Dr.

Samahis Lecture Post-Insertion Denture Problems Schedule of Post-Insertion Visits:

For many patients, three adjustments are sufficient to make them comfortable with their new denture.
1.

First appointment should be scheduled 24 hours of denture wearing. If during the first appointment no adjustments or only minor correction are required, the patient should be given another appointment for a week later. If pronounced tissue irritation is seen at the first adjustment period, adjustments should be made & the patient given an appointment for the following day or two. The patient should be scheduled for a recall examination approximately 12 months later if there are no further problems.

2.

3.

Classification of Post-Insertion Denture problems:

I)

Complaints abut comfort of the denture:

1. 2. 3. 4. 5. 6. 7. 8. 9. Sore spots Burning sensation Redness Pain in TMJ Tongue & cheek biting Swallowing & sore throat Nausea & gagging Deafness Fatigue of the muscles of mastication.

II)

Complaints about function of the denture:

1. Instability or poor fit 2. Interference a) When swallowing b) Clicking

III)

Complaints about esthetics:

1. 2. 3. 4. 5. Fullness under the nose Depressed philtrum or naso-labial sulcus Upper lip sunken in Too much of teeth exposed Artificial look

IV)

Complaints about phonetics:

1. 2. 3. 4. 5. Whistle on S sounds Lisp on S sounds Indistinct TH & T sounds T sound like TH F & V sounds indistinct

Table I: Complaints about comfort of the denture, causes & treatment

1. Sore spots Complaint A. Sore spots in the vestibule. B. Sore spots posterior limit of the maxillary denture. C. Single sore spots over ridge. D. Soreness under labial flange. E. Soreness under lingual flange of mandibular denture. F. Generalized soreness over the alveolar ridge. Potential causes a. b. a. b. c. Overextension Unpolished or sharp edge Posterior valve seal too deep Sharp valve seal Overextension a. b. a. b. c. a. b. a. b. c. a. b. a.

a. High occlusion in that area b. Bubbles of acrylic a. b. c. a. Excessive overbite Habit-mastication in protrusive relation Overextended labial flange CO not on harmony with CR (drives mandibular denture forward) b. Overextended lingual flange a. Excessive vertical dimension b. Inaccurate denture base

b. A. Anterior hard palate & anterior alveolar ridge areas. B. Rugae, lip & side of the tongue. C. Premolar to molar area Pressure over the anterior palatine foramen Climacteric , anxiety& ariboflavinosis Pressure on the posterior palatine foramen

Treatment Adjust denture (disclosing wax). Polish denture borders. Identify area with disclosing wax (PIP) & relief high pressure area. Round off sharp areas. Adjust peripheral extension. Check with articulating paper& adjust the occlusion. Inspect the denture under good light to detect surface roughness then remove & polish lightly. Reseat maxillary anterior teeth. Train the patient to masticate in centric relation. Adjust peripheral extension. If only slight, if can be corrected, record, remounting & selective grinding. Apply pressure indicating paste to denture periphery, adjust peripheral extension. If the occlusal plane of the upper is judged to be correct, make a new lower denture to the decreased vertical dimension, otherwise, new upper & lower dentures. New dentures, but the old ones can be rebased if the occlusion is adequate. Relief over the foramen.

Large dose of vitamin B-complex, taking the denture out, and holding a piece of ice in the mouth will provide a temporary relief. Relief area over the foramen.

2. Burning sensation

D. Lower anterior ridge

Pressure on the mental foramen

Relief over the foramen.

3. Redness

A. Fiery redness of all tissues contacted by denture, including tongue & cheeks. B. Redness of the denture bearing tissues.

a. b. c. d.

Denture base allergy (uncommon) Ill-fitting denture Avitaminois Insufficient vertical dimension of occlusion. CO not in harmony with CR. Arthritis. Trauma.

a. b. c. d.

Remake the denture & use metallic denture base. Remake or rebase the denture. Employ vitamin therapy regime. Increase vertical dimension. Correct occlusion by selective grinding. Treat with analgesics. Treat with analgesics.

5. Tongue & cheek biting

4. Pain in TMJ

a. Posterior teeth edge to edge (insufficient horizontal overlap). b. Over-closure c. Changes in the occlusal plane leading to cheek & tongue biting. d. Posterior teeth too far buccal leading to cheek biting. e. Posterior teeth too far lingual (reduction of tongue space) leading to tongue biting. f. Loss of muscle tonus (Lax cheek) leads to cheek biting. g. Tongue biting may occur in patient with epilepsy.

a. Re-contour buccal surface of mandibular molars & premolars to increase the horizontal overlap (buccal overjet). b. Restore the vertical dimension. c. New denture with proper occlusal height. d. Re-contour buccal surface of the upper molars, in some case it may be necessary to remove the last molar tooth. e. Re-establish adequate tongue space. f. Build out thin denture base or extent the underextended borders. g. Treat the cause.

6. Swallowing & sore throat

A. Maxillary denture B. mandibular denture

i) ii)

Over extension of posterior border. Too thick posterior border.

iOverextension of the posterior lingual flange area. iiToo thick lingual posterior flanges. C. Insufficient vertical dimension of occlusion D. Excessive vertical dimension of occlusion E. Posterior teeth set inside the ridge (tongue is crowded).

a. i) Adjust posterior border extension. ii) Thin posterior border. b. Reduce thickness or adjust posterior lingual flange area. c. Increase vertical dimension. d. Reduce vertical dimension. e. Re-set teeth in correct position.

7. Nausea & gagging

A. Immediately upon denture placement.

D. Delayed (2 weeks to months) after denture placement.

a- Maxillary denture: i) Overextension ii) Too thick posterior border b- Mandibular denture: i) Distolingual ii) Flange too thick c- Psychogenic factors a- Incomplete border seal allowing saliva under the denture. b- Faulty occlusion causing denture to loosen & allowing saliva under the denture.

a. Adjust denture or thin posterior border. b. Reduce thickness of disto-lingual flange. c. Prescribe a mild tranquilizer.

a. Improve border seal. b. Correct occlusion.

8.Deafness

Over closure of vertical dimension.

Increase vertical dimension.

mastication9.Fatigue of the muscles of

a- Excessive vertical dimension of occlusion. a. Reduce vertical dimension. b- Insufficient vertical dimension of occlusion. b. Increase vertical dimension.
Vertical dimension.

Table II: Complaints about function of the denture, causes & treatment :
Complaint a- When not occluding Potential causes a. Overextension of denture borders & posterior limit. b. Under extended denture borders. c. Loss of posterior valve seal: i) Valve seal on hard palate. ii) Posterior limit not in the hamular notches. iii) Insufficient valve seal. d. Dehydration of tissue due to alcoholism. e. Flabby tissue displaced when making impression. f. Under-filled buccal vestibule. Treatment a. Adjust denture border extension. b. Correct with auto-polymerizing acrylic resin but check with compound for diagnostic purposes. c. Improve posterior palatal seal. d. Remove the cause. e. Correct surgically-change. f. Correct the flange thickness.

A- Looseness of maxillary denture:

1- Instability or poor fit

b- When occluding in centric

c- Dislodgement of maxillary denture during function

a. Malocclusion: i) High occlusion in premolar area. ii) Premature individual tooth contact. iii) High occlusion in one side of the arch. b. Poor denture foundation (flabby tissues) c. Incorrect tooth position (teeth set too far buccally). d. Centric occlusion not in harmony with centric relation. e. Non-yielding area in hard palate (torus palatinus). a. Overfilled buccal vestibule. b. Over extension in the hamular notch area. c. Inadequate notches for frenum attachment. d. Excessively thick denture base over the disto-buccal alveolar tubercle. e. Placing the maxillary anterior teeth too far labial. f. Placing the maxillary posterior teeth too far buccal. g. Placing the posterior palatal seal too deep. h. Lack of occlusal harmony. a. b. c. d. a. b. Loss of posterior valve seal. Anterior teeth placed too far labially. Poor denture foundation. Improper incising habits. Denture base too thick in buccal posterior area. Denture over-extended in hamular notch area.

a. b. c. d. e.

Selectively adjust the occlusion. Correct surgically-change denture. Reset teeth in correct position. Selectively adjust the occlusion. Provide sufficient relief.

a. b. c. d. e. f. g. h. a. b. c. d. a. b. a. b.

d- When incising food

e- When yawing or opening wide f- When talking

a. Inadequate posterior palatal seal. b. Overextension in the posterior region.

Allow proper flange thickness. Correct border extension. Allow sufficient clearance for frenum attachments. Reduce the thickness of the distal ends of the buccal flanges. Reset the teeth. Reset the teeth. Identify pressure area with disclosing wax, provide sufficient relief. Correct occlusal disharmony by selective grinding. Improve posterior palatal seal. Reset teeth in correct position. Correct surgically0change denture. Train patient to masticate in centric. Reduce thickness of denture base. Shorten denture until pterygo-mandibular ligament doesnt exert tension on posterior border when mouth opened wide. Increase posterior palatal seal with auto-polymerizing acrylic resin. Adjust the posterior overextension.

B- Looseness of mandibular denture:

a- Peripheral overextension.

a- In the masseter groove area. b- In a lateral direction beyond the external oblique ridge. c- In the lingual flanges. d- In the retromolar pad.

Adjust the denture accordingly.

b- Tight lips.

a. Remake with the lower anterior teeth set more lingually, with a labial concavity on the denture & with maximum extension in the region of the retromolar pad. b. Vestibuoplasty may be considered.

c- Lower posterior tilted teeth or set lingually leading to cramping the tongue. d- Under-extension & lack of peripheral seal. e- Placing the occlusal plane too high. f- Improper contour of the polished surface. g- Lack of saliva.

Reduce the width of the lower posterior teeth by grinding off the lingual cusp. Correct the under-extension. Remake the denture with proper occlusal plane height. Re-contour the polished surface. Palliative treatment such as artificial saliva.

A- When swallowing

a- Maxillary denture too thick or overextended in posterior region. b- Mandibular denture too thick or overextended in posterior lingual region. c- Insufficient vertical dimension of occlusion. d- Excessive vertical dimension of occlusion. e- Incorrect tooth position.

a- Reduce thickness or adjust posterior region. b- Reduce thickness or adjust posterior lingual flange area. c- Increase vertical dimension. d- Reduce vertical dimension. e- Reset teeth.

Interference2-

B- Clicking

abcd-

Excessive vertical dimension. Denture with poor retention & stability. Cuspal interference. Excessive incisal guidance.

a. b. c. d.

Reduce vertical dimension- use acrylic resin teeth. Rebasing or remaking the dentures. Eliminate cuspal interference. Correct occlusion.

Table III: Complaint about esthetics, causes & treatment

Complaint A-Fullness under the nose B- Depressed philtrum or naso-labial sulcus C-Upper lip sunken in D-Too much of teeth exposed E- Artificial look

Potential causes Labial flange of the upper too long or too thick. Labial flange too short or too thin. Maxillary anterior teeth set too far lingually. a- Excessive vertical dimension. b- Incisal plane too low. c- Cuspids & lateral too prominent. a- Technique set-up (teeth are too regular in alignment. b- All teeth same shade. c- Lack of grinding incisal edges & angles.

Treatment Reduce length or thickness of labial flange. Increase length or thickness of labial flange. Reset anterior teeth labially. a. Reduce vertical dimension. b. Reset teeth at higher plane. c. Correct tooth prominence. a. Set up individualized (by rotating & shortening few teeth). b. Choose different shades. c. Grind incisal edges & angles to give a more individualized appearance.

Table IV: Complaints about function of Phonetics, causes & treatment

Complaint A. Whistle on S sounds B. Lisp on S sounds C. Indistinct TH & T sounds D. T sounds like TH E. F & V sounds indistinct

Potential causes Treatment Too large air space on the anterior part of Reshape the anterior part of the palate by the palate. thickening denture base. Too small anterior air space. Thin palato-lingual area. Inadequate inter-occlusal space. Reduce thickness of palatal of maxillary denture & lingual of mandibular denture base, reduce vertical dimension. Upper anterior teeth too far lingually. Reset teeth buccally. Improper position of the upper anterior Reset teeth either vertically or horizontally so teeth either vertically or horizontally. that they contact the lower lip at its highest point during these sounds.

..Regards,

Strawberry..