Soft Liner

Uses In Prosthodontics
 INDEX

• INTRODUCTION
• DEFINITION
• HISTORY
• CLASSIFICATION
• COMPOSITION
• IDEAL PROPERTIES
• INDICATIONS
• REFRENCES
 INTRODUCTION
• Post insertion clinical scenario of hard acrylic complete dentures
during functioning may lead to some common problems such as
denture stomatitis,irritation from the dentures, traumatic ulcers
etc. causing severe discomfort in wearing this prosthesis.
• In such situations, alternate solution is the application of
soft liners underneath the tissue surface of dentures and
thereby increasing the comfort of wearing the dentures.

• It usually acts as a cushion between the hard acrylic and

the soft tissue surface thus providing comfort to the
tissues

Kalamalla Ayappa Saran Babu /J. Pharm. Sci. & Res. Vol. 11(12), 2019, 3802-3805
 DEFINITION

• Resilient liners are elastomer polymers used

in the prevention of chronic soreness from
dentures and the preservation of the
supporting structures.
• Resilient denture liner: An interim (ethyl
methacrylate with phthalate plasticizers) or definitive
(processed silicone) liner of the intaglio surface of a
removable complete denture, removable partial denture,
or intraoral maxillofacial prosthesis.
GPT9

Tissue conditioner: A resilient denture liner resin

placed into a removable prosthesis for a short duration to
allow time for tissue healing; used in functional removable
relining procedures to evaluate denture function and
patient acceptance prior to laboratory reline processing.
GPT9
 HISTORY

• Soft liners have been in use for a long period of time and its usage dates
back to as early as 1869 by a person called Twitchell

• Velum rubber was the first soft liner material that was used.

• One of the first synthetic soft lining material was polyvinyl chloride
introduced by Mathews in 1945 in which a plasticizer di-n-butylphthalate
plasticizer was used for the first time
• Later Dioctyl phthalate was considered a better plasticizer
for poly(vinyl chloride)

• By late 1960s, more durable, resilient soft liners was

introduced which were made of silicone rubber materials
based on poly dimethyl siloxane
 IDEAL PROPERTIES OF SOFT LINERS
• For maximum efficacy, soft lining materials should display
the following properties:

• 1. They should be easily processed using conventional

laboratory equipment.

• 2. They should exhibit minimal dimensional change during

processing.
• 3. Water absorption should be minimal.

• 4. The materials should have minimal solubility in saliva.

• 5. They should retain their resilience.

• 6. They should bond sufficiently well to poly (methyl methacrylate) to

avoid separation during use.

• 7. Adequate tear resistance is of practical importance to resist rupture

during normal use.
• 8. They should be easily cleaned and not affected by food,
drink, or tobacco.

• 9. They should be nontoxic, odourless, and tasteless.

• 10. They should be aesthetically acceptable and their colour

should match that of the denture base material.
 INDICATIONS OF SOFT LINERS

• Ridge atrophy or resorption

• Surgery contraindicated
• The bruxer (bruxomania)
• Relief areas
• Restoration of congential or acquired oral defects
• Xerostomia
• Edentulous arch opposing natural dentition
 Ridge Atrophy Or Resorption

• The resilient liner is especially useful in areas where bone

and skin grafts are used to improve the edentulous ridges.

• Such materials seem to provide excellent protection for

these tissues.
 Surgery Contraindicated

• Resilient liners may be used when surgical correction of bony

undercuts is contraindicated.

• The usual approach to this problem has been to thicken the resin
base in the region of the undercut and to remove material from the
tissue surface in order to facilitate insertion and rem oval of the
denture.
 The Bruxer (Bruxomania)

• The use of a resilient liner helps protect the supporting

tissues from this excessive stress.
 Relief Areas
• Resilient liners can also be used to prevent irritation and pain on the
median palatal raphe, anterior nasal spine, and rugae areas.

• A layer of the soft material is placed over these regions to provide relief.

• This obviates the use of a relief cham ber in the maxillary denture and
the subsequent developm ent of hyperplastic tissue.
 Restoration Of Congential Or Acquired Oral
Defects
• Resilient materials are used in the fabrication of
prostheses required for the obturation and restoration of
congenital and acquired oral defects by disease or
trauma.

• The use of a flexible material affords the opportunity to

engage in undercut areas.
 Xerostomia
• The use of resilient liners can be very helpful in these
situations.

• However, caution should be observed in their use for

patients with severe xerostomia, because the resilient
material can be as much of an irritant as the hard denture
base.

• Preparations of artificial saliva have helped ameliorate

this problem .
 Edentulous Arch Opposing Natural
Dentition
• The use of a resilient liner under the denture has precluded
the need for the extraction of the natural teeth and has
resulted in the preservation of the remaining alveolar
process.
 CLASSIFICATION

• Based on duration of use , Soft liners are basically

classified as :

• Short term soft liners

• Long term soft liners
• Based on the type of curing type used they can be
classified into:-

• 1. Heat polymerized soft liners

• 2. Auto polymerized soft liners
 SHORT-TERM SOFT LINERS (TISSUE
CONDITIONERS)

Tissue conditioners remain soft for a limited period (days to

weeks)

For adequate cushioning, tissue conditioners should be replaced

with afresh mix every 2 to 3 days.

This procedure is continued till full recovery of tissues.

 INDICATION
• Treatment and conditioning of abused/ irritated denture supporting
tissues prior to impression making for new dentures

• For provisional adjunctive/ diagnostic purposes such as recovery

of vertical dimension of occlusion and correcting occlusion of old
prosthesis
• Temporary relining of immediate dentures/ immediate
surgical splints.

• Relining cleft palate speech aids.

• Tissue- conditioning during implant healing.

• Functional impression materials.

 COMPOSITION
• Powder-
Polymer,
polyethylmethacrylate(PEMA) or its copolymers

• Liquid –
Ethyl alcohol(solvent)
Aromatic ester- dibutyl phthalate(plasticizer)
 MECHANISM OF ACTION
• Tissue conditioners show
combination of both viscous
fluid and elastic solid
behavior.

• Viscous behavior allows

adaptation gel to inflamed/
irritated mucosa,improving
the fit of denture.
• During chewing, the material demonstrate a time
dependent elastic behavior 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

• Casts should be poured immediately after removal from

patient’s mouth.
DISADVANTAGES

• Temporary nature of tissue conditioners stems from the

fact that both the alcohol and Plasticizer leach out and are
partially replaced with water.

• Material thus hardens within a considerably short time

• Material becomes vulnerable to surface deterioration,

contamination and fouling by microorganisms.
Prerequisites for the use of this material are
as follows:

• That the dentures have

• [Link] coverage of the bearing area
• 2. A good centric relation
• 3. Adequate occlusal vertical dimension
• [Link] gross interferences in eccentric jaw
positions
PREPARATION OF THE DENTURE

• From the denture base all undercuts and some area

immediately on the ridge to a depth of 1 mm or more is
removed.

• The borders or flangets and the hard palatal area in the

maxillary denture is retained as vertical stops in seating or
placing it on the ridge.
• If the borders are not well defined, modeling compound is
used inside the denture and in occlusion, to provide a
tripod reference to relate the denture when placing it back
in the mouth with the conditioning material in it.
• Wherever the denture base is short, it should be extended
using activated acrylic resin to provide support for the soft
material, the important thing to remember is that the 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

• The material used is a

three component system;
the polymer (powder), the
monomer (liquid) and a
liquid plasticizer (“Flow
Control”). The ratio of use
of any of these
components may vary
depending upon its use.
• 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).
• The latter should be added to the liquid monomer and mixed prior to
mixing it with the polymer.

• It makes the material soft, smoother, glossy and it prolongs its

durability in use to approximately six to eight weeks without getting
hard and rough.
Mix in a glass jar by slowly adding the power to the liquid
and stirring continuously until the desired amount of it is
incorporated in the mixture.

The material will thicken by virtue of its own reaction.

While the material is still creamy and running pour it into the
denture
• Make certain that the entire the denture base is covered.
Where the material ceases to flow readily, insert the denture in the patient’s
mouth.

Slowly but firmly carry the denture to place.

Use the opposing dentition as a guide to centric relation.

Hold the dentures in this position at the desired occlusal vertical dimension for
three minutes.
• Following this, instruct the patient to move his or her lips and cheeks
to border mould the material.
• The excess that might be loose in the mouth is removed.
• By now the material will have set sufficiently that the denture can be
removed and the excess material that has come out over the labial
and buccal aspects can be removed or trimmed away.
• This can be done with a sharp knife, scalpel or scissors
Inspect the denture for pressure areas in which the pink part of the
denture base will show through.

Pressure areas should be relieved and small amounts of the material

added and the denture then returned to the mouth for contouring.

Once the criterion of even thickness of 1 mm or better of conditioning

material is satisfied, cover the sharp cut edges as well as the material
surfaces with a small amount of the “Flow Control” to allow the
conditioner to continue to flow and contour itself as the tissues recover.

Also this will allow the sharp edges to be rounded and become smoother
and glossy as the patient functions with the denture.
 LONG-TERM SOFT LINERS

• Heat activated material generally more durable.

• These material degrade over time and should not be
considered as permanent.
• Heat activated plasticized acrylics are available in two
forms sheets or in a powder liquid form.
• Long term tissue conditioner are further classified into four group based on
chemical structure:

• a. Plasticized Acrylic Resins Either Heat Cured Or Chemical

Cured,
• b. Vinyl Resins
• c. Polyurethane,
• d. Polyphosphazene And
• e. Silicon Rubbers
• As poly(methyl methacrylate) is replaced by higher methacrylates (e.g., ethyl, n-
propyl, and n-butyl), the Tg becomes progressively lower.

• As a result, less plasticizer is required and the effects of leaching can be minimized.

• A number of heat-activated soft liners are supplied as powder-liquid systems.

• The powders are composed of acrylic resin polymers and copolymers, whereas the
liquids consist of appropriate acrylic monomers and plasticizers.

• When mixed, these materials form pliable resins exhibiting glass transition
temperatures (Tg) below mouth temperature.
 Vinyl Resin
• Vinyl resins also have been used in soft liner applications.
Unfortunately, plasticized poly(vinyl chloride) and
poly(vinyl acetate) are subject to leaching and harden
during sustained use.
 Silicon Rubbers
• Most successful materials for soft liner applications have been the silicone
rubbers.

• These materials are not dependent on leachable plasticizers; therefore

they retain their elastic properties for prolonged periods.

• Unfortunately, silicone rubbers may lose adhesion to underlying denture

bases.
• Silicone rubbers may be chemically activated or heat-
activated. Chemically activated silicones are supplied as
two-component systems that polymerize via condensation
reactions.

• Hence, these materials are quite similar to condensation

silicone impression materials.
• Heat-activated silicones are one-component systems supplied as
pastes or gels.

• These materials are applied and contoured using compression molding

techniques.

• Heat-activated silicones may be applied to polymerized resin bases, or

they may be polymerized in conjunction with freshly mixed resins.

• To promote adhesion between silicone soft liners and rigid denture base
materials, rubber-poly(methyl methacrylate) cements often are used.
• These cements serve as chemical intermediates that
bond to both soft liners and denture resins.

• At least one silicone liner does not require an adhesive

when it is cured together with an acrylic denture base
material.

• This material actually is a silicone copolymer that contains

components capable of bonding with acrylic resins.
Laboratory procedure
• Laboratory procedures for heat-activated silicones are similar
to those described for chemically activated materials.

• Bases are invested, and mold spaces are prepared as

required.
• Relief is provided to permit an acceptable thickness of the chosen
material(s).

• Packing, compression molding, and processing are performed in

accordance with manufacturer’s recommendations.
The denture is then recovered, finished,
and polished.
 Disadvantages

• Silicone liners are poorly adherent to denture base resins.

•
• Silicone liners also undergo significant volume changes with the
gain and loss of water.

• Many soft liners bond well to denture bases but become

progressively more rigid as plasticizers leach from liner materials.
• Hardening rates for these liners are associated with the
initial plasticizer content.

• As the plasticizer content is increased, the probability for

leaching also is increased.

• Hence materials with a high initial plasticizer content tend

to harden rather rapidly.
• An adhesive is usually required in order to enhance the
adhesion between the liner and denture base.

• On the other hand RTV also is supplied in form of powder and

liquid and reaction takes place because of activator present,
very less amount of cross linking takes place than compared to
the heat cured ones.
 Advantages OF SOFT LINERS

• Viscoelastic Properties

• Can be applied chairside

• Denture fits well

 Disadvantages OF SOFT LINERS
• Greatest difficulty associated with long- and short-term
soft liners is that these materials cannot be cleaned
effectively
• patients often report disagreeable tastes and odors
related to these materials
• Research indicates the liners themselves do not support
mycotic growth, but such growth is supported by debris
that accumulates in the pores of these materials. The
most common fungal growth associated with soft liners is
Candida albicans. (phillips)
 Methods of cleaning soft relined dentures:-

• Denture plaque control using mechanical and chemical

methods is essential for maintenance of good oral hygiene
of denture wearers.
• However, mechanical cleansing (brushing) is not advisable
for soft denture liners since it can damage the resilient
lining.
• Chemical cleansing by denture cleansers is the first choice
for denture plaque control of tissue conditioners.
• The solutions used for denture cleaning can be divided
according to their chemical composition:

• alkaline peroxide
• alkaline hypochlorites
• acids
• disinfectants and enzymes.
• Peroxide cleansers
 REFRENCES
Kalamalla Ayappa Saran Babu /J. Pharm. Sci. & Res. Vol. 11(12), 2019, 3802-3805

Anusavice J.K. Phillips Science of Dental Materials . 11th edition . WB Saunders Elsevier , Philadelphia.2003;pg
no. 250-253 , 273-274 , 283-292.

Bhat V.S., Nandish B.T. Science of Dental Materials. 2nd edition. CBS Publishers , New Delhi.2006;pg no.80-93 ,
143-164 , 389-398.

Sheldon Winklers,Essentials of complete denture prosthodontics. 2nd edition. A.I.T.B.S Publishers, India;pg no.

Morrow M Robert , Dental Laboratory [Link].1 ,