P a t i e n t ' s a b i l i t y to l o c a l i z e a d j u s t m e n t s i t e s on t h e
mandibular denture
Leland R. Yeoman, DDS, a and Brent L. Beyak, BSc, D D S b
University of Southern California, School of Dentistry, Los Angeles, Calif.
A d j u s t m e n t o f n e w c o m p l e t e d e n t u r e s is o f t e n r e q u i r e d . P a t i e n t s m a y a t t e m p t to
g u i d e s u c h a d j u s t m e n t s b y p o i n t i n g o u t o f f e n d i n g a r e a s on t h e d e n t u r e s to t h e
clinician. Results of this study indicate that patient-perceived locations rarely
c o i n c i d e d w i t h t h e a c t u a l a r e a on t h e d e n t u r e t h a t r e q u i r e d a d j u s t m e n t a s d e t e r -
mined with the use of a dye-transfer indicating method. Accurate and minimal
a d j u s t m e n t s b a s e d on c l i n i c a l f i n d i n g s r a t h e r t h a n p a t i e n t p e r c e p t i o n s a r e r e q u i r e d
to a v o i d l o s i n g a d a p t a t i o n a n d e x t e n s i o n o f t h e n e w d e n t u r e s u n n e c e s s a r i l y . (J
PROSTHET DENT 1 9 9 5 ; 7 3 : 5 4 2 - 7 . )
E v e n with meticulous attention to detail in the
fabrication of complete dentures, variability of soft-tissue
behavior during impression-making procedures l, 2 and di-
mensional changes involved in processing various denture
base materials 3 often require adjustment to relieve soft-
tissue irritation and improve comfort for the patient. After
the recommended 24-hour postdelivery recall appoint-
ment, 4 subsequent adjustment appointments are usually
initiated by the patient. These patients often arrive with a
report of soreness from pressure on the denture base or
flange and usually attempt to localize the offending area on
the denture. All such reports must be thoroughly investi-
gated and diagnosed as to their causes before any treatment
is provided by the attending dentist. Specific causes of sys-
temic disease, hormonal imbalance, occlusal disharmony,
and poor fit of the prosthesis must be considered before any
modification of the prosthesis is made. T M
Many patients are seen with mandibular dentures that
are underextended. 15,16 Levin17 states, "most dentures ex-
amined by prosthodontists have woefully inadequate
bases," even though proper impression techniques have
been known and have generally been taught for most of this
century. Perhaps one of the reasons for this apparent dis-
crepancy between theory and practice is that the dentist is
adjusting the dentures according to the patients' desires
and suggestions instead of performing a thorough investi-
gation and arriving at a diagnosis as a guide to treatment.
The purpose of this study was to compare the location of
the denture perceived by the patient to be causing pain
with the actual offending region of the denture as deter-
aAssistant Clinical Professor, Department of Advanced Prostho-
dontics.
bFormer resident, Advanced Prosthodontics. Private Practice,
Victoria, British Columbia, Canada.
Copyright | 1995 by The Editorial Council of THE JOURNALOF
PROSTHETICDENTISTRY.
0022-3913/95/$3.00 + 0. 10/1/63400
542 THE J O U R N A L OF P R O S T H E T I C D E N T I S T R Y
mined by a dye-transfer method from the irritated soft tis-
sues to the denture base by the dentist..
MATERIAL AND METHODS
This study was confined to adjustments on mandibular
dentures, because they often have inadequate flange ex-
tensionsS Twenty edentulous patients were treated with
complete maxillary dentures and interim complete man-
dibular dentures. TM A tissue-conditioning material (Visco-
gel, DeTrey, Surrey, U.K.) was used in the mandibular
denture to begin functional development of a definitive
denture base form and to allow the patient to adapt to the
new prosthesis, as described by Landesman. 19 When the
associated soft tissues gave no signs of discomfort for sev-
eral weeks, the mandibular treatment denture was pro-
cessed after a functional, closed-mouth impression and in-
traoral central bearing pin (PTC Swissedent, Morgan Hill,
Calif.) tracing were completed.
At delivery the dentures were remounted, and a labora-
tory occlusal adjustment was performed. The central bear-
ing pin tracer and type 1 zinc oxide eugenol paste (H. J.
Bosworth Co., Skokie, Ill.) were again used for the intraoral
record. With a noninterfering, flat-plane, occlusal scheme
and anterior teeth set with clearance in all excursions, any
occlusal problems were minimized. During this appoint-
ment, the intaglio surface of the mandibular denture was
evaluated for fit with pressure-indicating paste composed
of 40 % zinc oxide USP (Sultan Chemists Inc., Englewood,
N. J.) and 60% hydrogenated vegetable oil (Crisco, Proc-
tor & Gamble, Cincinnati, Ohio). Required adjustments
were made until even contact with the bearing tissues was
achieved. Patients were given a 24-hour postdelivery recall
appointment and oral and written instructions on the use
and care of the new dentures.
At the recall appointment a careful notation of each pa-
tient's chief complaint and attitude towards the denture
were recorded. If a sore spot was present, the offending lo-
cation on the denture as perceived by the patient was care-
fully recorded by the patient on a clear 0.020-inch polysty-
V O L U M E 73 NUMBER 6
YEOMAN AND BEYAK THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 1. Patient-recording perceived offending area on clear template in place over inta-
glio surface of prosthesis.

Fig. 2. Application of lipstick for use as transfer dye indicator.

rene vacuum-formed template (Buffalo Dental Mfg. Co.
Inc., Syosset, N.Y.) of the intaglio surface of the mandib-
ular prosthesis. This recording was done under supervision
of an independent observer (Fig. 1). It was then labeled and
removed from the prosthesis before treatment was pro-
vided.
Lipstick (Pavion Ltd., Nyack, N. Y.) performs well as a
transfer dye and was applied to the traumatized tissue area
with the wooden end of a cotton-tip swab (Fig. 2~. On in-
sertion and seating of the denture to which pressure-indi-
cation paste has been applied, the lipstick transfers the of-
fended area to the denture base, indicating the proper area

J U N E 1995 543
THE J O U R N A L OF P R O S T H E T I C D E N T I S T R Y YEOMAN AND BEYAK

Fig. 3. Adjustment of intaglio surface of prosthesis at site indicated by transfer dye.

Fig. 4. Clear record template shows patient perceived offending area (blue), actual indi-
cated offending area (red), and area adjusted (green).

for adjustment on the denture (Fig. 3). This adjustment
was deemed complete when the patient reported a self-
perceived 80 % or better improvement of symptoms. The
area of actual adjustment was then delineated by the
attending dentist and was transferred to the same clear
vacuum-formed template that had earlier recorded the pa-
tient's perceptions by the independent observer (Fig. 4).
Notes regarding the chief problem, tissue appearance,
prosthesis condition, and resolution of symptoms were
made on the patient's chart, and duplicates correlated via
a numeric code to the vacuum-formed polystyrene tem-
plate were entered as data for further evaluation. To pre-
vent inadvertent bias, the attending dentist did not receive
information regarding the patient's perception of the

544 V O L U M E 73 NUMBER 6
YEOMAN AND BEYAK THE JOURNAL OF PROSTHETIC DENTISTRY

PERCEIVED OR ACTUAL
ADJUSTMENT AREAS
DELINEATED ON TEMPLATE

CENTER USED
FOR STUDY 1

PERIPHERY
OF DENTURE

F i g . 5. Determination of geometric center of actual or perceived adjustment area and

measurement from periphery of denture (Boley gauge not shown to scale).

/ INCISOR
BUCCAL CUSPDII
FLANGE
BUCCAL
INCLINE
RIDGE
CREST
LINGUAL
INCLINE
\
MOLAR
LINGUAL
FLANGE

PEAR SHAPED
PAD AREA

F i g . 6. Relative division of intaglio surface of m a n d i b u l a r denture.

offending area on the prosthesis or have access to this or
previous t e m p l a t e s during any a d j u s t m e n t procedures.
The p a t i e n t was then given five weekly follow-up ap-
pointments to assess comfort and make any necessary ad-
justments. P a t i e n t s were encouraged to eat hard, fibrous
foods and to be present for these appointments, even if they
perceived no problems.
Analysis of the information recorded on the vacuum-
f o r m e d templates was completed by a different dentist
from the one who a t t e n d e d the patients. The geometric
center of the patient-perceived areas for adjustment and
t h a t of the actual a d j u s t m e n t were located visually, and the
distance between t h e m was recorded in tenths of millime-
ters with a Boley gauge used for measurement (Fig. 5). The
distance of the perceived and actual centers was then mea-
sured from the nearest edge of the closest flange of the
denture along a line perpendicular to the ridge crest at t h a t
point. The actual and perceived centers were then corre-
lated to various areas of the denture-bearing structures.
The division of the intaglio surface of the denture was done
relative to the closest tooth area (incisor, canine, bicuspid,
or molar) with the addition of the area posterior to the last
molar (pear-shaped pad area) and the midline. The den-
ture was further divided from buccal to lingual into five
bands (buccal flange, buccal slope, ridge crest, lingual
slope, and lingual flange) (Fig. 6).
The actual and perceived areas were then scored as to the
extent of their coincidence. A value of 0,1, or 2 was assigned

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Table I. Distribution of distances between actual and denture extension) of the perceived center from the actual
perceived areas of adjustment center was also noted for each adjustment.
D i s t a n c e (mm) Events
RESULTS
0.0-0.4 3
0.5-2.4 5 Of the 20 patients included in this study, three had no
2.5-4.9 18 need for adjustment. The remaining 17 patients presented
5.0-9.9 42 with 90 discreet traumatic soft-tissue lesions or pressure-
10.0-14.9 12 sensitive areas. An average of 4.5 adjustment sites per pa-
15.0-19.9 9 tient was recorded during the term of this study.
20.0+ 1 The average distance between the centers of the actual
adjusted spot and the patients' perceived area requiring
adjustment was 8.3 m m with a range of 0 mm to 22.4 mm.
Table I summarizes the distances between the centers of
Table II. Average distance between center of sites and the actual and perceived areas. There were three instances
margin of flange periphery where the perceived center was within 0.5 mm of the actual
No. of Actual site Perceived site center and 10 instances where there was a greater than 15.0
Patient sites (mm) (mm) m m difference. Most of the events (42) fell in the 5 m m to
9.9 m m difference group.
1 10 13.2 8.8
2 1 6.4 5.0 The average distance from the center of the patient-per-
3 2 16.8 1.6 ceived offending area to the extent of the closest flange was
4 9 4.0 1.6 3.6 mm, whereas the distance from the center of the actual
5 5 5.0 1.6 adjustment area to the edge of the same flange averaged 7.2
6 4 5.3 2.3 m m (Table II). The most common area of the denture that
7 6 6.0 2.7 the patient indicated as offending was the lingual flange in
8 5 4.2 1.4 the bicuspid region. The area actually requiring adjust-
9 0 -- -- m e n t most commonly was the ridge crest at the midline.
10 0 -- --
Table III shows the results of the scoring of coincidence
11 9 6.5 4.7
between the actual and perceived areas. More than 50 % of
12 7 4.8 1.4
13 0 -- -- the events scored a value of 2 (no overlap), and only 10%
14 3 7.9 4.6 scored a value of 0 (greater than 50% overlap).
15 7 6.3 4.6
16 5 7.7 5.1 DISCUSSION
17 3 9.9 5.8
The patients knew they were involved in a study dealing
18 6 6.3 4.1
with location of the various "sore or tender spots" they had
19 4 6.2 2.5
20 4 6.5 3.5 and were encouraged to be as exact as they could in relat-
Average 4.5 7.2 3.6 ing the areas they perceived as requiring adjustment on the
denture base. A desire by the patient to perform well for the
attending dentist may have been responsible for some dif-
ference between the relation of their perception and that
T a b l e III. Distribution of correlation scores which may be encountered in a normal private practice
situation. This factor may result in less of a difference be-
Score No. of events Percentage
tween the actual and perceived areas of adjustment. Even
0--No overlap 49 54 so, during the course of this study patients tended to relate
1--<50% Overlap 32 36 areas remote from those actually requiring adjustment.
2-->50% Overlap 9 10 Each patient who required an a d j u s t m e n t of the intaglio
surface of the denture related at least once a perceived area
that was closer to the buccal or lingual flange of the den-
ture t h a n the actual area requiring adjustment. Many of
depending on the degrees of coincidence between the actual the patients perceived areas related to the extension of the
and perceived spots as marked on the vacuum-formed denture flange, and it became obvious that if a dentist re-
template. A value of 2 was given if the actual and perceived lied solely on the patient to inform him or her where an ad-
areas overlapped by greater than 50 % as determined visu- j u s t m e n t should be done, a n u m b e r of denture flanges
ally. A value of I was given if there was overlap up to 50 %, would be unnecessarily reduced.
and a value of 0 was assigned if there was no overlap. The Although making complete dentures is an exacting pro-
relative location (anterior, posterior, toward, or away from cedure, it is difficult to determine precisely the extent of

546 V O L U M E 73 NUMBER 6
YEOMAN AND BEYAK
soft-tissue irritations and correlate them accurately to the
morphology of the intaglio surface of the denture.
CLINICAL IMPLICATIONS
The results of this study confirm the importance of per-
forming a thorough investigation and diagnosis before
making denture adjustment. Careful intraoral observation
and the use of pressure-indicating paste and a dye transfer
indicator as described can localize the cause of trauma. Ac-
curate cause-and- effect treatment such as described in this
article ensures the maintenance of fit and extension as de-
signed.
SUMMARY AND CONCLUSIONS
Records were kept on the postdelivery adjustments
required by 20 patients treated with maxillary and man-
dibular removable complete prostheses. Some interesting
trends were revealed by the data gathered during this
study.
1. Patients often perceived offending morphology of the
denture base remote from the actual areas requiring
adjustment.
2. Patients often perceived this offending area as closer
to the periphery of the denture flange than was revealed
after close intraoral examination for evidence of ulceration
or inflammation of the denture-bearing tissues.
3. Actual areas of denture base requiring adjustment as
determined by an indicator dye transfer method were
commonly associated with the ridge crest.
4. Patient comfort could be achieved by confining den-
ture adjustment to the areas as delineated by intraoral tis-
sue response.
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DE. BRENT L. BEYAK
3066 SHELBOURNE ST.
SUITE 155
VICTORIA, BRITISH COLUMBIA
VSR 4M9
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