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Post insertion problems in complete dentures
- 1. Post Insertion ProblemsIn Complete Dentures Dr .Rohan Bhoil Hyperlinks present in this like .
- 2. Contents • Introduction • Reviewof Literature • Causes • Complaints • Conclusion • References
- 3. Introduction • Recall appointmentspost insertion • Eliminate problems faced in wearing of dentures • Listen, examine & treat
- 4. Examination • 24 houroral examination & treatment • Visual and digital examination of oral cavity • 1-3 day adjustment • Critical period • Periodic recall – 3 to 4 months for difficult patients – 12 month interval for most
- 5. Review of DentureRequirements Compatibility Restoration Harmony Esthetics Preservation
- 6. Review of Literature •Basker RM, Beck CB, et al 1993 did a survey of the dissatisfied denture patient. In the majority of cases technical errors in denture construction accounted for the presenting complaint.
- 7. • Champion Het al in 1995 investigated into the problems experienced by 114 referred patients with complete. The commonest problems were those of pain and lack of retention, mainly due to occlusal discrepancies and excessive VDO.
- 8. • Muller Fet al, 1995 did a study on adaptation to complete dentures. They concluded that good denture retention facilitates the adaptation process.
- 9. • Yoshida M,Sato Y, Akagawa Y. 2001 did a study on the correlation between the quality of life, and denture satisfaction in elderly complete denture wearers and concluded that people who are well satisfied with their daily lives are also satisfied with their complete dentures.
- 10. • Dervis E.et al 2002 did a study to investigate relationships between patient complaints with complete dentures and several factors such as age, gender, medical status and denture faults.
- 11. • No significantrelationship was found when age, gender, and medical status were compared but, statistically significant relationships were observed between denture construction faults or the condition of the patient's denture bearing mucosa and patient complaints.
- 12. • Roessler DMet al. 2003 Before treatment even begins, the patient's motivation for denture treatment and emotional attitude towards dentures must be evaluated.
- 13. –Patients will therebygain realistic expectations of what can and cannot be achieved, and dentists will understand what the patient really wants. – Finally, patients must be informed that continued success depends on regular denture maintenance at home, combined with periodic consultation with the dentist .
- 14. Causes For PostInsertion Problems • Inaccuracies in various denture construction steps
- 15. Border Moulding inOpen Mouth Technique • Vertical dimension and Support to muscles • Reduced force • Overextended flanges
- 16. Jaw Relation Recording •Inaccurate record bases • Flabby & displaceable tissue • Use of existing dentures • Excessive or unequal pressure • Patient inability to give proper registration
- 17. Mounting Errors • Recordbases not properly seated • Interferences in Heel region • Occlusal rims not properly keyed in correct orientation position.
- 18. Laboratory Processing • Teethdisplacement • Incomplete flask closure • Overheating
- 19. Loose Dentures Discomfort PoorAppearance Miscellaneous Complaints
- 20.
- 21. Decreased retentive forces LackOf Seal • Under Extended orders – Depth or Width. • Incorrect Posterior Palatal Seal. • Inelasticity of Cheeks. Air beneath Impression Surface • Poor Fit. • Undercut Ridge • Excessive Relief.
- 22. Xerostomia •Diabetes, drugs, menopause, irradiation. Poor Neuromuscular Control •Incorrect denture shape • Changed shape relative to old dentures • Motor – Neuron disorders.
- 23. Increased Displacing Forces Overextended Borders. PoorFit Denture not in Optimal Position Occlusal Problems. • Prematurities , MIP – CR, Occlusal Balance, Incorrect plane of Occlusion
- 24. Support Problems • FibrousDisplaceable Ridge • Lack of Ridge • Bony Prominence
- 25.
- 26. Related to ImpressionSurface • Sharp Acrylic Nodules • Un-relieved undercut areas • Overextension • Lower knife-edged ridge. • Deep Postdam- sore throat, difficulty in swallowing
- 27. Related to PolishedSurface • Thick distobuccal flange of upper denture
- 28. Related to OcclusalSurface • Pain on eating • Pain / Ulceration lingual to lower anterior ridge • Pain / ulceration labial aspect of lower ridge and incisive papilla • Excessive vertical dimension • Cheek / lip biting • Tongue biting.
- 29. Poor Appearance • Insufficientor too much tooth visibility • Creases at corner of mouth.
- 30.
- 31. Speech problems – Sibliants: S – Bilabial: P & B – Labiodental: F & V.
- 32. Difficulty in Eating •Instability • Too narrow occlusal table • Increased or decreased vertical dimension
- 33. Clattering of teethwhile eating / speaking • Porcelain teeth • Increased vertical dimension • Increased incisor overlap • Loose dentures • Cuspal interferences and lack of balance
- 34. Nausea & Gagging •Loose dentures • Poor occlusion • Thick distal termination in upper dentures • Palatal placement of upper posteriors • Low occlusal plane • Overextended retromylohyoid area • Underextended denture borders • Psychogenic
- 35. Commissural Cheilitis • Excessiveinterocclusal distance • Occlusal plane of lower teeth is too high • Elimination of Buccal Corridor • New Dentures
- 36. Burning Tongue &Palate • Anterior third of palate • Association with menopause
- 37. Tingling or Numbingsensation • Felt at corner of mouth / lower lip • Excessive pressure from mandibular buccal flange • Impingement of mental nerve • Excessive resorption
- 38. Food under thedenture • Usually by first time denture wearers • A perfect peripheral seal is rarely attained • Failure to keep dentures clean • Failure to polish denture surfaces
- 39. Care Of TheDenture • To avoid dropping of denture • To avoid self adjustments • Good oral and denture hygiene – Cleaned after each meal – Not to use boiling water – Denture should be kept in water or dilute antiseptic solution
- 40. Conclusion • Patient education •Forewarning • Explanations
- 41. References • Arthur ORahn, Charles M. Heartwell: Textbook of complete Dentures, ed 5, London, 1993. • George A. Zarb, Charles L.Bolender, Judson C. Hickey, Gunnar E. Carlsson: Boucher’s prosthodontic treatment for edentulous patients, ed 10, B.I Publications Pvt Ltd. • John J. Sharry: Complete Denture Prosthodontics, McGrawhill Book Company, Inc. 1962. • Sheldon Winkler: Essentials of complete Denture Prosthodontics, ed 2, Ishiyaku Euro America Inc.
- 42.
- 44.
- 45.
- 46.
- 47. PPS • Under extension– Loose denture • Overextension – loose while talking • Insufficient depth – loose while eating.
- 48. Causes of PoorFit • Deficient impression • Damaged cast • Warped denture • Over adjustment of impression surface.
- 49. Treatment: Lack ofSeal • Under extended borders – soft tracing compound • Incorrect posterior palatal seal – correct placement of border • Inelasticity of Cheeks – incremental border moulding and functional movements.
- 50. Treatment: Air beneathImpression Surface • Relining the denture • Remaking the dentures • A rotational path of insertion in case of unilateral undercuts.
- 51. Treatment: Xerostomia • Presence/ Absence of glandular function • Artificial saliva substitutes • Sucking on sour candy • Intermittent sips of water • Pilocarpine hydrochloride.
- 52. Treatment: Poor Neuromuscular Control •Polished surface should occupy the neutral zone • Use of denture adhesives.
- 53. Treatment : Overextendedborders.
- 54. Occlusal Problems • Anteriorand posterior prematurities
- 55. • Maximal intercuspalposition not coinciding with centric relation position –Patient unable to control mandibular movement –Poor ridge –Use of non anatomic teeth
- 56. • Lack ofocclusal balance • Incorrect plane of occlusion – Dentures move while eating – Commonly associated with large tuberosities • Removal of second molars may help
- 57. Treatment: Occlusal errors •Suspected when patient complains that dentures become loose after a few hours of wearing • Also when a collection of calculus is seen on one side of the denture
- 58. • Clinical Remounting –Better view of occlusion – Reduced patient participation – Stable foundation without shifting bases – Absence of saliva – accurate markings – Reduced clinical time & adjustment appointments.
- 59. • Mounting: maxillarycast – A remount jig fabricated after lab remount & selective grinding – Or a new facebow record
- 60. Interocclusal records forverifying centric relation
- 61. • Mounting :Mandibular cast – Using interocclusal check record. • Perform selective grinding procedures.
- 62. Discomfort: Symptoms • Pain •Altered sensation • Difficulty in chewing / swallowing.
- 63.
- 64. Treatment • Pain oneating – 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
- 65. • Pain /ulceration – labial aspect of lower ridge & incisive papilla – Undercut or sharp acrylic – Trim labial aspect of lower anteriors • Excessive vertical dimension – If increased greater than 2mm, better to remake dentures.
- 66. Biting of tongue •Usually due to – Teeth placed lingual to lower ridge – Decrease in tongue space in patients accustomed to old dentures – Changes in occlusal level
- 67. Treatment • Remove lowerlingual cusps • Reset and rearrange the teeth
- 68. Cheek biting • Usuallydue to – Insufficient overjet, in posterior region. – Very lax cheeks – Reduced vertical dimension • Treatment – Increase buccal overjet and plump the denture – Remove last molars – Grind buccal surfaces of lower posteriors.
- 69. Insufficient / Excessivetooth visibility • Can be due to improper – Orientation of occlusal plane – Vertical dimension – Labiolingual & labiopalatal positioning of anterior teeth. • Difficult to correct appearance without remaking dentures
- 70. Creases at Cornerof Mouth • Can be due to – Decreased labial fullness – Decreased vertical dimension • May require remaking of dentures • Important to verify and take patient consent for aesthetics at time of try-in.
- 71. Speech Problems • Takesfew days for getting accustomed • Dentures may need to be remade • Causes include – Incorrect vertical dimension – Incorrect overjet / overbite – Incorrect incisor position.