Title: Differential Diagnosis of Post-Insertion Problems
1Differential Diagnosis of Post-Insertion Problems
2Post Insertion Problems
- Minimal problems if remount
- Most problems will be occlusal if denture base
has been adjusted
3Principles 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
4Place Paste with Streaks
5Pressure 1st Molars
- Streaks - no contact (N)
- No Paste - Impingement (I)
- Paste, no streaks - normal contact (C)
6Principles of Diagnosing Denture Problems
- Patients frequently wrong in exactly locating
source of problem
7Principles of Diagnosing Denture Problems
- Spend time to look and think
8Principles of Diagnosing Denture Problems
- Where?
- Dentist needs to locate (PIP, tip of instrument,
indelible stick) - When?
- (Chewing only?)
9Principles of Diagnosing Denture Problems
- How long?
- Anything makes it better or worse?
- Have patient demonstrate problem
10Limited number of problems
- Denture base
- Occlusion -
- Interferences - esp. protrusive
- Retention
- Vertical dimension
- Allergies and infections
- Tooth position
11Denture Base
- Impingements, spicules, sharp edges
- Diagnosis - PIP (never adjust unless burnthrough)
12Denture Base
- Sore all time
- If worsens throughout day may be occlusion, not
denture base - May still be occlusal, if inflammation causes
swelling
13Occlusion
- One of most common problems
- Pain gets worse through day
- Difficult to determine, intraorally - reflex
avoidance of pain - Interferences - especially in protrusive
14Occlusion
- Fingers on canines - should feel smooooooooooth
- Sore when bite
- Fit changes or comfort deteriorates through day
- Remount
15Retention Problems
- Short flanges
- PIP - still streaky
- Fingers on canines outwards (post palatal seal)
16Retention Problems
- Short flanges
- Look for space
- May be retentive for a while if a lip seal
established, until movements disturbs the lip seal
17Retention Problems
- Long flanges
- Burn through (PIP)
- Intrudes tissue when placed
- May not dislodge if good seal, may loosen after
much function
18Retention Problems
- Post-palatal seal
- If the denture is short of the vibrating line,
the denture may bind on hard palate, (check with
PIP)
19Retention 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
20Occlusal Vertical Dimension (OVD)
- Excessive
- Continual and generalized pain and fatigue or
muscle soreness - Insufficient
- No power
21Allergies and Infections
- Rare allergies -
- General inflammation
- Hygiene
- Generalized inflammation
22Tooth Position
- Instability (teeth not over ridge)
- Difficulty chewing (occlusal table not long
enough - esp. rational teth) - Cheek and lip biting (insufficient overjet)
23Tooth Position
- Esthetic, phonetic problems
- May have to change position of teeth
24Most 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)
25The maxillary labial frenum is the most common
frenum to become irritated from denture
overextension
26Most Common Areas Requiring Adjustments
- Maxillary
- Mid-line fulcrum on the bony raphe
- Zygomatic impringement
27Most 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.
29Most Common Areas Requiring Adjustments
- Mandibular
- Retromylohyoid overextensions
- Sore throat
- Denture moves when swallowing
- Buccal shelf overextension
30Most 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