10- Post Insertion Problems and Complaints

1. 10- Post Insertion Problems
and Complaints

3. Dr. Amal Fathy Kaddah
Professor of Prosthodontic,
Faculty of Oral &Dental Medicine,
Cairo University

4. Diagnosis Causes Treatment
Managed by

5. Causes are attributed to
Patient's
dissatisfaction
Denture
settling Denture errors

6. Patient's dissatisfaction are attributed to
Denture
problems
Types of patient
Indifferent
Philosophical Hysterical
Exacting

7. Denture problems
Old denture
Loose fit
New denture
Over extension over closure
(Low VD)

8. The majority of the patients
with new denture may face
one or more of the following
problems:
Pain Poor
appearance
Poor
masticatory
efficiency
Poor
denture fit
Clattering or
noisy teeth
Nausea and
gagging
Discomfort
Altered
speech
Cheek, lip
and tongue
biting
Food under
the denture
and Halitosis
Loss of taste
sensation
Miscellaneous

9. 1. Overextension of the
periphery
2. Poor fit
3. Insufficient relief
4. Incorrect occlusion
and Cuspal interference
5. Teeth off the ridge
6. Retained roots,
unerupted tooth or sharp
bony spicules
7. Irregular and knife edge
ridge, V- shaped ridge.
8. Pressure on the Mental
foramen
9. Allergy
10. Rough fitting surface
11. Infection with Monilia
Albicans (Pathological conditions)
12. Difficulty in swallowing
and Sore throat
13. Severe Undercuts

10. Ridge VDDenture
borders
•Over-
extension
Basal Seat
Uneven
pressure
Occlusion
Cuspal
interference
Poor fit
Mental Foramen
Pressure area
Improper imp.
Warpage of denture base
Improper cast
CO#CR
Teeth off
ridge
Roughness
Allergy DD Patch test
Remaining
Root
undercut
•under-
extension
(disto-
lingual
area)

11.  Over extension interfere with muscle
Under extension break the seal,
 Improper trimming Thick or thin border
Borders
Mylohyoid ridge
movement

12. The most common cause of pain
May be due to :

13. Labial frenum
 Should be thin
and deep, not
broad
 Round internal
and external
angles

14. In the form of
UlcerationHyperaemia Cut in vestibule

15. Identification of over extended
denture flange by means of P.I.P.

16. Overextension of the periphery
New denture
Old denture
Occlusal view of the
edentulous
mandible
Epulis fissuratum

17. Never adjust without locating
exact position of the problem
Use P. I. paste

18.  Poor denture retention, rocking, tilting and
inability to seat the denture.
 Denture movement over the mucosa will
cause pain and areas of inflammation might
be present.
Treatment:
 ???????? According to the case
 Relining of old denture or Construct a new denture.

19. Looseness of dentures
or poor fit usually
results due to lack of
retention and/or stability
of the denture.

20. Poor retention of Lower denture
Less
surface area
Bathed in
saliva
Strong
movements of
the tongue

21. Related symptoms
Normal
- Open wide (Yawing)
Coronoid process.
 Cough& sneezing →
 New denture →
Saliva.
Abnormal
- Speaking
- Eating
- Pain

22. Poor Denture fit
1. Decreased retentive forces
A. Lack of peripheral seal
B. Under-extension border depth and width
C. Excessive relief
D. Xerostomea
E. Lack of posterior seal
2. Increased displacing forces
A. Over-extension border depth and width
B. Excessive fit
C. Occlusal errors
D. Upper lip pressure on upper denture
3. Inadequate supporting structure negotiate
A. Flat ridge
B. Fibrous displaceable tissues
C. Non resilient soft tissues

23. Areas to be relieved of the denture:
 Prominent bony areas (buccal canine
region, Bony tori (maxillary or mandibular).
 Sensitive areas
Treatment:
 Apply pressure indicating paste to
demarcate the area on the fitting surface
of the denture. Relief

25. Correct Amount
with Streaks
Insufficient
Amount
Too Much
w/o Streaks

27. Insufficient relief Burning sensation

29.  With resorption, it becomes over the crest
of ridge.
 Pressure from denture may elicit
numbness, localized or referred pain.
Treatment:
 Relief.

31. A denture border short of the mylohyoid
ridge digs into the residual ridge and
causes pain. If shortened, the denture
border will impinge again upon the ridge.

32. Poor base
adaptation
Fulcrum on bony
structures

34. Occlusion
VD CO # CR
Uneven
pressure
Cuspal
interference
Teeth off
ridge
Tuberosity
of opposite
side
In upper buccal
sulcus of
working side
White sore
area on the
site of
pressure
VD
(Neurological
pain)
VD (white
patch)

35. Adjusting Occlusion
 Reduces adjustment time
 Saves time removing & replacing dentures
Remount denture on an articulator
 Eliminates denture movement
 Can visualize interferences easily
 Centric relation & protrusive records
 Mark centric & excursive contacts, adjust

36. Don’t Adjust Occlusion
Intraorally
 Contact on inclines can cause
denture movement
 May cause pain, or reflex
avoidance
 May make interference difficult
to mark
Net Result
Can’t see real Problem
Can’t eliminate the Problem

37. Mounting the lower cast with new
CJRR
Make sure the denture bases are
not contacting posteriorly.
Clinical Remounting Procedure

38. High vertical
dimension
Low vertical
dimension
Solutions ???

39. • Gets worse during day
• Muscle/joint pain
• Small white patches + painful areas
Pain returns within few days of
immediate relief over patches
• Dentures ‘click’
• Esthetic complaints: too full
• Sore over entire ridge.
• Treatment: new lower denture if
upper occ. plane is correct or upper
and lower denture
Excessive OVD

40. • Indefinite pain location resembles
neuralgia of cheek
• Lack of chewing power
• Minimal ridge discomfort
• Costen’s syndrome mild deafness,
tenderness in TMJ, burning sensation of
the tongue, throat and nose, dryness of
the mouth.
Insufficient OVD

41. • Angular chelitis
• Esthetic complaints:
 Chin prominent
 Poor lip support
Treatment: new denture.
Insufficient OVD

42. CO#CR
Traumatic
occlusion

43.  Mismatch of ICP and RCP.
 The patient will not feel comfortable in that
situation.
 Trials to retrude the mandible will rub the
denture against the mucosa. This will cause
pain and looseness.
Treatment:
If Mild error: Selective grinding of teeth.
If Gross: New denture.

44. • Lesser degrees of
errors can be detected
by a celluloid strip or
articulating paper
• If more it is detected
with a wax knife

45.  Mild error: chair side occlusal
spot grinding.
 Moderate errors: clinical
remount.
 Severe errors either remake
denture or replace posterior
teeth.

47. A Dragging action will be exerted on both dentures
during lateral and protrusive movements with teeth in
contact if cusped posterior teeth are used or if excessive
incisal guidance angle has been used.
Dragging will cause pain
 With Well Fitting Retentive Dentures Or
 Instability with poorly retained dentures.
 Pain is widely distributed, and only experienced on
eating. Sore areas on buccal or lingual surfaces of ridges.
Treatment
Mild: chair side grinding or clinical remount.
Gross: new dentures with balanced occlusion.

48. Error in Eccentric Excursions
Irritation of the Crest of the Ridge
Localized Lesion Generalized Lesion Hyperkeratotic Ridge
Occlusal Prematurity Lesion –same side as error

49. Briefly
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

51.  Occlusal contact not
centered over ridge
 Tilting forces cause
displacement, abrasion,
ulceration
 Worse if xerostomia,
malnourished,
debilitated or poor
adaptability
Clinical Exam Cause: Setting of teeth far buccally.
Pain Upper buccal sulci and maxillary tuberosities.

52. Clinical Exam
 Patient
demonstrates
problem by biting
where pain occurs
Treatment:
New dentures. •Ulcer or sore spots on
sides of ridges

53.  Pain in upper buccal sulci and tuberosities.
 Upper teeth are often too far buccally (to meet
occlusion in cases of skeletal class III).
 During function, upper denture will tilt, digging the
periphery into the mucosa on the working side, and
pulling it down the tuberosity on the opposite side.
Treatment:
 Remove the last four posterior teeth and reduce the
bulk of acryl over the tuberosities and reset.
 New dentures

54. Avoid Contact on Inclines
• No teeth set
over ascending
portion of
ramus

56.  Pain results from direct
pressure on an area already
tender.
Treatment:
 Extraction of the root or tooth,
followed by relief over the
area. OR relining of the
denture.

57. Pressure during mastication causes pain .
Treatment: Alveoloplasty + relining (lower(
Relief over the crest (upper(.

58.  Often the lower ridge. The denture squeezes
the mucosa against the sharp bony ridge.
 Pain may be accompanied with burning
sensation. Worst after meals.
Treatment:
 Relief over the sharp irregular ridge.
 Alveolectomy followed by relining the denture

60.  This results in rough area on the crest of ridge
with sharp spicules of bone.
 Pain will be elicited when the intervening mucosa
is pressurized.
 Similar to pain due to narrow resorbed ridge, but
pain is localized.
Treatment:
 Surgical smoothing of the affected area followed
by relining the denture or; just relieve the
denture.

62.  Small pimples or blebs of
acrylic over the fitting
surface due to inaccuracies
of the surface of the cast.
Treatment:
 Remove roughness by
acrylic bur.

63. Treatment:
Treating the condition +
new denture
Rare.

64. Nicotinic Stomatitis
(Smoker's Palate) is a lesion of the
roof of the mouth. The concentrated
heat stream of smoke from. tobacco
products causes Nicotinic Stomatitis.

65.  The upper denture revealing of either
 Over-extension Over The Soft Palate
 Or pressing in the hamular notch area or
the postdam region.
 The lower will be
 Over-extended distally in the lingual pouch
(Pressure on the palatoglossal muscle).
 There will be an area of slight redness or
ulceration.

66. Treatment:
Reduction of the over extension.

67. Undercut
Tuberosities

68. Pain on insertion and removal.
Red and painful undercut area (ulcerated).
Treatment:
• Fitting Surface Cut Away With No Reduction
Of Periphery.
• Alveoloplasty + New Buccal Or Labial
Flange.
• Undercut on one side insert in one
side then rotate.

69. Unilateral
undercut

70.  Hamular Notches
 Commonly sharp
flange
 Sometimes long
 Use PIP

71. Bony Undercuts

72. Pain: Denture Base
Severe Tissue Undercuts
If the ridge is severely
undercut, the flange cannot
be placed to the depth of
the vestibule, otherwise
the denture will not seat or
ulceration will occur

73. A denture border short of the mylohyoid
ridge digs into the residual ridge and
causes pain. If shortened, the denture
border will impinge again upon the ridge.

74. Buccal
Attachments
To Hyoid
Mylohyoid
Ridge
X-section through
Mandibular ridge
in 2nd Molar region
Avoid Impinging on the Mylohyoid
Ridge
A problem if
prominent or sharp

75. Pain: Denture Base
Retromylohyoid Overextension
 Sore throat
 Denture moves when
swallow
 From retromolar pad,
flange should go straight
down or angle forward,
never backward

77.  Nose and chin approximating
 Cheeks and lips falling in
 Angular cheilitis or soreness of the corners of
the mouth
 Colour, shape, size and position of anterior
teeth.
 General dissatisfaction---- who?---female
middle age --- need kindness and patience.

78. 1- Nose –chin approximation
Due to closed bite.
Treatment:
As reduced bite.

79.  Nose and chin approximating
(Closed-bite)

80. As the occlusal vertical dimension is too small,
the vermilion border appears thin and wrinkles
occur around the lips.
The chin is apparently protruded.

81. 2. Cheeks and lips falling in:
Plumping: Unsupported lip and cheek.
Due to lack of tone of facial muscles.
Due to labial and buccal resorption in
max. ridge.
Teeth have been set too far lingually or
Having insufficient width of the buccal
and labial flanges.

82. Sunken lips and cheeks
Treatment: Building up of the upper
denture.

83. Corner of Mouth
3- Angular cheilitis or soreness of
the corners of the mouth

84. • Loss of muscular tone and
decreased VD .
• Saliva bathed in the fissure
secondary infection .
Treatment: Restoration of VD.
3- Angular cheilitis or soreness of
the corners of the mouth

85. 4. Colour:
5. Shape and Size:
Too large or too small
Teeth: too dark or too yellow
Acrylic resin.
Treatment: Replace teeth or new
denture.

87. 6. Arrangement and position:
Even or irregular
Too far forward or backward
Cheeks& lip falling- in
Treatment: Replace teeth or
new denture.

88. Irregular Occ. plan
Cheeks& lip falling- in

89. Colour, shape and position of anterior teeth.
Remember: there is upper labial resorption,
making the teeth too far lingually).

90. Shape, Shade and
Position of teeth

91. 7. Amount of tooth showing:
Treatment : New denture with corrected
occlusal plane.
Smile view of the patient and Amount of tooth showing:

92. Amount of
teeth showing

93. 8- General dissatisfaction:
• Appearance
• Women
• Middle Aged
• Menopause.

95. ‫يبلى‬ ‫ال‬ ‫البر‬..‫ينسى‬ ‫ال‬ ‫الذنب‬ ‫و‬..
‫يموت‬ ‫ال‬ ‫الديان‬ ‫و‬...
‫شئت‬ ‫ما‬ ‫فاعمل‬...‫تدين‬ ‫كما‬‫تدان‬

96. Inability to Eat Anything
Inability to Eat Meat
Dentures dislodged by eating
Phonetics (speech difficulties)

97. Dislodgement during eating
Borders
New denture
Anything
• Cuspal
interference
• Unbalanced
articulation
• Flat teeth
Meat
Improper tongue space
Cuspal interference
unbalanced articulation
Tooth off ridge
Occlusion
Basal seat
Eating
experience
Overextension
Unstable
denture

98. Borders
Improper Unstable
denture
Blunt Flat teeth
OcclusionBasal seat
Pt cant
open to get
Vertical
Dimension
Teeth
Elevate the muscle
& don’t work

99. Cuspless teeth ???

100. • Cuspal interference
• Unbalanced articulation
• Teeth outside the ridge
• Cramped tongue
• Overextended flange
• Unstable denture

101. Cramped Tongue
Improper tongue space

102.  Anterior Teeth:
Improper Labio-lingual positioning and Vertical overlap →
"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

103. Phonetic Problems
Lisping:
 Too much overlap
 Teeth are set too far palataly
 Palatal contour too constricted
 Bulky Rugae Area
 Insufficient tongue space
 Improper occlusal plane

104. Lisping
Bulky Rugae

106. The Linguo-alveolar S, Z, and, C (soft), sounds:
Linguo-alveolar consonants:
The S, Z and C sounds (sibilants): the formation of a narrow
midline groove of the tongue through which air is directed against
the incisal edge of the teeth; the lateral margins of the tongue
contact the teeth and gingivae and the blade of the tongue nearly
touches the alveolar ridge. The palatopharyngeal valve is closed
so that the air stream for these continuants can be emitted orally

107. •The upper and lower
incisors should approach
each other end-to-end, but
they should not touch that
indicate a possible error in
the amount of horizontal
overlap of the anterior
teeth.
•Always check on the total
length of the upper and lower
teeth (including their vertical
overlap)

108. If the channel formed
between the hard
palate and the tongue
is too narrow and
deep
Whistling
Lisping “Sh” sound
if the depth of the
channel is further
decreased or
obstructed
Lisping and whistling are opposite phenomena
If this channel is too
shallow (broad and
thin)
Lisping(th or etts)

109. In the production of the fricatives f, v, and ph sounds,
the lower lip is brought into contact with the incisal
edges of the maxillary anterior teeth. The lip may
curt over the labial surface of the maxillary teeth
to a height of 1-2 mm.
Labio-dental Consonants:

110. Effects of labiodental consonants
in denture construction
• Upper anterior teeth too long or too
far posterior or too far anterior.
 Position of the maxillary and
mandibular anterior teeth
 Vertical dimension: Increasing or
decreasing of the V.D. affects the
pronunciation of the labio dental
sounds.

111. What Comes
Around Goes
Around

112.  Occlusion
 Denture base (fit & contour)
 Poor anatomy
Poor denture fit

113. A-Reduced retentive
force
Lack of posterior
palatal seal
Under extension of
borders
Xerostomia
Excessive relief
Increased displacing
force
Over extension
of the border
Flabby ridge
Occlusal
Errors

114. Looseness of dentures
or poor fit usually
results due to lack of
retention and/or stability
of the denture.

115. Oral And Facial Musculature
 The polished surfaces are properly shaped,
 The teeth are positioned in the neutral zone.
 The denture bases are properly extended to
cover the maximum area possible.
 Occlusal plane levelled below the maximum
convexity of the tongue.
Muscular control is an important aspect of
successful complete denture therapy. providing
that:

116. The Polished Surface Contour

117. Addition of Post-dam

118. The denture base must be contoured to permit
the modulus to function freely, to avoid
displacement of the denture.
The distobuccal
corner of the
mandibular denture:
The buccal flange must
converge medially to
avoid displacement due
to contraction of the
masseter muscle

119. Denture Looseness
Denture Base
Dry Mucosa
Periphery terminates on
bony structures
 Hard palate
 Zygoma
 External oblique ridge
 Before retromolar pad
 No seal, discomfort
 Eventual resorption

120. Coronoid Interference
 Thick flange in retrozygomal
area
 Coronoid gets closer to
tuberosity as patient opens
or moves jaw to side
 Dislodges maxillary denture

121. Pterygomandibular Raphe
 Raphe from area of
hamular notch
 Very tight in some
patients
 Easily displaceable, but
raphe can displace
denture opening wide

122. Palatal Cleft
 In some patients midline
soft palate fissure
 Can “tent” during
function
 Allows air to leak under
denture

123. Denture Looseness
Anatomy

124. Xerostomia

125.  Overextension
 Under-extension
 Tight lips will push the lower denture
backwards and upwards
 Cramped Tongue Restricted tongue space
 Lack of peripheral seal
adding tracing compound, then reline.
 When coughing or sneezing
Denture base (fit & contour)

126.  Un-retentive denture
 Insufficient relief
 Incorrect centric occlusion
 Cuspal interference
 Unbalanced articulation
 Teeth off the ridge
 Insufficient tongue space
 Technical discrepancies

127. Typical History
Adequate stability
initially
Gets worse with time
Occlusion

128. Loose Maxillary Denture
• Heavy anterior interferences can cause
loosening at posterior
 Incisors placed too far labially Denture
displaces lingually.
Tilting/jiggling caused by:
• Contacts not centered over ridge
• Contacts on inclined portion of ridge
 Check centric position (articulating paper)
Occlusion

129. Tooth Position
Vertical
height of
mandibular
posterior
Teeth

131. When eating
When talking

133. Causes
Increased
VDO
Gross
cuspal
interference
Porcelain
teeth
NOISY DENTURES

134. Overextended upper
denture
Thick Posterior
Palatal seal
Distolingual area of
lower denture
Psychogenic factor

135. Causes
Posterior border of
upper denture
Overextension Under extension ↑ Thickness
Loose denture
Over extended distolingual
border of lower denture

136. Treatment
 Upper denture slightly
over-extended or under-
extended:
 Thick posterior border:
 Protrusive imbalance:
 Remove over-extension and
readapt post dam. under-
extension causes
intermittent contact with the
tissues
 Irritates dorsum of the
tongue.
 This will cause upper denture
to dislodge posteriorly and
tickle tissues there.

138. An involuntary series of uncoordinated spasmatic
movements of the swallowing muscles due to stimulation
of the swallowing receptors situated in the posterior
pharyngeal wall .
Causes :
1. Systemic disorders .
2. Psychologic factors. .
3. Physiologic factors.

139. Psychological gagging is the most
difficult to treat since it is out of
the dentist's control. In such
cases, an implant supported
palate-less denture may have to be
constructed or a hypnotist may
need to be consulted.

140. TRIGGER ZONES SENSITIVE
AREA
1. Tonsillar pillars
2. Tongue
3. Posterior pharyngeal wall
4. Soft palate
5. Hard palate

141. Physiologic factors:
1 . Extraoral stimuli
2 . Intraoral stimuli
a. Improper denture contour,
b. Overextended or underextended d.
c. Too thick posteriorly.
d. Inadequate denture retention .
e. Inadequate free way space .
f. Restricted tongue space .
g. Disharmonious occlusion .
h. Unfinished Surface of the denture .
i. New complete denture wearers .

142. Managements
Pre-prosthetic managements.
The use of medications.
During clinical procedures.

143. During clinical procedures
1. Seat the patient in upright position .
2. Tell the patient that little difficulty will be
encountered.
3. Ask the patient to breathe deeply.
4. Never say the word GAG.
5. Encourage physical and mental relaxation .
6. Speak loudly and clearly to the patient .
7. Ask the patient to rinse with astringent before
the procedure.
8. With impression procedures tilt the patient
head forward.

144. 9. Start with the lower impression first.
10. Select the proper impression material,
with fast setting time.
11. Use local surface anesthesia .
12. Bead the posterior border of the tray.
13. Mix the impression material out of the
sight of the patient.
14. Use proper amount of the impression
material
15. Seating the posterior part of the upper
tray first !!!!!!!!!!!!!!?.

145.  Cheek and lip biting could be due to:
1. Lack of horizontal overlap: Premolar and molar teeth that
occlude edge to edge… grinding the buccal cusps of the
mandibular posterior teeth
2. Reduced VDO cheeks tend to collapse into the occlusal area
3. Incorrectly positioned occlusal plan
Tongue biting could be duo to:
1. Reduced VDO *(No Freeway Space)
2. Cramped tongue
3. Low occlusal plane

146.  Monoplane
 Heavy Bite
 No Horizontal
Overlap

147.  Cramped tongue space
 Altered vertical dimension
 Altered occlusal plane
 Altered position of the upper incisors
and thick palate.
 Unemployed ridge: difficult to wear
lower denture.

148. Cramped tongue

149. High Plane of Occlusion

151.  Undoubtedly a perfect peripheral seal
will prevent the ingress of food
beneath the denture but perfection is
rarely attained and owing to alveolar
absorption never maintained.

152. Food Collection
Improper Flange Thickness

153. If the denture border is underextended in the buccal shelf area.
Therefore, it will not be able to occupy the buccal pouch.
A space will occur between the denture border and the lower
muscle bundle of the buccinator, resulting in food
accumulation.
The fibers of the buccinator run anteroposteriorly so that
the force dislodging the denture during mastication is minimal..

154. Alter Taste
Acrylic Resin
Explain to the Patient
Metal base.
Patient
instruction
Bacterial growth
Diagnosis: black area with
bright light
Oral HygieneHidden porosity

155. • Food may become lodged underneath dentures
and can be the root of any potential bad breath.
• The plaque caused by the lingering food can
form a layer around dentures, creating an
unpleasant smell.
• Failing to clean dentures every day due to a
build-up of bacteria,
• Wearing your dentures all the time.
• Soaking dentures in peroxide

156. Blood dyscrasia

158.  Inadequate finishing of denture
especially interdentally.
 Use of hard abrasives.
 Failure to clean dentures regularly.
 Incorrect use of denture cleansers.
 Reduced manual dexterity of the
elderly (or ill) patient.

159. Loose fit Over extension
over closure
due to
(Low VD)
Anterior sulcus Epilus Fissuratum
Hard palate Papillary hyperplasia
Ridge Flabby ridge
Ridge resorption
Denture Settling
Teeth Wear
Anterior Resorption
TMJ Disturbances
Lead to
*Chief complaint of old denture
-Discomfort - Discoloration
- Abraded Denture Base.

160. Mouth with old
dentures: sagging face
Mouth with new dentures: notice
the lift to the face and lips

161. Loose fit Pressure area &
Over extension over closure
(Low VD)
•Tissue
conditioning
material
•Relining
•Rebasing
•Remake
Occlusal Pivot:
Increase VDO in
lower 2nd premolar &
lower 1st molar by
adding acrylic resin
on their occlusal
surface.
Relieved
Hyper plastic
tissue
•Tissue rest
•Tissue
conditioning
•Surgery

163. Angular cheilitis or soreness of the corners of the mouth

164. The primary cause of this condition is over
extension of denture border which may be
the result of sinking of the denture.

165. Epulis Fissuratum
Ill fitting and
over extended
denture

166. The Labial Flange Of The Denture Produces A Low Grade Irritation
In The Surrounding Soft Tissues, Resulting In Development Of
Epulis Fissuratum, And Cause An Associated Overgrowth Of
Fibrous Tissue Covering The Maxillary Tuberosities.

167. The rehabilitation of abused oral tissue
is to improve its health and regain its
original form before making a new
denture:
I- Remove the cause
II- Recovery program

168. Remove the cause
 Removal of the denture from the patient's
mouth for few days, with an appropriate
recovery program to allow the inflammation to
subside and to allow the tissues to regain its normal
healthy form before making new impressions.
 Or, an alternative line of treatment is accomplished
by denture correction and then, starting the
recovery program.

169. 1. Finger Massage of the soft tissues two or
three times a day to stimulate the blood supply
and aid recovery.
2. Mouth wash: Instruct the patient to dissolve
one-half teaspoon of table salt in a half glass of
warm water and rinse vigorously.
3. Tissue rest: Remove old dentures from the
mouth for at least 8 hours every 24 hours for few
days before making new impressions to allow the
Recovery Program

170. 1. Detect and remove any pressure areas or sore
spots using pressure-indicating paste.
2. Relining the old dentures with soft tissue
conditioning materials to aid recovery before
constructing new dentures
3. Correction of occlusal disharmonies by clinical
remounting and Restoring (VDO) the occlusal
vertical dimension
4.Elimination of any contact between natural anterior
teeth and opposing artificial teeth.
Denture correction

172. Tissue conditioning material application

173. Add tooth coloured self curing resin
on the posterior occlusal surfaces of
the mandibular denture
When the patients closes the mouth with
the mandible guided to the centric
occlusal position, the occlusal surfaces of
maxillary posterior teeth are recorded in
the resin. Trim the resin to reestablish the
contours of the teeth.

174. If the condition persists then
the treatment may be either:
1.Prosthetic approach to the flabby
tissue OR
2. Surgical removal of the flabby
tissue.

175. Original appearance with upper and lower prosthesis in place
demonstrating inadequate facial support and improper plane of occlusion.

176. At the conclusion there are six
commonest causes of dentures
failing are:
Incorrect anteroposterior relation ship of the
mandible to the maxilla.
Uneven occlusion or unbalanced occlusion.
High and low vertical dimension.
A cramped tongue.
Poor retention.
An inexperienced denture wearer.

178. Cause Diagnosis Treatment
1. Lack of peripheral seal - Pulling down the anterior teeth (examines the
anterior labial flange)
- Pull out on incisors (examines the posterior
palatal seal).
- Pull out on canines (examines the tuberosity
region).
Proper border molding followed by relining or
rebasing the denture.
2. Under extension of the border in
depth
Tracing compound added will remain beyond the
border.
Remoulding the denture in mouth.
Change to acrylic resin either:
Directly by self cure resin or tissue
conditioning material.
3. Under extension of the border in
width
By tracing compound.
Lack of contact between polished surface and
cheeks especially in tuberosity area.
Remoulding by allowing the patient to move
mandible from side to side.
4. Posterior palatal seal:
a. Over extension on movable tissues.
b. Under extension on non
displaceable tissues.
Clinical examination:
a. Broken seal by speech
b. Under extended border.
a. Reduce border, add post dam and reline.
b. Extend with tracing compound, mold, wash
impression, make post dam on cast and then
reline.
5. Poor fit due to:
Deficient impression.
Damaged cast
Warped denture.
Grinding tissue surface.
Clinically, gap is seen between denture base and
tissues.
Pressure indicating paste reveals uniformity in
thickness.
Relining or rebasing.
6. Excessive relief Pressure indicating paste reveals excessive
thickness in this area.
Relining or rebasing. After forming proper
thickness for relief..
7. Xerostomia Patient complains of dry mouth and reduced taste.
Clinically, presence of sticky dry mouth.
The patient is advised to use artificial saliva,
frequent fluid intake, chew gums.
Denture with additional retentive means is
preferred.
8. Decreased neuromuscular control
due to:
Facial palsy
Mandibular molars placed too far
lingually.
Convex polished surface.
High mandibular occlusal plane.
Clinically evident through improper speech
and mastication.
Patient is advised to use denture fixatives
until he develops denture skills.
Correction of errors in the occlusal plane.
Poor fit due to decrease in retaining forces.

179. Cause Diagnosis Treatment
1. Over extension in depth Direct vision
Elevation of mandibular denture when
mouth opens slowly.
Reduce over extension and re-polish the
denture.
2. Over extension in width
a. In lingual flange
b. Mandibular labial flange
c. Maxillary labial flange
d. Tuberosity area
Patient complains of bulk and food
entrapment.
Denture will lift by tongue
Mentalis muscle lifts the denture.
Denture is displaced by maxillary lip
Cheek soreness and denture displacement.
Reduce over extension and re-polish the
denture.
3. Recoil of supporting tissues. Denture falls when teeth are not in contact
History of impression made without tissue
rest from old denture.
Muco compressive impression technique
was used.
Reline or rebase using minimum pressure
impression technique.
4. Occlusal errors
a. Uneven occlusal contact
b. Disharmony between centric
occlusion and centric relation.
c. Lack of freedom in intercuspal
position.
d. Lack of occlusal balance in
eccentric positions.
e. v. Excessive anterior vertical
overlap.
Ask patient to close slowly in centric
until teeth touch..
Presence of occlusal errors may be
masked by:
a. Displacement of the mucosa.
b. Tilting of dentures.
Achieve even contact or harmonious jaw
relation by:
Chair side tooth grinding.
Remounting.
Remake dentures.
Poor fit due to increase in displacing forces.

181. In the form of
UlcerationHyperaemia Cut in vestibule

182. Treatment
Remove the cause Tissue rest

183. Causes
Pressure by denture
Over extension
Movement of denture
Improper occlusion

184. Types
Generalized localized
Acute chronic

185. bruxism
Increased
VD
CO#CR
Oral
hygiene
Allergy Xerostomia
Eccentric
occlusal
interference

186. ExaminationXerostomia
24 h rest
Oral hygiene
Recurred
Another
denture
Allergy
Fluid
TTT
Bruxism
Remove
denture at night
Tranquilizer
Food
debris
Patient
instruction
Wear
facets

187. Denture
shifting
anteriorly
Increased
VD
CO#CR
No contact on
the other side
Eccentric occlusal
interference
Clicking
of teeth
Another
denture
Grinding
Grinding

188. Occlusion
• Occlusal
interferences
•Over extension
Border
• Ridge
• Spicules
& remaining roots.
• Denture
Pressure (PIP)
Basal Seat
•Unpolished • Tooth off ridge