Denture complaints (Post insertion complaints in complete denture patients)
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Transcript of Denture complaints (Post insertion complaints in complete denture patients)
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Restore the patient`s functional, esthetic & mental discomforts as requests .
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Purpose of recall appointments is to eliminate
problems faced by patient in wearing of
denture.
Dentist must LISTEN, EXAMINE, TREAT the
condition.
Complaint to be categorized in patients own
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LOOSENESS
DISCOMFORT
POOR APPEARANCE
MISCELLANEOUS
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Symptoms :
Fall on speaking, laughing
Food entrapment
Pain
Why do denture become loose?
1. Decreased retentive forces
2. Increased displacing forces
3. Support problem
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1. Why Decreased retentive forces?
Lack of seal
Air beneath impression surface
Xerostomia
Poor neuromuscular control
What causes lack of seal?
Under extended borders in depth & width
Mx : addition of tracing compound to required
extension & processing it with acrylic
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• Incorrect PPS
Mx : border molding done in PPS & processed with
new material
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Extend of
posterior border
should not extend
beyond the PPS ;
as posterior
over extension
can lead to looseness of
denture while eating , laughing , coughing
etc…
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Addition of tracing compound to under extended borders8/15/2017 18smile
In elasticity of cheek
(agening,scleroderma,fibrosis)
Mx : slight reduction of depth &
width of borders &
border molding done
as increments.
RRR
Mx : relining
What are the causes for air entrapment
beneath impression surface?
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Poor fit during technical works
- Deficient impression
- Damaged cast
- Warped denture
- Over adjustment of impression surface
Mx : areas to be identified using Pressure
Indicating Paste (PIP) & relined
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Over trimming for insertion
Mx : rotational path of insertion, soft liner
used
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Excessive relief
Mx : relining
Trapped air expands as denture move away
from supporting tissue until it reaches
borders & seal is broken.
Change of fluid content of supporting tissue
due to:
- Lack of recovery of tissue from pressure of
old denture
- Use of diuretics
Mx : ensure old denture in not worn 72hrs prior
to impression making, reline/rebase by
minimum pressure technique8/15/2017 24smile
What are the causes for xerostomia?
Diabetes
Drugs (atropine,
phenothiazine,CPZ)
Menopause
Irradiation
Vitamin deficiency (A,
B12, B2, folic acid)
Sialolithiasis
Xerostomia causes reduced ability to form seal along
borders & impression surface of denture
Mx : artificial salivary substitutes, soups, intermittent
sipping of water, pilocarpine hydrochloride, sucking
sour candy8/15/2017 25smile
How can poor neuromuscular control interfere
with denture wearing?
Incorrect denture shape
Mx : denture should occupy in neutral zone &
polished surface should be contoured
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Tongue unable to control denture
Mx : proper tongue positioning need to be
trained
- Practice mouth opening / closing with tongue
in forward position resting against inside of
denture flange & lower front teeth even
while receiving any food.
- If maxillary denture become loose, advice
the patient to close the mouth & swallow
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Change in shape relative to old denture
Mx : duplication of old denture with provided
VD & occlusion
Upper/lower motor neuron disorder
Mx : denture adhesive
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2. Why increased displacing forces?
Over extended borders(posterior & distal
corner of maxillary denture)
Mx : use PIP & correct the borders
Poor fit
Mx : reline/rebase
Denture not in optimal space
Mx : reshaping the borders
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Occlusal problems
- Anterior & posterior prematrities
Mx : selective grinding
- MIP not coinciding with CR ( unable to
control mandible movements, poor ridge,
skeletal class II , non anatomic teeth )
Mx : remounting
- Incorrect plane of occlusion ( last tooth too
far, tuberosity)
Mx : last tooth removed
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3. What causes support problems?
(associated with contour of ridge)
Lack of ridge support {RRR}
Mx : optimal border extension in depth & width, denture adhesives
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Fibrous displaceable ridge – denture sink in
on mastication
Mx : reline / rebase, optimal Occlusal
balance8/15/2017 32smile
Bony prominence covered by thin mucosa
(midline suture, tori , posterior nasal spine)
Mx : relieve denture
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Symptoms :
Pain
Altered sensation
Difficulty in swallowing & chewing
Why denture casues discomfort?
1. Defect in impression surface
2. Defect in polished surface
3. Defect in Occlusal surface
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1. Defects in impression surface
Sharp acrylic nodule
Undercut areas & attachments not relieved
Over extension
Deep post dam- sore throat, difficulty in
swallowing
Lower knife edged ridge
Mx : PIP & trimming, use of permanent soft
liners
2. Defects in polished surface
thick distobuccal flange of upper denture
Mx : PIP & trimming
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3. Defects in occlusal surface
Premature contacts – pain on eating
CR not coinciding with MIP – pain &
ulceration lingual to lower anterior
ridge
Insufficient incisal over jet – pain /ulceration on
labial aspect of lower ridge
Mx : selective grinding, trimming, heal ulcer(avoid
denture wearing 1 day)
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Excessive VD
Mx : VD >2mm – remake denture
Insufficient over jet – cheek/lip biting
Mx : posteriorly buccal cusps rounded,
anteriorily lower incisors corrected
Teeth placed lingual to lower ridge – tongue
biting
Mx : remove lower lingual cusps
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OCCLUSAL
PREMATURITIES
WITH
DECREASED
OVERJET &
OVERBITE
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Symptoms :
Insufficient tooth visiblity
Too much tooth visibility
Creases at corner of mouth
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Excessive tooth visibility
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Causes for insufficient / excessive tooth
visibility
1. Improper orientation of Occlusal plane
2. Improper VD
3. Improper labiolingual & labiopalatal
positioning of anterior teeth
Mx : remaking denture
Patient consent need to be taken for aesthetics
during try-in
Creases at corner of mouth
1. Decreased labial fullness
2. Decreased VD
Mx : remake denture
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1. Speech problems
2. Difficulty in eating
3. Clattering of teeth while eating & speaking
4. Altered taste
5. Nausea & gagging
6. Fibrous hyperplasia
7. Microbial infections
8. Soft tissue irritation
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SPEECH PROBLEMS
1. Problem with sibilants “S”
- Tooth contact on saying “S” due to
increased VD & excessive overbite
2. Problem with bilabial sounds “P” & “B”
- Incorrect VD & incisor position
3. Problem with labiodentals “F” & “V”
- Incorrect VD & upper anterior placed too far
back
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EATING DIFFICULTY
1. Instability
2. Posterior teeth trimmed more
3. Incorrect VD
CLATTERING OF TEETH WHILE SPEAKING &
EATING
1. Increased VD
2. Increased incisor overlapping
3. Loose denture
4. Cuspal interference
5. Use of porcelain teeth
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ALTERED TASTE
1. Acrylic reduces thermal conductivity
2. Alternative with metal base
NAUSEA & GAGGING
1. Loose denture
2. Poor occlusion
3. Thick distal terminal of upper denture & overextended posterior border of upper denture
4. Palatal placement of upper posterior
5. Psychogenic (fear of aspiration of denture & saliva pooling)
6. Prefer atropine & sedatives at initial period of denture use
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Whistling- high vault palate
Ear ache – decreased VD & Occlusal
prematurities
Food & saliva under denture
Drooling of saliva – decreased VD
Inability to eat meat
Allergy
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Denture insertion appointment is very important in
delivering a functional & aesthetic denture to the
patient. More important is the need for the patient
to understand the limitations of the denture service
& to comprehend the use &care of dentures.
Dentist need to spend time in educating &
recalling the patient for complete denture as it will
lead to success of denture!
Success of complete denture treatment depends on relievingcomplaints which are posed at different time intervals..
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Textbook of Prosthodontics – V Rangarajan
Textbook of Prosthodontics – Nallaswamy
Prosthodontic Treatment for Edentulous
Patients – Zarb Bolender
A primer on complete denture Prosthodontics
– K.Chandrashekharan Nair
World Wide Web
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