LEC 14 ///PROBLEM SOLVING

Post insertion problems for complete denture and their management

There is, inevitably,the potential for problems to arise subsequent to the
insertion of complete dentures. These problems may be transient and may be
essentially disregarded by the patient or they may be serious enough to result
in the patient being unable to tolerate the dentures.
Factors causing problems may be grouped, essentially into four causes.
1- Adverse intra-oral anatomical factors ex: atrophic mucosa.
2- Clinical factors ex: poor denture stability.
3- Technical factors ex: failure to preserve the peripheral roll on a master cast.
4- Patient adaptation factors.
Table (1):-problems(discomfort) related to impression , occlusal and polished
surface of the denture:

Symptoms cause Treatment

A- Related to impression Pearls or sharp ridges of Locate with finger or

surface
1-Discrete painful areas
2-Pain on insertion and
removal
,possibly inflamed mucosa on
side of ridge
3-Over-extension of lingual
flange. Painful mylohyoid
ridge; denture lifts on tongue
protrusion; painful to swallow
acrylic on the fitting
surface arising from
deficiency in laboratory
finishing
Denture not relieved in
area of under cut
Over-extended lower
impression:
instructions to laboratory not
clear or non-existent
snagging dry cotton wool
fiber . use disclosing material
to assist locality to ease
denture
Use pressure indicating
paste (PIP) to detect area of
undercut
Determine position and extent
of overextension
using disclosing material and
relieve accordingly

4- Lack of relief for frena or Peripheral overextension Relieve with aid of

muscle attachments;
pinching of tissue between
denture base and retromolar
pad or tuberosity. Sore
throat ,difficulty in
resulting from impression
stage and/or design error.
Palatal soreness as post
dam too deep
disclosing material. Care
with adjustment of post dam
- removal of existing seal
and its replacement in
greenstick prior to
swallowing permanent addition may be
required

B- Related to occlusal Anterior prematurity or Determine where occlusal

surfaces
1- Pain on eating in presence
of Occlusal imbalance (no
support problems
2- Cheek and or lip biting
3- Tongue biting
C- Related to polished
surfaces
1- Pain at posterior aspect of constraining coronoid
upper denture on opening
posterior prematurity, prematurities exist. Adjust
incisal locking, lack of occlusion by selective
balanced articulation grinding. If severe error
remount using facebow
and new interocclusal
records
For cheeks - likely that For cheek biting, restore
functional width of sulcus functional width of sulcus
was not restored. For lips - and/or reset. For lips, grind
poor lip support/inadequate lower incisors to provide a
anterior horizontal overlap more appropriate incisal
guidance angle
Lack of lingual overjet teeth Remove lower lingual
generally placed lingual to cusps, or reset teeth
lower ridge
Flange on buccal aspect of Use disclosing material to
tuberosity too thick and accurately define area
involved, relieve and
process repolish

Table (2):problems or discomfort

Symptoms cause Treatment

1- Burning sensation over Burning mouth syndrome Correction of any denture

upper denture supporting
tissues, but may involve
other intra-oral tissues, eg
tongue.
often seen in middle-aged or
elderly females. Denture
faults must be excluded,
also general organic and
psychogenic factors
faults, may require
multivitamin/nutrition
advice and treatment.
Possibly antidepressant
therapy. Refer to Consultant
in Oral Medicine
2- Beefy red tongue,
possibly glossodynia
3- Frictional lesions related
to dentures, mucosa may
adhere to probing finger,
may be complaint of dry
mouth
4- presence of herpetiform
ulcers in mouth
5- Patient complains of
allergy to denture material
6- Painless erythema
especially upper denture
Table(3) :factors resulting in looseness of denture(decrease retention forces):-
Symptoms
1- Lack of peripheral
seal
Vitamin B12/folate Refer for medical treatment
deficiency
Xerostomia, commonly side Where some saliva flow is
effect of prescribed drugs present, sugar-free citrus
lozenges may help. While
where there is an obvious
paucity of saliva, artificial
saliva may be considered
Herpes simplex or Herpes Dentures merely
zoster virus. coincidental to the
History and distribution of condition.
lesions to confirm May be useful to suggest
preventive remedy
(eg acyclovir) for some
sufferers
Rare symptoms may relate If excess residual monomer
to higher residual monomer detected, rebase denture
content of acrylic using controlled heat cure
cycle. May need to consider
remaking denture using
polycarbonate resin
Denture stomatitis may be Leave denture at least
with candida infection as 72houre and instruct patient
result from dirty denture to leave denture at least
with continuous wearing 8houre with daily cleaning
cause Treatment
Border underextension Add softened tracing
in depth, Border compound to relevant
underextension in width. border, mold digitally
Often a particular problem and by functional
in disto-buccal aspects of movements by patient.
upper periphery which may Replace compound with
be displaced by buccinator acrylic resin. As a temporary

2- Air beneath impression
surface.
Denture may rock
under finger pressure.
May see gap between
periphery of flange and
ridge.
Occlusal error subsequent to
ware page
3- Xerostomia
Reduces ability to form a
suitable seal
on mouth opening. Posterior measure a chair side reline
border of upper denture material may be used as
described above , Check
border is correctly sited on
fixed tissue at junction with
mobile tissue of soft palate.
Trace thin string of softened
tracing compound along
impression surface of
posterior border and seat
denture firmly in mouth.
Replace compound with
acrylic resin.
Deficient impression. Reline if design parameters
Damaged cast. of denture satisfactory,
Warped denture. otherwise remake as
Over-adjustment of required. Ensure that areas
Impression surface. of heavy contact between
Residual ridge resorption. denture and tissues are
Undercut ridge. relieved prior to impression
Excessive relief chamber. making. Where change in
Change in fluid content of tissue fluid distribution is
supporting tissues suspected check medication
(ex: diuretics) posture (ex:
heart failure) lack of
recovery of tissues from
effects of old denture prior
to working impressions
being obtained. Stabilize
fluid content of tissues and
use minimal pressure
impression method
Medication by many Design dentures to
Commonly prescribed maximize retention and
drugs, minimize displacing forces.
irradiation of head and Prescribe artificial saliva
neck region, where appropriate
salivary gland disease
 Table-4 :problems related to phonetics
Symptoms cause
Whistle on "S" sounds Air stream passes
unimpeded or with
inadequate impedance
between the dorsal surface
of the tongue and the
anterior palate
Lisp on "S" sounds The air stream passing
Between the tongue and
anterior palate is excessively no longer contact during
impeded, usually by rugae
or excessive resin contour
Maxillary & Mandibular Occlusal vertical dimension
incisors or premolars contact too great
during sibilant (s, sh, z, ch)
sounds
Table5 :problems related to esthetic
Symptoms cause
1- Fullness under nose Labial flange of maxillary
denture too long or too thick
2- Depressed philtrum Labial flange of maxillary
denture too short
3- Upper lip sunken in Maxillary anterior teeth set
too far lingually
Treatment
Increase the palatal resin
convex contours lingual to
the maxillary central
incisors to impede the air
stream passing between the
tongue and palate.
Create rugae if necessary
Reduce occlusal vertical
dimension until premolars
speech
Reduce occlusal vertical
dimension until premolars
no longer contact during
speech
Treatment
Reduce length or thickness
of labial flange
Increase length or thickness
of labial flange
Reset anterior teeth labially
4- Too much of the teeth a- Excessive vertical a- Reduce the vertical
are exposed dimension of Occlusion dimension of occlusion

b- Incisal plane too low b-Reset teeth at higher plane

c- Cuspids and lateral c- Adjust accordingly

incisors too prominent

5- Artificial appearance a- Technique setup (teeth a- Individualize by rotating

are too regular in alignment) and shortening some

b- All teeth in same shape b- Choose different but

Complimentary shades; use
staining techniques

c- Lack of individualization c- Individualize gingival

of denture base contour and color of denture
base

d- Lack of individualization d- Grind incisal edges and

of teeth angles

Pressure indicating paste (PIP)

Articulating paper

Articulating paper used to check occlusion on articulator

Tracing compound