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Differential Diagnosis of Post-Insertion Problems

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Differential Diagnosis of Post-Insertion Problems Post Insertion Problems Minimal problems if remount Most problems will be occlusal if denture base has been adjusted ... – PowerPoint PPT presentation

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Title: Differential Diagnosis of Post-Insertion Problems


1
Differential Diagnosis of Post-Insertion Problems
2
Post Insertion Problems
  • Minimal problems if remount
  • Most problems will be occlusal if denture base
    has been adjusted

3
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

4
Place Paste with Streaks
  • Mostly colour of Paste

5
Pressure 1st Molars
  • Streaks - no contact (N)
  • No Paste - Impingement (I)
  • Paste, no streaks - normal contact (C)

6
Principles of Diagnosing Denture Problems
  • Patients frequently wrong in exactly locating
    source of problem

7
Principles of Diagnosing Denture Problems
  • Spend time to look and think

8
Principles of Diagnosing Denture Problems
  • Where?
  • Dentist needs to locate (PIP, tip of instrument,
    indelible stick)
  • When?
  • (Chewing only?)

9
Principles of Diagnosing Denture Problems
  • How long?
  • Anything makes it better or worse?
  • Have patient demonstrate problem

10
Limited number of problems
  • Denture base
  • Occlusion -
  • Interferences - esp. protrusive
  • Retention
  • Vertical dimension
  • Allergies and infections
  • Tooth position

11
Denture Base
  • Impingements, spicules, sharp edges
  • Diagnosis - PIP (never adjust unless burnthrough)

12
Denture Base
  • Sore all time
  • If worsens throughout day may be occlusion, not
    denture base
  • May still be occlusal, if inflammation causes
    swelling

13
Occlusion
  • One of most common problems
  • Pain gets worse through day
  • Difficult to determine, intraorally - reflex
    avoidance of pain
  • Interferences - especially in protrusive

14
Occlusion
  • Fingers on canines - should feel smooooooooooth
  • Sore when bite
  • Fit changes or comfort deteriorates through day
  • Remount

15
Retention Problems
  • Short flanges
  • PIP - still streaky
  • Fingers on canines outwards (post palatal seal)

16
Retention Problems
  • Short flanges
  • Look for space
  • May be retentive for a while if a lip seal
    established, until movements disturbs the lip seal

17
Retention Problems
  • Long flanges
  • Burn through (PIP)
  • Intrudes tissue when placed
  • May not dislodge if good seal, may loosen after
    much function

18
Retention Problems
  • Post-palatal seal
  • If the denture is short of the vibrating line,
    the denture may bind on hard palate, (check with
    PIP)

19
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

20
Occlusal Vertical Dimension (OVD)
  • Excessive
  • Continual and generalized pain and fatigue or
    muscle soreness
  • Insufficient
  • No power

21
Allergies and Infections
  • Rare allergies -
  • General inflammation
  • Hygiene
  • Generalized inflammation

22
Tooth Position
  • Instability (teeth not over ridge)
  • Difficulty chewing (occlusal table not long
    enough - esp. rational teth)
  • Cheek and lip biting (insufficient overjet)

23
Tooth Position
  • Esthetic, phonetic problems
  • May have to change position of teeth

24
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)

25
The maxillary labial frenum is the most common
frenum to become irritated from denture
overextension
26
Most Common Areas Requiring Adjustments
  • Maxillary
  • Mid-line fulcrum on the bony raphe
  • Zygomatic impringement

27
Most Common Areas Requiring Adjustments
  • Mandibular
  • Lingual frenum - impingement can cause
    displacement of the denture of ulceration

28
  • Lesions associated with anterior mandibular
    denture border correspond to the PIP pattern.

29
Most Common Areas Requiring Adjustments
  • Mandibular
  • Retromylohyoid overextensions
  • Sore throat
  • Denture moves when swallowing
  • Buccal shelf overextension

30
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
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