Denture and Partial Troubleshooting Guide

Denture and Partial Troubleshooting Guide

www.MorseDentalLab.com

http://www.morsedentallab.com/

Which topic best describes the problem?

Esthetics PhoneticsSwallowing

InterferenceGagging Instability

BitingCheeks/Tongue

RednessMandibular

PainDiscomfort Burning



Esthetic Troubleshooting

Which best describes your problem?

Too bulky under nose.

Sinking in under nose.

Upper lip sinks in too far.

Shows too much teeth.

Looks too false.



Too bulky under nose:

Labial flange of upper too long or too thick.

Upper anterior teeth set too far out.

CAUSES:

SOLUTIONS:

Reduce bulk and/or length and repolish.

Reset anteriors lingually.



Sinking in under nose:

Upper labial flange needs more bulk.

Upper labial flange needs more length.

CAUSES:

SOLUTIONS:

Add wax to build up to proper contour and have lab build out base.

Grind out tissue side of labial flange, add compound border and take

wash impression

Reset anteriors for lip support.



Upper lip sinks in too far:

Upper anterior teeth set too far lingually.

CAUSES:

SOLUTIONS:

Add wax on teeth to proper contour and have lab set

teeth more labial for lip support.





Shows too much teeth:

Vertical too great.

Occlusal plane too low.

Cuspids and laterals set too prominent.

Upper anterior teeth set out too far.

CAUSES:

SOLUTIONS: Have lab reset all teeth closing vertical. Maintain esthetics by determining

whether to raise or lower upper or lower teeth.

Have lab reset all teeth raising occlusal plane.

Replace cuspids and laterals with smaller teeth and rotate them in.

Reset teeth back to ridge.



Denture looks too false:

Teeth are set too “regular”; technique type set up.

All teeth appear to be the same shade.

No gingival contouring or staggering of gingival depth.

CAUSES:

SOLUTIONS:

Try sculpturing anterior incisals to give abraded appearance. Rotate and

stagger teeth in set up.

Change to characterized anterior teeth.

Have lab process new base with anatomical finish and characterized base.



Phonetics Troubleshooting


Whistle on “S” sound.

Lisping on “S” sound.

“Th” and “T” sounds indistinct.

“F” and “V” sound indistinct.



Whistle on “S” sound:

Not enough room for tongue between upper bicuspids.

Space between centrals.

CAUSES:

SOLUTIONS:

Remove and move bicuspids to the buccal or (if room)

grind out more area for the tongue.

Close central anterior space.



Lisping on “S” sound:

Too much space for tongue between upper bicuspids.

CAUSES:

SOLUTIONS:

Narrow palate space between upper bicuspids by

adding ledge of acrylic.



“Th” and “T” sound indistinct:

Not enough room in dentures for tongue.

If “Th” and “T” sound alike the anteriors are too far lingual.

CAUSES:

SOLUTIONS:Thin out dentures from lingual sides. Don’t grind tissue

side.

Remount and move anteriors out to the buccal.

“F” and “V” sound indistinct:

Improper position of upper anterior- either vertically or

horizontally.

CAUSES:

SOLUTIONS:

Difficult adjustment- must decode and try to correct.

Swallowing interference Troubleshooting


Maxillary Interference

Mandibular Interference

Over Closed Vertical

Open Vertical

Posteriors too far lingual.



Maxillary Swallowing Interference:

Over extension in the posterior buccal flanges.

Too thick in lingual posterior flanges.

CAUSES:

SOLUTIONS:Carefully reduce distal buccal flange.

Adjust by thinning dentures from the outside, not the

tissue side.



Mandibular Swallowing Interference:

Over extension in the lingual.

Too thick in the posterior.

CAUSES:

SOLUTIONS:

Carefully reduce flange.

Reduce from outside- do not grind tissue side.



Over Closed Vertical Swallowing Interference:

Vertical is over closed.

CAUSES:

SOLUTIONS:

Remount and reset to correct VDO.



Open Vertical Swallowing Interference:

Vertical is open.

CAUSES:

SOLUTIONS:

Remount and reset to correct VDO.



Posterior too far lingual swallowing interference:

Posteriors too far lingual

Tongue Crowding

CAUSES:

SOLUTIONS:

Remount and reset opening arch to allow more

tongue room.



Gagging Troubleshooting


Gagging immediately upon insertion.

Delayed Gagging: 2 weeks to 2 months post delivery.



Immediate Gagging on Insertion:

Maxillary: Over extension, too thick at posterior border.

Mandibular: Distal-Lingual Flange too thick.

CAUSES:

SOLUTIONS:Maxillary: Double post dam and cut back to anterior

post dam. Shorten appliance.

Mandibular: Reduce from the outside. Do not grind tissue side.



Delayed Gagging- 2 weeks to 2 months

post delivery:

Faulty post dam allowing saliva to creep under denture.

Malocclusion allowing denture to loosen causing saliva

seepage.

CAUSES:

SOLUTIONS:

Grind out post dam area and take wash impression for

lab to rebase.

Remount and mill-in. May be necessary to reset teeth.



Instability Troubleshooting


Instability when not Occluding

Instability when chewing food

Instability when Occluding in Centric



Instability when not occluding:

Overextension of borders and posterior

limits.

Under extended borders.

Loss of post dam seal, misplaced post dam

or insufficient post dam.

Dehydration of tissue due to alcoholism or

medication.

Flabby tissues displaced when taking

impression due to improper tray.

CAUSES:

SOLUTIONS:

A new impression is necessary. It is best to grind out the tissue side and take a

wash impression, using compound where necessary to extend impression to

include post dam area. Rebase entire denture.



Instability when chewing food:

Loss of post dam seal.

Anterior teeth too far labial.

Flabby anterior tissue.

Improper incising habits.

Lower posteriors set off ridge.

CAUSES:

SOLUTIONS: A new impression is necessary. It is best to grind out the tissue side and take a wash impression, using

compound where necessary to extend impression to include post dam area. Rebase entire denture.

Remount and reset bringing anteriors back lingually.

Surgery to remove poor denture foundation and rebase.

Patient education.

Reset and correct posterior alignment.

Instability when Occluding in Centric:

Malocclusion

Upper denture “riding” on hard palate

surface.

Flabby tissues over ridge.

Teeth set too far buccally

Centric occlusion not in harmony with

centric relationship.

CAUSES:

SOLUTIONS: Remount, grind and mill-in selective

teeth.

Remount and reset.

Try chairside mill-in or remount and set.

Relieve pressure area.

Remove flabby tissue with surgery and

rebase.

Remount and reset lingual.

Remake one denture.

Biting Cheeks and Tongue:

Posterior teeth set end to end.

Over closed.

Posterior teeth set too far to the lingual or buccal.

CAUSES:

SOLUTIONS:

Rearticulate and reset posteriors (wax try-in highly recommended).

Rearticulate and reset all teeth opening bite.

Rearticulate and reset posterior teeth.



Redness of Tissue Troubleshooting


Tissue getting red in denture bearing area.

All tissues becoming fiery red including cheeks and tongue.



Tissue getting red in denture bearing area:

Ill fitting denture base.

Improper cure of denture base.

Avitaminosis.

CAUSES:

SOLUTIONS: Take a wash impression and rebase denture. Check for prematurity

in the occlusion.

Rebase with heat cure acrylic.

Consider vitamin deficiency solutions.

All tissues becoming fiery red including

cheeks and tongue:

Denture base allergy (extremely rare).

CAUSES:

SOLUTIONS:

Change base material by having lab “jump” a

vinyl base material. Remove all acrylic teeth

and replace. A patch test should be taken.

Pain in Mandibular Joint:

Vertical over closed.

Centric relation off.

Arthritis

Trauma

CAUSES:

SOLUTIONS: Rearticulate and reset all teeth to open bite.

Take intra-oral tracing and reset. Retrial advised.

Consult patient’s doctor.

Difficult to correct.www.MorseDentalLab.com


Comfort Troubleshooting


Sore spot in vestibule

Sore spot in maxillary post dam

Individual sore spots on crest of ridge

General overall soreness on ridge

Sore under lower lingual flange

Sore under lower labial flange

Sore spot in vestibule- maxillary or

mandibular denture:

Overextended borders.

Rough spot in base.

CAUSES:

SOLUTIONS:

Shorten borders and polish.

Refinish borders.



Sore spot in upper post dam or posterior

limit of upper:

Post dam too deep.

Sharp edges on the posterior seal.

Overextended.

CAUSES:

SOLUTIONS: Reduce base carefully and gradually to avoid loss of the border

seal.


Refinish borders.www.MorseDentalLab.com


Individual sore spots on the crest of the

ridge:

Premature occlusion

Inaccurate denture base.

Voids or porosity in acrylic.

Nodules under base.

CAUSES:

SOLUTIONS: New centric registration or accurate bite.

Remount dentures on articulator and

adjust.

Take wash impression and rebase after

tissue treatment.

Reduce base carefully and gradually to

avoid loss of the border seal.


Refinish borders.

Remove nodules.

General overall soreness on ridge:

Vertical open too much.

Totally inaccurate denture base.

Malocclusion or improper interdigitation.

CAUSES:

SOLUTIONS: Remake one of the dentures to correct vertical, if plane of

occlusion is correct.

Try a wash impression and rebase.

Remake denture after tissue treatment.

Sore under lower lingual flange:

Centric off, mastication drives lower forward.

Lingual flange overextended.

Posteriors too far distal.

CAUSES:

SOLUTIONS: Recheck vertical and centric. Rearticulate and remove the

interfering cusps or change to non-interfering teeth.

Shorten and polish flange.

Remove second molars.

Sore under lower labial flange:

Too much overbite.

Over extended labial flange.

When masticating, patient throws lower forward.

CAUSES:

SOLUTIONS:

Rearticulate and change tooth position.

Shorten flange and repolish.

Recheck vertical and centric. Check lingual flanges, shorten.www.MorseDentalLab.com


Burning Sensation Troubleshooting


Burning feeling on hard palate area or on lower anterior ridge

Burning feeling in bicuspid area to tuberosities

Burning feeling on upper anterior ridge



Burning feeling on hard palate area or on

lower anterior ridge:

High pressure area in the acrylic base.

Pressure on a nerve as it leaves nasopalatine.

Under-cured base.

Diabetic nerve pain

CAUSES:

SOLUTIONS:

Locate the high area, remove and polish.

Rebase denture with heat cured acrylic.www.MorseDentalLab.com


Burning feeling in bicuspid area to

tuberosities:

High pressure area in the acrylic base.


Under-cured base.

Diabetic nerve pain

CAUSES:

SOLUTIONS:

Locate the high area, remove and polish.

Grind first bicuspid out of occlusion.

Rebase denture with heat cured acrylic.

Burning feeling on upper anterior ridge:

Pressure on papilla and rugae area.


Under-cured base.

Diabetic nerve pain

CAUSES:

SOLUTIONS:

Relieve denture in papilla and/or rugae area.

Rebase denture with heat cured acrylic.



Denture and Partial Troubleshooting Guide

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Transcript of Denture and Partial Troubleshooting Guide