10-Post Insertion Problems and Complaints
10-Post Insertion Problems and Complaints
10-Post Insertion Problems and Complaints
and Complaints
Dr. Amal Fathy Kaddah
Professor of Prosthodontic,
Faculty of Oral &Dental Medicine,
Cairo University
Managed by
Patient's Denture
settling Denture errors
dissatisfaction
Patient's dissatisfaction are attributed to
Philosophical Hysterical
Exacting
Indifferent
Denture problems
Denture Ridge VD
Poor fit
•Over-
CO#CR
extension Roughness
Remaining undercut
Root
•under- Mental Foramen Uneven
pressure
extension
Allergy DD Patch test
(disto-
Cuspal
lingual Improper imp.
interference
area) Improper cast
Pressure area Teeth off
Warpage of denture base ridge
Borders
Over extension interfere with muscle
movement
Epulis fissuratum
New denture
Occlusal view of the
edentulous
mandible
Old denture
Never adjust without locating
exact position of the problem
Use P. I. paste
Poor denture retention, rocking, tilting and
inability to seat the denture.
Treatment:
???????? According to the case
Bathed in Strong
Less movements of
saliva
surface area the tongue
Related symptoms
Normal Abnormal
Treatment:
Apply pressure indicating paste to
demarcate the area on the fitting surface
of the denture. Relief
Insufficient
Amount
Correct Amount
with Streaks
Too Much
w/o Streaks
Insufficient relief Burning sensation
With resorption, it becomes over the crest
of ridge.
Treatment:
Relief.
A denture border short of the mylohyoid
ridge digs into the residual ridge and
causes pain. If shortened, the denture
border will impinge again upon the ridge.
Poor base
adaptation
Fulcrum on bony
structures
Occlusion
VD White sore
VD (white
(Neurological area on the In upper buccal Tuberosity
patch)
pain) site of sulcus of of opposite
pressure working side side
Adjusting Occlusion
Remount denture on an articulator
Net Result
Can’t see real Problem
Can’t eliminate the Problem
Clinical Remounting Procedure
Solutions ???
Low vertical
dimension
Excessive OVD
• Gets worse during day
• Muscle/joint pain
• Dentures ‘click’
• Angular chelitis
• Esthetic complaints:
Chin prominent
Poor lip support
occlusion
CO#CR
Mismatch of ICP and RCP.
The patient will not feel comfortable in that
situation.
Treatment:
If Mild error: Selective grinding of teeth.
• If more it is detected
with a wax knife
Mild error: chair side occlusal
spot grinding.
Moderate errors: clinical
remount.
Severe errors either remake
denture or replace posterior
teeth.
A Dragging action will be exerted on both dentures
during lateral and protrusive movements with teeth in
contact if cusped posterior teeth are used or if excessive
incisal guidance angle has been used.
Treatment
Mild: chair side grinding or clinical remount.
displacement, abrasion,
ulceration
Worse if xerostomia,
malnourished,
debilitated or poor
adaptability
Patient
demonstrates
problem by biting
where pain occurs
Treatment:
New dentures. •Ulcer or sore spots on
sides of ridges
Pain in upper buccal sulci and tuberosities.
Treatment:
Remove the last four posterior teeth and reduce the
New dentures
Avoid Contact on Inclines
• No teeth set
over ascending
portion of
ramus
Pain results from direct
pressure on an area already
tender.
Treatment:
Extraction of the root or tooth,
followed by relief over the
area. OR relining of the
denture.
Pressure during mastication causes pain .
Treatment: Alveoloplasty + relining (lower(
Relief over the crest (upper(.
Often the lower ridge. The denture squeezes
the mucosa against the sharp bony ridge.
Treatment:
Treatment:
Surgical smoothing of the affected area followed
by relining the denture or; just relieve the
denture.
Small pimples or blebs of
acrylic over the fitting
surface due to inaccuracies
of the surface of the cast.
Treatment:
Remove roughness by
acrylic bur.
Rare.
Treatment:
Treating the condition +
new denture
Nicotinic Stomatitis
Treatment:
Commonly sharp
flange
Sometimes long
Use PIP
Bony Undercuts
Pain: Denture Base
Severe Tissue Undercuts
A problem if
Mylohyoid
prominent or sharp Ridge
Attachments
To Hyoid
Pain: Denture Base
Retromylohyoid Overextension
Sore throat
Treatment:
As reduced bite.
Nose and chin approximating
(Closed-bite)
As the occlusal vertical dimension is too small,
the vermilion border appears thin and wrinkles
occur around the lips.
The chin is apparently protruded.
2. Cheeks and lips falling in:
Plumping: Unsupported lip and cheek.
Due to lack of tone of facial muscles.
Due to labial and buccal resorption in
max. ridge.
Teeth have been set too far lingually or
Having insufficient width of the buccal
and labial flanges.
Sunken lips and cheeks
Corner of Mouth
3- Angular cheilitis or soreness of
the corners of the mouth
Even or irregular
Too far forward or backward
Cheeks& lip falling- in
• Women
• Middle Aged
• Menopause.
البر ال يبلى ..و الذنب ال ينسى ..
و الديان ال يموت...
فاعمل ما شئت ...كما تدين تدان
Inability to Eat Anything
Inability to Eat Meat
Dentures dislodged by eating
Phonetics (speech difficulties)
Anything Meat Dislodgement during eating
Borders Overextension
Improper Unstable
denture
Vertical
Teeth Dimension
• Unbalanced articulation
• Cramped tongue
• Overextended flange
• Unstable denture
Cramped Tongue
Bulky Rugae
Linguo-alveolar consonants:
Occlusion
Poor anatomy
A-Reduced retentive Increased displacing
force force
Under extension of
borders Flabby ridge
Xerostomia
Occlusal
Excessive relief Errors
Looseness of dentures
or poor fit usually
results due to lack of
retention and/or stability
of the denture.
Oral And Facial Musculature
Muscular control is an important aspect of
successful complete denture therapy. providing
that:
The polished surfaces are properly shaped,
Periphery terminates on
bony structures
Dry Mucosa
Hard palate
Zygoma
No seal, discomfort
Eventual resorption
Coronoid Interference
Thick flange in retrozygomal
area
hamular notch
patients
Typical History
Adequate stability
initially
Gets worse with time
Occlusion
Loose Maxillary Denture
• Heavy anterior interferences can cause
loosening at posterior
Vertical
height of
mandibular
posterior
Teeth
When eating
When talking
NOISY DENTURES
Increased
VDO
Causes
Gross
Porcelain
cuspal
teeth interference
Overextended upper
denture
Thick Posterior
Palatal seal
Distolingual area of
lower denture
Psychogenic factor
Causes
Causes :
1. Systemic disorders .
2. Psychologic factors. .
3. Physiologic factors.
Psychological gagging is the most
difficult to treat since it is out of
the dentist's control. In such
cases, an implant supported
palate-less denture may have to be
constructed or a hypnotist may
need to be consulted.
TRIGGER ZONES SENSITIVE
AREA
1. Tonsillar pillars
2. Tongue
3. Posterior pharyngeal wall
4. Soft palate
5. Hard palate
Physiologic factors:
1 . Extraoral stimuli
2 . Intraoral stimuli
a. Improper denture contour,
b. Overextended or underextended d.
c. Too thick posteriorly.
d. Inadequate denture retention .
e. Inadequate free way space .
f. Restricted tongue space .
g. Disharmonious occlusion .
h. Unfinished Surface of the denture .
i. New complete denture wearers .
Managements
Pre-prosthetic managements.
2. Cramped tongue
A space will occur between the denture border and the lower
muscle bundle of the buccinator, resulting in food
accumulation.
Bacterial growth
Diagnosis: black area with Patient
Explain to the Patient
bright light instruction
Metal base.
• Food may become lodged underneath dentures
and can be the root of any potential bad breath.
• The plaque caused by the lingering food can
form a layer around dentures, creating an
unpleasant smell.
• Failing to clean dentures every day due to a
build-up of bacteria,
• Wearing your dentures all the time.
recovery program.
Recovery Program
1. Finger Massage of the soft tissues two or
three times a day to stimulate the blood supply
and aid recovery.
2. Mouth wash: Instruct the patient to dissolve
one-half teaspoon of table salt in a half glass of
warm water and rinse vigorously.
3. Tissue rest: Remove old dentures from the
mouth for at least 8 hours every 24 hours for few
days before making new impressions to allow the
Denture correction
1. Detect and remove any pressure areas or sore
vertical dimension
A cramped tongue.
Poor retention.
1. Lack of peripheral seal - Pulling down the anterior teeth (examines the Proper border molding followed by relining or
anterior labial flange) rebasing the denture.
- Pull out on incisors (examines the posterior
palatal seal).
- Pull out on canines (examines the tuberosity
region).
2. Under extension of the border in Tracing compound added will remain beyond the Remoulding the denture in mouth.
depth border. Change to acrylic resin either:
Directly by self cure resin or tissue
conditioning material.
3. Under extension of the border in By tracing compound. Remoulding by allowing the patient to move
width Lack of contact between polished surface and mandible from side to side.
cheeks especially in tuberosity area.
4. Posterior palatal seal: Clinical examination: a. Reduce border, add post dam and reline.
a. Over extension on movable tissues. a. Broken seal by speech b. Extend with tracing compound, mold, wash
b. Under extension on non b. Under extended border. impression, make post dam on cast and then
displaceable tissues. reline.
5. Poor fit due to: Clinically, gap is seen between denture base and Relining or rebasing.
Deficient impression. tissues.
Damaged cast Pressure indicating paste reveals uniformity in
Warped denture. thickness.
Grinding tissue surface.
6. Excessive relief Pressure indicating paste reveals excessive Relining or rebasing. After forming proper
thickness in this area. thickness for relief..
7. Xerostomia Patient complains of dry mouth and reduced taste. The patient is advised to use artificial saliva,
Clinically, presence of sticky dry mouth. frequent fluid intake, chew gums.
Denture with additional retentive means is
preferred.
8. Decreased neuromuscular control Clinically evident through improper speech Patient is advised to use denture fixatives
due to: and mastication. until he develops denture skills.
Facial palsy Correction of errors in the occlusal plane.
Mandibular molars placed too far
lingually.
Convex polished surface.
High mandibular occlusal plane.
Poor fit due to increase in displacing forces.
Cause Diagnosis Treatment
1. Over extension in depth Direct vision Reduce over extension and re-polish the
Elevation of mandibular denture when denture.
mouth opens slowly.
2. Over extension in width Patient complains of bulk and food Reduce over extension and re-polish the
a. In lingual flange entrapment. denture.
3. Recoil of supporting tissues. Denture falls when teeth are not in contact Reline or rebase using minimum pressure
History of impression made without tissue impression technique.
rest from old denture.
Muco compressive impression technique
was used.
4. Occlusal errors Ask patient to close slowly in centric Achieve even contact or harmonious jaw
a. Uneven occlusal contact until teeth touch.. relation by:
b. Disharmony between centric Presence of occlusal errors may be Chair side tooth grinding.
occlusion and centric relation. masked by: Remounting.
c. Lack of freedom in intercuspal a. Displacement of the mucosa. Remake dentures.
position. b. Tilting of dentures.
d. Lack of occlusal balance in
eccentric positions.
e. v. Excessive anterior vertical
overlap.
In the form of
Generalized localized
Acute chronic
Oral Increased
VD
hygiene Eccentric
bruxism
occlusal
Allergy Xerostomia
interference
CO#CR
Food Patient
Oral hygiene instruction
debris
Recurred
Allergy 24 h rest
Another
denture
Fluid
Xerostomia Examination
TTT
Remove
Wear denture at night
Bruxism
facets Tranquilizer
Eccentric occlusal No contact on Grinding
interference the other side
Denture
CO#CR Grinding
shifting
anteriorly
• Ridge • Occlusal
•Over extension • Spicules
interferences
& remaining roots.
•Unpolished • Tooth off ridge
• Denture
Pressure (PIP)