Clinical Errors in Complete Dentures

Clinical Errors In Complete
Dentures
Dr .Priyanka Aiyer
1st MDS
Dept of Prosthodontics 1
Faculty of Dental Sciences © Ramaiah University of Applied Sciences
Contents
• Introduction
• Review of Literature
• Causes
• Complaints
• Conclusion
• References
2
Introduction
• Recall appointments post insertion

• Eliminate problems faced in wearing of
dentures
• Listen, examine & treat
3
Examination
• 24 hour oral examination & treatment
• Visual and digital examination of oral cavity
• 1-3 day adjustment
• Critical period
• Periodic recall
– 3 to 4 months for difficult patients
– 12 month interval for most
4
Review of Denture Requirements
Preservation Restoration
Stability Esthetics
Support
5
Review of Literature
• Basker RM, Beck CB, et al 1993 did a survey

of the dissatisfied denture patient. In the
majority of cases technical errors in denture
construction accounted for the presenting
complaint.
6
• Champion H et al in 1995 investigated into the
problems experienced by 114 referred
patients with complete denture. The
commonest problems were those of pain and
lack of retention, mainly due to occlusal
discrepancies and excessive VDO.
7
• Muller F et al, 1995 did a study on adaptation
to complete dentures. They concluded that
good denture retention facilitates the
adaptation process.
8
• Yoshida M, Sato Y, Akagawa Y. 2001 did a
study on the correlation between the quality
of life, and denture satisfaction in elderly
complete denture wearers and concluded that
people who are well satisfied with their daily
lives are also satisfied with their complete
dentures.
9
• Dervis E. et al 2002 did a study to investigate
relationships between patient complaints with
complete dentures and several factors such as
age, gender, medical status and denture
faults.
Statistically significant relationships were observed between denture

construction faults or the condition of the patient's denture bearing mucosa
and patient complaints.
10
• Roessler DM et al. 2003 Before treatment
even begins, the patient's motivation for
denture treatment and emotional attitude
towards dentures must be evaluated.
Patients will thereby gain realistic expectations of

what can and cannot be achieved, and dentists will
understand what the patient really wants.
Finally, patients must be informed that continued

success depends on regular denture maintenance at
home, combined with periodic consultation with the
dentist . 11
Causes For Post Insertion Problems
• Inaccuracies in various denture construction

steps
Impression making
• Recording jaw relation
Processing errors
• Patient psychology
12
Loose Dentures Discomfort
Complaints
Poor Appearance Miscellaneous
13
A]Loose Dentures
Symptoms Causes
Speech Decreased
retentive
forces
Denture
falling
Increased
displacing
Food forces
entrapment
Support
Pain problems 18
1.Decreased retentive forces
• Under Extended orders – Depth or
Width.
Lack Of Seal • Incorrect Posterior Palatal Seal.
• Inelasticity of Cheeks.
• Poor Fit.
Air beneath
• Undercut Ridge
Impression • Excessive Relief.
Surface
19
Treatment: Lack of Seal
• Under extended borders – soft tracing

compound
• Inelasticity of Cheeks – incremental border
moulding and functional movements.
20
PPS
• Under extension – Loose denture

• Overextension – loose while talking
• Insufficient depth – loose while eating.
21
• Diabetes, drugs, menopause,
irradiation.
Xerostomia
• Incorrect denture shape

• Changed shape relative to old
Poor
dentures
Neuromuscular • Motor – Neuron disorders.
Control
22
Treatment: Poor Neuromuscular
Control
• Polished surface should occupy the neutral
zone
• Use of denture adhesives.
23
2.Increased Displacing Forces
Overextended
Borders.
Poor Fit
Denture not in
Optimal Position
• Prematurities , MIP – CR,
Occlusal Balance,
Occlusal Problems. Incorrect plane of
Occlusion
24
Treatment : Overextended borders.
25
3.Support Problems
• Flabby Ridge
• Lack of Ridge
• Bony Prominence
26
B]Discomfort.
Impression Polished Occlusal

Surface Surface Surface
27
Related to Impression Surface
• Sharp Acrylic Nodules
• Un-relieved undercut areas
• Overextension
• Lower knife-edged ridge.
• Deep Postdam- sore throat, difficulty in
swallowing
28
Related to Polished Surface
• Thick distobuccal flange of upper denture
29
Related to Occlusal Surface
• Pain on eating
• Pain / Ulceration lingual to lower anterior
ridge
• Pain / ulceration labial aspect of lower ridge
and incisive papilla
• Excessive vertical dimension
• Cheek / lip biting
• Tongue biting.
30
Biting of tongue
• Usually due to
– Teeth placed lingual to lower ridge
– Decrease in tongue space in patients accustomed
to old dentures
– Changes in occlusal level
31
Treatment
• Remove lower lingual cusps

• Reset and rearrange the teeth
32
Cheek biting
• Usually due to
– Insufficient overjet, in posterior region.
– Very lax cheeks
– Reduced vertical dimension
• Treatment
– Increase buccal overjet and plump the denture
– Remove last molars
– Grind buccal surfaces of lower posteriors.
33
Discomfort: Symptoms
• Pain
• Altered sensation
• Difficulty in chewing / swallowing.
34
Faculty of Dental Sciences
. 35
© Ramaiah University of Applied Sciences
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
36
• Pain / ulceration – labial aspect of lower ridge
& incisive papilla
– Undercut or sharp acrylic
– Trim labial aspect of lower anteriors
• Excessive vertical dimension

– If increased greater than 2mm, better to remake
dentures.
37
C]Poor Appearance
• Insufficient or too much tooth visibility

• Creases at corner of mouth.
38
Creases at Corner of Mouth
• Can be due to
– Decreased labial fullness
– Decreased vertical dimension
• May require remaking of dentures

• Important to verify and take patient consent
for aesthetics at time of try-in.
39
D]Miscellaneous
40
Speech problems
– Sibliants : S
– Bilabial: P & B
– Labiodental: F & V.
41
Speech Problems
• Takes few days for getting accustomed
• Dentures may need to be remade
• Causes include
– Incorrect vertical dimension
– Incorrect overjet / overbite
– Incorrect incisor position.
42
Difficulty in Eating
• Instability
• Too narrow occlusal table
• Increased or decreased vertical dimension
43
Clattering of teeth while eating /
speaking
• Porcelain teeth
• Increased vertical dimension
• Increased incisor overlap
• Loose dentures
• Cuspal interferences and lack of balance
44
Nausea & Gagging
• Loose dentures
• Poor occlusion
• Thick distal termination in upper dentures
• Palatal placement of upper posteriors
• Low occlusal plane
• Overextended retromylohyoid area
• Underextended denture borders
• Psychogenic
45
Commissural Cheilitis
• Reduced vertical dimension

• Occlusal plane of lower teeth is too high
• Elimination of Buccal Corridor
• New Dentures
46
Burning Tongue & Palate
• Excess pressure on incisive papilla

• Association with menopause
47
Tingling or Numbing sensation
• Felt at corner of mouth / lower lip

• Excessive pressure from mandibular buccal
flange
• Impingement of mental nerve
• Excessive resorption
48
Food under the denture
• Usually by first time denture wearers

• A perfect peripheral seal is rarely attained
• Failure to keep dentures clean
• Failure to polish denture surfaces
49
Causes of Poor Fit
• Deficient impression
• Damaged cast
• Warped denture
• Over adjustment of impression surface.
50
Treatment: Air beneath Impression
Surface
• Relining the denture
• Remaking the dentures
• A rotational path of insertion in case of
unilateral undercuts.
51
Occlusal Problems
• Anterior and posterior prematurities
52
• Maximal intercuspal position not coinciding
with centric relation position
– Patient unable to control mandibular
movement
– Poor ridge
– Use of non anatomic teeth
53
• Lack of occlusal balance
• Incorrect plane of occlusion
– Dentures move while eating
– Commonly associated with large tuberosities
• Removal of second molars may help
54
Treatment: Occlusal errors
• Suspected when patient complains that
dentures become loose after a few hours of
wearing
• Also when a collection of calculus is seen on
one side of the denture
55
• Clinical Remounting
– Better view of occlusion
– Reduced patient participation
– Stable foundation without shifting bases
– Absence of saliva – accurate markings
– Reduced clinical time & adjustment appointments.
56
Insufficient / Excessive tooth visibility
• Can be due to improper

– Orientation of occlusal plane
– Vertical dimension
– Labiolingual & labiopalatal positioning of anterior
teeth.
• Difficult to correct appearance without

remaking dentures
57
Care Of The Denture
• To avoid dropping of denture
• To avoid self adjustments
• Good oral and denture hygiene
– Cleaned after each meal
– Not to use boiling water
– Denture should be kept in water or dilute
antiseptic solution
58
Conclusion
Most of the complaints associated with complete
dentures are actual and not psychological, contrary to
the belief of most clinicians. Therefore care must be
taken right from the first step.
59
References
• Arthur O Rahn, Charles M. Heartwell: Textbook of
complete Dentures, ed 5, London, 1993.
• George A. Zarb, Charles L.Bolender, Judson C. Hickey,

Gunnar E. Carlsson: Boucher’s prosthodontic
treatment for edentulous patients, ed 10, B.I
Publications Pvt Ltd.
• John J. Sharry: Complete Denture Prosthodontics,

McGrawhill Book Company, Inc. 1962.
• Sheldon Winkler: Essentials of complete Denture

Prosthodontics, ed 2, Ishiyaku Euro America Inc.
60
References
• GrantA.A, Heath.J.R, McCordJ.F, complete prosthodontics
problems , diagnosis& management (1994)
• McCord J. F. and Grant A. A. , Identification of complete

denture problems: a summary, British Dental Journal 2000;
189: Pp:128–134
• Jethlia.H, Post Insertion Problems And Their Management In

Complete Denture journal of Evolution of Medical and Dental
Sciences.Vol 2(3) Jan, 2013 pp 194-99
• Verma.M ,Post Insertion Complaints in Complete Dentures - a

never Ending Saga; Journal of Academy of Dental Education,
Vol 1, No 1 (2014), Pp: 1-8
The split denture: A new technique for artificial saliva reservoirs in mandibular
dentures:Mendoza; Australian Dental journal 2003.
61
Thank You ...
62

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Clinical Errors In Complete

• Recall appointments post insertion

• Basker RM, Beck CB, et al 1993 did a survey

Statistically significant relationships were observed between denture

Patients will thereby gain realistic expectations of

Finally, patients must be informed that continued

• Inaccuracies in various denture construction

Poor Appearance Miscellaneous

• Under extended borders – soft tracing

• Under extension – Loose denture

• Incorrect denture shape

Impression Polished Occlusal

• Thick distobuccal flange of upper denture

• Remove lower lingual cusps

• Pain / ulceration lingual to lower anterior

• Excessive vertical dimension

• Insufficient or too much tooth visibility

• May require remaking of dentures

• Reduced vertical dimension

• Excess pressure on incisive papilla

• Felt at corner of mouth / lower lip

• Usually by first time denture wearers

• Can be due to improper

• Difficult to correct appearance without

• George A. Zarb, Charles L.Bolender, Judson C. Hickey,

• John J. Sharry: Complete Denture Prosthodontics,

• Sheldon Winkler: Essentials of complete Denture

• McCord J. F. and Grant A. A. , Identification of complete

• Jethlia.H, Post Insertion Problems And Their Management In

• Verma.M ,Post Insertion Complaints in Complete Dentures - a

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