Tissue Conditioning

1
Tissue Conditioning
This presentation includes images and text from
the UCLA/APC/Ivoclar Educational Curriculum
2

• Tissue Conditioning
• Oral hygiene
• Rest
• Occlusal Correction
• Resilient liner
• Surgery, if necessary

Traumatic ulcers secondary to denture trauma
Candida infection
3

• Improve health prior to new dentures
• Repeat until tissues appear healthy

Inflamed oral mucosa
Healthy oral mucosa
4
Oral Hygiene

• Plaque
• Inflammation Edema

5
Oral hygiene

• Demonstrate brushing
• All denture surfaces
• Massage tissues
• Soft brush
• 2x day
• 30 sec - 2 minutes

6
Tissue Rest

• Lytle (1957, 59)
• Abused tissue
• Removed dentures (48 - 72 hrs.)
• Inflammation reappeared when dentures replaced

7
Kydd et al (1974)

• Tissue loaded (Denture)
• Change in shape
• Recovery affected by age
• 10-30 years 90 had immediate
• 72-88 years 61 recovery after 10 min
• Some took 4.5 hr

8
Prior to Making Impressions

• Provide Rest
• Remove overnight
• Finger massage
• Tooth brushing of mucosa

9
Reluctance to Removing Denture

• Slight inconvenience (1-3 days) now will affect
  the new denture
• Fit
• Comfort
• For many years to come

10
Occlusal Correction

• Most overlooked cause of tissue irritation

11
Occlusal Correction

• Lytle
• Poor occlusion
• caused
• Poor tissue health

12
Occlusion Correction Principle

• If joint or muscle problems are found during
  initial exam
• Correct the occlusion prior to making new dentures

13
Initial Exam

• Check occlusion
• Palpate muscles joints
• Attempt centric jaw manipulation

14
Occlusal CorrectionClinical remountOcclusal
adjustment

• Non-Reversible

15
Missing Denture Teeth, Asymmetry
16
Correcting Occlusion Prevents

• Difficulty taking jaw relations records
• Perpetuating problems caused by denture wear,
  ridge resorption
• Perpetuating previous errors

17
Occlusal CorrectionAdd acrylic to occlusal
surfaces

• Improves vertical dimension
• Improves balance
• Permanently changes denture

18
Adding acrylic to improve occlusion
19
Occlusal CorrectionSoft Mouthguard

• Acts as occlusal splint
• Avoids cost of processed splint
• Reversible

20
Temporary Resilient Liners

• Lynal (Dentsply)
• Viscogel (Dentsply)
• Mollosil (Buffalo Dental)
• Coe-Soft (GC America Inc.)
• FITT (Functional Impression Tissue Toner-Kerr)
• Tru-Soft (Bosworth)
• Hydro-cast (K-C Dental)

21
Manufacturers Directions
22

• Indications
• Discomfort
• Abused tissues
• Lack of retention
• Loss of vertical dimension

Papillary hyperplasia
Loss of vertical dimension
23

• Clean denture prior to application
• Ultrasonic bath with cleanser

24
Thickness 2mmOtherwise not resilientAlters
vertical dimension May require relief of
dentures
25
Reducing Denture
26
Remove Glossy Denture Surface

• Where conditioner terminates on the denture ( at
  least 6mm over flange)
• Improves conditioner adherence
• Minimizes separation, leakage microbial
  colonization

27
Lynal

• Manufacturer recommendations
• 10cc powder 4 ml liquid
• Can mix thicker
• Dont make thinner

28
Mix Consistency

• Honey
• Strop, not stir
• Greater thickness - stiffer
• Mix carefully - bubbles

29
Applying Temporary Liner

• Apply in smooth, even layer
• Dont trap air

30
Applying Temporary Liner

• Smooth over flange
• Wont adhere to saliva
• Sticky - be neat

31
Seating Denture

• Treat one denture at a time
• Treat least stable denture first
• Most stable denture used to orient position via
  occlusion

32
Seating Denture

• Patient closes lightly
• Assess occlusal contacts
• Move/tilt denture to orient

33
Problems with Relined DenturesAltered OVD
Occlusion
34
Developing Liner Contours

• Border mold after 2-3 min.
• Allow patient to talk while setting

35
Developing Liner Contours

• Remove gross excess early (cotton swab)
• Leave intraorally 8-10 min.

36

• Verify Occlusal Vertical Dimension (OVD)
• Check midline, incisor length
• Wait 10, remove evaluate

37
Initial Trimming

• Minimal
• Leave unless gross excess
• Use hot scalpel blade
• No burs
• Hold by teeth, not liner

38
Finish Polish

• Patient return in 1-2 days
• If discomfort, use PIP
• Trim with acrylic burs

39
Finish Polish

• Polish all surfaces with pumice
• Patient can brush now

40
Patient Education

• Explain temporary nature
• Do not brush for first day
• No commercial cleaners
• Denture in water over night

41
No tissue resolution 10 - 14 days

• Consider systemic conditions
• Medical consult
• Surgical treatment
• Biopsy

42
After 4-6 weeks Becomes rigid as plasticizer
leeches out Breakdown - irritationColonization
- infection

• Coarse, infected liners cause more problems than
  poor fitting dentures

43
Note deterioration

• Life span of the material
• 4-6 weeks depending upon oral hygiene
• Do not to soak the denture in denture cleansers

44
Resilient Liner Hygiene

• Cleansers with bleach will alter liner (Protec)
• Teach patient to brush gently
• soft brush
• Remove at night
• keep in moist environment
• not immersed

45
Tissue ConditioningCombination of treatments
may be necessary
46
All Patients

• Clean denture for patient
• Education
• Denture brushing
• Brush, Massage tissues

47
All Patients

• Tissue Rest
• 8 hours/day
• 24 hours prior to final impressions

48
Moderate - Severe InflammationPain or Looseness

• Adjust Base
• Over extended - adjust
• Under extended - limited extension with liner
• Impingements
• Correct occlusal disharmonies
• Tissue soft liner

49
Change liner in 1-4 weeks

• Depends on severity of tissue irritation

50
Summary

• Good tissue health prior to new dentures
• If tissues healthy, no treatment
• Variety of protocols, depending on problems
• First patient
• If healthy - duplicate denture try resilient
  liner
• If unhealthy - line existing denture