Managing Problems in Managing Problems in Complete Dentures Complete Dentures Dent 445 Removable Prosthodontics (4) Dr Esam Alem Textbook Reference: Chapter 17 Complete Prosthodontics: Problems, diagnosis and management AA Grant, JR Heath, JF McCord p. 33-88 Managing Denture Problems Managing Denture Problems I. Direct from denture II. Indirect from denture III. Related to patients Managing Denture Problems Managing Denture Problems I. Direct from denture A. Related to denture surfaces B. Related to denture function C. Related to esthetics D. Related to phonetics II. Indirect from denture III. Related to patients Managing Denture Problems Managing Denture Problems I. Direct from denture A. Related to denture surfaces 1. Borders 2. Fitting surface 3. Polished surface 4. Teeth Managing Denture Problems Managing Denture Problems I. Direct from denture A. Related to denture surfaces 1. Borders a. Overextension b. Underextension c. Overcontoured flanges d. Undercontoured flanges SHORT TERM COMPLAINTS LONG TERM Managing Denture Problems Managing Denture Problems I. Direct from denture A. Related to denture surfaces 1. Borders a. Overextension 1
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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
•• 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.
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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
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
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
�� 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
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.
(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
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
Managing Denture ProblemsManaging Denture ProblemsII. Indirect from denture
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
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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Managing Denture ProblemsManaging Denture ProblemsII. Indirect from denture
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
Managing Denture ProblemsManaging Denture ProblemsII. Indirect from denture
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.
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
A. Patient psychology: remember House’s classification: which patient is most likely to find fault with the denture? Philosophical, critical, skeptical, orindifferent.