Treating Complete Edentulism with Removable

Complete Dentures:

Post-Insertion Complaints:
Complete Denture

Dr. Mohammad Sartaj Khan

Department of Prosthodontics
Peshawar Dental College
 Objectives

• Introduction
• Classification of post insertion denture problems
• Principles of Diagnosing Problems
• Management Common Complaints
• Uncommon Complaints
 Post Insertion Complaints: Complete Dentures.

“ Most of the complaints associated with complete

dentures are
actual and not psychological
contrary to the belief of most clinicians.”
Verma.M
 Complaints: Complete Dentures

Review of New CDs:

• Always arrange a review appointment:

- within next 24-hours or on next first working day.

• Many complaints to expect.

• Patient must have been instructed for it.

 Classification Of Post Insertion Problems:
Complete Denture

• Functions
“I can’t eat with my dentures”
• Esthetics
“My dentures don’t look good”
• Speech
“I can hardly speak with my new dentures”
• Comfort
“My dentures hurt my gums”
 Denture Complaints In Relation To Time Of Delivery

• Immediate complaints: Pressure spots redness

• Delayed complaints: Denture hyperplasia, Denture stomatitis

• Problems without complaints: Attrition of teeth

 Determining the cause of pain

• May be due to the denture base

• May be due to the occlusal problems

 Pain Caused by Denture Base:

• Sore all the time.

• May be occlusion & not DB related if:
- worsening throughout day.
• May still be occlusal if:
– inflammation caused swelling.
 Pain Caused by Occlusal Interferences (OIs):

• One of most common problems.

– Pain gets worse through the day.
– Difficult to determine, intra-orally: - b/c of reflex
avoidance of pain.
– Interferences - especially in protrusive.
 Principles of Diagnosing CDs Problems

Patients frequently wrong in exactly locating source of problem.

 Principles of Diagnosing CDs Problems

• Never adjust unless you can see exactly where

to adjust. and
•
Use Disclosing / indicator medium:
• PIP(pressure indicating paste), Disclosing Wax, etc
Loney & Knechtel, J Prosthetic Dent
2009;101:137-141
 Method of Diagnosing CDs Problems

• Place Paste (e.g ZnO Eugenol paste)with Streaks:

• Use contrasting color & appropriate amount of paste.
Streaks:
- No Contact (N).
No Paste:
- Impingement (I).
Paste / No streaks:
- Normal Contact (C).
 Post Insertion Problems

Post insertion problems can be broadly grouped into:

• Looseness of dentures
i. Decreased retentive forces
ii. Increased displacing forces.

• Discomfort associated with dentures

i. Related to impression surface of denture
ii. Related to occlusal surface
iii. Related to polished surface
iv. Related to possible systemic association
 Post insertion problems can be broadly grouped into:

• Faulty Esthetics:
• Unrealistic expectations
• Over supported or under supported dentures
• Altered vertical dimension

• Defective Speech:
• increased vertical dimension
• deficiency of palatal contour
• Poor PPS region
• Thick lingual flanges or restricted tongue movements
 Complaints: Loose Dentures
a) Decreased retention:

- Lack of seal ( because of under extended borders.)

- Poor adaptation of fitting surface (faulty impression &
processing techniques or continued residual ridge resorption/
lack of tissue elasticity.)
- Excessive saliva / lack of saliva.
- Presence of undercut areas on ridge.
- High occlusal plane of lower denture.
- Patient inability to learn neuromuscular control of denture.
DISCOMFORT WITH WEARING OF CD
 excessive displacement of denture

• Tongue & Cheek Biting:

- Posterior teeth edge to edge or in cross-bite.

- Over-closure / Excessive FWS.
- Posterior teeth too far lingual or buccal.
 Retention Problems
• Short flanges
– PIP - still streaky.
– Fingers on canines outwards (post palatal seal).
– Look for space.
– May be retentive for a while if a lip seal established, until
movements disturbs the lip seal.
• Long flanges:
– Burn through (PIP).
– Intrudes tissue when placed.
– May not dislodge if good seal, may loosen after much function.
• Labial Frenum: The most common site to become
irritated from overextended C/-.
 2. DISCOMFORT WITH WEARING OF CD

a) Denture impression surface related causes:

- Presence of acrylic pearls, nodules, sharp areas.

- Unrelieved areas passing over undercut ridges.
- Faulty impression, model making & processing techniques.
- Over extended & under extended bases (load concentration
over a small area)
- Frenal notches not properly relieved.
 Retention Problems
• Post-palatal seal:
Inadequate tissue contact:
• Food gets underneath.
• Bubbles as CD is placed (check with PIP).
If over-extended to moveable soft palate:
- CD gets loose during speech & chewing.
 Occlusal Vertical Dimension (OVD):
• Excessive OVD:
– Continued & generalized pain.
– Fatigue or muscle soreness.
• Insufficient OVD:
– No power / CDs felt blunt.
Lesions associated with anterior mandibular CD border
corresponding to the PIP pattern.
 Complaints: Complete Dentures

b) Denture polished surface related causes:

- Thick flanges restricting movements of coronoid processes.
- Unbalanced occlusion.
- Lack of overjet & overbite.
- Inappropriate freeway space.
- Unstable dentures.
 Complaints: Complete Dentures

c) Other causes:
- Nutritional hormonal disturbances.
- Xerostomia.
- Para functional habits.
- TMDs (Temporomandibular disorders)
- Nausea, gagging.
- Oral infections.
- Allergy to denture base materials.
 Denture Sounds/Noise During Eating &
Speaking:

Clattering of teeth while eating / speaking

• Porcelain Teeth
• Increased Vertical Dimension
• Increased Incisor Overlap
• Loose Dentures
• Support Problems
• Stability Problems
• Cuspal Interferences And Lack Of Balance
 Speech Problems with CD

a) Transient nature ( not any obvious fault in denture design)

- Due to unfamiliarity of patient to new dentures.
b) Persistent nature (assess the cause)
- Absence of freeway space with increased OVD.
(Asking pt to say sibilant words containing “S” sounds such as
counting from sixty to seventy, upper & lower teeth separated
with tongue coming in b/w them. If opposing teeth remain in
contact, it will appear pt is speaking from behind closed teeth
indicating absence of freeway space with increased OVD.)

- Incorrect tooth position & increased OVD

( Difficulty of pt in saying bi-labial sounds i.e “P” “B” & labio-dental
sounds i.e “F” “V”)
 Aesthetics Complaints:

- Colour of denture teeth ( too dark/bright.)

- Size of denture teeth (too big/small.)
- Inappropriate tooth show.
- Shade of acrylic not compatible with colour of oral mucosa.
- Gingival contouring not according to pt’s age/gender.
 Gag/Retching Complaints:

- Psychological.
- Over sensitive palatal tissues.
- Poor retention & stability.
- Thick posterior border of upper denture.
- Excessive freeway space.

- Too low occlusal plane.

- Posterior teeth too lingually/palatally placed over denture bases.
 SUMMARY

• We must be mentally ready for facing plenty of problems with new

Complete Dentures.
• Most of the problems can be rectified at first post insertion visit for
CD
• Diagnosing of problem is very important before treatment

• A greater part of dentures success is dependant on accepting the

dentures mentally or psychologically.
-THE END.