RELINING REMOVABLE PARTIAL DENTURES FOR

FIT AND FUNCTION

VICTOR L. STEFFEL, D.D.S.*

College of Dentistry, Ohio State liniversity, Columbus, Ohio

LL PROCEDURES in all phases of dentistry may be said to be truly im-

A portant. It would be difficult to single out any one service as being defi-
nitely more beneficial than all others. Nevertheless, it can be stated with certainty
that the timely and accurate relining of removable partial dentures constitutes a
prosthetic service of inestimable value. This procedure, carried through with
precision, accrues to more efficient mastication, to the health of all supporting
structures, the teeth, mucous membrane and osseus tissues, and to the correct
repositioning of the partial denture. Also, this last advantage re-establishes oc-
clusion with opposing teeth and restores maximum stability to the partial den-
ture within its own supporting arch.
To many who are keen students of dental prosthetics, it is quite disconcert-
ing to learn that many prosthodontists do not reline complete dentures. Re-
lining is considered neither beneficial nor practical because, even in the hands
of the most skilled, the entire painstaking and time-consuming operation may re-
sult in major errors and discrepancies. It takes only a little thought to. render
this attitude on the part of some thoroughly understandable. So with reference
to complete * dentures, the theory of “discarding the old and constructing the
new,” is largely sound.
Removable partial denture relining, however, presents an entirely different
problem. In securing the relining impression of a properly designed partial
denture, the appliance, upon each insertion, is steered accurately into place by
either clasps or precision attachments. There is, therefore, no chance for the
restoration to be misplaced either anteriorly, posteriorly, or laterally. With or-
dinary caution in carrying out the steps in the procedure, there is no danger of
the relining impression recording an eccentric relationship due to the centric oc-
clusion index afforded by the remaining natural teeth. And, because of the pilot-
ing provided by the direct retainers along with the interarch relationships pre-
sented by the natural tooth contacts or facets, the occlusal plane elevation of the
partial denture can readily be re-established at the time of making the correc-
tive impression. There are many guiding and interlocking factors combining
to aid US in removable partial denture relining which are entirely lacking in the
building of the same type of impression for complete dentures.
Read before the Academy of Denture Prosthetics, Los Angeles, Calif., April 15, 1953.
Read before the Partial Denture Section of the American Dental Association, Cleveland,
Ohio, Sept. 30, 1953.
Received for publication Sept. 21, 1953.
*Professor of Prosthetic Dentistry.
496
Volume 4 RELINING REMOVABLE PARTIAL DENTURES w7
Xumber 4

OBJECTIVES OF RELINING

In its ultimate attainment, partial denture relining is the means by which

the displaceable mucous membrane, osseus structures, natural teeth, occlusal con-
tacts, and the complete removable restoration can be all readjusted and synchro-
nized to best resist and support functional stresses; and further, it is the means
by which the components of the temporomandibular jloint are restored to and
maintained in a harmonious relationship, avoiding in this area displacements,
impingements, retrogressive changes, and pain.
Only the correcting of lower removable partial dentures by relining will be
considered in this treatise. It is, no doubt, within the realm of truth to say
that 70 to 80 per cent? of all partial dentures made and in use are of the bilateral,
distal-extension saddle type, and the great majority of ,this stated percentage are
being worn in the mandibular arch. The lingual bar partial denture, both because
of the great numbers in which it is found and because of the unfavorable condi-
tions under which it must function, is the one which most often needs revamp-
ing and servicing. Therefore, this article will be devoted to a consideration of
that which most needs it-the lower distal extension saddle type of restoration.
Upper partial dentures which have been properly extended for adequate tissue
coverage require a minimum of reorienting, if any at aIll, that might be due to a
shift in the positional relationship of the partial denture to the supporting and
opposing structures. Physiologic stimulation of the tissues seems to occur as
a natural normal sequence in the maxillary arch. Those upper dentures, pre-
dominantly of the free-end saddle design, rarely need improving by relining be-
cause all biologic and mechanical factors are extremely favorable to this arch,
in contrast with the conditions presenting in the mandibular arch. In the
upper jaw,’ the efficient and permanent functioning of the artificial appliance
is practically insured by the large tuberosities, broad ridges, and resilient tissues
due to the presence of a mucoperiosteum, an abundant blood supply, and the pos-
sibility of extensive tissue coverage for stress distribution and support. In the
lower arch, in addition to the regrettable fact that all the favorable points pre-
viously mentioned are lacking, ridge support is structurely poor and in small
quantity, the mucous membrane is relatively thin, and any necessary repair of
tissue takes place slowly.
A brief reference to the dental literature will further substantiate the argu-
ments in favor of partial denture relining service as it relates to the support-
ing tissues; Weinmann and Sicher :’ “The pressure-bearing bones , . . are re-
inforced by the production of new bone . . . . The reaction in this case proves
the contention that the increase of any physiologic stress in the limits of toler-
ance acts as a growth stimulus on bone . . . . Growth of bone is stunted under
disuse . . . . An excellent object for detailed study of the changes in bone with
elimination of function is the jaw. Here, several sta.ges of disuse atrophy can
be recognized. The first of these stages is evident in the bone surrounding a
 J. Pros. Den.
498 STEFFEL July, 1954

tooth which has lost its antagonists . . . . The supporting bone is greatly re-
duced . . . . The second stage of disuse atrophy can be observed in the edentu-
lous area after loss of one or several teeth. The changes . . . consist of a re-
generative period followed by reconstruction . . . . This process of reconstruc-
tion . . . depends upon the presence or absence of functioning teeth. As long
as function is maintained in the neighborhood, the spongy bone shows a definite
functional arrangement. The leveling of the alveolar process is moderate and
the compact lamella at the surface fairly strong. If the loss of teeth is extensive
[with no restoration of function], . . . the osteoporosis is much more severe
and the loss of bone substance at the alveolar ridge is much greater . . , . The
most extensive disuse atrophy of the jaws is found after total or nearly total loss
pf the teeth. If all the teeth have been lost and no denture is worn [to apply
functional stresses], the entire alveolar process gradually is resorbed.”

WOLFF’S LAW OF TRANSFORMATIONa

“
. . . Functional stresses shape the bone . . . [and] will lead to changes
in the form and structure of bones’ . . . . Lack of function leads to osteoporosis;
increased function may lead to the formation of . . . bone . . . . Within the
limits of tolerance, an increase of the normal forces of pressure or tension leads
to formation of new bone.”
“Bone tissue is in continuous flux throughout life. According to the change
in the mechanical requirements . . . , an internal reconstruction of bone tissue
takes place.”
The anatomists and physiologists have not yet successfully explained
how mechanical forces stimulate the deposition of bone, and how lack
of function brings about bone resorption. Nevertheless, these occurrences now
constitute an accepted premise, practical findings have established it as axiomatic.
As a result, articles by various writers appear in support of the benefits of relin-
ing. Applegate writes : “An impression material is required which will effect
partial displacement in the softer areas . . . ; where stress is applied, the fluid
content of the subjacent tissues will be slightly displaced. After the load is re-
leased, a slight tissue rebound occurs . . . . This physiologic stimulation main-
tains a healthy condition and counteracts resorptive processes.” Girardot says :’
“The saddles . . . should conform to the functional shape of the tissue, rather
than the anatomic shape. This is assured by a special relining technic.” Os-
borne states : “There is no doubt that the dental profession could avoid many
prosthetic difficulties if the principles of [partial] denture relining . . . were more
universally adopted.” A statement made by Roberts” is particularly relevant :
“Close adaptation to the basal seat contributes to stability. Tissues which . . .
are contained by the denture base will resist vertical crushing loads. The degree
of the effective resistance is in direct ratio to the amount of containment. Total
containment is obviously impossible.” Schuyler’s’ has repeatedly advocated that :
“
. . . adaptation of saddles to the tissues . . . [is] essential to the health of
the supporting tissues . . . ; [this] adaptation of saddles may be secured by re-
lining the finished denture . . . . Adaptation of the saddles to supporting tissue
l’olume 4 RELINING REMOVABLE PARTIAL DENTURES 4’N
xllmbcr 4

is an essential to a favorable distribution of functional force . . , ; the value

,of the tissue support is in relation to the area covered. [This results in] in-
creased firmness of the underlying tissues and the increased density of the sul9-
porting bony structure.” In 1945, Steffel’ advanced that: “. . . Relining, though
not always necessary, is never undesirable. No [partial] denture base ever iits
so well that it cannot be made to fit better by relining.” The preceding quota-
tions have been lifted from the dental literature for the purpose of showing the
advisability of relining as a health measure and to present the sustaining opinions
of some who routinely do it.

TYPES OF PARTIAL DENTURES NEEDING RELINING

In investigating the types of mandibular partial dentures which might yre-

sent the necessity for relining, we find that they may be classified into three
definite types :
Type 1. Those in which occlusion has been lost, but the bases still fit the
tissues.
Type 2. Those in which basal contact has been lost, but the occlusion is
still perfect.
Type 3. Those in which there is no longer occlusion with the teeth present,
nor do the bases fit the tissues.
The first type pertains to those mouth-wrecking, tissue-destroying partial
dentures, not even worthy of the name, which most often have no tooth attach-
ments at all, have short and narrow basal seats, and are entirely tissue home.
This type of prosthetic insert rapidly loses contact with the opposing teeth due
to traumatic resorption of the alveolar process. The excessive functional stresses
interfere with the interplay between the osteoclasts and osteoblasts and throw
them out of balance. Ridge resorption results, but not so fast that the tishucs
run away from the tissue surface of the bases. So the abbreviated bases still con-
tinue to fit the disappearing ridges, since the unattached partial denture is free
to follow them to destruction. This type of partial denture should be constructed
only for temporary purposes, if at all. And, most emphatically, it need not and
certainly should not be dignified by a meticulous relining procedure.
If, however, one were to be inadvertently trapped into the unjustified pro-
cedure of relining a denture in this first classification, it would be necessary tu
use a correcting medium with sufficient body and resistance to raise the appliance
back into occlusion with its upper opponents. Various modeling compositions,
in a range of fusing temperatures, would be best for accomplishing this unwar-
ranted and destructive end.
In the second type fall the tooth-borne partials. These present the fewest
problems. Being tooth-borne, a good occlusion is maintained almost indefinitely
similar to a fixed restoration. The fact that the saddles no longer fit tht-
ridges is a matter of sitnple concern to rectify. Among cases in this category
the resorption has come about as a result of shrink;sge following recent extrac,
tions and through “disuse atrophy,” as contrasted with that due to “oversiimu
lation.” It is almost an elementary procedure to fill in the voids between the ridge
 STEFFEL J. Pros. Den.
500 July, 1954

tissues and basal seats ; the bases are to be restored to again contact the ridges
to close the intervening spaces. In securing this simple reline impression, waxes,
modeling compositions, plaster, pastes; in fact, any impression substance which
will accurately fill the gaps will be adequate, since ridge tissues will not be ex-
pected to support the stresses of mastication. This operation constitutes about
all the servicing this form of partial denture ever requires.
The third type of relining problem, the one in which there is no longer occlu-
sion of teeth present, nor do the saddles fit the supporting tissues, is the one with
which we are most often confronted. It is exemplified by the too-often-neglected
bilateral, distal extension species with tooth support mesial to the bases. The

Fig. I.-A line drawing illustrating how an indirect retainer is raised when
base extensions are depressed, and vice versa.

relining procedure for this type of partial denture involves not merely the making of
a corrective impression ; on the contrary, it generally embodies three objectives :
1. The repositioning of the displaced metal framework.
2. The re-establishing of lost occlusal contacts,
3. The making of an impression which will ensure ‘intimate tissue adapta-
tion of the basal seat.

In most restorations involving a combination ,of tooth and ridge tissue sup-
ports, we are dealing with a loss of synchronized occlusion as a result of partial
depression of the distal extensions of the partial denture in addition to the dis-
crepancy in tissue adaptation. Therefore, if the partial denture has three or more
tooth contacts (as, for example, the two occlusal stops and the embrasure rest
type of indirect retainer), the indirect retainer anteriorly (Fig. 1 ), will be
raised off its seat under the posterior functional loads. And, vice versa, when
the indirect retainer is again seated, the distal ends of the bases will raise pro-
portionately with attendant rotation about the fulcrum line.
Volume 4 RELINING REMOVABLE PARTIAL DENTLY RES .xll
Number 4

METHODS OF RELINING

To re-establish stability, two methods of securing a ,relining impression may

be used : (1) the static, or impression paste method ; (2) the functional, or semi-
functional, method. To permit employment of the first method, the partial den-
ture must have three or more positive seating contacts of its framework against
the remaining natural teeth (Fig. 2). The farther apart these contacts are, the
better and more stable the tripoding. A restoration which has only the occlusal
rests of the two clasps as contacts may tilt anteriorly almost indefinitely when
pressure is applied against the lingual bar. With an indirect retainer, the frame-
work is arrested in its downward movement, and immobilized at tooth contact.

Fig. 2.- A restoration to illustrate that for the repositioning of the metal framework, there
must be three (or more) positive contacts against the teeth for tripoding.

STATIC RELINE IMPRESSION

For the static reline impression, very little preparation or modification of the
tissue side of the basal seats is required. These surfaces must merely be out of
contact with tissues when the stabilizing points are in contact with the teeth, and
should be roughened. An impression paste of the operator’s choosing (probably
one of the zinc oxide-eugenol variety which he likes best to use, or with which
he gets best results) is applied in limited abundance, and the partial denture is
carried to the mouth where, with the fingers pressing against the anterior frame-
work and with thumbs under the chin, the points of contact are held firmly
against the natural teeth. While this is being done, no attention is directed to
the distal extensions. The paste-type of static impression literally makes itself
as it fills the spaces and flows between the slightly upraised bases and the un-
disturbed ridge tissues. The resulting imprint records the tissues without dis-
tortion. When the impression paste has hardened, the denture is removed, the
finlike excesses are eliminated, and the reline impression portion of the denture
is converted to plastic in the usual manner by meticulous &king. If the par-
tial denture is an all-metal type, the reline material is replaced by plastic which
 STEFFEL J. Pros. Den.
502 July, 1954

is mechanically locked to the base, or by a metal casting of the same proportions.

When the relined denture, now ready for service again, is seated back to place,
the metal framework will be accurately reoriented with reference to the natural
teeth at the same time as there occurs intimate relationship of the basal seats to
the ridge tissues. The occlusion, however, will be heavy, the degree of occlusal
disparity depending upon the distance the extensions had raised when pressure
was applied anteriorly in the impression making. This interfering occlusion is
now reduced only to the level of anticipated tolerance, and the teeth coordinated
with their opponents by grinding, all correcting being done on the lower arti-
ficial teeth if the denture is opposed by natural one ; on both upper and lower
teeth if both dentures are artificial. The artificial occlusal contacts should be
left “heavy” to allow for estimated reintrusion of natural teeth partially extruded
by thickening of the periodontal fibers or for the reseating of an upper denture
partially displaced by congested subjacent tissues, and to correct to a certain ex-
tent the strained relationship of the temporomandibular joint components.
The method of relining just described, in which there is no displacement of
tissues, can be used to secure accurate results only when the design of the den-
ture makes framework stabilization possible (Fig. 2). This fact seems so appar-
ent as not to require further elaboration.
For most relining problems, then, the method of choice is the second, a
method which can be feasibly used with any type of denture design, one which
enables us to distribute additional stress loads against the slopes of the ridges,
and which makes possible the molding of functional saddle borders.

FUNCTIONAL RELINING IMPRESSION

If the partial denture has only the two clasps with no indirect retainer(s),
an effort should be made to refine the occlusion before going forward with the
relining impressions, which step-by-step procedure will be carried out in the
same manner whether or not an indirect retainer is present. If there is an in-
direct retainer, or additional points of contact of the framework to make tripod-
ing or stabilization possible, in the technique about to be described, it is preferred
to reharmonize the positional relationship of the partial denture to teeth and tissues
first, and to correct the occlusion first also, before proceeding with the reline
impression. To do this, the technical procedure is as follows : Low-fusing model-
ing composition is placed in excess on the distal one-third to one-half of the tissue
surface of the bases (this amount is sufficient for the purpose intended and in
convenient location for subsequent removal). The denture is now mass heated
in the 140” F. water, quickly carried to the patient’s mouth while the impres-
sion material is still readily moldable, and seated with firm pressure against only
the framework. The material at the distal ends of the bases (Fig. 3) will have
contacted the tissues and hardened so that the appliance is now reoriented in rela-
tion to its own arch, but out of harmony with the opposing arch. With the model-
ing composition for support distally, and accurate metal-to-tooth support ante-
riorly, the partial denture is stabilized and positioned, and the occlusion can now
be altered and balanced in accordance with our judgment for this specific location.
Volunle 4 RELINING REMOVABLE PARTIAL DENTIJRES
SumtJer 4 .3,.;

After the occlusion has been corrected with the denture being supported ar
its proper relative elevation, the impression substance w!%ch has now served it\
purpose is removed, undercuts are eliminated from the base, and some base n~a
terial is cut away from the tissue surfaces and from the peripheries of the i,as;ll
seats (Fig. 4) to make more room for, and provide better workability of, th?
impression materials.
Fig. 3.

Fig. 4.
Fig. X-Modeling composition placed so as to support the distal extensions during !he
correction of occlusion.
Fig. 4.-The ridge surfaces of the bases prepared to receive the excess of motlel~n~
composition.

An excess amount of low-fusing modeling composition (low-fusing to pre-

vent overdisplacement of tissues) is now applied to the bases. Excess is used
so that there will always be some present wherever needed. The appliance is
mass heated in the water bath and inserted part way toward the tissues but lrot
seated. The patient is not allowed to close for contact. Seating all the way at
the first insertion might result in too-severe pressures against supporting tissues.
Bowing of the moldable materials into the direct retainers, and the lack of oc-
clusal contacts in the finished denture due to overclosure. Usually about ft.jur
mass heatings and insertions, progressively, are necessary before allowing the
patient to close natural teeth to light centric occlusal contacts. For final closnre,
 STEFFEL J. Pros. Den.
504 July, 1954

the- patient should be instructed to proceed just to the point of faint facet-to-
facet or interdigitative contact, not asked to close with great force. Doing so
might result in an upward mandibular displacement: At this juncture, the bases
will be at their correct vertical position, occlusion will be re-established, and be-
cause correct occlusal contacts were provided beforehand, the metal work will
have accurate adaptation to the natural teeth. Since modeling compositions are
always under the operator’s control, he can make them do what is required for
any specific case ; and since they do not soften again at mouth temperatures, there
is no danger of his losing subsequently the corrections which he has so painstak-
ingly made.
Fig. 5.

Fig. 5.-The smooth, accurate, muscle-trimmed impression in modeling composition.

Fig. 6 .-Bases prepared for the application of impression wax (Iowa Formula).

The border limits are now formed by heating short sections with the torch,
then manipulating the cheeks and lips for border outline.
The reline impression (Fig. S), at this point, looks acceptable, with ade-
quate tissue coverage, rounded smooth borders, smooth impression surfaces, and
a stabilized, properly repositioned composite partial denture. However, the
Volume 4 RELINING REMOVABLE PARTIAL DENTlJRES SOS
Number 4

borders are really not physiologically trimmed, and as recorded, there will 1~:
small inaccuracies in surface detail, excessive stress against the crest of thtb
ridge, and prabably against the mylohyoid ridge.
Impression substance, and even base material if necessary, is now removecl
all along the crest of the ridge, and usually along the mylohyoid ridge. Also, ii
the distal extensions are long, escape holes are bored completely through thr?
base material at these areas requiring relief (Fig. 6) ; if they are short, their
open ends provide sufficient escape ways. No impression bulk is removed along
the normal slopes of the ridges.
Impression wax (Iowa) is now painted over the entire impression surface,
the partial denture is inserted, and the patient instructed to gradually force it to
place, then to continue with the functional movements of chewing. In contrast
to modeling composition, the wax must always be well chilled before removal for
examination. After a short period in the mouth, five minutes for example, ey-
cesses of wax should be removed and the restoration reinserted (with wax arl-
ditions, if necessary). The patient is again instructed to go through the functional
movements of chewing, together with facial and oral gymnastics, for about ten
minutes. The wax flows so readily that there is no danger of its remaining on
any surface where its contour will not be tolerated later. Limited movement of
the base extensions under the functional stresses will mold the soft wax for
relief of vulnerable areas. Also, in the completed restoration, the slight movr-
ment allowed by the passive retainers will preclude the possibility of tisstlc
strangulation.
This final step in the reline impression (the relieving of areas and the ad#li-
tion of wax) does not change the previously re-established position of thr
partial denture in the arch, but merely refines the imprlession, and specializes thr
fit with reference to the different types of supporting tissues. Obviously, at this
point, the impression (Fig. 7) is ready for accurate conversion into a permanent
material as it presents : (1) A surface which is absolutely smooth and tissue
adapted. The wax corrects any small surface discrepancies. (2) A surface out-
line which will place additional stresses on tissues which can tolerate them, giv-
ing relief to others. The rationale of this is clearly understood. (3) Borders
(Fig. 8) which have a functional outline molded by physiologic muscular ac-
tion and not by excessive manual manipulation,

COMPARISON OF METHODS

In evaluating the two methods, it seems clear that this second type of reline
impression is “one made to order.” Being under the control of the operator,
it can be built to best utilize those tissues which must give support. It is a
therapeutic measure, and although no thinking operator would advocate shoving
tissues around in impression making to the extent of seriously displacing them,
nevertheless, the second type of reline impression makes possible a closer adapta-
tion of bases to tissues, more extensive tissue coverage, and carefully limited but
fully extended border outlines for greater containment of tissues, all leading to
enhanced stability over a longer period of time. This is because all stresses are
within the limits of tolerance. The subsequent stimulation of tissues should then
506 STEFFEL

result in a thickening of the cortical layer of hone and in the proliferation of soft
tissue cells. As noted previously, the corrected partial denture, upon reinsertion,
should present and be left with slightly premature occlusal contacts to allow for
the various physiologic tissue adaptations.

Fig. 7.

Fig. 8.
Fig. 7 .-The finished impression made of modeling composition and wax. Note the escape
of wax through holes in the denture bases.
Fig. 8.-The finished impression. Note the well-rounded borders.

The static type of reline impression is probably the one of choice for partial
dentures resting on low flat ridges with soft, flabby, unfirm, movable tissues
which, at best, are incapable of very satisfactory functional support. This form
of relining procedure, due to lack of containment, does not provide the degree of
stability to offset either vertical or horizontal stresses, nor is it as efficient for
maintaining the partial denture in a correct functional position over a period of
years as is the modeling composition-wax method.*

*Regardless of whether the denture bases present the anatomic or functional form of
the ridge tissues, it is the author’s conviction that, in some cases, a small measure of the
maintenance of an unbroken occlusal plane indefinitely is effected by a very sUght physi-
ologic intrusion8 of the abutment teeth over a long period of intermittent stress application.
l:olume 4 RELINING REMOVABLE PARTIAL DENTI:l<ES 5Oi
Vumher 4

RELINES WITH SELF-CURING RESINS

Only the routine, laboratory-processed type of reline has been considered in

this treatise. The method of relining using the self-curing activated resins, while
constituting an excellent emergency procedure, serves mostly as a stopgap until
such time as a corrective impression can be processed into a homogeneous n~ass.
Although the self-curing reline has the advantage of precluding the possibility oC
the accurate impression being ruined by a faulty laboratory operation, it does
not afford the same opportunity for precise muscle trim, uniform density of
plastic bulk, unbroken color, excellent appearance. and refinement of finish a>
does the processed one.

OTHER CONSIDERATIONS

In many instances, free-end extension restorations seem to maintain cxcellem

occlusal contact almost indefinitely. Is this because of the relining service, is il.
due to bone apposition and cell multiplication, can it be attributed to the partial
extrusion of opposing teeth from thickening of the periodontal structures, does it
result from the displacement downward of the upper denture from fluid congestion
of the subjacent tissues in dysfunction, or is it because of slight mandibular diz;-
placement by the force of the muscles of mastication? The author is advancmg . <
the theory that, in addition to the important parts played by the first four, muscle
strength and action play an important part in perpetuating good occlusion 11~
changing the relationship between the condyles and the articular slopes undrr
hard stresses.
Craddock’” recently made an extensive study of many temporomandibular
joints by means of roentgenograms. He found that the space occupied by the
interarticular soft tissues (Fig. 9) averages 3 mm. in width when measured di-
rectly above the condyle. The smallest dimension of the interarticular space
averages 2 mm. and is found directly opposite the articulate slope. Posteriorly
the space is constantly more uniform and intermediate in .width, averaging 2.5 mm.
\Vithin limits, Craddock found the condyles to exist seemingly normally tn
a great variety of locations within their fossae.
The articular slope is said to be the main pressure-bearing region of the
:joiut. Nothing can be found in the dental literature to refute this statement.
However, owing to the vast existence of normal variations, it is impossible to
define exactly the place on the articular slope with which the condyle is normally
in most intimate relation. Also, a definite statement as to the exact normal re-
lation of the other functioning parts cannot be made due to the fact that the joint
is adaptable and flexible and presents a wide latitude of movement. To 4rt
further complicate the picture, a condyle may be large, its fossa shallow; or,
it may be small and its fossa deep, which would present an articular surface steel~ly
inclined. Problem : state the normal relationships.
As a result of these findings, we cannot determine definitely radiographicallJ
‘whether or not a condyle is in a more intimate relationship with an articular
slope than it formerly was. We can merely find that c’ne is a more or less inti-
mate relationship than another or others. Nevertheless: taking into consideration
508 STEFFEL J. Pros. Dm.
July, 1954

Fig. 9.-Interarticular soft tissue averages 2 mm. through A, 3 mm. thx

through C. (Courtesy F. W. Craddock.)

Fig. lO.-Schematic drawing to show the more intimate relationship of the condyle n 11th
the artlcular slope of the glenoid fossa which results from muscular pull after the loss Of
occl &don distally.
Volume 4 RELINING REMOVABLE PAR'I'I.%L ItENTlJRES
Yumber 4 5 OQ

the flexibility of the temporomandibular joint, it certainly is reasonable to as-

sume that since there is a general forward and upward direction of muscular
forces on the joint and because upward movement of the mandible is definitely
limited anteriorly by the contacting remaining natural teeth, and due to the
fact that the histologic structure of the meniscus allows slight upward displace-
ment of the condyles, we may safely conclude that somse of the maintenance of
occlusal contacts, distally, is effected by the assumption of a more intimate re-
lationship, upward and forward, of the condyles with the articular slopes (Fig.
10). This is just another of nature’s many adaptations.

SELECTION OF THE PROCEDURE

On the technical side, the wise and skilled operator is the one who, in his
determination to do what is best for the patient, and in his application of good
judgment, selects and is able to use the procedure for relining which best applies
to the problem at hand and to the structures involved. A qualified expert is distin-
guished not only by an accumulation of information, but more particularly hy
his ability to interpolate such information into practice. This statement is ad-
mirably supported and best clarified by two scholarly quotations : Girardot,’ “The
problems . . . have ceased to be strictly mechanical and are subordinated to the
biologic. The biologic concept of the effect of pressure and movement on liv-
ing tissue, and the ability of the tissue to accept it, should motivate and direct
every application we make of mechanical principles.” Pendleton,” “Materials
and methods avail but little when the structural characteristics of the tissues are
ignored. The biologic factors . . . are the directing influence or controls that
determine the virtue of the procedures employed in clinical practice.”

REFERENCES

1. Steffel, V. L.: Simplified Clasp Partial Dentures Designed for Maximum Function,
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COLLW;E OF DENTISTRY
OaIo STATE UNIVERSITY
COLUMBUS 10, OHIO