Post Insertion Follow Up

1
Post insertion follow up

• Dr. Shujah a khan
• Mds resident clinical prosthodontics
• Dikiohs - duhs

2
(No Transcript)
3
introduction

• The complete denture service cannot be adequate
  unless patients are cared for after the dentures
  are placed in the mouth.
• The dentist is responsible for the care of the
  patient throughout this period, and this
  occasionally requires a number of follow-up
  appointments.
• Patient cooperation is essential

4
24 hour oral examination and treatment

• An appointment for a 1 to 3 day adjustment should
  be made routinely.
• Patients who do not receive this attention have
  more trouble than those who are cared for the
  first several days after the insertion of the new
  dentures.

5

• This is the critical period in the
  denture-wearing experience of the patient
• The dentist must listen carefully to the patient
  and on the basis of these comments can learn
  approximately where to look for trouble.

6
Examination procedures
7
Examination procedures

• The occlusion should be observed before the
  dentures are removed from the mouth.
• To do this, the mandible is guided into CR by
  stabilizing the mandibular denture with the index
  fingers on the buccal flanges and the thumbs
  under the mandible.

8

• The patient is instructed to retrude and elevate
  the tongue to touch the roof of the mouth in the
  back during closure.
• Some gentle manual guidance on the patient can be
  applied simultaneously in a hinge movement

9

• If the teeth touch and slide, there is an error
  in centric occlusion (CO).
• Remount and recheck occlusion
• If the same error is found on the articulator, it
  requires occlusal adjustment.
• If there is an error in the mouth and none is
  found on the articulator, new interocclusal
  records must be made.

10

• After the occlusion has been tested and corrected
  (if necessary), ask the patient where the worst
  soreness is and a thorough visual and digital
  examination of the oral cavity follows so the
  location of sore spots can be determined.

11

• The examination begins with
• Mucosa of the maxillary buccal vestibule
• Labial and the buccal vestibules on the other
  side of the mouth, with careful observation of
  the frena.
• The hamular notches and the hard and soft palates
  are examined for signs of abrasion.
• The area of the coronoid process is palpated, and
  the patientis asked if there is any tenderness in
  this region

12

• The mandibular dental arch and associated dental
  structures are systematically examined both
  visually and digitally.
• The tissues lining the vestibular spaces and the
  alveololingual sulci, particularly the mylohyoid
  ridges and the retromylohyoid spaces, are
  observed carefully.
• The sides of the tongue and the mucosal lining of
  the cheeks also must be inspected

13
Adjustments related to the occlusion
14

• Soreness may develop on the crest of the residual
  ridge from pressures created by heavy contacts of
  opposing teeth in the same region.
• Soreness also may be seen on the slopes of the
  residual ridge as a result of shifting of the
  denture bases from deflective occlusal contacts.

15

• Before unnecessarily shortening or excessively
  relieving the denture base, the dentist must
  observe the occlusion carefully in the mouth and
  on the articulator, giving particular attention
  to the possibility of heavy balancing-side
  contacts that could cause rotation of the
  mandibular denture base.

16

• Small lesions on the buccal mucosa of the cheek
  in line with the occlusal plane indicate that the
  patient is biting the cheek during mastication.
• This problem usually can be corrected by reducing
  the buccal surface of the offending mandibular
  tooth to create additional horizontal overlap,
  thus providing an escape for the buccal mucosa

17

• A patient may complain, My dentures are tight
  when I first put them in my mouth, but they seem
  to loosen after several hours.
• This symptom usually is an indication of errors
  in the occlusion that can be corrected after new
  interocclusal records are made, the dentures are
  remounted, and the occlusion is adjusted on the
  articulator.
• The dentures become loose because the deflective
  occlusal contacts cause a continual shifting of
  the denture base, which in turn causes distortion
  of the tissues in the basal seat.

18
Adjustments related to the denture bases
19

• Irritation to the vestibular mucosa is most often
  caused by denture borders that are too sharp or
  denture flanges that are overextended.
• This is often seen at the hamular notch area,
  along the mandibular retromylohyoid area,
  mandibular buccal area, and prominent anterior
  frena.
• Before any adjustments are made, a heavy coating
  of PIP or disclosing wax in the offending area,
  with border molding, will determine if the
  problem is overextension or
• contact pressure along the bone at the flange
  extension.

20

• Lesions in the region of the hamular notch must
  be considered carefully.
• If the irritated tissue is posterior to the
  notch, the denture base is too long and must be
  shortened.
• However, if the soreness is in the notch itself,
  the posterior palatal seal is likely creating too
  much pressure, and the inside of the tissue
  surface of the denture base will need to be
  relieved very cautiously so as not to loosen the
  border seal.

21

• Use the following three steps to evaluate this
  area with PIP
• (1) one notch with adjustment,
• (2) the other notch with adjustment, and then
• (3) the posterior border length and posterior
  palatal seal on the denture surface with
  adjustment.
• The use of these steps will minimize making an
  error in reading thePIP and overreducing the seal

22
(No Transcript)
23

• The remainder of denture borders are shortened
  and rechecked with paste again.
• Finally they can be polished with pumice and a
  rag wheel

24

• Irritated frena and disclosing wax showing
  pressure in the notches will require that the
  notches be deepened slightly.
• Widening of the notch may not be necessary and,
  if done to excess, could reduce denture
  retention.
• The notch is deepened with a fissure bur and
  polished with a stone or small wheel.

25

• When pressure areas are found, they need to be
  adjusted and the entire denture disclosed again.
• It will be common that additional pressure areas
  will present and need relieving.
• Finally the contact will be uniform throughout
  the denture.

26

• Excessive pressure from the mandibular buccal
  flange in the region of the mental foramen may
  cause a tingling or numbing sensation at the
  corner of the mouth or in the lower lip.
• This results from impingement on the mental nerve
  and occurs particularly when excess resorption
  has caused the mental foramen to be located near
  the crest of the mandibular residual ridge

27
(No Transcript)
28

• A similar situation can occur in the maxillae
  from pressure on the incisive papilla transmitted
  to the nasopalatine nerve.
• The patient may complain of burning or numbness
  in the anterior part of the maxillae.
• Relief may be required in the maxillary denture
  base in this region

29

• Patients may return for the initial adjustment
  appointment complaining that their dentures cause
  them to gag.
• This problem may actually be related to the
  dentures themselves, or there may be a
  psychological component.

30

• When the problem is denture related, usually the
  maxillary denture is the culprit, although on
  occasion the mandibular denture or both will be
  involved.
• Most often, the gagging relates to the posterior
  border of the maxillary denture.
• The border may be improperly extended, or the
  posterior border seal may be inadequate.

31

• Gagging often occurs when the posterior border
  seal is disrupted as the tissue distal to the
  vibrating line moves upward and downward during
  function.

32

• If the posterior palatal seal is inadequate,
  modeling compound can be added to reshape this
  part of the maxillary denture and help alleviate
  the situation.
• Then the modeling compound can be replaced with
  acrylic resin.
• The occlusion may also be a factor because
  shifting of the denture bases affects the
  posterior palatal seal

33

• On occasion, patients will state that the
  maxillary denture comes loose when they open
  their mouth wide to bite into a sandwich or to
  yawn.
• distobuccal flange of the maxillary denture is
  too thick and interferes with normal movements of
  the coronoid process.
• The borders of the maxillary buccal flanges
  should properly fill the buccal vestibule.
  However, the distal corners of the denture base
  below the borders must be thin to allow the
  freedom necessary for movement of the coronoid
  process.

34

• Again, in discussions with patients, it may be
  revealed that the maxillary denture tends to
  loosen during smiling or other forms of facial
  expression.
• Excessive thickness or height of the flange of
  the maxillary denture in the region of the buccal
  notch or distal to the notch may cause this
  problem.
• As the buccal frenum moves posteriorly during
  function, it encroaches on a border that is too
  thick, and the denture becomes loosened.
• Reduction of the width of the border posterior to
  the maxillary buccal notch often will relieve
  this problem.

35
Periodic recall for oral examination
36

• When patients are judged to be successfully
  treated and the necessary adjustment appointments
  after denture insertion are completed, patients
  are instructed to call for an appointment if they
  have any problems.
• Patients with some of the more difficult problems
  should be scheduled for appointments
  periodically, perhaps at 3- to 4-month intervals

37

• Every denture-wearing patient should be in a
  recall program, just as any other dental patient
  is.
• The dentist should not hesitate to inform a
  patient that occlusal corrections, relining, new
  dentures, or other fairly involved procedures may
  be necessary as changes in the mouth continue to
  occur.
• 12-month interval is the suggested time between
  recall appointments for most patients with
  complete dentures.

38
(No Transcript)