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
- Clinically
- No discomfort when press firmly on 1st molars
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 displaces lingually.
- 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 LoosenessCD RPD Denture Base
- Typical History
- Loose/discomfort immediately on insertion
- Clinically
- Discomfort when press firmly on 1st molars
- Pressure up/outward from lingual of canine causes
looseness
11Denture 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.
12Denture LoosenessCD RPD Denture Base
- Short flange
- PIP streaks
- Looks short of vestibule
- Often displaces easily
13Denture LoosenessCD RPD Denture Base
- Long flange
- PIP burnthrough
- Retentive until speaking, eating
- Watch when seating denture
- Flange touches vestibular depth, denture
continues to seat
14Denture LoosenessCD RPD Denture Base
- If flange too thick
- Seal may be maintained at rest
- Pulls during function - drops
- If flange is short or long
- Displacement as lips or cheeks move
- Allows air to break vestibular seal
15Denture LoosenessCD RPD Denture Base
- Principle
- Always have the patient demonstrate how a denture
loosens
16Denture LoosenessCD RPD Denture Base
- Lack of post dam/ retrozygomal seal
- Pull upward and outward on canine
- Test hypothesis add compound/functional wax
-opposite side
17Denture LoosenessCD RPD Denture Base
- Poor base adaptation
- Fulcrum on bony structures
- Test hypothesis PIP
18Denture 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
19Denture LoosenessCD RPD Denture Base
- Principle
- Denture peripheries always terminate on
displaceable soft tissues - Retromolar pads, Vestibular tissues, Vibrating
line (nonmoveble soft palate), Hamular notches
20Gagging 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)
21(No Transcript)
22Denture 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
23Denture LoosenessDenture Base Pterygomandibular
Raphe
- Raphe from area of hamular notch
- Very tight in some patients
- Easily displaceable, but raphe can displace
denture opening wide
24Denture LoosenessDenture Base Palatal Cleft
- In some patients midline soft palate fissure
- Can tent during function
- Allows air to leak under denture
25Denture Looseness or Pain CD RPD
- Principle
- Always have the patient rate improvement (0-100)
after adjustment. If below 90, more
diagnosis/adjustment is required
26Denture LoosenessCD RPD
- Occlusion
- Denture base (fit contour)
- Poor anatomy
27Denture LoosenessCD RPD Poor Anatomy
- Many sets of dentures
- Use articulator
- More involved/precise impression jaw relation
procedures - Implants
- Refer
28Overview
- Deal with denture problems systematically
- Use a differential diagnosis
- Address probable causes until problem eliminated
- If cant identify problem, refer
29Phonetic Problems
- Lisping
- too much overjet
- triangular spaces between max. mand. teeth
- palatal contour too constricted
- insufficient tongue space
30Difficult Denture Patients
- Anatomic Problem
- Diagnosis Problem
- Adaptive Problem
- Psychologic Problem
31Difficult Denture Patients
- Principle
- If you cant determine the problem using
indicating medium - 1. Tell the patient
- 2. Dont adjust
- 3. Refer
32Difficult Denture Patients
- Principle
- Never pretend to adjust a denture
- Reinforces maladaptive behaviour - harder for the
next guy
33Difficult Denture PatientsAdaptive Problem
- Elderly take more time to adapt
- More teeth missing, less adaptation
(loss of PDM receptors) - Better perception - less adaptive
34Difficult Denture PatientsAdaptive Problem
- Denture may be the cause of the problem
- Patient response may also be part of the problem
35Difficult Denture PatientsAdaptive/Psychologic
Problem
- Dentists response to patient may also affect the
patient response to the denture - Laying on of Hands
36Adaptive, Psychologic ProblemPrevention
- Good interview technique
- Tips
- Many dentures
- Disparaging previous dentures/dentists
- Body Language/ Deportment
37Adaptive, Psychologic ProblemPrevention
Interview
- 1. Recognize Acknowledge Problem
- Open ended questions
- Let patient identify problem
- If you identify the wrong problem - fail
38Adaptive, 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
39Adaptive, 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
40Adaptive, 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
41Adaptive, Psychologic ProblemPrevention
Interview
- If bells go off in your head, listen to them,
talk more, dont proceed past interview, until
satisfied
42Adaptive, Psychologic ProblemPrevention
Interview
- Remember Most patients are not problem patients
- 80-85 are satisfied
- Better adaptation than eyeglass wearers
43Adaptive, Psychologic Problem
- Rule out objective findings
- Chart findings objectively
44Overview
- Deal with denture problems systematically
- Use a differential diagnosis
- Address probable causes until problem eliminated
- If cant identify problem, refer