Best-in-Class Solution for Long-Term Denture Relining

Partial and full edentulism is still common in today’s age of implant dentistry. The cost of implant procedures is prohibitive for many of our patients and requires modification of treatment plans to include removable prostheses, like dentures, to fill in the gap.

Anyone who has been a dentist long enough realizes and understands that dentures are not an easy procedure and requires expectation setting with our patients. In my personal experience, dentures are an adjunct to what we do daily but still require a depth of knowledge in order to execute properly.

Because of their commonplace in dental practices, offices working with dentures require effective prosthetic reline materials, regardless of if implants are a part of the surgical plan. Reline materials that are familiar to many of us dentists come with many downsides. Typically, those materials require extensive modification and maintenance, are hard to keep clean, have questionable longevity, or may require keeping the dentures for several days while we send the prosthetic to the lab. Utilizing materials specifically designed for clinician ease-of-use, with the benefit of patient comfort and longevity, is a win-win.

In general, there are three categories of reline material. In each category, some have the capability of chairside use, while others require lab time and curing done outside of a typical dental office. The three categories are generally tissue conditioners, hard reline materials, and soft reline materials.

Tissue conditioners such as Visco-Gel or Coe-Comfort are amazingly soft and can be changed out easily, albeit frequently, to help with post-operative comfort. Their biggest flaws include rapid dimensional changes, short lifespan, and being easily colonized by Candida. As these products are both cost-effective and do exactly what they are designed to do, this category has remained relatively unchanged for many years. For those of us who have patients with prolonged post-surgical discomfort over many weeks/months, this category of reline materials falls short.

The second category of reline materials includes both a chairside and a lab-side hard reline material. This category is great for long-term and stable soft/hard tissue prosthetic wearers and when purely addressing fit and stability on a non-atrophic ridge. There remains excellent adhesion to existing acrylic, and it works wonderfully when working with healthy or relatively healthy ridges. The issues existing within this category depend on if it is lab-processed or chairside-processed relining. Lab processing remains the gold standard for reestablishing the fit and longevity of a restoration. You cannot get much better than pure PMMA to PMMA adhesion. However, sending to a lab for a well-done hard reline takes time, and our patients often do not like to go without their dentures. This is where a chairside reline material comes into play. We do get good results, but chairside hard relines fall short when it comes to residual monomer within the prosthetic, polymerization shrinkage, and exothermic heat from the setting of the material. They are also time-consuming to properly execute and often we can see separation and/or staining where the chairside reline meets with the existing acrylic.

The last category is our soft-reline materials. Namely, we need to consider that these are often a temporary solution and fall somewhere between the tissue conditioners and hard reline materials. Existing soft reline materials such as Coe-Soft or Soft Oryl are easy to place and work with but tend to also have a relatively short lifespan. It takes several weeks to months for bone and soft tissue remodeling to occur, and as such, we would really be served to have a material that falls within a category of moderate to long-term use. The pitfalls associated with traditional soft-reline materials include becoming quickly brittle/hard with porosity, which traps microbes, stains, and odors. The silicone-based liners, first introduced in the 1970s, had an on/off use within dentistry. While they maintained their softness and had better moderate to long-term cushioning of tissue, they fell short on bond strength to the dentures, delamination issues, finishing and polishing difficulty, and still had rough surfaces which attracted plaque.

Seeing a need to fill an important niche in denture prosthetic dentistry, Tokuyama Dental developed its proprietary Sofreliner Tough silicone-based reline material. They perfected the chemistry to have much better physical properties, including high tear resistance, excellent shock absorption, and a closed, less-porous texture that remains soft for years. Surface preparation of the denture takes slightly longer than other traditional soft-reline materials, but the patient leaves the same day with a well-fitting and comfortable prosthetic. Additionally, besides post-surgical healing, the material is well-suited for patients with severely resorbed/knife-edge ridges, bruxers, patients with chronic soreness, and implant overdentures requiring even stress distribution. A good word to describe Sofreliner Tough is versatile.

A great example of a case where Sofreliner Tough really showed its versatility is with a complete denture reline for my patient presenting with a resorbed maxilla consistent with anterior/posterior combination syndrome. She also suffered from chronic denture soreness. She, at the time, was an 84-year-old female with a 30+ year history of denture wearing. Her severely resorbed ridges made it difficult for her to wear a hard acrylic denture comfortably, and she had already undergone a previous reline with an older style silicone reline material (Picture 1). After noting that her dentures were still serviceable, I decided to use Tokuyama Dental’s Sofreliner Tough Medium to address my patient’s concerns. A reproducible occlusion was achieved with bite registration material (Picture 2). The intaglio of the maxillary denture was cleaned, prepared, and primed according to the manufacturer’s directions (Picture 3). Sofreliner Tough Medium is dispensed and applied within the intaglio of the maxillary denture, similar to a wash impression (Picture 4), and then bordered molded as it sets intraorally (Picture 5). This provides the framework where the excess material is then trimmed and polished to allow for a final and well-fitting product (Picture 6 & 7).

Sofreliner Tough, in both its soft and medium formulations, is widely used in my practice. It is easy to clean, feels great to patients, and lasts a long time without additional intervention. Sofreliner Tough is especially useful post-surgery, tooth extraction, and implant placement. Being a soft yet durable material, it makes post-procedure comfort greater than alternative products. And like in the case above, it allows for special uses that other soft reline materials just don’t provide. Additionally, the lifespan of each Sofreliner Tough is up to 1.5-2 years of heavy active use. Because of its versatile nature and the amount I use it in my practice, it is a material that I have found is by far “Best in Class”.