Denture Complaint

De ntu r e C om pl ai nt

Complaints

Diagnosis Patient Dissatisfaction Denture limitations

Philosophical

Causes

Treatment

Denture settling

Denture error

Types of patients

Hysterical

Indifferent

Exacting

Problems Retention

Support

Muscle Balance

Occlusal Balance

Complaints 1- Over extension → Movement interfere with muscle movement → ( ↓ Stability) 2- Under extension → Break the Seal → ( ↓ Retention) 3- Trimming → Thick or thin border → (ttt) Boxing.

Problems of New Denture [ I ] Tissue irritation

→ In the form of : Hyperemia Cut in vestibule

Ulceration

→ Causes: Over-extension Pressure by denture Movement of denture Improper occlusion → ttt: Remove the cause

Tissue rest → Types:

Generalized

Localized Acute

1) Generalized Tissue irritation

Chronic

2) Localized Tissue Irritation Crest

Vestibule

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Over extension (displacing wax)

Border

Ant. lingual & Lat. buccal slop

Median Palatine Raphe

Retro Mylohyoi d

Tuberosity - Over extension

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- Over extension labially → lift the denture posteriorly.

- Pressure

- ↓ relief → (Denture rocking)

- pressure

- Bilateral undercut → (Relief)

- Un polished (Visual& digital) *D.D.→ Aphsus ulcer

Basal Seat

-Ridge (x ray & visual *Ex) -Spicules& remaining roots (Visual Ex)

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- ↓ support of 1ry stress bearing area → (Relining or Rebasing)

- Denture pressure *(P.I.P.)

Occlusion

- Deflective occlusal contact

- Tooth off ridge

- Deflective occlusal contact 7 7 - *C.O. ≠ *C.R. Loose denture anteriorly

• • •

D.D. → Differential Diagnosis. Ex. → Examination. P.I.P. → Pressure Indicating Paste.

•

C.O. → Centric Occlusion. C.R. → Centric Relation. ttt → Treatment. C.C. → Chief Complaint.

• • •

- Anterior contact in C.R. → *ttt (Reset)

- Pressure area - Dimensional changes → (Relief – Rebase) - Occlusal interference on opposite side→Denture move in opposite direction.

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[ II ] Poor Denture Fit • Cause: Lack of retention& Support. • Lower denture more than Upper. Why? ↓ Support

↑ Saliva

Tongue

• Chief complaint (C.C.): Loose denture

Too bulky

Rocking denture

• Related symptoms: Normal - Open wide (Yawing) → Coronoid process. - Cough& sneezing → ↑ the pressure. - New denture → Saliva.

Abnormal - Speaking. - Eating. - Pain.

[ III ] Pain

[ IV ] Esthetic problem • Color :

a) Teeth → too dark or too yellow.

b) Acrylic resin.

• Size: a) Too larger. b) Too smaller.

• Arrangement: a) Too even or Irregular. b) Visibility of anterior teeth (Too for forward) or (Too for backward). c) Cheeks& lips Falling-in → Unsupported lip& cheek → Plumping (Building-out

the upper denture to compensate for the loss of muscular tone).

• Nose& Chin approximation (closed bite): -

Due to ↓ Vertical dimension.

•

General dissatisfaction:

-

Who? → Female / middle age. Need → Kindness& Patience.

[ V ] Spee ch d if ficul tie s • Anterior teeth: a- ↑ Vertical overlap → "S" sound. b- Improper Labio-lingual positioning → "S" sound → (Whistling or lisping). • Encroachment on tongue space: a- Posterior teeth placed too far lingually. b- Too great Bucco-lingual width of posterior teeth. c- Excessive thickness of the lingual flange. d- Poor palatal contour (Rugae area) → "S" sound → P.I.P. • Poor denture retention. • Excessive salivation. • Vertical dimension → P, B, F, V. N.B. When pronouncing letter "S" the lateral margins of the tongue Contact the lingual surface of posterior teeth, and the tip of the tongue contact with the palate in rugae area forming a slit like channel. a. Whistling: If anterior teeth placed too forward, the channel will be to large& the air will escape with a whistling sound → Resetting the teeth backward or thickening the denture base behind these teeth. b. Lisping: If anterior teeth placed too backward, the channel will be obliterated& the patient may lisp → Resetting the anterior teeth forward or reducing the denture base in the Rugae area.

[ VI ] Nausea • Cause: Contact of the denture with the soft palate or the tongue. Posterior Periphery of upper denture

Over-extension

Under-extension

Loose denture

↑ Thickness

[ VII ] Inef fic ient e ating Borders → Improper. Basal seat → Unstable denture. • Occlusion • •

Teeth Blunt

Vertical dimensions Flat cusps

↑ V.D.O.

Elevate the muscle& don't work.

↓ V.D.O.

Patient can't open to get food.

[ VIII ] Cheek, Lip& Tongue Biting a) Cheek& Lip biting: ↓ Overlap → ↓ Lower buccal cusp or Reset. Laxity of muscle (loose of muscle tone). ↓ Vertical dimension → sagging of cheek.

b) Tongue biting: Teeth set lingual → Rounding the lower lingual cusps or Reset. [ IX ] Alter taste

[ X ] Clattering teeth

Unfamiliarity with New denture.

↑ Vertical dimension

Cuspal interference Unstable denture

- Teeth contact sooner.

Problems of Old Denture