Tissue conditioners

Tissue conditioners

1. Tissue conditioners AND LINERS Presented by, Dr. Chaithra Prabhu B 1st year post graduate Department of Prosthodontics 75

2. contents Introduction Definitions Relining and rebasing Classifications Requirements of denture liners Hard liners Soft liners types ,indications, procedure for application of soft liners Tissue conditioners composition, uses, procedure for application of tissue conditioners & care and maintenance Conclusion Reference 75

3. introduction Maintenance of the adaptation of denture bases to the mucosa that covers the ridges is a critical part of complete denture service. Residual ridges have been described as plastic in nature, always changing in topography and morphology because of alteration in the contour of soft tissues and resorption of underlying bone. Resorption occurs most rapidly in first 6 months following extraction of teeth and levels at about 12 months, and increases again as the patient reaches age of about 65. /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

4. introduction Every edentulous patient among with other things should be examined on an annual basis to determine the rate of resorption of the residual ridges. More rapidly in females than in males. More rapidly in Caucasians than in Negroes. / 75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

5. In such a case a replacement of the denture can be done , o r we can reline or rebase the denture Further the Denture soreness , pain, presence of abused, hypertrophic, irritated, hyperaemic and displaced oral mucosa, once very difficult to treat can now with the advent of soft liners can be conditioned to a healthy state /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

6. definitions RELINE The procedure used to resurface the intaglio of a removable dental prosthesis with new base material thus producing an accurate adaptation to the denture foundation GPT 9 The process of replacing the tissue contacting surface of an existing denture PHILIPS /75

7. REBASE The laboratory process of replacing the entire denture base material on an existing prosthesis GPT 9 The process of replacing the entire denture base of an existing complete or partial denture PHILIPS TISSUE CONDITIONER: A resilient denture liner resin placed into a removable prosthesis for a short duration to allow time for tissue healing -GPT 9 A soft liner used to treat traumatized mucosa -0’BRIEN

8. Indication for relining or rebasing Immediate dentures at 3 to 6 months after their original construction When the residual alveolar ridge have resorbed and the adaption of the denture base to the ridge is poor When the patient cannot afford the cost of having new dentures constructed When the construction of new dentures with the accompanying series of appointments can cause physical or mental stress such as for chronically ill patients /75 E ssentials of complete denture prosthodontics Sheldon Winkler 2nd ed

9. CONTRAINDICATIONs Excessive amount of resorption Presence of abused soft tissues When patients complain about TMJ problems If the denture have poor esthetics If the denture create major speech problem When severe osseous undercuts exist /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

10. Relining or rebasing /75 Boucher's prosthodontic treatment for edentulous patients 13 1h ed

11. General considerations The occlusal vertical dimension should be satisfactory CO should coincide with CR The size shape shade and arrangement of the artificial teeth must be satisfactory The oral tissue should be in optimum health The posterior limit of the maxillary denture should be correct The denture base extensions should be adequate and should distribute masticatory load over large surface area Inter-occlusal distance should be correct Satisfactory speech /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

12. relining Tissue preparation Excessive hypertrophic tissue should be surgically removed. The oral mucosa should be free of areas of irritation. Dentures should not be worn at least 2-3 days before the final impression. Daily message is helpful to stimulate their blood supply. Denture preparation Pressure areas on the tissue surface of the dentures should be removed. Minor occlusal disharmony is corrected by selective grinding. Small border inadequacies are corrected. A correct posterior palatal seal area should be established. /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

13. Relining techniques /75 Closed mouth technique Open mouth technique ( B oucher’s technique) Articulator method Jig method Boucher's prosthodontic treatment for edentulous patients 9 th ed

14. /75 CLOSED MOUTH TECHNIQUE Is preferred when the static impression technique is used. Several variations have been suggested, all based on using the denture as an impression tray and the actions of the patient to mold the peripheries. The prosthesis is held in position by the patient occluding on the opposing denture before which the occlusion should be corrected either in the preliminary treatment or by modification with hard wax or compound

15. OPEN MOUTH TECHNIQUE Given by Boucher . Reining of both upper & lower dentures at the same time. Dentures are used as special trays for making secondary impression. ZnOE is the material of choice After impression a new Centric Relation is recorded . DISADVANTAGES: Difficult procedure because more clinical and lab work is involved. /75

16. Chair side reline technique Several attempts had been made to produce an acrylic or other plastic material that could be added to the denture and allowed to set in the mouth to produce an instant chairside reline/rebase. These are not recommended because of following drawbacks: Chemical burns (from the monomer) Porosity and poor odor Poor color stability Material cannot be removed easily if there is any mistake /75 R ecent introduction of VLC resin systems These materials can be partly polymerized at the chairside using handheld curing lights, but require a more powerful light chamber device for complete curing . USE temporary modification of dentures corrections to the posterior border seal on the upper denture & the extension of flanges, and may be employed for relining dentures. The technique is not, however, suited to situations where there are undercut areas REASON : can be distorted during removal and becomes rigid once cured

17. Laboratory method ARTICULATOR METHOD /75 Dental laboratory procedure for complete denture Rudd and Morrow vol 1

18. /75 Dental laboratory procedure for complete denture Rudd and Morrow vol 1

19. /75 JIG METHOD Dental laboratory procedure for complete denture Rudd and Morrow vol 1

20. CLASSIFICATION /75 Science of dental materials V Shama Bhat 2nd ed

21. CLASSIFICATION BASED ON CURING Self cure Eg -soften, viscogel Heat cure Eg-supersoft , molloplast B, Lucisoft , Flexor, Permaflex Light cure Eg-clearfitLC ( polyisoprene based material) BASED ON COMPOSITION Silicone elastomers Soft acrylic compounds Pthalate ester free compounds Polyolefin liners Fluoride containing liners /75 TISSUE CONDITIONERS : A REVIEW NUJHS Vol. 4, No.2, June 2014

22. CLASSIFICATION Cntd BASED ON DURABILITY Temporary/Short term liners- eg ., soft comfort Definitive/long term liners BASED ON CONSISTENCY Hard denture liners Eg-Ufigel hard C Soft denture liners Eg-Silastic 390 Soft denture liners are further classified as a) silicone based and resin based b)Auto cured and heat cured /75 TISSUE CONDITIONERS : A REVIEW NUJHS Vol. 4, No.2, June 2014

23. CLASSIFICATION cntd BASED ON THE AVAILABILITY Home reliners Tissue conditioners BASED ON WATER SORPTION PROPERTY Hydrophilic Eg-kooliner ( polymethyl /ethyl methacrylate polymer) 2. Hydrophobic Eg -Elite soft(silicone polymer) /75 TISSUE CONDITIONERS : A REVIEW NUJHS Vol. 4, No.2, June 2014

24. Requirements of resilient denture base liners They should be biologically inert material They should be resilient and capable of maintaining this characteristics Should be dimensionally stable & insoluble in oral fluids to maintain proper tissue contacts Should be color stable throughout their use Even though flexible, they should resist abrasion & thereby allow the practice of proper hygiene of surface Should maintain their bond to denture base without damaging it Ease while working with them /75 Dental laboratory procedure for complete denture Rudd and Morrow vol 1

25. HARD LINERS Due to resorption and shrinkage of the tissues, after the teeth extraction, the denture prepared gradually becomes lose or mis -fitting. This requires an additional layer on the tissue side of denture for better fit /75

26. Hard liners Type 1 Powder PMMA----Polymer beads Benzoyl Peroxide-----initiator Liquid MMA-------monomer Di-n-butyl phthalate-----plasticizer Tertiary amine----Chemical activator Type 2 Powder PMMA----Polymer beads Benzoyl Peroxide- ----initiator Liquid Butyl/ iso -butyl/ higher methacrylates -----monomer Di-methacrylate ----CLA Tertiary amine----Chemical activator Applied Dental Materials John F. McCabe 9th ed Disadvantage is that it is irritant to the soft tissues May cause allergic reaction Less irritant comparitively

27. Cold cure is preferred Simpler curing procedure Less distortion or warpage of denture Strength of cold cure is adequate for liner /75 Science of dental materials V Shama Bhat 2nd ed

28. SOFT LINING MATERIALS Permanent soft lining materials are most commonly used for patients who cannot tolerate a hard base . This problem generally arises if the patient has an irregular mandibular alveolar ridge covered by a thin and relatively non-resilient mucosa . I t may be very painful when a masticatory load is applied through a hard base on to this type of supporting tissue. In such cases, a soft lining on the denture will help to relieve the pain and increase patient acceptance of the denture. /75 Applied Dental Materials John F. McCabe 9th ed

29. /75 Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

30. NATURAL RUBBERS H ave been used as soft lining materials since 1860s N ot a material of choice because of Quick absorbance of intraoral liquids Difficulty in preparation Low quality of connection to base materials /75 Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

31. Soft acrylics Plasticized acrylic resins chemically cured heat cured Available in powder and liquid forms Polymer is either methyl or ethyl-methacrylate Primary difference between conventional PMMA and these is that liquid contains large amount of plasticizers Plasticizers limits the tangling of the polymer chains /75

32. silicones One of the more successful soft lining materials There is no need for addition of plasticizing agents The material retains its rubbery consistency for long period of time Available as Chemical cure Supplied as two components Setting is by condensation reaction Heat cure S upplied as one-component pastes Applied using compression moulding technique /75 Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

33. Disadvantages They generally do not bond to the denture base and require some form of adhesive The material is also unsuitable for polishing and has to be left in the finished state. Thus they are prone to bacterial contamination and growth of C. albicans ( GC reline modifier which removes surface roughness and manufacturing defects when added ) They occupy space and as their thickness increases, the thickness of the denture itself is reduced. Affects the strength of denture base /75 A Clinical guide to applied dental materials Stephen J Bonsor

34. Fluorinated soft lining materials Polyphosphazene is a fluorinated nitrogen- phosphate elastomers distinctly different from plastiols and silicones It quickly deforms under load converting the deformation energy into a small amount of heat before returning to its original shape /75 Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

35. Olefinic soft lining material Have good elastic properties But these require a special apparatus for lining and the lining procedures are complicated Eg MOLTENO /75 Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

36. /75 INDICATIONS OF SOFT LINING Aging & pathological changes Atropy and resorption Decreasing the pressure locally Reducing the pressure locally Reducing occlusal irritation Providing retention in presence of undercuts Rehabilitation of congenital/acquired defects Following radiation therapy Some systemic disease or excessive usage of alcohol or cigarate Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

37. disadvantages Hardening of materials by loosing its softness Bonding problems to the denture base Fracture of denture base Cost application problems Color stability Candidal growth /75 Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

38. /75 CLINICAL APPLICATION OF SOFT LINING MATERIALS DIRECT METHOD INDIRECT METHOD Soft lining materials are applied on the tissue surface of Acrylic base and left to polymerize intraorally Lining procedure is carried out in laboratory after the impression is made

39. APPLICATION OF SOFT LINING MATERIAL BY DIRECT METHOD /75

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44. APPLICATION OF SOFT LINING MATERIAL BY INDIRECT METHOD /75

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48. /75 Application of liner to already processed dentures

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51. /75 This study evaluated the effect of two commonly used methods of processing permanent soft liner on tensile bond strength between denture base and silicone based soft liner Group 1: Specimens which were relined at the time of processing denture base resin. Group 2: Specimens relined after the denture base resin specimens were fabricated. Conclusion Bond strength of soft liner relined directly to the denture base resin during processing was significantly higher than the bond strength of the soft liner applied to already processed denture base resin.

52. TISSUE CONDITIONERS Tissue conditioners are also known as temporary soft lining materials Intraorally these materials can be used 1 week to 10 days at most /75 Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

53. COMPOSITION POWDER Polyethylmethacrylate ---- Polymer beads LIQUID Ethyl alcohol---Solvent Butylphthalyl Butylglycolate ------Plasticizer 60 -80% DOES NOT CONTAIN MONOMER /75 TISSUE CONDITIONER Applied Dental Materials John F. McCabe 9th ed

54. Setting reaction is by gelation ----------15-20 min In tissue conditioners, polymerization starts with mixing the powder with plasticizer and penetrant involving liquid mixture and letting the liquid penetrating into powder monomers. This procedure is accelerated by the presence of ethyl alcohol. /75 Complete denture prosthodontics treatment and problem solving Yasemin K ozkan

55. Use of tissue conditioners Adjuncts in tissue conditioning Temporary obturators Stabilizers of baseplates and surgical splints or stents Adjunct in the impression making procedure or as a final impression material /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

56. Adjuncts in tissue conditioning These materials provide an excellent medium to aid in the conditioning of traumatized denture bearing tissues because of their flow consistency p ermits the tissue recovery and prevents further breakdown Specific situations like hyperemic and traumatized oral mucosa Poorly occluding dentures Bruxism Papillary hyperplasia Patients with avitaminosis or general debilitating disease /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

57. Adjunct in temporary obturators Temporary obturation is usually accomplished 7 to 10 days after surgery, and so it is important that minimal pressure and no irritation be produced by obturators The use of these materials protects the tissue and thereby enhances the healing process /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

58. Stabilizers of baseplates and surgical splints When undercuts are present on an edentulous cast, tissue conditioners of a stiffer consistency may be used to stabilize recording base and prevent breakage of the cast enhances the stability, retention and comfort of the recording base /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

59. They are used to line surgical stents or splints when performing maxillary or mandibular vestibuloplasties Their use provide closer adaption to the healing tissues and so protects them from trauma /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

60. In impression making procedure Can be used when it is difficult to determine the extent of the denture base by means of the movable oral structures. The materials will record the extension in a dynamic form that will later help in preparing an impression tray for the final impression. /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

61. PROCEDURE FOR APPLICATION OF TISSUE CONDITIONER

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64. /75 This in vitro study evaluated and compared the tensile bond strength of two commercial brands of temporary soft liners to d ifferent types of denture base resins . Soft liners Denture resin base Visco gel DPI GC tissue conditioner TREVELON TREVELON HI Conclusion Viscogel showed better bond compared to GC tissue conditioner with all type of denture base Trevelon exhibited better bond with both the liners compared to other type of denture base resins The bond failures were classified as Adhesive, Cohesive, and Mixed types. Tensile strength > than bond strength ADHESIVE FAILURE Tensile strength < bond strength COHESIVE FAILURE Tensile strength = bond strength MIXED

65. /75 Purpose of this study was to evaluate effect of two surface treatments, sandblasting and monomer treatment, on tensile bond strength between two long term resilient liners and poly (methyl methacrylate) denture base resin. Conclusion Surface pretreatment of the acrylic resin with monomer prior to resilient liner application is an effective method to increase bond strength between the base and soft liner. Sandblasting, on the contrary, is not recommended as it weakens the bond between the two.

66. care & maintenance Soft brush is recommended to clean the material under cold running water. Soaking in denture cleansers - not recommended – adversely affects physical properties & causes premature deterioration. /75 Essentials of complete denture prosthodontics Sheldon Winkler 2nd ed

67. /75 Conclusion Silicone-based soft liners showed better compatibility with cleansing solutions and maintained their resiliency better thereby, proving to be more promising for long term usage. This study was aimed to determine the effect of two chemically distinct denture cleansers (0.2% sodium hypochlorite & sodium perborate) and water on the surface hardness of acrylic and silicone based soft denture liners at various time intervals.

68. /75 This study evaluated the effect of denture cleansers on C . albicans biofilm formation over resilient liners and to evaluate compatibility between resilient liners and denture cleansers. Conclusion Based on the C. albicans binding levels results, it is not recommended to immerse COE-SOFT in denture cleansers, and GC RELINE and SOFRELINER TOUGH should be immersed in Cleadent

69. /75 VARIOUS LINERS

70. conclusion Soft liners have an important place in denture prosthetics but require improved strength, improved adhesion to the denture base and the ability to inhibit the growth of microorganisms. The greatest virtue of tissue conditioners is their versatility and ease of use . However they’re temporary materials and are not adequate substitute for new dentures. /75

71. references Science of dental materials V Shama Bhat 2 nd ed Phillips science of dental materials 12 th ed Applied dental materials John f McCabe 9 th ed Dental materials and their selection William O’brien 3 rd ed Clinical guide to applied dental materials Stephen J Bonsor Essentials of complete denture prosthodontics Sheldon Winkler 2 nd ed Complete denture prosthodontics treatment and problem solving Y asemin k Ozkan /75

72. Cross references An In vitro Evaluation of Tensile Bond Strength of Commercially Available Temporary Soft Liners to Different Types of Denture Base Resins 2018 Journal of Natural Science, Biology and Medicine Tensile Bond Strength of Soft Liner to denture Base Resin Processed by two Commonly used Processing Techniques Int J Sci Res Sci Technol . March-April-2019 Effect of denture cleansers on surface hardness of resilient denture liners at various time intervals- an in vitro study J Adv Prosthodont 2013 Effect of denture cleansers on Candida albicans biofilm formation over resilient liners J Adv Prosthodont 2014 The effect of denture base surface pretreatments on bond strengths of two long term resilient liners J Adv Prosthodont 2011 /75

73. Thank You!