Journal of

Oral Rehabilitation

Journal of Oral Rehabilitation 2012 39; 838--846

Complete denture displacement following open-mouth

reline
NER*, S. BAYER*,
K.-H. UTZ*1, D. SCHNEIDER*1, J. FEYEN, M. GRU

*Department of Prosthetic Dentistry, Propaedeutics and Dental Materials, University of

R. FIMMERS & F. MULLER
Bonn, Bonn, Private Practice, Lennestadt, Institute for Medical Biometrics, Informatics and Epidemiology (IMBIE), Bonn, Germany and

Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland

SUMMARY In 21 complete denture wearers, six

upper and 15 lower denture relines were performed
with the open-mouth technique. The centric
relation (CR) was recorded with the CentralBearing-Point (CBP) method three times before and
three times after the reline. For each registration,
the right and left condylar position was recorded in
three dimensions using a custom-made measuring
device. The average denture displacement from an
initial reference position (CR) was calculated for
each registration. An upper denture reline leads to
a mean displacement of 2
5 mm, both in the right
and left condylar area. With an average of 2
0 mm,
this displacement was smaller following a lower
denture reline (right and left mean, 1
6 mm). The
precision of the CBP-registrations proved 0
5 mm

Introduction
Following insertion, complete dentures settle into the
denture-bearing tissues, especially during the first
weeks post-extraction (15). This leads potentially to
a shift in denture position and changes in occlusion.
Remodelling and atrophy of the alveolar ridges never
cease completely, but progress more slowly and show
a large interindividual variation (59). The ridge
resorption is two- to fourfold greater in the mandible
than in the maxilla and appears more pronounced in
the anterior than in the posterior regions. This may

These authors contributed equally to the work.

2012 Blackwell Publishing Ltd

before and 0
3 mm after reline; hence, the

measured condylar displacement after reline could
not attribute to a methodological bias. This clinicalexperimental study demonstrates that relining
complete dentures with the open-mouth technique
may lead to a substantial denture shift and thus
imply inevitably clinically relevant occlusal
discrepancies. It is therefore important to carefully
check the occlusion at denture delivery and
remount the prostheses if necessary.
KEYWORDS: occlusion, relining, open-mouth reline,
closed-mouth
reline,
remounting
complete
dentures, complete dentures
Accepted for publication 13 June 2012

be related to differences in bone density, but may

equally depend to the total surface of the denture
base, which implies distinctly different occlusal load
distribution patterns for the upper and lower denture
(10). No scientific evidence exists on a potential influence of complete denture quality or a particular
occlusal concept on the progression of the alveolar
ridge resorption (9, 11, 12). Consequently, it is frequently necessary to reline the denture base according
the individual ridge resorption.
Various reline techniques exist with respect to preparation of the denture, choice of impression material,
border moulding as well as loading during impression
setting. The closed-mouth technique implies coating
the denture base with impression material, placing the
doi: 10.1111/j.1365-2842.2012.02339.x

COMPLETE DENTURE DISPLACEMENT FOLLOWING OPEN-MOUTH RELINE

denture and then guiding the patient into centric
relation (CR). Its aim is to maintain or even correct
the previous occlusion in addition to the improvement
in denture adaptation. In contrast, the open-mouth
technique does not take into account the occlusion
until the insertion of the relined prosthesis. Both techniques have their advantages and disadvantages
[Table 1, for further detail see (13)]. Although both
techniques introduce a denture displacement, the
resulting change in occlusion may vary considerably.
The aims of this study are therefore to analyse and
quantify complete denture displacement following
open-mouth reline to provide scientific evidence for
clinical recommendations concerning occlusal adjustments in complete dentures following reline.

Table 1. Clinical aspects of open-mouth versus closed-mouth

reline technique
Closed-mouth technique
Reline in maximum
intercuspation, thus little
occlusal adjustment
required after insertion
Positioning of denture
during impression taking
determined by patient,
thus little control over
load distribution
Border moulding performed
by patient only, thus
denture flanges potentially
too thick
Lingual borders sharp and
overextended as no
tongue movements are
possible
Denture flange fills the
static space lateral to the
tuberosities, thus
potentially blocking
opening and lateral
movements
Physical properties and
quantity of impression
material may determine
vestibular denture shape
Little chairside time
required at insertion
Sore spots likely as tissues
were deformed when the
patient closed in occlusion

2012 Blackwell Publishing Ltd

Open-mouth technique
Reline whilst the patient opens
the mouth, thus changes in
occlusion likely after denture
insertion
Perfect loading of the denture
during impression taking as
denture positioning and
loading is entirely controlled
by the operator
Border moulding by patient
and operator, thus shaped
perfectly during function
Good lingual and sublingual
border moulding as patient
can pull the tongue
Opening and lateral movements
during impression taking
provide a dynamic rather than
a static shape of the denture
flange
Excess impression material could
be removed before setting, thus
controlled shape of the
vestibular denture flange
Occlusal adjustments at insertion
likely
Denture base perfectly adapted as
tissues were not deformed
during impression taking

Materials and methods

Permission from the ethical committee of the Medical
Faculty of the University of Bonn (No 001/07) was
obtained and all patients gave written, informed consent. For this study, complete denture wearers who
consecutively presented for a reline at the Department
of Prosthetic Dentistry of the University of Bonn were
screened. Inclusion criteria comprised wearing upper
and lower complete dentures of which at least one
needed relining. Exclusion criteria were flabby ridges
affecting denture stability, surgical resection of the
alveolar ridges or the palate as well as a history of
neuro-muscular disease.
The clinical procedures were undertaken by one
operator (D. Schneider) and began in the first session
with alginate impressions taken from dental arches of
the upper and lower denture. Central-Bearing-Point
(CBP)-plates were manufactured on the plaster casts
by positioning a lower writing plate* parallel to the
occlusal plane and between the teeth, bridging the gap
to the lingual aspects of the lower teeth with lightcured resin (Fig. 1). The upper CBP-pin was placed
centrally on the palate, so that the denture bearing tissues were loaded evenly when the patient closed.
In the second clinical session, the laboratory-manufactured CBP-plates were fitted to the dentures. Small
lingual undercuts in the lower plates were exploited for
snap-retention or friction. When no undercuts were
present, red Kerr compound was used to stick the
CBP-plates to the dentures. The upper plates were simply adapted to the palatal contours and fixed by means
of a thin layer of powder adhesive. Dentures and plates
were then inserted into the mouth, and the height of
the upper pin was adjusted so that a minimal interocclusal separation was present; hence, in CR the pin was
the only contact between the upper and the lower jaw.
Occlusal foil was used to verify the separation of upper
and lower teeth and the registration plates, respectively.
After adding wax colour to the writing plate, the
patient performed mandibular border movements to
engrave the gothic arch on the lower metal plate.
Moderate manual pressure on the chin was applied
whilst the patient performed the tracing. This proce-

*Gerber Condylator Set Nr. 105; Condylator Service, Zurich,

Switzerland.

Kerr Corporation, Orange, CA, USA.

839

840

K . - H . U T Z et al.

Fig. 1. The Central-Bearing-Point

(CBP)-registration plates were
connected with light-curing resin to
the relined dentures.

dure was performed three times, thus repeated twice

on the same layer of wax.
Only after the three positions of the tips of the
gothic arch coincided, a pierced plastic plaque was
stuck, so that its hole would house the upper CBP-pin
when the patient closed in CR (Fig. 2). Upper and
lower dentures were then keyed with Snow-White
impression Plaster No 2 in this CR. Two separate
plaster keys were produced simultaneously for the
right- and left-side teeth, respectively. Once the plaster had set, both dentures were retrieved as a block.
We checked whether the pin was correctly placed in
the hole of the acrylic plate and whether a sufficient
interocclusal separation was present and bridged by
the plaster keys. After dissembling dentures and registration material, the plaster keys were trimmed and
labelled for further analysis. This first registration was
followed by two subsequent ones, using the identical
protocol. The CBP-plates remained attached to the
dentures, but the gothic arch tracing was recoloured
and over-written until another identical tip was
obtained. Only then, the acrylic plate was newly
placed and again attached with sticky wax before new
plaster keys were taken. In total, three independent
pre-reline CBP-registrations were performed, producing three right and three left plaster keys for analysis.
Subsequently, the planned reline was performed
using the open-mouth technique and zinc-oxideeugenol pastes. Luralite was used for the upper and
SS-White impression paste for the lower reline.
Both materials present different flow and setting characteristics. Initially, both materials seem similar, but
SS-White has different rheological features and sets

Fig. 2. The hole of the plastic plaque was located over the tip
of the gothic arch before that it was fixed with sticky wax.

faster. In contrast, Luralite is less viscous and has a

longer period of unchanged fluidity (14). Different
materials were chosen for the upper and lower reline
to address the respective resiliencies of upper and
lower denture bearing tissues.
For the laboratory procedures, the Speikodent
reline device was employed (15). All relines were
performed by the same experienced technician. At
delivery, the following day the relined dentures were
adjusted until painfree under light manual pressure.
The upper denture was then mounted by means of a
Dentatus-AEK** face-bow (16) into a DentatusARL** articulator, equipped with an adjusted magnetic Adesso split-cast system.

SPEIKO Dr. Speier GmbH, Munster, Germany.

**Dentatus AB, Spanga, Sweden.

Kerr GmbH, Rastatt, Germany.

SS White Manufacturing, Gloucester, UK.

Malzer-Dental, Wunstorf, Germany.

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COMPLETE DENTURE DISPLACEMENT FOLLOWING OPEN-MOUTH RELINE

1st session: - taking alginate impressions of upper and lower dentures

Laboratory : - pouring plaster casts
- manufacturing upper and lower Central-Bearing-Point (CBP) plates
2nd session: - fitting of CBP-plates to the dentures
- 3 CBP registrations of the CR (CBP no 1 to 3: before reline)
- taking reline impression
Laboratory : - relining of denture

Fig. 3. Flow chart of protocol.

3rd session: - fitting of relined denture

- face-bow transfer of upper denture into the Dentatus ARL-articulator
- 3 CBP-registrations in CR (CBP no 4 to 6: after reline)
- mounting of the lower denture by means of CBP no 6
- transfer of both mounted dentures to the measuring device equipped with Adesso splitcast system)
- recording of the condylar position in 3 dimensions using CBP no 1 to 6 (each twice A + B)
- transferring both dentures back to the articulator
- adjusting the occlusion until equilibrated
- insertion of dentures and discharge of the patient

In the following, three post-reline CBP-registrations were performed according to the pre-reline
protocol.
The lower cast was mounted with the last not
dissembled plaster keys (for procedures see Fig. 3).
Then, upper and lower Adesso split-casts together
with the dentures were removed from the articulator and transferred to a custom-made measuring
device.
Measuring device
To assess the denture displacement between the different CBP-registrations, a custom made measuring
device, based on the Kondymeter by Posselt, was used
(17). It consists of independent upper and lower parts
of an articulator, both also equipped with an
Adesso split-cast system. The lower part disposed
of three digital gauges in the right and two in the left
condylar area to record the position of condyles from
the upper, detached part of the measuring device in
three dimensions (Fig. 4). A sixth digital gauge was
mounted at the incisal pin. The latter was important
for calculating the 3D displacements in the condylar
area with a custom-made software.
All gauges were zeroed before and after each
patient by means of the calibrated key of the
Adesso split-cast system. A custom-made software
calculated the spatial displacement of the upper denture from the horizontal, frontal and vertical measurements. Data were stored for offline analysis.
2012 Blackwell Publishing Ltd

Fig. 4. Custom-made measuring device, based on a Dentatus

ARL articulator.

Measurements
Each pair of right and left plaster keys, three taken
before and three after relining, were placed two times
between the upper and lower dentures and the spatial
coordinates of the right and left condyles were
recorded electronically. The mean of these two registrations was used for analyses.
The experimental set-up used then the mean of the
three CBP registrations before as reference in comparison with the three subsequent CBP-registrations after
the relining. When all measurements were finished,
the casts were transferred back to the conventional

841

K . - H . U T Z et al.
Table 2. Displacements (mm) of right and left condyles following reline of the upper complete dentures

n=6
Upper dentures
Median
Mean
s.d.
Minimum
Maximum

Right

Spatial
displacement

Left

Sagittal

Vertical

0
77
0
30
1
49
1
85
1
57

0
91
1
04
1
13
2
90
0
19

Transversal

Sagittal

Vertical

0
01
0
50
1
97
2
94
2
14

0
77
0
88
0
82
2
27
0
26

0
74
0
06
1
99
2
83
2
39

Transversal
0
74
0
06
1
99
2
39
2
83

Right

Left

2
47
2
51
1
14
0
53
3
95

2
40
2
45
1
59
0
49
4
67

Displacement of upper dentures

Max

45

4
35
[mm]

842

Max

75%

75%

25

Median
Median

2
15

25%

Max

1
05
0

Min

Min
Median
Min
Displacement [mm] Reproducibility [mm] Displacement minus
Reproducibility [mm]

articulator and the occlusion was adjusted before the

dentures were delivered.

Results
A total of 21 patients (16 men and five women) took
part in the experiments. Their average age was
67
4 9
7 years (5684 years), and they had been
wearing their current complete dentures for
5
5 4
9 years (0
518 years). Relines were performed six times on the upper and 15 times on the
lower complete dentures.
Relining the upper dentures leads to a mean condylar displacement for the right side of 2
5 1
1 mm
(0
54
0 mm) and for the left side of 2
5 1
6 mm
(0
54
7 mm) (Table 2, Fig. 5).
The condylar displacement following reline of the
lower denture was on the right side with 2
0 1.2 mm

PalaXpress; Heraeus Kulzer GmbH & Co. KG, Hanau, Germany.

25%

Bite Compound; GC Germany GmbH, Bad Homburg, Germany.

Fig. 5. Box-plot of the denture

displacement following open-mouth
reline of upper dentures in the
condylar area, the precision of the
Central-Bearing-Point (CBP)registration method as well as the
displacement minus the precision.

(0
45
1 mm) and on the left side with 2
0 1
4 mm

(0
65
1 mm) slightly smaller than the one following
the upper denture reline (Table 3, Fig. 6).
The directions of all shifts of the upper comparing
with all shifts of the lower dentures following the
reline were statistically significantly different (Pillais
Trace, right P = 0.0045; left P = 0.027).
The precision of the CBP-registrations was 0
5
0
4 mm (0
081
2 mm) before and 0
34 0
22 mm
(0
100
93 mm) after the reline. There was a tendency towards a higher interindividual variability
after reline (Pillais Trace, P < 0
097), although this
difference was not significant (n.s.).

Discussion
Although denture displacement in this study was
measured in the condylar area, the corresponding
occlusal interferences have been shown to be of a similar magnitude (18); hence, the results are clinically
relevant. Measuring the occlusal interferences directly

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COMPLETE DENTURE DISPLACEMENT FOLLOWING OPEN-MOUTH RELINE

Table 3. Displacements (mm) of right and left condyles following reline of the lower complete dentures.

n = 15
Lower dentures
Median
Mean
s.d.
Minimum
Maximum

Right

Spatial
displacement

Left

Sagittal

Vertical

0
10
0
34
0
92
0
77
2
75

0
80
0
99
1
44
4
26
1
31

Transversal
0
56
0
56
1
09
1
34
2
58

Sagittal

Vertical

0
91
1
35
1
29
0
64
3
60

0
35
0
56
0
88
2
43
0
55

Transversal
0
56
0
56
1
10
2
58
1
34

Right

Left

1
56
1
95
1
24
0
37
5
12

1
64
2
02
1
37
0
55
5
05

Displacement of lower dentures

6

Max

Max

[mm]

Fig. 6. Box-plot of the denture

displacement following open-mouth
reline of lower dentures in the
condylar area, the precision of the
Central-Bearing-Point (CBP)registration method as well as the
displacement minus the precision.

75%
75%

Median
1

25%
Min
0

Displacement [mm]

is difficult, as no stable reference points can be identified on the denture bearing tissues.
Whilst relining is a routine procedure in clinical
practice, little is known on the denture displacement
at insertion. In a study on 16 patients, Sassen used a
method similar to ours to evaluate the condylar shift
following denture reline, but he performed only one
single measurement before and after reline, so that
the precision of the methods remains unknown (19).
His experiments also took place at various time points
following reline, not taking into account that the occlusion of complete denture wearers changes over the
wearing period (20, 21). He also used different reline
techniques and materials for the lower dentures (8 9
reline with X3N whilst chewing, 5 9 Xantopren, one
further technique without precise description). Sassens
measurements therefore confound the denture shift
because of reline and denture settling; in addition, they
comprise methodological imprecisions of unknown
extent. Furthermore, his mechanical registration of the
2012 Blackwell Publishing Ltd

Median
Max
Median
Min
Reproducibility [mm]

25%
Min
Displacement minus
Reproducibility [mm]

condylar position only allowed for 2-dimensional measurements. Consequently, the reported displacements
proofed with 3
35 mm (25 mm) for the upper and
3
9 mm (1
88 mm) for the lower denture larger than
those in the present study. These early findings confirm
nevertheless a considerable denture displacement following reline procedures. Sassen could not evince differences between the impressions whilst chewing
(mouth-closed) and the other ones (most likely mouthopen, but not precisely described).
Javid et al. (22) performed a three-dimensional analysis of maxillary denture displacement following reline
procedure by means of a mechanical contourmeter in
six patients. The authors performed relines in three
patients using an open-mouth technique, and three
further patients were treated by means of a closedmouth technique. They used four different reline materials and measured differences immediately after reline
on the fitting surface of the upper dentures. Their
smallest displacement was in the lateral direction (0
42

843

844

K . - H . U T Z et al.
0
77 mm) followed by a forward displacement
between 0
56 and 1
23 mm and finally a vertical displacement between 1
25 and 1
92 mm. Compared with
the present results, their displacements were smaller,
but they investigated only the reline impressions,
which were subsequently not transformed and delivered to the patient, hence technical deformations
owing to plaster expansion or resin contraction as well
as denture settling after delivery was not considered. In
their experiments, Javid et al. could not evince statistically different discrepancies between open-mouth and
closed-mouth techniques.
The lack of relevant literature may also be caused
by the methodological difficulties of establishing a
reference position to measure the displacement of the
prostheses. Javid et al. (22) added reference
depressions with a rose bur to the denture base. Their
reference position was given by a fixed tripod on the
table, whereas the denture was placed on an occlusal
key. In the present study, we used the mean of three
CBP-registrations before reline as reference position
and compared those to the mean of three subsequent
CBP-registrations when the relined denture was
inserted 1 day later. Our reference position was the
CR. Thus, the reported denture displacement relates
only to the reline procedure and is independent of
the initial intercuspation, denture settling during the
wearing period as well as the vertical opening during
registration of the gothic arch. The latter is negligible
for two reasons, first because an arbitrary face-bow
transfer had been performed and second because
measurements were taken with the plaster-keys in
place, so the vertical dimension remained virtually
unchanged between the clinical situation and the
bench measurements (23).
The precision of the CBP-registration method in this
study corresponded to the 0
5 0
3 mm (01
5 mm)
reported in previous independent publications,
although the clinical procedures were performed by a
different operator (24, 25). This precision is only
slightly larger than the one found in the CBP-registration of fully dentate volunteers (0
3 mm (26)), a
remarkable finding considering the resiliency of the
denture-bearing tissues. However, the precision
increased slightly after reline, which might be due to
a better adaptation of the denture base, but may
equally include a certain training effect of the patients
in carrying out the movements necessary to write a
gothic arch. The initial high precision is particularly

interesting, as the patients in this study all presented

for a reline, meaning that the denture fit was compromised. It can therefore be assumed that central loading of the dentures via the CBP plates stabilises the
denture base independently of discrepancies between
the denture-bearing tissues and the denture base. The
CBP thus proves a robust and precise way to register
the CR. Nevertheless, it has to be considered that the
patient sample was with an average age of 67 years
rather young for an edentulous cohort, so they are
likely to have a better muscle coordination, more
favourable anatomical conditions and less flabby
ridges than an older cohort.
Adding a layer of impression material on the horizontal surfaces of the denture base such as the palate or the ridges may be expected to raise the
vertical dimension. In contrast, adding a layer of
impression material to a vertical surface like the vestibular flanges might rather displace the denture in
an anterior direction. However, in this study, no systematic anterior displacement for the dentures could
be evinced. Looking at the individual shifts in the
six upper relines, it can be noted that only in one
patient occurred a bilateral dorsal displacement of
the condylar balls of the non-arcon measuring device
(corresponding to an anterior displacement of the
upper denture). The other five upper relines created
a ventral displacement of the condylar balls on one
side and a dorsal displacement on the other side,
indicating a rotational component. If all these rotations were in the same direction, an influence from
the right-handedness of the operator or his position
during the clinical procedures may be suspected, but
in the present six upper denture relines, no systematic direction of denture displacement could be
evinced. A possible explanation might be related to
the patients demand for denture reline. Bone
resorption in the upper ridge occurs in a centripetal
direction, hence creating a space between the bony
ridge and the vestibular denture flange. As all
patients perceived a need for reline, this space might
have been already sufficiently large to preclude denture displacement by the additional layer of reline
material. Another reason for the absence of any particular direction of upper denture displacement following upper denture reline might be the use of the
open-mouth technique, which allows loading the
denture centrally whilst the impression material is
setting. The central hard palate is usually less
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COMPLETE DENTURE DISPLACEMENT FOLLOWING OPEN-MOUTH RELINE

affected by bone resorption than the alveolar ridges,
so it provides an excellent reference for placing the
denture during the reline procedure. This ideal denture placement has to be considered one of the
main advantages of the open-mouth technique compared with the closed-mouth technique where denture placement is uncontrolled and guided by a
given intercuspation. Although Javid et al. (22)
found with their mechanical measurements no significant difference between open- and closed-mouth
techniques, it would be interesting to verify their
results with nowadays more sophisticated methodology.
The present clinical-experimental study confirms
and quantifies the displacement of complete dentures
following an open-mouth reline. It seems reasonable
to assume that the resulting occlusal changes are substantial and will be detected by the patient (27, 28).
They might also challenge denture retention, stability
and patient comfort and even the TMJ function.
In conclusion, it is very important to carefully
check the occlusion of a relined denture at delivery
and remount the prostheses if necessary!

6.
7.

8.

9.

10.

11.

12.

13.

14.

Acknowledgments
The dental technician Gabi Reppert produced the
CBP-registration plates, performed all relines and
adjusted the occlusion after denture remounting.
Dr. Vera Klein and Dr. Sabine Linsen helped in
recruiting patients. Dr. Oliver Lottner constructed the
program of the connection between condylar and
occlusal displacement.

15.

16.

17.
18.

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Correspondence: K.-H. Utz, Department of Prosthetic Dentistry,

Propaedeutics and Dental Materials, University of Bonn, Welschnonnenstrae 17, 53111 Bonn, Germany.
E-mail: karl-heinz.utz@ukb.uni-bonn.de

2012 Blackwell Publishing Ltd

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