Differential Diagnosis of Post-Insertion Problems

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Differential Diagnosis of Post-Insertion Problems
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Post Insertion Problems

• Minimal problems if remount
• Most problems will be occlusal if denture base
  has been adjusted

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Principles of Diagnosing Denture Problems

• Never adjust unless you can see exactly where to
  adjust
• Use indicator medium
• (PIP, indelible marker, articulating paper, etc.)
• Loney Knechtel, J Prosthetic Dent
• 2009101137-141

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Place Paste with Streaks

• Mostly colour of Paste

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Pressure 1st Molars

• Streaks - no contact (N)
• No Paste - Impingement (I)
• Paste, no streaks - normal contact (C)

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Principles of Diagnosing Denture Problems

• Patients frequently wrong in exactly locating
  source of problem

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Principles of Diagnosing Denture Problems

• Spend time to look and think

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Principles of Diagnosing Denture Problems

• Where?
• Dentist needs to locate (PIP, tip of instrument,
  indelible stick)
• When?
• (Chewing only?)

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Principles of Diagnosing Denture Problems

• How long?
• Anything makes it better or worse?
• Have patient demonstrate problem

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Limited number of problems

• Denture base
• Occlusion -
• Interferences - esp. protrusive
• Retention
• Vertical dimension
• Allergies and infections
• Tooth position

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Denture Base

• Impingements, spicules, sharp edges
• Diagnosis - PIP (never adjust unless burnthrough)

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Denture Base

• Sore all time
• If worsens throughout day may be occlusion, not
  denture base
• May still be occlusal, if inflammation causes
  swelling

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Occlusion

• One of most common problems
• Pain gets worse through day
• Difficult to determine, intraorally - reflex
  avoidance of pain
• Interferences - especially in protrusive

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Occlusion

• Fingers on canines - should feel smooooooooooth
• Sore when bite
• Fit changes or comfort deteriorates through day
• Remount

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Retention Problems

• Short flanges
• PIP - still streaky
• Fingers on canines outwards (post palatal seal)

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Retention Problems

• Short flanges
• Look for space
• May be retentive for a while if a lip seal
  established, until movements disturbs the lip seal

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Retention Problems

• Long flanges
• Burn through (PIP)
• Intrudes tissue when placed
• May not dislodge if good seal, may loosen after
  much function

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Retention Problems

• Post-palatal seal
• If the denture is short of the vibrating line,
  the denture may bind on hard palate, (check with
  PIP)

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Retention Problems

• Post-palatal seal
• Inadequate tissue contact
• Food gets underneath
• Bubbles as denture is placed (check with PIP)
• If over-extended to moveable soft palate
• denture loosens during speech, chewing

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Occlusal Vertical Dimension (OVD)

• Excessive
• Continual and generalized pain and fatigue or
  muscle soreness
• Insufficient
• No power

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Allergies and Infections

• Rare allergies -
• General inflammation
• Hygiene
• Generalized inflammation

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Tooth Position

• Instability (teeth not over ridge)
• Difficulty chewing (occlusal table not long
  enough - esp. rational teth)
• Cheek and lip biting (insufficient overjet)

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Tooth Position

• Esthetic, phonetic problems
• May have to change position of teeth

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Most Common Areas Requiring Adjustments

• Maxillary
• Hamular notches - ulceration can occur if
  over-extended
• Labial frenum - requires adequate relief (often
  feels too bulky to the patient)

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The maxillary labial frenum is the most common
frenum to become irritated from denture
overextension
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Most Common Areas Requiring Adjustments

• Maxillary
• Mid-line fulcrum on the bony raphe
• Zygomatic impringement

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Most Common Areas Requiring Adjustments

• Mandibular
• Lingual frenum - impingement can cause
  displacement of the denture of ulceration

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• Lesions associated with anterior mandibular
  denture border correspond to the PIP pattern.

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Most Common Areas Requiring Adjustments

• Mandibular
• Retromylohyoid overextensions
• Sore throat
• Denture moves when swallowing
• Buccal shelf overextension

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Most Common Areas Requiring Adjustments

• Phonetic problems
• Wait and allow time for adaptation
• Add soft wax to palate and check
• If anterior poorly positioned, then remove and
  replace