Cast Metal Partial Denture Reline or Rebase
Is it worth it?
Cast Metal Partial Denture Reline or Rebase
Is it worth it?
By Dr. Hudnall DMD
Nothing stays the same. The mouth changes over time. But patients fail to realize this fact when it comes to removable dental appliances. How many times have you heard a patient proclaim that the metal partial “you made” them is loose or it doesn’t fit the way it originally did when “you made” nine years ago? They did some research on the internet and they want it relined. Their proclamation is true – it really doesn’t fit the same as the day it was delivered because of numerous evolving biological changes. Before you go along with their web-based diagnosis, consider if a reline the correct course of treatment.
perform a thorough examination to determine what is causing their concern. Has the condition of the natural teeth changed? Are cavities or periodontal disease present? Is there poor oral hygiene or a denture sore mouth? Does the metal framework fit correctly in every aspect? If the framework doesn’t fit the teeth correctly, the partial is no longer functioning the way it was designed to and a new plan should be developed.
A reline involves resurfacing the tissue surfaces of the partial denture base with new material to make it fit the underlying tissue more accurately. If the tissue under the edentulous areas has resorbed and the partial denture is trapping food or causing sore tissue, a reline may be a consideration.
Can you see space under the saddles when the partial is seated? If the partial has a distal extension, does the denture framework dislodge from its fully-seated position when the distal extension is pressed? Has the occlusal contact between the distal extension and the opposing dentition lessened because the free-end moves in occlusion? Then a reline may be a solution.
Before committing yourself to a lab-processed reline, apply a tissue conditioner to the partial denture saddles and have the patient wear it for a week or two. If nothing else, the overall condition of the underlying tissue should improve visibly. See if the tissue conditioning “reline” made a difference in patient comfort. If it did, a reline is an option.
Consider the pros and cons before relining a cast metal partial denture.
The framework has obviously been used for a number of years. Is it likely to break during handling? Does the partial have several short spans of acrylic that require relining? If so, flasking is required to perform a lab processed reline. Can the patient be without the partial while the lab relines it? What is the cost compared to the cost of a new partial? All of these things and more must be well thought through before making the decision to modify an existing appliance.
The goal of a reline impression is to return the partial denture to its original occlusal relationship without changing the vertical dimension of occlusion. It is important to provide the dental laboratory with all of the records they will need to do the procedure.
First, take an accurate bite registration of the natural teeth with the appliance to be relined in the patient’s mouth. Take an impression of the opposing arch. Relieve the underside of the tissue saddles of the partial that is to be relined. Apply adhesive to the roughened areas and borders. Then apply an appropriate impression material to the underside of the saddles only. Light-body rubber base, elastomeric silicone, mouth temperature wax, or tissue conditioner all work well to record the underlying tissue. The trick is to have an adequate amount of material to accurately record the tissue contour and the space under the saddles without having a lot of excess material that locks the impression into place. Seat the framework fully in the mouth and hold the tooth-supported area of the framework into place until the impression has set.
Some patients have never been happy with their smile and are ready for a change. I once had a patient bring me a picture of Reba McEntire and asked that her new teeth look like Reba’s. Talk about a drastic change for her. Have you ever looked at Reba McEntire’s teeth closely? I did warn the patient that the tooth shape was quite a bit different than her own. With some discussion, we made her immediate dentures as she requested then compromised on the tooth mold somewhat for the permanent denture to obtain the look that she really had in mind.
If for any reason the framework does not fully seat, it moves during the impression, or there is so much impression material that it goes everywhere, allow the material to set. Then remove the impression from the partial and start over. It is critical to send the lab an impression that accurately depicts what is to be filled in by reline material.
After you are satisfied with your technique, do not remove the partial denture from the mouth. Take a full arch alginate impression over the partial while it is still in the mouth. Once the alginate has set, remove the impression, keeping the partial in the full-arch impression. The laboratory will use all of these records to reline the cast metal partial. When you seat the relined partial, you should notice improved fit and improved adaptation to the tissue.
A rebase to a cast metal partial denture works in the same way as a reline except that the entire saddles and all of the teeth are generally replaced during the lab procedure. Practically speaking, if it becomes necessary to replace all of the acrylic and teeth on a cast metal partial denture, a new partial denture should be considered.
Stomadent Dental Laboratory has the experienced staff to walk you through the process of relining cast metal partial dentures as well as many other modifications to existing partials. Expert advice is just a phone call or email away. When you think of removable appliances, think of Stomadent!
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