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Int Chin J Dent 2003; 3: 31-35.

Augmentation prosthesis fabricated with the use of a soft denture
reliner as a functional impression material: A clinical report
Naomi Tanoue, DDS, PhD,a Shuichi Mori, DT,b and Hideo Matsumura, DDS, PhDc
aProsthodontics, Department of General Dentistry and bDental Laboratory Center,Nagasaki University Hospital of Dentistry, Nagasaki, and cDepartment of Crownand Bridge Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan.
The objective of this case report is to describe a functional impression procedure for improvement of thesealing between a maxillary defect and an augmentation prosthesis.

Three-step impression wasimplemented in the fabrication of the prosthesis. The primary impression was made for reproduction ofdentition and palate, and the secondary impression was taken mainly for maxillary defect, using a
combination of two silicone elastomeric materials. A slow-setting soft denture reliner was then used as afunctional impression material under a loaded condition to facilitate palatal seal of the obturator. The
patient recovered facial outline form, mastication, nasal respiration, and swallowing with the use of theaugmentation prosthesis. The three-step impression technique including the final functional impression
procedure is useful for sealing the interfacial gap between the movable oral tissue and the hard denture
segment. (Int Chin J Dent 2003; 3: 31-35.)
Key Words: augmentation, functional impression, soft denture reliner.

Introduction
The augmentation prosthesis is used as an obturator not only for the alleviation of speaking, swallowing
and chewing difficulties but also for separation between the oral and nasal cavities. The prosthesis needs tobe made elaborately for effective obturation of the maxillary defect. It is difficult, however, to make aprecise impression of surrounding structures including the defect due to the severe undercut. A number ofreports demonstrated the effectiveness of impression techniques for palatal and alveolar bone defects,1-5 oneof these being a functional impression technique.6

The appropriate methods and materials varyconsiderably according to the status of the defects. This report describes the application of a soft denture
relining material as a functional impression material in fabricating an augmentation prosthesis for a patientwith maxillary defect.

Clinical Report
A 52-year-old woman was referred to our dental hospital by the otorhinolaryngology department of a
local hospital for prosthetic treatment for missing teeth and maxillary defect. The defect resulted from31

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surgical treatment of a verrucous carcinoma of the left maxilla two months earlier. The chemotherapy, theonly post-operative treatment since radiation therapy was unnecessary, had been completed by the time ofher first visit, and it was predicted that the final outline form of the defect would not change significantly.
Her medical history was notable for deaf-mutism. Her left premolars and molars were missing, and only
about two thirds of the palate was intact. The mobility of the left canine was not remarkable, since theproximal alveolar bone support remained (Figs. 1-2). The teeth had been extracted during the surgicaloperation, and the patient had not been wearing any interim obturator by the time of the first visit to thedental hospital. Examination revealed problems associated mainly with chewing capability and swallowing.
Difficulty in speech was not a major concern for the patient because of her deaf-mutism. After additional
examinations based on X-ray photographs and a study cast, we decided to implement an augmentation
prosthesis for reconstruction of the left maxillary defect and obtained the patient’s consent to this treatment.

Fig. 1. A radiograph shows the alveolar bone support on distal side of the left canine.
Fig. 2. Occlusal view before prosthetic treatment.
The primary impression of the dentition and palate was made with a combination of two silicone
elastomeric materials (Exafine Regular and Injection, GC America Inc., Chicago, IL, USA) using a custom
tray. The impression of the perimeter structure of the defect was also taken at this time. The metalframework of the removable denture was made with a cobalt-chromium alloy (Summalloy Cobalt, Shofu
Dental Corp., Menlo Park, CA, USA), and a wax obturator-bite rim was inserted. After registration of themixillo-mandibular relation, composite artificial teeth (Endura, Shofu Dental Corp.) were arranged in theleft molar area.
When the wax model denture was tried-in, a secondary impression of the maxillary defect was made. A
silicone impression material (Exafine Regular) was applied to the tissue side surface of the obturator, andthe denture framework was inserted into the patient’s oral cavity. The patient was instructed to maintainthe centric occlusion position until the impression material settled (Fig. 3).
The impression was poured with die stone, and a working cast for the obturator was made by the altered
cast technique. The cast was surveyed, severe undercut was blocked out, and the prosthesis was processedwith a heat-polymerized denture-base acrylic resin (Acron, GC America Inc.).

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obturator was thereafter excavated so as to be light in weight. The denture was carefully adjusted, andadaptation of the obturator was tested by having the patient swallow water. Fig. 4 shows the tissue sidesurface of the transitionally formed obturator. At this stage, the patient complained that the sealing of thedefect was unsatisfactory.

Fig. 3. Secondary impression for the palatal defect.
Fig. 4. Obturator made from the secondary impression.

Fig. 5. Obturator relined on the basis offunctional impression.

Fig. 6. Frontal view with the seated prosthesis.

Fig. 7. Occlusal view of the prosthesis.

A functional impression was then made to improve the peripheral seal of the obturator. The surface to bemodified was ground with a carbide rotary cutting instrument, followed by application of an adhesive agent

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(Sofreliner Primer, Tokuyama Corp., Tokyo, Japan). A soft denture relining material made of silicone
rubber (Sofreliner Medium Soft, Tokuyama Corp.) was applied to the obturator surface and the prosthesis
was inserted into the cavity. The patient was instructed to tap the prosthesis very gently into the centricocclusion position to achieve the proper vertical dimension. The denture was removed five minutes afterinsertion. The reliner was then carefully trimmed, lubricated and again placed in the original position.
Since the reliner sets gradually, the impression procedure extended for 48 hours. A working die was again
prepared, and the soft relining material was replaced with a heat-polymerized denture-base acrylic resin(Quick Acron, GC America Inc.).
Figs. 5-7 show the completed augmentation prosthesis.

The patient recovered mastication andswallowing abilities with the use of the prosthesis. In addition, the palatal seal was considerably improved
after relining of the obturator. The prosthesis is functioning for more than two year and six months, and norecurrence has been detected at the resected area.

Discussion
To achieve an ideal prosthesis, it is essential that the defect be properly sealed by the obturator and thatthe denture be supported in its optimum position with varying types of retainer. The denture support in thecurrent case was facilitated by extending the metal framework to the right second premolar and first molar.
The obturator should be extended into the nasal aperture or onto the nasal surface of the soft palate5 when
the denture cannot be retained with the remaining dentition. Since the retention of the denture wasestablished in the present case, the sealing of the palate was the primary concern. The original obturator
made by the two-step impression technique resulted in inadequate sealing performance, probably due to theoutline form of the obturator prepared on the basis of a static impression technique. Specifically, staticimpression reproduces only limited movement and shape of oral tissue in the impression material, thus
creating the possibility of gap formation depending on the movement of soft tissue.
Functional impression is a technique for recording neutral zones in removable dentures. This technique
was used in the current case for obturation of a narrow gap between the soft tissue and the prosthesis underloaded conditions. A soft denture relining material was selected for the impression material. The excellent
elasticity and long setting time of the material made it possible to record a dynamic impression of thepalatal defect and to win the satisfaction of the patient with the sealing characteristics of the obturator.
Although alternative techniques and materials may be available for this type of treatment, the use of soft
denture reliner as functional impression material is a practical choice for the fabrication of augumentation
prostheses.

Conclusion
A procedure for fabrication and adaptation of an augmentation prosthesis to maxillary defect has been
described.

In order to take precise impression of the defect, three impressions including functional

impression were made for this case. The functional impression technique using a soft denture relining

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material was considered to be clinically useful for obturation of the defect and separation between the oral
and nasal cavities.

References
1. Gardner LK, Parr GR, Rahn AO. Simplified technique for the fabrication of a hollow obturator prosthesis using vinyl
polysiloxane. J Prosthet Dent 1991; 66: 60-2.
2. Schmaman J, Carr L. A foam impression technique for maxillary defects. J Prosthet Dent 1992; 68: 342-4.
3. Jacob RF. Duplication of interim speech aid for definitive impression tray fabrication. J Prosthet Dent 1992; 68: 561-2.
4. Dumbrigue HB, Arcuri MR, Funk GF, LaVelle WE. Impression technique for nonosseous free-tissue transfer
reconstruction after cranioorbitomaxillary resection: A clinical report. J Prosthet Dent 1996; 76: 4-7.
5. Pigno MA, Funk JJ. Augmentation of obturator retention by extension into the nasal aperture: a clinical report. JProsthet Dent 2001; 85: 349-51.
6. Pow EH, McMillan AS. Functional impression technique in the management of an unusual facial defect: a clinical report.
J Prosthet Dent 2000; 84: 458-61.

Reprint request to:Dr. Naomi Tanoue
Prosthodontics, Department of General Dentistry, Nagasaki University Hospital of Dentistry
1-7-1, Sakamoto, Nagasaki 852-8588, Japan
FAX: +81-95-849-7689 E-mail: t-naomi@net.nagasaki-u.ac.jp
Received on April 1, 2003. Revised on May 1, 2003. Accepted on May 12, 2003.
Copyright ©2003 by the Editorial Council of the International Chinese Journal of Dentistry.

International Chinese Journal of Dentistry 2003 Outstanding Article AwardInternational Chinese Journal of Dentistry announces the second Outstanding Article Award.
Award:A cash prize of US$ 600 and a certificate of commendation are awarded for the most outstanding article published in
the International Chinese Journal of Dentistry.
Criteria:
Original articles, clinical reports, and dental technology articles published in the Journal between issue 1 and issue 4
are considered for the award. The winning article will be selected by a committee on the basis of scientific impact on
the dental professional communities, and interest to the readers. The 2003 Award is sponsored by the International
Chinese Journal of Dentistry and the following award sponsors.
Award Sponsors:
Kuraray Medical Inc., Tokyo, Japan, http://www.kuraray.co.jp/dental
Sun Medical Co., Ltd., Moriyama, Japan, http://www.sunmedical.co.jp
Toho Dental Products, Saitama, Japan
Tokuyama Dental Corp., Tokyo, Japan, http://www.tokuyama-dental.co.jp
3M Health Care Limited, Sagamihara, Japan, http://www.3m.com/espe/
2002 Award Winner:
Miyazaki M, Onose H, Hirohata N, Nishizawa O, Moore BK.
Influence of cutting of enamel surface with Er: YAG laser on bond strength. Int Chin J Dent 2002; 2(2): 75-85.

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