brief discussion on common problems faced by patients wearing complete denture after insertion and their management, presented in a seminar at Dhaka dental college and hospital.

1. POST INSERTION
MANAGEMENT
OF
EDENTULOUS PATIENT

2. CHAIRPERSON
Dr. AKM. AZIZUL HAQUE
Head of Dept. Prosthodontics
Dhaka Dental College and Hospital
PRESENTERS
Dr. NUSRAT FAHMIDA TRISHA

3. INTRODUCTION
A patient wearing a partial or a complete denture have
to face a lot of problems. We , the clinicians must
listen, examine and treat the condition , during the
recall post insertion appointment and treat them
accordingly.

4. Post insertion denture complaints
1. Pain
2. Discomfort
3. Appearance
4. Inability to eat
5. Lack of retention
& stability
6. Clicking of teeth

5. Post insertion denture complaints
7. Nausea and gagging
8. Inability to tolerate dentures
9. Altered speech
10. Biting the cheeks & tongue
11. Food under the denture
12. Inability to keep the denture clean

6. Pain
And
Discomfort

7. Causes of Pain & Discomfort
Localized painful areas with ulceration
• Blebs & surface irregularities
• Periphery too sharp
• Post dam too deep
• Edges of relief areas
• Lack of relief

8. •Occlusal error
•Excess periphery
•Tissue displacement by impression
 Pterygomaxillary notch
 Frenum
 Pear-shaped pad

9. Localized painful areas without ulceration
• Upper displaceable ridge
• Rough bony alveolar ridge
• Dental remnant
• Mental foramen
• Mylohyoid ridge
• Buccal prominence of tuberosity

10. • Lack of relief, e.g. incisive papilla
• Occlusal error
• Excessive vertical dimension
• Peripheral over-extension
• Denture into undercuts
• Cramped tongue space
• Mucosal displacement

11. 1.Over-extension of the periphery
CAUSE
• Incorrect moulding of the impression
• Incorrect outlining of the denture on the cast
• Presence of an ulcer

12. Treatment
• Use of pressure-indicating paste
• Use of tincture of benzoin
compound

13. 2.Poor fit
This is easily detected by the poor retention
Treatment
•New dentures

14. 3.Insufficient relief
Occur over a prominent bony area
Treatment
•Application of pressure-indicating paste

15. 4. Occlusal faults
a. Wrong anterior-posterior relationship
This is often associated with a complaint of looseness
Treatment:
•Remounting & grinding of the dentures
•Placement of occlusal pivots to reposition the lower
denture

16. b. Uneven pressure
Cause
•Faulty setting of teeth
•Tilting of the record blocks
•Excessive vertical dimension

17. Treatment
•Grinding
•Remounting
•Remake the denture

18. c. Excessive vertical dimension
Due to excessive vertical height
Treatment
•New upper & lower denture

19. d. Insufficient vertical dimension
Due to loss of vertical height
Treatment
• Occlusal pivots, following new dentures

20. e. Cuspal interference :
Cause
•Excessive vertical overlap
•An incorrect incisal guidance angle

21. Treatment
•Grinding
•Adjusting the occlusal surfaces on the
articulator
•New dentures with balanced occlusion

22. 5.Teeth off the ridge :
Cause
• Discrepancies between the size of upper arch & lower arch
• Lack of peripheral seal &
• Incorrectly shaped polished surfaces
Treatment :
• New dentures

23. 6. Retained root / unerupted tooth
Diagnosis should be confirmed by radiograph
Treatment
• Extraction of the root or tooth followed by
relining of that part of denture

24. 7. Narrow resorbed ridge
Common in lower denture, associated with burning
sensation
Treatment
• Alveolectomy followed by relining the denture

25. 8. Mental foramen
•Gross resorption of alveolus the puts presssure on the
denture
•Radiograph will be helpful to locate the mental foramen
Treatment :
• The denture is relieved

26. 9. Irregular resorption
Presence of rough bony area due to
resorption
Treatment
• Surgical smoothing of the affected
area followed by relining the denture

27. 10.Rough contact or fitting surface
Cause
Denture processed on a cast with a porous surface
Treatment :
• Roughness is removed from the denture & polished lightly

28. 11. Swallowing & sore throat
•Upper denture: Extension on to the soft palate with trauma in the
post dam region or excessive pressure in the hamular notches
•Lower denture: Over-extension distally in the lingual pouch
Treatment :
• Reduction of the over-extension produces relief

29. 12. Undercuts
Patients with old dentures
Treatment :
• Reduction of the periphery
• Alveolectomy

30. Appearance

31. 1.Facial appearance
Cause
• Old dentures
• Continuous alveolar resorption
• In case of new denture, the
occlusal face height was not correct

32. 2.Dissatisfaction with teeth
a.Colour :The teeth are too dark or too yellow
Treatment
• The colour of teeth is compromised between the shade chosen by the
operator & that chosen by the patient

33. b. Shape
Artificial teeth usually look larger than natural
teeth of identical size
Treatment :
• Removal of the teeth complained of & replacing
them with others mounted in wax

34. c.Position
The teeth are too far back in the mouth
or too far forward
Treatment
• Remaking the denture

35. Inability
to eat

36. Causes
•Low cusp or zero cusp posterior teeth
•Lack of interdigitation of posterior teeth
•Use of acrylic teeth instead of porcelain
•Unbalanced occlusion or locked occlusion

37. • Set of upper teeth directly over the ridge
•Too broad lower posterior teeth
•Over extended periphery of the denture
Treatment
•Psychological approach

38. Lack of retention and
instability

39. Cause
1. Wide mouth opening
2. Treatment
•Low tongue position in edentulous patient causes the
denture to rise on wide mouth opening- this explanation
will help the patient to counteract the problem

40. 2.Tight lips
Treatment
• Remaking the denture
• Denture space techniques are useful
• Surgical vestibuloplasty

41. 3. Less tongue space due to tilted or
lingually set posterior teeth
Treatment
• Reducing the width of the lower posterior
teeth by grinding off the lingual cusp

42. 4.Underextension
Treatment
• Remaking

43. 5.Lack of saliva
Treatment
•No specific treatment is available
•Palliative treatment like artificial
saliva

44. 6.Movement of dentures during coughing
or sneezing
Treatment
•No specific solution
•Covering the mouth with hand or handkerchief

45. Clicking of teeth

46. Causes
• Excessive vertical height
• Movement of lower dentures from whatever causes
• Cuspal interferences or lack of balanced occlusion
• Excessive incisal guidance angle

47. Treatment
•Correction of the faults of the dentures
mentioned above
•Use of acrylic teeth

48. NAUSEA
&
Gagging

49. Causes
1.Denture slightly over extended
•By observing the relation of the posterior border of the vibrating line
Treatment
•Excess should be removed
•If necessary, the postdam
should be readapted

50. 2. Denture under-extended
•By feeling with the dorsum of the tongue, too far
forward placed posterior edge is detected
Treatment
• Re-adaptation

51. 3. Thick posterior border
Treatment
•The edge should be thin
•Slightly embedded in the compressed mucosa
Posterior

52. 4.Protrusive imbalance
Heavy contact on the incisors and no contact between the molars
Back of the upper denture moves
Collection of saliva at the posterior border
Tickling effect leading to nausea

53. Inability to tolerate
dentures

54. CAUSES
1.Cramped tongue space
Cause
•Alveolar ridge resorption

55. 2.Altered vertical height
Cause
•Slight difference in vertical height
•If original one was made with a very small
freeway space

56. 3. Altered occlusal plane
Cause
Very few millimeter of change may require extensive
adjustment in muscle movement and control,
particularly the tongue.

57. 4. Unemployed ridge
Ridge resorption occurs
Peripheral part of the denture bearing area gives more support
The alveolar ridge takes less and less of load
The ridge becomes unemployed

58. 5. Change in shape
Cause
• When new denture is made with marked change in form and dimension
of periphery or more polished surface
• Particularly in old patient
Treatment
• Advice to give time to let the discomfort disappear
• Modify or remake

59. Altered Speech

60. Factors in denture affecting speech
The vowel sound
1. The lower anterior teeth must not impede the tongue
positioning and not lingual to the alveolar ridge.
2. Upper denture base must be thin
3. The posterior border should merge into soft tissue
4. No square edge should remain

61. The consonant sound
1.Denture thickness and peripheral outline
2. Vertical dimention
3.Occlusal plane
4.Anteroposterior position of the incisors
5.Postdam area
6.Width of dental arch
7.Relationship of the upper and lower anterior teeth

62. Biting the cheek and
tongue

63. Cheek bite
1.Insufficient overjet
Treatment
•The buccal overjet need to be increased
•Adequate width and height of the peripheral form should be maintained
•If necessary ,the last molar teeth can be removed or the buccal surface of
the teeth can be grinded

64. 2.Reduced vertical height
Cause
If occlusal plane of either denture is incorrectly positioned
Treatment
•Vertical dimension should be restored
•Occlusal plane should be changed.

65. Biting the tongue
Cause
1.Decrease in tongue space
2. Changes in occlusal level

66. Food under the denture

67. Cause
1.New users who cant control foods
2. Imperfect peripheral seal
Treatment
1.Maximum possible area need to be covered
2.Adequate peripheral seal need to be obtained

68. 3.Perseverance of the patient

69. Inability to keep the
denture clean

70. Cause
1.Inadequate laboratory work
2.Using hard household abrasive to polish the denture
3.Fail to clean regularly and efficiently

71. 4.Incorrct denture cleansers,
• Oxygenating cleansers
• Hypochloride solutions
• Mineral acids
• Powder and paste
• Liquid detergent

72. EXAMINATION
• 48-72 hours after receiving the denture
• Visual and digital examination
• 1-3 day adjustment
• Periodic recall
-3-4 months for difficult patients
-12 month interval for most

73. CONCLUSION
• At the end, we must mention that thorough counselling
according to the nature of the patient is very important for
the patient as well as the clinician. Patient will thereby gain a
realistic expectations of what can and can not be achieved,
and dentists will understand what the patient really wants.
• Patient need to be advised on taking proper nutrition supply.

74. CONCLUSION
• Finally, patient must be
informed that continued
success depends on regular
denture maintenance at
home, combined with
periodic consultation with
the dentist.

75. References
• Clinical Dental Prosthetics,Fenn,Liddelow and Gimson’s
• Textbook of prosthodontics, V. Rangarajan
• Clinical Images taken from internet