Keywords
denture relining - complete denture - quality of life - bite force - dental prosthesis
- edentulous mouth - edentulous jaws
Introduction
In 2015, 8.5% of the 7.3 billion people in the world were aged 65 years or older.
In 2050, those aged 65 or older will represent ~16.7% of the total world population,
estimated to be 9.4 billion people.[1] Therefore, the average annual increase in people aged 65 years or older between
2015 and 2050 will be 27.1 million.[1] Edentulism is a worldwide health problem[2] and can be associated with people aged above 50 years.[1]
[3]
[4] Thus, due to the increase in the elderly population that will occur, edentulism
can continue to be a worldwide health problem in the future.
Despite the popularity of implant-supported prostheses, questions of health, finance,
and/or psychology could impede their use.[2] Thus, an edentulous patient would need to use conventional complete dentures for
aesthetic and functional reasons.[2] Therefore, conventional complete dentures can be considered an extremely important
treatment option for odontology.
The majority of patients who use complete dentures encounter difficulties in the use
of a mandibular denture, due to the fault of retention and stability.[5]
[6]
[7]
[8] This occurs through the continuous process of resorption of the mandibular bone
ridge, which can be four times greater in comparison to the maxillary ridge.[8] These functional limitations can damage quality of life,[5]
[7]
[9] occlusal force, and the coordination of muscular movements of the individual.[6]
[10]
Relining with a soft material is used to reduce the sensation of discomfort and localized
pressure, as well as improving mastication, the distribution of masticatory forces,
and the retention and stability of the complete denture.[2]
[5]
[7]
[10] In addition, this procedure avoids lesions of the mucosa and the accelerated resorption
of the bone ridge, which can occur due to a maladjustment of a complete denture on
the ridge.[11] It is worth emphasizing that the low muscular exertion of patients who use complete
dentures, primarily due to advanced age and discomfort of the dentures, could lead
to muscular atrophy and the weakening of the mandibular muscles.[2] Thus, the relining of complete dentures is an extremely important treatment for
edentulous patients.
Beside the question of function, relining of a complete denture provides a new contact
surface between the denture and the mucosa. This is important since complete dentures
can accumulate and retain a microbial film over time,[12]
[13] worsening oral hygiene and affecting the health of patients.[14]
[15] This situation occurs principally because of the surface roughness of the acrylic
resin, which tends to increase through time due to its low resistance to abrasion
and daily brushing with dental pastes containing abrasives.[14]
[15]
[16] It is important to emphasize that the accumulation of microbial plaque on the complete
denture can lead to bad breath.[12]
[13]
The relining of a complete denture can be done in a direct manner in the clinic, or
indirectly, combining the clinical and laboratorial phase.[11]
[16] There are no known studies in the literature that compare these techniques clinically
with a silicone-based reliner. Therefore, the objective of the present study was to
compare the direct relining technique with the indirect relining technique in relation
to quality of life, satisfaction with the relining, occlusal force, and halitosis
of complete dentures users.
Materials and Methods
This study was approved by the Human Research Ethics Committee of the São Paulo State
University (School of Dentistry, Araçatuba, São Paulo, Brazil) with the number 48606215500005420.
All patients gave their informed consent prior to their inclusion in the study.
Twenty individuals drawn from UNESP (São Paulo State University, School of Dentistry,
Araçatuba, São Paulo, Brazil) were selected. These individuals were randomly divided
in two groups (n = 10). Group 1 received relining by using the direct method. Group 2 received relining
by using the indirect method. The relining was performed only on the inferior denture
of each individual,[2]
[5]
[10] due to its instability.[2]
[6]
[7]
[8] The individuals in each group did not know the difference between the treatments
performed.
Inclusion Criteria
-
This study included users of bimaxillary acrylic complete dentures from 40 to 80 years
old,[2]
[5] with complete dentures without fractures and with unworn cuspids,[2]
[5]
[17] with an unstable inferior denture, without retention, and which could cause pain.[7]
[9]
-
Individuals with a favorable maxillary-mandibular relation[2]
[5]
[18] and with a correct occlusal vertical dimension[2]
[5] based on aesthetic techniques, physiology,[9] and pleasure.[19]
-
Individuals classified by the American Society of Anesthesiologists (ASA) as ASA 1
or ASA 2 (controlled systemic disease),[20] with cognitive ability to respond to questions[9]; which used the same pair of complete dentures for a minimum of 1 year and a maximum
of 5 years,[7] with moderate resorption of the mandibular alveolar ridge[2]
[5]
[10] which did not use fixation adhesives for complete dentures.
-
The maxillary ridge must provide retention to the upper denture.
Exclusion Criteria
-
This study excluded individuals who were carriers of oral pathologies in soft or hard
tissues,[2]
[5] with implants or residual roots,[2]
[5] or who were incapable of responding to the questions in the questionnaires for any
reason.[5]
-
Those who drink alcohol frequently.
-
Traumatic injuries in oral tissues.
-
Maxillary and / or mandibular torus.
-
Individuals with neurological illnesses or without motor coordinations.[2]
[5]
-
Temporomandibular dysfunction, verified by the Research Diagnostic Criteria.[9]
[17]
-
Individuals with tumors.[17]
-
Patients undergoing radiotherapy or chemotherapy treatment.
-
Smokers.
-
Use of illicit drugs.
-
Individuals with partial or total dependency of care by third parties.
Time Points at Which Tests and Questionnaires Were Performed
The clinical interventions were performed by one single professional. The halitosis
and occlusal force tests and questionnaires (quality of life and satisfaction with
the relining) were applied by one single examiner, who was not the professional that
performed the clinical interventions on the patients, and in a manner not knowing
what group each patient belonged to. The laboratory phase was always performed in
the same prosthesis laboratory and by the same prosthetic technician.
The tests (halitosis and occlusal force) were performed initially (before the relining),
immediately after the relining, and 30, 60, 90, and 180 days after the relining. The
time points “initial” and “immediately after the relining” were on different days.
The questionnaires (quality of life and satisfaction with the relining) were performed
initially (before the relining) and 30, 60, 90, and 180 days after the relining. The
time point “immediately after the relining” was not included in the evaluations using
the questionnaires, as patients needed to use their dentures for a period of time.
Occlusal Force
A digital dynamometer (Model IDDK, Kratos, Brazil) was used.[6] The evaluations were done in the regions of the first molar (right and left) and
in the region of the central incisors. Each individual bit the device three times
in each region with maximum force. The rest between each recording was from 2 to 3
minutes.[6] The maximum occlusal force was recorded in kgf. After performing the test three
times in each region, the highest value in each region was recorded.[6]
Halitosis Test
A Halimeter (Breath Alert, TANITA, Japan) was used for the measurement of halitosis.[21]
[22]
[23] This device quantifies the levels of volatile sulfur compounds that cause bad oral
odor.[21]
[22] The values of this device vary from 1 to 4, being: 1—absence of odor (normal); 2—light
odor (normal); 3—moderate odor (bad breath—perceptible); and 4—strong odor (bad breath—perceptible).[21]
[22]
[23] The assessments were performed according to the orientation of the manufacturer,
leaving the sensor a distance of ~1 cm from the half-open mouth. After examining each
patient, the air opening was cleaned with a dry cloth and the Halimeter was gently
shaken four to five times in the air to remove any odors or moisture left in product.[22]
[23]
The halitosis test was performed at each time point (initial, immediately after relining,
and after 30, 60, 90, and 180 days after relining) in the following sequence:
-
Evaluation of halitosis with dentures and without dentures—patients were evaluated
as soon as they arrived at the dental clinic; the only exception was on the days when
the relining techniques were performed, because the patients’ halitosis was measured
after the techniques were performed (“immediately after relining”). The measurements
of halitosis were performed first with the dentures and then without the dentures.
-
Evaluation of halitosis with dentures and without dentures immediately after cleaning
the mouth and dentures. No type of hygiene guidance was recommended to the research
participants. Each patient performed their hygiene, based on their own knowledge.
Patients were asked to take the products they used to perform their oral hygiene to
the clinic on the days of the evaluation. The measurements of halitosis were performed
first with the dentures and then without the dentures.
The halitosis test was performed three times at each time point to confirm the results.
Therefore, for each patient, the value of the Halimeter (1, 2, 3, or 4) that was repeated
at least 2 times was recorded. If no number appeared, it was considered a reading
error and the procedure was repeated.[22]
In this study, mean values of halitosis level < 3 were considered clinically acceptable,
and mean values ≥ 3 were considered clinically unacceptable.
Relining Procedure According to the Manufacturer
The material used in the clinic for all of the relining was UFI Gel SC (VOCO, Germany).
This product is a polyvinyl siloxane-based reliner of long duration (up to 2 years).
Initially, the dentures were cleaned with a toothbrush and subsequently immersed in
denture cleaning solution (Corega Tabs, GSK, Brazil), to remove residues on their
bases and acrylic teeth. These procedures were important to avoid failure of adhesion
of the reliner to the base of the denture. Gauze was passed over the edges of the
maxilla and mandible to remove debris. Finally, the patient was asked to perform a
mouthwash with water.
The occlusal vertical dimension of the patient was measured with a compass, which
measured the distance between two previous marked points, being on the nose and the
on the chin.[19] Then, a 2 mm wear of the inferior complete denture base was performed with a Maxicut
1251 tungsten bit (Edenta, Switzerland), followed by the rounding of its margins.
For Group 1, after wear, the inferior complete denture was cleaned with cotton embedded
with 90% alcohol, and after 1 minute of drying, the adhesive (VOCO) was applied. One
minute after the application of the adhesive (VOCO), the reliner was applied over
the inferior complete denture base, and after 1 more minute the inferior denture was
carried to the mouth of the patient. The patient was instructed to occlude their acrylic
teeth until the occlusal vertical dimension was reestablished, that is, at the moment
in which the compass united the two marked points. Afterward, the occlusion was maintained
for 1 minute. Next, it was recommended that the patient do movements of mastication
and swallowing for 5 minutes. After 6 minutes in total, the inferior complete denture
was removed from the mouth. The finishing of the inferior denture was performed with
a scalpel blade, scissors, and polishing discs (VOCO, Germany) 30 minutes after its
removal from the mouth of the patient. Then, the glazing was applied over the relining
to seal and smooth this surface, following the manufacturer's recommendations.
For Group 2, after applying a universal adhesive (Universal Tray Adhesive, Zhermack,
Italy) over the base of the worn inferior denture (2 mm), silicone (light-addition
silicone, Express XT, 3M ESPE, United States) was placed over the denture base, and
it was positioned on the mandibular ridge. The patient was asked to perform movements
of the tongue. Then the patient was asked to close until the occlusal vertical dimension
was reestablished, with the same principle as mentioned earlier (if necessary, the
mold was refilled). After molding and disinfecting the mold (hypochlorite),[24] type IV plaster (Durone, Dentsply, Brazil) was dispensed over the mold to obtain
the inferior plaster model. The other procedures were in accordance with the manufacturer's
recommendations. The finishing was performed in the same manner for Group 1. While
the laboratory procedures were being performed, the patient waited at the clinic.
Before placing the inferior denture in the patient's mouth, it was disinfected with
hypochlorite.[24]
The participants returned for possible adjustments after 24, 48, and 72 hours.[5]
Oral Health Impact Profile in Edentulous Individuals and Satisfaction Questionnaire
with the Relining
The Oral Health Impact Profile in edentulous individuals (OHIP-EDENT—Brazil) is composed
of 19 questions evaluating handicap, social disability, psychological disability,
physical disability, psychological discomfort, physical pain, and functional limitation.25 Thus, this questionnaire assesses oral health-related quality of life. For each question,
the patient could choose one of the following answers: “never”; “sometimes”; or “always”.[25]
A questionnaire with nine specific questions was developed to verify satisfaction
with the relining. For each question, the patient could choose one of the following
answers: “never”; “sometimes”; or “always”. The questions were:
-
Do you have some painful sensation in the mouth?
-
Do you taste some unpleasant taste in your mouth?
-
Do you smell some odor coming from the complete dentures?
-
Do you perceive that there is retention of food in the inferior complete dentures?
-
Do you feel your complete dentures are unstable?
-
Do you feel difficulty cleaning the complete dentures?
-
Do you feel that the inferior complete denture base is rough?
-
Do you notice a loss of reliner material adhered to the complete denture?
-
Do you feel that the relining material is hard?
Scores from 1 to 3 for each question were assigned to these two questionnaires according
to the answers of the patients, being “1” corresponding to “never,” “2” equal to “sometimes,”
and “3” corresponding to “always.” The sum of these values in each questionnaire corresponded
to quality of life and satisfaction with the relining. Thus, the smaller the sum of
the values in each questionnaire, the greater the quality of life and satisfaction
with the relining.
Statistical Analysis
Statistical analysis of the results was performed by using a statistical software
program (IBM SPSS Statistics, v24.0, IBM Corp, United States). The statistical analysis
was performed by the analysis of variance and the Tukey test. The level of significance
was 5%.
Results
In this study, 75% of the patients were female. The mean age of the participants was
67.3 years and the mean time of use of the same pair of complete dentures was 4.5
years. All cleaned their complete dentures with a brush and dental paste. For the
hygiene of oral tissue, the most common method was the use of a brush and toothpaste
(n = 13), followed by mouthwash with water (n = 5) and lastly, mouthwash with Listerine (Johnson & Johnson, Brazil) (n = 2).
Quality of Life
For quality of life, there was no difference between the techniques (p = 0.608). There was a significant statistical difference between the time points
evaluated for each technique (p < 0.001). After 30 days of relining, quality of life increased significantly when
compared with the initial time point, for both techniques (p < 0.05). There was no significant difference in quality of life between time points
30, 60, 90, and 180 days after relining, for both techniques (p > 0.05; [Table 1]).
Table 1
Mean and standard deviation of quality of life for each time point and relining technique
|
Time points
|
Techniques
|
|
Direct
|
Indirect
|
|
Note: Tukey test (p < 0.05). Different capital letters in vertical (column) show a statistically significant
difference (p < 0.05). Different lower case letters in horizontal (line) show a statistically significant
difference (p < 0.05).
|
|
Initial
|
35.6 (6.6) Aa
|
34.1 (4.7) Aa
|
|
30 d
|
24.1 (2.4) Ba
|
23.7 (2.7) Ba
|
|
60 d
|
24.3 (2.9) Ba
|
25.0 (2.8) Ba
|
|
90 d
|
24.2 (3.1) Ba
|
24.7 (2.5) Ba
|
|
180 d
|
23.2 (1.9) Ba
|
23.1 (2.3) Ba
|
Satisfaction with the Relining
There was no difference between the relining techniques (p =0.170). There was a difference between the time points for each technique (p < 0.01). After 30 days of relining, satisfaction with the relining increased significantly
when compared with the initial time point, for both techniques (p<0.05). There was no significant difference in satisfaction between time points 30,
60, and 90 days after relining, for both techniques (p > 0.05). After 180 days of relining, there was a reduction in satisfaction when compared
with time points 30, 60, and 90 days, for both techniques (p < 0.05; [Table 2]).
Table 2
Mean and standard deviation of satisfaction for each time point and relining technique
|
Time points
|
Techniques
|
|
Direct
|
Indirect
|
|
Note: Tukey test (p < 0.05). Different capital letters in vertical (column) show a statistically significant
difference (p < 0.05). Different lower case letters in horizontal (line) show a statistically significant
difference (p < 0.05).
|
|
Initial
|
13.0 (3.3) Aa
|
13.9 (1.9) Aa
|
|
30 d
|
10.1 (0.8) Ba
|
9.7 (1.2) Ba
|
|
60 d
|
10.0 (0.9) Ba
|
10.5 (1.0) Ba
|
|
90 d
|
11.6 (1.0) Ba
|
11.7 (2.0) Ba
|
|
180 d
|
13.2 (1.5) Aa
|
12.4 (1.8) Aa
|
Occlusal Force
There was no statistical difference between the relining techniques (p < 0.05). There was a difference between the time points evaluated for each technique
(p < 0.01). The occlusal force increased significantly after 90 and 180 days when compared
with the initial time point, for both techniques (p<0.05), and for the three regions evaluated (p < 0.05; [Table 3]).
Table 3
Mean (kgf) and standard deviation of occlusal force for each time point and relining
technique
|
Region
|
Time points
|
Techniques
|
|
Direct
|
Indirect
|
|
Note: Tukey test (p < 0.05). Different capital letters in vertical (column) show a statistically significant
difference (in each region individually) (p < 0.05). Different lower case letters in horizontal (line) show a statistically significant
difference (p < 0.05).
|
|
Right molar
|
Initial
|
3.92 (1.3) Aa
|
4.50 (1.6) Aa
|
|
Immediately after the relining
|
4.00 (2.1) Aa
|
3.54 (1.5) Aa
|
|
30 d
|
5.25 (2.1) ABa
|
5.15 (1.7) ABa
|
|
60 d
|
4.88 (1.6) ABa
|
5.27 (1.9) ABa
|
|
90 d
|
6.59 (1.5) BCa
|
6.49 (1.6) BCa
|
|
180 d
|
8.00 (2.2) Ca
|
6.47 (1.9) Ca
|
|
Central incisors
|
Initial
|
2.82 (1.1) Aa
|
2.96 (1.3) Aa
|
|
Immediately after relining
|
2.52 (1.3) Aa
|
2.51 (1.1) Aa
|
|
30 d
|
3.85 (1.6) Aa
|
3.60 (1.3) Aa
|
|
60 d
|
3.34 (1.7) Aa
|
4.20 (1.2) Aa
|
|
90 d
|
5.43 (1.1) Ba
|
5.03 (1.4) Ba
|
|
180 d
|
6.43 (2.0) Ba
|
4.78 (1.6) Ba
|
|
Left molar
|
Initial
|
4.16 (2.0) Aa
|
4.78 (1.8) Aa
|
|
Immediately after relining
|
4.22 (2.6) Aa
|
3.27 (1.3) Aa
|
|
30 d
|
5.00 (2.1) ABa
|
5.18 (2.4) ABa
|
|
60 d
|
5.36 (1.8) ABCa
|
5.51 (2.2) ABCa
|
|
90 d
|
6.76 (1.3) BCa
|
6.52 (1.8) BCa
|
|
180 d
|
8.03 (1.9) Ca
|
6.33 (1.4) Ca
|
Halitosis
There was no statistical difference between the relining techniques (p < 0.05). There was a difference between the time points evaluated for each technique
(p = 0.01). There was a significant reduction in halitosis immediately after relining
when compared with the initial time point, in all cases shown in [Table 4], for both techniques (p < 0.05).
Table 4
Mean and standard deviation of halitosis for each time point and relining technique
|
Presence of dentures and hygiene
|
Time points
|
Techniques
|
|
Direct
|
Indirect
|
|
Note: Tukey test (p < 0.05). Different capital letters in vertical (column) show a statistically significant
difference (in each assessment individually) (p < 0.05). Different lower case letters in horizontal (line) show a statistically significant
difference (p < 0.05).
Mean values < 3 were considered clinically acceptable. Mean values ≥3 were considered
clinically unacceptable.
|
|
Evaluation without dentures
|
Initial
|
3.20 (0.9) Aa
|
3.00 (1.2) Aa
|
|
Immediately after relining
|
1.30 (0.6) Ba
|
1.90 (0.9) Ba
|
|
30 d
|
2.10 (1.1) Ba
|
2.50 (0.5) Ba
|
|
60 d
|
1.40 (0.6) Ba
|
2.60 (0.9) Ba
|
|
90 d
|
1.80 (0.7) Ba
|
1.90 (0.6) Ba
|
|
180 d
|
1.40 (0.7) Ca
|
1.50 (1.1) Ca
|
|
Evaluation with dentures
|
Initial
|
3.20 (0.9) Aa
|
3.00 (1.2) Aa
|
|
Immediately after relining
|
1.30 (0.6) Ba
|
1.90 (0.9) Ba
|
|
30 d
|
2.10 (1.1) Ba
|
2.50 (0.5) Ba
|
|
60 d
|
1.40 (0.6) Ba
|
2.60 (0.9) Ba
|
|
90 d
|
1.80 (0.7) Ba
|
1.90 (0.6) Ba
|
|
180 d
|
1.40 (0.7) Ba
|
1.50 (1.1) Ba
|
|
Immediate evaluation without dentures after cleaning
|
Initial
|
1.90 (0.9) Aa
|
2.10 (1.5) Aa
|
|
Immediately after relining
|
1.00 (0.7) Ba
|
0.80 (1.0) Ba
|
|
30 d
|
0.70 (0.7) Ba
|
1.50 (0.7) Ba
|
|
60 d
|
0.70 (1.8) Ba
|
1.40 (0.8) Ba
|
|
90 d
|
1.10 (0.9) ABa
|
1.40 (0.7) ABa
|
|
180 d
|
0.70 (0.5) Ba
|
1.20 (0.9) Ba
|
|
Immediate evaluation with dentures after cleaning
|
Initial
|
1.90 (0.9) Aa
|
2.30 (1.3) Aa
|
|
Immediately after relining
|
1.00 (0.7) Ba
|
1.00 (1.0) Ba
|
|
30 d
|
0.80 (0.6) Ba
|
1.50 (0.7) Ba
|
|
60 d
|
0.70 (0.8) Ba
|
1.50 (0.8) Ba
|
|
90 d
|
1.40 (0.8) ABa
|
1.50 (0.7) ABa
|
|
180 d
|
1.80 (1.1) ABa
|
1.20 (0.9) Ba
|
Discussion
According to Souza et al, OHIP-EDENT can be considered a good indicator of oral health-related
quality of life for edentulous subjects.[25] It is worth mentioning that the OHIP-EDENT used in this study was validated for
the Portuguese language (Brazil).[25]
In the present study, there was no difference between the two relining techniques
in all the evaluations, probably due to the fact that the relining material used was
of long duration (up to 2 years). Therefore, as the patients were evaluated in a maximum
period of 180 days, the material “durability” factor could have influenced the absence
of difference between the techniques.
Despite the absence of difference between the techniques, the direct technique could
be considered more advantageous by the dentist and patient, since it is simpler, quicker,[16] and avoids the laboratorial phase in which the patient remains without his or her
complete denture.[11]
As to the OHIP-EDENT questionnaire, in the questions related principally to the sensation
of pain and function, in which the responses were initially “always” or “sometimes,”
there was a change to “never” after 30 days of relining ([Table 1]). Probably, the greater stability, retention, adaptation, and softness after relining
could have contributed to a greater comfort,[2]
[5]
[7]
[9]
[16] a better biomechanical response,[9] a greater masticatory performance,[10] and a greater number of occlusal contacts[10] with more milling of food, which consequently could have helped in digestion, which
according to Boland 2016 is a process that begins in the mouth.[26] Another important observation is that after relining, the uniform distribution of
the masticatory stress on the alveolar ridge could have facilitated the maximum intercuspation
without overloading a determined muscle more than another.[2] Thus, the quality of life increased after 30 days of relining (p < 0.05) due to these probable factors. It is worth mentioning that between the time
points 30, 60, and 180 days after relining, the quality of life was maintained, that
is, there was no statistically significant change in quality of life between these
time points (p >0.05; [Table 1]).
As to the questionnaire of satisfaction with the relining, the satisfaction increased
significantly after 30 days of relining with both techniques ([Table 2]). It was observed that the category related to pain had the greatest influence on
the results after 30 days of relining (pain reduction) (p < 0.05; [Table 2]). This reduction in pain could have occurred due to better distribution of masticatory
stresses on the ridge[2]
[5]
[7]
[10] and because the softness of the material (UFI Gel SC, VOCO, Germany) compensates
the thickness and viscoelasticity lost from the mucosa overlying the bone.[10] It is important to remember that viscoelasticity and thickness of the mucosa are
lost due to the resorption of the ridge with time.[10] Satisfaction was maintained between time points 30, 60, and 90 days after the relining
for both techniques (p >0.05; [Table 2]). After 180 days of relining, there was a reduction (p < 0.05) in relation to satisfaction compared with time points 30, 60, and 90 days
after relining (
[Table 2]). There was no difference between the initial time points and 180 days after relining;
however, after 180 days of relining, there was no return of painful sensation compared
with the initial time point. The score for the satisfaction questionnaire with the
relining in the final time point (after 180 days) was negatively influenced by reliner
material in both techniques, in a way that there was a perception that parts of the
relining material had come loose from the base of the inferior denture, probably due
to the lack of chemical union between these materials.[2]
[20]
[27]
[]
[28]
In the last two time points (90 and 180 days) of the evaluation, the occlusal force
of the patients significantly greater when compared with the initial time point, for
both techniques, and for the three regions evaluated (p < 0.05; [Table 3]). This probably occurred since the effort, capacity, and the muscular force increased
due to the inferior complete denture having good retention and stability after the
relining.[2] A uniform distribution of occlusal force on the mucosa by the relining could have
increased the capacity to support tensions of the mucosa, generating this significant
increase in occlusal force.[10] In addition, the greater use times of the inferior complete denture with the reliner
(90 and 180 days) could have generated an increase in adaptation, muscular capacity,
and neuromuscular abilities of the patients,[17] generating this significant increase in occlusal force.
Halitosis, also known as oral malodor or bad breath, is characterized by unpleasant
odor originating from the mouth of an individual and is noticed by others.[29]
[30] For evaluation without prior hygiene ([Table 4]), immediately after relining (evaluation with and without denture), there was a
significant reduction in halitosis when compared with the initial time point, for
both techniques ([Table 4]). In this reduction, the level of halitosis went from a clinically unacceptable
situation (≥ 3) to a clinically acceptable situation (< 3). Possibly both relining
techniques have contributed to a reduction in halitosis, since for the execution of
both, a hygienization is performed during the process (hygiene is part of the techniques),
as described in the methodology. It is worth remembering that due to the wear of the
base of the inferior denture for the addition of the relining material, this leads
to the removal of the microorganisms related to bad breath15,29 (e.g., Candida albicans).15,31,32,33 Despite this, more studies are needed with different methodologies to confirm this
result.
In evaluations with and without dentures (without prior hygiene), the initial halitosis
level was clinically unacceptable in all situations (≥ 3; [Table 4]). This was different initially after cleaning, as in evaluations with and without
dentures, halitosis became clinically acceptable in all situations (< 3; [Table 4]). This shows the importance of cleaning the oral tissue and dentures.
Another important point to be considered is that, for evaluations without prior hygiene
of the mouth and dentures after 30, 60, 90, and 180 days of relining, the levels of
halitosis remained clinically acceptable in all situations (for both techniques) (<
3; [Table 4]). Perhaps with the improvement in the patients’ quality of life, they started to
take better care of their oral health. In addition, according to the reliner manufacturer
(UFI Gel SC, VOCO, Germany), after relining, the growth of bacteria and fungi is minimized
on the surface of the new silicone-based denture base, due to its surface smoothness
and hydrophobic characteristic.
Conclusion
Independent of the relining technique used, there was an increase in the quality of
life, satisfaction with relining, and occlusal force, as well as a reduction in the
level of halitosis. Both techniques generated similar results and therefore can be
options in clinical practice.[28]
[34]
