Title: Denture Looseness CD
1Denture LoosenessCD RPD
- Occlusion
- Denture base (fit contour)
- Poor anatomy
2Denture LoosenessCD RPD Occlusion
- Typical History
- Adequate retention initially
- Gets worse with time
3Denture LoosenessCD RPD Occlusion
- Perpetually Loose Maxillary Denture
- Heavy anterior interferences can cause loosening
at posterior - Tuberosity mucosa grows into space
- Space develops under midline of denture base
4Denture LoosenessCD RPD Occlusion
Tuberosity
- Tilting Growth Loss of retention
5Denture LoosenessCD RPD Occlusion
- Incisors placed too far labially
- Denture displaceslingually.
- Inclined ridge provides no resistance.
6Denture LoosenessCD RPD Occlusion
- Tilting/jiggling caused by
- Contacts not centered over ridge
- Contacts on inclined portion of ridge
7Denture LoosenessCD RPD Occlusion
- Check for looseness in excursions with fingers on
canines
8Denture LoosenessCD RPD Occlusion
- Check centric position (articulating paper)
- even, stable contacts both sides
- stop patient upon initial contact
9Denture LoosenessCD RPD
- Occlusion
- Denture base (fit contour)
- Poor anatomy
10Denture LoosenessMandibular lingual flange too
thick
Eyes in Your Fingers Blanchard, JPD 236
Tongue
Flange bulges into tongue space, lifts denture
during function. Flange is not too long.
11Denture LoosenessCD RPD Denture Base
- Short flange
- PIP streaks
- Looks short of vestibule
- Often displaces easily
12Denture LoosenessCD RPD Denture Base
- Long flange
- PIP burnthrough
- Retentive until speaking, eating
- Watch when seating denture
- Flange touches vestibular depth, denture
continues to seat
13Denture LoosenessCD RPD Denture Base
- If flange is too thick, seal may be maintained at
rest - If flange is also short or long, displacement may
occur as lips or cheeks move, allowing air to
break vestibular seal
14Denture LoosenessCD RPD Denture Base
- Principle
- Always have the patient demonstrate how a denture
loosens
15Denture LoosenessCD RPD Denture Base
- Lack of post dam/ retrozygomal seal
- Pull upward and outward on canine
- Test hypothesis add compound/functional wax
-opposite side
16Denture LoosenessCD RPD Denture Base
- Poor base adaptation
- Fulcrum on bony structures
- Test hypothesis PIP
17Denture LoosenessCD RPD Denture Base
- Periphery terminates on bony structures
- Hard palate
- Zygoma
- External oblique ridge
- Before retromolar pad
- No seal, discomfort
- Eventual resorption
Dry Mucosa
18Denture LoosenessCD RPD Denture Base
- Principle
- Denture peripheries always terminate on
displaceable soft tissues - Retromolar pads, Vestibular tissues, Vibrating
line (nonmoveble soft palate), Hamular notches
19Gagging with Dentures
- Usually not soft palate contact
- Denture contact with tongue
- thick posterior border rubs on tongue
- posterior border drops onto tongue
- Occlusal interferences
- Terminates on hard palate (no seal)
20(No Transcript)
21Denture LoosenessDenture Base Coronoid
Interference
- Thick flange in retrozygomal area
- Coronoid gets closer to tuberosity as patient
opens or moves jaw to side - Dislodges maxillary denture
22Denture LoosenessDenture Base Pterygomandibular
Raphe
- Raphe from area of hamular notch
- Very tight in some patients
- Easily displaceable, but raphe can displace
denture opening wide
23Denture LoosenessDenture Base Palatal Cleft
- In some patients midline soft palate fissure
- Can tent during function
- Allows air to leak under denture
24Denture LoosenessCD RPD
- Occlusion
- Denture base (fit contour)
- Poor anatomy
25Denture LoosenessCD RPD Poor Anatomy
- Many sets of dentures
- Use articulator, more complex impression and jaw
relation procedures - Implants
- Refer
26Overview
- Deal with denture problems systematically
- Use a differential diagnosis
- Address probable causes until problem is
eliminated - If cant identify problem, refer
27Phonetic Problems
- Lisping
- too much overjet
- triangular spaces between embrasures of max.
mand. teeth - palatal contour too constricted
- insufficient tongue space
28Difficult Denture Patients
- Anatomic Problem
- Diagnosis Problem
- Adaptive Problem
- Psychologic Problem
29Difficult Denture Patients
- Principle
- If you cant determine the problem using
indicating medium - 1. Tell the patient
- 2. Dont adjust
- 3. Refer
30Difficult Denture Patients
- Principle
- Never pretend to adjust a denture
- Reinforces maladaptive behaviour - harder for the
next guy
31Difficult Denture PatientsAdaptive Problem
- Elderly take more time to adapt
- More teeth missing, less adaptation
(loss of PDM receptors) - Better perception - less adaptive
32Difficult Denture PatientsAdaptive Problem
- Denture may be the cause of the problem
- Patient response may also be part of the problem
33Difficult Denture PatientsAdaptive/Psychologic
Problem
- Dentists response to patient may also affect the
patient response to the denture - Laying on of Hands
34Adaptive, Psychologic ProblemPrevention
- Good interview technique
- Tips
- Many dentures
- Disparaging previous dentures/dentists
- Body Language/ Deportment
35Adaptive, Psychologic ProblemPrevention
Interview
- 1. Recognize Acknowledge Problem
- Open ended questions
- Let patient identify problem
- If you identify the wrong problem - fail
36Adaptive, Psychologic ProblemPrevention
Interview
- 2. Explore and Identify Problems
- Let the patient talk (silence)
- Watch for nonverbal clues
- Short verbal clues may be significant
- (...and I guess the appearance)
- Dont be afraid of questions relating to
emotional health
37Adaptive, Psychologic ProblemPrevention
Interview
- 3. Interpret Explain Problems
- Advise patient of your view
- Use care in dealing with emotional problems
- Dont be afraid to address emotional component
38Adaptive, Psychologic ProblemPrevention
Interview
- 4. Offer a Solution
- If chance denture will not be a success, state at
outset - If sense trouble, refer or address immediately
- If suggest a therapist, patient will run or say
yes
39Adaptive, Psychologic ProblemPrevention
Interview
- If bells go off in your head, listen to them,
talk more, dont proceed past interview, until
satisfied
40Adaptive, Psychologic ProblemPrevention
Interview
- Remember Most patients are not problem patients
- 80-85 are satisfied
- Better adaptation than eyeglass wearers
41Adaptive, Psychologic Problem
- Rule out objective findings
- Chart findings objectively
42Overview
- Deal with denture problems systematically
- Use a differential diagnosis
- Address probable causes until problem is
eliminated - If cant identify problem, refer