Complaints

Diagnosis CausesTreatment

Patient Dissatisfaction

Denture errorDenture settling

Denture limitations

Types of patients

Philosophical ExactingIndifferentHysterical

Denture Complaint

Problems

Retention Support Muscle BalanceOcclusal Balance

Complaints1- Over extension → Movement interfere with muscle movement → ( ↓ Stability)2- Under extension → Break the Seal → ( ↓ Retention)3- Trimming → Thick or thin border → (ttt) Boxing.

Problems of New Denture

[ I ] Tissue irritation→ In the form of :

Hyperemia Cut in vestibule Ulceration

→ Causes:

Over-extension Pressure by denture Movement of denture Improper occlusion

→ ttt:

Remove the cause Tissue rest

→ Types:

Generalized Localized

Acute Chronic

1) Generalized Tissue irritation

2) Localized Tissue Irritation

TuberosityRetro Mylohyoid

Median Palatine Raphe

Ant. lingual & Lat.

buccal slop

VestibuleCrest

- Over extension

- Over extension

labially → lift the denture posteriorly.

____

Over extension (displacing

wax)

- Un polished (Visual& digital)*D.D.→

Aphsus ulcer

__

Border

- Bilateral undercut →

(Relief)

- Pressure area

- Dimensional changes →

(Relief – Rebase)

- pressure- ↓ relief → (Denture rocking)

- ↓ support of 1ry stress

bearing area →

(Relining or Rebasing)

- Pressure

__

-Ridge (x ray &

visual *Ex)

-Spicules& remaining

roots(Visual Ex)

- Denture pressure*(P.I.P.)

Basal Seat

__

- Occlusal interference on opposite

side→Denture move in opposite

direction.

- Anterior contact in

C.R. → *ttt (Reset)

- Deflective occlusal contact

7 7

- *C.O. ≠ *C.R. Loose denture

anteriorly

- Tooth off ridge

- Deflective occlusal contact

Occlusion

D.D. → Differential Diagnosis. Ex. → Examination. P.I.P. → Pressure Indicating Paste. C.O. → Centric Occlusion. C.R. → Centric Relation. ttt → Treatment. C.C. → Chief Complaint.

[ II ] Poor Denture Fit Cause: Lack of retention& Support. Lower denture more than Upper. Why?

↓ Support ↑ Saliva Tongue

Chief complaint (C.C.):

Loose denture Too bulky Rocking denture

Related symptoms:

Normal Abnormal

- Open wide (Yawing) → Coronoid process. - Speaking.- Cough& sneezing → ↑ the pressure. - Eating.- New denture → Saliva. - Pain.

[ III ] Pain

[ IV ] Esthetic problem

Color :a) Teeth → too dark or too yellow.b) Acrylic resin.

Size:a) Too larger.b) Too smaller.

Arrangement:a) Too even or Irregular. b) Visibility of anterior teeth (Too for forward) or (Too for backward). c) Cheeks& lips Falling-in → Unsupported lip& cheek → Plumping (Building-out

the upper denture to compensate for the loss of muscular tone). Nose& Chin approximation (closed bite):- Due to ↓ Vertical dimension.

General dissatisfaction:- Who? → Female / middle age.- Need → Kindness& Patience.

[ V ] Speech difficulties

Anterior teeth: a- ↑ Vertical overlap → "S" sound.b- Improper Labio-lingual positioning → "S" sound → (Whistling or lisping). Encroachment on tongue space:a- Posterior teeth placed too far lingually.b- Too great Bucco-lingual width of posterior teeth.c- Excessive thickness of the lingual flange.d- Poor palatal contour (Rugae area) → "S" sound → P.I.P. Poor denture retention. Excessive salivation. Vertical dimension → P, B, F, V.N.B. When pronouncing letter "S" the lateral margins of the tongue Contact the lingual surface of posterior teeth, and the tip of the tongue contact with the palate in rugae area forming a slit like channel.

a. Whistling: If anterior teeth placed too forward, the channel will be to large& the air will escape with a whistling sound → Resetting the teeth backward or thickening the denture base behind these teeth.

b. Lisping: If anterior teeth placed too backward, the channel will be obliterated& the patient may lisp → Resetting the anterior teeth forward or reducing the denture base in the Rugae area.

[ VI ] Nausea Cause: Contact of the denture with the soft palate or the tongue.

Posterior Periphery of upper denture Loose denture

Over-extension Under-extension ↑ Thickness

[ VII ] Inefficient eating Borders → Improper. Basal seat → Unstable denture. Occlusion

Teeth Vertical dimensions

Blunt Flat cusps ↑ V.D.O. ↓ V.D.O.

Elevate the muscle& don't work. Patient can't open to get food.

[ VIII ] Cheek, Lip& Tongue Bitinga) Cheek& Lip biting:

↓ Overlap → ↓ Lower buccal cusp or Reset. Laxity of muscle (loose of muscle tone).

↓ Vertical dimension → sagging of cheek.

b) Tongue biting: Teeth set lingual → Rounding the lower lingual cusps or Reset.

[ IX ] Alter taste

[ X ] Clattering teeth

Unfamiliarity with ↑ Vertical dimension Cuspal interference Unstable denture New denture. - Teeth contact sooner.

Problems of Old Denture