Denture Maintenance

Denture maintenance is a crucial aspect of prosthodontic care and long-term oral health for individuals who wear full dentures or other removable prostheses. Proper aftercare not only prolongs the lifespan of the prosthesis but also protects the health of the oral tissues that support it. Unfortunately, many denture wearers believe dentures require minimal upkeep once delivered, when in fact the opposite is true.

Importance of Regular Denture Maintenance

Regular review of denture patients—ideally annually—is essential. Over time, changes occur in both the denture and the underlying oral tissues. These changes are often subtle and progressive, making professional monitoring necessary to catch problems early.

Why yearly reviews matter

  1. Detection of ill-fitting dentures:
    Even well-made dentures become less effective with time due to jawbone resorption and wear of acrylic surfaces. Loose or unstable dentures can traumatise the mucosa.
  2. Prevention of tissue injury:
    Ill-fitting dentures can create pressure points, leading to inflammation, ulceration, or chronic trauma.
  3. Monitoring for pathology:
    Denture wearers are at higher risk for oral lesions, including candidiasis, denture hyperplasia, and, in rare cases, lesions suspicious for malignancy. Regular examination ensures early detection.
  4. Improvement in function:
    Routine checks allow adjustments to be made that improve mastication, speech, and comfort.
  5. Education reinforcement:
    Patients often forget instructions for cleaning and overnight removal; reinforcement helps maintain oral health.

 

Problems Caused by Lack of Aftercare

As the alveolar ridge gradually resorbs over time (a natural process following tooth extraction), dentures inevitably become ill-fitting. When this occurs, denture retention, stability, and support are reduced, leading to functional and biological consequences.

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1. Resorption of the Ridge

Loss of bone volume beneath dentures is normal but can accelerate when dentures move excessively during function.

  • Mechanism: Excessive pressure and micro-movement create chronic inflammation, which stimulates osteoclastic activity, increasing bone loss.
  • Clinical impact: Patients may complain of decreased fit, instability, or pain.

 

2. Predisposition to Candidal Infection

Loose dentures create sheltered, moist areas where Candida albicans can thrive.

  • Poor hygiene worsens the situation.
  • Continuous denture wear (especially overnight) contributes significantly.
  • Symptoms include redness, burning, angular cheilitis, and soreness.

 

3. Denture Irritation Hyperplasia

Also known as epulis fissuratum, this is an inflammatory fibrous hyperplasia caused by the denture flange repeatedly rubbing on the mucosa.

  • Appears as folds of excess soft tissue.
  • Often occurs when patients avoid reviews and continue wearing poorly fitting dentures.

 

4. Inflammatory Papillary Hyperplasia

Usually found on the palate in long-term denture wearers.

  • Appears as “cobblestone” mucosal overgrowth.
  • Associated with chronic trauma, poor denture hygiene, or fungal infection.

 

5. Exacerbation Due to Occlusal Wear

As the denture teeth wear down:

  • Occlusal vertical dimension (OVD) decreases.
  • Premature contacts develop.
  • Chewing efficiency declines.
  • Increased movement causes tissue trauma.

 

Maintenance appointments provide an opportunity to detect early wear and plan for relining, rebasing, or replacement.

 

Rebasing and Relining: Key Clinical Procedures

Rebasing and relining are two common methods used to improve the fit of an existing denture. Although often used interchangeably, they refer to different levels of intervention.

1. Relining: Definition and Use

  • Relining involves replacing only the fitting (tissue) surface of the denture.
  • Usually accomplished with a temporary or permanent lining material.
  • Indicated when the denture’s extension and occlusion remain acceptable, but the fit is poor due to ridge resorption.

 

2. Rebasing: Definition and Use

  • Rebasing replaces most or all of the denture base, keeping the existing denture teeth.

  • Appropriate when:

    • Extension is acceptable,

    • Occlusion is acceptable,

    • But the denture base is worn, discoloured, or poorly fitting.

Rebasing is the option of choice when the only significant issue is the condition or fit of the denture base.

3. Material Choices in Rebasing

  • Heat-cured acrylic resin is the preferred material due to its strength and durability.
  • Self-cure acrylic can be used chairside but has inferior mechanical properties and may not bond as well.
  • Wash impressions using ZOE or low-viscosity elastomer must be taken inside the denture during heat-cured rebasing procedures.

 

4. Impression Technique for Rebasing

Recording accurate impressions is crucial, and careful steps must be taken to avoid inadvertently increasing the OVD.

Procedure summary

  1. Check and adjust occlusion: Record the original OVD to prevent over-opening.
  2. Remove undercuts on the tissue surface to ensure the denture seats properly during impression making.
  3. Correct denture extension: Apply greenstick compound as needed to refine borders and create a reliable post-dam area.
  4. Apply impression material: Insert denture into the mouth while ensuring the patient closes into proper occlusion.
  5. Remove and assess: Repeat if the impression shows voids or distortion.

Alternative Technique for Inflamed Tissues

When tissues are swollen or hyperplastic:

  • A functional impression with a tissue conditioner (e.g., Visco-gel®) is used over several days.
  • This provides a dynamic, self-adjusting impression that adapts during normal function.
  • The resulting impression must be cast immediately for accuracy.

 

Tissue Conditioners: Clinical Role and Application

Tissue conditioners are resilient, soft, viscoelastic materials used to allow traumatized tissues to heal and to improve the fit of a denture temporarily.

Common examples:

  • Coe-Comfort™
  • Visco-gel®

 

Why Tissue Conditioners Are Important

Tissue conditioners are beneficial in cases where:

  • Denture trauma has caused mucosal inflammation.
  • The patient has been wearing ill-fitting dentures for a long time.
  • A functional impression is required prior to rebasing or making new dentures.
  • Post-surgical healing is underway and tissues require protection.

 

How They Work

  • Provide cushioning between denture and tissue.
  • Distribute occlusal loads evenly.
  • Encourage tissue rebound and healing.

 

Technique for Application

  1. Relieve pressure areas on the denture base.
  2. Ensure adequate thickness: Minimum of 2 mm is required for proper cushioning.
  3. Avoid leaving the material in place too long: Should not exceed one week; replaced frequently if needed.

Use After Pre-prosthetic Surgery

After surgical procedures such as alveoplasty, epulis removal, or implant site preparation:

  • Tissue conditioners protect healing tissue from denture trauma.
  • Because they harden over time, weekly replacement is necessary.

 

Use in Atrophic Ridges

Patients with very resorbed ridges often struggle with denture retention and stability.

  • Soft lining materials (e.g., Permasoft®, GC Reline™) can be used for longer-term solutions.
  • These materials help distribute stresses more evenly.

 

Soft Linings: Indications and Considerations

Soft linings are semi-permanent materials used inside dentures to provide comfort in specific clinical scenarios.

Indications

  • Elderly patients with delicate, atrophic mucosa
  • Following prosthetic or pre-prosthetic surgery
  • To engage tissue undercuts for increased retention (e.g., cleft palate cases or hemimaxillectomy patients)

 

Clinical Considerations

  • A new acrylic denture should ideally be fabricated first, and occlusion corrected before lining.
  • Minimum thickness of 2 mm is necessary but weakens the denture, especially lower dentures. May require a metal strengthener on the lingual surface.
  • No soft lining material is perfect; many harden, discolor, degrade, or harbor microorganisms.
  • Soft liners are best avoided when possible unless clinically necessary.

 

Cleaning Dentures: Methods, Materials, and Patient Education

Denture hygiene is vital for maintaining oral health, preventing infections, and extending denture life.

The Importance of Regular Cleaning

When dentures are new, clinicians must stress the importance of routine cleaning:

  • Removes plaque, stains, food debris, and calculus.
  • Prevents fungal infections.
  • Reduces bad odors.
  • Protects underlying mucosa.

 

Patients often mistakenly believe denture cleansers replace brushing; this misconception must be corrected.

Best Practice Advice

  • Clean dentures over a basin of water or a towel to prevent breakage in case they are dropped.
  • Emphasize cleaning all surfaces, especially the fitting surface.

 

Chemical Denture Cleansers: Formulations and Their Effects

Denture cleansers vary widely in chemical composition and effectiveness.

Denture Cleansing Formulations Explained

Below is an expanded explanation of the table:

Powder Cleansers

  • Active ingredient: Abrasives (e.g., calcium carbonate)
  • Issue: Excessive abrasion can damage acrylic surfaces, causing scratches that harbor plaque.

 

Paste Cleansers

  • Active ingredients: Abrasives + eugenol

  • Problems:

    • Abrasion

    • Crazing (micro-cracks in acrylic)

Dentu-creme®

  • Contains abrasive and phenol oil
  • Problems: Sensitivity and abrasion

 

Hypochlorite Solutions (e.g., Dentural®)

  • Active ingredient: Sodium hypochlorite
  • Advantages: Excellent disinfectant, removes stains and destroy fungi.
  • Disadvantages: Corrodes metal components—should not be used with metal dentures.

 

Effervescent Tablets (e.g., Steradent®)

  • Release alkaline peroxide
  • Issues: Some doubt effectiveness unless used for extended periods (>30 min)

 

Dilute Acids (e.g., Denclen®)

  • Contain hydrochloric or phosphoric acid
  • Danger: Metal corrosion, enamel etching (if used near natural teeth)

 

Enzymatic Cleaners

  • Contain proteolytic enzymes
  • Effective but not widely accessible.

 

Peroxide Denture Cleaners: What to Avoid and What to Use

This outlines which cleaning agents are suitable for particular denture materials.

Key Principles

  • Soft liners (Visco-gel®, Molloplast®, Coe-Comfort™)
    → Avoid acids and alkaline peroxide as they degrade liner materials.
  • Metal dentures
    → Avoid hypochlorite—it corrodes metal.
    → Use soap and water instead.
  • Any denture
    → Avoid household bleach—too strong, unsafe.
    → Use alkaline peroxide products designed for dentures.

 

Practical Tips for Patients

  • Hypochlorite is effective for acrylic dentures only.
  • Avoid hot water when using hypochlorite—it increases bleaching risk.
  • Effervescent tablets require longer soaking than advertised for fungal control.

 

Conclusion

Denture maintenance is a shared responsibility between the clinician and the patient. While patients must be diligent with daily cleaning and proper usage, dental practitioners are responsible for ongoing monitoring, early detection of issues, and timely intervention through relining, rebasing, or providing tissue conditioners. Understanding the purpose and application of various denture maintenance materials—such as soft liners, tissue conditioners, and appropriate cleaning solutions—ensures optimal oral health and denture longevity.

By expanding and clarifying the clinical principles outlined in the extracted text, this comprehensive guide aims to support students, clinicians, and denture wearers in making informed decisions about denture care. Ultimately, appropriate maintenance improves comfort, function, and quality of life for denture patients.

 

References

  1. Zarb GA, Hobkirk J, Eckert S, Jacob R. Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses. 13th ed. Mosby Elsevier; 2013.
    – A foundational text detailing denture physiology, relining/rebasing procedures, and maintenance protocols.
  2. Sheiham A, Steele JG, Marcenes W, et al. Oral health in older people: the WHO global oral health programme. Community Dental Health. 2001;18(4): 219–227.
    – Discusses oral health needs in elderly denture wearers.
  3. Felton D. Complete Edentulism and Denture Care. Journal of Prosthodontics. 2009;18(2): 87–94.
    – Provides evidence-based best practices for denture hygiene and maintenance.
  4. Budtz-Jørgensen E. Diseases of the Denture-Bearing Tissues. In: The Textbook of Complete Dentures. Quintessence Publishing; 1994.
    – Key reference on candidiasis, denture stomatitis, inflammatory papillary hyperplasia.
  5. Shen C, Colaizzi FA. Evaluation of tissue conditioners. Journal of Prosthetic Dentistry. 1986;56(1): 35–39.
    – Classic paper evaluating properties and clinical use of tissue conditioners.
  6. Jones JA, Orner MB, Spiro A, et al. Denture cleaning: a review of published studies. Gerodontology. 1994;11(4): 149–155.
    – Reviews efficacy of cleaning methods and denture cleansers.
  7. Polyzois GL. Denture cleansing habits: a survey. Gerodontology. 1983;2(2): 80–83.
    – Early but foundational study highlighting patient compliance issues.
  8. American College of Prosthodontists. ACP Position Statement: Denture Hygiene. 2016.
    – Current clinical recommendations for proper denture cleaning.
  9. Crawford CA, et al. Denture plaque and denture cleaners. Dentistry. 1986;14: 258.
    – Reference cited in the original text regarding hypochlorite use and denture cleaning efficacy.
  10. O’Brien WJ. Dental Materials and Their Selection. 3rd ed. Quintessence Publishing; 2002.
    – Details chemical interactions of denture materials with cleansers, including corrosion risks.
  11. Atwood DA. Postextraction changes in the adult mandible. Journal of the American Dental Association. 1971;81(4): 786–790.
    – Classic research on ridge resorption, supporting the need for relining/rebasing.
  12. Kapur KK. A clinical evaluation of denture adhesives. Journal of Prosthetic Dentistry. 1967;18(6): 550–558.
    – Historical but relevant research on denture retention factors.
  13. Murray MD, Darvell BW. The evolution of the complete denture base. Journal of the American Dental Association. 1993;124(3): 76–90.
    – Discusses denture base materials and durability, relevant to rebasing choices.
  14. Jain AR, et al. Relining and rebasing of dentures — A review. Journal of Pharmacy & Bioallied Sciences. 2015;7(Suppl 1): S10–S14.
    – Summarizes indications, techniques, and materials for relining and rebasing.