Post insertion problems in complete dentures
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Post insertion problems are common with complete dentures as they act as foreign bodies in the mouth. Common complaints include looseness, pain, difficulty eating and speaking. Causes of problems include poor fit from over-extended or under-extended borders, poor jaw relations, cusp interference, and an uncooperative patient. It is important to thoroughly check dentures before delivery by examining the borders, retention, stability, jaw relations, and other factors to minimize post insertion issues. Proper evaluation and adjustment can help reduce complaints and improve patient satisfaction with their new dentures.
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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
- 6. ACCORDING TO SHARRY Frequent Complaints : • Excessive bulk • Speech difficulties • Masticatory shortcomings • Insufficient retention • Mucosal irritation • Unattractive Apperence
- 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
- 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
- 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
- 26. CAUSES OF DENTURE FAILURE 1. Poor Retention and Stability. Loose, moving sets. 2. Wrong jaw relations. • Wrong centric relation. • Wrong centric occlusion. • Wrong vertical dimension. 3. Cuspal interference. 4. Cramped tongue. 5. Poor alveolar ridges. 6. Un-cooperating patient. 7. Poor esthetics. 8. Technically inferior dentures. 9. Un-skilled dentist. 10. Incomplete flask closure and tooth movement during denture processing.
- 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
- 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
- 42. THANK YOU
Editor's Notes
- Sharry.J.J Complete denture Prosthdontics, 3rd edition, chapter 17, pg 358
- A.A.Grant, J.R.Heath, J.F.McCord- complete prosthodontics problems, diagnosis & management (1994)
- 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.