Professional Documents
Culture Documents
Identification of Complete Denture Problems: A Summary: Prosthetics
Identification of Complete Denture Problems: A Summary: Prosthetics
prosthetics
Identification of complete
10 denture problems:
a summary
J. F. McCord,1 and A. A. Grant,2
Table 1 List of factors resulting in discomfort related to the impression surface of dentures
Related to impression surface Pearls or sharp ridges of acrylic on the fitting Locate with finger, or snagging dry cotton wool
Discrete painful areas surface arising from deficiency in fibres. Use disclosing material to assist locality to
laboratory finishing ease denture
Pain on insertion and removal, possibly Denture not relieved in region of undercuts Use disclosing material to adjust in region of
inflamed mucosa on side(s) of ridges ’wipe off’. Exercise care as excessive removal
may reduce retention. Also clinician should only
insert denture and then remove it - the patient
should not occlude as this may confuse an
occlusal fault with support problems
Areas painful to pressure Pressure areas resulting eg from faulty Use disclosing material to accurately locate area
impressions, damage to working cast, to be relieved. If severe, remake may be required.
warpage of denture base. Consider also Consider removal of root
residual pathology (eg retained root), lack
of relief for active frena, non-displaceable
mucosa over bony prominence (eg torus)
Over-extension of lingual flange. Painful Over-extended lower impression: Determine position and extent of over-extension
mylohyoid ridge; denture lifts on tongue instructions to laboratory not clear or using disclosing material and relieve accordingly
protrusion; painful to swallow non-existent
Generalised pain over denture-supporting Under-extended denture base - may be the Extend denture to optimal available denture
area result of over-adjustment to the periphery, support area. If insufficient FWS, remake may be
or impression surface. Check for adequacy required
of FWS
Lack of relief for frena or muscle attachments; Peripheral over-extension resulting from Relieve with aid of disclosing material. Care with
pinching of tissue between denture base and impression stage and/or design error. adjustment of post dam - removal of existing seal
retromolar pad or tuberosity. Sore throat, Palatal soreness as post dam too deep and its replacement in greenstick prior to
difficulty in swallowing permanent addition may be required
Table 2 List of factors resulting in discomfort - relating to occlusal and polished surfaces of dentures
Related to occlusal surfaces Anterior prematurity or posterior prematurity, Determine where occlusal prematurities exist.
Pain on eating in presence of occlusal incisal locking, lack of balanced articulation Adjust occlusion by selective grinding. If severe
imbalance (no support problems) error remount using facebow and new
interocclusal records
Pain lingual to lower anterior ridge If no over-extension present, look for Mark deflecting inclines of posterior teeth with thin
protrusive slide from RCP to ICP articulating paper. If slide exceeds half a cusp
width, re-register and reset
Pain and/or inflammation on labial aspect of If no impression surface defect, may be lack Reduce incisal vertical overlap. If appearance
lower ridge of incisal overjet causing incisal locking compromised, resetting the incisors may be
required
Pain about periphery of dentures possibly Vertical dimension of occlusion more than If excess less than 1.5 mm, grind to provide FWS.
accompanied by pain in masseter and patient can tolerate If greater than 1.5 mm, re-register to reset dentures
posterior temporalis muscles (classically pain at new OVD
increases as the day progresses)
Cheek and or lip biting For cheeks - likely that functional width of For cheek biting, restore functional width of sulcus
sulcus was not restored. and/or reset. For lips, grind lower incisors to
For lips - poor lip support/inadequate provide a more appropriate incisal guidance
anterior horizontal overlap angle
Tongue biting Lack of lingual overjet - teeth generally Remove lower lingual cusps, or reset teeth
placed lingual to lower ridge
Related to polished surfaces Flange on buccal aspect of tuberosity too Use disclosing material to accurately define area
Pain at posterior aspect of upper denture on thick and constraining coronoid process involved, relieve and repolish
opening
peripheral roll on a master cast. a logical and systematic way. That is to say, an
• Patient adaptional factors. adequate history of the problem must be
obtained and a careful examination of the
By far the most critical factors are the patient mouth carried out so that an accurate diagno-
adaptional factors. Many patients with positive sis can be made, and an appropriate treatment
stereotypes may overcome errors of prescrip- plan devised.
tion. Some patients, however, are unable to Without doubt listening to the patient (as
adapt physically and/or psychologically to den- their difficulties are described) is the most
tures that satisfy clinical and technical prostho- important first step in the process, and its
dontic norms. Clearly it would be in the best importance cannot be overemphasised.
interests of the clinician and the patient to deter- Because of the plethora of potential com-
mine this at the assessment stage, and was plete denture problems, this section is largely
referred to in Part 2. confined to those that are most commonly
The prescribing clinician is responsible for encountered at the time of insertion of
planning complete dentures after diagnosing replacement dentures or during review
potential problems; be they anatomical, appointments in the days and weeks after
physiological, pathological or emotional. insertion. For a comprehensive overview of
Once a denture-wearing problem becomes the diagnosis and management of complete
apparent, it is important that it is addressed in denture problems, readers are referred to
Table 3 List of factors resulting in discomfort - factors with possible systemic associations. Some of these
conditions may occur several months post insertion
Burning sensation over upper denture Burning mouth syndrome often seen in Correction of any denture faults, may require
supporting tissues, but may involve other middle-aged or elderly females. Denture multivitamin/nutrition advice and treatment.
intra-oral tissues, eg tongue. faults must be excluded, also general Possibly antidepressant therapy. Refer to
organic and pyschogenic factors Consultant in Oral Medicine
Beefy red tongue, possibly glossodynia Vitamin B12/folate deficiency Refer for medical treatment
Frictional lesions related to dentures, Xerostomia, commonly side effect of Where some saliva flow is present, sugar-free
mucosa may adhere to probing finger, prescribed drugs citrus lozenges may help. Where there is an
may be complaint of dry mouth obvious paucity of saliva, artificial saliva may
be considered
Tongue thrusting. Empty mouth ’chewing’. May have neurological or psychological Difficult to manage. Treatment may be required
Often seen in elderly patients aspects. Possibly drug related to include occlusal adjustment and/or occlusal
pivots
Presence of herpetiform ulcers in mouth Herpes simplex or Herpes zoster virus. Dentures merely coincidental to the condition.
History and distribution of lesions to confirm May be useful to suggest preventive remedy
(eg acyclovir) for some sufferers
Painful ’click’ related to TMJ on opening TMJ pain dysfunction syndrome may be If denture faults present, careful correction
and/or closing mouth and/or tenderness related to rapid change on OVD (either required with special care to registration and
of muscles of mastication gross increase or decrease) on production vertical dimension
of new denture. May have psychological
aspects, occasionally part of general
joint disease
Patient complains of allergy to denture Rare symptoms may relate to higher residual If excess residual monomer detected, rebase
material monomer content of acrylic denture using controlled heat cure cycle. May
need to consider remaking denture using
polycarbonate resin
Painless erythema of mucosa related to Denture-related stomatitis. Often has a Best to leave denture out until condition clears,
support of (usually) upper denture, may be frictional element due to ill-fitting denture then remake. If not possible, correct denture
accompanied by angular cheilitis plus opportunistic candidal infection. faults, eg using occlusal pivots, regularly
Occasionally related to iron or folate supervised and replaced tissue conditioners
deficiency prior to remake. If angular cheilitis present,
combinations of antifungal and antibacterial
agents (eg miconazole) useful
Border under-extension in width. Add softened tracing compound to relevant border, mould digitally
Often a particular problem in and by functional movements by patient. Replace compound with
disto-buccal aspects of upper acrylic resin. As a temporary measure a chairside reline material
periphery which may be displaced may be used as described above
by buccinator on mouth opening.
Posterior border of upper Check border is correctly sited on fixed tissue at junction with mobile
denture tissue of soft palate. Trace thin string of softened tracing compound
along impression surface of posterior border and seat denture firmly
in mouth. Replace compound with acrylic resin. For temporary
solution, use butymethacrylate resin as above
Inelasticity of cheek tissues Consequence of ageing process; Mould denture borders incrementally using softened tracing-
scleroderma, submucous fibrous compound as functional movements are performed - aim to slightly
under-extend depth and width of denture periphery. Repeated
treatment may be required as inelasticity progresses
Air beneath impression surface. Deficient impression. Damaged Reline if design parameters of denture satisfactory, otherwise remake
Denture may rock under finger cast. Warped denture. as required. Ensure that areas of heavy contact between denture and
pressure. May see gap between Over-adjustment of impression tissues are relieved prior to impression making. Where change in
periphery of flange and ridge. surface. Residual ridge resorption. tissue fluid distribution is suspected check medication (eg diuretics)
Occlusal error subsequent to Undercut ridge. Excessive relief posture (eg heart failure) lack of recovery of tissues from effects of old
warpage chamber. Change in fluid denture prior to working impressions being obtained. Stabilise fluid
content of supporting tissues content of tissues and use minimal pressure impression method
Xerostomia Reduces ability Medication by many commonly Design dentures to maximise retention and minimise displacing
to form a suitable seal prescribed drugs, irridation of forces. Prescribe artificial saliva where appropriate
head and neck region, salivary
gland disease
Neuromuscular control Basic shape of denture incorrect, Correct design faults by, eg removal of lingual cusps of posterior teeth.
Essential for successful lower molars too lingual; occlusal Flatten polished lingual surface of lower from occlusal surface to
denture wearing: speech plane too high: upper molars periphery, fill sulci to optimal width. May require remake to optimal
and eating difficulties occur buccal to ridge and buccal flange design. Use information from successful previous denture if
not wide enough to accommodate available. Denture adhesives may be deemed to be necessary
this; lingual flange of lower
convex. Patient of advanced
biological age, infirm
Poor fit to supporting tissue Poor/inappropriate impression Reline if all other design parameters
Recoil of displaced tissue lifts technique especially in posterior satisfactory, otherwise remake.
denture lingual pouch area Ensure denture is removed from
mouth 90 mins prior to impression
Denture not in optimal space Molars on lower denture lingual Remove lingual cusps and lingual
to ridge, optimum triangular surface from relevant area, repolish.
shape of dentures absent If triangular form not restored, reset
teeth or remake dentures
Posterior occlusal table too Narrow posterior teeth and/or
broad, causing tongue trapping remove most distal teeth from
dentures. Reshape lingual polished
surface
Thick lingual flanges encroaching Thin lower labial flange, ensure
on tongue space, causing lifting. optimal extension to retromolar
Excess lip pressure to lower pads to resist displacement, reset
anterior aspect - teeth anterior anterior teeth if necessary
to ridge, thick periphery Usually requires remaking denture
Excess pressure from upper lip to
upper denture arising from teeth
too labially sited to acute
naso-labial angle; or failure to
adequately seat denture during
relining impression procedure
Occlusal errors Uneven tooth contact causing Adjust occlusion until even initial contact
ttilting of dentures and prevents in RCP obtained. If gaps between teeth
even seating of loosened exceeds 1.5 mm reset teeth or remake
appliances dentures. For gaps less than 1.5 mm it
may still be necessary, in the interest of
accurate diagnosis, to remount the
dentures, as a patient’s mouth may be
too tender to permit chairside adjustment.
ICP and RCP not coincident Adjust occlusion for coincident ICP/RCP
- disrupts border seal and contact. If error is greater than half width
prevents accurate reseating of cusp, all teeth on at least one denture
need resetting.
Lack of freedom in ICP Remount dentures on adjustable
(occlusal-locking) dentures will articulator and adjust area of occlusal
shift on supporting tissues for contact. Allow 1.5 mm of anterior
those patients with poor control movement from RCP. May use cuspless
of mandibular movements teeth where appropriate
Ulceration labial to lower Excessive vertical overlap of Reduce height of lower anteriors.
ridge anterior teeth. Lack of balance Aesthetic problems may necessitate
and anterior tooth contact may resetting of teeth
cause tilting, soreness in lower
ridge
Last mandibular molars placed Remove most posterior teeth from denture
too far posteriorly and lie over
retromolar pad or ascending part
of ramus. Occlusal contact on this
’inclined plane’ causes denture to
slip forward
Occlusal plane/s not Usually requires teeth to be reset or
orientated appropriately dentures to be remade
and masticatory forces tend
to move dentures over
supporting tissues
Fibrous displaceable ridge Masticatory forces tend to Reline after removal of acrylic from
cause denture to sink into impression surface until no contact with
and tilt towards supporting displaceable tissue, provide many vent
tissues holes, low viscosity impression material,
maximise posterior border seal
Bony prominence covered Denture rocks over prominence Remove acrylic from impression surface
by thin mucosa (eg tori) which may be covered with where disclosing material shows
inflamed tissue excessive loading of supporting tissues.
Do not create excessive relief or loss of
retention may result
Non-resilient soft tissue Does not adapt to impression Reline dentures to obtain optimal border
surface of denture reducing extensions in depth and width, use low
support and retention factors viscosity impression material
Pain avoidance mechanisms Use of excessive amounts of Eliminate the cause of pain
fixative, or self-applied reline
material, or even cotton wool, to
attempt to relieve contact with
supporting tissues
Noise on eating/speaking May be lack of skill with new Where unfamiliarity present,
May be apparent on first insertion dentures, excessive OVD, occlusal reassurance and persistence
or may appear as resorption interference, loose dentures, or recommended. Address specific
causes dentures to loosen poor perception of patient to faults or remake as required
denture wearing
’Blunt teeth’ Broad posterior occlusal surfaces Where non-anatomical teeth used,
which replaced narrow teeth on careful explanation of rationale is
previous denture. Non anatomical required, may be possible to
type teeth used where cusped teeth reshape teeth. Routine use of
previously used narrow tooth moulds recommended.
’Jaws close too far’ Lack of OVD, so that mandibular May increase up to 1.5 mm by
elevator muscles cannot work relining but if deficiency is greater,
efficiently remake denture
’Cannot open mouth wide enough Excessive OVD Can remove up to 1.5 mm from
for food’. May be speech occlusal plane by grinding, but if
problems and facial pain more is required, remake dentures
especially over masseter region
Speech problems Cause may not be obvious. May Check for vertical dimension
Uncommon, but presence is of be unfamiliarity - check that accuracy, and that vertical incisor
great concern to patient. May problem not present with old overlap not excessive. Palatal
affect sibilant (eg s), bilabial dentures contour should not allow excessive
(eg p,b), labiodental (eg f.v) tongue contact or air leakage -
assess using disclosing paste over
denture palate while sound is made.
NB It is recommended that the
patient’s speech is assessed at trial
insertion visit
Too much visibility of teeth Level of occlusal plane Accurate prescription to laboratory
unacceptable, teeth placed on via optimally adjusted occlusal rim
upper anterior ridge and no/poor
lip support
Creases at corners of mouth Labial fullness and anterior tooth Adjust tooth position as appropriate.
position may be inaccurate. OVD If OVD problem, re-register jaw
may be inadequate relations
Colour of denture base material Patient’s skin colour not taken into Remake using suitable base material
’unnatural’ account in determining colour of
base material