Post Insertion Problems In Complete Dentures

Dr .Rohan Bhoil Hyperlinks present in this like .

Contents

• Introduction• Review of Literature• Causes• Complaints• Conclusion • References

Introduction

• Recall appointments post insertion• Eliminate problems faced in wearing of

dentures• Listen, examine & treat

Examination • 24 hour oral examination & treatment• Visual and digital examination of oral cavity• 1-3 day adjustment • Critical period • Periodic recall– 3 to 4 months for difficult patients– 12 month interval for most

Review of Denture Requirements

Compatibility

Restoration

Harmony

Esthetics

Preservation

Review of Literature

• Basker RM, Beck CB, et al 1993 did a survey of the dissatisfied denture patient. In the majority of cases technical errors in denture construction accounted for the presenting complaint.

• Champion H et al in 1995 investigated into the problems experienced by 114 referred patients with complete. The commonest problems were those of pain and lack of retention, mainly due to occlusal discrepancies and excessive VDO.

• Muller F et al, 1995 did a study on adaptation to complete dentures. They concluded that good denture retention facilitates the adaptation process.

• Yoshida M, Sato Y, Akagawa Y. 2001 did a study on the correlation between the quality of life, and denture satisfaction in elderly complete denture wearers and concluded that people who are well satisfied with their daily lives are also satisfied with their complete dentures.

• Dervis E. et al 2002 did a study to investigate relationships between patient complaints with complete dentures and several factors such as age, gender, medical status and denture faults.

• No significant relationship was found when age, gender, and medical status were compared but, statistically significant relationships were observed between denture construction faults or the condition of the patient's denture bearing mucosa and patient complaints.

• Roessler DM et al. 2003 Before treatment even begins, the patient's motivation for denture treatment and emotional attitude towards dentures must be evaluated.

–Patients will thereby gain realistic expectations of what can and cannot be achieved, and dentists will understand what the patient really wants.

– Finally, patients must be informed that continued success depends on regular denture maintenance at home, combined with periodic consultation with the dentist .

Causes For Post Insertion Problems

• Inaccuracies in various denture construction steps

Border Moulding in Open Mouth Technique

• Vertical dimension and Support to muscles• Reduced force• Overextended flanges

Jaw Relation Recording• Inaccurate record bases• Flabby & displaceable tissue• Use of existing dentures• Excessive or unequal pressure• Patient inability to give proper registration

Mounting Errors

• Record bases not properly seated• Interferences in Heel region• Occlusal rims not properly keyed in correct

orientation position.

Laboratory Processing

• Teeth displacement• Incomplete flask closure• Overheating

Loose Denture

s

Discomfort

Poor Appearance Miscellaneous

Complaints

Loose Dentures

Symptoms

Speech

Denture falling

Food entrapment

Pain

Causes

Decreased retentive

forces

Increased displacing

forces

Support problems

Decreased retentive forces

Lack Of

Seal

•Under Extended orders – Depth or Width.

•Incorrect Posterior Palatal Seal.

•Inelasticity of Cheeks.

Air benea

th Impression

Surface

•Poor Fit.

•Undercut Ridge

•Excessive Relief.

Xerosto

mia

•Diabetes, drugs, menopause, irradiation.

Poor Neuromuscu

lar Contr

ol

•Incorrect denture shape

•Changed shape relative to old dentures

•Motor – Neuron disorders.

Increased Displacing ForcesOverextended

Borders.

Poor Fit

Denture not in Optimal Position

Occlusal Problems.• Prematurities , MIP – CR,

Occlusal Balance, Incorrect plane of Occlusion

Support Problems

• Fibrous Displaceable Ridge• Lack of Ridge• Bony Prominence

Discomfort.

Impression Surface

Polished Surface

Occlusal Surface

Related to Impression Surface• Sharp Acrylic Nodules• Un-relieved undercut areas• Overextension• Lower knife-edged ridge.• Deep Postdam- sore throat, difficulty in

swallowing

Related to Polished Surface

• Thick distobuccal flange of upper denture

Related to Occlusal Surface• Pain on eating• Pain / Ulceration lingual to lower anterior

ridge• Pain / ulceration labial aspect of lower ridge

and incisive papilla• Excessive vertical dimension• Cheek / lip biting• Tongue biting.

Poor Appearance

• Insufficient or too much tooth visibility• Creases at corner of mouth.

Miscellaneous

Speech problems

– Sibliants : S– Bilabial: P & B– Labiodental: F & V.

Difficulty in Eating

• Instability• Too narrow occlusal table• Increased or decreased vertical dimension

Clattering of teeth while eating / speaking

• Porcelain teeth• Increased vertical dimension• Increased incisor overlap• Loose dentures• Cuspal interferences and lack of balance

Nausea & Gagging

• Loose dentures• Poor occlusion• Thick distal termination in upper dentures• Palatal placement of upper posteriors• Low occlusal plane• Overextended retromylohyoid area• Underextended denture borders• Psychogenic

Commissural Cheilitis

• Excessive interocclusal distance• Occlusal plane of lower teeth is too high• Elimination of Buccal Corridor• New Dentures

Burning Tongue & Palate

• Anterior third of palate• Association with menopause

Tingling or Numbing sensation

• Felt at corner of mouth / lower lip• Excessive pressure from mandibular buccal

flange• Impingement of mental nerve• Excessive resorption

Food under the denture

• Usually by first time denture wearers• A perfect peripheral seal is rarely attained• Failure to keep dentures clean• Failure to polish denture surfaces

Care Of The Denture• To avoid dropping of denture• To avoid self adjustments • Good oral and denture hygiene– Cleaned after each meal– Not to use boiling water– Denture should be kept in water or dilute

antiseptic solution

Conclusion• Patient education• Forewarning • Explanations

References• Arthur O Rahn, Charles M. Heartwell: Textbook of

complete Dentures, ed 5, London, 1993.

• George A. Zarb, Charles L.Bolender, Judson C. Hickey, Gunnar E. Carlsson: Boucher’s prosthodontic treatment for edentulous patients, ed 10, B.I Publications Pvt Ltd.

• John J. Sharry: Complete Denture Prosthodontics, McGrawhill Book Company, Inc. 1962.

• Sheldon Winkler: Essentials of complete Denture Prosthodontics, ed 2, Ishiyaku Euro America Inc.

Thank You ...

Under extended borders

Under extended borders

Under extended borders.

PPS

• Under extension – Loose denture• Overextension – loose while talking• Insufficient depth – loose while eating.

Causes of Poor Fit• Deficient impression• Damaged cast• Warped denture• Over adjustment of impression surface.

Treatment: Lack of Seal

• Under extended borders – soft tracing compound

• Incorrect posterior palatal seal – correct placement of border

• Inelasticity of Cheeks – incremental border moulding and functional movements.

Treatment: Air beneath Impression Surface

• Relining the denture• Remaking the dentures• A rotational path of insertion in case of

unilateral undercuts.

Treatment: Xerostomia

• Presence / Absence of glandular function• Artificial saliva substitutes• Sucking on sour candy• Intermittent sips of water• Pilocarpine hydrochloride.

Treatment: Poor Neuromuscular Control

• Polished surface should occupy the neutral zone

• Use of denture adhesives.

Treatment : Overextended borders.

Occlusal Problems• Anterior and posterior prematurities

• Maximal intercuspal position not coinciding with centric relation position–Patient unable to control mandibular

movement–Poor ridge–Use of non anatomic teeth

• Lack of occlusal balance• Incorrect plane of occlusion– Dentures move while eating– Commonly associated with large tuberosities• Removal of second molars may help

Treatment: Occlusal errors• Suspected when patient complains that

dentures become loose after a few hours of wearing

• Also when a collection of calculus is seen on one side of the denture

• Clinical Remounting– Better view of occlusion– Reduced patient participation– Stable foundation without shifting bases– Absence of saliva – accurate markings– Reduced clinical time & adjustment appointments.

• Mounting: maxillary cast– A remount jig fabricated after lab remount &

selective grinding– Or a new facebow record

Interocclusal records for verifying centric relation

• Mounting : Mandibular cast– Using interocclusal check

record.

• Perform selective grinding procedures.

Discomfort: Symptoms

• Pain• Altered sensation• Difficulty in chewing / swallowing.

.

Treatment • Pain on eating – premature contacts / lack of

occlusal balance– Use articulating paper to identify offending area

• Pain / ulceration lingual to lower anterior ridge– CR and MIP do not coincide– A slide from CR to MIP– Selective grinding to correct

• Pain / ulceration – labial aspect of lower ridge & incisive papilla– Undercut or sharp acrylic– Trim labial aspect of lower anteriors

• Excessive vertical dimension– If increased greater than 2mm, better to remake

dentures.

Biting of tongue • Usually due to– Teeth placed lingual to lower ridge– Decrease in tongue space in patients accustomed

to old dentures– Changes in occlusal level

Treatment

• Remove lower lingual cusps• Reset and rearrange the teeth

Cheek biting• Usually due to– Insufficient overjet, in posterior region.– Very lax cheeks– Reduced vertical dimension

• Treatment– Increase buccal overjet and plump the denture– Remove last molars– Grind buccal surfaces of lower posteriors.

Insufficient / Excessive tooth visibility

• Can be due to improper– Orientation of occlusal plane– Vertical dimension– Labiolingual & labiopalatal positioning of anterior

teeth.

• Difficult to correct appearance without remaking dentures

Creases at Corner of Mouth

• Can be due to – Decreased labial fullness– Decreased vertical dimension

• May require remaking of dentures• Important to verify and take patient consent

for aesthetics at time of try-in.

Speech Problems• Takes few days for getting accustomed• Dentures may need to be remade• Causes include– Incorrect vertical dimension– Incorrect overjet / overbite– Incorrect incisor position.