21
Relining and rebasing the removable partial
denture
Relining Tooth-Supported Denture Bases Relining
Distal Extension Denture Bases Method!i of Ree!
itllbli_hing Ocdu_ion
on a Relined Partial Denture Self.Assessment
Aid_
ifferentiation between relining and rebasing halO
D been di5cu55ed previously in
Chapter 1. Briefly, relining is the resurfacing of the
tissue surface of a denture base with new
material to make it fit the underlying tisSUQS
more accurately, whereas rebasing is the replacement of
the entire denture base with new material while
preserving the occlusal relationship. The artificial teeth
may need to be replaced in a rebase procedure.
Relining removable restorations is 11 common
occurrence in many dental practices; however, rebasing
is not indicated as often.
In either situation a new impreSSion regis_ tration is
necessary and uses the existing denture base as an
impression tray for either a dosed-mouth or an open-
mouth impression procedure. One of several types of
impression materials may be used. The impression may
be made with a metallic oxide impression paste, with
one of the rubber-base or silicone impression materials,
with one of the
tissue conditioning material5, with an activated acrylic
resin used as an impression material, or with a mouth-
temperature wax:
In deciding between a closed-mouth and an open-
mouth impression method for relining, one must first
consider the reasons for doing so and the objectives to be
obtained. Again, it is necessary to differentiate between
the two basic types of partial dentures, one being the all
tooth-supported restoration and the other the tooth- and
tissue-supported restoration.
Before relining or rebasing is undertaken, the oral
tissues must be returned to an acceptable state of health.
For murt: information refer to the Chapter 16 discussion
about conditioning abused and irritated tissues.
'From An impression made while the mouth is closed and
with the patient's muscular activity molding the borders.
In Zwemer TJ, ed: Boucher's clinical dental terminology,
ed 3, St Louis, 1982, Mosby.
451
452 McCracken's removable partial prosthodontics
RELINING TOOTH-SUPPORTED DENTURE
BASES
When total abutment support is available but for one
reason or another a removable partial denture has been
the restoration of choice, support for that restoration is
derived entirely from the abutment teeth at each end of
each edentulous span. This support may be effective
through the use of occlusal rests, boxlike internal rests,
internal attachments, or supporting ledges on abutment
restorations. Except for intrusion of abutment teeth under
functional stress, settling of the restoration toward the
tissues of the ri:'gidual ridgl" is prl"vl"ntl"d by thl"
supporting abutments. Tissue changes that occur beneath
tooth-supported denture bases do not affect the support
of thl" denture, and therefore relining or rebMing is
usually donI" for rl"asons that include (1) unhygienic
conditions and the trapping of debris between the
denture and the residual ridge; (2) an unsightly conaition
that results from tnespace that has developed; or (3)
patient discomfort associated with lack of tissue contact
that arises from open spaces between the denture base
and the ti:5:5ue:5. Anteriorly, 10:5:5 of support beneath a
denture base may lead to some denture movement,
despite occlusal support and direct retainers located
posteriorly. Ri:'basing would bl" the trl"atment of choice
if the artificial teeth are to be replaced or rearrangi:'d, or
if the denture base needs to be replaced for esthetic
reasons or because it has become defective.
To accomplish either relining or rebasing, the original
denture base must have been made of an acrylic resin
material that can be relim!d or rQplaCQd. Commonly,
tooth-!;upportQd partial dQnture bases are made of
metal as part of the cast framework. These generally
cannot be satisfactorily relined, although they may
sometimes be altered by drastic grinding to provide
mechanical retention for the attachment of an entirely
new acrylic resin base, or some of the new acrylic resin
bonding agents, such as Four-meta, Silicoating, or
Rocatec, may be used. Ordinarily a metal base, with its
several advantages, is not used in a tooth
supported area in which early tissue changes are
anticipated. A metal base should not be used after recent
extractions or other surgery or for a long span when
relining to provide secondary tissue support is
anticipated. (A distal extension metal base is ordinarily
used only when a partial denture is made over tissues
that have become conditioned to supporting a previous
denture base.)
Because the tooth-supported denture base cannot be
depressed beyond its terminal position with the occlusal
rests seated and the teeth in occlusion, and because it
cannot rotate about d fulcrum, d closed-mouth
impression method is used. Virtually any impression
material may be used, provided sufficient space is
allowed beneath the denture base to permit the excess
material to flow to the borders, where it is either turned
by the bordering tissues Of, as in the palate, allowed to
escape through venting holes without unduly displaclfig
thl' undl'rlying tissues. The qualities of each type of
impression matl'rial must hI' kept in mind when onl" is
selecting the material to be used. Ordinarily an
impression material is used that will record the anatomic
form of the oral tissues.
A word of caution 5hould be mentioned when
relining a tooth-:5upported acrylic resin base with
autopolymerizing acrylic resin as an intraoral procedure.
When one or more relatively short spans are to be
relined, making an impression for rl"lining purpOSl"S
rl"quirl"s that the denture be flasked and processed. The
po55ibility that thr vrrtiml di11lW5ion of OCclU5ioll
may be increased and that the denture may be
dibtuTtnl eluTing luuuTutunj prucraurr5 mu5l be;
weighed against the disadvantages of the use of a direct
reline material. Fortunately thQ!;Q material!; are
constantly improved with greater predictability and color
stability. The possibility that the original denture base
will become crazed or distorted by the action of the ac-
tivated monomer is minimal when the base is made of
modern cross-linked acrylic resin. However, caution
should be exercised to be sure that the older types of
acrylic resin bases are compatible when relining with
direct reline acrylic resins.
When relining in the mouth with an acrylic
 Chapter
21
resin reline material is done with a definite technique,
the results can be quite satisfactory, with complete
bonding to the existing denture base, good color
stability, permanence, and accuracy. The procedure for
applying a direct reline of an existing acrylic resin base
is as follow:5;
L Gf'nf'rously rf'lieve the tissue side of the
denture base. Lightly relieve the borders. This not
only provides space for an adequate thickness of new
material but also eliminates the possibility of tissue
impingement because oi coniinement of the material.
2. Apply lubricant or tape over the polished surfaces
from the relieved border to the occlusal surfaces of
the teeth to prevent new resin from adh_rinB to th(:,\
Pf(:,\S(:,\fV(:,\d bases find teeth.
3. Mix th(:,\ POWd(:'\f and liquid in a suitable
container according to the proportions recom-
mEndEd by the manufacturer.
4. While the material is. reaching the desired
consistency, have the patient rinse the mouth with
cold water. At the same time, wipe the fresh surfaces
of the dried dentur_ bas(:,\ with a cotton p_ll,;>t or
small brm:h saturated with some of the reline acrylic
resin monomer. This facilitates bondinsand ensures
that the surface is free of any contamination.
5. When the material has first begun to thicken, but
while it is still quite fluid, apply it to the tissue side
of the denture base and over the
borders. Immediately place the denture in the mouth
in it:5 terminal po:5ition, and have
the patient close into occlusion. Be sure no
malerial floW:5 over the occlu:ml :mrfaces or
alLer:5 the establi:5hed vertical dimension of
occlusion. Then, with the patient's mouth open,
manipulate the cheeks to turn the exce"" at the border
and establish harmony with bordering attachments. If
a mandibular partial denture is being relined, have
the patient move the tongue into each cheek and then
against the anterior teeth to establish i'! functional
lingual border. It i5 necessary that the direct retainers
be effective to prevent displacement of the denture
while molding of the borders is accomplished.
Otherwise the denture must be held in its
Relining and rebasing the removable partial denture 453
terminal position with finger pressure on the occlusal
surfaces while border molding is in progress.
6. Immediately remove the denture from the mouth and
with fine curved iris scissors, trim away gross excess
material and any material that has flowed onto
proximal tooth surfaces and other components of the
denture framework. While doing this, have the patient
again rinse the mouth with cold water. Then replace
the denture in its terminal position to bring the teeth
into occlusion. Then l-epeat the border movements
with the patient' s mouth open. By this hme, or soon
thereafter, the material will have become firm enough
to maintain it:5 form out of the mouth.
7. Remove the denture, quickly rin_e it in water, and dry
the relined surface with compressed air. Apply a
generous coat of glycerine or Teet-ol with a brush or
cotton peJ1et to prevent frosting of the surface caused
by evaporation of monomer- Allow the material to
bench cure in a container of cold waterThis will
eliminate any patient discomfort and tissue damage
that could have resulted
from exothermic heat or prolonged contact of the
tissues with raw monomer. Allhough it is
preferablQ that 20 to 30 minutes elapse before
trimming and polishing, it may be don(:,\ as
soon as the material hardens- Polymerization
may be expedited and condensed by placing the
denture in warm water in a pressure pot for 15 minutes
at 20 psi. The masking tape must be removed before
trimming is done but :5hould be replaced over the
teeth and polished surfaces below the junction of the
new and old materials to protect those surfaces during
final polishing
Properly done, a direct reline is entirely acceptable
for mO:5t tooth-:5upported pelrtiell denlure bll.:5e:5
llUtde of an acrylic resin material, except when some
tissue support may be obtained for long spans between
abutment teeth. In the latter situation, a reline impression
in tissue-conditionins material or other suitable elastic
impression material may be accomplished, the denture
may then be flasked, and a processed reline may be
added for optimum tissue contact and support.
454 McCracken's removable partial prosthodontics
RELINING DISTAL EXTENSION DENTURE BASES
A distal extension partial denture, whkh derives its major
support from the tissues of the residual ridge, requires
relining much more often than does a tooth-supported
denture. Because of this, distal extension bases are
usually made of an acrylic resin material that can be
relined to compensate for loss of support caused by
tissue changes. Although tooth-supported areas are
relined for other reasons, the primary reason for rl'lining
a distal extl'nsion base is to reestablish tissue support for
that base.
The need for relining a distal extension base is
determined by evaluating thl-' st<ibility and occlusion at
reasonable intervals after initial placement of the
denture. Before initial placement of the denture the
patient must be advised that (1) periodic examination
and also relining, when it becomes necessflry, are
imperative; (2) the success of the partial denture and the
health of the remaining tissues and abutment teeth
depend on periodic examination and servicing of both
the denture and the abutment teeth; and (3) a charge will
be made for these visits in proportion to the treatment
required.
There arc two indications of the need for relining a
distal extension partial denture base. Fir1it, a lo:s:s of
occlu:sal contact between oppo:sins dentures or between
the denture and opposing natural dentition may be
evident (see Fig. 9-15). This is determined by having
the ?ati_mt close on ,two strips of 2S-gauge soft green or
blue (casting) wax or Mylar matrix strips. If occlusal
contact between artificial dentition is weak or lacking
while the remaining natural teeth in opposition are
making £inn contact, the distal extension denture needs
to have occlusion reestablished on the present base by
altering the occlusion reestablishing the original position
of the denture framework and ba:se, or, :sometimes,
both. In most instances, reestablishing the original
relationship of the denture is necessary, and the
occlusion will automatically be reestablished.
Second, a loss of tissue support that causes rotation
and settling of the distal extension base or bases is
obvious when alternate finger
pressure is applied on either side of the fulcrum
line (see Fig. 9-16). Although checking for occlusal
contact alone may be misleading, such rotation is positive
proof that relining is necessary. If occlusal inadequacy is
detected without any evidence of denture rotation toward
the resldual ridge, all that needs to be done is to
reestablish occlusal contact by rearranging the teeth or by
adding to the occlusal surfaces with resin or cast gold
onlays. On the other hand, if occlusal contact is adequate
but denture rotation can be demonstrated, it is usually a
result of migration or extrusion of opp05in_ teeth or CI
_hift in position of an opposing maxillary denture, thus
maintaining occlusal contact at the expense of the
stability and tissue support of that denture. This is often
the situation when a partial denture is opposed by a
maxillary complete denture. It is not unusual for a
patient to complain of looseness of the maxillary com-
plete denture and request relining of that denture when
dctudlly it is the pdrtidl denture that needs relining.
Relining and thus repositioning the partial denture results
in repositioning of the maxillary complete denture with
CI return of stability and retention in that denture.
Therefore evidence of rotation of a distal extension
partial denture about the fulcrum line must be the
deciding factor as to whether relining needs to be done.
Rotation tis:meward about the fulcrum line always
results in a lifting of the indirect retainer(s). The
framework of any distal extension partial denture must be
in its original terminal position with indired retainers
fully seated during and at the end of any relining
procedure. Any p05sibility of rotation about the fulcrum
line because of occlusal influence must be prevented, and
therefore the frdmework must bc held in its original
terminal position during the time the impression is being
made. This all but eliminate:; the practicality of the use
of a do:sed-mouth impres:sion procedure effectively
when relining unilateral or bilateral distal extension
bases.
Therefore the only sure method of making a reline
impression for a distal extension partial denture is with
an open-mouth procedure done in exactly the same
manner as the original secondary impression (see Fig.
16-13). The

Chapter Relining and rebasing the removable partial denture
21
denture to be relined is first relieved generously on the
tissue side and then is treated the same as the original
impression base for a functional impression. The step-
by-step procedure is the same, with the dentist's three
fingers placed on the two principal occlusal rests and at
a third point between, preferably at an indirect retainer
farthest from the axis of rotation. The framework is thus
returned to its original terminal position, with all tooth-
supported components fully seated. The tissues beneath
the distal extension base are then registered in a
relationship to the original position of the denture that
will ensure (1) the denture framework will be returned
to its intended relationship with the supporting teeth;
(2) thl" rl"l"stablishment of optimum tissue support for
the distal extension base; and (3) the restoration of the
original occlusal relationship with the opposing teeth.
Although it is true that the teeth are not
allowed to come into occluBion during an open-mouth
impression procedure, the original position of the
denture is ptJ5itively determined by its relation:ship
with the Bupporting abutment teeth. Becau:se thi5 i5
the relationship on which
the orit;inal occlusion was established, returning the
denture to that position should bring about a rerurn to
the original occlusal relationship if two conditions are
sati"fied. Fir5t of theBe iB that the laboratory
procedure::; durin!'; relining must be done accurately
without any increase in vertical dimension of occlusion.
This is essential to any reline procedure, but it is a
partiLuhu nece__ity with a partial dl'nture because any
change in occlusal v_rtil!a.l dim_ngion will prevent
occlusal rests from sedting dnd will reBult in over-
loading and. trauma to th{\ und{\rlying tissues. The
second condition is that the opposing teeth have not
extruded or mi15rated or that the position of an
oppoSing denture has not become irrcver_ibly altered. In
the latter situation some
adjustment of the occlusion will be necessary, but
lhi:> :>hould be deferred until the opposing teeth or
denture and the structures lI:>:>ocillted with the
temporomandibular joint have had a chance to return to
their original position before denture settling occurred.
One of the greatest satisfactions of a job well done is in
the execution of an open-mouth reline procedure as
described previously, which results in the resto
455
ration not only of the original denture relationship and
tissue support but also of the original occlusal
relationship (Fig. 21-1).
METHODS OF REESTABLISHING OCCLUSION
ON A RELINED PARTIAL DENTURE
Occlusion on a relined partial denture may be
reestablished by several methods and depends on whether
the relining results in an increase in the vertical
dimension of occlusion or in a lack of opposing occlusal
contacts Tn either instance, it is usually necessary to
make a remounting cast for the relined partial denture so
that the denture can be correctly related to an opposing
cast in an articulator as described in Chapter 20 (see Fig.
20-2).
In rare instances, after the relining of a distal
extension partial denture by the method previously
described, the occlusion is found to be negative rather
than positive, or the same as it was before relining. This
may be a result of wear of occlusal surfaces over a period
of time, the
original occlusion being high with resulting
depression of opposing teeth, or other reasons. In such a
_ituation, occlu5ion on the denture must be restored to
reeshblish an even distribution of occlusal loading over
both natural and artificial dentition. Otherwise, the natural
dentition must carry the burden of ma::;tication
unaided, and the denture becomes only a space-filling or
cosmetic device.
If the artificial teeth to be corrected arc acrylic
resin, the occlusion can be reestablished either by adding
autopolymerizing or light-activated acrylic resin to
occlusal surfaces or by fabricatinB Bold occlusal surfaces,
which can be attached to the original repillced teeth. The
oribinal h!Qth may also be removed from the denture base
and replaced by new teeth anang,ed to harmonize with the
opposing occlusal surfaces. Baseplate _ax may be used to
support the tQQth as they are arranged. The wax should
be carved to restore the lingual anatomy of the teeth and
the portion of the denture base that was
eliminated when the original teeth were removed. A stone
matrix is made that covers the occlusal and lingual
surfaces of the teeth and
456 McCracken's removable partial prosthodontics

A B

c D

Fig. 21-1 Because of potential for occlusal distortion, alternative procedure for relining _hould be
considered. Metal reline jig may be used effectively to preserve vertical and occ1wml rdalion;:!hip_
of partial denture. Procedure firBt requircB that suitable impression be "ccompli"hQd, following
guidelines discu""ed in text. A, Stone cast 1S made to record impression portion and also to contact
but not entrap, sufficient parts of framework to ensure stable cast base. I}, Cast is then affixed to
upper or lower member of reline jib' C, OcclUBaJ BurfaceB are isolMp.1 in blackout and stone
opposing cast is poured and secured to other member of jig. V, When stone has thoroughly set, jig is
separated, partial denture i" removed from cast and
ti"sue surface(,,) and border" are relieved

Contmuect
denture flange. Then wax may bc rcmovcd from the
denture base and teeth and the tissuebea.rinlJ tmrfa.ce
coated with a bondino aocnt. Those areas on the stone
matrix, intimate to the new acrylic resin to be added,
should be painted with a tinfoil substitute or an air
barrier coating material if a visible light-cured (VLC)
material is to be used. The new teeth are placed in the
stone matrix, and the matrix is accurately attached to the
denture base with sticky wax or a hot glue gun. VLC
material or an autopolymerizing
acrylic resin is then used to attach the teeth. If an
autopolymerizing material is used it can be conveniently
sprinkled on by a buccal approach. The buccal surface of
the denture base adjacent Lo Lhe Leeth _hould be
_li15htly overfilled BO the cuned :shape nmy be re_tored
to thiB portion of the base during finishing and polishing
procedures. Occlusal discrepancies caused by this
procedure should be corrected on the articulator by new
jaw relation records if the denture has a distal extension
base.
 Chapter Relining and rebasing the removable partial denture 457
21

E f

FiS' :1:1-1, c:ont'd. E, A1.1.toFolymorizins acrylic rQsin is mixQd to thick, runny consistency and
carefully placed into base and into any deep llrell1\ of Cll1\t. F, Framework io replaced on Ci1ot, and
membcm of jig Qre realigned. and. tisht...nQd to complete closure, covered with warm water, and
placQd in a pmssure pot at 20 psi for 15 minutes G, Re'<toration is finished and polished. Became of
secure positioning of base to cast this mf'thod virtually ensures that no changes will occur in occlusal
vertical dimension or in occlusal relationship.

A second method i1\ to remove the original teeth and
replace them '-\lith a hard inlay '-\laX occlusion rim vn
which a functional ret;iBtmtion of occlusal pathways is
then established (see Chapter 17). Either the original
teeth or new teeth may then be arranged to occlude with
the templ:at._ thus obtained and subsequently attached
to the denture base with processed VLC material or
alltopolymerizing acrylic resin. If the latter is used, the
need for flasking may be eliminated by securing the
teeth to a stone matrix while the acrylic resin attachment
is applied with a brush technique. Regardless of the
method used for reattaching the teeth, the occlusion thus
established should require little
adjuBtment in the mouth and should exhibit the occlusal
harmony that is possible by this method.
SJ:,LF- A:):)J:,sSMBNT
AIDS
1. What is the difference between relining and
rebaBin15 an acrylic reBin denture base?
2. On occasion, tissue changes beneath toothsupported
denture bases require correction of the bases to
reestablish intimate contact of the base and residual
ridge. List three indications that would lead one to
believe that intimate contact must be restored.
458 McCracken's removable partial prosthodontics
3. In any relining procedure, it is necessary to relieve
the borders and tissue surface of the denture base
before making an impression. Why b thb required?
4. Tooth-supported removable partial denture bases
may often be relined with a colormatching,
autopolymerizing, or VLC acrylic resin as a
chairside procedure. Describe such a procedure, and
include preparation of the
bases as well as the precautions that must be
observed for patient comfort.
5. When relining a tooth-supported base, why should the
anatomic or functional form of the ridge be used?
6. Suppose that rests are not correctly seated in their
prepared _eat_ when a chair_ide reline procedure is
accomplished. What mu_t be done?
7. Suppose a Class III, modification I, type of
removable restoration must be relined: the
edentulous areas of the residual ridge are from
canine to third molar on each side, and some
support of the _ases by the residual ridges is
desired. What procedure should be undertaken to
acceptably reline the restoration? Include
impression procedure, impression material,
processing, and correction of any occlusal
discrepancies encountered.
8. There are two indications of the need for relining a
distal extension removable partial denture. State
the"e two indications.
9. There is little difference in relining a distal extension
denture base and making a secondary impression
with a tray attached to the framework. Describe the
procedures, both clinical and laboratory, that must
be performed in relining a distal extension base.
10. After completion of the reline procedure and
finishing of the restoration, occlusal dbcrepancil's
invariably occur. ThI'Y must bl' cor
rected before the patient IS given possessIOn of the
restoration. How are occlusal discrepancies for a relined
distal extension denture corrected?
11. Should the same adjustment procedures of the
denture ba_e to re_idual ridge be undertaken for a
relined base as was performed for initial placement
of a new denture? Why or why not?
12. Dues adjustment of the denture base to the basal
seat precede or follow correction of occlusal
discrepancies? Why?
13. Suppose that after relining a distal extension denture
base one finds occlusal contacts of opposing
posterior artificial teeth are minimal or nonexistent
What then?14. Before relining or reba"ing i"
undertaken, the oral tissues should be returned to a
state of health. True or falsl'? Rationalizl' your
answer.