P O S T-P L A C E M E N T P R O B L E M S O L V I N G
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Complaints/area |
Causes |
Treatments |
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Peripheral
areas |
Overextension |
Adjust denture
accordingly |
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Unpolished or sharp
edge |
Polish denture
borders | |
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Herpetic or apthous ulcer |
Leave
denture out as much as possible and wait 7-10
days | |
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Crest
of ridge |
Bone
spicules |
Identify the area in denture
with pressure – indicating paste and provide relief over spicule and/or surgically remove spicule |
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Spinous ridge
crest |
Provide relief in the
denture | |
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Pressure spots at time of
impression |
Use
PIP or indelible pencil to determine the areas and adjust
accordingly | |
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Occlusal prematurities |
Correct occlusal defects, recheck
vertical dimension and clinical remount | |
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Side
of ridge-anterior area |
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Use pressure indicating paste and adjust denture border involved |
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Side
of ridge-bicuspid area |
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Provide adequate relief in denture base |
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Adjust denture accordingly | |
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processing ( dimensional changes) |
Rebase denture | |
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Error in occlusion - occlusal prematurities |
Check occlusion on the opposite side of arch from the sore spot | |
| Pressure on mental foramen if ridge is greatly resorbed | Provide adequate relief | |
| Side of ridge-posterior area | Overextension in lateral throat area | Shorten posterior of lingual flange |
| Error in occlusion | Check teeth diagonally across the arch from the sore area | |
| Spinous projection of mylohyoid ridge distolaterally ( feeling of sore throat) | Correct undercut surgically; you must under extend the denture. Relieve denture if not severe | |
| Overextension in anterior area (causes rotation of distal flanges) | Adjust peripheral overextension | |
| Under lingual flange | Maximum intercuspation not in harmony with centric relation (drives mandibular denture forward) | Enlarge centric area and adjust local area- |
| Under labial flange | Excessive overbite | Adjust anterior occlusion |
| Habit- mastication in protrusive relation | Train patient to masticate in centric | |
| Generalized soreness and redness | Heavy biting force- strong musculature | Reduce buccolingual width of teeth; reduce vertical dimension; use soft lining if necessary |
| Excessive vertical dimension of occlusion | Reduce vertical dimension | |
| Locked occlusion | Enlarge centric area | |
| Failure to provide freedom for Bennett movement (soreness usually on working side | Reduce cusps to a nonanatomical plane or reset teeth | |
| Improperly processed base material | Rebase denture | |
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| Peripheral areas | Overextension | Adjust denture accordingly |
| Unpolished or sharp edge | Polish denture borders | |
| Herpetic or apthous ulcer | Leave denture out as much as possible for 7-10 days | |
| Maxillary frenum | Overextension | Open a V-shaped notch for the labial frenum and widen the buccal frenum areas |
| Posterior border of denture | Sharp edge at the post dam area | Adjust sharp edge slightly without reducing dam area |
| Midline of denture | Prominent midsuture or torus maxillaries | Provide some relief over the area |
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| Improper occlusion | Correct occlusion (clinical reline) | |
| Maximum intercuspation not in harmony with centric relation | Enlarge centric area (clinical reline) | |
| Excessive vertical dimension of occlusion | Reduce vertical dimension (clinical reline) | |
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| Maxillary anterior hard palate and anterior alveolar ridge area | Pressure on anterior palatine foramen | Relieve area over foramen |
| Maxillary bicuspid area or molar tuberosity | Pressure on posterior palatine foramen | Relieve area over foramen |
| Mandibular anterior region | Pressure on mental foramen | Relieve area over foramen |
| Generalized | Improperly processed | Reline denture; replace as much as possible base material with new acrylic resin |
| Tongue | Allergic reaction xerostoma | |
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| Fiery redness - All tissue contacted by denture including tongue and cheeks | Denture base allergy (very unusual) | Remake denture and use all metal base (after allergy test) |
| Bearing tissues | Ill-fitting denture, Avitaminosis | Remake or rebase dentures. Employ vitamin therapy regimen |
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| Thin or under extended periphery (base material does not provide enough support for the cheek) | Build out thin areas, or extend the short periphery | |
| Insufficient interarch clearance between distal parts of denture bases | Thin maxillary denture over tuberosity; if more space is required, remove it from the retromolar area of the mandibular denture | |
| Inadequate amount of horizontal overlap in molar region | Re-contour buccal surface of mandibular molars and bicuspids; eliminate the tight contact of the maxillary buccal cusps on the mandibular buccal surfaces | |
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| Insufficient vertical dimension of occlusion | Increase vertical dimension of occlusion | |
| Maximum intercuspation not in harmony with centric relation | Make new occlusal record, regrind and remount occlusion | |
| Arthritis | Treat with analgesics | |
| Trauma | Treat with analgesics | |
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| Immediately upon insertion | Maxillary denture overextended or too thick in posterior border | Adjust denture or thin posterior border |
| Lack of retention | Reline denture | |
| Mandibular denture too thick in distolingual flange | Reduce thickness or distolingual flange | |
| Delay (2 weeks - 2 months after insertion) | Incomplete border seal allowing saliva under denture | Increase border seal with self-curing acrylic resin ( possibly at the posterior palatal border |
| Improper occlusion causing denture to loosen and allowing saliva under denture | Correct occlusion (clinical remount) | |
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| Excessive vertical dimension of occlusion | Excessive vertical dimension of occlusion | |
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| Excessive vertical dimension of occlusion | Reduce vertical dimension of occlusion | |
| Insufficient vertical dimension of occlusion | Increase vertical dimension of occlusion | |
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Complaints/area |
Causes |
Treatments | |
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| Looseness of mandibular denture | Error in occlusion (maximum intercuspation not in harmony with centric relation) | Correct faulty occlusion by remount and regrind procedure | |
| Occlusion plane too high | Reset teeth at a lower plane | ||
| Underextension of periphery (inadequate impression) | Rebase denture providing proper extension | ||
| Inability of patient to master denture | Use denture adhesives to help develop skill in handling denture ( for a short time only) | ||
| Tongue position (retracted tongue) | |||
| Looseness of maxillary denture | Occasionally | Underextension in some area | Correct with self-curing acrylic resin; first check with compound for diagnostic purpose |
| Faulty occlusion | Correct Occlusion | ||
| Overextension of peripheries | Adjust denture accordingly | ||
| Dehydration of tissue due to alcoholism | Remove cause | ||
| Displacement of flabby tissues when making impression | Correct surgically; modify impression technique to change primary denture stress-bearing area to the buccal shelf | ||
| When eating on either side | Nonyeilding area in hard palate (ridge tissue yields under chewing stresses; denture rocks on hard area | Provide relief chamber over non-yielding area | |
| Incorrect tooth position (teeth may beset too far buccally off ridge | Rebalance in lateral excursions; reset teeth where nature should have had them | ||
| Chewing resistant foods | Instruct patient to maintain soft diet until mouth is conditioned to wearing denture | ||
| Approximately every 2 hours | Heavy mucinous saliva | Prescribe astringent mouthwashes and regular scrubbing of dentures; reduction of carbohydrate | |
| Incorrect tooth position ( teeth may be set too far buccally and labially | Correct surgically; change primary denture stress -bearing area to the buccal shelf | ||
| Improper incising habits | Train patient to masticate in centric relation | ||
| Loss of posterior palatal seal (seal on hard palate; posterior limit not in hamular notches; insufficient valve seal) | Increase postpalatal seal with self-curing acrylic resin; first use compound as a diagnostic aid | ||
| When yawning or opening wide | Denture base too thick in buccal posterior area (coronoid process exerts forward and downward force on posterior of denture upon opening) | Reduce thickness of denture base | |
| Overextended in hamular notch | Shorten denture until pterygomaxillary ligament does not exert tension on posterior border when mouth is opened wide | ||
| Inadequate posterior palatal seal | Increase postpalatal seal with self-curing acrylic resin | ||
| When talking | Inadequate posterior palatal seal | Increase postpalatal seal with self-curing acrylic resin | |
| Overextended in posterior region | Shorten posterior until soft palate does not lift upward and break contact with the denture base | ||
| When occluding in centric relation | Improper occlusion | Correct occlusion | |
| Poor denture foundation (flabby tissues over ridge) | Correct surgically; change primary denture stress-bearing area to the buccal shelf | ||
| Incorrect tooth position (teeth set too far buccally) | Reset teeth | ||
| Maximum intercuspation not in harmony with centric region | Enlarge centric area | ||
| Nonyielding area in hard plate | Provide relief in area | ||
| Only a feeling of looseness (support and retention are present yet denture feels suspended in mouth | Large area of nonyeilding tissue in hard plate | Provide relief chamber, adequate to permit denture to be properly seated | |
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| When swallowing | Maxillary denture too thick or over-extended in posterior region | Reduce thickness or adjust posterior | |
| Mandibular denture too thick or overextended in posterior lingual flange area | Reduce thickness or adjust posterior lingual flange area | ||
| Insufficient vertical dimension of occlusion | Reduce vertical dimension | ||
| Excessive vertical dimension of occlusion | Reduce vertical dimension | ||
| Incorrect tooth position (posterior teeth set too far lingually - tongue crowded | Reset teeth | ||
| Clicking | Excessive vertical dimension of occlusion | Reduce vertical dimension | |
| Ill-fitting dentures | New dentures | ||
| Overextended lower dentures | Reduce peripheral length | ||
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| Complaints | Causes | Treatments |
| Fullness under nose | Labial flange of denture too long or too thick | Reduce length or thickness of labial flange |
| Depressed philtrum | Labial flange of mandibular denture too short | Increase length or thickness of labial flange |
| Upper lip sunken in | Maxillary anterior teeth set too far lingually | Reset anterior teeth labially |
| Too much of the teeth are exposed | Excessive vertical dimension of occlusion | Reduce the vertical dimension of occlusion |
| Incisal plane too low | Reset teeth at higher plane | |
| Cupids and lateral incisors too prominent | Adjust accordingly | |
| Artificial appearance | Technique setup (teeth are too regular in alignment) | Individualize by rotating and shortening some teeth |
| All teeth in same shape | Choose different but complimentary shades; use staining techniques | |
| Lack of individualization of teeth | Grind incisal edges and angles | |
| Lack of individualization of denture base | Individualize gingival contour and color of denture base | |
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| Complaints | Causes | Treatments |
| Whistle on "S" sounds | Air stream passes unimpeded or with inadequate impedance between the dorsal surface of the tongue and the anterior palate | 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 |
| Lisp on "S" sounds | The air stream passing between the tongue and anterior palate is excessively impeded, usually by rugae or excessive resin contour | Reduce occlusal vertical dimension until premolars no longer contact during speech |
| Maxillary & Mandibular incisors or premolars contact during sibilant (s, sh, z, ch) sounds | Occlusal vertical dimension too great | Reduce occlusal vertical dimension until premolars no longer contact during speech |
| Clinician observes that incisal edges of maxillary incisors contact the lower lip 1 mm or more labial to the wet/dry junction of lower lip when "F" & "V" sounds are made | Maxillary teeth may be set too far labially | Evaluate lip support and overall appearance of anterior teeth as they are positioned. Reset to a more lingual postiion as needed. incisal edge of maxillary incisiors should contact the wet dry junction ro just lingual to it during production of the "F" & "V" sounds. |