Dr.

Marwa Amer
Lecturer of Prosthodontics
Faculty of Dentistry
Tanta University

Post insertion problems in

complete denture
Objectives:

1. Be able to identify the post insertion problems of complete

dentures
2. Be able to establish the cause of post insertion complaints ,
determine the best method to treat it
• There is the potential for problems to arise
subsequent to CD insertion, It may be transient or
serious enough to result in the patient being unable
to tolerate the dentures

• Once a denture-wearing problems becomes

apparent it is important that it is addressed in a
logical and systematic way

• An adequate history of the problem, careful

examination carried out so that an accurate
diagnosis can be made, an appropriate treatment
plan advised
 Complaints in relation to
time of delivery

Immediate Delayed
Complaints Complaints
 Post insertion complaints

Complaints Complaints Complaints Complaints

about about about about
comfort function phonetics esthetic

Sore spots Instability (poor fit) Whistle on “s” sound Labial fullness
Burning sensation interference Lisp on s sound Depressed philtrum or
Redness indistinct “th & t sound NL fold
Pain in tmj T sound like TH Too much teeth
Tongue, cheek biting “f” & “V” sound exposed
Sore throat indistinct artificial look
Nausea &gagging
Deafness
 1- Pain

Pain related to occlusal surfaces

• Incorrect centric or Cuspal interference

(Dragging action during excursive movements)
• Teeth of the ridge
• Excessive VD
• Uneven occlusal balance
 Pain related to foundation

• Undetected pathology, Retained root or

unerupted tooth,
• V shape ridge
• Irregular ridge.
• Undercut.
• Mental foramen.
 Pain related to denture base
• Over extended borders
• Poor fit or rough surface denture
• Insufficient relief to prominent genial
tubercle, mylohyoid ridge
• Pressure area
• Sore throat
• Allergy.
Pain: Denture Base
Retromylohyoid Overextension

• Sore throat
• Denture moves when swallow
• From retromolar pad, flange
should go straight down or angle
forward, never backward
 Problem Solving in Complete Denture Patients

Complaint Potential Causes treatment

A. Pain
1. Overextension of border ⚫Identify the area &
during construction. determine the magnitude
with disclosing wax; reduce
2. Prolonged use of length; polish.
immediate dentures ⚫Construct new dentures or

which were not relined reline the existing dentures

1-Pain at the (thus, increasing the
periphery of effective length of flange).
the denture 3. Sharp edge at periphery ⚫Round and polish.
or along frenal notches.
⚫Reduce the depth of the
4. Impingement on mobile post-palatal seal and/or
soft palate tissues. shorten the distal border as
needed.
 Complaint Potential Causes treatment

A. Pain
1. Bleb on the denture base. ⚫Remove with bur.
2. Exfoliating bone spicule. ⚫Remove.

3. Malocclusion in a single ⚫Remount dentures on an

area. articulator and equilibrate.
4. Pressure in the denture ⚫Mark with pressure
base due to defects in the indicating paste and relieve.
impression making
2- Localized procedure or damage to
pain on the the master cast.
⚫Relieve the base if other
Pressure over prominent
residual ridge 5.
areas of bone, i. e.,
denture, support tissues are
more displaceable.
or palate terminus of mylohyoid
line, midline suture, tori,
and exostoses. ⚫Relieve and evaluate medical
6. Knife-edged ridge. history.
⚫Relieve and/or reline.
7. Subsequent to immediate ⚫Relieve and/or reline.
dentures.
8. Subsequent to ridge
augmentation.
 Complaint Potential Causes treatment
A. Pain
1. Cheek biting. ⚫Increase the horizontal overlap by
rounding the appropriate buccal
cusp.
⚫Thin & recontour the denture
2. Pinching of the soft
bases; do not cut either one short. If
tissues between the an error occured during diagnosis it
denture bases over the may be necessary to create the
retromolar pad and needed space by surgically
tuberosity. reducing the tuberosity, relining
3. Localized the denture, and then relieving the
pain other than surface. Metal tabs can also be
1. TMJ pain from incorrect constructed when little space is
over the palate,
vertical dimension of available.
residual ridges,
occlusion and/or ⚫Reset the teeth at correct VDO;
or vestibular
pathologic occlusion. equilibrate occlusion on the
areas
articulator.
⚫Reset the denture teeth, raise the
1. Tongue biting.
occlusal plane, and position the
posteriors more to the buccal.
1. Lip biting due to reduced ⚫Evaluate the vertical dimension of
muscle tone and/or large occlusion (it may be insufficient).
anterior horizontal ⚫Reset the anterior teeth.
overlap
Pain: Occlusion

• No contact on
inclines of denture
bases
 Complaint Potential Causes treatment
A. Pain
1. Excessive vertical dimension of ⚫If adequate tooth stock is
occlusion available, equilibrate on the
articulator. Otherwise reset new
denture teeth at the correct vertical
dimension of occlusion.
2. Candida albicans infection.
⚫Rest, anti-fungal medication
(Nystatin), and/or construction of
3. Occlusal discrepancies causing new dentures with metal bases and
the denture bases to shift. dense plastic. Check the medical
4. 4. Unidentifiable pain without
oral lesions. Explore altered
history for general health problems.
⚫Remount and equilibrate on an
Generalized health status: articulator.
pain on the hormonal disturbances
⚫ ⚫Refer to physician; remove
residual ridge ⚫ Alcoholism dentures for 8 hours a day.
or palate ⚫ Diabetes
⚫ duodenal ulcers
⚫ Tuberculosis
⚫ Tumors
⚫ kidney disease
⚫ blood chemistry imbalance
mental stress leading to
bruxism
 Complaint Potential Causes treatment

A. Pain

5. Allergy: Refer for testing ⚫After identifying allergens

to confirm specific allergic construct new dentures out of
response to methyl non-porus, non allergenic
methacrylate or dyes used materials.
Continue… to color the plastic. Some
4- Generalized tissue responses may also
pain on the be caused by foreign
residual ridge matter, bacteria, fungi, or
or palate toxins in the porous
plastic.
Review of Indicating Media
Loney & Knechtel,J Prosthet Dent 2009;101:137-141
Avoid Impinging on the Mylohyoid Ridge

X-section through
Mandibular ridge
in 2nd Molar region
Buccal
A problem if
prominent or sharp Mylohyoid
Ridge

Attachments
To MyloHyoid
 Poor
Retention

When opening the mouth

due to :
 Over extension
 Tongue cramped.
 Under extension.
 Tight lips.

When coughing or sneezing

due to:
 Break the prepheral seal.
 Complaint Potential Causes treatment

B. Loss of Retention
1. Overextension, i.e., the ⚫Shorten the peripheries and
vestibular tissues are under polish.
tension and are unseating
the denture. ⚫Evaluate the periphery with
2. Underextension, causing modeling compound. Add
loss of seal. plastic as needed.
⚫Augment post-palatal seal by
1. May be in 3. Insufficient postpalatal seal. adding auto polymerizing
either denture; plastic.
occurs most of
the time. 4. Faulty occlusion (most ⚫Equilibrate on the
instability can be attributed articulator.
to a faulty occlusion).

5. Xerostomia. ⚫Stimulate salivary flow with

sugarless lozenges. Lubricate
mucosa with glycerin-based
mouthwash.
 Complaint Potential Causes treatment

B. Loss of Retention
6. Restricted tongue ⚫Increase VDO, if possible. Use
space. cast palate, and thin the lingual
flange and set denture teeth
Continue further to the buccal if possible
- all to increase tongue space.
…
1. May be in 7.
⚫Education,
Rejection of dentures hypnosis.
motivation, &
either
due to failure to adapt.
denture;
occurs most ⚫Place roughness, a divot or a
of the time. 8. Habitual retruded bleb, on lower lingual flange in
tongue position. order to train the patient to
keep the tongue forward in the
floor of the mouth.
 Complaint Potential Causes treatment

B. Loss of Retention
1. Maxillary denture is ⚫Relieve palate until pivoting
pivoting over the midline ceases. If relief was not
suture. provided during construction
and the plastic is thin, add
plastic to the external surface
before relieving internally.
2. Unilateral
loss of ⚫Remove the existing teeth with
retention 2. Posterior teeth are located an arbor band. Set new teeth in
during too far buccally. the correct position and
mastication. reprocess.

3. Heavy unilateral function ⚫Teach the patient to chew

on atrophic ridges. bilaterally or refer to a
specialist for ridge
augmentation or subperiosteal
implant.
 Complaint Potential Causes Treatment

B. Loss of Retention
1. Teeth are located too far ⚫Evaluate esthetics & relocate
anteriorly. anterior teeth, if needed.

2. Insufficient postpalatal ⚫(1) Evaluate the need with

seal. modeling compound.

3. When ⚫(2) Augment the seal with

sprinkle-on autopolymerizing
plastic.
incising

⚫Recommend that a knife and

3. Mobile anterior denture fork be used to cut bite sized
support food. Surgical correction may
be indicated .
 Complaint Potential Causes Treatment

B. Loss of Retention

1. Overextension. ⚫Reduce
to physiologic extension.
Increase to physiologic extension;
2. Undertextension evaluate with modeling plastic
first.
5. Looseness while 3. Bulky flanges .
coughing, laughing ⚫Reduce to physiologic contour.
singing, and swallowing
 Complaint Potential Causes treatment

B. Loss of Retention

1. Polymerization and ⚫Cast a metal palate or reline.

cooling produced Evaluate the need with tissue
shrinkage of the plastic conditioner first.
causing the palate to
4. General distort. ⚫Refer for specialized care.
feeling of Surgery may be indicated
looseness 2. Mobile denture base
support due to atrophic or
pendulous ridges
Avoid Setting Teeth in Tongue Space

Tongue
 Problem Solving in Complete Denture Patients
Complaint Potential Causes treatment

C. Gagging
Lack of tissue adaptation ⚫Consider thin cast palate. May
1. Upon 1.
and firm post-palatal seal; reline with autopoly-merizing
insertion each thick palate; overextended plastic and augment the
day. palate. postpalatal seal. Reduce palatal
thickness and extension if
possible.

⚫Increase VDO if possible; cast

2. During the 2. Insufficient tongue space,
lack of post-palatal seal,
day
and/or faulty occlusion.
palate; set teeth to the buccal;
increase post-palatal seal and/or
equilibrate the occlusion on the
articulator.

3. While eating ⚫Equilibrate on the articulator

3. Unstable dentures due to
faulty occlusion.
 Complaint Potential Causes treatment

D. Clicking
1. Upon 1. Excess VDO.
insertion ⚫Reduce VDO by equilibration or
each day. 2. Habit. reset teeth as needed. Best that can
be offered is to refrain from using
porcelain teeth. Refer to specialist
3. Unstable mandibular if specific cause cannot be
denture due to lack of determined.
2. During the tongue space, poor
day tongue position, over-
extension,
underextension, lack of
adaptability, poor
3. While muscular coordination,
eating pendulous atrophic
ridges, xerostomia, etc.
 Problem Solving in Complete Denture Patients

Complaint Potential Causes treatment

E. Speech aberrations
1. Faulty tooth position.
⚫Reset teeth and/or practice
2. Faulty palatal contours. speaking. Trial and error
corrections;' add wax to increase
contours first; then reduce the
plastic as needed to improve
articulation of sounds
 Problem Solving in Complete Denture Patients

Complaint Potential Causes treatment

F. Altered and/or reduced taste.

1. Common in elderly. ⚫Education.

⚫Education. Since food quality is

2. Dentures cover some taste
buds perceived by all of the senses it may
help to cast a metal palate in order to
permit temperature perception.

3. Poor oral hygiene ⚫Motivation.

 Appearance

• Nose and chin approximation.

• Check and lips fall in.
• Color, shape, position of anterior teeth.
• Amount of teeth showing.
• Artificial look
Appearance
Too little/much visibility of teeth
 Inefficiency

Inability to eat any thing.

Dislodging by eating
• Insufficient tongue space
• Over extension
• Cuspal interference.
• Unbalanced occlusion.

Inability to eat meat due to:

• Cuspless teeth.
• Over closure.
• Unbalanced occlusion.
• Lake of experience
✓ Due to prolonged overclousre of the mandible. The condyle
is forced back in articular fossa.
✓ It consists of:

• Otological symptoms: tinnitus on chewing, mild catarrhal

deafness (loss of hearing).
• Pain in head and neck headache in occupital area.
• Miscellaneous symptoms:

− Tenderness at T.M.J.
− Burning sensation at the tongue.
− Dryness of the mouth.
− Metallic taste.
Five Principles For Troubleshooting

1. Establish differential diagnosis

2. Identify variations from normal
3. Have patient demonstrate problems
4. Always use indicating medium when adjusting
5. Have patient rate improvement after adjustment
History of Chief Complaint
Where?

• Have patient point to problem

• Partially ignore patient’s position
• Dentist locates with stick,
instrument or paste
History of Chief Complaint
When?

• Chewing only - Occlusion

• Gets worse throughout day - Occlusion
• When first insert dentures - Denture Base
• Pressure on 1st molars - Denture Base
History of Chief Complaint
Details

• How long?
• does it last?
• since it began?
• Anything make it better/worse?
Applying Pressure Indicating Paste

Dry denture
Thin coat with stiff brush
Leave streaks
“ Most of the complaints associated with complete
dentures are actual and not psychological, contrary to
the belief of most clinicians.”

“There was no statistically significant relationship

between patient age, gender, systemic health and
denture complaints; but statistically significant
relationship exist between types of denture, denture
faults and complaints.”
 References:

• Sheldon Winkler, Essentials of complete denture Prosthodontics

2nd edition, 2004, AITBS Publishers, pp 318 - 330
• Boucher, Prosthodontic treatment for edentulous patients, 10th
edition, 1994, B I Publications, 298-313
• Verma.M ,Post Insertion Complaints in Complete Dentures - a never
Ending Saga; Journal of Academy of Dental Education, Vol 1, No 1
(2014), Pg: 1-8