SOFT LINERS AND

DENTURE ADHESIVES
SOFT LINERS

INTRODUCTION

• A soft lining material may be

defined as a soft, elastic and
resilient material forming all or
part of the fit (impression)
surface of a denture.
• Acts as a cushion between the
hard denture base and tissues
• Elastic and resilient
CLASSIFICATION
• International Organization for Standardization (ISO) has issued two
international standards related to soft liner materials:
1. Resilient lining materials for removable dentures–Part 1: short-term
materials and soft lining materials and
2. Resilient lining materials for removable dentures–Part 2: materials
for long-term use.
• Based on duration of use
1. Short term liners : Upto 1 month
2. Intermediate liners : 1-6 months
3. Long term liners : 1 year or longer
• Based on composition:
(1) Heat-polymerised acrylic resin
(2) auto polymerized acrylic resin
(3) heat polymerised silicone,
(4) auto polymerized silicone
(5) treatment liners (tissue conditioners).
Available Materials
• The commercially available soft lining materials generally fall
into two basic groups:
1. Silicone type and
2. Acrylic type materials
Acrylic resin soft liners
Both heat processed and auto-polymerizing types have powder and
liquid components
• Powder : acrylic polymers and copolymers; benzoyl peroxide- initiator
• Liquid : methyl methacrylate monomer and a plasticizer.
• Purpose of the plasticizer : usually di-n-butyl phthalate, is to reduce
the transition of the polymer from liquid to solid below mouth
temperature.
• No adhesive is required
Silicone rubber materials
• Composed of polymers of dimethyl siloxane—a viscous liquid that can
be crosslinked to give good elastic properties.
• The crosslinking agent: alkyl-silane
• Catalyst: an organometal salt or benzoyl peroxide
• E.g.: molloplast b, flexibase.
IDEAL PROPERTIES
1. Ease of processing
2. Minimal dimensional change during processing
3. Water absorption should be minimal
4. Minimal solubility in saliva
5. Resilience
6. Bonding to poly(methyl methacrylate)
7. Adequate tear resistance
8. Easily cleansability and maintenance
9. Nontoxic, odourless, and tasteless
10. Aesthetically acceptable
TREATMENT LINERS / TEMPORARY SOFT
LINERS/ TISSUE CONDITIONERS
COMPOSITION
• Consist of a two-component powder and liquid system
• Powder : higher methacrylate, e.g. poly(ethyl methacrylate) and
copolymers
• Liquid : mixture of ethyl alcohol as solvent and dibutyl phthalate as
plasticizer
• Leaching and evaporation of these components leads to rapid
hardening of the material in the mouth.
• Tissue conditioners need to be replaced every 2-3 days in the mouth
INDICATIONS FOR SHORT TERM
SOFT LINERS/ TISSUE
CONDITIONERS
1. Treatment and conditioning of abused/ irritated denture
supporting tissues prior to impression making for new
dentures
2. For provisional adjunctive/ diagnostic purposes such as
recovery of vertical dimension of occlusion and correcting
occlusion of old prosthesis
3. Temporary relining of immediate dentures/ immediate
surgical splints
4. Relining cleft palate speech aids
5. Tissue- conditioning during implant healing
6. Functional impression materials
MECHANISM OF GELATION

• Gelation of tissue conditioners is a physical process ( devoid of any

chemical reaction or any monomeric substances that could cause
tissue irritation).
• Upon mixing the powder and liquid, the alcohol and plasticizer mix
diffuses into the swellable acrylic beads.
• Gelation involves the entanglement of outer polymer chains of
swollen beads, resulting in a tacky set gel with high cohesive
properties.
MECHANISM OF ACTION
• Tissue conditioners show combination of both viscous fluid and elastic solid
behaviour
• Viscous behaviour allows adaptation gel to inflamed/ irritated mucosa, improving
the fit of denture
• During chewing, the material demonstrates a time dependent elastic behaviour
that allows it to recover initial deformation, absorbing impact forces and
cushioning the underlying tissues.
• Short-term soft liners used for functional impressions differ from those used for
tissue conditioning
• Functional impression material should display good flow but with minimal elastic
recovery, and exhibit adequate dimensional stability in terms of weight change ,
water sorption and solubility
INDICATIONS FOR LONG TERM SOFT
LINERS
1. Thin, non-resilient mucosal
coverage
• The provision of a resilient liner
beneath a rigid denture base can
improve both masticatory
efficiency and oral comfort for
patients presenting with a
reduced thickness or lessened
resilience of the oral
mucoperiosteum.
2. Poor ridge morphology where the
mental nerve is at the crest of the ridge
• In some individuals, the gradual
resorption of bone can lead to the
mental nerve lying on the surface of
the alveolar ridge.
• The nerve can be trapped between the
denture and the tissue causing pain.
• Inclusion of appropriate relief on the
master cast together with a soft lining
may help to reduce the pressure on the
nerve.
• 3. Persistent denture sore mouth
• It may be due to occlusal problems,
underlying bony irregularities, reduced
keratinization of the epithelium with
increasing age, and atrophic changes in
postmenopausal women.
• If these have been eliminated but
discomfort persists, soft lining materials
may be used to line the fit (impression)
surface of the denture.
• To be effective, a permanent soft lining
should be about 2 to 3mm thick.
• The lining acts to absorb part of the force of
occlusion, releasing the stored energy as
elastic recoil.
• It therefore increases a patients ability to
use a denture comfortably and may lead to
relief of the symptoms of chronic soreness.
4. Acquired or congenital oral defects
• Soft lining material could be used for the cleft palate patient, or an
acquired oral defect related to trauma, to improve retention of the
denture by engaging undercuts.
• Soft lining materials are also used for obturators after maxillofacial
surgery.
5. Xerostomia
• A soft lining may be indicated in those with a reduced saliva
flow, possibly as a result of degenerative changes in the
salivary glands, radiotherapy or drug therapy.
• However, the use of silicone resilient liners which lack
wettability may result in trauma to the mucosa due to
friction if the denture is loose and is dragged across the
tissues.
• Candidal colonization of permanent resilient linings is a
common feature in the edentulous patient with a dry mouth.
6. The need to promote mucosal
healing
• After implant surgery or with
immediate dentures the dentures
can be lined with resilient liners.
• The soft lining material assists in
producing an even distribution of
functional load over the entire
denture bearing area, avoiding
local concentration of stress and
to a limited degree reducing the
overall load falling onto the
denture bearing area.
7. In cases of bilateral undercuts
• Placing a rigid acrylic resin denture is difficult and there is a problem
of retention.
• Its use in this situation allows the denture to be placed over the
prominence and since the soft material is elastic, it will spring back
into close contact with the undercut area.
8. Irregular foundation
• In the presence of a
maxillary torus, mandibular
tori, prominent mylohyoid
ridges or in irregular bony
foundations, soft lining may
be indicated because there
is usually an associated
very thin mucosa covering
these bony projections.
9. Single denture opposing natural teeth
• In patients who have single denture either maxillary
or mandibular opposing natural teeth or patients who
are bruxers, the soft lining material acts to absorb part
of the force of occlusion, releasing the stored energy
as elastic recoil
10.Mandibular distal extension base partial dentures
• For improving retention in mandibular distal extension base partial
dentures where there is retromylohyoid undercut and the presence of
teeth limits the available paths of placement, resulting in an absence
of valuable retentive and stabilizing areas of the denture extensions.
• To overcome this problem, acrylic resin material in undercut region of
the retromylohyoid fossa is replaced with soft lining material.
CONTRAINDICATIONS
• Contraindications for use of soft liners are:
1. drastic loss of vertical dimension,
2. altered plane of occlusion,
3. short denture borders,
4. dramatically changed tissues,
5. dissatisfying original esthetics.

“ Liners are not a panacea for the correction of all denture base problems and the
patient should understand that eventually a reline, rebase, or remake of the prosthesis
will be necessary.”
TECHNIQUES FOR USING SOFT LINERS
As a tissue conditioner
1. Pre-requisites:
• Dentures should have adequate coverage of the bearing areas
• Adequate OVD
• No occlusal interferences
2. Preparation of the denture.
• From the denture base all undercuts and some area immediately on
the ridge to a depth of 1mm or more is removed.
• Borders and flanges maintained as vertical stops
• If the denture base is short, it should be extended using self cure
acrylic resin to provide support for the soft material
• Dentures should be provided with room for the conditioning material
that is sufficient to allow the displaced and traumatized tissue over to
a normal state.
PREPARATION AND PLACEMENT OF THE TISSUE
CONDITIONER IN THE MOUTH

• Material used is a three component system; the polymer (powder),

the monomer (liquid) and a liquid plasticizer (“Flow Control”).
• For conditioning tissues, a ratio of 1 ¼ parts of polymer to 1 part of
monomer is recommended with the addition of approximately ½ cc of
the plasticizer (flow control).
INDIRECT METHOD OF PROCESSING
SOFT LINERS
FOR FUNCTIONAL IMPRESSIONS

Maxillary trial base with

occlusion and mandibular
impression tray in centric
relation at acceptable vertical
dimension of occlusion. Flat
rims in maximum contact are
without inclines.
Initial application of thicker tissue-conditioning material.
Final conditioner impression after two applications of thinner
conditioning material.
Detailed areas are shown in mylohyoid and retromylohyoid
areas.
Polysulfide rubber impression with mouth open. Excellent
tissue detail is produced
OTHER TYPES OF SOFT LINERS
• Fluorinated soft lining material
Excellent viscoelastic properties
Adheres well to denture base as the
fluorinated copolymer adheres
physically to the acrylic resin
Composition: Fluorinated copolymer –
50% vinylidene fluoride, 30% chlorotrifluoroethylene and 20%
tetrafluoroethylene by weight
• Kregard
Ethyl acetate solution containing a fluorinated soft resin.
Applied to the surface of the tissue conditioner leaving the surface
coated by a thin film of the resin after the solvent evaporates.
Hence, components of tissue conditioner will not leach out leading
to:
1. Increased duration of viscoelasticity of the conditioner
2. More smoother and abrasion resistant
3. Decreased contamination
MAINTENANCE
• Should not be cleaned by scrubbing with a hard brush in order to
prevent tearing of the material.
• The use of soft brush under running water is recommended.
• Soaking denture in cleanser is not recommended.
• Most of denture cleansers are acidic and are absorbed by tissue
conditioners and retained even after rinsing with water
• Mild acid can later be released when denture is placed in the mouth
and can cause irritation.
• Longevity in wear is limited. Hardening takes place in 4-8 weeks. Close
observation and re-application required
 LIMITATIONS

1. Reduction of the denture base

strength.
2. Loss of softness and resilience.
3. Colonisation by Candida albicans.

Intaglio surface of mandibular complete

denture shows presence of Candida
albicans on the soft liner material.
4. Difficulty in keeping soft linings clean using normal denture cleaning
methods.

5. Dimensional instability.
• Some soft linings lose their plasticizer with time, and most of them
absorb water.
• These factors may cause dimensional changes.
6. Failure of adhesion.
• A common problem of soft-lined
dentures is the failure of
adhesion between the soft lining
and the denture base.
• Methods used to increase bonding between liner and denture base
resin:
1. Surface roughening using lasers and alumina abrasion
2. Chemical etching with acetone, methylene chloride
3. Oxygen plasma treatment
DENTURE ADHESIVES
 INTRODUCTION

DEFINITION
“As a material used to adhere a denture to oral mucosa” (GPT 8)
 classification

• Creams
Soluble • Pastes
• Powder

• Pads
• Synthetic wafers
Insoluble
1. Based on components:
 Natural gum - Karaya gum.
 Synthetic gum - Grantez polymer.

2. Based on duration of action:

 Long acting - Poly vinyl methyl ether maleate
 Short acting – carboxy methyl cellulose

3. Based on forms:
 Powder.
 Cream
 Paste
 Soluble group

• Blend of polymer salts-

short acting- carboxy methyl cellulose (CMC)
long acting – polymethylvinyl-ether maleic anhydride
(PVM-MA).

CREAM POWDER
Petrolatum Calcium acetate
Mineral oil Silicon dioxide
Polyethylene oxide
ANTI CLUMPING
BINDING AGENT
AGENT
• FLAVORING -Menthol and peppermint oil
• COLOR - dye
• PRESERVATIVES-Sodium borate and methylparaben or
polyparaben
 Powder formulation Cream formulation
 Degree of hold is less.  Degree of hold is high
 Duration of action is  Duration of action is long.
short.  Requires more material.
 Can be used in smaller  Difficult to clean of
quantities. denture and tissue.
 Easy to clean of denture  Initial hold is achieved
and tissue. comparatively late.
 Initial hold is achieved
soon.
 Insoluble group

1. Pads
2. Synthetic wafers

• laminated fabric with a water-activated

component impregnated within the fabric’s mesh
• Adhesive ingredients may be sodium alginate or ethylene
oxide polymer.
 Composition:

Components Action
Poly vinyl methyl ether maleate, Adhesive properties.
Karaya gum,
Methyl cellulose,
Hydroxy methyl cellulose,
Carboxy methyl cellulose sodium.
Sodium borate, Antimicrobial agent
Sodium tetra borate,
Hexa chlorophene.
Propythy-hydroxy benzoate Preservative and anti
fungal
Sodium lauryl sulfate Wetting agent
Magnesium oxide Filler
Silicon-di-oxide, calcium stearate To minimize clumping
Petrolatum, mineral oil, poly Binder
ethylene oxide
Menthol, Pepper mint oil & oil of Flavoring agent
winter green
 Mechanism of action

•Swell to obliterate the space between the base of denture and the oral mucosa.

1.WATER ABSORPTION
-50 to 150 percent

2.BIOADHESION BY CARBONYL GROUPS

-Bioadhesive And Bio Cohesive Forces
-Polymethyl vinyl ether-maleaic anyhride
-Sodium carboxymethyl cellulose
Grasso ,Denture adhesives changing attitudes,JADA1996, 177,1,90-
96
 Viscous gel

Before applying adhesive

After applying adhesive
 INTERFACIAL FORCE

Influence:
Increase the coefficient of surface tension of the fluid
Forms a viscous gel on contact with water
Increases cohesiveness of the film of saliva by increasing
viscosity of the film.

Grasso ,Denture adhesives changing attitudes,JADA1996, 177,1,90-

96
 Ideal requirements

• Physically it should be in a powder, cream, or a gel form.

• nontoxic, non-irritant, and biocompatible with the oral
mucosa.
• odorless and tasteless.
• easy to apply and to remove from the tissue surface of the
denture.
• Should not promote microbial growth.
• Should retain its adhesive properties for 12–16 h.
• Provide comfort, retention and stability to the denture,
 INDICATIONS
1. Jaw relation records
2. Try in
3. Insertion of denture
4. Immediate dentures
5. Reduction of tissue irritation
6. Systematic diseases
7. Maxillofacial surgery patients
8. Administration of drug therapy
9. For extra severity of stable denture
10. Osseointegrated implants
11. Removable partial dentures
 Contraindications

1. Allergy
2. Inadequate ill fitting and function dentures
3. Excessive loss of vertical dimension
4. Broken dentures
5. Improperly using denture adhesive
ADVANTAGES
• Reduces irritation
• Increases masticatory efficacy
• Psycological benefit
• Retention
• Stability

DISADVANTAGES
• Poor oral hygiene
• Tissue destruction-insoluble adhesives
Can Denture Adhesives Contribute To Oral Pathoses?

Growth of microorganisms in denture adhesives

• Denture adhesives often include antimicrobial agents such as
hexachlorophene, sodium tetra borate, methyl salicylate, sodium borate and
amphotericin (Kim 2003, Okzan 2012).
• Adhesives do not have an inhibitory effect upon the oral flora, whereas others
were claimed to promote Streptococcus mitis and C. albicans growth (Stafford,
1971).
• Adisman (1989) denture adhesives have a cushion effect and thereby prevent
the food bolus going underneath the denture and eventually inhibit C. albicans
growth.
 APPLICATION

CREAMS
•Two approaches

Thin beads
Small spots
Thin bead technique:
Spot technique:
 advantages

• A more controlled application

• Less likelihood of applying an excessive amount
• Elimination of ooze
• Easier to achieve a more even distribution
• Helps impress upon the patient that he/she has control of the amount used
Powder form:
 Pads and synthetic wafers

• fabric carrier impregnated with an adhesive.

 Denture maintenance

• Daily removal of adhesive product from tissue surface

• Prosthesis soaked in water over night, so readily rinsed off.
• Running hot water over tissue surface of denture while
scrubbing with a hard toothbrush.
• Adhesive on ridge is removed by rinsing with warm or hot
water and then firmly wiping the area with gauze or a
washcloth saturated with hot water .
 Ada REQUIREMENTS

• Product composition should be supplied

• Should not affect the integrity of denture
• Biologically acceptable
• Effective function as adherant
1. Polygrip
2. Fixodent
3. Fitty dent
4. Fixon
4. Cushion grip
5. Sea bond
6. End slip