Complains aftddddddgggjgffrredfgerf.pptx

COMPLAINS AFTER
COMPLETE DENTURE
INSERTION
Supervisor
Prof. Dr Abdelsalam Ezzat
Prof .Dr Ahlam Elsharkawy
By
Dr. Abdelrahman Badawi ahmed
DR. Abd elWahab Mohamed 1

l-complaints regarding mastication
2-complaints regarding esthetics
3-complaints regarding speech 2
1. PAIN
2. SORENESS
3. TONGUE AND CHEEK BITING
4. SORETHROAT
5. NAUSEA AND GAGGING
6. TMJ PAIN
Main complications
Others complication

WHAT IS PAIN ?
3
A subjective unpleasant sensory (afferent) and emotional experience
associated with actual or potential tissue damage or described in terms of
such damage.

PAIN
4
• LOCALIZED
• GENERALIZED

POSSIBLE POST INSERTI0N COMPLAINTS
OF COMPLETE DENTURE :
5
1. DISCOMFORT
2. FUNCTION
3. ESTHETICS
4. speech

POST INSERTION DISCOMFORT COULD BE :
6
1. PAIN
2. SORENESS
3. TONGUE AND CHEEK BITING
4. SORE THROAT
5. NAUSEA AND GAGGING
6. TMJ PAIN

LOCALIZED PAIN
7
1- MANDIBLE
A pain at the peripheries of dentures in depth of sulci in muscles of
mastication e.g. masseter and posterior fibers of temporalis, pain intensify as
day progresses
Causes :
i-Unpolished or sharp edge
2-herpetic or aphthous ulcer
3-Excessive vertical dimension of occlusion
Zarb GA, Jacob R, Eckert S. Prosthodontic treatment for edentulous patients, 13/e. Elsevier India; 2012.

1- MANDIBLE
8
Treatment :
1. polish denture borders
2. leave denture out as much as possible and wait 7-10 days
3. If the excessVDO is less than 1.5mm, grind to provide
adequate freeway space. If it is more than 1.5mm, re-register
and reset at new vertical. dimension of occlusion.

1- MANDIBLE
9
B. Crest of the ridge
Causes : occlusal prematurities
Management : correct occlusal defects, recheck vertical dimension
and clinical remount .

1- MANDIBLE
10
C. side of ridge-anterior area
Causes :
maximum intercuspation not in harmony with centric relation (CR)
Management :
enlarge centric area : grind mesial inclined planes of maxillary teeth and distal inclined planes of
mandibular teeth using a clinical remount.

1- MANDIBLE
11
D. Side of ridge-bicuspid area
Causes :
1.lingual tori (nonyielding areas)
2-shrinkage of denture during processing
3-occlusal prematurities
4-pressure on mental foremen

1- MANDIBLE
12
Management
1-Provide adequate relief in denture base.
a-Rebase denture
3-Check occlusion on the opposite side of arch
from
the pain point

1- MANDIBLE
13
E- Under lingual flange
Causes
Maximum intercuspation not in harmony with CR
(drives mandibular denture forward)
Management
Mark deflective inclines of posterior teeth with
articulating paper; these will be the mesial slopes of
the maxillary buccal cusps and the distal facing
slopes of the lower buccal cusps.

CENTRIC OCCLISION IS NOT
COINCIDING WITH CENTRIC RELATION
14
• If the defect is within half of a premolar, it can be corrected by selective
grinding.
• If it is more than half a premolar, it must be corrected by recording a new
centric occluding relation, grinding the lower posterior teeth, and then
resetting of teeth . (clinical remount step)

1- MANDIBLE
15
F. under labial flange
Causes :
1. excessive overbite
2. habit-mastication in protrusive relation
Management
Adjust anterior occlusion
Train patient to masticate in centric

1- MANDIBLE
16
G. Mandibular retromylohyoid area
Cause :
thick or overextended distolingual flange
Detection : disclosing wax
Management : adjusting the distolingual flange

2. MAXILLA
17
a. Maxillary frenum
Detection: Disclosing wax
Management: slight widening of the
notch with fissure bur or taperd thin
acrylic bur, carefully not to affect
retention

2. MAXILLA
18
C. crest of the ridge
Causes :
1. high occlusion in that area
2. bubbles in acryl
Management
1. Check with articulating papers and adjust the occlusion.
2. inspect the denture under good light to detect surfme
roughness then remove & polish lightly.

2. MAXILLA
19
C. Slopes
Causes
a. Occlusal disharmony in eccentric jaw
positions
b. Pressure area,
c. Presence of irregularities in the
denture bearing area

2. MAXILLA
20
C-Vestibule
.The patient feels severe pain in
this region when he/she inserts
the denture and particularly while chewing
causes :
Unpolished or sharp edge
Management :
. Polish denture borders

PAIN AT POSTERIOR LIMIT OF
MAXILLARY DENTURE
21
In the postdam region, the changes that are characterized by erythema and
edema are observed in the soft tissues.The patient feels severe pain in this
region when he/ she inserts the denture and
especially while chewing
Ozkan,Y. K. (2018). Post insertion problems in complete dentures.

MAXILLARY DENTURE
22
Post dam area should be at vibrating line
if at soft tissue : pressure will be created leading
to a tear in mucosa

MAXILLARY DENTURE
23
posterior overextensio of
maxillary denture base
posterior palatal seal
creates much pressure
sharply prepared
postdam area

PAIN AT THE DISTOBUCCAL FLANGE OF
MAXILLARY DENTURE
24
-Impression was made without opening the mouth enough
-The coronoid process will come forward when patient opens his/her mouth

PAIN AT THE DISTOBUCCAL FLANGE OF
MAXILLARY DENTURE
25
Cause :
increase thickness and
retention in this area
Detection :
disclosing wax

GENERALIZED PAIN
26
Causes :
1-heavy biting force-strong musculature.
2-excessive OVD
3- Improperly processed base materials
4- inflamation
5- Asprin under denture
6- Allergy

GENERALIZED PAIN
27
EXCESSIVEVDO :
Treatment:
a. Return it on the articulator and grind
to decrease theVDO (limited by
esthetics and amount of clearance
between anterior teeth "horizonal and
vertical overlap '’
b. reset teeth in one or both dentures
c. Remake the denture

GENERALIZED PAIN
28
• Denture Allergy
* The patient complains of
• burning sensation
• Edema
• hyperemia

GENERALIZED PAIN
29
• Denture Allergy
How to differentiate between denture
allergy and denture stomatitis?
In denture allergy, it is short-term complaint,
fiery red and glazed surface.
In denture stomatitis, it is long-term
complaint, with a more pink surface and no
glaze.

GENERALIZED PAIN
30
2- SORENESS
Causes:
i-Occur as a result of
pressure on blood vessels
or nerve foramen
2- Ariboflavinosis

GENERALIZED PAIN
31
2- SORENESS ---------> According to site
anterior hard palate & upper anterior ridge = Pressure over the anterior palatine foramen (incisive
foramen)
Premolar to molars = Pressure on greater pallatine foramen
lower anterior ridge = Pressure on mental foramen
Upper denture supporting tissue which may involve other intra oral tissues = Burning mouth syndrome
seen in middle-aged or elderly females with hormonal changes or psychological disorders

GENERALIZED PAIN
32
TONGUE AND CHEEK BITING
Cheek biting
Causes :
. Posterior teeth cusp to cusp
(insuffecient horizontal overlap)
. DecreasedVDO (Excessive
interocclusal space)
rahn,Arthur O., John R. Ivanhoe, Kevin D. Plummer, and Charles M. Heartwell.Textbook of Complete Dentures. Shelton,
Con: People's Medical Publishing House, 2009

GENERALIZED PAIN
33
Cheek biting
Causes : .setting of lower second molar on the
slope of retromolar area (inclined plane)
will cause displacement of lower denture
and cheek biting. Distal end of second
molar should stop at the beginning of
retromolar pad.

GENERALIZED PAIN
34
Cheek biting
Causes :
. Posterior teeth too far buccal
. loss of muscle tonus (lax cheek)
. Existence of cross bite

GENERALIZED PAIN
35
Cheek biting
Management:
• buccal contours of lower posterior teeth may be
ground if not excessive
• IfVDO is decreased, remake the
dentures
• Provide adequate horizontal overlap by
resetting teeth in maxillary/mandibular
dentures or both.

GENERALIZED PAIN
36
SORE THROAT
Causes
1-irritation in the region of mylohyoid ridges, either overextension or pressure area
internal to the flange
2-overextended or thick maxillary posterior denture border
3- Insufficient vertical dimension of occlusion
4- Excessive vertical dimension of occlusion
5- Posterior teeth set inside the ridge (tongue is crowded).

GENERALIZED PAIN
37
Management
1-Relief the pressure area
2-Adjust the flange extension
3- Correct vertical dimension
4- Make a new denture
5- Rearrangement of teeth in correct position
SORE THROAT

GENERALIZED PAIN
38
NAUSEA AND GAGGING
Management
1- Adjust the overextended/thick border
2- remake the denture in case of low OVD
3- Put modeling compound and add resin to
enhance PPS

OTHER COMPLAINTS AFTER COMPLETE DENTURE
INSERTION
39
l-complaints regarding mastication
2-complaints regarding esthetics
3-complaints regarding speech

1-COMPLAINTS REGARDING
MASTICATION
40
A-Dislodgment during mastication
Maxillary Denture
causes:
-Lack of occlusal harmony
bilateral balanced occlusion is achieved
-the problem is occlusal interferences
( compromised stability)
Textbook of Complete Dentures ( 6th edition )

A-DISLODGMENT DURING
MASTICATION
41
Maxillary Denture
Management :
1- recheck deflection &
prematurities
2- reinstruct patient about their
limits in using complete denture

MASTICATION
42
Maxillary Denture
• balanced occlusion can only be
achieved within functional limits of
teeth (2mm)
• so hard food has an effect of
premature contacts disturbing
occlusal balance

MASTICATION
43
Maxillary Denture
causes:
premature contacts differs after
insertion session ( we should check
after 24 hours , 48 hours ) due to
different mucosal topography
changes during function of
mastication

MASTICATION
44
Mandibular Denture
1-Lack of occlusal harmony -->( compromised stability)
Causes :
premature contacts ( cause tipping movements)
During function :
the lever action tilts the denture base causing
a loss of the seal between the tissues and the denture
base.The result is loss of stability and retention

MASTICATION
45
Mandibular Denture
2-placing the occlusal
plane too high--> causing
dislodgment when the
tongue tries to handle the
bolus of food

MASTICATION
46
Mandibular Denture
3- residual ridge condition :
• the resiliency of the supporting mucosa
• amount of residual alveolar bone
• the inherent instability of the dentures during functional and
parafunctional movements.
Zarb. George A. ProsthodonticTreatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses 13th Edition. St. Louis.
Mo:Elsevier Mosby, 2013

MASTICATION
47
The insertion of a new
denture introduces an
altered environment for the
tongue, requiring its intrinsic
musculature to reorganize
both its shape and learned
activity patterns

MASTICATION
48
4- severly resorbed
ridge or falppy ridge -->patient should know the limitations of removable complete denture

PROBLEMS REGARDING MASTICATION
49
- Insufficient Chewing:
1. Lack of denture experience
if it is the first time they have used dentures.This time
can vary from a week to 6 months, or even longer.
2- Incorrect position or antero-posterior
orientation of occlusal plane
When saying the sound ‘e’ the tongue should be on the
occlusal surface, and it should be under the occlusal
surface while saying ‘o’
Syllabus of complete dentures by Heartwell, Charles M (third edition)
Ozkan.Y. K. (2018). Post insertion problems in complete dentures. In Springer ebooks (pp. 145-195)

50
- Insufficient Chewing:
3. vertical dimension effect:
High vertical dimension
interocclusal space is insufficient,A patient that has difficulty in locating
the food on the occlusal surface needs to open their mouth wider
than normal
Low vertical dimension
the freeway space is greater than normal,The patient's
muscles cannot apply enough chewing force. the force of
the chewing
muscles will be inadequate

51
Correction of vertical dimension :
if increased :
1- if minor changes needed :
selective grinding
2- if major changes needed :
resetting anterior & posterior teeth
if decresed :
3- resetting the teeth to the correct
vertical dimension
4- if minor changes with 2mm
remounting & self cure arylic resin can be added.

52
- Noise on Eating and Speaking
1.The lack of retention of the denture
for any reason
2.The high occlusal vertical dimension
3. interferences & premature contacts
4.The use of porcelain teeth which
causes increase of noise caused due
to previous causes . .

PROBLEMS REGARDING ESTHETICS
53
Generally a result of not taking sufficient care at the try-in stage and by not asking
the patient's opinion. Besides, the close environment of the patient has a great
effect on the esthetic complaints.
After modification of Denture to meet the functional patient requirements &
mastication habits , there might be changes that affect the denture from
esthetic aspect

54
1-(taught face / collapsed face )
Inadequate vertical dimension

55
2-The closed distance between chin tip to the nose tip low vertical dimension

56
THEVISIBILITY OFTHE TEETH
too much exposed:
1-short lips
2-increased vertical dimension
3- incorrect level of occlusal plane
4-incorrect shape and prominence of teeth
less teeth exposed:
1-long lips
2-decreased vertical dimension
3- incorrect level of occlusal plane
4-incorrect shape and prominence of teeth

PROBLEMS REGARDING SPEECH
57
Fortunately,The adaptability of the tongue to compensate for changes is so great
most patients master speech with new dentures within a few weeks.

58
-Mispronunciation of the "S" Sound
1-The "s" sound is pronounced by the passage
of air from the small space between tongue and the palatinal
part of the denture
2-The sound "S" is produced with the tongue tip behind the
upper anterior teeth

59
-Mispronounciation of the ‘S’ sound
• lisping the S=> TH:too much room for the tongue between the upper bicuspids.To test for this,
• add a piece of wax palatal to the bicuspids and check phonetics. If successful, adding chairside acrylic to the
denture base will help narrow that palatal space.
• Whistling S=>Sh : absence of sufficient space for the tongue between upper bicuspids.
• making a groove that is too large for the air to escape at incisors tongue in contact with palate

60
-Mispronunciation of the ‘T’ ‘D’ and "r" Sounds
-Retention problems
as the patient tries to keep the denture in their
mouth while speaking
-AS ( Xerostomia or excessive salivation )
-Incompatibility --> Rough unpolished surface can lead to difficulity in
speech degulition & mastication
Syllabus of complete dentures by Heartwell, Charles M (third edition)

61
Refrences l-Syllabus of complete denturesnby Heartwell, Charles M jthird
edition)
2-Zarb, George A. Prosthodontic Treatment for Edentulous Patients: Complete
Dentures and Implant-Supported Prostheses13th Edition. St. Louis, Mo:Elsevier
Mosby, 2013.
3-10SR Journal of Dental and Medical Sciences IOSR-JDMSi e-
lSSN: 2279-1 0853, p-lSSN: 2279-086LVolume 15. Issue 9Ver.Vlll
September). 2016), PPI 133-135 www.iosrjournals.org
4-0zkan,Y. K. 2018). Post insertion problems in complete
dentures. In Springerl ebooks bp. 145-195).
https://doi.org10.1007/978-3-319-69017-9
5-5harma,A., Singh, R., Sharma, R. Dhanda,A., & Neha, N. 2020).
Post insertion problems in complete denture:A review. IP
Annals of Prosthodontics anti Restorative Dentistry, 64),189-
193. https://doi.org/IO.18231/i.aprd.2020.040

62
6-Textbook of Complete Dentures 2009 PEOPLE'S MEDICAL
PUBLISHING HOUSE SHELTON, CONNECTICUT)
7-Phonetics in Complete DentureA Prime Concern Rajya Lakshmi Ravuril ,
Suchital Tella2 , KiranThota3 : October, 2013 www.nacd.in) 9 NAD, 2013
Sherry, J.J. (1974) Complete Denture Prosthodontics. 3rd Edition, Mcgraw-
HiU, NewYork Ozkan,Y. K. (2018). Post insertion problems in complete
dentures. Rahn,Arthur O., John R. Ivanhoe, Kevin D. Plummer, and Charles
M. Heartwell.Textbook of Complete Dentures. Shelton, Conn: People's
Medical Publishing House, 2009

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