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Post insertion problems in complete dentures
1. POST INSERTION PROBLEMS
IN COMPLETE DENTURES
P R E PA R E D B Y
S A K S H AT L A M I C H H A N E
B D S F I N A L Y E A R
2. CONTENT
• Introduction
• Problem in Adjusting to Complete Dentures
• Classification of complaints
• Causes, manifestation and treatment
• Check points
• Conclusion
3. WHY SHOULD THERE BE A PROBLEM IN
ADJUSTING TO COMPLETE DENTURES?
• Complete denture treatment is an unnatural treatment of oral tissues left
over after loss of teeth
• Dentures act as foreign body which sandwiches the oral mucosa against the
hard bone
• Dentures are simply placed on tissues without anchors and the patient is
expected to acquire neuromotor skills in holding them. In this exercise, the
dentures are expected to remain seated during various functional
excursions.
4. • Denture bearing area present varying degrees of different morphology and
altered physiology. In fact, the dentures reveal a lot of skidding effect
adding to the problem of sensitive oral mucosa.
• Similarly food habits manifest diversity to a point that patient needing to
use the dentures successfully, has to accept the changes in life style.
• Emotional disturbances and more so in advancing age are yet another
manifestation that causes irritation of tissues and resulting in tissue loss
7. • Uncommon Complaints:
• Whistling - Rough & sharp surfaces
• Ear ache - Dull teeth
• Difficult swallowing - Halitosis
• Loss of taste sensation - Dry mouth
• Saliva under the dentures - Noisy teeth
• Peculiar taste - cheek, lip & tongue biting
• Food under the denture - nausea & gagging
• Dislodgement on sneezing - tingling of the lower lip
• Dislodgement on drinking - burning of mouth
• Drooling at the corner of the mouth
• Inability to chew with equal vigor on both side.
8. ACCORDING TO GRANT.A.A
Looseness of dentures
i. Decreased retentive forces
ii. Increased displacing forces.
Discomfort associated with dentures
i. Related to impression surface of denture
ii. Related to occlusal surface
iii. Related to polished surface
iv. Related to possible systemic association
9. • Support problems
Problems associated with retention and stability
Other difficulties
i. Noise on eating and speaking.
ii. Speech problems.
iii. Eating difficulties.
a. Altered taste sensation.
b.Gagging (nausea)
10. PAIN
Most common problems associated with complete dentures
Causes
• Over extended periphery Poorly fitting denture
• Undercut at the periphery Delicate patients
• Rough fitting surface Delicate mucous membrane
• Non-relief of hard areas Retained root in ridge
• Sharp alveolar ridges Allergy to denture base
• Uneven pressure on the denture Pressure on the frenum causing
ulcer
• Wrong jaw relations cheek and tongue biting
• Cusp-locking
• Uneven alveolar ridges
11.
12. Over-extension of the periphery
most common cause of pain
• Due to incorrect moulding of the impression or incorrect outlining of the denture
on the cast
• Visible in the mouth as an area of hyperemia or an ulcer,
• Depending upon how continuously the denture has been worn, or how gross is
the over-extension
Management
• Remove the denture and ease the periphery
• slightly edematous and therefore only the minimum material should be removed
from the denture
• If denture is an old one, the overextension may be due to alveolar resorption and
the slow, chronic irritation may have caused a local hyperplasia
13. Poor fit
• This is easily detected by the poor retention, rocking, tilting and inability to seat
the denture accurately in any position.
• The movement of the denture rubbing the mucosa causes pain, and patches of
redness are sometimes visible.
Treatment:
• New dentures, but the old ones can be worn in the meantime with a lining of
tissue
14. LOOSE DENTURE
Poor retention
Causes
• Poorly adapted base of a denture
• Over extended or under extended border
• Lack of peripheral seal
• Poor alveolar ridges
• Non-relief of hard areas
• Improper contour of buccal and lingual surfaces
• Wrong Jaw relations and teeth setup.
16. MOVING DENTURE
Instability
• Causes
• Poor alveolar ridges
• Distortion of denture base due to distortion of impression
• Wrong Jaw Relation
• Large cusp angle
• Over bite
• Non-relief of hard areas
• Cramped tongue
17. POOR APPEARANCE
• Wrong vertical dimension
• Wrong contour of labial and buccal flanges
• Wrong color, shape, size of teeth
• Wrong positioning of anterior teeth
• Patient expecting too much
• Teeth showing too much
18. CAN’T EAT
• Over Closed bite
• Cusp less teeth
• Due to pain
• Cuspal interference
• Cramped tongue
• Loose dentures
19. CAN’T TALK PROPERLY
• Loose dentures
• Cramped tongue
• Open bite
• Wrong position of anterior teeth
• Patient not making effort to speak
• Thick lingual flanges or restricted tongue movements
20.
21. TEETH MAKE NOISE
• Porcelain teeth
• Increased Vertical dimension
• Cuspal Interference
• Lack of saliva
22. CHEEK AND TONGUE BITING
• Reduced (over closed) vertical dimension
• Insufficient over jet
• Lack of tongue space
23. NAUSEA AND SENSITIVE PATIENT
Moving, unstable dentures
Over extended posterior border of maxillary denture
Thick posterior border
Protrusive imbalance
24. FOOD GOING UNDER DENTURE
• Poor fit of dentures
• usually made by patients wearing dentures for the first time and who have
not yet learnt how best to control the food.
• May cause inflammation and ulceration
Treatment:
• covering the maximum possible area
• obtaining an adequate peripheral seal
• Patient education
25. INABILITY TO KEEP DENTURE CLEAN
• Inadequate laboratory work
• Loss of original polish by patient's use of hard household abrasives
• Failure of patient to clean the dentures regularly or efficiently
• Incorrect use of denture cleansers
34. CHECK LIST BEFORE DENTURE DELIVERY
Inspection of the finished denture
• Evaluation of the tissue side of the denture base for under- cut areas and
accuracy of tissue contact
• Fitting surfaces- no irregularities
• The edges of the relief area should be rounded
• Each denture should be evaluated individually
• Pheriphery should be rounded and polished properly
35. • Clinical evaluation of the denture
• Evaluating of borders
CHECKING FOR ADAPTATION
• I Checked at the posterior palatal seal using mouth mirror- there should be no
space.
• Patient is asked to say ‘Ah’ in unexaggerated short bursts
CHECKING FOR BORDER EXTENSION
• Cheeks are elevated and borders are examined.
• Buccal and labial mucosa are stretched to check for denture displacement
CHECKING FOR FRENAL RELIEF
• Labial frenum is very thin and require a deep notch
• A shallow relief should be given
36.
37. • Evaluating the retention and stability of denture
• » Retention:
by applying dislodging forces as attempting to remove the denture
Posterior palatal seal is checked by gently pressing the anterior teeth
perpendicular to the path of insertion, if adequate we can feel the
resistance.
- Stability: using the finger’s pad, applying pressure on the occlusal surface
at the premolar region on each side alternatively. If that caused the
denture to tilt (rock) and dislodge from the ridge at other side, this may
indicates that there is a problem in stability
38. • Evaluation of jaw Relation
• Jaw relations are once again verified
• I) Centric relation is verified
• 2) Vertical dimension is verified.
• Evaluation of denture esthetics
• Lip Support
• Cheek Support
• Vertical Height
• Low Lip Line
• High Lip Line
• Smile Line Are Examined
39. • Evaluation of speech
• asked to speak or read aloud. If there is any error in the denture, patient
will have difficulty in pronounciation of certain words.
• Counting from fifty to sixty
40. CONCLUSION
• Post insertion complaints are common
• It can be minimized
• Patient should be evaluated individually during denture delivery
41. REFERENCES
• Nair KC, A primer on complete denture fabrication, 1st edition, 2013, Ahuja publication, India
Pp 158 -166
• Winkler S, Essentials of complete denture Prosthodontics 2nd edition, 2012, AITBS
Publishers, pp 318 – 330
• Sharry JJ, Complete Denture Prosthodontics, 3rd edition, USA, Mcgraw-Hill Book Company,
1974, pp 289-294.
• Heartwell C M , Syllabus of complete dentures, 4th edition, 1984, Varghese Publishing
House, 407 – 420
• GrantA.A, Heath.J.R, McCordJ.F, complete prosthodontics problems , diagnosis&
management (1994)
• McCord J. F. and Grant A. A. , Identification of complete denture problems: a summary,
British Dental Journal 2000;189: Pp:128–134
• Verma.M ,Post Insertion Complaints in Complete Dentures – a never Ending Saga; Journal of
Academy of Dental Education, Vol 1, No 1 (2014), Pp: 1-8
basis of the problem of judging the appearance at the trial stage
The posterior natural teeth are often lost some time before the anterior ones, with the result that a habit is formed of eating on
the anterior teeth. When complete dentures are being worn for the first time, it is only natural that the patient should try to continue his previous eating habits with bad results.
If the palate is too thick at this point, or if the incisors are positioned too far palatally, the /s/ may become a /th/
If the denture is shaped so that it is difficult for the tongue to adapt itself closely to the palate, a channel narrow enough
to produce the /s/ sound will not be produced and a whistle or /sh/ sound may result.
The lower lip makes contact with the incisal edges of the upper anterior teeth when the sounds /f/ and /v/ are produced. If the position
of these teeth on a replacement denture is dramatically different from that on the old denture there is likely to be a disturbance in speech.
Lateral margin of the tongue to posterior teeth Contact between the lateral margins of the tongue and the posterior teeth is necessary to
produce the English consonants /th/, /t/, /d/, /n/, /s/, /z/, /sh/, /zh/ (as in measure), /ch/, /j/ and /r/ (as in red). Air is directed forwards over the
dorsum of the tongue and may be modified by movement of the tongue against the teeth or anterior slope of the palate to produce the final
sound.
Porcelain teeth by nature of the material create more impact noise than acrylic; a problem increased if the patient has been
used to acrylic for many years.
Excessive vertical height causes the dentures to contact during speech,particularly the sibilant sounds, as the m andible moves vertically through thespeaking space
Movement of the lower denture from whatever cause is very liable to lead to clicking of the teeth, particularly the molars if the distal part of
the denture rises
Cuspal interference or lack of balanced occlusion is a likely cause of faulty tooth contacts. Particular attention should be paid to
the retruded contact position as faults here are often missed in the examination of the occlusion.
Movements of the soft palate cause intermittent contact with the denture and this may be diagnosed by observing
the relation of the posterior border to the vibrating line.
Treatment: remove the excess and readapt the postdam if necessary.
border of the upper denture does not extend beyond the hard palate it cannot compress the soft tissues sufficiently to maintain close contact under all normal conditions, and this will often cause nausea because of the intermittent contact and tickling effect at the back of the palate. A
posterior edge which lies too far: forward is detected by the dorsum of the tongue and is a common cause of nausea.
Undoubtedly a perfect peripheral seal will prevent the ingress of food beneath the denture, but perfection is not always attained and, owing to alveolar resorption, never maintained.