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					                                ‫بسم اهلل الرحمن الرحيم‬
                            Repair, relining &rebasing


   1st of all u should refer to the book for this lecture (Macgregor ch.15).

   Let’s start with repair of complete denture.

  We can do repair for complete & partial denture but in this stage we are
interested in repair of complete denture.

 What is the meaning of repair?

  we mean people who come to the clinic with fractured pieces of complete
denture either during function or dropped on hard surface while the patient
clean it for example & they want u to repair there denture .

 What’s the key of repair”i.e what’s determine if I can repair the denture or
not”?

 It is depending if I can resemble pieces together or not.



 We can classify fracture according to:

  1*location of the fracture & they could be:
 A*denture base fracture OR

 B**teeth fracture

 2**or it could be classified as fracture without missing part “as the patient
come to the clinic with fractured denture but without missing part ”OR
fracture with missing part .




                                                                                 1
We have a very common fracture, which is midline fracture that is
happen in maxillary & mandibular denture but mainly in maxillary
dentures.


What are the possible causes of midline fracture?


1*if u have a prominent torus palatinus so in this area we will have a good
relief & the acrylic will be thin on this area Sooooooo this is will be a good
reason for fracture of maxillary denture in this area.


2**or u could do good relief but with time there will be good resorption &
the denture will sink in →→ there’s no more relief →→the torous palatinus
will be a fulcrum point SOOOOOOOO the denture will fracture during
function.


3*** a very common reason is the prominent labial frenum “low
attachment level” where we do relief a lot.
Imagine that I have upper C.D where the labial frenum opened about 7-8
mm SOOOO this area will be the fulcrum point during function &it will be
the weakest point.
So the people who have fracture in the midline almost they have low
attached labial frenum “i.e. the labial frenum attached to the crest of the
residual ridge ”Soooooooooo we need to relief the crest a lot to avoid
interference with labial frenum SOoOoOo it will become the weakest point
& cause midline fracture of upper C.D .


REMEMBER that without diagnosing the problem we can’t treat it
SoOoOoo after diagnosing prominent labial frenum DO WE HAVE ANY
SORT OF MANEGMENT before cracking in C.D?
Frenectomy is the solution.


                                                                             2
                          Steps of repair of C.D
To make sure that we can repair C.D or not we need to make sure that the
two pieces could come together, if they come together evenly we can repair
C.D otherwise we need to make a new denture.
***Now the broken part will be brought together & we will stick them
together using sticky wax.
Do u know sticky wax ?
Cylindrical, yellowish in color, we melt it by heat, sticky wax by itself is
weak & brittle SoOoO u can easily remove it by carver & some of us use it
in the clinic after jaw registration stage.


****to make sure that this denture will not fracture again after we stick
pieces together using sticky wax we reinforce it by using “wires for
example or burs” just to make sure that the two pieces will be kept together
all the way through .


****now once they are okey & the two pieces stick to each other “i.e the
denture more or less the same as before” I need to pour this denture.
If I pour this denture using “plaster, stone or whatever …..”if there is any
undercut in the denture the denture will not be retrieved from the cast “i.e. if
u pour the denture in stone & after u complete u’r work u try to remove the
denture it will not because there’s undercut SoOoOoO u will need to break
the stone therefore there will be a very high chance to break the denture
again”
Therefore, the solution for this problem is block out undercut in C.D using
“wax, gauze, or whatever …..”But the most important thing is u block out
undercut then pour it.


****once we pour it we need to refresh ,clean the area of fracture & we
will make like retention key ways “i.e. grooves on margin of fractured
pieces of C.D” as u can see on the page#2 slide #3.


                                                                              3
Note :after we pour the denture, the denture will not move any more so we
will remove sticky wax & wires “remember that we but sticky wax & wires 1 st to
make sure that the cast will not move while u pour the denture ” but now the denture
is fixed & u refresh the acrylic & do retention grooves so when we add new
acrylic it will bind perfectly with old acrylic .


****now we will add new resin & by using new resin u will repair the
denture perfectly.


****finally, u de-invests the denture “just remove the denture from the
cast” & gives it to the patient.


Summary of steps :
1*make sure the 2 pieces come together.
2*stick pieces together using sticky wax.
3*reinforce the pieces using burs.
4*block out the undercut.
5*pour the denture.
6*refresh the acrylic & make retention grooves.
7*add new resin & finally de-invest the denture &give it to the patient .



                              Types of repair
                  We have two types of repair either we use :
1**cold cure pink acrylic resin: add it to fractured area & wait tell the
acrylic set then u will make finishing.
Or 2**we add wax (wax the denture up) to the slot that we open then we
flask it out to replace wax. the problem with this type that most of the
denture will be processed again “i.e. the denture was processed before 4, 5

                                                                                  4
year & now u need to reprocess it again” once u reprocess it there will be a
very high chance of warpage & may be the whole denture is changed after
processing.
For that reason, we prefer the cold cured acrylic resin though in cold cure
acrylic there is some sort of monomers, it is quite porous & is slightly
weaker than heat cured acrylic.
Therefore, the new repaired denture “by using cold cure acrylic” is:
Unhygienic & there is high chance of fracture again.


Notes: **if I have fracture with missing part then I need to make impression.
        **The idea about pouring the denture is just to make it stable as we
said.
     **we don’t use light cured acrylic because 1-until now there is no pink
light cured acrylic 2-light cured acrylic come in thick section & it doesn’t
bind well to heat cured & self cured acrylic.
   ** The idea about making retention grooves is to make a large surface
area to bind the new acrylic to the old acrylic perfectly.
   **if I have fractured denture with 3 or 4 pieces, remember the key of
repair I mean if I can resemble them together or not.


& now let’s continue with types of fracture :

We talked about midline fracture & we said that it’s the most common
type of fracture, most of the time the fracture happened during function ,
&the causes of it is we do so much relief on torus palatinus or labial frenum
so during function the denture is just click because the torus or labial frenum
will act as fulcrum point & if u look to this denture u will find cracks or even
micro cracks but finally it will fracture.


We have other part fracture such as ,labial or buccal flange fracture
what’s u will do ?


                                                                               5
If u can resemble the flange to it’s place there is no problem & we do the
same procedure explained above.
But if u have fracture with missing pieces 1 st of all u need to make sure that
this area is not too critical, for example when we speak about post dam area
it’s not easy to add it to broken denture, but when we speak about flanges,
usually these fractures need experience to tell if u can repair it or not, but if
it’s simple as the one on the page#2 slide #6 so what’s u will do ?
>>Bring the patient to the clinic
>>do border molding & make impression, this impression is like C.D
impression .
>>regarding missing part u either flask it or add cold cured acrylic resin.
So take impression >>>pour it >>>>now the denture on the cast >>>remove
the pieces that u added from green stick & impression material >>>u will
have a space so either u add heat or cold cured acrylic resin


So it’s the same as fracture without missing part but in 1st one we resemble
the pieces together while on the fracture with missing part we added a new
piece but the new piece added from new impression for the area I want .


Or u could end up with fractured teeth or missing teeth :
>>>usually if tooth is totally lost as u see on the page#3 slide#1 it’s easy to
reposition a new tooth & repair it with cold cured acrylic .
>>>if there are 3 or more teeth get fractured but part of them are still in the
denture base what is u need to do ?
1<<<<remove the whole teeth as u see in page#3 slide #2 .
2<<<add new teeth with wax up if u want & we use wax up especially when
we have multiple missing teeth “i.e. add teeth to existing denture as we do
on setting of complete denture ”
3<<<after we add teeth to the denture we make index what’s we meant by
index?

                                                                               6
_we make it using plaster or stone .
_I pour the labial surface only .
_on the index the shape of the ant. Teeth are carved.
_so after I make setting for teeth as we said it’s fixed by wax then I make the
index then I dewax the denture then I add the teeth again using index & by
using cold cured acrylic resin.
 Let’s take an example :
Imagine that the four incisor are missed what I can do?
Here we can’t add the teeth using cold cured acrylic directly because this
will take time but what’s we do is:
First add the teeth on the denture >>wax up >>make mould “index” for this
teeth from 5 to 5 using plaster for example because if I don’t have index how
I can know the position of the teeth cause as u know the teeth may be moved
during de-waxing >> send the denture to dewxer as u know the dewaxer will
remove all the wax & the teeth now loose & not on it’s place so what I
should do now?>> bring the index & put it on the present teeth “i.e. 3,4,5
because I extend it from 5 to 5 & the four incisors missed only” so the four
incisor that I want to place it on the denture have a place on the index
>>>add cold cured acrylic while the index attached to the denture so the
teeth are back to the denture with set up that u make according to the index
“which is made of plaster in our case”.


So the idea about index is just to reposition the teeth that u make setting for
it in it’s place because the wax lost in dewaxer.& it will act as record to keep
the position of teeth for u after dewaxing.




Now we finished first topic in this lecture, which is repair, & we will
continue with second topic that is relining.




                                                                               7
                                    Relining:
It’s resurfacing or correction of denture adaptation to underlying tissue by
the addition of new acrylic resin material to it’s fitting surface without
changing the occlusal relation.
What’s the meaning of this ?
In relining process the patient will come to u & have loss of (stability,
fitting, retention) between the denture & underlying mucosa because the
underlying mucosa is keeping resorping so after “1,2 or3 year” of wearing
the denture the patient could come back to u’r clinic complaining that his
denture is loose “the reason of looseness is the loss of adaptation i.e. there’s
space between fitting surface of denture & mucosa so the denture is tilting
easily ” so the denture is loose denture but the reason of looseness is the
loss of adaptation.


How to adjust this or to improve the adaptation?
We could add new layer of acrylic resin material on the fitting surface of
denture & again this procedure is called relining “beje 3andak el patient
be2olk bde ab6n el denture”

So we make anew surface for an old denture the main complaint with
it is looseness.


                       ***Indication of relining:***


1* loss of retention & stability.
2*to alleviate pain:
The patient come to u with loose denture “because this loose denture result
in overextension & it will make trauma on susceptible area such as; bone” so
the denture start traumatize him & the pain result from looseness so after we
adjust looseness the trauma & pain will go automatically.


                                                                               8
3*to restore occlusion.
4* to improve appearance.
The above 2 indication are not so mush realistic, it’s difficult to improve the
occlusion or appearance, back to the definition without changing the
occlusal relation so we should’t change the relationship of occlusion
when we do relining.
Therefore, when I say that I want to make relining to improve occlusion this
is kind of disagreement with definition.
Therefore, from now we should say & understand that the relining is mainly
to improve fitting of u’r denture because of resorption of bone that happen
with time.


                  General consideration of relining:
>>before doing relining, we should make sure that the underneath tissues are
in perfect healthy situation.
As u knows before doing secondary impression, we should ask our patient to
get rid of his old denture 48 hours before coming to secondary impression
stage because I need to make sure that the mucosa is healthy.
So we need optimal health tissue.


>>>>we need reasonable Centric Relation / Centric Occlusion.
That’s mean u could find a relationship between upper & lower denture &
there is still intercuspation & the vertical dimension is acceptable.


>>>>we need adequate vertical dimension .
>>>>we need adequate peripheral extension.
 If u’r denture getting loose because of resorption definitely it will become
overextended in certain areas because the denture is sinking down.
                                                                                9
>>>>u need to evaluate u’r denture .
To evaluate u’r denture u need to make sure it’s indicted for relining .


Note: Now complaint of loose denture doesn’t in itself consist of evidence of
lack of fit & stability. What is the meaning of this?
i.e. if the patient come to u & saying my denture is loose that’s not mean it’s
the fitting surface it could be other reasons so u should make sure that u
diagnose the cause of looseness before going to relining.
But what’s the other causes of looseness?
There are 100 of reasons the denture could go loose because of it such as;
                           1**flanges overextension:
If u have overextended flange on labial frenum & the labial frenum was
active u will never get retentive upper denture even if u make a perfect
peripheral seal .
So make sure that u don’t have overextended flanges.


                            2**occlusal interferences
We will go back to balanced articulation because may be the patient have
premature contact on working side & this premature contact will prevent
contact on nonworking side so the denture will flip.
So we need to make sure that u have balanced occlusion & articulation.


                        3**inadequate post palatal seal
If u don’t have post palatal seal it’s difficult to repair u’r denture .
So u need to make sure that u have good palatal seal area.




                                                                             10
 So relining will only solve retention problem related to denture base
adaptation “i.e. the denture fitting surface will not any more fitting” so u
should diagnose all retention problem then go to relining.


Let’s take an example:
“Look to page#4 slide #5” if u have such an extension on buccal frenum this
patient will definitely complains of loose upper denture so 1 st u need to relief
it before relining, the 2nd thing that u could have occlusal interferences
“unbalanced occlusion as happen on protrusion as u see on the page#4
slide#6” so again definitely the denture will go loose.
Now after modification of these problems “I adjust the occlusion , I adjust
the extension ,I adjust every thing” then I wait for a week if the patient come
after week complaining of loose denture so now the reason is most likely
adaptation problem& the solution is relining.


                      Contraindication for relining:
                              1**worn out denture
If the dentures are worn out, we don’t reline them but we need to replace
them .
Look to page#5 slide #3as u can see the dentures are totally worn out even if
u reline them u have enough occlusal troubles to get dentures loose “no
teeth, no balanced occlusion, no balanced articulation”
So it’s useless to go for relining.


                  2**if u have vertical dimension loss >7mm


i.e. if the occlusal vertical dimension was 60mm & now 53mm don’t do
relining .
do u know why?


                                                                               11
Because RCP will be changed, remember that for every vertical dimension
there’s centric relation .
So if u have loss in vertical dimension the horizontal relationship in retrusive
contact position will not any more correct & there is a new one .
Therefore, u can’t correct RCP, VD, & adaptation only in relining.
So it’s contraindicated to make relining if u have loss of VD.


                     3**significant mucosal inflammation
 If u have significant mucosal inflammation that result from deture
stomatites it’s not indicated for relining unless the tissues are healthy .
Because if u do relining “while the inflammation there” the denture will be
loose again after the tissues heal & u will repeat relining.


                           4**poor denture esthetic
If the esthetic was the complaint, the relining will not solve the problem .


                      5**denture related speech problem
Speech problem often result from V.D so we can’t solve it out using
relining.


So again, we should agree that we have definite diagnosis that the denture
problem is with fitting surface only before going to relining.
Again & again, u should make sure that the tissues are healthy before doing
relining by:
__Oral hygiene instruction such as;
#leave u’r denture out during night.
#use disinfecting solution.


                                                                               12
__relief pressure area.
__correct faulty occlusion.
__use tissues conditioner in order to get healthy mucosa.
So now after u do relining this will going to be the final relining because the
tissues are healthy.


                              Types of relining :
It will be either:
**** Chair side i.e. in the clinic “we do it on our clinic commonly” or lab
side which is need processing & it’s the best, what’s the meaning of this ?
If we need processing we need impression & the impression could be
conventional impression or functional impression such as; tissue conditioner.


****the relining material could be hard or resilient denture base material
such as; silicon based or acrylic based resilient relining or monoplast 3.


**** it could be permanent relining such as; silicon based or monoplast 3
OR temporary relining such as; tissues conditioner.
Note: When we talk about permanent or temporary, we talked about relining
it self.


****It could be done for complete or partial denture.


Note: In our clinic, mostly we do chair side relining after we adjust every
thing as explained above but it’s not the best, the best is lab side relining &
the cause of this will be clarified latter on.




                                                                              13
                    Procedure of lab side relining :
>>we bring the patient in.
>> u need to do proper impression this impression will end with proper
relining.
>>in C.D construction we do border molding & secondary impression & in
relining we will do both .
Now the denture flange could be properly extended or overextended so I
need to trim “1-2mm” from flanges to make place for green stick.
>>any undercut area on the denture I should remove it because I need to
retrieve the denture after I pour the impression & as explained above on
repair, if this undercut was not blocked out on the denture, the denture will
not be retrieved from the cast.
>>do border molding & take the impression usually using ZOE because we
don’t create space on the denture i.e. if I use rubber I need space “1.5-2mm”
but we don’t do this although the fitting surface of the denture is ,more or
less, slightly different from mucosa but it’s not 1.5-2mm so the impression
material of choice is ZOE.
>>pour the impression & some time we need to mark post dam area on the
upper denture.
Look to page#6 slide #3 this is post dam area I mark it “using marker” in the
patient mouth before I take the impression then I put the impression on
patient mouth so it will be marked on the impression & cast later on.
>>do boxing & pouring of the impression.
>>retrieve the denture.
>>the cast that remains will act as secondary cast & now I do usual flasking
for the cast.
Note: after u retrieve the denture & remove the impression away, if u put the
denture again on the cast there will be a space i.e. space of impression
material, now what I will do?
>>I will put the acrylic on the cast & readapt the denture because the
impression material was removed & the acrylic takes place of it.

                                                                                14
>> do processing so here definitely I will use heat cured acrylic & as we said
the problem with heat cured acrylic is I could end with warpage of C.D.
I can use cold cured acrylic but the problem with it as we said porosity,
monomers.


This was lab side relining because we take impression.
But in chair side relining,
*** we do slight adjustment of the denture if there is overextension.
***we have special chair side material we mix it up >>> place it in denture
base >>>fit it in patient mouth & tell the patient to bite lightly in centric
relation >>>>wait tell it set>>>if there’s excess we do finishing as C.D.
But why the chair side relining is not the best?
Because it’s cold cured acrylic “relining material that we use in the clinic”
So we will have porosity & very high level of monomers so it’s not really
indicated ,but we do it because if I want to do lab side relining it will take 3-
4 visits & it’s so much.


If u have loose upper & lower denture “but not excessive looseness”& u
want to do relining for both dentures usually we start with lower denture
because when u take impression u need that the opposing to be more stable
than the other & as u know the lower denture is always more loose than
upper one.


Note: if the upper & lower was excessively loose we make a new denture.


Let’s take an example of lab side relining for upper denture “look to slide
#1,2,3&4 page#7”:
→→Check extension.
→→Border reduction.


                                                                               15
→→Tissues surface reduction “if I need to make smoothening for tissues
surface”.
→→Border molding >>> good peripheral seal.
→→Post dam marking in patient mouth.
→→Slight venting holes in denture, what’s the meaning of this?
After I do border molding & I have good peripheral seal I do holes on
denture so the excess impression will be released & if I don’t have this holes
then I will have voids on impression.
In secondary impression stage we don’t do this because the fitting of
secondary impression isn’t like C.D so if I have excess impression in
secondary it will go to the throat but in C.D I have peripheral seal & fitting
“really it’s loose but there is some sort of fitting” & this will not allow
excess impression to be released from margins so definitely u need to make
this venting holes so the excess impression released from it.


→→Take ZOE impression.
Note: in post dam we can use functional wax such as; iowa wax & as u
know we put it in patient mouth & wait , what’s attached to the tissues will
be melt & what’s not attached will not melt & will appear dull.


Note: U can do impression-using rubber if u has excessive looseness &
there’s so much space between denture & tissues, but it’s recommended to
use ZOE.
The rest of procedure was explained above.


Regarding the lower denture is the same as upper one as follow slide#5
page#7:
→→Remove the undercut.
→→Border molding.
→→We take the impression.
                                                                               16
→→Pour the impression>>>the result is master cast.
→→Do processing on master cast “on processing we will do flasking &
then deflasking”
As we said we would remove the impression & green stick so we will have
space between the denture & cast then we add acrylic then processing as
explained above.
→→ & finally we will retrieve the denture & does finishing then submit it to
the clinic to give it to the patient later on.
→→Now after we insert it in patient mouth we examine the extension &
occlusion.
To make sure that the occlusion is not changed during taking the impression,
u need to make sure to set the denture properly back to it’s original place i.e.
when u take the impression by denture u should make sure that the denture
in it’s place if the denture was tilted in any way , u will loss u’r occlusion
relationship.
To understand this more look to slide#3 page#8 :
If u misplace the denture as in the slide there will be more impression
material here & as u know all the impression material will be replaced by
acrylic later on.
So the acrylic will make interferences with the denture & the denture will
not set in it’s place so we will have loss of occlusion.
So u need to make sure when u take u’r impression that the occlusion is
correct, but how we make sure that the occlusion is correct?
When u take u’r impression after border molding ask u’r patient to bite on
his upper & lower denture lightly in centric relation “maximum
intercuspation”, but why we said lightly?
Because if the patient bites heavily the denture will flip because as u knows
the denture was loose, so by this u makes sure that the occlusion is correct.


 Note: If the patient doesn’t have maximum intercuspation u can’t know how
much the patient bite so the patient who have worn out dentures are
contraindicated for relining.
                                                                              17
                         Partial denture relining:


is the same as C.D relining & it could be chair side relining or lab side
relining,the only difference in partial denture that u’r impression is more or
less like altered cast technique & we use ZOE because we do this technique
on free end saddle & again u need to make sure that Cr-Co partial denture is
back to it’s place.
We make sure by one thing which is the rests, the rests should be fully
seated in there rest seats so u need to hold the rest by u’r finger because if
the denture tilted in any way we will loss the partial denture.


                                  Rebasing:


It’s exactly the same principles as relining but instead of resurfacing the base
of denture in relining, in rebasing we remove all the base &we leave the
teeth & make a new base.
Regarding the procedure also it’s the same as relining but the difference is:
In relining u take u’r impression then do flasking & deflasking after that we
remove the impression & green stick & the space remained I fell it with
acrylic while in rebasing I take the impression then flasking & deflasking &
after that I remove the impression, green stick & all the flanges of the
denture so the space will be impression, green stick & flanges then I fell the
space & complete the procedure as relining.
Therefore, in rebasing I will have new base.
Note: the teeth will remain as one unit “i.e. the horse shoe shape of the
teeth” after I cut the flanges so there’s part of old acrylic with teeth & again
the new acrylic will only replace the flanges ,green stick& impression
material.
                                   That’s all
                                       &
                         Forgive mw for any mistake.
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