Diagnosing denture problems usingpressure-indicating media

Robert W. Loney, Mark E. KnechtelJ Prosthet Dent 2009;101:137-141

Purpose

Provide guidelines for optimal use of the media

To identify alternative uses that could be considered in daily practice

Patients often cannot precisely pinpoint the location of irritations.

Never be modified without first using media toidentify specific areas requiring adjustment.

Commonly used media

Nonsetting and cream-based (Pressure Indicator Paste; Mizzy, Inc, Cherry Hill, NJ)

Nonsetting aerosol powders (Occlude; Pascal Intl, Inc, Bellevue, Wash)

Media that polymerize (typically catalyst/base elastomers such as Fit Checker)

Procedure

Remove any obvious spicules or sharp projections from the denture

Evaluate the denture base adaptation prior to occlusal adjustments

Dry the denture and Moist the oral mucosa

Application of media

Cream types:

apply sufficient material so that the base appears to be primarily the color of the media

Use a stiff brush to place pronounced streaks in the material

For Polymerizing materials

As thin a layer as possible to completely obscure the underlying denture

Do not place streaks in elastomeric materials.

Seat dentures with polymerization-type materials before the start of polymerization

Insertion of denture into mouth

Using mouth mirror

Quadrants, periphery and denture base separately

Seating the prosthesis

Use light pressure initially – ensure comfort

Apply firm pressure in the area of the first molars

Do not allow occlusal contacts – tipping of denture

Exert pressure perpendicular to the occlusal plane

Evaluating flange extensions

Stabilize the denture over the occlusal

surfaces of the teeth

The patient makes functional movements

Clinician manipulates the cheeks or lips

Because of moveable mucosa and frena, which typically do not displace

media

Interpretation of media

For nonsetting pastes:

areas where streaks remain - no contact with tissues

areas with paste but no streaks - acceptable contact

areas without paste - excessive pressure or impingement

For polymerizing pastes: areas of excess pressure - uncovered, or

more lightly covered

Different thickness, different viscosity can be used

Caution

Undercut areas

expect slightly more pressure on primary bearing areas

Commonly adjusted areas

Maxillary areas : ▪ Vestibular sulcus – 41%▪ Maxillary tuberosity – 21%▪ Hamular notch – 12%

Mandibular areas : ▪ Retromylohyoid area – 17%▪ Lingual sulcus – 14%▪ Vestibular sulcus – 13%

Frequency and location of traumatic ulcerations following placement of complete dentures.Int J Prosthodont. 2007 Jul-Aug;20(4):397-401.

Can be used for adjacent areas on

the oral surface of the prosthesis.

Coronoid process against the distobuccal surface of the denture

Bulky buccal contours Teeth placed too far buccally

Loney R. Diagnosing denture pain: principles and practice. J Can Dent Assoc2006;72:137-41

Diagnose speech problems To diagnose tongue contact areas on the

denture palate Instruct the patient to repeat problematic

sounds with the media covering the palate.

Farley DW, Jones JD, Cronin RJ. Palatogram assessment of maxillary complete dentures. J Prosthodont 1998;7:84-90

Adjust the denture with an acrylic bur of appropriate size and shape

Reapply media to ensure that the adjustment has been effective

Removing the media

For cream-type media - use an air syringe to blow off and wipe away.

For elastomeric media Mark the exposed areas The polymerized elastomer catch the

bur and tear or pull away from the denture.

Frequency

After 1 week: 87%

After 2 weeks: 50%

After 3 weeks: 7%

Frequency and location of traumatic ulcerations following placement of complete dentures.Int J Prosthodont. 2007 Jul-Aug;20(4):397-401.

Cheapest is the home-made type media equal quantities of hand lanolin and zinc

oxide powder 

3% of the costliest media

Most effective

A comparison of the cost effectiveness of pressure-indicating materials and their ability to detect pressure areas in complete dentures SADJ. 2001 May;56(5):228-32.

Suggestions:

If interpretation is difficult Avoid adjustments until signs and

symptoms appear

Opinion from the patient

SUMMARY

Denture placement - not be the final patient-clinician encounter

Denture adjustments are very important clinical phases of denture fabrication and essential in patient care.

References:

Firtell DN, Arnett WS, Holmes JB. Pressure indicators for removable prosthodontics. J Prosthet Dent 1985;54:226-9.

Greenwood AH, Firtell DN. Pressure indicators-a useful diagnostic aid. Quintessence Int 1985;16:531-3.

Zarb GA, Bolender CL, 12th ed. St. Louis: Mosby; 2003. p. 402-26.

A comparison of the cost effectiveness of pressure-indicating materials and their ability to detect pressure areas in complete dentures SADJ. 2001 May;56(5):228-32

Farley DW, Jones JD, Cronin RJ. Palatogram assessment of maxillary complete dentures. J Prosthodont 1998;7:84-90

Frequency and location of traumatic ulcerations following placement of complete dentures. Int J Prosthodont. 2007 Jul-Aug;20(4):397-401.

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