Dr. Samahi’s Lecture Post-Insertion Denture Problems

Schedule of Post-Insertion Visits:

For many patients, three adjustments are sufficient to make them comfortable with their new

denture.

1. First appointment should be scheduled 24 hours of denture wearing. If during the first

appointment no adjustments or only minor correction are required, the patient should be given

another appointment for a week later.

2. If pronounced tissue irritation is seen at the first adjustment period, adjustments should be made

& the patient given an appointment for the following day or two.

3. The patient should be scheduled for a recall examination approximately 12 months later if there

are no further problems.

Classification of Post-Insertion Denture problems: I) Complaints abut comfort of the denture :

1. Sore spots2. Burning sensation3. Redness4. Pain in TMJ5. Tongue & cheek biting6. Swallowing & sore throat7. Nausea & gagging8. Deafness9. Fatigue of the muscles of mastication.

II) Complaints about function of the denture: 1. Instability or poor fit2. Interference

a) When swallowingb) Clicking

III) Complaints about esthetics : 1. Fullness under the nose2. Depressed philtrum or naso-labial sulcus3. Upper lip sunken in4. Too much of teeth exposed5. Artificial look

IV) Complaints about phonetics : 1. Whistle on “S” sounds2. Lisp on “S” sounds3. Indistinct “TH” & “T” sounds4. “T sound like “TH”5. “F” & “V” sounds indistinct

Table I: Complaints about comfort of the denture, causes & treatment :Complaint Potential causes Treatment

1.

Sore

sp

ots

A. Sore spots in the vestibule. a. Overextensionb. Unpolished or sharp edge

a. Adjust denture (disclosing wax).b. Polish denture borders.

B. Sore spots posterior limit of the maxillary denture.

a. Posterior valve seal too deepb. Sharp valve sealc. Overextension

a. Identify area with disclosing wax (PIP) & relief high pressure area.

b. Round off sharp areas.c. Adjust peripheral extension.

C. Single sore spots over ridge. a. High occlusion in that areab. Bubbles of acrylic

a. Check with articulating paper& adjust the occlusion.b. Inspect the denture under good light to detect surface

roughness then remove & polish lightly.D. Soreness under labial flange. a. Excessive overbite

b. Habit-mastication in protrusive relationc. Overextended labial flange

a. Reseat maxillary anterior teeth.b. Train the patient to masticate in centric relation.c. Adjust peripheral extension.

E. Soreness under lingual flange of mandibular denture.

a. CO not on harmony with CR (drives mandibular denture forward)

b. Overextended lingual flange

a. If only slight, if can be corrected, record, remounting & selective grinding.

b. Apply pressure indicating paste to denture periphery, adjust peripheral extension.

F. Generalized soreness over the alveolar ridge.

a. Excessive vertical dimensionb. Inaccurate denture base

a. If the occlusal plane of the upper is judged to be correct, make a new lower denture to the decreased vertical dimension, otherwise, new upper & lower dentures.

b. New dentures, but the old ones can be rebased if the occlusion is adequate.

2.

Bu

rnin

g

sen

sati

on

A. Anterior hard palate & anterior alveolar ridge areas.

Pressure over the anterior palatine foramen Relief over the foramen.

B. Rugae, lip & side of the tongue. Climacteric , anxiety& ariboflavinosis Large dose of vitamin B-complex, taking the denture out, and holding a piece of ice in the mouth will provide a temporary relief.

C. Premolar to molar area Pressure on the posterior palatine foramen Relief area over the foramen.

D. Lower anterior ridge Pressure on the mental foramen Relief over the foramen.

3.

Red

ness A. Fiery redness of all tissues

contacted by denture, including tongue & cheeks.

Denture base allergy (uncommon) Remake the denture & use metallic denture base.

B. Redness of the denture bearing tissues.

Ill-fitting dentureAvitaminois

Remake or rebase the denture.Employ vitamin therapy regime.

4.

Pain

a. Insufficient vertical dimension of occlusion.b. CO not in harmony with CR.c. Arthritis.d. Trauma.

a. Increase vertical dimension.b. Correct occlusion by selective grinding.c. Treat with analgesics.d. Treat with analgesics.

5.

Ton

gu

e &

ch

eek

bit

ing

a. Posterior teeth edge to edge (insufficient horizontal overlap).

b. Over-closurec. Changes in the occlusal plane leading to cheek &

tongue biting.d. Posterior teeth too far buccal leading to cheek biting.e. Posterior teeth too far lingual (reduction of tongue

space) leading to tongue biting.f. Loss of muscle tonus (Lax cheek) leads to cheek biting.g. Tongue biting may occur in patient with epilepsy.

a. Re-contour buccal surface of mandibular molars & premolars to increase the horizontal overlap (buccal overjet).

b. Restore the vertical dimension.c. New denture with proper occlusal height.d. Re-contour buccal surface of the upper molars, in

some case it may be necessary to remove the last molar tooth.

e. Re-establish adequate tongue space.f. Build out thin denture base or extent the under-

extended borders.g. Treat the cause.

6.

Sw

allow

ing

& s

ore

th

roat

A. Maxillary denture i) Over extension of posterior border.ii) Too thick posterior border.

a.i) Adjust posterior border extension.ii) Thin posterior border.

B. mandibular denture i- Overextension of the posterior lingual flange area.ii- Too thick lingual posterior flanges.

b. Reduce thickness or adjust posterior lingual flange area.

C. Insufficient vertical dimension of occlusion c. Increase vertical dimension.

D. Excessive vertical dimension of occlusion d. Reduce vertical dimension.

E. Posterior teeth set inside the ridge (tongue is crowded). e. Re-set teeth in correct position.

7.

Nau

sea &

gag

gin

g A. Immediately upon denture placement.

a- Maxillary denture: i) Overextensionii) Too thick posterior border

a. Adjust denture or thin posterior border.b. Reduce thickness of disto-lingual flange.c. Prescribe a mild tranquilizer.

b- Mandibular denture: i) Distolingualii) Flange too thick

c- Psychogenic factorsB. Delayed (2 weeks to months) after

denture placement.a- Incomplete border seal allowing saliva under the

denture.b- Faulty occlusion causing denture to loosen &

allowing saliva under the denture.

a. Improve border seal.b. Correct occlusion.

8.D

eafn

es

s

Over closure of vertical dimension. Increase vertical dimension.

9.F

ati

gu

e o

f th

e m

uscle

s

of

masti

cati

on

Vertical dimension.

a- Excessive vertical dimension of occlusion.b- Insufficient vertical dimension of occlusion.

a. Reduce vertical dimension.b. Increase vertical dimension.

Table II: Complaints about function of the denture, causes & treatment :Complaint Potential causes Treatment

A-

Loo

sen

ess

of m

axil

lary

den

ture

:

a- When not occluding a. Overextension of denture borders & posterior limit.b. Under extended denture borders.c. Loss of posterior valve seal:

i) Valve seal on hard palate.ii) Posterior limit not in the hamular notches.iii) Insufficient valve seal.

d. Dehydration of tissue due to alcoholism.e. Flabby tissue displaced when making impression.f. Under-filled buccal vestibule.

a. Adjust denture border extension.b. Correct with auto-polymerizing acrylic resin but

check with compound for diagnostic purposes.c. Improve posterior palatal seal. d. Remove the cause.e. Correct surgically-change.f. Correct the flange thickness.

b- When occluding in centric a. Malocclusion:i) High occlusion in premolar area.ii) Premature individual tooth contact.iii) High occlusion in one side of the arch.

b. Poor denture foundation (flabby tissues)c. Incorrect tooth position (teeth set too far buccally).d. Centric occlusion not in harmony with centric

relation.e. Non-yielding area in hard palate (torus palatinus).

a. Selectively adjust the occlusion.b. Correct surgically-change denture.c. Reset teeth in correct position.d. Selectively adjust the occlusion.e. Provide sufficient relief.

c- Dislodgement of maxillary denture during function

a. Overfilled buccal vestibule.b. Over extension in the hamular notch area.c. Inadequate notches for frenum attachment.d. Excessively thick denture base over the disto-buccal

alveolar tubercle.e. Placing the maxillary anterior teeth too far labial.f. Placing the maxillary posterior teeth too far buccal.g. Placing the posterior palatal seal too deep.h. Lack of occlusal harmony.

a. Allow proper flange thickness.b. Correct border extension.c. Allow sufficient clearance for frenum attachments.d. Reduce the thickness of the distal ends of the buccal

flanges.e. Reset the teeth.f. Reset the teeth.g. Identify pressure area with disclosing wax, provide

sufficient relief.h. Correct occlusal disharmony by selective grinding.

1-

Insta

bilit

y o

r p

oor

fit

d- When incising food a. Loss of posterior valve seal.b. Anterior teeth placed too far labially.c. Poor denture foundation.d. Improper incising habits.

a. Improve posterior palatal seal.b. Reset teeth in correct position.c. Correct surgically0change denture.d. Train patient to masticate in centric.

e- When yawing or opening wide

a. Denture base too thick in buccal posterior area.b. Denture over-extended in hamular notch area.

a. Reduce thickness of denture base.b. Shorten denture until pterygo-mandibular ligament

doesn’t exert tension on posterior border when mouth opened wide.

f- When talking a. Inadequate posterior palatal seal.b. Overextension in the posterior region.

a. Increase posterior palatal seal with auto-polymerizing acrylic resin.

b. Adjust the posterior overextension.

B-

Loo

sen

ess

of m

and

ibu

lar

den

ture

:

a- Peripheral overextension. a- In the masseter groove area.b- In a lateral direction beyond the external oblique

ridge.c- In the lingual flanges.d- In the retromolar pad.

Adjust the denture accordingly.

b- Tight lips. a. Remake with the lower anterior teeth set more lingually, with a labial concavity on the denture & with maximum extension in the region of the retromolar pad.

b. Vestibuoplasty may be considered.

c- Lower posterior tilted teeth or set lingually leading to cramping the tongue. Reduce the width of the lower posterior teeth by grinding off the lingual cusp.

d- Under-extension & lack of peripheral seal. Correct the under-extension.

e- Placing the occlusal plane too high. Remake the denture with proper occlusal plane height.

f- Improper contour of the polished surface. Re-contour the polished surface.

g- Lack of saliva. Palliative treatment such as artificial saliva.

2-

Inte

rfere

nce A- When

swallowinga- Maxillary denture too thick or overextended in posterior region.b- Mandibular denture too thick or overextended in posterior lingual

region.c- Insufficient vertical dimension of occlusion.d- Excessive vertical dimension of occlusion.e- Incorrect tooth position.

a- Reduce thickness or adjust posterior region.b- Reduce thickness or adjust posterior lingual flange

area.c- Increase vertical dimension.d- Reduce vertical dimension.e- Reset teeth.

B- Clicking a- Excessive vertical dimension.b- Denture with poor retention & stability.c- Cuspal interference.d- Excessive incisal guidance.

a. Reduce vertical dimension- use acrylic resin teeth.b. Rebasing or remaking the dentures.c. Eliminate cuspal interference.d. Correct occlusion.

Table III: Complaint about esthetics, causes & treatment :Complaint Potential causes Treatment

A-Fullness under the nose

Labial flange of the upper too long or too thick.

Reduce length or thickness of labial flange.

B- Depressed philtrum or naso-labial sulcus

Labial flange too short or too thin. Increase length or thickness of labial flange.

C-Upper lip sunken in Maxillary anterior teeth set too far lingually. Reset anterior teeth labially.D-Too much of teeth

exposeda- Excessive vertical dimension.b- Incisal plane too low.c- Cuspids & lateral too prominent.

a. Reduce vertical dimension.b. Reset teeth at higher plane.c. Correct tooth prominence.

E- Artificial look a- Technique set-up (teeth are too regular in alignment.

b- All teeth same shade.c- Lack of grinding incisal edges & angles.

a. Set up individualized (by rotating & shortening few teeth).

b. Choose different shades.c. Grind incisal edges & angles to give a more

individualized appearance.

Table IV: Complaints about function of Phonetics, causes & treatment :Complaint Potential causes Treatment

A. Whistle on “S” sounds

Too large air space on the anterior part of the palate.

Reshape the anterior part of the palate by thickening denture base.

B. Lisp on “S” sounds Too small anterior air space. Thin palato-lingual area.C. Indistinct “TH” &

“T” sounds Inadequate inter-occlusal space. Reduce thickness of palatal of maxillary

denture & lingual of mandibular denture base, reduce vertical dimension.

D. “T sounds like “TH” Upper anterior teeth too far lingually. Reset teeth buccally.E. “F” & “V” sounds

indistinct Improper position of the upper anterior

teeth either vertically or horizontally. Reset teeth either vertically or horizontally so

that they contact the lower lip at its highest point during these sounds.

..Regards, Strawberry..