Denture Insertion,Patient Education and Management

Denture insertion,patient Denture insertion,patient education and managementeducation and management

Manikya AraboluManikya AraboluIst year PG studentIst year PG student

Department of ProsthodonticsDepartment of ProsthodonticsA.E.C.S.Maaruti Dental CollegeA.E.C.S.Maaruti Dental College

Behavioral factors affecting insertionBehavioral factors affecting insertion Lab remountingLab remounting Management of tissue surface discrepanciesManagement of tissue surface discrepancies Treatment of polished surfacesTreatment of polished surfaces Checking the fit of the dentureChecking the fit of the denture Clinical remountingClinical remounting Eliminating occlusal errorsEliminating occlusal errors Patient instructions and involvementPatient instructions and involvement

Behavioural factors affecting Behavioural factors affecting insertioninsertion

Easily satisfied Easily satisfied patientpatient

Office fixtureOffice fixture Average denture Average denture

patientspatients

Patient motivationPatient motivation

Response to denture insertion-threshold of Response to denture insertion-threshold of acceptabilityacceptability

Patient acceptance of treatment and Patient acceptance of treatment and reaction to results - measures of his reaction to results - measures of his motivationmotivation

CommunicationCommunication

Patient education programPatient education program

* Ist phase – verbal in nature* Ist phase – verbal in nature

* 2* 2ndnd phase – summary of expected phase – summary of expected

problems and hygieneproblems and hygiene

InsertionInsertion

Old dentures to be out of the mouth at Old dentures to be out of the mouth at least for 24 hours before insertionleast for 24 hours before insertion

Lab remountingLab remounting

Permanent denture basePermanent denture base Temporary denture baseTemporary denture base

Lab remountingLab remounting

Dentures returned Dentures returned to articulator to articulator positionspositions Notching castsNotching casts Split cast technique Split cast technique

Deflecting Deflecting contacts removed contacts removed by grinding by grinding

Plaster indexPlaster index

Upper cast attached to Upper cast attached to upper mountingupper mounting

Remount jig on lower Remount jig on lower member member

Upper denture closed Upper denture closed into plasterinto plaster

Index can be made after Index can be made after final wax up before final wax up before investinginvesting

Construction of remounting castsConstruction of remounting casts

Undercuts on tissue Undercuts on tissue surface blocked with wet surface blocked with wet tissue paper,clay or wet tissue paper,clay or wet pumicepumice

Fast setting plaster or Fast setting plaster or artificial stone poured into artificial stone poured into denturedenture

Remounting castsRemounting casts

Management of tissue surface Management of tissue surface discrepanciesdiscrepancies

Presence of foreign Presence of foreign bodiesbodies

Sharp line anglesSharp line angles



Treatment of polished surfacesTreatment of polished surfaces

Frenal reliefFrenal relief


Inspection of denture Inspection of denture borders outside and borders outside and inside the mouthinside the mouth

Irregularities in bulk of Irregularities in bulk of materialmaterial


Check root Check root prominences and prominences and thick peripheriesthick peripheries

Evaluation of function of dentureEvaluation of function of denture

RetentionRetention

* * Posterior sealPosterior seal

* Anterior seal* Anterior seal

StabilityStability Concave polished Concave polished

surfacessurfaces

Errors in occlusionErrors in occlusion Change in state of TMJ’sChange in state of TMJ’s Inaccurate maxillomandibular recordsInaccurate maxillomandibular records Ill fitting temporary record basesIll fitting temporary record bases Change of vertical dimension of occlusion on Change of vertical dimension of occlusion on

articulatorarticulator Incorrect arrangement of posterior teethIncorrect arrangement of posterior teeth Failure to close the flasks completely during Failure to close the flasks completely during

processingprocessing Too much pressure in closing flasksToo much pressure in closing flasks Shrinking of acrylic,processing changesShrinking of acrylic,processing changes

Clinical remountingClinical remounting

At the time of insertionAt the time of insertion Guide into centric relationGuide into centric relation

Recording centric relationRecording centric relation

Patient instructed to Patient instructed to close until the first close until the first “feather touch” is felt “feather touch” is felt on the posterior teeth. on the posterior teeth.

Interocclusal check Interocclusal check recordrecord



Verifying centric Verifying centric relation recordrelation record

If the opposing teeth If the opposing teeth do not fit - either the do not fit - either the original mounting was original mounting was incorrect or patient incorrect or patient gave an incorrect gave an incorrect relation when making relation when making second recordsecond record

Eliminating errors in anatomic teethEliminating errors in anatomic teeth

Final correction of Final correction of occlusal disharmoniesocclusal disharmonies

Goal - to maintain the Goal - to maintain the integrity of the stamp integrity of the stamp or central bearing or central bearing cusp tips in both cusp tips in both arches and allow all arches and allow all cusps to move cusps to move through the through the sluiceways of the sluiceways of the opposing dentition. opposing dentition.

Eliminating errors in anatomic teethEliminating errors in anatomic teeth

Contacts in centric occlusion establishedContacts in centric occlusion established

Corrections in lateral occlusion-Corrections in lateral occlusion-lingual inclines of the lingual inclines of the maxillary buccal cusps and the buccal inclines of the maxillary buccal cusps and the buccal inclines of the mandibular lingual cusps on the working side and the mandibular lingual cusps on the working side and the lingual inclines of the mandibular buccal cusps on the lingual inclines of the mandibular buccal cusps on the balancing sides. balancing sides.

Interceptive lateral and protrusive contacts in the Interceptive lateral and protrusive contacts in the anterior area must be eliminated- grinding lower anterior area must be eliminated- grinding lower anteriorsanteriors

Flat plane non anatomic arrangementFlat plane non anatomic arrangement

Doctor should be concerned only with creation of Doctor should be concerned only with creation of noninterfering tooth surfaces in protrusive lateral noninterfering tooth surfaces in protrusive lateral movementsmovements –using ramps as occlusal stabilizers –using ramps as occlusal stabilizers posteriorlyposteriorly

Interocclusal centric record madeInterocclusal centric record made

Complimentary opposing arch adjustment in eccentric Complimentary opposing arch adjustment in eccentric occlusion –no grinding on distobuccal portion of occlusion –no grinding on distobuccal portion of mandibular second molar,balancing side grinding done mandibular second molar,balancing side grinding done on lingual portion of maxillary second molaron lingual portion of maxillary second molar

Patient involvementPatient involvement

CommunicationCommunication Subsequent course of treatmentSubsequent course of treatment Remove and wear the prosthesisRemove and wear the prosthesis

Nature of complete denturesNature of complete dentures

Patient must have an understanding of the Patient must have an understanding of the denture foundationdenture foundation

Complete dentures are not a substitute for Complete dentures are not a substitute for natural teeth but only a prosthetic solutionnatural teeth but only a prosthetic solution

First oral feelingsFirst oral feelings

Patients should view themselves in the Patients should view themselves in the mirrormirror

Temporary feeling of fullnessTemporary feeling of fullness Excess saliva- deglutition Excess saliva- deglutition

SpeechSpeech

Most patients master speech with new Most patients master speech with new dentures within a few weeks. dentures within a few weeks.

0.5 mm change at the linguogingival 0.5 mm change at the linguogingival border of the anterior teeth- s sound border of the anterior teeth- s sound defectivedefective

Practice,read aloudPractice,read aloud

Tongue positionTongue position

Normal level- Normal level- mandibular denture is mandibular denture is stablestable

Tongue retracted- Tongue retracted- denture unstable and denture unstable and looseloose

Proper tongue Proper tongue position should be position should be demonstrated.demonstrated.

MasticationMastication

Eating skills slowly refined and developedEating skills slowly refined and developed Bilateral chewing Bilateral chewing Area of Ist molar – increases masticatory Area of Ist molar – increases masticatory

strokestroke Chewing stroke- up and down motion- Chewing stroke- up and down motion-

minimize lateral thrustsminimize lateral thrusts

Maintaining tissue healthMaintaining tissue health

Adequate tissue restAdequate tissue rest Complete denture hygieneComplete denture hygiene Tissue hygiene and massageTissue hygiene and massage

Complete denture hygieneComplete denture hygiene

Chemical cleaningChemical cleaning Mechanical cleaningMechanical cleaning Sonic cleaningSonic cleaning

Chemical cleaningChemical cleaning

Sodium hypochloriteSodium hypochlorite White vinegarWhite vinegar Silicone polymerSilicone polymer

Mechanical cleaningMechanical cleaning

Cleaning and care for the dentureCleaning and care for the denture

Sonic cleanersSonic cleaners Tissue conditionersTissue conditioners Care for the dentureCare for the denture Tissue hygiene and Tissue hygiene and

massagemassage

Over the counter denture productsOver the counter denture products

Home relining, repairingHome relining, repairing Excessive use of adhesive powder or Excessive use of adhesive powder or

pastepaste

Denture adhesivesDenture adhesives

A temporary measure to provide increased A temporary measure to provide increased retention of dentures retention of dentures

Analgesic ointments – increase the vertical Analgesic ointments – increase the vertical dimension of the denture dimension of the denture

Thinly spread to correspond with mucosal Thinly spread to correspond with mucosal sorenesssoreness

Instructions to the patientInstructions to the patient

Complete denture wearer should insert the lower Complete denture wearer should insert the lower denture first followed by the upper.denture first followed by the upper.

There might be difficulty in wearing new There might be difficulty in wearing new dentures . Report to the hospital for necessary dentures . Report to the hospital for necessary adjustments.adjustments.

It is better to avoid eating hard food with new It is better to avoid eating hard food with new denturesdentures

It is advised to eat soft food in the beginning and It is advised to eat soft food in the beginning and slowly progress to hard food.slowly progress to hard food.


Handle dentures carefully ,they can break Handle dentures carefully ,they can break if dropped.if dropped.

Dentures should be cleaned after every Dentures should be cleaned after every mealmeal

In the night it is better to discontinue the In the night it is better to discontinue the use of dentureuse of denture

In the morning the denture should be In the morning the denture should be cleaned using soap and brushcleaned using soap and brush


Do not clean the dentures using hot water Do not clean the dentures using hot water or chemicalsor chemicals

When the dentures are not in use, keep in When the dentures are not in use, keep in waterwater

In case of breakage of dentures report to In case of breakage of dentures report to the hospital for repairthe hospital for repair

To get the maximum service from your To get the maximum service from your dentures it is imperative that you follow dentures it is imperative that you follow your doctor’s adviceyour doctor’s advice

ReferencesReferences

Sheldon Winkler,Essentials of Complete Denture Sheldon Winkler,Essentials of Complete Denture Prosthodontics,2nd edition,A.I.B.T.S publishers and Prosthodontics,2nd edition,A.I.B.T.S publishers and distributors, India, pp-318-340distributors, India, pp-318-340

Charles.L.Bolender,Prosthodontic treatment for Charles.L.Bolender,Prosthodontic treatment for edentulous patients,12th edition,2003,Mosby edentulous patients,12th edition,2003,Mosby publications,St.Louis,pp-389-426publications,St.Louis,pp-389-426

A.O Rahn and C.M Heartwell,Textbook of complete A.O Rahn and C.M Heartwell,Textbook of complete dentures,4th edition,1993,Lea and Fabiger,USA,pp-dentures,4th edition,1993,Lea and Fabiger,USA,pp-391-406391-406

ReferencesReferences Deepak Nallaswamy,Textbook of Deepak Nallaswamy,Textbook of

Prosthodontics, Ist edition,2003,Jaypee Prosthodontics, Ist edition,2003,Jaypee publishers,New Delhi,pp-219-228publishers,New Delhi,pp-219-228

H.R.B Fenn, K.P Liddelow ,A.P. H.R.B Fenn, K.P Liddelow ,A.P. Gimson,Clinical Dental Prosthetics,2nd Gimson,Clinical Dental Prosthetics,2nd edition,1986, C.B.S publishers and edition,1986, C.B.S publishers and distributors,New Delhi,pp- 326-364distributors,New Delhi,pp- 326-364

John.J Sharry,Complete denture John.J Sharry,Complete denture prosthodontics,3rd edition,1999,Blackiston prosthodontics,3rd edition,1999,Blackiston Publication,218-234Publication,218-234


Alan A.Grant ,Complete Prosthodontics, Alan A.Grant ,Complete Prosthodontics, Problems,diagnosis and management, 1994, Problems,diagnosis and management, 1994, Mosby Publishers,England,129-136Mosby Publishers,England,129-136

J.F.Mc Cord,A.A grant,Trial dentures , J.F.Mc Cord,A.A grant,Trial dentures , insertion of processed dentures and review of insertion of processed dentures and review of complete dentures.British Dental Journal ,Vol complete dentures.British Dental Journal ,Vol 189,No 1 ,July 2000,4-8189,No 1 ,July 2000,4-8

Lamb,David J,Complete dental prosthetics ,pp-Lamb,David J,Complete dental prosthetics ,pp-1-411-41


Kenneth Shay,Denture Hygiene: A Kenneth Shay,Denture Hygiene: A review and update,The Journal of review and update,The Journal of Contemporary dental practice Contemporary dental practice 2000;1,2:1-82000;1,2:1-8

instructions for complete denture instructions for complete denture patients.htmpatients.htm

denturetrouble.htmdenturetrouble.htm

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Denture Insertion,Patient Education and Management