Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1692 - 1694

Prosthodontic Management of Undercut Tuberosities: A Clinical Report

Chakravarthy Ramasamy, Abby Abraham

1. M.D.S, Senior lecturer Department of Prosthodontics & Implantology Meenakshi ammal dental college Maduravoyal, Chennai – 600095 2. M.D.S, Reader Department of Prosthodontics & Implantology Meenakshi ammal dental college Maduravoyal, Chennai – 600095

Correspondence Address :
Chakravarthy Ramasamy
No-1009A, TVS colony, Anna nagar west Extn.
Chennai, India – 600101
E-mail: drchakra19@gmail.com
Phone: + (91)-044-26493246
Fax: + (91)-044-23781652

Abstract

The buccal undercut of the maxillary tuberosity, together with the reduced width of the buccal vestibule can complicate denture fabrication. This clinical report describes the treatment options which are available for this situation, the rationale for the design, the use of soft resilient denture flanges in the maxillary posterior buccal vestibule, and the chair-side permanent reline procedure for the incorporation of resilient denture flanges in the undercut area.

Keywords

Resilient liner, Bulbous tuberosity, Bilateral undercuts

How to cite this article :

Chakravarthy Ramasamy, Abby Abraham. PROSTHODONTIC MANAGEMENT OF UNDERCUT TUBEROSITIES: A CLINICAL REPORT. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Sep 16 ]; 5:1692-1694. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1692-1694&id=1777

Introduction
Unilateral or bilateral undercuts on the buccal aspect of the maxillary tuberosity are frequently encountered and these may complicate the successful fabrication of a complete maxillary denture. The management in these situations includes an alteration of the denture-bearing area, adaptation of the denture base, careful planning of the path of insertion, and the use of resilient lining materials. The alteration of the denture-bearing area refers to the elimination of the undercut by surgical reduction of the tuberosity. Following surgery, a good border seal can generally be attained (1). If surgery is not an option, prosthodontic management of the bilateral undercuts can be done by blocking out the undercut on the cast and finishing the denture to the full available height of the vestibule. Alternatively, the height of the flange of the denture can be reduced to the crest of the undercut (to the survey line when the cast has been surveyed). A reduced border seal may accompany such a denture base adaptation.

A pre-planned rotational path of placement may be used when a unilateral undercut of the tuberosity occurs (2), thus allowing the buccal undercut to aid in the retention of the denture. A good border seal in this situation is generally achievable. Sectional lining of the denture base with a resilient lining material in the area of the undercut can allow the engagement of the undercut with resultant increased denture retention (3),(4). This procedure is usually limited to shallow undercuts which does not affect the border seal.

A novel means of managing the bilateral undercut areas in the posterior region without compromising on the border seal has been reported in the literature for the past 20 years. Abrams (5) reported on the use of resilient lining material which was supported by a harder but flexible base which was extended into the undercut area. Such a bilaminate periphery may be too thick in situations where the width of the vestibule is limited. Other methods of incorporating an undercut into the design of a denture include sectional dentures (6) or hinge mechanisms (7). These options are complex and may require specialized technical skills. When the mouth is opened, the width of the posterior buccal vestibule is reduced by the movement of the coronoid process (8). Where the maxillary tuberosity is bulbous; the width of this space is even morereduced. When a denture is designed to manage an undercut on the buccal aspect of the maxillary tuberosity, the available vestibular dimension should be considered.

This clinical report describes an alternative method of denture designing by using a resilient liner material. By using this technique, an optimal flange height, thickness, and an excellent border seal can be achieved in situations where the maxillary tuberosities are bulbous, where bilateral undercuts are present, and where the vestibular width is limited. This design is especially useful where surgical intervention has been contraindicated.

Case Report

Clinical report
A healthy 52-year-old woman who was being examined in the Department of Prosthodontics, Meenakshi University, India, was referred from the Department of Periodontics for the fabrication of dentures. Examination of the patient revealed a completely edentulous maxillary arch and 10 remaining mandibular teeth (the right second premolar to the left second premolar). The planned treatment was the placement of a maxillary complete denture and a mandibular cobalt chromium-based removable partial denture. The maxillary tuberosities were moderately enlarged and bulbous (Table/Fig 1). These were covered by firmly attached and well keratinized gingival mucosa. The total amount of the undercut was 2 to 4 mm. When the mouth was open, the buccal vestibule was 3 mm wide, as it was reduced in width by the forward movement of the coronoid process of the mandible. The width reduction was the greatest in the depth of the vestibule. This reduced width prevented the extension of the flange to the full depth of the vestibule if the undercut was blocked out. With the aim of maximizing the border seal to ensure retention, the decision was made to incorporate resilient flanges in the undercut tuberosity region by using a permanent resilient lining material (Permasoft; DENTSPLY-Caulk, USA) (Table/Fig 2) to allow an optimal height (extension) and thickness (width) of the denture flange. The denture flange was designed to fill the entire available vestibular space. Preliminary impressions were made, and custom trays with 1.5-mm spacing were fabricated. In the area of the undercut, the tray was extended as far as the crest of the undercut. At the definitive impressionappointment, the entire border, except the undercut section of the maxillary tray, was border molded by using a modeling plastic impression compound (Green Impression Compound; DPI, India). The definitive impression material (Aquasil LV; DENTSPLYCaulk, USA) was syringed into the undercut and the adjacent buccal vestibule and the loaded tray were placed and correctly positioned. Functional movements were performed by the patient while making the maxillary definitive impression, which included opening the mouth to allow the forward movement of the coronoid process to define the width of the posterior maxillary buccal flange. An accurate impression of the available vestibular space in the maxillary tuberosity area was thus achieved. Definitive casts were made to record the vestibular space. The casts were surveyed, and the crest of the undercut which was buccal to the maxillary tuberosity was marked. The undercuts were blocked out for the construction of temporary denture bases. The maxillo-mandibular relationship was determined. The final tooth arrangement was completed and invested in a conventional manner (9). The flask was packed with heat-polymerized polymethyl methacrylate (PMMA) (Trevalon; Dentsply-India) and it was mixed according to the manufacturer’s instructions and was trial closed. After processing, the denture was finished and polished in a conventional manner (Table/Fig 3). The mandibular cobalt chromium-based RPD, which incorporated clasps and occlusal rests (Bio-dur Ni-free, [NIOM, DFS], GERMANY) was processed in the laboratory. It was fitted and placed during an appointment which was prior to the chairside lining procedure.

The processed resin in the maxillary denture which filled the buccal undercut area (the area which was apical to the marked survey line) was carefully trimmed away by using an acrylic trimmer. The cut was angled to leave a long bevel which faced the intaglio surface of the denture. The feather edge of the bevel was trimmed. This bevel increased the area of bonding between the PMMA andthe resilient permanent liner that was to replace the resin that was removed. The angulation of the bevel allowed the acrylic resin to support the flexible material on insertion of the denture, at which time these flanges would flex before seating in to the undercut. During the chair-side reline procedure, the resilient liner was packed in the areas from which the resin had been removed. The functional movements were performed. The P: L ratio which was used as per the manufacturer’s recommendations was 2:1. After the initial set of the reline material, it was removed and polymerized in a hot water bath. After heat polymerization, the excess was trimmed by using scissors and it was then finished by using acrylic finishing burs. The sealer was then applied to the resilient surfaces of the new material and it was kept to air dry for 2 minutes (Table/Fig 4). The placement of the maxillary denture was uneventful (Table/Fig 5). The previously fitted mandibular interim RPD was placed. The occlusion was evaluated for discrepancies and was corrected, and patient instructions were given. At the 24-hour follow-up appointment, redness was noted on the buccal side of the bulbous tuberosities. It was judged that this redness was due to the flexible flange which was being pressed against the tissues by the coronoid process of the mandible when the mouth was opened. The resilient silicone material was then removed from the buccal (external) surface of the flange to reduce the thickness of the flange. The patient reported improved comfort.

The further recall appointments were uneventful. On the recall appointment of one year, the resilient flanges, although slightly discoloured, were found to remain well adhered to the acrylic resin base.

Discussion

SUMMARY AND DISCUSSION
This clinical report presents a chair-side method for fabricating a flexible denture flange by using a resilient lining material. The flange extended into the bilateral tissue undercuts on the buccal aspect of the maxillary tuberosity area, an area that in the situation which has been presented, had limited width due to the anatomical dimensions and movement of the coronoid process. The rationale for using a resilient flanges (10), (11) was to aid retention by ensuring a seal around the entire border of the denture. Some authors (12) investigated and concluded that the peel strength of various silicone based soft liners on the denture base resin (PMMA) had been increased while the curing was done simultaneously.

Regarding the oral health related quality of life, denture relining with a soft liner also has been found to have a positive impact on the perceived oral health of edentulous patients (13). Some authors (14) also investigated the colonization potential of the softliners by microorganisms. They concluded that the fewer adherences of microbes on the silicone based softliners over the PMMA based ones, were because of their surface roughness. Some investigators (14) also suggested the addition of silver nano particles to the softliners for increasing their anti-fungal activity.

It is also imperative to do a surface pre-treatment of the acrylic resin with a monomer prior to the resilient liner application. This has been found to be an effective method which increases the bond strength between the base and the soft liner. Sandblasting, on the contrary, has not been recommended as it weakens the bond between the two (15).

Finally, by using this technique, an optimal flange height, thickness, and an excellent border seal can be achieved in situations where the maxillary tuberosities are bulbous, where bilateral undercutsare present, and where the vestibular width is limited. This design is especially useful where surgical intervention has been contraindicated.

Acknowledgement

The authors sincerely thank Dr.C.R.Karthikeyan, Post graduate student, Department of Prosthodontics for his constant support during the clinical and laboratory work.

References

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Moore UJ, Cowpe JG, Meechan JG, Postlethwaite KR, Thomson PJ. Principles of Oral and Maxillofacial Surgery. 5th ed. Oxford: Blackwell Publishers; 2001; 147.
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Basker RM, Davenport JC. Prosthetic treatment of the edentulous patient. 4th ed. Oxford: Blackwell Publishers; 2002; 65.
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Qudah S, Harrison A, Huggett R. Soft lining materials in prosthetic dentistry: A review. Int J Prosthodont 1990; 3:477-83.
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Jagger DC, Harrison A. Complete dentures–the soft option. An update for the general dental practice. Br Dent J 1997; 182:313-7.
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Abrams S. A technique for using maxillary anterior soft-tissue undercuts in denture placement: a case report. J Can Dent Assoc 2002; 68:301-4.
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Matsumura H, Kawasaki K. A magnetically connected removable sectional denture for a maxillary defect with a severe undercut: a clinical report. J Prosthet Dent 2000; 84:22-6.
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Jaggers JH, Boyd M. A bilaterally hinged complete denture for a severely undercut maxillary arch. Solution to a problem. J Prosthet Dent 1979; 41:373-6.
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Davenport JC, Basker RM, Heath JR, Ralph JP, Glantz PO. A clinical guide to a removable partial denture design. London: BDJ Books; 2000; 31.
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Anusavice KJ, Phillips RW. Phillips’ Science of Dental Materials. 11th ed.St. Louis: Elsevier Science; 2003; . 721-34.
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Lowe LG. Flexible denture flanges for patients who exhibited undercut tuberosities and reduced width of the buccal vestibule: a clinical report. J Prosthet Dent. 2004 Aug; 92(2):128-31.
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Abrams S, Hellen W. Fabrication of an overdenture which could cover a torus palatinus by using a combination of denture base materials: a case report. Dent Today. 2006 Apr;25(4):74, 76-7.
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Demir H, Dogan A, Dogan OM, Keskin S, Bolayir G, Soygun K. Peel bond strength of two silicone soft liners to a heat-cured denture base resin. J Adhes Dent. 2011 Jun 29. doi: 10.3290/j.jad.a21851. [Epub ahead of print]
13.
Pisani MX, Malheiros-Segundo AD, Balbino KL, Souza RD, Paranhos HD, Lovato da Silva CH. Oral health related quality of life of edentulous patients after denture relining with a siliconebased soft liner. Gerodontology. 2011 Jun 22. doi: 10.1111/j.1741- 2358.2011.00503.x. [Epub ahead of print]
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JCDR/2011/1777

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