Post Insertion Problems
DENTURE PROBLEMSCauses, Diagnostic Procedures, and Clinical
Treatment.
I. Retention Problems
Maxillary denture lacks retention at time of insertion
Possible Cause
Diagnostic ProcedureTreatment
1.
Tissue contours or fluid balance change
Checking
Patient reassurance
2.
Inadequate clearance for labial or buccal frenum
Pull lip or cheek
Use P.I.P and correction.
3.
Incorrect posterior palatal seal
Checking
Correction
a
Seal placed on non-displaceable tissue
Check posterior extension
Relieve
b.
Seal on movable tissue.
Use transfer ink
Shorten
c.
Inadequate depth of seal
Add wax seal along posterior border and check
Replace wax with autopolymerizing resin.
d.
Posterior border and seal does not extend into haimular notch
Transfer ink line to palate with denture .
Extend posterior border
4.
Posterior palatal seal causing tissue rebound and denture displacement
Use. P.I.P
Relieve
5.
Thin tissue covering over prominent mid-palatal suture or torus.
Use. P.I.P
Relieve
6.
Dry mouth (alcoholism, radiation, medication , or disease).
Saliva substitute
Saliva substitute
7.
Inaccurate denture base
Thin mix of alginate impression material
Reline or remake
8.
y
Posterior border too short or too thin
Retract cheek
Correction
9.
Short labial flange or excessive notch.
Retract lip and check
Correction
B. Maxillary denture loosens when patient opens widely
Possible Cause
Diagnostic Procedure
Treatment
Posterior borders too
thick or too long
Interference with
coronoid process
Pull cheek
CheckingP.I.P and correction
P.I.P and correction
C. Maxillary denture loosens while patient is speaking
Possible CauseDiagnostic Procedure
Treatment
1.
Inadequate posterior palatal seal
Checking
Correction
2.
Interference with coronoid process
Checking
P.I.P and correction
3.
Posterior border too long or too thick
Pull cheek
P.I.P and correction
4.
Short labial flange or excessive notch for labial frenum
Retract lip
Correction
5.
Notch for buccal frenum too thick or of insufficient size
Checking
P.I.P and correction
D. Mandibular denture lacks retention at time of insertion
Possible Cause
Diagnostic ProcedureTreatment
1.
Change in tissue contours or fluid balance since impression
Checking
Reassurance
2.
Borders too wide or too long in labial or buccal frena and/or flanges
Checking
Correction
3.
Buccal flanges undere xtended
Pull cheek
Impression wax . Replace with resin
4.
Labial flange undere xtended
Pull lip
Impression wax. Replace with resin
5.
Inadequate notch for lingual frenum
Patient forceably places tongue to touch posterior palate .
P.I.P and correction
6.
Overextension or excessive thickness of lingual border in molar area
Patient lightly places tip of tongue into right and left buccal vestibule.
Correction
7.
Overextension or excessive thickness in distolin gual area
Patient protrudes tongue from mouth.
Correction
8.
Underextension of lingual border in molar and/or distolingual area
Patient lightly protrudes tongue from mouth
Correction with resin
9.
Inadequate lingual seal
Impression wax
Replace wax with resin
10.
Retracted tongue position
Relationship of tongue to denture
Tongue exercises
11.
Lack of adequate neuromuscular control
Patient ability checking hypotonicity
Denture adhesives
12.
Posterior teeth set too lingual
Position of. Lingual cusps
Reposition teeth
13.
Poorly contoured polished surfaces
Polished surfaces
Reshape denture base
14.
Diy mouth
Place saliva substitute
Prescribe saliva substitute
E. Maxillary denture loosens at different times of day.
Possible Cause
Diagnostic ProcedureTreatment
1.
Heavy secretion of saliva
Tissue surface covered with rbpysaliva
Remove and clean
2.
Dry mouth
Place saliva substitute
Prescribe saliva substitute
F. One or both dentures loosen while eating
Possible CauseDiagnostic Procedure
Treatment
Teeth set too far buccal to crest of ridge
Check lingual cusps position
Reposition teethOcclusal plane higher than retromolar pad
Check position
Reposition teeth
Interceptive contact in occlusion
Check relationship of teeth
Correction
Inadequate neuromuscular control
Rule out all possible errors with dentures
Reassurance
II. Patient Discomfort Problems
A. Excessive salivation
Possible Cause
Diagnositc ProcedureTreatment
1
New denture .
Checking during first . 72 hours .
Reassurance .
B. Sore mouth at 24 hour
Possible Cause
Diagnostic ProcedureTreatment
1
Pressure over zygomatic process
Apply pressure
P.I. P. and correction
2
Distobuccal border of maxillary denture base too wide
Place finger on anterior teeth protrude mandible and move from side to side
P.I.P and correction .
D. Generalized soreness after repeated adjustments
Possible Cause
Diagnostic ProcedureTreatment
1
Clenching and bruxing
Shiny wear facets on teeth
Relaxation procedures Keep denture out at night
2
Increased V.D.
Check V.D.O vertical dimension of occlusion
Remount and reposition of teeth
3
Errors in occlusion
Check for interfernces
Correct occlusion
4
Low tissue tolerance due to nutritional deficiencies
Dietary analysis
Consultation with physician
5
Low tissue tolerance due to disease
Thorough history
Referral to physician
E. Cheek biting
Possible Cause
Diagnositc Procedure
Treatment
1
Insufficient horizontal overlap of posterior teeth
Observe relationship of posterior
Round in buccal cups
2
Insufficient clearance between denture bases distal to last tooth
Check for clearance
Thin denture bases
3
Sharp buccal cusps
Run finger
Round sharp
edges
F. Tingling and-or pain of lower lip
1Possible Cause
Diagnostic Procedure
Treatment
2
Pressure over mental foramen
Palpate
Relieve area
H. Patient complains of sore throat
Possible Cause
Diagnostic Procedure
Treatment
1
Overextension and ulceration on soft palate
Determine Overextension
Shorten
2
Overextension of hamular notch , distolingual of mandibular denture , above retromolar pad
Inflamed ulcerated tissues in these area
Adjustment
III. Gagging with Dentures
A. Gagging at time of insertionPossible Cause
Diagnostic ProcedureTreatment
1.
Nervousness
Rule out other possible causes
A piece of hard sweet-sour
2.
Posterior border too long
Apply transfer ink to posterior border of denture.
Adjust denture . Reestablish a posterior palatal seal
3.
Posterior border too thick
Thickness of posterior border is 1 m mm .
Reduce thickness .
4.
Distolingual flange of ma-ndibular denture too long or too thick
Use disclosingwax or P.I.P to check for overextension thickness .
Shorten borders and reduce thickness
5.
Maxillary occlusal plane too low
Simulate contact on tongue with mouth mirror to check for gagging response
Reposition teeth on denture base.
B. Delayed gagging - begins subsequent to day of insertion
Possible Cause
Diagnostic Procedure
Treatment
1.
Heavy mucinous saliva
Remove denture and observe thick ropy saliva
Reassurance and using an astringent mouthwash
2.
Mandibular teeth set too far lingtially.
Correct buccal lingual position
Grind lingual surface of man dibular posterior teeth or reposition teeth .
3.
V. D. of occlusion occlusal incr- eased beyond physiologic limits
Use rest position and phonetics
Reposition