managing problems in complete dentures_lecture

Managing Problems in Managing Problems in

Complete Dentures Complete Dentures

Dent 445Removable Prosthodontics (4) Dr Esam Alem

Textbook Reference: Chapter 17

Complete Prosthodontics: Problems, diagnosis and managementAA Grant, JR Heath, JF McCordp. 33-88

Managing Denture ProblemsManaging Denture Problems

I. Direct from denture

II. Indirect from denture

III. Related to patients



A. Related to denture surfaces

B. Related to denture function

C. Related to esthetics

D. Related to phonetics






1. Borders

2. Fitting surface

3. Polished surface

4. Teeth




1. Borders

a. Overextension

b. Underextension

c. Overcontoured flanges

d. Undercontoured flanges

SHORT TERM

COMPLAINTSLONG TERM




1. Borders

a. Overextension

1




1. Borders

a. Overextension

i. Immediate effect

- Pain

- Bleeding and ulcer

- Loss of retention before functional movements

- Loss of retention during functional movements

- Seen as areas exposed through PIP




1. Borders

a. Overextension

ii. Delayed (late) effect

- Ulcer

- Erythema (red area)

- Fibroma

- Hyperkeratinized mucosa

- TMD

- Loss of retention on functional movements

Managing overextensionsManaging overextensions

� Method 1 – Patient complaint

� Let the patient point to the area

� Problems with this

technique:

� Patient may not point

correctly to the area

� Reductions are not

controlled in amount or location

� Not all overextensions cab be detected by this method


� Method 2 – Indelible (Copier) pencil

– Locate area of erythema or ulceration

– Mark it with copier (indelible) pencil

– Seat the denture and allow the copier pencil ink to imprint on the denture


� Method 3 -

– Locate area of tissue reaction lesion

– Place PIP / disclosing wax

– Paste

– Wax

– Rubber

– Perform functional movements in the affected area

– Trim the denture flange where the border is exposed through the disclosing wax

– Repeat until no PIP / wax is displaced

• Note the ulcer associated with the denture border

overlying the canine eminence.

2

Note the posterior palatal seal area: The bead is too Note the posterior palatal seal area: The bead is too

deep and too sharp. Note the ulcer at the midline.deep and too sharp. Note the ulcer at the midline.

• Disclosing wax is tempered in a water

bath.

• Apply PIP or disclosing wax to the dried

denture border.

• Carefully insert the denture and mold the

borders of the selected area.

PIP or disclosing wax is used to check the length PIP or disclosing wax is used to check the length

of the denture borders. In this example it has of the denture borders. In this example it has

been placed in a disposable syringe.been placed in a disposable syringe.

• Carefully adjust the denture flange as necessary.

• Reapply, border mold and adjust until areas of overextension are eliminated.

• Other examples of commonly overextended

areasThese flanges are too thickThese flanges are too thick

These flanges are too longThese flanges are too long




1. Borders

a. Overextension

i. Delayed (late) effect

- Ulcers under labial flange

Causes: Overextended Flanges → Shorten

Excessive overbite → Adjust anterior occl.

Habitual mastication in protrusive relationship→ train patient to masticate in CR

These flanges are too thickThese flanges are too thick

These flanges are too longThese flanges are too long

3




1. Borders

b. Underextensions

i. Immediate effect

- Loss of retention before functional movement

- Loss of retention during functional movement

Managing Managing underextensionsunderextensions� Method

� Check for overextensions

� Check retention� Anterior retention

� Lateral retention

� Posterior retention

� Add green stick to build in the area under suspicion → Border mold with functional movements intra-orally

� Recheck retention

� Replace green stick with cold-cure acrylic (partial reline)

Anterior (labial flange) Anterior (labial flange)

retention check retention check →→

Hold anterior teeth and pull Hold anterior teeth and pull

denture down denture down labiallylabially

Lateral (Lateral (buccalbuccal flange) flange)


Hold Hold contralateralcontralateral posterior posterior

teeth and rotate flange away teeth and rotate flange away

from from sulcussulcus

Posterior (post dam) Posterior (post dam)


Place finger palatal to Place finger palatal to

anterior teeth and push anterior teeth and push

upward to rotate denture upward to rotate denture

down down posteriorlyposteriorly

Posterior (Posterior (hamularhamular notch) notch)


Press upwards on Press upwards on

contralateralcontralateral canine to rotate canine to rotate

denture down denture down posteriorlyposteriorly in in

hamularhamular notch areanotch area

4




2. Fitting Surface

a. Lateral Ridge Slopes

i. Nerve compression

ii. Unfavorable undercuts

b. Flat Areas

i. Palatal rugae area

ii. Palatal suture area

c. Crest of residual ridges




2. Fitting Surface



- Inferior Dental Nerve

- Mental Nerve




2. Fitting Surface




- Mental Nerve




2. Fitting Surface




- Mental Nerve




2. Fitting Surface


ii. Unfavorable undercuts

5


ii. Unfavorable Undercuts

• Maxillary

• Natural – due to anatomy of ridges

• Tuberosities

• Premaxillary (anterior) area

• Uncompressed extraction sockets

• Mandibular

• Natural

• Anterior area

• Internal oblique ridge

• Mylohyoid ridge

• Mandibular tori

• Uncompressed extraction sockets

Managing undercutsManaging undercuts

� Leave engaged

� No trauma

� A path of insertion present

� Minimal undercut

� E.g. normal max. ant. and tuberosity undercuts

� Lingual undercuts in lateral wall of ling. pouch


� Leave but partially block on cast

� Minimal trauma

� A path of insertion is present


� Block undercut with dental stone before

flasking and packing


� Reduce one side

� Minimal trauma


� Reduce both sides without compromising retention


� Preprosthetic surgical removal or

block-out and use implant-retained prosthesis

� If undercut is severe

� If blockout/relief of denture will compromise retention

� If undercuts encircle more than 180º

6




2. Fitting Surface

b. Flat Areas

i. Palatal rugae area

nasopalatine nerve compression

ii. Palatal suture area

thin mucoperiostium – check post dam

iii. Lateral palate

posterior palatine nerve compression




2. Fitting Surface

c. Crest of residual ridges

i. From ridge:

Bone spicules, knife edge, impacted roots, impacted teeth, cysts, nerves, thin mucosa

ii. From denture:

Denture surface may include sharp prominences

or irregularities

iii. From occlusion:

Heavy occlusal interferences

7




3. Polished surface

•• Finish borders with an acrylic bur. Finish borders with an acrylic bur. Remove excess resin beyond the Remove excess resin beyond the land. Be careful to preserve the land. Be careful to preserve the border width and contour. border width and contour.

•• Remove all plaster or stone.Remove all plaster or stone.

•• Smooth the denture bases to the Smooth the denture bases to the proper contour with your acrylic proper contour with your acrylic burs.burs.

•• Bubbles and other irregularities Bubbles and other irregularities around the denture teeth can be around the denture teeth can be removed with chisels or scrapers.removed with chisels or scrapers.

�� Remove small particles of stone from the Remove small particles of stone from the

proximal areas with a brush wheel.proximal areas with a brush wheel.

�� The palatal portion should be about 3 mm The palatal portion should be about 3 mm

thick (minimum 2 mm).thick (minimum 2 mm).

•• Check the bearing Check the bearing surfaces of the surfaces of the dentures for bubbles dentures for bubbles and sharp and sharp projections.projections.

•• Use a very wet rag wheel with liberal amounts of wet Use a very wet rag wheel with liberal amounts of wet

pumice to polish the palatal, lingual, labial and buccal areas. pumice to polish the palatal, lingual, labial and buccal areas. The periphery of the denture must also be carefully The periphery of the denture must also be carefully polished. Use the edge of the wheel as shown during polished. Use the edge of the wheel as shown during

polishing to avoid burning the acrylic resin. Do not polishing to avoid burning the acrylic resin. Do not overpolish and thereby loose the contours that were overpolish and thereby loose the contours that were developed during festooning.developed during festooning.

8

Polished denturesPolished dentures

Note that the borders are rounded and smooth, Note that the borders are rounded and smooth,

and the palate is highly polished and the proper and the palate is highly polished and the proper

thicknessthickness

Do not over polishDo not over polish

Be careful not to overpolish the occlusal or incisal Be careful not to overpolish the occlusal or incisal

surfaces of the denture teeth.surfaces of the denture teeth.

•• Reexamine the tissue side of the dentures Reexamine the tissue side of the dentures

and carefully remove any and carefully remove any bubblesbubbles present present

with a sharp instrument.with a sharp instrument.

•• Prior to delivery the dentures must be soaked in Prior to delivery the dentures must be soaked in

water for 72 hours.water for 72 hours.




4. Teeth

a. Cheek-biting

b. Tongue biting

c. Unfamiliarity with modifications

Managing Denture ProblemsManaging Denture Problemsa. Cheek-biting

Causes

• Thin or overextended periphery

(denture base material does not provide enough support for the cheek)

• Loss of tone of cheek musculature in old

patients

• Insufficient inter-arch clearance between distal part of denture

• Inadequate horizontal overjet in molar region (posterior edge-to-edge occlusion)

9

Managing Denture ProblemsManaging Denture Problemsa. Cheek-biting

Treatment

• Build out thin areas, or extend the short

periphery

• Trim maxillary denture buccal to tuberosityand/or from over retromolar pad of mandibular

denture

• Tooth positions

• Re-set teeth in correct relationship

• Recontour and polish buccal surface of mandibular posterior teeth to create horizontal overjet

Managing Denture ProblemsManaging Denture Problemsb. Tongue-biting

Causes

• Artifcial teeth positioned too far lingually

• Occlusal plane of is too low

• Large tongue : if lower posterior teeth missing for long time,

tongue muscles will lose muscle tone and

tongue will become broad and flattened. Tongue will regain normal contour with time












1. Denture Instability

a. Looseness of mandibular denture

b. Looseness of maxillary denture

2. Denture Interference

a. During swallowing

b. Tooth clicking





a. General looseness of mandibular denture

i. Causes

• Error in occlusion (centric occlusion not in harmony with centric relation)

• occlusal plane too high

• underextension of periphery (deficient

impression)

• Inability of patient to adapt and control denture

• Poor tongue position (retracted/guarded tongue position)





a. General looseness of mandibular denture

i. Treatments

→ Correct faulty occlusion by remount procedures and occlusal adjustment

→ Reset teeth at lower occlusal plane

→ Reliner/rebase denture providing proper

extension

10






i. While yawning or opening wide

ii. While rinsing

iii. While talking






i. While yawning or opening wide

ManidibleManidible -- While yawning or rinsingWhile yawning or rinsing

Causes

� Denture base too thick in buccal

posterior area (masseter exerts

forward force on posterior part of

denture)

� Overextended in retromolar area

(pterygomandibularraphe interference)

Treatment

� Reduce thickness of denture base

� Shorten denture until pterygomandibular

ligament does not

exert tension on posterior border

when mouth opens wide

Mandible Mandible -- While talkingWhile talkingCauses

� Inadequate seal in lingual pouch area

� Lingual flange overextensions

Treatment

� Correct seal with reline

� Shorten overextensions until

tongue does not

interfere causing lifting up of denture

and breakage of seal






i. Occasional

ii. When eating on sides

iii. Approximately every 2 hours

iv. While yawning/opening wide

v. While rinsing

vi. While bending over

vii. While talking

viii. Looseness when occluding in centric relation

Maxilla Maxilla –– occasional loosenessoccasional loosenessCauses

� Underextension in localized area

� Faulty occlusion

� Overextension of peripheries

� Xerostomia

� Displacement of

flabby tissues during impression

Treatment

� Reline

� Correct occlusion

� Adjust denture

� Treat cause

� Modify impression technique to change

primary denture bearing area

11

Maxilla Maxilla –– when eating on sideswhen eating on sidesCauses

� Non-yielding area in hard palate-midpalatine raphe(crestal ridge tissues yield under chewing stresses so denture rocks or “see-saws”across mid-palatal fulcrum)

� Incorrect tooth position (too far buccally)

� Chewing resistant foods

Treatment

� Provide relief area over rigid area

� Rebalance in lateral excursions; reset teeth in correct relationship to ridge

� Instruct patient to maintain soft diet until mouth is conditioned to wearing dentures

Maxilla Maxilla –– approx. every 2 hrsapprox. every 2 hrsCauses

� Heavy mucinoussaliva

� Incorrect tooth position (teeth too far

buccally or labially)

� Improper incising habits

� Loss of posterior

palatal seal (seal on palate; posterior limit

not in hamularnotches)

Treatment

� Prescribe astringent mouth wash; regular

cleaning of dentures; reduction of

carbohydrate intake may help

� Train patient to

masticate in centric relation

Maxilla Maxilla -- While yawning or rinsingWhile yawning or rinsingCauses

� Denture base too thick in buccal

posterior area (masseter exerts

forward force on posterior part of

denture)

� Overextended in retromolar area

(pterygomandibularraphe interference)

Treatment

� Reduce thickness of denture base

� Shorten denture until pterygomandibular

ligament does not

exert tension on posterior border

when mouth opens wide

Maxilla Maxilla –– while bending overwhile bending overCauses

� Overextended in posterior palatal seal

area

� Overextended in

hamular notch area

Treatment

� Reduce thickness/extension

of posterior palatal seal area

� Valsalva maneuver /

pip

Maxilla Maxilla –– while talkingwhile talkingCauses

� Inadequate posterior palatal seal area

� Overextended in posterior region

Treatment

� Reline posterior palatal seal

� Shorten posterior extension until soft

palate does not lift

upward and break contact with denture

base

Maxilla Maxilla –– in RCPin RCPCauses

� Incorrect occlusion

� Poor denture

foundation (flabby tissues over ridge)

� Teeth set too far

buccally / labially

� Centric occlusion not in harmony with

centric relation

� Midpalatine suture fulcrum

Treatment

� Correct occlusion

� Selective pressure

impression / special impression /

preprosthetic surgery

� Reset teeth

� Enlarge centric area

� Provide relief in area of midpalatine suture

12







2. Denture Interference

a. During swallowing

b. Tooth clicking

When swallowingWhen swallowingCauses

� Maxillary denture too

thick or overextended in posterior region

� Mandibular denture too

thick or overextended in posterior lingual flange area

� Insufficient VDO

� Excessive VDO

� Incorrect tooth position (posterior teeth set too far

lingually – tongue is crowed)

Treatment

� Reduce thickness or

adjust posterior area

� Reduce thickness or adjust posterior lingual flange area

� Increase VDO

� Reduce VDO

� Reset teeth












1. Fullness under nose

2. Depressed philtrum

3. Upper lip sunken in

4. Too much of the teeth are exposed

5. Artificial appearance




1. Fullness under nose

a. Cause: labial flange of denture too long or thick

b. Treatement: reduce flange length or thickness

2. Depressed philtrum

a. Cause: Labial flange too short

b. Treatment: increase length or thickness of flange

3. Upper lip sunken in

a. Cause: maxillary teeth set too far lingually

b. Treamtent: reset anterior teeth labially







a. Causes:

i. excessive VDO

ii. Incisal plane too low

iii. Cuspids and lateral incisors too prominent

b. Treatment:

i. Reduce VDO

ii. Reset teeth at higher plane

iii. Adjust


13





a. Causes

i. Technique setup (teeth are too regular in alignment

– too perfect)

ii. All teeth have same shape – lack of individualization

b. Treatment

i. Individualization by rotating and shortening some

teeth

ii. Choose different but complimentary shades/ use

staining techniques

iii. Grind incisal edges and angles

iv. Individualize gingival contour and color

Anterior Maxilla Pattern of ResorptionAnterior Maxilla Pattern of Resorption

•• Following extraction, resorption is from labial Following extraction, resorption is from labial

towards the lingual. Therefore anterior teeth should towards the lingual. Therefore anterior teeth should

NOTNOT be placed directly over the ridge.be placed directly over the ridge.

Labial incisal positionLabial incisal position

On average the distance On average the distance

from the center of the from the center of the

incisal papillae to the incisal papillae to the

labial surface of the labial surface of the

central incisor is 8central incisor is 8--10 10

mm. This average mm. This average

influenced by the age influenced by the age

and gender of the and gender of the

patient.patient.

FemaleFemale

Young 8Young 8

Middle 7Middle 7

Old 6Old 6

MaleMale

Young 6Young 6

Middle 5Middle 5

Old 4Old 4

Average Value Positions

8

Maxillary incisal lengthMaxillary incisal length

On the average the position of the On the average the position of the

maxillary central incisor edge is 22mm maxillary central incisor edge is 22mm

measured from from the labial sulcus measured from from the labial sulcus

adjacent to the labial adjacent to the labial frenumfrenum..

Visibility of the central incisor should be Visibility of the central incisor should be

approximately 1.0 with an average length approximately 1.0 with an average length

upper lip in a middle aged patient. upper lip in a middle aged patient.

In older patients or in patients with longer In older patients or in patients with longer

lips the visibility decreases.lips the visibility decreases.

In younger patients or with patients with In younger patients or with patients with

shorter lips visibility increasesshorter lips visibility increases

Average Value Positions

Tooth Length Tooth Length -- estheticsesthetics

•• Incisor length is important for those patientIncisor length is important for those patient’’s who have a s who have a

significant display of anterior teeth.significant display of anterior teeth.

•• We normally expect to see approximately 2/3 We normally expect to see approximately 2/3 –– 3/4 of the 3/4 of the

facial surfaces of the maxillary anterior teeth when the facial surfaces of the maxillary anterior teeth when the

patient smiles widely. However, the degree of display of patient smiles widely. However, the degree of display of

maxillary anterior teeth varies greatly between individuals.maxillary anterior teeth varies greatly between individuals.

•• An average An average ““high smile linehigh smile line”” is one where the patientis one where the patient’’s s

upper lip lies approximately 6upper lip lies approximately 6--7 mm above the 7 mm above the incisalincisal edge edge

of the maxillary wax rim when the patient smiles or laughs.of the maxillary wax rim when the patient smiles or laughs.

•• If a patient has an average If a patient has an average ““high smile linehigh smile line”” 7 mm above 7 mm above

the the incisalincisal edge, then an appropriate length of tooth to edge, then an appropriate length of tooth to

select for good esthetics would be: 7 x 3/2 = 10.5 mm select for good esthetics would be: 7 x 3/2 = 10.5 mm

Tooth Length Tooth Length –– resorption of residual ridgeresorption of residual ridge

•• In some cases the amount of residual ridge resorption will In some cases the amount of residual ridge resorption will

take precedence over the take precedence over the ““high smile linehigh smile line”” and esthetics and esthetics

when tooth length is concerned.when tooth length is concerned.

•• In patients who have had recent extraction, the residual In patients who have had recent extraction, the residual

ridges are large because ridge resorption has not ridges are large because ridge resorption has not

progressed significantly yet.progressed significantly yet.

•• When the maxillary anterior residual ridge is large then the When the maxillary anterior residual ridge is large then the

overlying occlusal rim will be relatively short and there will overlying occlusal rim will be relatively short and there will

only be limited height for the anterior teeth to be set. only be limited height for the anterior teeth to be set.

•• In such cases, shorter teeth are often selected to make In such cases, shorter teeth are often selected to make

setting easier without the need of trimming the root end setting easier without the need of trimming the root end

(ridge(ridge--lap) end of the artificial teeth.lap) end of the artificial teeth.

14












1. Whistle “S” sound

2. Lisp “S” sound (“S” sounds like “Th”)

3. Upper and lower incisors contact during “S/

Ch/ J” sounds

4. “F” sounds like “V”

5. “These/Those” sound like “Dese/Dose”

6. General speech difficulty

Phonetic ConsiderationsPhonetic ConsiderationsThe anterior teeth, tongue, and lips act as a part of the The anterior teeth, tongue, and lips act as a part of the

valvingvalving mechanism which modifies the flow of air to produce mechanism which modifies the flow of air to produce

speech soundsspeech sounds

LinguopalatalLinguopalatal sounds: sounds: ““ss””, , ““shsh””

�� are made by contact between the tip of the tongue and the are made by contact between the tip of the tongue and the

palate at the palate at the rugaerugae area with a small space for the escape of area with a small space for the escape of

airair

LabiodentalLabiodental sounds: sounds: ““ff”” ““vv””

�� are produced by contact between the maxillary incisors are produced by contact between the maxillary incisors

and the posterior oneand the posterior one--third of the lower lip (vermillion border)third of the lower lip (vermillion border)

Labial sounds: Labial sounds: ““pp”” ““bb””�� if the lips are not supported properly by the teeth theseif the lips are not supported properly by the teeth these

sounds may be defectivesounds may be defective

Linguopalatal sounds: Linguopalatal sounds: ““ss””

The The ““ss”” sound is made by contact sound is made by contact

between the tip of the tongue and the between the tip of the tongue and the palate at the rugae area with a small palate at the rugae area with a small space for the escape of air.space for the escape of air.

If the space is too small a whistle usually If the space is too small a whistle usually results and if the space is too broad and results and if the space is too broad and

thin, the thin, the ““ss”” sound is replaced by the sound is replaced by the ““shsh””sound which sounds like a lisp. sound which sounds like a lisp.

(1) This is affected by the shape and (1) This is affected by the shape and thickness of the denture base in the thickness of the denture base in the palatal region.palatal region.

(2) The (2) The ““ss”” and and ““shsh”” sounds also indicates sounds also indicates

whether the whether the (anterior(anterior--posterior position) of posterior position) of the upper incisorsthe upper incisors is correct. If the patient is correct. If the patient

says says ““shsh”” when he means to say when he means to say ““ss””, then the , then the

teeth may be too far forward.teeth may be too far forward.

Teeth set too far

labially

Teeth set too far

palatallyNormal position

Linguopalatal sounds: Linguopalatal sounds: ““ss”” –– closest speaking spaceclosest speaking space

(3) The (3) The ““ss”” sound also indicates whether the patient has adequate sound also indicates whether the patient has adequate ““freeway spacefreeway space””

or or interocclusalinterocclusal clearance. clearance.

When we speak, our upper and lower teeth do not normally contactWhen we speak, our upper and lower teeth do not normally contact each other. each other.

(They only contact during function and swallowing).(They only contact during function and swallowing).

During speech, our teeth come closest together (1.0 mm) during tDuring speech, our teeth come closest together (1.0 mm) during the pronunciation he pronunciation

of the of the ““ss”” or or ““sibilantsibilant”” sounds.sounds.

(They also come close together during (They also come close together during ““chch”” and and ““jj”” sounds). sounds).

During pronunciation of all other sounds, the space between the During pronunciation of all other sounds, the space between the upper and lower upper and lower

teeth is larger than this.teeth is larger than this.

That is why we call the 1.0 mm space between the upper and lowerThat is why we call the 1.0 mm space between the upper and lower teeth during teeth during

speech the speech the ““closest speaking spaceclosest speaking space””

If we donIf we don’’t give the patient enough t give the patient enough ““freeway spacefreeway space”” during during ““jaw relation recordsjaw relation records””, , then the patientthen the patient’’s denture teeth will start hitting each other when the patient s denture teeth will start hitting each other when the patient

pronounces the pronounces the ““ss”” sound.sound.

15




1. Whistle “S” sounda. Cause:

i. Existence of too narrow an air space on the anterior part of the palate for the tongue (mis-shapen palate)

ii. Anterior teeth (i.e. central incisors set too far forward; increased horizontal overjet)

iii. Anterior part of tongue is crowded by maxillary premolars set too far palatally

b. Treatment

i. Reshape palatal contour correctly to mimic underlying palatal contour (remove thick acrylic in rugae area if necessary)

ii. Correct overjet and anterior/premolar tooth positions if necessary




2. Lisp “S” sound (“S” sounds like “Th”)

a. Cause:

i. Existence of broad air space on the anterior part

of the palate

ii. When anterior palatal air channel is obliterated

iii. Anterior teeth placed too far palatally

b. Treatment:

i. Adjust thickness of anterior palatal area; reduce thickness of palatal acrylic if necessary

ii. Reposition teeth further anteriorly if necessary




3. Upper and lower incisors contact during “S/

Ch/ J” sounds

a. Cause:

i. Vertical dimension of occlusion too great

ii. Reduced horizontal overlap (lower anterior teeth set too far anteriorly)

b. Treatment:

i. Reduce vertical dimension of occlusion

ii. Reset lower anterior teeth for increased horizontal overlap




4. “F” sounds like “V”

a. Cause:

i. Upper anterior teeth set too inferior (long)

ii. (Occasionally, upper anterior teeth too far palatal and inferior)

b. Treatment:

i. Reset upper anterior teeth in a more superior

position (shorter)

Labial Labial ––dental dental ““FF”” & & ““VV”” soundssounds

The The ““ff”” and and ““vv”” sounds indicate sounds indicate

whether the whether the length (superiorlength (superior--

inferior position) of the upperinferior position) of the upper

incisorsincisors is correct.is correct.

The upper lip contacts the the The upper lip contacts the the

wetwet--dry line of the lower lip dry line of the lower lip

during speech production of during speech production of

““ff”” and and ““vv”” sounds.sounds.

If the upper anterior teeth are set If the upper anterior teeth are set

too long, then a too long, then a ““vv”” sound is made sound is made

when the patient means to make when the patient means to make

an an ““ff”” sound.sound.




5. “These/Those” sound like “Dese/Dose”

a. Cause: Upper anterior teeth set too far lingually

b. Treatment: Reset teeth anteriorly

6. General speech difficulty

a. Initial disturbance of speech is to be expected (especially for patients who are first-time denture

wearers)

b. Increased vertical dimension of occlusion

c. Poor retention

16







A. Generalized discomfort

B. Generalized soreness (pain)

C. Generalized burning sensation

D. Gagging

E. Temperomandibular joint pain

F. Fatigue of muscles of mastication

G. Difficulty during mastication

H. Excessive salivation

I. Unpleasant taste



A. Generalized discomfort1. Cause:

i. Improper occlusion

ii. Centric occlusion not in harmony with centric

relation

iii. Excessive vertical dimension of occlusion

2. Treatment

i. Correct occlusion

ii. Enlarge centric contact area

iii. Reduce vertical dimension of occlusion

Managing Denture ProblemsManaging Denture ProblemsII. Indirect from denture

B. Generalized soreness (pain)1. Cause:

i. Heavy biting force – strong musculature

ii. Excessive vertical dimension of occlusion (VDO)

iii. Locked occlusion (no freedom of movement in CR)

iv. Failure to provide freedom for Bennett movement (soreness usually on working side only)

v. Improperly processed base acrylic material

2. Treatment

i. Reduce buccolingual width of teeth, reduce VDO, use soft lining material if necessary)

ii. Enlarge centric relation contact area to allow some “freedom of movement in centric relation”. Possibly change occlusal scheme from anatomic to flat monoplane occlusion

iii. Rebase acrylic of denture if necessary


C. Generalized burning sensation1. Common during menopause in middle-aged females

2. Allergy to acyrlic resin (but this condition is very rare) → remake material using alternative polymers or metal base

3. Dentures incorrectly processed (excessive free unpolymerized monomer remains) → rebasing may be necessary

4. Pressure on nerve

a. Maxillary anterior ridge generalized burning sensation due to pressure on anterior palatine nerve → relieve area over incisive papilla

b. Maxillary premolar/molar/tuberosity generalized burning sensation → relieve area greater+lesser palatine nerves

c. Mandibular anterior region generalized burning sensation → relieve area over mental foramen



D. Generalized gagging

1. Alteration of the vertical dimension of

occlusion:

a. Decreased vertical dimension results in crowding of the tongue and soft tissues →

gagging

b. Increased vertical dimension results in loss of freeway space which can cause

exhaustion and spasm of the levator and tensor veli palatini muscles of the palate →

gagging

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E. Temperomandibular joint pain

1. Cause:

a. Insufficient VDO

b. Centric occlusion not in harmony with centric relation

c. Arthritis

d. Truama

2. Treatment:

a. Increase VDO

b. Make new centric relation record (clinical remount) →correct occlusion

c. Refer to physician

d. Remove dentures and treat with analgesics


F. Fatigue of muscles of mastication

1. Excessive VDO → decrease VDO

2. Reduced VDO → increase VDO

G. Difficulty during mastication

Most patients who have trouble chewing at first, have not had posterior teeth for several years. The patient has lost the neuromuscular skills required to use the posterior teeth in grinding the food. The patient should be informed that a reasonable period of time is necessary to relearn the masticatory process. The length of time will depend, to some extent, on the patient’s innate neuromuscular coordination and on the duration of the edentulous state.



F. Difficulty during mastication1. Food under denture ← due to movement, flabby ridge,

or poor adaptation to tissues and general lack of

retention

2. Blunt cusps or worn down cusps of teeth

3. Increase or decrease in VDO

4. Pain and soreness under denture prevents patient from

chewing normally

5. Occlusal disharmonies

6. Excessive bulk/thickness of denture

7. Patient takes too much food into the mouth at once

8. The patient should be advised to avoid extremely tough, stringy, or sticky food, especially during the initial

period of adjustment



G. Excessive salivation

This is often a normal physiological response to a foreign body by the autonomic nervous system. It usually persists for a short period of time and then secretion returns to normal.

H. Unpleasant taste

1. If metal base is used (metallic taste)

2. If denture is not kept clean

3. If denture is incorrectly polymerized, residual

monomer may create bad taste







A. Patient psychology: remember House’s classification: which patient is most likely to find fault with the denture? Philosophical, critical, skeptical, orindifferent.

B. Disabilities: neuromuscular, Parkinsons, etc.

C. Medical conditions

D. Systemic medications

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managing problems in complete dentures_lecture

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