1. It can be said that complete denture treatment is an unnatural
treatment of oral tissues left over after loss of teeth.
2. The oral tissues are exposed to the presence of a foreign body which
sandwitches the oral mucosa against the hard bone.
3. It may be understood that the oral tissues have not evolved to accept
the ravages of such large foreign bodies. It is therefore natural that
an initial copious flow of saliva is a proof of rejection of the oral
tissues of invading agency.
4. If however the tissues are compelled to accept them rationally
spea!ing they have got to be formulated !eeping in mind the tissue
biology and the mechanical needs of retention and stability.
". The dentures are simply placed on tissues without anchors and the
patient is expected to ac#uire neuromotor s!ills in holding them. In
this exercise the dentures are expected to remain seated during
various functional excursions.
$. The neuromuscular attainment of s!ill is more easily said than done
since the learning potential of patiens vary at every age level and
hence in advanced age the patients face a situation of tight rope
wal!. This itself constitutes yet another genesis for trouble shooting.
%. It is to be rec!oned that the foundations present varying degrees of
different morphology and altered physiology.
&. Infact the dentures reveal a lot of s!idding effect adding to the
problem of sensitive oral mucosa.
'. (imilarly food habits manifest diversity to a point that patient
needing to use the dentures successfully has to accept the changes
in life style.
1). *motional disturbances and more so in advancing age are yet
another manifestation that causes irritation of tissues and the
resulting tissue loss. It is for these reasons the following text is
presented to present classified information in respect of tissue
injuries and the impared functions. Therefore the purpose of this
presentation is to concentrate on tissue injuries with the intention of
!nowing how to treat these conditions.
It is difficult to discuss every complaint made by a patient but the
following are the most common and will give a comprehensive outline of
how the dentist may diagnose their cause and how they should be treated.
+rossly these problems can be grouped under these categories.
,. Tissue Injury
-. Impaired function
.. /iscellaneous
A. Tissue Injury
a) Involving supporting and stabilizing areas
0 /ucosa of the crest
0 (lopes of the ridge
0 /ucosa of palate
0 -one
Truamatic lesions of the stress bearing mucosa of the crest of the
residual ridge, slopes of the ridge and palate are usually the result of 1i2
imperfections in or on the tissue side of the denture base 1ii2 3ressure areas
on the tissue side of the denture that were developed either in the
impression procedures or as a result of damage to the master cast and 1iii2
disharmony in occlusion in either the centric or the eccentric jaw positions.
1. 3unched out areas
2. 4hitish areas
3. 5yperaemic and painful areas
4. 6ocali7ed or generali7ed areas of inflammation
". 5ypertrophy
1. 3unched out lesions and the surrounding hyperaemic mucosa are
usually the result of imperfections in denture base trauma from food
particles when the dentures were not in the mouth.
2. 6esions particularly of the crest are whitish due to the presence of
excess 8eratin 1whitish  may also be due to ischaema 
improper impression techni#ue2.
3. 6esions that are hperaemic and painful are encountered over the
mylohyoid ridges the cuspid eminences the alveolar tubercles and
areas of exostosis. It is usually seen when undercuts are present in
the lateral aspect of maxillary tuberosites. It is produced by the
flanges of the denture during the placement and removal of denture
from the mouth or from excessive friction when the denture moves
during function.
5yperaemic painful and detached areas of epthelium that develop on
the slopes of residual ridge are usually the result of disharmony of
occlusion when the teeth are ma!ing unbalanced contacts in eccentric
jaw positions.
4. 6ocali7ed or generali7ed areas of inflammation
• 6ac! of 9est: (ome patients do not remove
their dentures and hence do not allow rest to the tissues. The constant
pressure of the dentures retards the normal blood supply which
oxygenates the tissue and removes waste products.
• ;entures instability: It may be due to a faulty
impression techni#ue or when posterior teeth are placed too far
buccally or when there is ine#uillibrium between resilient and non
resilient areas.
• Inade#uate free way space: , generali7ed
hyperaemia of the crest and slopes of the ridges accompanied by pain in
the muscles attached to the mandible the production of hyper8eratin
and a looseness of the dentures are often the result of insufficient
interocclusal distance.
• 3oor oral hygiene can result in inflammatory
reactions< e.g. in =erostomia
• , complete denture opposing natural teeth or a
partial denture may cause locali7ed hyperaemia and edema.
• ,n unbalanced diet and avitaminosis contribute
to inflammatory conditions in all age groups. ,lcoholism and senility
may lead to malnutrition which is reflected in the inability of the oral
mucosa to the resist the pressure of dentures.
• *ndocrine gland disturbances and parafunction
resulting from neurosis can cause inflammation of the oral mucosa.
• (ystemic debilitating diseases contribute to
poor tissue tone and poor tissue resistance of dentures. *.g.
5ypertension diabetes.
• ,llergic reactions of the supporting tissues to
denture base materials.
". 5ypertrophy:
,n abnormal increase in si7e of the stress bearing oral mucosa is
unusual. In the midpalatal suture area particularly when a relief is placed
in the tissue side of the denture base hypertrophy of the mucosa does
occur. (mall nodules which are defined as >papilloma0li!e hypertrophy?
develop throughout the area. The incisive papilla is another area that
becomes enlarged hyperaemic and painful if it is not relieved in the
dentures. 4hen the cause is not removed the tissue becomes pendulous.
Problems involving bone:
,lveolar residual ridge is the major bony support for the denture
base to resist tor#uing and hori7ontal forces.
Isolated spinous processes may develop on the surface of the bone.
The soft tissue covering is caught between the hard dentures base and the
spine of bone with resulting discomfort and pain.
-one growth on the surface and exostosis results in a thinning of the
over lying mucosa. These areas of bony growth act as fulcrums and
pressure points.
(harp and prominent mylohyoid ridge acts li!e a !nife edge and also
creates an undercut area.
-one sore mouth a rarely encountered condition in senile patients
shows no soft tissue damage but expresses a feeling of constant soreness
and desire to remove the dentures.
b) Tissue Injury in Contact with Denture Periphery
These lesions are mostly encountered in following areas and in the
order named:
0 @renum attachments
0 9etromylohyoid space
0 9etromolar pad
0 /asetteric notch
0 5amular notch
0 Aestibular fornix
0 @loor of the mouth
0 (oft palate
6esions seen are
0 (lit li!e fissures and
0 Blcers
0 5ypertrophy
Causes i) Cver extensions of dentures periphery
ii) (harp thin unpolished borders
5ypertrophy at the junction of tightly and loosely attached mucosa
is caused by initial trauma which may be a result of disharmony of
occlusion in the eccentric positions. This is especially true when the forces
of occlusion are directed towards the anterior residual ridges in biting. The
bone loss results in a loose denture and a loose denture produces more
5ypertrophy in the labial flange area often occurs following the
insertion of an immediate complete denture when the occlusion and
denture base have not been altered to meet the changes ta!ing place in the
basal seat.
c) Tissue Injury in Contact with Polished !urface of Teeth
,reas involved are lips chee!s and tongue.
6esions seen are
0 .hee! biting
0 Tongue bititing
0 Irritation of mucosa
1. Improper placement of teeth in hori7ontal or vertical
direction can lead to tongue biting or chee! biting.
2. 9ough margins of teeth an unpolished denture base or
porous dentures can lead to irritation of mucosa.
Treatment procedures:
;entures that are essentially satisfactory can be ruined by
indiscriminately altering the denture base or the teeth. To determine the
etiology the dentist must conduct these procedures in a systemic manner.
1. *xamine each denture for stability and retention with the mouth at rest
and with the mouth in function. To chec! functional stability and
retention instruct the patient to spea! laugh yawn wipe the lips with
the tip of tongue and swallow.
2. .hec! the dentures for indications of undercut areas. ,pply pressure
disclosing paste to the tissue side of either maxillary or mandibular
denture. Instruct the patient to place and remove the dentures from the
mouth. ,n undercut is detected where the paste is removed from the
denture as if it were dragged from the surface. 4hen it has been
definitely established that an undercut exists alter the tissue side of the
denture base with an acrylic bur. Cne should be careful during this
procedure since tissue contact with the denture must be maintained.
(mooth and polish all ground areas.
3. ,pply pressure indicating paste to the entire tissue side of the maxillary
denture. Instruct the patient to place both the dentures and tap the teeth
together with the jaws in centric relation. ,n area of displaced paste in
the tissue side of the denture is a sign of pressure. The pressure area
may result from premature tooth contact or imperfection of the denture
4. To determine if the pressure area is produced by faultly occlusion
institute patient remount procedures.
/a!e a face bow record
9emount the dentures on an adjustable articulator
,djust protrusive condylar and incisal guidance
.orrect the occlusion
". The steps mentioned are done after tissue conditioning. 3atient is
advocated only with soft food during the entire course of treatment.
4hen problem arises from loose and illfitting dentures either rema!e
or rebase the dentures. It is possible that both the occlusion and denture
base may need correction.
$. 4hen a generali7ed inflammatory condition exists or hyper!eratosis
is present in the stress bearing mucosa evaluate interocclusal distance.
If the interocclusal distance is not ade#uate alter the teeth to provide
space or rema!e the prosthesis.
%. 4hen traumatic lesions are present in relation to the denture border
apply disclosing wax to the borders of one denture at a time. Instruct
the patient to spea! swallow laugh yawn wipe the lips with the tip of
the tongue in the buccal and labial vestibular spaces. If the wax is
moved from the border of the denture overextention is indicated.
9emove the overextended area by grinding with an acrylic bur.
(moothen the ground surface with wet pumice on a wet rag wheel.
&. 5ypertrophy of the mucosa which does not include fibrous
hyperplasia is usually reversible and will resolve when the source of
trauma is removed.
'. 4hen abrasions and ulcerations of the tongue and chee! occur the
vertical and hori7ontal positions of the teeth must be evaluated. , loss
of muscle tonus allow the chee! to sag and the result may be chee!
Tongue biting can occur in patients who have disease of the nervous
system such as epilepsy.
1). =erostomia or ,sialorrhoea
9esults from regressive changes in salivary glands particularly of the
cells lining the intermediate ducts causing decreased flow of saliva.
Causes: ;iabetes Dephritis 3ernicious anaemia /enopausal women
Aitamin deficiency =0ray irradiations /edications.
Treatment for "erostomia
0 @re#uent lubrication with petroleum jelly silicone fluid and
improving hydration of the patient.
0 If glandular function is present administration of sialogogues E
pylocarpine hydrochloride or pylocarpine nitrate " mg dose before
0 Therapeutic dose of nicotinamide 12")04))2 mg T;( for 2 wee!s.
;entures are to be used minimally as tissues are fragile. These
patients are prone to conditions and chlorhexidine is the treatment of
11. (urgical procedures or systemic theraphy usually resolve problems
involving bone.
B. Impaired Function
/ental and emotional responses to the appearance of dentures vary.
4hat is acceptable to one person may be unacceptable to another.
9egardless of age or sex esthetics is an important factor in denture
.ommon problems
1. ;issatisfaction with appearance
2. ;issatisfaction with teeth colour
3. ;issatisfaction with teeth position
1. Dissatisfaction with appearance: The number of patients who are
dissatisfied with their appearance with final dentures can be much
reduced if the dentist insists on a relation or a candid friend being
present at the trail stage although it has to be stressed that the
appearance cannot be fully assessed until four to six wee!s after
placement of finished dentures. This is because the lip and muscles
have to adapt to the dentures.
2. Dissatisfaction with teeth colour: The complaint is almost
invariably that the teeth are too dar! or too yellow but before
changing them it must be explained to the patient that natural teeth
dar!en with age and that very light shaded teeth loo! more artificial
than dar!er ones.
Treatment: .omply if possible with the patients re#uest for lighter
teeth usually by a compromise between the shade chosen by the
operator and that chosen by the patient.
3. Dissatisfaction with teeth position: The complaint may be that the
upper incisal edges are too low and therefore too much tooth is
showing. If there is a fault in the orientation of the occlusal plane
the anterior teeth may be removed and replaced at a higher level but
usually this is unsatisfactory as it spoils the acrylic matrix and ruins
the protrusive tooth contacts. The best solution in such cases is to
rema!e the dentures.
The complaint may also be that the teeth are too far bac! in the
mouth or too far forward. , fear is sometimes expressed that moving the
teeth anterior to the ridge in the position the natural teeth occupied will
affect the stability of the denture. -ut it is not so. (tability will be
jeoparadised much more by encroaching on the tongue.
4hen complete dentures are first worn there is always some
temporary alteration in speech owing to the thic!ness of the denture
covering the palate necessitating slightly altered positions of the tongue.
.ommonly this is only a temporary inconvenience most rapidly overcome
by the patient reading aloud. 5owever some !nowledge of phonetics in
relation to dentures is necessary inorder to correct speech defects that may
occur in denture wearers and also to act as a guide for the more accurate
design of complete dentures.
Factors in denture design aecting speech
The vowel sounds
These sounds are produced by a continuous air stream passing
through the oral cavity which is in the form of a single chamber. ,ll vowel
sounds involve the tongue which has a convex configuration. The tip of the
tongue in all the vowel sounds lies on the floor of the mouth either in
contact with or close to the lingual surfaces of the lower anterior teeth and
gums. The application of this in denture construction is that the lower
anterior teeth should be set so that they do not impede the tongue
positioning for these sounds.
Consonant sounds
0 6abial sounds E They are b p and m formed mainly by the lips
0 6abiodental sounds E They are f and v made between the upper
incisors when they contact the posterior 1F3 of the lower lip. /ost
important information to be sought while the patient ma!es these
sounds is the relation ship of incisal edges to lower lip.
Dental and alveolar sounds
;ental sounds such as >th? are made with the tip of the tongue
extending slightly between the upper and lower anterior teeth. This sound
is closer to the alveolar than the tip of the teeth. .areful observation of the
amount of tongue that can be seen can provide information regarding
labiodental position of anterior teeth.
The sibilants s 7 sh ch and j are alveolar sounds because the
tongue and alveolus form the controlling valve. 4hen these sounds are
made the upper and lower incisors should approach each other end to end
but they should not touch.
The >(? sound can be considered dental and alveolar speech sounds
because they are produced e#ually well with two different tongue
positions. /ost people ma!e the >(? sound with the tip of the tongue
against alveolus in the area of rugae with small space for escape of air
between tongue and alveolus. (i7e and shape of this small space will
determine the #uality of the sound. If the opening is too small a whistle
will result. If the opening is too broad the >(? sound will be developed as
an >(h?. @re#uent cause of undersired whistles with denture is a posterior
dental arch form that is too narrow.
, cramped tongue space especially in the premolar region forces
the dorsal surface of the tongue to form too small an opening for the escape
of air. The procedure for correction is to thic!en the center of the palate so
that the tongue does not have to extend up so far into the narrow palatal
3osterior palatal seal area: *rrors of construction in this region
involves the vowels >u? and >o? and the consonants >!? >g?. , denture
which has a thic! base in the posterior seal area or a posterior edge finished
s#uare instead of chamfered will probably irritate the dorsum of the
tongue impeding speech and possibly producing a feeling of nausea.
Inability to eat
This complaint is mainly confined to patients who are wearing
complete dentures for the first time and are impatient at the time spent in
ac#uiring new habits of eating. .areful attention by the operator to the
psychological approach to denture wearing will eliminate his complaint
except in rare cases.
;ifficulty may be encountered with certain fibrous foods and this is
li!ely to be due to low0cusp or 7ero cusp posterior teeth or lac! of
interdigitation of posterior teeth.
,n overextended periphery may cause a denture to dislodge. 1This is
because movements during eating are more extensive than those employed
when moulding the periphery of the impression. Intelligent observation by
the patient of the exact movements which cause the instability will
eventually enable the operator to locate the overextention2.
"etention and #tability
3atients more often complain that the lower denture lifts than that
the upper one drops.
Cver extension Tight lips Bnder extension 6ac! of saliva when
coughing or snee7ing Bpper denture drops when patient yawns 6ower
denture raises when mouth is partly open 6ower denture unseats with
various tongue movements Bpper denture drops while patient is tal!ing
;islodgement of dentures on ta!ing fluids.
$vere%tention :
It is due to incorrect moulding of the impression or incorrect
outlining of the denture on the cast and is visible in the mouth as an area of
hyperaemia or an ulcer.
4ith the help of pressure indicating paste the overextention can be
detected and corrected.
Tight lips:
It can be the most difficult problem if the mandibular ridge is flat
and atrophic. The inward pressure from the lips will push the lower denture
bac!wards up the ascending ramus.
Treatment: 9ema!e the lower denture with the lower anterior teeth set
more lingually with a labial concavity an the denture. (urgical
vestibuloplasty must be considered.
Tongue space
It the lower posterior teeth are tilted or set lingually they produce an
undercut area into which the wide middle third of the tongue will get
loc!ed. /ovements of the tongue then lift the denture.
Treatment: 9educe the width of the lower posterior teeth by grinding off
the lingual cusps.
/aximum retention cannot be obtained without covering the
greatest possible denture bearing area.
It can be corrected by proper border moulding procedures with low
fusing compound and a conventional reline can then be carried out.
Lac' o saliva: already discussed under xerostomia. (erous salva produces
better cohesive force than mucous saliva.
(hen coughing or snee)ing: occasionally a new denture wearer will
complain that his upper denture falls and his lower denture lifts whenever
he coughs or snee7es.
Treatment: It must be explained to the patient that when coughing or
snee7ing the soft palate rises suddenly and the air pressure is considerable
so that the peripheral seal of the upper denture is bro!en and it is liable to
fall< the usual muscular movement will cause the lower denture to lift.
There is no way of preventing these movements of the dentures but
covering the mouth with a hand or hand!erchief is an obvious suggestion.
&pper denture drops *hen patient ya*ns:
• ;uring the act of yawning the mouth is opened
to its fullest extent and the border tissues pull down against the
borders of the denture. If there is an area of irritation the borders are
overextended and should be reduced. If there is no evidence of
overextention the patient should be cautioned to refram from
opening the mouth too wide.
• ;istobuccal flange of the denture may be too
thic! so that they interface with the action of ramus. , side to side
movement of the jaw will loosen the denture. If this occurs reduce
the thic!ness of the distal ends of the buccal flanges.
• ;enture is inade#uate in posterior palatal seal.
This leads to a poor palatal seal and air is permitted to enter under
the posterior border of the denture.
• -uccal surfaces of the teeth are placed too far
towards the chee!. 4hen this occurs and the mouth is opened the
muscles of the chee! pull against the buccal surfaces of teeth and
tend to unseat the denture.
• ;enture is overextended in the pteregomixillary
notch. 4hen this occurs the functional activity of the
pteregomandibular raphae is interfered with and during jaw
movements the denture is unseated.
• 6ower denture rises when the mouth is partly
 6ingual flanges are over extended in the mylohyoid
 6ower posterior teeth are too far to the buccal.
 Cverextention of the buccal flangs.
• Bpper denture drops while patient is tal!ing
 3oor border seal
 Improper frenum relief in the denture.
• ;islodgement of dentures on ta!ing fluids
The patient should be told that when the dentures are delivered it is
possible for him or her to experience a loosening of dentures while
drin!ing. ;uring swallowing the soft palate rises and the posterior palatal
seal may be lost. The tongue and floor of the mouth are raised by the
tongue muscles. The mandible is prevented from moving downwards by
the suprahyoid muscles. (o the mandibular denture rises during
5owever this will not persist when the tongue lips and chee!s
learn to manipulate the dentures.
Cne of the most bewildering problems encountered in complete
denture prosthodontics is that presented by the patient referred to as
G+agging is an involuntary retching reflex that may be stimulated
by something touching the posterior palatal regionH. The retching may lead
to actual vomiting and is accompanied by lacrimation salivation and
flushing. These symptoms are usually triggered by tactile stimulation of the
soft palate by the maxillary denture but may also be caused by virtually
any intraoral procedure.
The maxillary denture of the gagging patient usually has either of
the two characteristic contours. It may have a posterior palatal margin that
is so concave that it almost terminates on the hard palate or it may have a
palate which has a mar!ed downward slope away from the soft palate. In
either case the dentures can exert only minimal pressure against the soft
The most paradoxical feature found in almost every gagging patient
is although the soft palate is extremely sensitive to the contact of the
denture or any instrument the patient seldom gags on foods and li#uids of
his diet which contact this same area during swallowing.
It can thus be seen that the picture presented by the average gagger
can be separated into E
i2 ,cute
ii2 .hronic
(hortening of palatal margin does not decrease the tendency to gag
but may actually increase it. *ven in a non gagger light touch or pressure
against the soft palate can cause tic!ling sensation whereas firm pressure
is much less apt to do so. , similar experiment can be performed by
touching the bac! of one?s hand with the lightest possible pressure< this
will usually cause a tic!ling sensation. 5owever if the pressure on the same
area is firm no tic!ling is felt. ,nd so too with the maxillary denture< it is
much more apt to cause a tic!ling sensation if it exerts too little pressure
against the soft palate than if it exerts too much.
(o the consistent feature of the acute phase is a maxillary denture
which feels Gtoo longH and causes gagging which is not relieved by palate
,hronic phase:
In this phase the gaggers history resembles a simple conditioned
reflex in that the gagging becomes so intimately associated with the
denture that ultimately any procedure involving the denture or the oral
cavity can set off the reflex. *ven the thought of such contact may cause
8ovats and 8rol mentioned that the gag reflex can be mar!edly
diminished if the patient?s complete attention is diverted by having him
maintain a leg in an elevated position.
There are a number of methods of dealing with the problem. It is
important to give the patient a feeling of confidence of on the part of the
3rior to the impression ma!ing the patient should be instructed to
breathe through the nose slowly and audibly and at the same time to
rhythmically tap his right leg on the floor. -y doing so the patients
attention would be diverted enough to allow the ma!ing of mandibular
impression without incident.
The palate may be sprayed with surface anesthetic or ethylchloride
prior to recording the impression. 3osterior third of the tongue which is
often implicated in the retching reflex can also do anestheti7ed.
It is wise to have the patients head upright and to record the lower
preliminary impression first  an impression compound with minimal
flow is recommended eg. /edium fusing compound. *ither silicone or
heavy bodied polysulphide is suitable for final impression.
@or registration of centric relation virtually the entire palate of the
maxillary occlusal rim was removed in order to reduce to an absolute
minimum the area of contact between rim and palatal tissue. In addition a
thin film of adhesive was sprin!led onto the record base for retention and
an anesthetic was sprayed onto the palate. 3atient followed instructions
regarding breathing and foot tapping.
3rior to actual placing of new dentures the patient was prepared for
a temporary period of discomfort but was assured that although initially
uncomfortable it would be short lived.
6ower denture should be placed first. The maxillary denture should
then be placed and the patient is re#uested to close into centric occlusion in
centric relation. The patient should be made to nose0breathe in a deep slow
fashion. ,lthough initially very severe the gagging will subside over a
period of 140"2 minutes.
5ypnotheraphy is also used as are various types of behaviour
therapy. -arbiturates may be used to depress the .D( antihistamines to
lower the feeling of sic!ness or pararymphathetic depressants to reduce the
salivary flow which increases at the outset of retching.
1. -urning tongue 1glossopyrosis2 and burning mouth 1stomatipyrosis2
these symptoms are fre#uently seen in complete denture patients.
5owever complete dentures are not always the etiologic factor.
It is almost impossible to ma!e a clear cut diagnosis of the cause of
stomatopyrosis. (evere burning mouth is most fre#uently found in
menopausal women between 4) and $) yrs of age.
Cther causes:
Deficiency : Ait -
@olate Iron
Infections : (taphylococcal .andidiasis
Psychogenic : .ancerophobia depression
Prosthetic : Ccclusal faults bony irregularities allergy to denture base
0 Ccclusion should be balanced in all positions
0 .hec! for roughness on the tissue and polished surface of the
0 Treat the causative systemic diseases.
0 9econstruct the dentures if porous and unhygienic
0 .hange denture base material if necessary
0 , balanced diet rich in vitamins and essential minerals should be
0 4henever indicated hormones should be administered
0 3sychotherapy can be instituted.
-. Food under the denture
This compliant is usually made by patients wearing dentures for the
first time and who have not yet leant how best to control the food. ,
perfect peripheral seal will prevent the ingress of food beneath the denture
but perfection is not always attained and owing to alveolar resorption
never maintained.
Treatment: .overing maximum possible area of the edentulous foundation
and obtaining an ade#uate peripheral seal
.. ,lic'ing o teeth
The main causes are
0 *xcessive vertical dimension of occlusion causes the denture to
contact during speech particularly the sibilant sounds as the
mandible moves vertically through the spea!ing space.
0 /ovement of the lower denture from whatever cause is very liable
to lead to clic!ing of teeth.
0 *xcessive incisive guidance angle usually means that the hori7ontal
overjet is inade#uate in relation to the vertical overlap. This means
that during speech in which there is often a pronounced hori7ontal
movement of mandible the incisors contact each other and cause
0 3orcelain teeth by nature of the material creates more impact noise
than acrylic.
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