Differential Diagnosis of Post-Insertion Problems.

Differential Diagnosis of Differential Diagnosis of

Post-Insertion ProblemsPost-Insertion Problems

Differential Diagnosis of Differential Diagnosis of

Post-Insertion ProblemsPost-Insertion Problems

Principles of Diagnosing Principles of Diagnosing Denture ProblemsDenture Problems


• Never adjust unless you can see exactly where to adjust

• Use indicator medium – (PIP, indelible marker, articulating paper, etc.)

Loney & Knechtel, J Prosthetic Dent

2009;101:137-141

• Never adjust unless you can see exactly where to adjust

• Use indicator medium – (PIP, indelible marker, articulating paper, etc.)

Loney & Knechtel, J Prosthetic Dent

2009;101:137-141

Place Paste with Streaks

Place Paste with Streaks

Mostly colour of PasteMostly colour of Paste

Pressure 1st MolarsPressure 1st MolarsPressure 1st MolarsPressure 1st Molars

• Streaks - no contact (N)

• No Paste - Impingement (I)

• Paste, no streaks - normal contact (C)

• Streaks - no contact (N)

• No Paste - Impingement (I)

• Paste, no streaks - normal contact (C)



•Patients frequently wrong in exactly locating source of problem

•Patients frequently wrong in exactly locating source of problem



•Spend time to look and think

•Spend time to look and think



•Where?–Dentist needs to locate (PIP, tip of instrument, indelible stick)

•When?–(Chewing only?)

•Where?–Dentist needs to locate (PIP, tip of instrument, indelible stick)

•When?–(Chewing only?)



•How long?•Anything makes it better or worse?

•Have patient demonstrate problem

•How long?•Anything makes it better or worse?

•Have patient demonstrate problem

Limited number of Limited number of problems:problems:

Limited number of Limited number of problems:problems:

•Denture base•Occlusion - –Interferences - esp. protrusive

•Retention•Vertical dimension•Allergies and infections•Tooth position

•Denture base•Occlusion - –Interferences - esp. protrusive

•Retention•Vertical dimension•Allergies and infections•Tooth position

Denture BaseDenture BaseDenture BaseDenture Base

•Impingements, spicules, sharp edges

•Diagnosis - PIP (never adjust unless burnthrough)

•Impingements, spicules, sharp edges

•Diagnosis - PIP (never adjust unless burnthrough)

Denture BaseDenture BaseDenture BaseDenture Base

•Sore all time•If worsens throughout day may be occlusion, not denture base

•May still be occlusal, if inflammation causes swelling

•Sore all time•If worsens throughout day may be occlusion, not denture base

•May still be occlusal, if inflammation causes swelling

OcclusionOcclusionOcclusionOcclusion

•One of most common problems–Pain gets worse through day–Difficult to determine, intraorally - reflex avoidance of pain

–Interferences - especially in protrusive

•One of most common problems–Pain gets worse through day–Difficult to determine, intraorally - reflex avoidance of pain

–Interferences - especially in protrusive

OcclusionOcclusionOcclusionOcclusion

–Fingers on canines - should feel smooooooooooth

–Sore when bite–Fit changes or comfort deteriorates through day

–Remount

–Fingers on canines - should feel smooooooooooth

–Sore when bite–Fit changes or comfort deteriorates through day

–Remount

Retention ProblemsRetention ProblemsRetention ProblemsRetention Problems

•Short flanges–PIP - still streaky–Fingers on canines outwards (post palatal seal)

•Short flanges–PIP - still streaky–Fingers on canines outwards (post palatal seal)


•Short flanges–Look for space–May be retentive for a while if a lip seal established, until movements disturbs the lip seal

•Short flanges–Look for space–May be retentive for a while if a lip seal established, until movements disturbs the lip seal


•Long flanges–Burn through (PIP)–Intrudes tissue when placed

–May not dislodge if good seal, may loosen after much function

•Long flanges–Burn through (PIP)–Intrudes tissue when placed

–May not dislodge if good seal, may loosen after much function


•Post-palatal seal–If the denture is short of the vibrating line, the denture may bind on hard palate, (check with PIP)

•Post-palatal seal–If the denture is short of the vibrating line, the denture may bind on hard palate, (check with PIP)


•Post-palatal seal–Inadequate tissue contact

•Food gets underneath •Bubbles as denture is placed (check with PIP)

–If over-extended to moveable soft palate

–denture loosens during speech, chewing

•Post-palatal seal–Inadequate tissue contact

•Food gets underneath •Bubbles as denture is placed (check with PIP)

–If over-extended to moveable soft palate

–denture loosens during speech, chewing

Occlusal Vertical Occlusal Vertical Dimension Dimension

(OVD)(OVD)

Occlusal Vertical Occlusal Vertical Dimension Dimension

(OVD)(OVD)•Excessive–Continual and generalized pain and fatigue or muscle soreness

•Insufficient–No power

•Excessive–Continual and generalized pain and fatigue or muscle soreness

•Insufficient–No power

Allergies and InfectionsAllergies and InfectionsAllergies and InfectionsAllergies and Infections

•Rare allergies -–General inflammation

•Hygiene–Generalized inflammation

•Rare allergies -–General inflammation

•Hygiene–Generalized inflammation

Tooth PositionTooth PositionTooth PositionTooth Position

–Instability (teeth not over ridge)

–Difficulty chewing (occlusal table not long enough - esp. rational teth)

–Cheek and lip biting (insufficient overjet)

–Instability (teeth not over ridge)

–Difficulty chewing (occlusal table not long enough - esp. rational teth)

–Cheek and lip biting (insufficient overjet)

Tooth PositionTooth PositionTooth PositionTooth Position

•Esthetic, phonetic problems

•May have to change position of teeth

•Esthetic, phonetic problems

•May have to change position of teeth

Most Common Areas Most Common Areas Requiring Adjustments Requiring Adjustments

Most Common Areas Most Common Areas Requiring Adjustments Requiring Adjustments •Maxillary–Hamular notches - ulceration can occur if over-extended

–Labial frenum - requires adequate relief (often feels too bulky to the patient)

•Maxillary–Hamular notches - ulceration can occur if over-extended

–Labial frenum - requires adequate relief (often feels too bulky to the patient)

The maxillary labial frenum is the most common frenum to The maxillary labial frenum is the most common frenum to become irritated from denture overextensionbecome irritated from denture overextension

Most Common Areas Most Common Areas Requiring AdjustmentsRequiring AdjustmentsMost Common Areas Most Common Areas

Requiring AdjustmentsRequiring Adjustments

•Maxillary–Mid-line fulcrum on the bony raphe

–Zygomatic impringement

•Maxillary–Mid-line fulcrum on the bony raphe

–Zygomatic impringement


Requiring AdjustmentsRequiring Adjustments•Mandibular–Lingual frenum - impingement can cause displacement of the denture of ulceration

•Mandibular–Lingual frenum - impingement can cause displacement of the denture of ulceration

Lesions associated with anterior mandibular denture border correspond to the PIP pattern.

Lesions associated with anterior mandibular denture border correspond to the PIP pattern.


Requiring AdjustmentsRequiring Adjustments

•Mandibular–Retromylohyoid overextensions•Sore throat•Denture moves when swallowing

–Buccal shelf overextension

•Mandibular–Retromylohyoid overextensions•Sore throat•Denture moves when swallowing

–Buccal shelf overextension


Requiring AdjustmentsRequiring Adjustments•Phonetic problems –Wait and allow time for adaptation

–Add soft wax to palate and check

–If anterior poorly positioned, then remove and replace

•Phonetic problems –Wait and allow time for adaptation

–Add soft wax to palate and check

–If anterior poorly positioned, then remove and replace

Differential Diagnosis of Post-Insertion Problems.

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