Post insertion problems in complete denture

Post insertion problems in complete denture
Loss of natural teeth &subsequent alveolar resorption has a significant impact on appearance &function. CD fabrication techniques, &placement of a CD are not the final steps in the treatment of a dentulous patients &patient s visit to the dentist continues long after that.
Post insertion problem classification:
1. Problem related to soft tissue.
2. Problem related to function.
3. Problem related to aesthetic.
4. Problem related to phonetic.
Problem related to soft tissue
Sore spots- mandible
Complains/area Causes Treatments
Peripheral areas 1.Over extension Adjust denture accordingly
2.Unpolished or sharp edge Polish denture borders
3.herpetic or aphthous ulcer Leave denture out as much as possible &wait 7-10 days.
Crest of ridge 1.bone spicules. Identify the area in denture with PIP & provide relief over spicule &/or surgically remove spicule.
2.spinous ridge crest Provide relief in the denture.
3.pressure spots at time of impression. Use PIP or indelible pencil to determine the areas& adjust accordingly
4.occlusal prematurities. Correct occlusal defects, recheck vertical dimension &clinical remount.
Side of ridge-anterior area 1.over extension Use PIP &adjust border involved
2.maximium intercuspation not in harmony with centric relation (CR) Enlarge centric area; grind mesial inclined planes of maxillary teeth& distal inclined planes of mandibular teeth using a clinical remount.
Side of ridge-bicuspid area 1.lingual tori (nonyielding areas) Provide adequate relief in denture base.
2.pressure spots at time of impression Adjust denture accordingly.
3.shrinkage of denture during processing Rebase denture
4.errors in occlusion- occlusal prematurities. Check occlusion on the opposite side of arch from the sore spot.
5.pressure on mental foramen if ridge is greatly resorbed. Provide adequate relief.
Under lingual flange Maximum intercuspation not in harmony with CR (drives mandibular denture forward) Enlarge centric area &adjust local area.
Under labial flange 1.excessive overbite Adjust anterior occlusion
2.habit-mastication in protrusive relation. Train patient to masticate in centric.
Generalized soreness &redness 1.heavy biting force-strong musculature. Reduce buccolingual width of teeth; reduce VD;use soft lining if necessary
2.excessive OVD Reduce VD
3.locked occlusion Enlarge centric area.
4.failure to provide freedom for Bennett movement (soreness usually on working side). Reduce cusps to a non-anatomic plane or reset teeth.
5.Improperly processed base materials Rebase denture.
Sore spots- maxilla
Complains/area Causes Treatments
Peripheral areas 1.Over extension Adjust denture accordingly
2.Unpolished or sharp edge Polish denture borders
3.herpetic or aphthous ulcer Leave denture out as much as possible &wait 7-10 days.
Maxillary frenum Over extension Open a V-shaped notch for the labial frenum &widen the buccal frenum area
Posterior border of denture Sharp edge at the post dam area Adjust sharp edge slightly without reducing dam area
Midline of denture Prominent mid suture or torus maxillaries Provide some relief over the area
Generalize discomfort
1.improper occlusion Correct occlusion (clinical reline)
2.maximum intercuspation not in harmony with CR Enlarge centric area(clinical reline)
3.excessive OVD Reduce VD(clinical reline)
Burning sensation
Maxillary anterior hard palate &ant. alveolar ridge area Pressure on anterior palatine foramen Relief area over foramen
Maxillary bicuspid area or molar tuberosity Pressure on posterior palatine foramen Relief area over foramen
Mandibular anterior region Pressure on mental foramen Relief area over foramen
Generalized Improperly processed Reline denture; replace as much as possible base material with new acrylic
Tongue Allergic reaction/xerostomia Treated according to the cause
Redness
Fiery redness-all tissue contacted by denture including tongue &cheeks Denture base allergy (very unusual) Remake denture and use all metal base (after allergy test).
Bearing tissues Ill-fitting denture, avitaminosis Remake or rebase dentures. Employ vitamin therapy regimen.
Tongue &cheek biting
Thin or under extended periphery (base material does not provide enough support for the cheek) Build out thin areas, or extend the short periphery.
Insufficient inter-arch clearance between distal parts of denture base. Thin maxillary denture over tuberosity; if more space is required, remove it from the retromolar area of the mandibular denture.
Inadequate amount of horizontal overlap in molar region. Re-contour buccal surface of mandibular molars &bicuspid; eliminate the tight contact of the max. buccal cusps on the mand. buccal surface.
Pain in TMJ
Insufficient OVD Increase OVD
maximum intercuspation not in harmony with CR Make new occlusal record, regrind &remount occlusion.
Arthritis Treat with analgesic
Trauma Treat with analgesic
Gagging
Immediately upon insertion 1.max. denture over extended or too thick in posterior border. Adjust denture or thin posterior border.
2.lack of retention Reline denture.
3.Mand. denture too thick in distolingual flange. Reduce thickness or distolingual flange.
Delay (2weeks-2 months after insertion) 1.incomplete border seal allowing saliva under denture. Increase border seal with self-curing acrylic resin (possibly at the posterior palatal border)
Improper occlusion causing denture to loosen & allowing saliva under denture. Correct occlusion (clinical remount).