Denture LoosenessDenture LoosenessCD & RPDCD & RPD
Denture LoosenessDenture LoosenessCD & RPDCD & RPD
•OcclusionOcclusion•Denture base (fit & Denture base (fit & contour)contour)
•Poor anatomyPoor anatomy
•OcclusionOcclusion•Denture base (fit & Denture base (fit & contour)contour)
•Poor anatomyPoor anatomy
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusionDenture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusion
Typical HistoryTypical History
Adequate retention Adequate retention initially initially
Gets worse with timeGets worse with time
Typical HistoryTypical History
Adequate retention Adequate retention initially initially
Gets worse with timeGets worse with time
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusionDenture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusion
Perpetually Loose Maxillary Perpetually Loose Maxillary DentureDenture• Heavy anterior interferences Heavy anterior interferences can cause loosening at can cause loosening at posteriorposterior
• Tuberosity mucosa grows into Tuberosity mucosa grows into spacespace
• Space develops under midline Space develops under midline of denture baseof denture base
Perpetually Loose Maxillary Perpetually Loose Maxillary DentureDenture• Heavy anterior interferences Heavy anterior interferences can cause loosening at can cause loosening at posteriorposterior
• Tuberosity mucosa grows into Tuberosity mucosa grows into spacespace
• Space develops under midline Space develops under midline of denture baseof denture base
TuberosityTuberosity
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusionDenture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusion
Tilting Growth Loss Tilting Growth Loss of retentionof retention
Tilting Growth Loss Tilting Growth Loss of retentionof retention
InclinedInclinedResidual RidgeResidual Ridge
InclinedInclinedResidual RidgeResidual Ridge
LipLipLipLip
Denture LoosenessDenture LoosenessCD & RPD: OcclusionCD & RPD: OcclusionDenture LoosenessDenture Looseness
CD & RPD: OcclusionCD & RPD: Occlusion
•Incisors placed Incisors placed too far labiallytoo far labially
•Denture displacesDenture displaceslingually.lingually.
•Inclined ridge Inclined ridge provides no provides no resistance.resistance.
•Incisors placed Incisors placed too far labiallytoo far labially
•Denture displacesDenture displaceslingually.lingually.
•Inclined ridge Inclined ridge provides no provides no resistance.resistance.
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusionDenture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusion
Tilting/jiggling Tilting/jiggling caused by:caused by:• Contacts not Contacts not centered over centered over ridgeridge
• Contacts on Contacts on inclined portion inclined portion of ridgeof ridge
Tilting/jiggling Tilting/jiggling caused by:caused by:• Contacts not Contacts not centered over centered over ridgeridge
• Contacts on Contacts on inclined portion inclined portion of ridgeof ridge
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusionDenture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusion
Check for looseness in excursions Check for looseness in excursions with fingers on canineswith fingers on canines
Check for looseness in excursions Check for looseness in excursions with fingers on canineswith fingers on canines
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusionDenture LoosenessDenture LoosenessCD & RPD: CD & RPD: OcclusionOcclusion
• Check centric Check centric position position (articulating (articulating paper)paper)–even, stable contacts even, stable contacts both sidesboth sides
–stop patient upon stop patient upon initial contactinitial contact
• Check centric Check centric position position (articulating (articulating paper)paper)–even, stable contacts even, stable contacts both sidesboth sides
–stop patient upon stop patient upon initial contactinitial contact
Denture LoosenessDenture LoosenessCD & RPDCD & RPD
Denture LoosenessDenture LoosenessCD & RPDCD & RPD
•OcclusionOcclusion•Denture base (fit & Denture base (fit & contour)contour)
•Poor anatomyPoor anatomy
•OcclusionOcclusion•Denture base (fit & Denture base (fit & contour)contour)
•Poor anatomyPoor anatomy
Denture LoosenessDenture LoosenessMandibular lingual flange Mandibular lingual flange
too thicktoo thick
Denture LoosenessDenture LoosenessMandibular lingual flange Mandibular lingual flange
too thicktoo thick
TongueTongueTongueTongue
Flange bulges into tongue space, Flange bulges into tongue space, lifts denture during function. lifts denture during function. Flange is not too long. Flange is not too long.
Flange bulges into tongue space, Flange bulges into tongue space, lifts denture during function. lifts denture during function. Flange is not too long. Flange is not too long.
“Eyes in Your Fingers” Blanchard, JPD 2:36
“Eyes in Your Fingers” Blanchard, JPD 2:36
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Denture BaseDenture BaseDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Denture BaseDenture Base
Short flangeShort flange •PIP streaksPIP streaks•Looks short of Looks short of vestibulevestibule
•Often displaces Often displaces easilyeasily
Short flangeShort flange •PIP streaksPIP streaks•Looks short of Looks short of vestibulevestibule
•Often displaces Often displaces easilyeasily
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Denture BaseDenture BaseDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Denture BaseDenture Base
Long flangeLong flange • PIP burnthroughPIP burnthrough• Retentive until Retentive until speaking, eatingspeaking, eating
• Watch when seating Watch when seating denturedenture- Flange touches Flange touches vestibular depth, vestibular depth, denture continues to denture continues to seatseat
Long flangeLong flange • PIP burnthroughPIP burnthrough• Retentive until Retentive until speaking, eatingspeaking, eating
• Watch when seating Watch when seating denturedenture- Flange touches Flange touches vestibular depth, vestibular depth, denture continues to denture continues to seatseat
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Denture BaseDenture BaseDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Denture BaseDenture Base
• If flange is too thick, seal If flange is too thick, seal may be maintained at restmay be maintained at rest
• If flange is also short or If flange is also short or long, displacement may occur long, displacement may occur as lips or cheeks move, as lips or cheeks move, allowing air to break allowing air to break vestibular sealvestibular seal
• If flange is too thick, seal If flange is too thick, seal may be maintained at restmay be maintained at rest
• If flange is also short or If flange is also short or long, displacement may occur long, displacement may occur as lips or cheeks move, as lips or cheeks move, allowing air to break allowing air to break vestibular sealvestibular seal
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Denture BaseDenture BaseDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Denture BaseDenture Base
PrinciplePrinciple
Always have the Always have the patient demonstrate patient demonstrate
how a denture loosenshow a denture loosens
PrinciplePrinciple
Always have the Always have the patient demonstrate patient demonstrate
how a denture loosenshow a denture loosens
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Denture BaseDenture BaseDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Denture BaseDenture Base
Lack of post dam/ Lack of post dam/ retrozygomal sealretrozygomal seal• Pull upward and Pull upward and outward on canineoutward on canine
• Test hypothesis:Test hypothesis: add add compound/functional compound/functional wax -opposite sidewax -opposite side
Lack of post dam/ Lack of post dam/ retrozygomal sealretrozygomal seal• Pull upward and Pull upward and outward on canineoutward on canine
• Test hypothesis:Test hypothesis: add add compound/functional compound/functional wax -opposite sidewax -opposite side
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Denture BaseDenture BaseDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Denture BaseDenture Base
•Poor base Poor base adaptationadaptation
•Fulcrum on bony Fulcrum on bony structuresstructures
•Test hypothesis: Test hypothesis: PIPPIP
•Poor base Poor base adaptationadaptation
•Fulcrum on bony Fulcrum on bony structuresstructures
•Test hypothesis: Test hypothesis: PIPPIP
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Denture BaseDenture BaseDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Denture BaseDenture Base
Periphery terminates on Periphery terminates on bony structuresbony structures– Hard palateHard palate– ZygomaZygoma– External oblique ridgeExternal oblique ridge– Before retromolar padBefore retromolar pad
• No seal, discomfortNo seal, discomfort• Eventual resorptionEventual resorption
Periphery terminates on Periphery terminates on bony structuresbony structures– Hard palateHard palate– ZygomaZygoma– External oblique ridgeExternal oblique ridge– Before retromolar padBefore retromolar pad
• No seal, discomfortNo seal, discomfort• Eventual resorptionEventual resorption
Dry MucosaDry MucosaDry MucosaDry Mucosa
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Denture BaseDenture BaseDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Denture BaseDenture Base
PrinciplePrinciple
Denture peripheries always Denture peripheries always terminate on displaceable terminate on displaceable
soft tissuessoft tissues
Retromolar pads, Vestibular tissues, Retromolar pads, Vestibular tissues, Vibrating line (nonmoveble soft Vibrating line (nonmoveble soft
palate), Hamular notchespalate), Hamular notches
PrinciplePrinciple
Denture peripheries always Denture peripheries always terminate on displaceable terminate on displaceable
soft tissuessoft tissues
Retromolar pads, Vestibular tissues, Retromolar pads, Vestibular tissues, Vibrating line (nonmoveble soft Vibrating line (nonmoveble soft
palate), Hamular notchespalate), Hamular notches
Gagging with DenturesGagging with DenturesGagging with DenturesGagging with Dentures
• Usually not soft palate contactUsually not soft palate contact• Denture contact with Denture contact with tonguetongue : :
– thick posterior border rubs on tonguethick posterior border rubs on tongue– posterior border drops onto tongue:posterior border drops onto tongue:
- Occlusal interferencesOcclusal interferences- Terminates on hard palate (no seal)Terminates on hard palate (no seal)
• Usually not soft palate contactUsually not soft palate contact• Denture contact with Denture contact with tonguetongue : :
– thick posterior border rubs on tonguethick posterior border rubs on tongue– posterior border drops onto tongue:posterior border drops onto tongue:
- Occlusal interferencesOcclusal interferences- Terminates on hard palate (no seal)Terminates on hard palate (no seal)
Denture LoosenessDenture LoosenessDenture Base: Denture Base: Coronoid Coronoid
InterferenceInterference
Denture LoosenessDenture LoosenessDenture Base: Denture Base: Coronoid Coronoid
InterferenceInterference
• Thick flange in Thick flange in retrozygomal arearetrozygomal area
• Coronoid gets closer to Coronoid gets closer to tuberosity as patient tuberosity as patient opens or moves jaw to sideopens or moves jaw to side
• Dislodges maxillary Dislodges maxillary denturedenture
• Thick flange in Thick flange in retrozygomal arearetrozygomal area
• Coronoid gets closer to Coronoid gets closer to tuberosity as patient tuberosity as patient opens or moves jaw to sideopens or moves jaw to side
• Dislodges maxillary Dislodges maxillary denturedenture
Denture LoosenessDenture LoosenessDenture Base: Denture Base: Pterygomandibular Pterygomandibular
RapheRaphe
Denture LoosenessDenture LoosenessDenture Base: Denture Base: Pterygomandibular Pterygomandibular
RapheRaphe
•Raphe from area of Raphe from area of hamular notchhamular notch
•Very tight in some Very tight in some patients patients
•Easily displaceable, Easily displaceable, but raphe can but raphe can displace denture displace denture opening wideopening wide
•Raphe from area of Raphe from area of hamular notchhamular notch
•Very tight in some Very tight in some patients patients
•Easily displaceable, Easily displaceable, but raphe can but raphe can displace denture displace denture opening wideopening wide
Denture LoosenessDenture LoosenessDenture Base: Denture Base: Palatal CleftPalatal Cleft
Denture LoosenessDenture LoosenessDenture Base: Denture Base: Palatal CleftPalatal Cleft
•In some patients In some patients midline soft palate midline soft palate fissurefissure
•Can “tent” during Can “tent” during functionfunction
•Allows air to leak Allows air to leak under dentureunder denture
•In some patients In some patients midline soft palate midline soft palate fissurefissure
•Can “tent” during Can “tent” during functionfunction
•Allows air to leak Allows air to leak under dentureunder denture
Denture LoosenessDenture LoosenessCD & RPDCD & RPD
Denture LoosenessDenture LoosenessCD & RPDCD & RPD
•OcclusionOcclusion•Denture base (fit & Denture base (fit & contour)contour)
•Poor anatomyPoor anatomy
•OcclusionOcclusion•Denture base (fit & Denture base (fit & contour)contour)
•Poor anatomyPoor anatomy
Denture LoosenessDenture LoosenessCD & RPD: CD & RPD: Poor AnatomyPoor AnatomyDenture LoosenessDenture Looseness
CD & RPD: CD & RPD: Poor AnatomyPoor Anatomy
• Many sets of denturesMany sets of dentures• Use articulator, more complex Use articulator, more complex impression and jaw relation impression and jaw relation proceduresprocedures
• ImplantsImplants• ReferRefer
• Many sets of denturesMany sets of dentures• Use articulator, more complex Use articulator, more complex impression and jaw relation impression and jaw relation proceduresprocedures
• ImplantsImplants• ReferRefer
OverviewOverviewOverviewOverview
•Deal with denture problems Deal with denture problems systematicallysystematically
•Use a differential diagnosisUse a differential diagnosis•Address probable causes until Address probable causes until problem is eliminatedproblem is eliminated
•If can’t identify problem, If can’t identify problem, referrefer
•Deal with denture problems Deal with denture problems systematicallysystematically
•Use a differential diagnosisUse a differential diagnosis•Address probable causes until Address probable causes until problem is eliminatedproblem is eliminated
•If can’t identify problem, If can’t identify problem, referrefer
Phonetic ProblemsPhonetic ProblemsPhonetic ProblemsPhonetic Problems
LispingLisping::–too much overjettoo much overjet–triangular spaces between triangular spaces between embrasures of max. & mand. teethembrasures of max. & mand. teeth
–palatal contour too constrictedpalatal contour too constricted–insufficient tongue spaceinsufficient tongue space
LispingLisping::–too much overjettoo much overjet–triangular spaces between triangular spaces between embrasures of max. & mand. teethembrasures of max. & mand. teeth
–palatal contour too constrictedpalatal contour too constricted–insufficient tongue spaceinsufficient tongue space
Difficult Denture PatientsDifficult Denture PatientsDifficult Denture PatientsDifficult Denture Patients
•Anatomic ProblemAnatomic Problem•Diagnosis ProblemDiagnosis Problem•Adaptive ProblemAdaptive Problem•Psychologic Psychologic ProblemProblem
•Anatomic ProblemAnatomic Problem•Diagnosis ProblemDiagnosis Problem•Adaptive ProblemAdaptive Problem•Psychologic Psychologic ProblemProblem
Difficult Denture PatientsDifficult Denture PatientsDifficult Denture PatientsDifficult Denture Patients
PrinciplePrincipleIf you can’t determine the If you can’t determine the problem using indicating problem using indicating
medium: medium: 1. Tell the patient1. Tell the patient
2. Don’t adjust2. Don’t adjust
3. Refer3. Refer
PrinciplePrincipleIf you can’t determine the If you can’t determine the problem using indicating problem using indicating
medium: medium: 1. Tell the patient1. Tell the patient
2. Don’t adjust2. Don’t adjust
3. Refer3. Refer
Difficult Denture PatientsDifficult Denture PatientsDifficult Denture PatientsDifficult Denture Patients
PrinciplePrinciple
Never pretend to adjust a Never pretend to adjust a denturedenture
Reinforces maladaptive behaviour Reinforces maladaptive behaviour - harder for the next guy- harder for the next guy
PrinciplePrinciple
Never pretend to adjust a Never pretend to adjust a denturedenture
Reinforces maladaptive behaviour Reinforces maladaptive behaviour - harder for the next guy- harder for the next guy
Difficult Denture PatientsDifficult Denture PatientsAdaptive ProblemAdaptive Problem
Difficult Denture PatientsDifficult Denture PatientsAdaptive ProblemAdaptive Problem
•Elderly take more time to adaptElderly take more time to adapt•More teeth missing, less More teeth missing, less adaptation adaptation (loss (loss of PDM receptors)of PDM receptors)
•Better perception - less Better perception - less adaptiveadaptive
•Elderly take more time to adaptElderly take more time to adapt•More teeth missing, less More teeth missing, less adaptation adaptation (loss (loss of PDM receptors)of PDM receptors)
•Better perception - less Better perception - less adaptiveadaptive
Difficult Denture PatientsDifficult Denture PatientsAdaptive ProblemAdaptive Problem
Difficult Denture PatientsDifficult Denture PatientsAdaptive ProblemAdaptive Problem
•Denture may be the cause of the Denture may be the cause of the problemproblem
•Patient response may also be part Patient response may also be part of the problemof the problem
•Denture may be the cause of the Denture may be the cause of the problemproblem
•Patient response may also be part Patient response may also be part of the problemof the problem
Difficult Denture PatientsDifficult Denture PatientsAdaptive/Adaptive/PsychologicPsychologic Problem ProblemDifficult Denture PatientsDifficult Denture PatientsAdaptive/Adaptive/PsychologicPsychologic Problem Problem
Dentist’s response to patient Dentist’s response to patient may also affect the patient may also affect the patient
response to the dentureresponse to the denture
““Laying on of Hands”Laying on of Hands”
Dentist’s response to patient Dentist’s response to patient may also affect the patient may also affect the patient
response to the dentureresponse to the denture
““Laying on of Hands”Laying on of Hands”
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPreventionPrevention
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPreventionPrevention
•Good interview techniqueGood interview technique•Tips Tips
– Many denturesMany dentures– Disparaging previous Disparaging previous dentures/dentistsdentures/dentists
– Body Language/ DeportmentBody Language/ Deportment
•Good interview techniqueGood interview technique•Tips Tips
– Many denturesMany dentures– Disparaging previous Disparaging previous dentures/dentistsdentures/dentists
– Body Language/ DeportmentBody Language/ Deportment
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
1. Recognize & 1. Recognize & AcknowledgeAcknowledge Problem Problem– Open ended questionsOpen ended questions– Let patient identify problemLet patient identify problem– If you identify the wrong problem - If you identify the wrong problem - failfail
1. Recognize & 1. Recognize & AcknowledgeAcknowledge Problem Problem– Open ended questionsOpen ended questions– Let patient identify problemLet patient identify problem– If you identify the wrong problem - If you identify the wrong problem - failfail
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
2. Explore and Identify Problems2. Explore and Identify Problems–Let the patient talk (silence)Let the patient talk (silence)–Watch for nonverbal cluesWatch for nonverbal clues–Short verbal clues may be significant Short verbal clues may be significant
(“...and I guess the appearance”)(“...and I guess the appearance”)
–Don’t be afraid of questions relating to Don’t be afraid of questions relating to emotional healthemotional health
2. Explore and Identify Problems2. Explore and Identify Problems–Let the patient talk (silence)Let the patient talk (silence)–Watch for nonverbal cluesWatch for nonverbal clues–Short verbal clues may be significant Short verbal clues may be significant
(“...and I guess the appearance”)(“...and I guess the appearance”)
–Don’t be afraid of questions relating to Don’t be afraid of questions relating to emotional healthemotional health
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
3. Interpret & Explain Problems3. Interpret & Explain Problems–Advise patient of your viewAdvise patient of your view–Use care in dealing with emotional Use care in dealing with emotional problemsproblems
–Don’t be afraid to address Don’t be afraid to address emotional componentemotional component
3. Interpret & Explain Problems3. Interpret & Explain Problems–Advise patient of your viewAdvise patient of your view–Use care in dealing with emotional Use care in dealing with emotional problemsproblems
–Don’t be afraid to address Don’t be afraid to address emotional componentemotional component
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
4. Offer a Solution4. Offer a Solution–If chance denture will not be a If chance denture will not be a success, state at outsetsuccess, state at outset
–If sense trouble, refer or address If sense trouble, refer or address immediatelyimmediately
–If suggest a therapist, patient will If suggest a therapist, patient will run or say yesrun or say yes
4. Offer a Solution4. Offer a Solution–If chance denture will not be a If chance denture will not be a success, state at outsetsuccess, state at outset
–If sense trouble, refer or address If sense trouble, refer or address immediatelyimmediately
–If suggest a therapist, patient will If suggest a therapist, patient will run or say yesrun or say yes
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
If bells go off in your If bells go off in your head, listen to them, talk head, listen to them, talk more, don’t proceed past more, don’t proceed past
interview, until satisfiedinterview, until satisfied
If bells go off in your If bells go off in your head, listen to them, talk head, listen to them, talk more, don’t proceed past more, don’t proceed past
interview, until satisfiedinterview, until satisfied
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemPrevention: InterviewPrevention: Interview
•Remember: Most patients are not Remember: Most patients are not problem patientsproblem patients
•80-85% are satisfied80-85% are satisfied•Better adaptation than eyeglass Better adaptation than eyeglass wearerswearers
•Remember: Most patients are not Remember: Most patients are not problem patientsproblem patients
•80-85% are satisfied80-85% are satisfied•Better adaptation than eyeglass Better adaptation than eyeglass wearerswearers
Adaptive, Psychologic ProblemAdaptive, Psychologic ProblemAdaptive, Psychologic ProblemAdaptive, Psychologic Problem
Rule out objective findingsRule out objective findings
Chart findings objectivelyChart findings objectivelyRule out objective findingsRule out objective findings
Chart findings objectivelyChart findings objectively
OverviewOverviewOverviewOverview
•Deal with denture problems Deal with denture problems systematicallysystematically
•Use a differential diagnosisUse a differential diagnosis•Address probable causes until Address probable causes until problem is eliminatedproblem is eliminated
•If can’t identify problem, referIf can’t identify problem, refer
•Deal with denture problems Deal with denture problems systematicallysystematically
•Use a differential diagnosisUse a differential diagnosis•Address probable causes until Address probable causes until problem is eliminatedproblem is eliminated
•If can’t identify problem, referIf can’t identify problem, refer
Top Related