10- Post Insertion Problems

and Complaints
 Dr. Amal Fathy Kaddah
Professor of Prosthodontic,
Faculty of Oral &Dental Medicine,
Cairo University
 Managed by

Diagnosis Causes Treatment

 Causes are attributed to

Patient's Denture
settling Denture errors
dissatisfaction
Patient's dissatisfaction are attributed to

Denture Types of patient

problems

Philosophical Hysterical
Exacting
Indifferent
 Denture problems

New denture Old denture

Loose fit Over extension over closure

(Low VD)
The majority of the patients
with new denture may face
one or more of the following
problems:
Poor
Pain Poor masticatory
Poor
appearance denture fit
efficiency

Clattering or Nausea and Altered

Discomfort
noisy teeth gagging speech

Cheek, lip Food under

Loss of taste
and tongue the denture Miscellaneous
sensation
biting and Halitosis
1. Overextension of the 7. Irregular and knife edge
periphery ridge, V- shaped ridge.

2. Poor fit 8. Pressure on the Mental

foramen
3. Insufficient relief
9. Allergy
4. Incorrect occlusion
10. Rough fitting surface
and Cuspal interference
11. Infection with Monilia
5. Teeth off the ridge Albicans (Pathological conditions)

6. Retained roots, 12. Difficulty in swallowing

unerupted tooth or sharp and Sore throat

bony spicules 13. Severe Undercuts

borders Basal Seat
Occlusion

Denture Ridge VD
Poor fit
•Over-
CO#CR
extension Roughness
Remaining undercut
Root
•under- Mental Foramen Uneven
pressure
extension
Allergy DD Patch test
(disto-
Cuspal
lingual Improper imp.
interference
area) Improper cast
Pressure area Teeth off
Warpage of denture base ridge
 Borders
 Over extension interfere with muscle
movement

Under extension break the seal,

Mylohyoid ridge

 Improper trimming Thick or thin border

The most common cause of pain
May be due to :
Labial frenum
 Should be thin
and deep, not
broad
 Round internal
and external
angles
 In the form of

Hyperaemia Cut in vestibule Ulceration

Identification of over extended
denture flange by means of P.I.P.
 Overextension of the periphery

Epulis fissuratum

New denture
Occlusal view of the
edentulous
mandible
Old denture
Never adjust without locating
exact position of the problem
Use P. I. paste
 Poor denture retention, rocking, tilting and
inability to seat the denture.

 Denture movement over the mucosa will

cause pain and areas of inflammation might
be present.

Treatment:
 ???????? According to the case

 Relining of old denture or Construct a new denture.

 Looseness of dentures
or poor fit usually
results due to lack of
retention and/or stability
of the denture.
Poor retention of Lower denture

Bathed in Strong
Less movements of
saliva
surface area the tongue
 Related symptoms

Normal Abnormal

- Open wide (Yawing)

- Speaking
Coronoid process.
- Eating
 Cough& sneezing →
- Pain
 New denture →
Saliva.
Poor Denture fit
1. Decreased retentive forces
A. Lack of peripheral seal
B. Under-extension border depth and width
C. Excessive relief
D. Xerostomea
E. Lack of posterior seal
2. Increased displacing forces
A. Over-extension border depth and width
B. Excessive fit
C. Occlusal errors
D. Upper lip pressure on upper denture
3. Inadequate supporting structure negotiate
A. Flat ridge
B. Fibrous displaceable tissues
C. Non resilient soft tissues
Areas to be relieved of the denture:
 Prominent bony areas (buccal canine

region, Bony tori (maxillary or mandibular).

 Sensitive areas

Treatment:
 Apply pressure indicating paste to
demarcate the area on the fitting surface
of the denture. Relief
 Insufficient
Amount

Correct Amount
with Streaks

Too Much
w/o Streaks
Insufficient relief Burning sensation
 With resorption, it becomes over the crest
of ridge.

 Pressure from denture may elicit

numbness, localized or referred pain.

Treatment:
 Relief.
A denture border short of the mylohyoid
ridge digs into the residual ridge and
causes pain. If shortened, the denture
border will impinge again upon the ridge.
 Poor base
adaptation

 Fulcrum on bony
structures
 Occlusion

Uneven Cuspal Teeth off

VD CO # CR pressure interference ridge

VD White sore
VD (white
(Neurological area on the In upper buccal Tuberosity
patch)
pain) site of sulcus of of opposite
pressure working side side
Adjusting Occlusion
Remount denture on an articulator

 Eliminates denture movement

 Can visualize interferences easily

 Centric relation & protrusive records

 Mark centric & excursive contacts, adjust

 Reduces adjustment time

 Saves time removing & replacing dentures

Don’t Adjust Occlusion
Intraorally
 Contact on inclines can cause
denture movement
 May cause pain, or reflex
avoidance
 May make interference difficult
to mark

Net Result
Can’t see real Problem
Can’t eliminate the Problem
 Clinical Remounting Procedure

Mounting the lower cast with new

CJRR
Make sure the denture bases are
not contacting posteriorly.
 High vertical
dimension

Solutions ???

Low vertical
dimension
 Excessive OVD
• Gets worse during day

• Muscle/joint pain

• Small white patches + painful areas

Pain returns within few days of

immediate relief over patches

• Dentures ‘click’

• Esthetic complaints: too full

• Sore over entire ridge.

• Treatment: new lower denture if

upper occ. plane is correct or upper

and lower denture
Insufficient OVD

• Indefinite pain location resembles

neuralgia of cheek
• Lack of chewing power

• Minimal ridge discomfort

• Costen’s syndrome mild deafness,

tenderness in TMJ, burning sensation of
the tongue, throat and nose, dryness of
the mouth.
Insufficient OVD

• Angular chelitis

• Esthetic complaints:

 Chin prominent
 Poor lip support

Treatment: new denture.

Traumatic

occlusion

CO#CR
 Mismatch of ICP and RCP.
 The patient will not feel comfortable in that
situation.

 Trials to retrude the mandible will rub the

denture against the mucosa. This will cause
pain and looseness.

Treatment:
 If Mild error: Selective grinding of teeth.

 If Gross: New denture.

• Lesser degrees of
errors can be detected
by a celluloid strip or
articulating paper

• If more it is detected
with a wax knife
 Mild error: chair side occlusal
spot grinding.
 Moderate errors: clinical
remount.
 Severe errors either remake
denture or replace posterior
teeth.
 A Dragging action will be exerted on both dentures
during lateral and protrusive movements with teeth in
contact if cusped posterior teeth are used or if excessive
incisal guidance angle has been used.

 Dragging will cause pain

 With Well Fitting Retentive Dentures Or

 Instability with poorly retained dentures.

 Pain is widely distributed, and only experienced on

eating. Sore areas on buccal or lingual surfaces of ridges.

Treatment
 Mild: chair side grinding or clinical remount.

 Gross: new dentures with balanced occlusion.

Error in Eccentric Excursions

Occlusal Prematurity Lesion –same side as error

Localized Lesion Generalized Lesion Hyperkeratotic Ridge

Irritation of the Crest of the Ridge

 Briefly
Treatment
 Pain on eating- premature contacts |Lack of
occlusal balance

 Use articulating paper to identify offending area

 Pain |ulceration lingual to lower anterior ridge

 CR and MIP do not coincide

 A slide from CR to MIP

 Selective grinding to correct

Clinical Exam Cause: Setting of teeth far buccally.

 Occlusal contact not

centered over ridge

 Tilting forces cause

displacement, abrasion,
ulceration

 Worse if xerostomia,

malnourished,
debilitated or poor
adaptability

Pain Upper buccal sulci and maxillary tuberosities.

Clinical Exam

 Patient
demonstrates
problem by biting
where pain occurs

Treatment:
New dentures. •Ulcer or sore spots on
sides of ridges
 Pain in upper buccal sulci and tuberosities.

 Upper teeth are often too far buccally (to meet

occlusion in cases of skeletal class III).

 During function, upper denture will tilt, digging the

periphery into the mucosa on the working side, and

pulling it down the tuberosity on the opposite side.

Treatment:
 Remove the last four posterior teeth and reduce the

bulk of acryl over the tuberosities and reset.

 New dentures
Avoid Contact on Inclines

• No teeth set
over ascending
portion of
ramus
 Pain results from direct
pressure on an area already
tender.

Treatment:
 Extraction of the root or tooth,
followed by relief over the
area. OR relining of the
denture.
Pressure during mastication causes pain .
Treatment: Alveoloplasty + relining (lower(
Relief over the crest (upper(.
 Often the lower ridge. The denture squeezes
the mucosa against the sharp bony ridge.

 Pain may be accompanied with burning

sensation. Worst after meals.

Treatment:

 Relief over the sharp irregular ridge.

 Alveolectomy followed by relining the denture

 This results in rough area on the crest of ridge
with sharp spicules of bone.

 Pain will be elicited when the intervening mucosa

is pressurized.

 Similar to pain due to narrow resorbed ridge, but

pain is localized.

Treatment:
 Surgical smoothing of the affected area followed
by relining the denture or; just relieve the
denture.
 Small pimples or blebs of
acrylic over the fitting
surface due to inaccuracies
of the surface of the cast.

Treatment:
 Remove roughness by
acrylic bur.
 Rare.

Treatment:
Treating the condition +
new denture
 Nicotinic Stomatitis

(Smoker's Palate) is a lesion of the

roof of the mouth. The concentrated
heat stream of smoke from. tobacco
products causes Nicotinic Stomatitis.
 The upper denture revealing of either
 Over-extension Over The Soft Palate
 Or pressing in the hamular notch area or
the postdam region.
 The lower will be
 Over-extended distally in the lingual pouch
(Pressure on the palatoglossal muscle).
 There will be an area of slight redness or
ulceration.
Treatment:
 Reduction of the over extension.
Undercut
Tuberosities
Pain on insertion and removal.

Red and painful undercut area (ulcerated).

Treatment:

• Fitting Surface Cut Away With No Reduction

Of Periphery.

• Alveoloplasty + New Buccal Or Labial

Flange.

• Undercut on one side insert in one

side then rotate.
Unilateral
undercut
 Hamular Notches

 Commonly sharp
flange

 Sometimes long

 Use PIP
Bony Undercuts
Pain: Denture Base
Severe Tissue Undercuts

If the ridge is severely

undercut, the flange cannot
be placed to the depth of
the vestibule, otherwise
the denture will not seat or
ulceration will occur
A denture border short of the mylohyoid
ridge digs into the residual ridge and
causes pain. If shortened, the denture
border will impinge again upon the ridge.
Avoid Impinging on the Mylohyoid
Ridge
X-section through
Mandibular ridge
in 2nd Molar region Buccal

A problem if
Mylohyoid
prominent or sharp Ridge

Attachments
To Hyoid
Pain: Denture Base
Retromylohyoid Overextension

 Sore throat

 Denture moves when

swallow

 From retromolar pad,

flange should go straight
down or angle forward,
never backward
 Nose and chin approximating

 Cheeks and lips falling in

 Angular cheilitis or soreness of the corners of

the mouth

 Colour, shape, size and position of anterior

teeth.

 General dissatisfaction---- who?---female

middle age --- need kindness and patience.
1- Nose –chin approximation

Due to closed bite.

Treatment:
As reduced bite.
 Nose and chin approximating
(Closed-bite)
As the occlusal vertical dimension is too small,
the vermilion border appears thin and wrinkles
occur around the lips.
The chin is apparently protruded.
2. Cheeks and lips falling in:
Plumping: Unsupported lip and cheek.
Due to lack of tone of facial muscles.
Due to labial and buccal resorption in
max. ridge.
Teeth have been set too far lingually or
Having insufficient width of the buccal
and labial flanges.
Sunken lips and cheeks

Treatment: Building up of the upper

denture.
3- Angular cheilitis or soreness of
the corners of the mouth

Corner of Mouth
3- Angular cheilitis or soreness of
the corners of the mouth

• Loss of muscular tone and

decreased VD .

• Saliva bathed in the fissure

secondary infection .

Treatment: Restoration of VD.

4. Colour:
Teeth: too dark or too yellow
Acrylic resin.
5. Shape and Size:
Too large or too small

Treatment: Replace teeth or new

denture.
6. Arrangement and position:

Even or irregular
Too far forward or backward
Cheeks& lip falling- in

Treatment: Replace teeth or

new denture.
Cheeks& lip falling- in

Irregular Occ. plan

 Remember: there is upper labial resorption,
making the teeth too far lingually).

Colour, shape and position of anterior teeth.

Shape, Shade and
Position of teeth
7. Amount of tooth showing:

Treatment : New denture with corrected

occlusal plane.

Smile view of the patient and Amount of tooth showing:

 Amount of
teeth showing
8- General dissatisfaction:
• Appearance

• Women

• Middle Aged

• Menopause.
‫البر ال يبلى ‪ ..‬و الذنب ال ينسى ‪..‬‬
‫و الديان ال يموت‪...‬‬
‫فاعمل ما شئت ‪ ...‬كما تدين تدان‬
 Inability to Eat Anything
 Inability to Eat Meat
 Dentures dislodged by eating
 Phonetics (speech difficulties)
Anything Meat Dislodgement during eating
Borders Overextension

Basal seat Unstable

• Cuspal denture
New denture Occlusion
interference
• Unbalanced Improper tongue space

Eating articulation Cuspal interference

experience • Flat teeth unbalanced articulation

Tooth off ridge

Borders Basal seat Occlusion

Improper Unstable
denture

Vertical
Teeth Dimension

Blunt Flat teeth

Elevate the muscle Pt cant

& don’t work open to get

Cuspless teeth ???
• Cuspal interference

• Unbalanced articulation

• Teeth outside the ridge

• Cramped tongue

• Overextended flange

• Unstable denture
Cramped Tongue

Improper tongue space

 Anterior Teeth:
Improper Labio-lingual positioning and Vertical overlap →
"S" sound → (Whistling or lisping).

•Encroachment on tongue space:

a- Posterior teeth placed too far lingually.
b- Too great Bucco-lingual width of posterior teeth.
c- Excessive thickness of the lingual flange.
d- Poor palatal contour (Rugae area) → "S" sound → P.I.P.

• Poor denture retention.

• Excessive salivation.
• Vertical dimension → P, B, F, V
Phonetic Problems
Lisping:
 Too much overlap

 Teeth are set too far palataly

 Palatal contour too constricted

 Bulky Rugae Area

 Insufficient tongue space

 Improper occlusal plane

Lisping

Bulky Rugae
Linguo-alveolar consonants:

The Linguo-alveolar S, Z, and, C (soft), sounds:

The S, Z and C sounds (sibilants): the formation of a narrow

midline groove of the tongue through which air is directed against
the incisal edge of the teeth; the lateral margins of the tongue
contact the teeth and gingivae and the blade of the tongue nearly
touches the alveolar ridge. The palatopharyngeal valve is closed
so that the air stream for these continuants can be emitted orally
•The upper and lower
incisors should approach
each other end-to-end, but
they should not touch that
indicate a possible error in
the amount of horizontal
overlap of the anterior
teeth.
•Always check on the total
length of the upper and lower
teeth (including their vertical
overlap)
If this channel is too
shallow (broad and
thin)
Lisping “Sh” sound
if the depth of the
channel is further
decreased or Lisping (th or etts)
obstructed

If the channel formed

between the hard
palate and the tongue Whistling
is too narrow and
deep

Lisping and whistling are opposite phenomena

Labio-dental Consonants:

In the production of the fricatives f, v, and ph sounds,

the lower lip is brought into contact with the incisal
edges of the maxillary anterior teeth. The lip may
curt over the labial surface of the maxillary teeth
to a height of 1-2 mm.
 Effects of labiodental consonants
in denture construction

 Position of the maxillary and

mandibular anterior teeth

 Vertical dimension: Increasing or

decreasing of the V.D. affects the
pronunciation of the labio dental
sounds.

• Upper anterior teeth too long or too

far posterior or too far anterior.
What Comes
Around Goes
Around
Poor denture fit

 Occlusion

 Denture base (fit & contour)

 Poor anatomy
A-Reduced retentive Increased displacing
force force

Lack of posterior Over extension

palatal seal of the border

Under extension of
borders Flabby ridge

Xerostomia
Occlusal
Excessive relief Errors
 Looseness of dentures
or poor fit usually
results due to lack of
retention and/or stability
of the denture.
 Oral And Facial Musculature
Muscular control is an important aspect of
successful complete denture therapy. providing
that:
 The polished surfaces are properly shaped,

 The teeth are positioned in the neutral zone.

 The denture bases are properly extended to

cover the maximum area possible.

 Occlusal plane levelled below the maximum

convexity of the tongue.
The Polished Surface Contour
Addition of Post-dam
The distobuccal
corner of the
mandibular denture:
The buccal flange must
converge medially to
avoid displacement due
to contraction of the
masseter muscle
The denture base must be contoured to permit
the modulus to function freely, to avoid
displacement of the denture.
Denture Looseness
Denture Base

Periphery terminates on
bony structures
Dry Mucosa
 Hard palate

 Zygoma

 External oblique ridge

 Before retromolar pad

 No seal, discomfort
 Eventual resorption
Coronoid Interference
 Thick flange in retrozygomal
area

 Coronoid gets closer to

tuberosity as patient opens
or moves jaw to side

 Dislodges maxillary denture

Pterygomandibular Raphe

 Raphe from area of

hamular notch

 Very tight in some

patients

 Easily displaceable, but

raphe can displace

denture opening wide
Palatal Cleft
 In some patients midline
soft palate fissure

 Can “tent” during

function

 Allows air to leak under

denture
Denture Looseness
Anatomy
Xerostomia
Denture base (fit & contour)
 Overextension
 Under-extension
 Tight lips will push the lower denture
backwards and upwards
 Cramped Tongue Restricted tongue space
 Lack of peripheral seal
adding tracing compound, then reline.

 When coughing or sneezing

 Un-retentive denture
 Insufficient relief
 Incorrect centric occlusion
 Cuspal interference
 Unbalanced articulation
 Teeth off the ridge
 Insufficient tongue space
 Technical discrepancies
 Occlusion

Typical History
Adequate stability
initially
Gets worse with time
 Occlusion
Loose Maxillary Denture
• Heavy anterior interferences can cause
loosening at posterior

 Incisors placed too far labially Denture

displaces lingually.

Tilting/jiggling caused by:

• Contacts not centered over ridge

• Contacts on inclined portion of ridge

 Check centric position (articulating paper)

Tooth Position

Vertical
height of
mandibular
posterior
Teeth
When eating

When talking
NOISY DENTURES

Increased
VDO

Causes
Gross
Porcelain
cuspal
teeth interference
Overextended upper
denture

Thick Posterior
Palatal seal

Distolingual area of
lower denture

Psychogenic factor
 Causes

Posterior border of Over extended distolingual

upper denture border of lower denture Loose denture

Overextension Under extension ↑ Thickness

 Treatment
 Remove over-extension and
 Upper denture slightly readapt post dam. under-

over-extended or under- extension causes

intermittent contact with the
extended:
tissues

 Thick posterior border:

 Irritates dorsum of the
tongue.
 Protrusive imbalance:
 This will cause upper denture
to dislodge posteriorly and
tickle tissues there.
An involuntary series of uncoordinated spasmatic
movements of the swallowing muscles due to stimulation
of the swallowing receptors situated in the posterior
pharyngeal wall .

Causes :
1. Systemic disorders .

2. Psychologic factors. .
3. Physiologic factors.
Psychological gagging is the most
difficult to treat since it is out of
the dentist's control. In such
cases, an implant supported
palate-less denture may have to be
constructed or a hypnotist may
need to be consulted.
TRIGGER ZONES SENSITIVE
AREA

1. Tonsillar pillars
2. Tongue
3. Posterior pharyngeal wall
4. Soft palate
5. Hard palate
Physiologic factors:
1 . Extraoral stimuli
2 . Intraoral stimuli
a. Improper denture contour,
b. Overextended or underextended d.
c. Too thick posteriorly.
d. Inadequate denture retention .
e. Inadequate free way space .
f. Restricted tongue space .
g. Disharmonious occlusion .
h. Unfinished Surface of the denture .
i. New complete denture wearers .
Managements
Pre-prosthetic managements.

The use of medications.

During clinical procedures.

During clinical procedures
1. Seat the patient in upright position .
2. Tell the patient that little difficulty will be
encountered.
3. Ask the patient to breathe deeply.
4. Never say the word GAG.
5. Encourage physical and mental relaxation .
6. Speak loudly and clearly to the patient .
7. Ask the patient to rinse with astringent before
the procedure.
8. With impression procedures tilt the patient
head forward.
9. Start with the lower impression first.
10. Select the proper impression material,
with fast setting time.
11. Use local surface anesthesia .
12. Bead the posterior border of the tray.
13. Mix the impression material out of the
sight of the patient.
14. Use proper amount of the impression
material
15. Seating the posterior part of the upper
tray first !!!!!!!!!!!!!!?.
 Cheek and lip biting could be due to:
1. Lack of horizontal overlap: Premolar and molar teeth that
occlude edge to edge… grinding the buccal cusps of the
mandibular posterior teeth

2. Reduced VDO cheeks tend to collapse into the occlusal area

3. Incorrectly positioned occlusal plan

Tongue biting could be duo to:

1. Reduced VDO *(No Freeway Space)

2. Cramped tongue

3. Low occlusal plane

 Monoplane
 Heavy Bite
 No Horizontal
Overlap
 Cramped tongue space

 Altered vertical dimension

 Altered occlusal plane

 Altered position of the upper incisors

and thick palate.

 Unemployed ridge: difficult to wear

lower denture.
Cramped tongue
High Plane of Occlusion
 Undoubtedly a perfect peripheral seal

will prevent the ingress of food

beneath the denture but perfection is

rarely attained and owing to alveolar

absorption never maintained.

Food Collection

Improper Flange Thickness

If the denture border is underextended in the buccal shelf area.
Therefore, it will not be able to occupy the buccal pouch.

A space will occur between the denture border and the lower
muscle bundle of the buccinator, resulting in food
accumulation.

The fibers of the buccinator run anteroposteriorly so that

the force dislodging the denture during mastication is minimal..
 Alter Taste

Acrylic Resin Hidden porosity Oral Hygiene

Bacterial growth
Diagnosis: black area with Patient
Explain to the Patient
bright light instruction
Metal base.
• Food may become lodged underneath dentures
and can be the root of any potential bad breath.
• The plaque caused by the lingering food can
form a layer around dentures, creating an
unpleasant smell.
• Failing to clean dentures every day due to a
build-up of bacteria,
• Wearing your dentures all the time.

• Soaking dentures in peroxide

Blood dyscrasia
 Inadequate finishing of denture
especially interdentally.

 Use of hard abrasives.

 Failure to clean dentures regularly.

 Incorrect use of denture cleansers.

 Reduced manual dexterity of the

elderly (or ill) patient.
 Loose fit (Low VD)
Over extension
over closure
due to

Anterior sulcus Epilus Fissuratum

Hard palate Papillary hyperplasia Ridge resorption
Ridge Flabby ridge Denture Settling
Teeth Wear
*Chief complaint of old denture
Lead to
-Discomfort - Discoloration
Anterior Resorption
- Abraded Denture Base.
TMJ Disturbances
 Mouth with old Mouth with new dentures: notice
dentures: sagging face the lift to the face and lips
Loose fit Hyper plastic Pressure area & (Low VD)
tissue over closure
Over extension

•Tissue •Tissue rest Relieved Occlusal Pivot:

conditioning
•Tissue
material Increase VDO in
conditioning
•Relining lower 2nd premolar &
•Surgery lower 1st molar by
•Rebasing
adding acrylic resin
•Remake on their occlusal
surface.
Angular cheilitis or soreness of the corners of the mouth
The primary cause of this condition is over
extension of denture border which may be
the result of sinking of the denture.
 Epulis Fissuratum

Ill fitting and

over extended
denture
The Labial Flange Of The Denture Produces A Low Grade Irritation
In The Surrounding Soft Tissues, Resulting In Development Of
Epulis Fissuratum, And Cause An Associated Overgrowth Of
Fibrous Tissue Covering The Maxillary Tuberosities.
The rehabilitation of abused oral tissue
is to improve its health and regain its
original form before making a new
denture:
I- Remove the cause

II- Recovery program

Remove the cause
 Removal of the denture from the patient's

mouth for few days, with an appropriate

recovery program to allow the inflammation to
subside and to allow the tissues to regain its normal
healthy form before making new impressions.
 Or, an alternative line of treatment is accomplished

by denture correction and then, starting the

recovery program.
Recovery Program
1. Finger Massage of the soft tissues two or
three times a day to stimulate the blood supply
and aid recovery.
2. Mouth wash: Instruct the patient to dissolve
one-half teaspoon of table salt in a half glass of
warm water and rinse vigorously.
3. Tissue rest: Remove old dentures from the
mouth for at least 8 hours every 24 hours for few
days before making new impressions to allow the
Denture correction
1. Detect and remove any pressure areas or sore

spots using pressure-indicating paste.

2. Relining the old dentures with soft tissue

conditioning materials to aid recovery before

constructing new dentures

3. Correction of occlusal disharmonies by clinical

remounting and Restoring (VDO) the occlusal

vertical dimension

4.Elimination of any contact between natural anterior

teeth and opposing artificial teeth.

Tissue conditioning material application

Add tooth coloured self curing resin
on the posterior occlusal surfaces of
the mandibular denture
When the patients closes the mouth with
the mandible guided to the centric
occlusal position, the occlusal surfaces of
maxillary posterior teeth are recorded in
the resin. Trim the resin to reestablish the
contours of the teeth.
If the condition persists then
the treatment may be either:

1.Prosthetic approach to the flabby

tissue OR
2. Surgical removal of the flabby
tissue.
 Original appearance with upper and lower prosthesis in place
demonstrating inadequate facial support and improper plane of occlusion.
At the conclusion there are six
commonest causes of dentures
failing are:
 Incorrect anteroposterior relation ship of the
mandible to the maxilla.

 Uneven occlusion or unbalanced occlusion.

 High and low vertical dimension.

 A cramped tongue.

 Poor retention.

 An inexperienced denture wearer.

 Poor fit due to decrease in retaining forces.
Cause
1. Lack of peripheral seal
2. Under extension of the border in
depth
3. Under extension of the border in
width
4. Posterior palatal seal:
a. Over extension on movable tissues.
b. Under extension on non
displaceable tissues.
5. Poor fit due to:
Deficient impression.
Damaged cast
Warped denture.
Grinding tissue surface.
6. Excessive relief
7. Xerostomia
8. Decreased neuromuscular control
due to:
Facial palsy
Mandibular molars placed too far
lingually.
Convex polished surface.
High mandibular occlusal plane.
Diagnosis Treatment
- Pulling down the anterior teeth (examines the Proper border molding followed by relining or
anterior labial flange) rebasing the denture.
- Pull out on incisors (examines the posterior
palatal seal).
- Pull out on canines (examines the tuberosity
region).
Tracing compound added will remain beyond the Remoulding the denture in mouth.
border. Change to acrylic resin either:
Directly by self cure resin or tissue
conditioning material.
By tracing compound. Remoulding by allowing the patient to move
Lack of contact between polished surface and mandible from side to side.
cheeks especially in tuberosity area.
Clinical examination: a. Reduce border, add post dam and reline.
a. Broken seal by speech b. Extend with tracing compound, mold, wash
b. Under extended border. impression, make post dam on cast and then
reline.
Clinically, gap is seen between denture base and Relining or rebasing.
tissues.
Pressure indicating paste reveals uniformity in
thickness.
Pressure indicating paste reveals excessive Relining or rebasing. After forming proper
thickness in this area. thickness for relief..
Patient complains of dry mouth and reduced taste. The patient is advised to use artificial saliva,
Clinically, presence of sticky dry mouth. frequent fluid intake, chew gums.
Denture with additional retentive means is
preferred.
Clinically evident through improper speech Patient is advised to use denture fixatives
and mastication. until he develops denture skills.
Correction of errors in the occlusal plane.
 Poor fit due to increase in displacing forces.
Cause Diagnosis Treatment
1. Over extension in depth Direct vision Reduce over extension and re-polish the
Elevation of mandibular denture when denture.
mouth opens slowly.
2. Over extension in width Patient complains of bulk and food Reduce over extension and re-polish the
a. In lingual flange entrapment. denture.

b. Mandibular labial flange Denture will lift by tongue

c. Maxillary labial flange Mentalis muscle lifts the denture.

d. Tuberosity area Denture is displaced by maxillary lip
Cheek soreness and denture displacement.

3. Recoil of supporting tissues.
Denture falls when teeth are not in contact Reline or rebase using minimum pressure
History of impression made without tissue impression technique.
rest from old denture.
Muco compressive impression technique
was used.

4. Occlusal errors Ask patient to close slowly in centric Achieve even contact or harmonious jaw
a. Uneven occlusal contact until teeth touch.. relation by:

b. Disharmony between centric Presence of occlusal errors may be Chair side tooth grinding.
occlusion and centric relation. masked by: Remounting.
c. Lack of freedom in intercuspal a. Displacement of the mucosa. Remake dentures.
position. b. Tilting of dentures.
d. Lack of occlusal balance in
eccentric positions.
e. v. Excessive anterior vertical
overlap.
 In the form of

Hyperaemia Cut in vestibule Ulceration

 Treatment

Remove the cause Tissue rest

 Causes

Over extension Improper occlusion

Pressure by denture Movement of denture

 Types

Generalized localized

Acute chronic
Oral Increased
VD
hygiene Eccentric
bruxism
occlusal
Allergy Xerostomia
interference
CO#CR
 Food Patient
Oral hygiene instruction
debris

Recurred
Allergy 24 h rest
Another
denture

Fluid
Xerostomia Examination
TTT

Remove
Wear denture at night
Bruxism
facets Tranquilizer
Eccentric occlusal No contact on Grinding
interference the other side

Denture
CO#CR Grinding
shifting
anteriorly

Increased Clicking Another

VD of teeth denture
Border Basal Seat Occlusion

• Ridge • Occlusal
•Over extension • Spicules
interferences
& remaining roots.
•Unpolished • Tooth off ridge
• Denture
Pressure (PIP)