PROSTHODONTIC IMPLICATIONS OF ORAL MUCOSA

1. PROSTHODONTIC
IMPLICATIONS OF ORAL
MUCOSA
PRENISHA.F.P
PG STUDENT

2. CONTENTS
• Introduction
• Biomechanics of oral mucosa
• Types of oral mucosa
• Types of Prosthesis
• Interaction of prosthetic materials with oral environment
• Removable prosthesis
• Fixed prosthesis
• Conclusion
• References

4. BIOMECHANICS OF ORAL MUCOSA
• During mastication, oral mucosa plays a critical role in
distributing occlusal loads to the underlying bony ridge.
• Within this highly vascular tissue, the functional pressure
namely interstitial fluid pressure or hydrostatic pressure is
one of the most important etiological factors causing
clinical complications.
Chen J, Ahmad R, Li W, Swain M, Li Q. 2015 Biomechanics of oral mucosa. J. R. Soc. 2015;

5. Anatomical and physiological factors
• The masticatory mucosa comprises of a surface epithelial
layer and a deeper connective tissue layer(lamina
propria).
• The underlying lamina propria is a compact fibrous tissue
comprising of the papillary layer and the deeper reticular
layer.
• The abundance of fibrous attachments, known as
mucoperiosteum, renders the oral mucosa immovable
with firm connection to the bone, resisting compression
and shear in function.

6. • Elasticity
• • Modulus of elasticity is the physical description of an
object’s tendency to be deformed proportionally to the
applied force.
• The oral mucosa was found to be highly deformable
under compression, and the elastic modulus appears to
vary over a broad range.

7. Viscosity and permeability
• • Accompanying the instant elastic responses, the oral
mucosa also exhibits a dynamic response over the time
under loading and upon unloading, interpreting as creep
and delayed recovery.
• • Both the fluidic viscosity and permeability influence the
dynamic response.
• • The mucosa in the elderly population often has more
significant viscous behavior, and reduced rebound with
delayed recovery because of the reduced amount of
elastin.
• • Increasing contact areas generally leads to stiffer
mucosal responses

8. • Friction coefficient • The oral mucosa does not only
sustain compressive loading, but also the surface shear
induced by the friction beneath the dentures. • Denture-
induced symptoms, such as traumatic ulcers, angular
cheilitis, irritation hyperplasia and keratosis are related to
the frictional loading on the mucosa. • With the same oral
condition, the friction coefficient can also change between
different denture materials. • A material with higher
wettability will be more likely to form a superior lubricating
layer between the supporting mucosal surface and the
denture base, thus protecting the surface tissue by
reduced friction.

9. • Tissue displaceability • Some dentures distribute occlusal loads
unevenly to multiple supporting tissues, such as the teeth
(including the PDL), mucosa and bone around an implant.
Examples are removable partial dentures and implant-retained
overdentures. They obtain stiffer support compared to complete
dentures. • Their different material properties contribute to the
difference in denture displacement. • The displacement of the
contact surface generally increases from the supporting tooth
unit towards the distal extension resulting in stress
concentrations in the underlying mucosa. The tissue
displaceability difference does not only cause stress-induced
pain, discomfort and bone resorption but also affects the long-
term health of the remaining teeth and other surrounding soft
tissues.

10. • Pressure–pain threshold • The sensation of pain is the
most direct indication of a maladaptive denture or a
prosthesis to the mucosa. • High contact pressure can
cause pain in the mucosa. The contact pressure here
refers to the load borne perpendicularly on the mucosal
surface. • Patients with a thin mucosa covering sharp
bony ridges are more likely to have a lower pressure-pain
threshold than those with a thick mucosa over a flat bone
surface under a denture base. • The loading locations,
such as the palatal, lingual and buccal mucosa, have their
different morphologies, thickness and anatomical
features, leading to the various pressure-pain thresholds
observed

11. TYPES OF ORAL MUCOSA

12. REALEFF EFFECT
• The oral mucosa on which
the complete dentures are
fabricated is displaceable and
compressible. It is called as
Realeff effect or Resiliency like effect.

14. MUCOSAL PATHOLOGIES OF ORAL
PROSTHESIS
Due to REMOVABLE
PROSTHESIS
Mucosal lesions Burning mouth syndrome
Allergic response Fungal infections
Trauma

15. Due to FIXED PROSTHESIS
Secondary caries
Pulpal and Periodontal infections
Allergic reactions
Occlusion related disorders
Periimplantitis

16. REMOVABLE
PROSTHESIS

17. • MEAN AREA OF MUCOSA AVAILABLE FOR DENTURE
SUPPORT;
• MAXILLA-22.96 cm2
• MANDIBLE-12.25 cm2

19. • ETIOLOGY
• Multifactorial
• DIAGNOSIS
• Presence of mycelia or pseudohyphae in the direct
smear in large numbers.
• TREATMENT
• Oral and denture hygiene
• Using disinfectant solutions to soak the denture.
• Remove denture at night
• Treating any underlying systemic conditions

20. • Correction of ill-fitting denture.
• Rough areas should be smoothened and relined with
tissue conditioners.
• Antifungal therapy: For 4 weeks.
• Surgical elimination of deep crypt formation in type 3
denture stomatitis.

21. FLABBY RIDGE

22. • Excessive forces by unstable occlusal condition can
cause flabby ridge which provides poor support for the
denture.
• Caused by replacement of underlying supporting bone by
fibrous tissue.
• Common in anterior maxilla.

23. • MANAGEMENT:
• Conservative approach
• Prosthetic approach
• Surgical approach.

24. • CONSERVATIVE APPROACH:
• Tissue rest.
• Soft tissue massage.
• Modification of the denture by Flange and
occlusal adjustment.
• Tissue conditioning.

25. • PROSTHETIC APPROACH:
1. Impression.
2.Centric occlusion record
3.Occlusal form and posterior teeth
arrangement.

26. • SURGICAL ABLATION:
• Removal of fibrous tissue to leave a firm
ridge.
• May recur.
• Results in elimination of vestibular sulcus.

27. DENTURE HYPERPLASIA
• Also known as Epulis fissuratum.
• Contains flaps of hyperplastic connective tissue.

28. • MANAGEMENT:
• Removing offending denture or shortening the
overextended flange to aid in tissue rest.
• Denture is corrected with soft liners or tissue
conditioning agents.
• Surgical removal is attempted only if other
approaches fails.

29. Gagging
• • Stimulation of sensitive areas in posterior pharyngeal wall,
soft palate, uvula, fauces or the posterior surface of tongue
results in series of uncoordinated and spasmodic movements
of swallowing muscles. This is referred to as gagging.
• • Usually, this may be due to a denture that is too loose, too
thick or extended too far posteriorly onto the soft palate.
• • Stimuli such as sight, taste, noise, as well as psychological
factors, or a combination of these, may trigger gagging.
• • In wearers of old dentures, gagging may be a symptom of
diseases or disorders of the gastrointestinal tract, adenoids or
catarrh in the upper respiratory passages, alcoholism, or
severe smokin

30. TRAUMATIC ULCER
• Develop within 1-3 days after placement of new dentures.
• Also known as sore spots.
• Causes- overextended denture or unbalanced occlusion.
• Predisposing factors- diabetes ,nutritional deficiencies,
radiation therapy, xerostomia.

31. • MANAGEMENT:
• In the systemically non-compromised host, sore spots
will heal after correction of the denture.
• If no treatment is instituted, patient will adapt to the
painful situation while will develop into denture irritation
hyperplasia.

32. ANGULAR CHELITIS
• Also known as angular cheilosis, perleche.
• Affecting the corner of the lips.
• Predisposing factors include infections, nutritional
deficiencies and reduced vertical dimension of the mouth.

33. • MANAGEMENT:
• Evaluation of the predisposing factors.
• Topical anti fungal ointment or cream.
• Replacing with a new denture to modify the face
vertical dimension.
• Follow up.

34. ORAL CANCER
An association between oral carcinoma and chronic
irritation of the mucosa by dentures has often been
claimed, but no definite proof seems to exist.
• Continuous trauma chronic inflammation
Panat et al;Denture induced squamous cell carcinoma: a rare case report. Journal of oral science and
health; April 2012

35. • Management •
• Any persistent sore spot remaining even after the
correction of dentures are often suspected for malignancy.
• Regular recall visits at duration of 6 months has to be
followed for comprehensive oral examination.
• • Treatment for oral cavity cancer is based largely on the
stage (extent) of the cancer- chemotherapy, radiotherapy
and surgical resection.

36. BURNING MOUTH SYNDROME
• 5-7 % of denture wearing population.
ETIOLOGY:
Local factors
Systemic factors
Psychogenic factors

37. • Management
• • Identifying the causative factor is important and it should
be removed.
• • Vitamin therapy is provided when associated with its
deficiency.
• • If psychogenic / psychosocial disturbance are
diagnosed, adequate treatment should be offered through
counselling and use of tranquilizers if required

38. ALLERGIC REACTIONS
• Hypersensitivity to resins.
• Denture wearers suffer from burning sensation in the
mouth or in the tongue.
• Similar to burning mouth syndrome.
• Dysgeusia
• Bitter or metallic taste in the mouth.

39. • MANAGEMENT;
• Treated symptomatically until the mucosa heals.
• Properly heat cured acrylic resins are recommended.
• Indirect methods are preferred when fabricating
autopolymerising temporary prosthesis.
Choudary et al. Contact Allergy to Denture Resins;2016 International journal of oral
implantology and Clinical Research 7(2):40-44

40. •FIXED
PROSTHESIS

41. GINGIVAL RESPONSE TO CROWNS AND
BRIDGES
• Localised gingival irritation caused by excess
cement.(Artificial calculus)
• Corelation- gingival inflammation and distance of the
crown margin below the gingival crest.
• Gingival hyperplasia- subgingivally placed restoration
margin.

42. • Gingival hyperplasia –subgingivally placed restoration
margins.
• MANAGEMENT:
• Patient education
• Maintenance of oral hygiene.
• Re-fabrication of the prosthesis.

43. PERI-IMPLANT DISEASE
• Peri-implant mucositis:
• Peri-implantitis
•

44. • PERI-IMPLANT MUCOSITIS:
• Accumulation of bacterial biofilms
• Disruption of host –microbe homeostasis
• Clinical signs- Redness, swelling, bleeding on gentle
probing and suppuration.

45. • PERI-IMPLANTITIS:
• Progressive loss of peri-implant bone.
• Following initial loading ,some 0.5 to 2 mm of
crestal bone is lost.

46. TREATMENT APPROACHES
• Mechanical debridement of biofilm and calculus.
• Occlusal therapy.
• Local or systemic antimicrobials
Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment. European Journal of
Dentistry .

47. • Implant surface decontamination .
• Flap surgical intervention.
• Regenerative approach.

48. •CONCLUSION

49. REFERENCES:
• Boucher 12th edition, Sequalae of complete denture.
• Shafer; Textbook of oral pathology ed 7th ; Mucosal response to oral
prostheses .
• Chen J, Ahmad R, Li W, Swain M, Li Q. 2015 Biomechanics of oral mucosa.
J. R. Soc. 2015; Interface 12: 20150325
• Figuero, E., Graziani, F., Sanz, I., Herrera, Management of peri-implant
mucositis and peri-implantitis. Periodontology 2000, 66(1), 255–273.
• Heitz-Mayfield, 2008; Diagnosis and management of peri-implant diseases.
Australian Dental Journal, 53(s1), S43–S48.
• Choudhary et al. Contact Allergy to Denture Resins; 2016 International
Journal of Oral Implantology and Clinical Research 7(2):40-44