When to reline or rebase a Immediate complete denture?

[Dental916]

On a patient of mine, we inserted maxillary and mandibular immediate dentures. The maxillary denture fits beautifully. The mandibular fits pretty good, but could be better. The occlusion is perfect. So would you do a hard reline or a rebase of the lower?

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[crazy_sherm]

The ridge will be remodeling a lot over the next few months, especially the first two. Try to see the pt every 2-4 wks for the first couple months for adjustments, you may at some point need to put in a temporary soft liner. When you're comfortable that the ridge has stabilized, then it's time for a hard reline. I usually wait 5-6 months post extraction before doing a hard reline for an immediate, but it really depends on the pt. It could be sooner, or it could take longer. Doing it right rather than trying to rush it will save you headaches in the long run.

 

[aphistis]

The ridge will be remodeling a lot over the next few months, especially the first two. Try to see the pt every 2-4 wks for the first couple months for adjustments, you may at some point need to put in a temporary soft liner. When you're comfortable that the ridge has stabilized, then it's time for a hard reline. I usually wait 5-6 months post extraction before doing a hard reline for an immediate, but it really depends on the pt. It could be sooner, or it could take longer. Doing it right rather than trying to rush it will save you headaches in the long run.

Great post. 👍

 

[DrJeff]

The ridge will be remodeling a lot over the next few months, especially the first two. Try to see the pt every 2-4 wks for the first couple months for adjustments, you may at some point need to put in a temporary soft liner. When you're comfortable that the ridge has stabilized, then it's time for a hard reline. I usually wait 5-6 months post extraction before doing a hard reline for an immediate, but it really depends on the pt. It could be sooner, or it could take longer. Doing it right rather than trying to rush it will save you headaches in the long run.

Great post. 👍

Agree! Relines and immediates *MOST* of the time will follow Crazy-Sherm's timeline.

Everynow and then though things can very ALOT. I've had some folks who I've relined with hard acrylic within 2 weeks after the extractions(generally situations where ALOT more bone than anticipated need to be removed to get the tooth - or more likely root tip - out) and I've also had cases where YEARS after the extractions/immediates being delivered the patient is functioning fine with great prosthesis stability without every needing a reline.

That's the "joy" of immediates sometime, you never know what you're going to get both the moment your go to put them in the 1st time, and then in the following months🙂

 

[Dental916]

Thanks guys. I understand the timeline and so on, but when do you do a hard reline vs a rebase? And the hard reline would be a chairside one?

 

[DrJeff]

Thanks guys. I understand the timeline and so on, but when do you do a hard reline vs a rebase? And the hard reline would be a chairside one?

The VAST majority of the time, unless there was ALOT more bone removal than anticipated, you'll be doing a reline. If say an entire tuberosity fractured off or the entire buccal plate over a canine eminence and adjacent teeth fractured off during the extractions or heaven forbid, your bite registration was WAY off, then you'd consider a rebase. Otherwise, 98% of the time a reline will do.

Chairside vs. lab reline. Personally I do all my relines chairside using an autopolymerizing cartridge dispensed acrylic. Including prepping the denture, the resin set time and trimming, the patient is in and out in 30 minutes with about 1/2 of that time being idle setting/curing time.

If I'm rebasing, then I'm taking a pick up impression using a combination of different viscosity polyvinyl siloxane impression materials and sending it out to my local removeable lab where they'll rebase the denture for me during the day (basically the denture is picked up by the lab by 9:30AM and is back in my office by 3:30PM the same day).

When treatment plan discussions of immediates are happening between me and my patients, over and over at each visit from the initial discussion on through the impression visits/border moulding/wax try in/etc I keep reiterating to my patients that they should EXPECT to see me quite regularly over the first 12 months post extraction/denture delivery for adjustment work. That way, you're patients don't/won't get frustrated if they need multiple adjustments for sore spots and/or relines over the major soft + hard tissue remodeling time. And if you're lucky enough where minimal adjustments are needed, you'll look like a "dental god" to your patients, and they'll refer all their friends to you😀

 

[Dental916]

Thanks jeff. Good write up. Clears up a lot of things. As far as chairside reline goes. Do you dispense the material into the denture and insert in mouth until it hardens and then trim and polish? Can you elaborate the procedure a little more? I have to do one in the next few months for an immediate mandibular denture. Faculty will assist me, but just wanted to know more about it before I go in.

 

[DrJeff]

Thanks jeff. Good write up. Clears up a lot of things. As far as chairside reline goes. Do you dispense the material into the denture and insert in mouth until it hardens and then trim and polish? Can you elaborate the procedure a little more? I have to do one in the next few months for an immediate mandibular denture. Faculty will assist me, but just wanted to know more about it before I go in.

The material I use(Mucohard from parkell), a cartridge based autopolymerizing resin, reaches a "semi rigid" state in about 3 1/2 minutes after dispensing, at which time you remove it from the patients mouth and then let it finish curing for another 5 or so minutes. Trim + polish and done.

Basically during the initial 3 1/2 minute set, I'm alternating between border molding motions and having the patient close into their "regular" denture centric occlusion position to ensure that I have captured both the tissue anatomical features AND the occlussal relationship that the patient is used to.

Their are other chairside reline materials out there, that while they'll get you the same finish result, some of them are simple powder/liquid autopolymerizing acrylics and other are ligth cured acrylics. What you'll typically find once your out of d-school and if your doing some relines in your office, that you'll end up trying a couple of the different types of chairside acrylics and eventually settle on one that a) you like and b) is consistant clinically for you.

 

[aphistis]

The material I use(Mucohard from parkell), a cartridge based autopolymerizing resin, reaches a "semi rigid" state in about 3 1/2 minutes after dispensing, at which time you remove it from the patients mouth and then let it finish curing for another 5 or so minutes. Trim + polish and done.

Basically during the initial 3 1/2 minute set, I'm alternating between border molding motions and having the patient close into their "regular" denture centric occlusion position to ensure that I have captured both the tissue anatomical features AND the occlussal relationship that the patient is used to.

Their are other chairside reline materials out there, that while they'll get you the same finish result, some of them are simple powder/liquid autopolymerizing acrylics and other are ligth cured acrylics. What you'll typically find once your out of d-school and if your doing some relines in your office, that you'll end up trying a couple of the different types of chairside acrylics and eventually settle on one that a) you like and b) is consistant clinically for you.

This is a little off-topic, but the topic of denture relines reminded me. I was doing the anesthesia for a couple of knee replacements on Thursday, and I noticed a familiar, oddly comforting smell as the surgeons mixed up cement for the knee prosthetics. When I asked about it, they told me they cement artificial joints with the same methyl methacrylate we use for dentures. To quote the attending surgeon, "we stole the idea from you guys." 😀