Dent Clin N Am 48 (2004) 709–720

Soft liners
Lily T. Garcia, DDS, MS*, John D. Jones, DDS
Department of Prosthodontics, University of Texas Health Science Center,
San Antonio Dental School, 7703 Floyd Curl Drive, MCS 7812,
San Antonio, TX 78992, USA

Soft liner materials

Dentists currently are faced with a selection of many soft liners with
a wide variety of uses (Table 1) [1–9]. With the increased number of
products available, the dentist must understand the differences in the
materials to prescribe, select, and use the product best suited to meet the
challenges a patient may present clinically. Even with an appropriate
diagnosis and subsequent use of a particular dental material, the prognosis
should be given with caution. It often is important to consider whether the
treatment should include remaking the prosthesis rather than simply relining
a prosthesis for short-term benefit without a plan for long-term success.
Relining materials offer the dentist short-term resolutions for a patient’s
problems.
Soft liner material has been available since the days of vulcanite dentures
[10]. The liner material at the time, velum rubber, was comprised of a sponge
rubber, which had limitations related the porosity of the material and the
ability to adjust and polish it. Velum rubber, originally named for use of the
material in cleft palate prostheses, had increased amounts of sulfur and
vulcanized as a soft pliable vulcanite [11]. It provided better comfort than
most of the vulcanite materials [12]. As early as the turn of the twentieth
century, efforts were made to improve the fit and comfort in prosthodontic
treatment of edentulous patients, although these efforts were limited by
materials available during the time. Before the early 1950s there was limited
research on soft liners [13–15]. Many of the publications that were available
relied on anecdotal information or case reports.
According to Lytle’s [16] publication on abused tissues, zinc oxide
eugenol or silicone impression material could be used satisfactorily to treat
damaged tissues. In the late 1950s through the early 1960s, tissue

* Corresponding author.
E-mail address: garcialt@uthscsa.edu (L.T. Garcia).

0011-8532/04/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.cden.2004.03.001
Table 1
Soft liner materials
Brand name Manufacturer Description
a
Coe-Comfort Tissue GC America Tissue conditioner
Conditioner
Coe-Soft Soft Denture Reline GC Americaa Resilient, soft chairside
Material material
Dinabase 7 Quattroti S.R.L.b Long-term tissue conditioning
Dinabase Classic
F-I-T Stratford-Cooksonc Functional impression and soft
temporary relining material
GC Chairside Soft & Extra GC Americaa Resilient vinyl polysiloxane
Soft Denture Reline Material used as a soft, temporary
liner
Hydro-Cast Sultand Tissue treatment material,
functional impression
material
Light Liner Light Cure Bosworthe Soft formula available
Chairside Reline Composite
Luci-Sof Denture Liner System Dentsply Caulkf Silicone-based liner
Lynal Dentsply Caulkf Tissue conditioner and
temporary liner
Molloplast-B Buffalog Permanent soft reline material
Mollosil Plus
Palasive 62 Kulzer and Co.h
Perma Soft Dentsply Caulkf Soft reline material
PROFLEX Dental Resourcesi
Recon Tissue Conditioner Hygenicj Tissue conditioner
Sofreliner Chairside Soft J. Moritak Soft reline material
Denture Reline
Softone Tissue Conditioner Bosworthe Tissue conditioner and
functional material
Super-Soft Resilient GC Americaa Resilient denture liner
Denture Liner
Tempo Langl Cushion treatment reliner
material
Tokuyama Sofreliner Tokuyamam Long-term reliner material
Tokuyama Sofreliner Tough
Tru-Soft Intermediary Bosworthe Soft up to 12 months
Relining Material
Versasoft Sultand Silicone denture soft liner
Visco-Gel Dentsply Caulkf Tissue treatment
a
Alsip, Illinois.
b
Porro, Italy.
c
Westbury, New York.
d
Englewood, New Jersey.
e
Skokie, Illinois.
f
Milford, Deleware.
g
Syosset, New York.
h
Armonk, New York.
i
Maple Lake, Minnesota.
j
Akron, Ohio.
k
Irvine, California.
l
Wheeling, Illinois.
m
Tokyo, Japan.
 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720 711

Fig. 1. Intaglio surface of mandibular complete denture shows presence of Candida albicans on
the soft liner material.

conditioners were introduced for use in tissue treatment, for lining surgical
splints, for stabilizing a record base, and as a functional impression material
[17]. Soon after, short-term liners appeared on the market and were used for
tissue treatment or tissue conditioning [18].
By the late 1960s, more durable, resilient soft liners were used [19]. At the
time, the two common materials were silicone rubbers including Silastic 390
and Silastic 616 (Dow Corning, Midland, Michigan) and a silicone rubber
Molloplast-B (Buffalo Dental Manufacturing Co, Syosset, New York),
which currently remains available [20–22]. As with the products available
today, the limitation with the silicone rubber products lies in the lack of
bonding between the silicone rubber and the acrylic resin base material.
Also, fungal growth on and within processed soft liners continues to be
a complicating factor (Fig. 1) [23–29].

Material properties
Certain clinical limitations occur with the use of soft liners, primarily
resulting from failures in the physical properties of the material [30–38].
Desirable material properties for a soft liner include resilience, tear
resistance, viscoelasticity, biocompatibility, lack of odor and taste, adhesive
bond strength, low solubility in saliva, low adsorption in saliva, ease of
adjustability, dimensional stability, color stability, lack of adverse effect on
denture base material, resistance to abrasion, and ease of cleaning.
O’Brien [10] classified the soft liners as being made of either acrylic or
silicone. Silicone soft liners include heat-cured liners and those vulcanized at
room temperature. A material different from the silicone or acrylic resin
soft liners is the poly(fluoroalkoxy) phosphazine elastomeric system.
The material developed by Gettleman and others [39,40] was promising.
The incorporation of methyl methacrylate provided good adhesion to the
denture, and the physical properties were acceptable.
An example of a heat-processed silicone liner is Molloplast-B. This is
a gamma methacryloxy propyl trimethoxy silane heat-polymerized silicone
712 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720

rubber. In the past, this material provided better adhesion to the resin
denture base and was less prone to growth of Candida albicans than other
materials. One drawback is a limited shelf life, which can be increased with
refrigeration. The main limitation associated with this material is a lower
resistance to tearing than other soft liners. The resilience of silicones is not
based on plasticizers but on an intrinsic property of the polymer to retain
resilience throughout the working life of the material.
The tissue conditioners are categorized as plasticized acrylics. The soft
liner acrylics that are heat polymerized are generally composed of polyethyl
methacrylate powder, a monomer of methacrylate ester, and a phthallate
ester plasticizer. The monomer may include ethyl, N-butyl, 2-ethoxy ethyl
esters. The advantage of these materials is their ability to bond to the
poly(ethylmethacrylate) denture resin base; a drawback is the loss of
plasticizers.
Tissue conditioners may be comprised of poly(ethylmethacrylate),
poly(ethylacrylate), or butyl methacrylate. Conditioners are usually
made of a poly(ethylmethacrylate) mixture of phthallate plasticizer and up
to 25% ethanol. The plasticizer lowers the glass-transition temperature so the
rigid acrylic resin becomes rubbery and resilient.

Categories
Currently the International Organization for Standardization (ISO) has
issued two international standards related to soft liner materials: ISO 10139-
1:1991, Resilient lining materials for removable dentures–Part 1: short-term
materials and soft lining materials for removable dentures [41], and ISO
10139-2:1999, Resilient lining materials for removable dentures–Part 2:
materials for long-term use [42].
The ISO categorizes a short-term liner as one used intraorally for up to
30 days. A long-term liner is categorized as one that maintains softness and
elasticity for more than 30 days. The authors of this article categorize short-
term liners as tissue conditioners and temporary soft liners used for up to 1
month following surgical procedures, diagnostic procedures, immediate
placement of transitional removable partial dentures and immediate
dentures, immediate transitional dentures, and other temporary situations
(Fig. 2). Liners used from 1 to 6 months are categorized as intermediate
liners. The intermediate liners are made of plasticized acrylic. An in-
termediate liner placed in a removable prosthesis usually lasts for 1 to 2
months before the plasticizers are leached out and the material loses
resiliency.
Although the ISO categorizes a long-term liner as one used for more than
30 days, for this discussion, the authors consider a long-term liner to beone
used for 1 year or longer (Fig. 3). These liners commonly are referred to as
permanent soft liners because of their relative longevity. Long-term
permanent liners are frequently used when preprosthetic surgery is not
 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720 713

Fig. 2. Intaglio surface of mandibular complete denture shows milky, opaque appearance of
a short-term conditioner.

indicated but the patient presents with significant bony undercuts or poor
residual alveolar ridge anatomy, such as a knife-edge ridge. Many these
patients are unable to function with complete dentures without the
incorporation of a soft liner. Patients report greatly improved comfort
and function when using complete dentures with soft liners (K.D. Rudd,
personal communication, 1998). Also, use of a soft liner can increase
a patient’s tolerance for tissue pain associated with a hard-resin denture
base. In a patient with denture stomatitis with C albicans, however, use of
a soft liner material may exacerbate the tissue discomfort often associated
with an increase in fungal growth.

Complicating factors
A soft liner material often is used to reline a removable prosthesis.
Boucher [17] stated, ‘‘[R]elining of complete dentures is one of the most
difficult and trying procedures in prosthodontics, however, it can be effective
if the denture was made correctly during the initial fabrication and if
a precise technique is performed with meticulous attention to every detail.’’
Before a soft liner is used, the prosthesis must be evaluated and deemed

Fig. 3. View of maxillary complete denture shows the color difference between the long-term
soft liner material and the denture-base hard acrylic resin.
714 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720

clinically acceptable; the liner material should not be used to compensate for
a poorly made, ill-fitting prosthesis. A liner, whether hard or soft, should be
used as a simple tool to improve a clinically acceptable prosthesis.
Brown [31] described the success of using a soft liner with a simple
analogy: ‘‘Hit the table in front of you with your hand, and it is a painful
experience; cover it with a sheet of foam rubber, and do it again, and there is
no pain.’’ Use of a soft liner may make the difference in a patient’s being
able to function with a removable prosthesis such as a complete denture and
not being able to function properly. Patients may have intraoral anatomic
features such as a sharp, bony residual alveolar ridge or bony undercuts for
which surgery may be contraindicated. The key rationale for use of a soft
liner in this instance and in related clinical scenarios is based on its intrinsic
resilience, that is, its ability to absorb energy as the material undergoes
deformation. Clinically, energy is absorbed by the soft liner material and not
by the underlying, supporting intraoral tissues. The soft lining material
allows a ‘‘uniform distribution of stress at the mucosa/lining interface’’ but
does not necessarily reduce transmitted forces [5].
Authors have described why a reliner material fails as a denture reliner. If
the existing prosthesis is poorly made or does not fit well, the existing soft
tissue problems can be exacerbated with a relining procedure, regardless of
material quality. Winkler’s [43] initial description, based on incorrect
diagnosis and similar to Boucher’s statements, concluded that a denture
that should be rebased or remade can never be relined successfully. If the
existing intraoral tissues are in poor condition, the abused tissue is an
inadequate foundation for successful prosthodontic therapy. Some dentists
may conclude that, if all else fails or patients are having considerable
difficulty with their removable prostheses, dental implants should be
considered. Dental implants should not be viewed as a substitute for
adherence to fundamentally sound prosthodontic principles, however. For
a patient who cannot afford dental implant treatment, use of a soft relining
material is a poor substitute for a well-made removable prosthesis Winkler
[43] states, ‘‘All relined procedures will cause a change in vertical dimension
due to the addition of new material, to the tissue side of the denture base.’’
Incorporation of too much material significantly affects the interocclusal
space necessary for a patient to function properly.
Denture bases also may shift during relining procedures. The increased
amount of material in the dentures may shift the dentures forward and affect
both esthetics and occlusion. Patients may complain of increased fullness or
that the ‘‘dentures are too big, don’t look right, don’t bite right.’’ As with
other common dental materials (eg, the routine use of alginate impression
material), the ease of use of some soft liners makes it easy to abuse the
material.
Nikawa et al [26] have shown that different components of soft liners
affect the growth, acid production, and colonization of C albicans. They
studied the affects of polymer particle size, ethyl alcohol content, and type
 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720 715

of plasticizer. They found that the size of polymer particle had little effect on
C albicans growth. The amount of ethyl alcohol content and type of plasti-
cizer made a significant difference, however.
Increased ethanol content with benzoyl salicylate increased fungal
colonization. With benzyl N-butyl phthlate, however, the fungal growth
rate decreased. With plasticizers, benzoate, and benzyl salicylate, coloniza-
tion decreased, whereas colonization increased with the use of dibutyl
phthalate butyl, N-butyl phthalate, and butyl phthalate butyl glyconate.

Clinical uses
Tissue conditioners offer alternative materials for practitioners who
manage patients in today’s esthetically conscious society. Most patients
are reluctant to be without their dentures at any time, and many patients
state that their spouses or partners have never seen them without their
removable prostheses. Patients are more active than in previous years, in
both professional and recreational activities. A dentist’s request that
a patient remove the prosthesis for a brief period, and even more for
a day, may be considered an impossible demand. Patients may be more
amenable to having a series of appointments using a tissue-treatment
material than to going about daily activities without removable prostheses
(ie, maxillary and mandibular complete dentures).
Lytle [16] reported differences found in patients who used dentures
continually and those who removed the prostheses throughout the night. In
conventional treatment, patients who have abused tissues are instructed to
leave the dentures out of the mouth, or the dentist prescribes and uses
a tissue-conditioner material, changing the material every 3 days for a series
of three relinings. Chase [44] first described use of tissue-treatment material
in 1962. Use of tissue-treatment material expanded in the complete denture
teaching techniques of Earl Pound [45]. The technique used both the
resilient and short-term qualities of a tissue conditioner to enhance clinical
outcomes in denture fabrication.
Tissue-treatment material, when mixed, results in a gel of the polymer
and monomer with a resilient consistency. The resilient gel provides an
excellent cushion for traumatized tissue adjacent to the intaglio surface of
the hard, processed denture-base material. When the tissue-treatment liner is
replaced frequently, the damaged intraoral supporting tissues can return to
a state of health. Effective use of any tissue-treatment material may require
replacement every 3 days for 2 weeks or longer.
Before a tissue conditioner is applied, the intraoral tissues must be clean
and dry. Although most dental materials should be mixed according to the
manufacturer’s instructions, the mixing instructions of some tissue-treat-
ment materials can be altered depending on the desired viscosity and flow
needed clinically. Once the material is placed on the intaglio surface of
a prosthesis and seated intraorally, the material is allowed to flow as the
716 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720

patient closes the bite into maximum intercuspation or appropriate

interocclusal relation. After the material sets, excess amounts are trimmed
using a sharp, heated scalpel.
Placing a tissue conditioner in a prosthesis for frequent liner replacement
is a relatively simple procedure, but a soft liner material that is not changed
frequently can cause additional tissue damage. Improper use of tissue-
treatment material and failure to change the material according to the
manufacturer’s instructions can exacerbate the clinical condition. Plasti-
cizers that leach out of the material can result in a hardened material. Parts
of the liner may wear out or peel off, affecting the intraoral tissue
foundation. This problem is seen particularly in patients with immediate
dentures who have had a soft relining and who do not return for a post-
insertion follow-up appointment.

Diagnostic relining
A diagnostic relining is indicated in several clinical scenarios. It may
be used in conjunction with a diagnostic acrylic resin removable partial
denture, also referred to as a temporary or transitional prosthesis.
Diagnostic removable prostheses can be used to evaluate the patient’s
occlusal vertical dimension, to re-establish esthetics, or to ascertain whether
a perspective patient can tolerate and accept a removable prosthesis. The
diagnostic relining can be used in preventive program to evaluate oral
hygiene or to evaluate a patient’s commitment to maintaining a prosthesis
before undertaking a major financial obligation for prosthodontic treat-
ment.
A diagnostic, reversible procedure of this type can be interpreted as
a treatment of last resort to preserve remaining natural teeth. This
procedure can also be used to evaluate an existing or repaired complete
denture or other removable prosthesis, and this evaluation, in turn, can help
determine proposed changes for a new prosthesis. A diagnostic soft liner can
be beneficial in determining the eventual thickness of a hard relining;
a periodontal probe can be inserted through the material to measure the
thickness of the soft liner. The measurement of the volume or thickness of
the soft liner can indicate the volume of bone resorption often associated
with loss of natural teeth.
Once the soft liner is placed, the dentist may need to replace it with
a processed hard relining material, or evaluation may show that a new
prosthesis is necessary. When the prognosis includes possible significant
modification of an existing prosthesis, the dentist may want to duplicate the
original denture before placing the soft liner. If this diagnostic phase is
unsuccessful, the patient still has an intact prosthesis because the material
can be removed; the modifications made using a soft liner material, such as
a tissue conditioner, are reversible.
 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720 717

Impression material
A number of dentists use tissue conditioner as a border-molding material
and as an impression material for edentulous and partially edentulous
patients [46]. The dentist can prescribe a series of soft relining procedures
using a tissue conditioner to evaluate borders (ie, depth and thickness of
a border in relation to muscle function; also considered a preprosthetic
diagnostic procedure). The final placement of soft liner material can be used
as the final impression either following the initial set of material (as with other
final impression materials) or by having the patient wear and function with
the prosthesis for a defined period of time. Some dentists may even have the
patient eat something to generate an in-the-chair assessment of functional
rather than having the patient wear the prosthesis for a defined period of time.
Another method of making a functional impression is selective finger-
pressure placement following a selective-pressure impression technique. This
technique is similar to that used in making an impression for an altered cast
procedure for a bilateral distal extension removable partial denture or for
a final impression for a complete denture. In one example, the functional
impression can be made in the definitive prosthesis at the insertion
appointment [47].

Immediate complete denture

Patients’ needs for removable prosthodontic treatment in the future have
been confirmed [48]. Fabrication of immediate complete dentures offers an
acceptable transition for a patient and allows the patient to continue to
function socially. In a conventional clinical protocol for a patient with
immediate dentures, posterior teeth are removed 6 weeks before construction
of the immediate prosthesis. Patients may retain up to six anterior teeth in
one or both arches during the initial healing phase. During the insertion
appointment, the remaining natural teeth are removed, and the maxillary and
mandibular immediate complete dentures are placed. Although some dentists
may place soft liners along with insertion of the immediate prostheses during
this surgical appointment, this practice should be discouraged. If made well,
the new immediate complete denture should be well adapted to the previously
healed tissues except around the recent extraction sites.
Soon after the surgical and prostheses insertion appointment, a patient
may complain that the dentures are loose. There is a tendency to reline the
dentures too soon at the request of the patient. A hard clinical relining is
usually indicated 6 months to 1 year after extractions. A soft liner may be
used as soon as the surgical and prostheses insertion appointment or as late
as 2 months before the hard relining process (Fig. 4). The patient will need
to be evaluated frequently to help determine when the soft relining material
should be placed; the series of appointments for maintenance should begin
before the final hard relining/replacement.
718 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720

Fig. 4. Intaglio surfaces of maxillary and mandibular immediate complete dentures. The
mandibular immediate denture has an intermediate soft liner that appears as a semitranslucent
material.

Surgery and implant therapy

Following preprosthetic surgery, temporary soft liners are used to meet
functional needs. Using a soft relining material improves adaptation to the
prosthesis because the material helps reduce edema and control postsurgical
bleeding, much like a pressure bandage. This function and use differs from
using the material for simple tissue conditioning. Soft liners are used after
removal of exostosis, tori, tuberosity reductions, or reductions in the
mylohyoid ridge. After surgery the soft material works well to fill any void
between the soft tissues and the intaglio surface of the removable prosthesis.
The need to replace the material still exists, and appropriate patient follow-
up is required to avoid further complications related to material limitations.
Soft liners are used in prosthodontic implant therapy. Patients who have
an implant placed following a two-stage implant surgical protocol are
advised not to use any removable prosthesis immediately following surgery
and to leave their removable prostheses out for approximately 2 weeks. The
intaglio surface of the denture is relieved considerably to create a space over
the implants; the intent is to avoid direct contact between the hard denture-
base material and the implant. A soft liner material is placed to minimize
direct pressure on the tissue covering the implants and to provide a broad
distribution of occlusal forces transferred to supporting tissues. The soft
liners can be used intraorally over implant sites to modify a temporary
complete denture or a temporary removable partial denture. In each case,
the soft liner material must be changed frequently to maintain resiliency.
Soft liner materials can be used in conjunction with mechanical attach-
ments or other simple retentive attachments in either an interim or
a definitive removable prosthesis. In similar manner, the material is used
as a permanent soft liner covering the denture base to improve soft tissue
adaptation.
 L.T. Garcia, J.D. Jones / Dent Clin N Am 48 (2004) 709–720 719

Summary
The article provides a background for understanding the properties of
soft liner materials, describing associated problems, and discussing clinical
applications of soft liners in dental practice. Although not a panacea, soft
liner materials provide the practitioner with a valuable tool in providing
excellent clinical care for patients.

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