieved, and the border of the denture
was reduced by 2 mm. Border molding procedures were
performed with green modeling plastic impression com-
pound. Two holes were created at the middle anterior
palatal part of the denture. The relining impression was
made with low-viscosity PVS impression material (Aquasil
Ultra LV; Dentsply Caulk) and the closed-mouth tech-
nique with an occlusal record (Fig. 4). The vibrating line
was marked at the junction of the movable and immovable
soft palate and transferred to the impression. The midline
of the face was marked on the mandibular denture. The
maxillary denture with the impression was boxed and
poured with a Type 3 dental stone (Microstone; Whip Mix
Corp). After the stone had set, the maxillary denture with
the stone cast was mounted in a semiadjustable articulator
(Hanau Wide-Vue; Whip Mix Corp) with a facebow
Hsu
- 2015
Figure 5. Separate denture teeth from base.
Figure 7. Denture teeth with silicone matrix and maxillary cast.
transfer (Spring-Bow; Whip Mix Corp). A remount cast
was fabricated for the mandibular denture, and this den-
ture was oriented to the maxillary denture with the CR
record. The maxillary denture was removed from the stone
cast, and the postpalatal seal area was carved in the cast
according to the vibrating line transferred from the
impression. The impression material and modeling plastic
impression compound were removed from the denture.
The denture teeth with acrylic resin were cut from the
denture (Fig. 5). The teeth block was centered with the
midline mark and oriented to the mandibular denture to a
maximum intercuspation position and secured with sticky
wax (Fig. 6). The horizontal overlap for the anterior teeth
decreased from 4.5 mm to 2 mm. An index was fabricated
with PVS putty (Splash; DenMat Holdings, LLC) on the
facial and buccal surfaces of the denture teeth. The intaglio
surface of the teeth block was adjusted until there was no
contact between the stone cast and acrylic resin when the
upper member of the articulator closed (Fig. 7). Two layers
of baseplate wax were added to cover the stone cast and to
connect the teeth block (Fig. 8). The thickness of wax was
measured with a periodontal probe to avoid a bulky den-
ture base. The denture was processed with the
Hsu
3
Figure 6. Maxillary teeth oriented and secured to mandibular denture.
Figure 8. Wax added to seal tooth block and stone cast.
conventional technique. At the delivery appointment, the
intaglio surfaces were evaluated by a pressure-indicating
paste (Pressure Indicating Paste (PIP); Keystone In-
dustries), and the dentures were remounted with a new CR
record for occlusal adjustment. The patient returned to the
clinic for a 24-hour follow-up, and no sore spot was
noticed. At the 6-month follow-up, he was satisfied with
the retention and comfort of the maxillary and mandibular
dentures.
DISCUSSION
The fit of a denture decreases with use because of ridge
resorption or the wear of the acrylic resin base by daily
brushing. However, no guidelines exist to assist clinicians
in determining when a denture should be relined.18
Patients may not be aware of the change and have no
regular postdelivery appointments with clinicians until
improved retention is needed.19 In this report, the patient
returned to the clinic for regular follow-up appointments
every 6 months, and the relining request was initiated by
the patient 2 years after the delivery because of the lack
of retention on the maxillary arch.
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When a displaced relined denture is identified, a
clinician may either remake or repair the denture.
Remaking a denture usually requires more appointments
and additional costs. Using this presented technique will
decrease the number of appointments. Although the
intaglio surface of a denture is relieved before making the
relining impression, the amount of relief is an estimate
and will be uneven in different locations. The denture
may be seated at an unstable position if the intaglio
surface is relieved aggressively. When the denture is
loaded with an impression material, even with a low
viscosity one, the material still may push the denture
away from the original position. The displacement may
be more significant when a soft liner type of material is
used because of the viscosity of liner material. The den-
ture is easily displaced forward, and the vertical dimen-
sion of occlusion is increased if too much material is
used.2 Using an occlusal record may not ensure the
original position because the mandible could move to a
different position to fit the record. Removing the palatal
portion of a denture will minimize the hydraulic pressure
from the impression material but will also decrease the
stability of the denture during the impression procedure
and create another challenge to record the palatal area
accurately through the impression. In this report, only
holes were created on the palatal area to prevent voids on
the impression. Because the denture was displaced for-
ward, the border of the denture was no longer accurately
adapted to the range of muscle movements. The
border extension was reduced and remolded with
modeling plastic impression compound. When making
the impression, the denture was seated in the anterior
part of the ridge first and the posterior part rotated up to
the ridge to avoid displacement from the undercut of the
anterior ridge. After the impression, a clinician can
examine the thickness of impression material, especially
at the anterior ridge area. To evaluate whether the den-
ture has been displaced anteriorly, a clinician can mea-
sure the distance between the center of incisive papilla to
the anterior teeth with a Boley gauge or an Alma gauge
(Dentsply Intl) before and after the relining impression.
In addition, the thickness of impression material at the
distal buccal corner should be similar to the dimension of
the molded modeling plastic impression compound. If
the polymerized impression material on this area be-
comes thinner than the dimension of modeling plastic
impression compound, or becomes unsupported from
the modeling plastic impression compound, the denture
was not seated to the position where the border molding
procedure was performed and the impression will not be
accurate.
If cusped denture teeth are used, the 2 opposing
dentures may be oriented with the existing cusp-to-fossa
relationship without an occlusal record. For nonanatomic
teeth, the dentures should be placed according to the
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horizontal relationship of the posterior teeth to avoid the
cheek-biting problem. The thickness of the baseplate
wax has to be measured with a sharp instrument or a
periodontal probe to ensure the ideal thickness of the
denture base. In this report, the maxillary denture was
placed according to the cusp-fossa relationship and the
midline mark on the mandibular denture. A relined
denture must be mounted on an articulator for occlusal
equilibration because of the discrepancy of position.15-17
The limitation of this reported technique is that if the
occlusal surfaces of the denture have been ground too
aggressively after the initial relining, a new denture is
indicated.
CONCLUSIONS
Relining impression may result in a displaced denture. If
a displaced denture is identified, a clinician could use the
presented technique to avoid remaking the denture.
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Corresponding author:
Dr Yung-tsung Hsu
1919 7th Avenue South, Rm 534
Birmingham, AL 35294
Email: ythsu@uab.edu
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Hsu