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

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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

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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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