P o S T-P L A C e M e N T P R o B L e M S

COMPLETE DENTURE THEORY AND PRACTICE
PROBLEM
P O S T-P L A C E M E N T
PROBLEM
S O L V I N G 13
SOLVING
PROBLEMS RELATED TO SOFT TISSUE

Complaints/area
Peripheral areas
Crest of ridge
Causes
Sore spots - mandible
Overextension
Unpolished or sharp edge
Herpetic or apthous ulcer
Bone spicules
Spinous ridge crest

Pressure spots at time of
impression
Occlusal prematurities
Side of ridge-anterior area
Overextension
Maximum intercuspation not in
harmony with centric relation
Side of ridge-bicuspid area
Side of ridge-posterior area
Under lingual flange
Dr.mostafa.fayad@gmail.com
Lingual tori ( nonyielding areas)

Pressure spots at time of
impression
Shrinkage of denture during
processing ( dimensional
changes)
Error in occlusion - occlusal
prematurities
Pressure on mental foramen if
ridge is greatly resorbed
Overextension in lateral throat
area
Error in occlusion
Spinous projection of mylohyoid
ridge distolaterally ( feeling of
sore throat)
Overextension in anterior area
(causes rotation of distal flanges)
harmony with centric relation
(drives mandibular denture
forward)
Treatments
Adjust denture accordingly

Polish denture borders
Leave denture out as much as
possible and wait 7-10 days
Identify the area in denture with
pressure indicating paste and
provide relief over spicule and/or
surgically remove spicule
Provide relief in the denture
Use PIP or indelible pencil to
determine the areas and adjust
accordingly
Correct occlusal defects, recheck
vertical dimension and clinical
remount
Use pressure indicating paste and
adjust denture border involved
Enlarge centric area; grind mesial
inclined planes of maxillary teeth
and distal inclined planes of
mandibular teeth using a clinical
remount
Provide adequate relief in denture
base
Rebase denture
Check occlusion on the opposite

side of arch from the sore spot
Provide adequate relief
Shorten posterior of lingual flange
Check teeth diagonally across the
arch from the sore area
Correct undercut surgically; you
must under extend the denture.
Relieve denture if not severe
Adjust peripheral overextension
Enlarge centric area and adjust
local area-

Under labial flange
Generalized soreness and

redness
Excessive overbite
Habit- mastication in protrusive
relation
Heavy biting force- strong
musculature
Excessive vertical dimension of

occlusion
Locked occlusion
Failure to provide freedom for
Bennett movement (soreness
usually on working side
Improperly processed base material
PROBLEM
S O L V I N G 13
Adjust anterior occlusion

Train patient to masticate in
centric
Reduce buccolingual width of
teeth; reduce vertical
dimension; use soft lining if
necessary
Reduce vertical dimension
Enlarge centric area
Reduce cusps to a
nonanatomical plane or reset
teeth
Rebase denture
Sore spots - maxilla

Peripheral areas
Overextension
Unpolished or sharp edge
Herpetic or apthous ulcer
Maxillary frenum
Overextension
Posterior border of denture
Sharp edge at the post dam area
Midline of denture
Prominent midsuture or torus

maxillaries

Polish denture borders
Leave denture out as much as
possible for 7-10 days
Open a V-shaped notch for the
labial frenum and widen the
buccal frenum areas
Adjust sharp edge slightly
without reducing dam area
Provide some relief over the
area
Generalized discomfort
Improper occlusion
Maximum intercuspation not in harmony with centric relation
Excessive vertical dimension of occlusion
Correct occlusion (clinical

reline)
Enlarge centric area (clinical
reline)
(clinical reline)
Burning sensation
Maxillary anterior hard palate
and anterior alveolar ridge area
Maxillary bicuspid area or molar
tuberosity
Mandibular anterior region
Generalized
Pressure on anterior palatine

foramen
Pressure on posterior palatine
foramen
Pressure on mental foramen
Improperly processed
Tongue
Allergic reaction xerostoma
Relieve area over foramen

Reline denture; replace as
much as possible base material
with new acrylic resin
PROBLEM
S O L V I N G 13
Redness
Fiery redness - All tissue
contacted by denture including
tongue and cheeks
Bearing tissues
Denture base allergy (very unusual)
Remake denture and use all

metal base (after allergy test)
Ill-fitting denture, Avitaminosis
Remake or rebase dentures.

Employ vitamin therapy
regimen
Tongue and cheek biting

Thin or under extended periphery (base material does not provide
enough support for the cheek)
Insufficient interarch clearance between distal parts of denture bases
Inadequate amount of horizontal overlap in molar region
Build out thin areas, or extend

the short periphery
Thin maxillary denture over
tuberosity; if more space is
required, remove it from the
retromolar area of the
mandibular denture
Re-contour buccal surface of
mandibular molars and
bicuspids; eliminate the tight
contact of the maxillary buccal
cusps on the mandibular buccal
surfaces
Pain in TMJ
Insufficient vertical dimension of occlusion
Maximum intercuspation not in harmony with centric relation
Arthritis
Trauma
Increase vertical dimension of

occlusion
Make new occlusal record,
regrind and remount occlusion
Treat with analgesics
Treat with analgesics
Gagging
Immediately upon insertion
Delay (2 weeks - 2 months after

insertion)
Maxillary denture overextended or

too thick in posterior border
Lack of retention
Mandibular denture too thick in
distolingual flange
Incomplete border seal allowing
saliva under denture
Improper occlusion causing denture
to loosen and allowing saliva under
denture
Adjust denture or thin posterior

border
Reline denture
Reduce thickness or
distolingual flange
Increase border seal with selfcuring acrylic resin ( possibly at
the posterior palatal border
Correct occlusion (clinical
remount)
PROBLEM
S O L V I N G 13
Deafness

occlusion
Fatigue of the muscles of mastication

Insufficient vertical dimension of occlusion
Reduce vertical dimension of

occlusion
Increase vertical dimension of
occlusion
PROBLEM
S O L V I N G 13
PROBLEMS RELATED TO FUNCTION
Complaints/area
Causes
Treatments
Instability
Looseness of mandibular denture Error in occlusion (maximum

intercuspation not in harmony with
centric relation)
Correct faulty occlusion by

remount and regrind procedure
Occlusion plane too high
Reset teeth at a lower plane
Underextension of periphery
(inadequate impression)
Rebase denture providing proper

extension
Use denture adhesives to help

Inability of patient to master denture develop skill in handling denture
( for a short time only)
Tongue position (retracted tongue)
Looseness Occasionally
of maxillary
denture
Underextension in some area
Correct with self-curing acrylic

resin; first check with compound
for diagnostic purpose
Faulty occlusion
Correct Occlusion
Overextension of peripheries
Dehydration of tissue due to

alcoholism
Remove cause
Correct surgically; modify

Displacement of flabby tissues when impression technique to change
making impression
primary denture stress-bearing
area to the buccal shelf
When eating on
either side
Approximately every
2 hours
Nonyeilding area in hard palate

Provide relief chamber over non(ridge tissue yields under chewing
yielding area
stresses; denture rocks on hard area
Incorrect tooth position (teeth may
beset too far buccally off ridge
Rebalance in lateral excursions;

reset teeth where nature should
have had them
Chewing resistant foods
Instruct patient to maintain soft

diet until mouth is conditioned to
wearing denture
Heavy mucinous saliva
Prescribe astringent
mouthwashes and regular
scrubbing of dentures; reduction
of carbohydrate
Incorrect tooth position ( teeth may

be set too far buccally and labially
Correct surgically; change

primary denture stress -bearing
Improper incising habits
Train patient to masticate in

centric relation
When yawning or
opening wide
When talking
When occluding in
centric relation
PROBLEM
S O L V I N G 13
Loss of posterior palatal seal (seal

on hard palate; posterior limit not in
hamular notches; insufficient valve
seal)
Increase postpalatal seal with

self-curing acrylic resin; first use
compound as a diagnostic aid
Denture base too thick in buccal

posterior area (coronoid process
exerts forward and downward force
on posterior of denture upon
opening)
Reduce thickness of denture

base
Overextended in hamular notch
Shorten denture until

pterygomaxillary ligament does
not exert tension on posterior
border when mouth is opened
wide
Inadequate posterior palatal seal

self-curing acrylic resin
Inadequate posterior palatal seal

self-curing acrylic resin
Overextended in posterior region
Shorten posterior until soft palate

does not lift upward and break
contact with the denture base
Improper occlusion
Correct occlusion
Poor denture foundation (flabby

tissues over ridge)
Correct surgically; change

primary denture stress-bearing
Incorrect tooth position (teeth set too

Reset teeth
far buccally)
Only a feeling of
looseness (support
and retention are
present yet denture
feels suspended in
mouth

harmony with centric region
Enlarge centric area
Nonyielding area in hard plate
Provide relief in area
Large area of nonyeilding tissue in

hard plate
Provide relief chamber, adequate

to permit denture to be properly
seated
PROBLEM
S O L V I N G 13
Interference
When swallowing
Clicking
Maxillary denture too thick or overextended in posterior region
Reduce thickness or adjust

posterior
Mandibular denture too thick or

overextended in posterior lingual
flange area
Reduce thickness or adjust

posterior lingual flange area
Insufficient vertical dimension of

occlusion

occlusion
Incorrect tooth position (posterior

teeth set too far lingually - tongue
crowded
Reset teeth

occlusion
Ill-fitting dentures
New dentures
Overextended lower dentures
Reduce peripheral length
PROBLEM
S O L V I N G 13
PROBLEMS RELATED TO ESTHETICS

Complaints
Causes
Treatments
Fullness under nose
Labial flange of denture too long or too thick
Reduce length or
thickness of labial
flange
Depressed philtrum
Labial flange of mandibular denture too short
Increase length or
thickness of labial
flange
Upper lip sunken in
Maxillary anterior teeth set too far lingually
Reset anterior teeth

labially
Too much of the teeth are

exposed
Reduce the vertical

dimension of occlusion
Incisal plane too low
Reset teeth at higher

plane
Cupids and lateral incisors too prominent
Adjust accordingly
Technique setup (teeth are too regular in

alignment)
Individualize by rotating
and shortening some
teeth
All teeth in same shape
Choose different but

complimentary shades;
use staining techniques
Lack of individualization of teeth
Grind incisal edges and

angles
Lack of individualization of denture base
Individualize gingival
contour and color of
denture base
Artificial appearance
PROBLEM
S O L V I N G 13
PROBLEMS RELATED TO PHONETICS

Complaints
Causes
Whistle on "S" sounds
Increase the palatal

resin convex
contours lingual to
the maxillary central
Air stream passes unimpeded or with inadequate
incisors to impede
impedance between the dorsal surface of the
the air stream
tongue and the anterior palate
passing between the
tongue and palate.
Create rugae if
necessary
Lisp on "S" sounds
Maxillary & Mandibular incisors

or premolars contact during
sibilant (s, sh, z, ch) sounds
The air stream passing between the tongue and

anterior palate is excessively impeded, usually
by rugae or excessive resin contour
Reduce occlusal
vertical dimension
until premolars no
longer contact during
speech
Occlusal vertical dimension too great
Reduce occlusal
vertical dimension
until premolars no
longer contact during
speech
Maxillary teeth may be set too far labially
Evaluate lip support

and overall
appearance of
anterior teeth as they
are positioned.
Reset to a more
lingual postiion as
needed. incisal edge
of maxillary incisiors
should contact the
wet dry junction ro
just lingual to it during
production of the "F"
& "V" sounds.
Clinician observes that incisal

edges of maxillary incisors
contact the lower lip 1 mm or
more labial to the wet/dry junction
of lower lip when "F" & "V"
sounds are made
Treatments
PROBLEM
S O L V I N G 13
Denture Complaint
Complaints
Diagnosis
Patient
Dissatisfaction
Denture
limitations
Philosophical
Causes
Treatment
Denture
settling
Denture error
Types of
patients
Hysterical
Indifferent
Exacting
Problems
Retention
Support
Muscle Balance
Occlusal
Balance
10
PROBLEM
S O L V I N G 13
Complaints
1- Over extension Movement interfere with muscle movement ( Stability)
2- Under extension Break the Seal ( Retention)
3- Trimming Thick or thin border (ttt) Boxing.
11
PROBLEM
S O L V I N G 13
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
12
PROBLEM
S O L V I N G 13
1) Generalized Tissue irritation
13
PROBLEM
S O L V I N G 13
2) Localized Tissue Irritation

Crest
Border
__
Vestibule
Over
extension
(displacing
wax)
Ant. lingual
& Lat. buccal
slop
Median
Palatine
Raphe
__
__
- Pressure
- relief
(Denture
rocking)
Retro
Mylohyoid
Tuberosity
- Over
extension
labially lift
the denture
posteriorly.
- Over
extension
- pressure
- Bilateral
undercut
(Relief)
- Un polished
(Visual&
digital)
*D.D.
Aphsus ulcer
Basal Seat
-Ridge
(x ray &
visual *Ex)
-Spicules&
remaining
roots
(Visual Ex)
__
- support
of 1ry
stress
bearing
area
(Relining
or
Rebasing)
- Denture
pressure
*(P.I.P.)
Occlusion
- Deflective
occlusal
contact
- Tooth off
ridge
- Deflective
occlusal
contact
7 7
- *C.O. *C.R.
Loose denture
anteriorly
- Anterior
contact in
C.R. *ttt
(Reset)
- Pressure
area
- Dimensional
changes
(Relief
Rebase)
- Occlusal
interference
on opposite
sideDenture
move in
opposite
direction.
__
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.
14
Cause: Lack of retention& Support.

Lower denture more than Upper. Why?
Saliva
Tongue
Too bulky
Rocking denture
Chief complaint (C.C.):

Loose denture
S O L V I N G 13
[ II ] Poor Denture Fit
Support
PROBLEM
Related symptoms:
Normal
- Open wide (Yawing) Coronoid process.

- Cough& sneezing the pressure.
- New denture Saliva.
Abnormal
- Speaking.
- Eating.
- Pain.
15
PROBLEM
S O L V I N G 13
[ 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.
16
PROBLEM
S O L V I N G 13
[ 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
Over-extension
Under-extension
Loose denture
Thickness
17
PROBLEM
S O L V I N G 13
[ VII ] Inefficient eating

Borders Improper.
Basal seat Unstable denture.
Occlusion
Teeth
Blunt
Vertical dimensions
Flat cusps
V.D.O.
Elevate the muscle& don't work.
V.D.O.
Patient can't open to get food.
[ VIII ] Cheek, Lip& Tongue Biting

a) 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.
18
PROBLEM
S O L V I N G 13
[ IX ] Alter taste
[ X ] Clattering teeth
Unfamiliarity with
New denture.
Vertical dimension
Cuspal interference Unstable denture
- Teeth contact sooner.
19
PROBLEM
S O L V I N G 13
Problems of Old Denture
20

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COMPLETE DENTURE THEORY AND PRACTICE

PROBLEMS RELATED TO SOFT TISSUE

Spinous ridge crest

Side of ridge-anterior area

Side of ridge-bicuspid area

Side of ridge-posterior area

Under lingual flange

Lingual tori ( nonyielding areas)

Adjust denture accordingly

Check occlusion on the opposite

COMPLETE DENTURE THEORY AND PRACTICE

Generalized soreness and

Excessive vertical dimension of

Adjust anterior occlusion

Sore spots - maxilla

Posterior border of denture

Sharp edge at the post dam area

Prominent midsuture or torus

Adjust denture accordingly

Correct occlusion (clinical

Pressure on anterior palatine

Allergic reaction xerostoma

Relieve area over foramen

COMPLETE DENTURE THEORY AND PRACTICE

Denture base allergy (very unusual)

Remake denture and use all

Ill-fitting denture, Avitaminosis

Remake or rebase dentures.

Tongue and cheek biting

Inadequate amount of horizontal overlap in molar region

Build out thin areas, or extend

Increase vertical dimension of

Delay (2 weeks - 2 months after

Maxillary denture overextended or

Adjust denture or thin posterior

COMPLETE DENTURE THEORY AND PRACTICE

Excessive vertical dimension of

Fatigue of the muscles of mastication

Reduce vertical dimension of

COMPLETE DENTURE THEORY AND PRACTICE

PROBLEMS RELATED TO FUNCTION

Looseness of mandibular denture Error in occlusion (maximum

Correct faulty occlusion by

Occlusion plane too high

Reset teeth at a lower plane

Rebase denture providing proper

Use denture adhesives to help

Underextension in some area

Correct with self-curing acrylic

Adjust denture accordingly

Dehydration of tissue due to

Correct surgically; modify

Nonyeilding area in hard palate

Rebalance in lateral excursions;

Chewing resistant foods

Instruct patient to maintain soft

Heavy mucinous saliva

Incorrect tooth position ( teeth may

Correct surgically; change

Improper incising habits

Train patient to masticate in

COMPLETE DENTURE THEORY AND PRACTICE

Loss of posterior palatal seal (seal