While conducting a product concept review meeting with about 14 dentists in attendance, the question was raised, “do you ever use a long-term soft denture liner?” “As a last resort” was the loudest reply. The definitive tone used spoke louder than the words.
Esthetics, comfort, and function are the benchmarks for a successful complete or partial denture. Many patients who need dentures have lived with a lot of pain due to their teeth, self-consciousness about their smile, and sacrifices with their diet as they couldn’t eat certain foods. They look forward to having solid teeth again and especially being pain-free. Unfortunately, as traditional dentures are not known to provide the desired stability, patients have been known to struggle with keeping dentures in place with their tongue, cheek, and lip muscles. This may become noticeable as they speak and even impact the physical appearance of their face and cheeks. Edentulous patients with severely resorbed ridges may notice a loss of retention or discomfort and may be unable to tolerate occlusal forces during functional and parafunctional movements. The soft denture-bearing mucosa is confined between the hard denture base and bone that which, during function, can cause damage to supporting tissues resulting in chronic soreness, pathologic changes, and bone loss. After 15 or more years wearing dentures, many patients’ bite-force and chewing efficiencies have been shown to be reduced, making simple functional tasks like eating very difficult.
Benefits of a soft denture liner
Soft liner materials are used on dentures to absorb some of the force produced by the dynamic action of the masticatory muscles during the act of chewing. A soft liner will distribute the stresses more evenly and act as a shock absorber adding comfort to the denture. A good soft liner will be resilient enough to conform to the ridge and the undercuts. Dentures with this type of soft liner should remain securely in place with suction created by the close fit of the soft liner and fit securely when one smiles, talks, or eats. A soft liner should start out soft and be able to maintain that softness for many years. The care of the denture by the patient is of key importance in extending the life of the denture. Therefore, it would be ideal if one could clean the soft liner with toothpaste and a toothbrush without relying heavily on denture cleansers that have been known to harden and discolor some soft liners. Regardless, bacteria will grow on both hard and soft dentures with odors absorbing into these materials if not well maintained. This means the adhesive qualities of the soft liner to the denture base are paramount in reducing bacteria and odor.
Types of soft denture liners
There are both chairside and lab-processed materials available. The chairside soft liners are often used immediately following surgery, teeth extraction, or while implants and tissues heal. These soft liners are generally intended for short term use. Lab-processed soft liners are designed to last longer and be more durable. They are meant to provide long-term stability and comfort for the denture wearer.
Many dentists have said that the normal standard of care is to add a soft liner to the mandibular denture and leave the maxillary denture as a hard denture. The mandibular denture usually has a reduced resorbed ridge and is more likely to be impacted by the pressure from functional forces while operating in a very mobile environment. A soft denture liner will then aid in stability and retention for these cases. However, it could also be stated that one hard and one soft-lined denture would certainly feel very different together in the mouth, and patient comfort could be compromised. While the patient may adjust, it raises the question of, should they.
Now back to the product review meeting. A sample of a soft liner with a 2–3mm cushion on an acrylic base was shown to the group. Anecdotal cases were shared of the liner remaining soft for more than 5 years, and the attendees were encouraged to attempt to separate the liner from the base, all being unsuccessful. Recommended cleaning of this soft liner included use of a toothbrush and toothpaste for long-term care of the denture.
Having the last word on the subject, our above mentioned attendee said, “With a product like this, maybe soft liners could be more than a last resort.”