See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/23937852

Diagnosing denture problems using pressure-indicating media

Article in The Journal of prosthetic dentistry · March 2009

DOI: 10.1016/S0022-3913(09)60009-3 · Source: PubMed

CITATIONS READS

5 3,325

2 authors, including:

Robert W Loney
Dalhousie University
37 PUBLICATIONS 919 CITATIONS

SEE PROFILE

All content following this page was uploaded by Robert W Loney on 30 March 2018.

The user has requested enhancement of the downloaded file.

136
study were close to the final DC.
At the 10-minute interval, differ-
ences in DC between light- and auto-
polymerized groups ranged from 3.5%
(Calibra) to 33.9% (RelyX ARC). The
clinical relevance of such differences in
DC deserves consideration, as only a
4% decrease in DC impairs elastic mod-
ulus, hardness, and fracture strength of
composite resins.25 The relative hard-
ness of composite resins has been pro-
posed as a means of determining the
effectiveness of polymerization when
comparing values of a test group to
those of a control group known to have
been maximally polymerized. It is also
suggested that a ratio of 90% would be
acceptable for a clinical situation.10 If
such an assumption was extrapolated
to the DC analysis of the current study,
the autopolymerizing modes of prod-
ucts exhibiting PCA/D values of approxi-
mately 90% might provide RLA layers
with mechanical properties capable of
resisting the high stress imparted after
cementation of an indirect restora-
tion. Based on these findings, it may
be assumed that RLAs demonstrating
such polymerization characteristics
would perform adequately when light
is completely blocked by the indirect
restoration. However, studies evaluat-
ing the mechanical properties of dual-
polymerized RLAs within the short
period of time following the mixing of
the components may provide further
information.
CONCLUSIONS
Within the limitations of the cur-
rent study, it was concluded that the
dual-polymerizing mode of all RLAs
tested generated higher DC values than
the autopolymerizing mode. However,
Rpmax and PCA/D varied widely among
products. The DC of all products at
10 minutes after initial material mixing
was higher than that at 5 minutes, only
in the autopolymerizing mode. Thus,
the first 2 research hypotheses were val-
idated, while the third hypothesis was
only validated when the resin cements
were allowed to autopolymerize.
The Journal of Prosthetic Dentistry
REFERENCES
1. Braga RR, Cesar PF, Gonzaga CC. Mechanical
properties of resin cements with different ac-
tivation modes. J Oral Rehabil 2002;29:257-
62.
2. Peutzfeldt A. Dual-cure resin cements: in
vitro wear and effect of quantity of remaining
double bonds, filler volume, and light curing.
Acta Odontol Scand 1995;53:29-34.
3. Santos GC Jr, El-Mowafy O, Rubo JH, Santos
MJ. Hardening of dual-cure resin cements
and a resin composite restorative cured with
QTH and LED curing units. J Can Dent Assoc
2004;70:323-8.
4. Tanoue N, Koishi Y, Atsuta M, Matsumura H.
Properties of dual-curable luting composites
polymerized with single and dual curing
modes. J Oral Rehabil 2003;30:1015-21.
5. Arrais CA, Giannini M, Rueggeberg FA, Pash-
ley DH. Effect of curing mode on microtensile
bond strength to dentin of two dual-cured
adhesive systems in combination with resin
luting cements for indirect restorations. Oper
Dent 2007;32:37-44.
6. Lu H, Mehmood A, Chow A, Powers JM.
Influence of polymerization mode on flexural
properties of esthetic resin luting agents. J
Prosthet Dent 2005;94:549-54.
7. el-Mowafy OM, Rubo MH, el-Badrawy
WA. Hardening of new resin cements
cured through a ceramic inlay. Oper Dent
1999;24:38-44.
8. Hofmann N, Papsthardt G, Hugo B, Klaiber
B. Comparison of photo-activation versus
chemical or dual-curing of resin-based
luting cements regarding flexural strength,
modulus and surface hardness. J Oral Rehabil
2001;28:1022-8.
9. Fonseca RG, Santos JG, Adabo GL. Influence
of activation modes on diametral tensile
strength of dual-curing resin cements. Braz
Oral Res 2005;19:267-71.
10.Johnston WM, Leung RL, Fan PL. A math-
ematical model for post-irradiation hardening
of photoactivated composite resins. Dent
Mater 1985;1:191-4.
11.Blackman R, Barghi N, Duke E. Influence
of ceramic thickness on the polymerization
of light-cured resin cement. J Prosthet Dent
1990;63:295-300.
12.Cardash HS, Baharav H, Pilo R, Ben-Amar A.
The effect of porcelain color on the hardness
of luting composite resin cement. J Prosthet
Dent 1993;69:620-3.
13.Arrais CA, Rueggeberg FA, Waller JL, de Goes
MF, Giannini M. Effect of curing mode on the
polymerization characteristics of dual-cured
resin cement systems. J Dent 2008;36:418-26.
14.Milleding P, Ahlgren F, Wennerberg A,
Ortengren U, Karlsson S. Microhardness and
surface topography of a composite resin
cement after water storage. Int J Prosthodont
1998;11:21-6.
15.Nathanson D. Etched porcelain restorations
for improved esthetics, part II: Onlays. Com-
pendium 1987;8:105-10.
16.Cook WD, Standish PM. Polymerization
kinetics of resin-based restorative materials. J
Biomed Mater Res 1983;17:275-82.
17.Asmussen E. Setting time of composite
restorative resins vs. content of amine,
peroxide, and inhibitor. Acta Odontol Scand
1981;39:291-4.
Volume 101 Issue 2
18.Caughman WF, Chan DC, Rueggeberg FA.
Curing potential of dual-polymerizable resin
cements in simulated clinical situations. J
Prosthet Dent 2001;86:101-6.
19.Anusavice KJ, Hojjatie B. Tensile stress in
Diagnosing denture problems using
pressure-indicating media
glass-ceramic crowns: effect of flaws and ce-
ment voids. Int J Prosthodont 1992;5:351-8.
20.Rueggeberg FA, Craig RG. Correlation of
parameters used to estimate monomer con-
version in a light-cured composite. J Dent Res
1988;67:932-7. Robert W. Loney, DMD, MS,a and Mark E. Knechtel, DDSb
21.Rueggeberg FA, Hashinger DT, Fairhurst CW.
Calibration of FTIR conversion analysis of Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia
contemporary dental resin composites. Dent
Mater 1990;6:241-9.
Pressure-indicating media have more diverse applications than merely the identification of areas on the denture base
22.Ruyter IE. Methacrylate-based polymeric
dental materials: conversion and related that cause mucosal pressure and pain. The purpose of this article is to provide guidelines for optimal use of the media
properties. Summary and review. Acta Odon- and to identify alternative uses that could be considered in daily practice. (J Prosthet Dent 2009;101:137-141)
tol Scand 1982;40:359-76.
23.Ruyter IE. Unpolymerized surface layers on
sealants. Acta Odontol Scand 1981;39:27-
32.
Pressure-indicating media have TECHNIQUE ly obscure the underlying denture.
24.Ruyter IE, Svendsen SA. Remaining methacry- long been advocated for use in di- Do not place streaks in elastomeric
late groups in composite restorative materials. agnosing problems with dentures at 1. Prior to applying media, remove materials. Place both types of media
Acta Odontol Scand 1978;36:75-82.
25.Ferracane JL, Berge HX, Condon JR. In vitro
insertion and denture adjustment any obvious spicules or sharp projec- on the intaglio side of the prosthesis
aging of dental composites in water--effect appointments.1-8 Typically, pressure tions from the denture, to minimize and over the flanges to evaluate for
of degree of conversion, filler volume, and indicators are used to identify prob- patient discomfort.9 proper extension or frenal impinge-
filler/matrix coupling. J Biomed Mater Res
1998;42:465-72. lems related to impingement, exten- 2. Evaluate the denture base adap- ments (Fig. 2). Seat dentures with
26.Braga RR, Ferracane JL. Contraction stress sion, and/or width of prostheses.8 tation with pressure-indicating media polymerization-type materials before
related to degree of conversion and reaction Although patient input is useful in prior to occlusal adjustments, as al- the start of polymerization, so that
kinetics. J Dent Res 2002;81:114-8.
27.Barron DJ, Rueggeberg FA, Schuster GS. A identifying the general location of sore terations in the base adaptation can the development of increased viscos-
comparison of monomer conversion and spots, patients often cannot precisely alter the occlusal contacts.3 ity will not prevent complete seating
inorganic filler content in visible light-cured pinpoint the location of irritations.9,10 of the denture.2
3. Dry the denture before the ap-
denture resins. Dent Mater 1992;8:274-7.
28.Rueggeberg FA, Caughman WF. The influence Therefore, some authors5,9 advocate plication of media,6,9 so that the 6. Insert the denture using mouth
of light exposure on polymerization of dual- that a denture base should never be material will adhere to the denture mirrors to retract the commissures,
cure resin cements. Oper Dent 1993;18:48-
modified without first using media to surface. However, leave the oral mu- so that the material is not wiped
55.
29.Paul SJ, Leach M, Rueggeberg FA, Pashley identify specific areas requiring ad- cosa moist, so that the paste does not away from the denture during inser-
DH. Effect of water content on the physi- justment. adhere to it. Instruct patients with a tion. If the entire prosthesis cannot
cal properties of model dentine primer and
bonding resins. J Dent 1999;27:209-14.
While primarily used to locate ar- dry mouth to rinse with water and/or be placed without touching the lips or
30.Lee IB, An W, Chang J, Um CM. Influence of eas on the denture base that cause spray the paste-covered denture with cheeks, evaluate right and left quad-
ceramic thickness and curing mode on the po- pressure and pain,8 pressure-indi- water prior to placement intraorally.1 rants separately,8 and/or evaluate the
lymerization shrinkage kinetics of dual-cured
resin cements. Dent Mater 2008;24:1141-7. cating media have diverse applica- Note that spraying the paste-covered denture base and denture peripheries
tions for identification of a variety of denture with air-water aerosol is ef- separately.
Corresponding author: denture-related problems.5 Pressure- fective. After removal from the oral 7. When seating the prosthesis
Dr Cesar AG Arrais
Department of Operative Dentistry, School of indicating media can be nonsetting cavity, ensure that the media is not to verify tissue adaptation, use light
Dentistry and cream-based (Pressure Indicator adhering to tissues and pulling off the pressure initially to ensure patient
University of Guarulhos Paste; Mizzy, Inc, Cherry Hill, NJ), base, creating a false positive for ex- comfort.6 Subsequently, apply firm
R. Dr. Nilo Peçanha, 81, Predio U – 6 Andar
– Centro nonsetting aerosol powders (Occlude; cessive pressure. pressure in the area of the first molars
Guarulho, Sao Paulo Pascal Intl, Inc, Bellevue, Wash), 4. Use the correct amount of mate- or instruct the patient to close with
BRAZIL firm pressure on cotton rolls over the
or media that polymerize (typically rial. For cream types, apply sufficient
CEP: 07011-040
Fax: 55-11-64641758 catalyst/base elastomers such as Fit material so that the base appears to posterior teeth.1,3,4,9,11 Do not allow
E-mail: cesararrais@yahoo.com.br Checker; GC Corp, Tokyo, Japan). be primarily the color of the media, occlusal contacts, which can cause
The purpose of this article is to as too little or too much material will tipping of the denture and a change
Acknowledgment
The authors thank Bisco, Inc, Kerr Corp, provide guidelines for optimal use of make interpretation more difficult.4,5 in the distribution of pressure.4,7,9,11
Pentron, Inc, Dentsply Caulk, and 3M ESPE the media, and to identify alternative Use a stiff brush to place pronounced 8. If manual pressure is used, apply
for providing all restorative materials, and
the Medical College of Georgia School of
applications for consideration in daily streaks in the material (Fig. 1).1,3,6,11 it as firmly as possible,4 as increased
Dentistry, Augusta, Ga, for allowing the use of practice. 5. For polymerizing materials, use pressure tends to increase the flow of
facilities and providing all required equipment as thin a layer as possible to complete- indicator media.7 Do not apply pres-
to perform the study.
Copyright © 2009 by the Editorial Council for Professor and Head, Division of Removable Prosthodontics.
a
The Journal of Prosthetic Dentistry.
Instructor and Head, Division of Comprehensive Care.
b
Arrais et al Looney and Knechtel
138
1 Coat denture with enough paste so base is primarily
color of medium, with streaks in paste as on left. Too little Lines of burn-through on flanges often indicate over-
(upper right) or too much (lower right) can make inter-
pretation more difficult.
sure on the palatal portion of a max-
illary denture, as functional loading
does not occur in this location.3
9. Exert pressure perpendicular to
the occlusal plane unless evaluating
the pressure pattern when the den-
ture is moving.9 Do not move or tip
the denture or allow it to shift when
assessing normal denture base fit.5
10. To evaluate flange extensions,
stabilize the denture over the occlus-
al surfaces of the teeth to prevent it
from moving while the patient makes
functional movements,12 or while the
clinician manipulates the cheeks or
lips,8 to detect overextensions in areas
of the moveable mucosa and frena,
which typically do not displace media
as easily as firmer tissues.
11. To interpret nonsetting pastes,
examine the denture for 3 distinct pat-
terns in the media: areas where streaks
remain, representing areas where
there has been no contact with tis-
sues; areas with paste but no streaks,
where there has been acceptable con-
tact; and areas without paste, which
normally suggest excessive pressure or
impingement (Fig. 3).3,5,6
12. For polymerizing-type pastes,
areas of excess pressure will appear
as uncovered, or more lightly covered,
with media (Fig. 4). Although nonpo-
lymerizing pastes have been found to
be more accurate in some situations,2
use media of different thicknesses7 or
The Journal of Prosthetic Dentistry
2 Apply paste well over flange edge onto buccal surface.
extended or overcontoured areas. Note double line of
burn-through on facet where denture has already been
adjusted.
viscosities to identify problem areas
that might not be identified by anoth-
er media (Fig. 4).
13. Use caution when interpret-
ing lack of paste surrounding tissue
undercuts (Fig. 5).9,11 Note that when
the denture moves over an undercut,
paste will normally be removed from
the denture.9,13 Adjust the undercut
area only when there are signs or
symptoms of excess pressure or tissue
impingement. Similarly, expect slight-
ly more pressure on primary bearing
areas and do not adjust these areas
unnecessarily.1,11
14. Note that commonly adjusted
areas of complete dentures include
the incisive papilla,8 malar process
of the zygoma,9,13 median palatal
raphe,14 posterior palatal seal area,9
hamular notch8 (Fig. 6), pterygoman-
dibular raphe, mylohyoid ridge,8,9,12
border of the retromylohyoid space,8
distobuccal border of the maxillary9,13
and mandibular8,9 dentures, bony
prominences8,14 or spicules, mental
formina,9 buccal shelves,9 and frenal
attachments.8,9
15. Use pressure-indicating media
to detect and adjust other areas on
the oral, rather than the intaglio, sur-
face of a prosthesis. Note that func-
tional impingements of the coronoid
process against the distobuccal sur-
face of the denture8,9,14 (Fig. 7), bulky
buccal contours8 (Fig. 8), and teeth
Volume 101 Issue 2 February 2009 139
3 Areas with streaks remaining in paste have not con- 4 Slight flange overextension in retrozygomal area (ar-
tacted tissue (N). Areas of paste with no streaks represent rows) caused displacement of denture during function.
acceptable contact (C). Areas without paste represent Cream-type media failed to reveal overextension.
areas of tissue impingement (I).
placed too far buccally into the ves-
tibule (Fig. 8) can be identified using
pressure-indicating media.9
16. Diagnose speech problems,
when possible, with palatograms,
using paste and spray-type pres-
sure-indicating media to diagnose
tongue contact areas on the denture
palate.14,15 Instruct the patient to re-
peat problematic sounds with the
media covering the palate. Note that
different sounds result in different
contact patterns15,16 (Fig. 9), which
can be modified by selective removal 5 Undercut areas will cause paste to be wiped off and 6 Use of indicating medium for adjustment of hamular
from or additions to the palatal con- will appear to need adjustment. Use caution in these notch areas is critical, as removal of acrylic resin in incor-
tour. Note that the registration of the areas. rect areas can result in breach of posterior palatal seal,
tongue contact area on the palate us- resulting in decreased retention.
ing paste-type media may sometimes
require numerous repetitions of pho-
netic phrases before the registrations
are easy to interpret.
17. After identifying areas requir-
ing modification, adjust the denture
with an acrylic bur of appropriate size
and shape (H79E, H351E, H261E,
H251E; Brasseler USA, Savannah,
Ga). After adjustment, reapply me-
dia to ensure that the adjustment has
been effective or to determine if other
areas require modification.8
18. For cream-type media, use an
air syringe to blow off as much of the 7 Use indicating medium on nonbearing surfaces of
adjustment debris as possible, then dentures to disclose problems such as impingement by
wipe away6 any remaining debris in coronoid process in lateral excursions. Interferences can
the cream, prior to reapplying paste cause both pain and loosening of dentures.
with streaks.
Looney and Knechtel Looney and Knechtel
138
1 Coat denture with enough paste so base is primarily
color of medium, with streaks in paste as on left. Too little Lines of burn-through on flanges often indicate over-
(upper right) or too much (lower right) can make inter-
pretation more difficult.
sure on the palatal portion of a max-
illary denture, as functional loading
does not occur in this location.3
9. Exert pressure perpendicular to
the occlusal plane unless evaluating
the pressure pattern when the den-
ture is moving.9 Do not move or tip
the denture or allow it to shift when
assessing normal denture base fit.5
10. To evaluate flange extensions,
stabilize the denture over the occlus-
al surfaces of the teeth to prevent it
from moving while the patient makes
functional movements,12 or while the
clinician manipulates the cheeks or
lips,8 to detect overextensions in areas
of the moveable mucosa and frena,
which typically do not displace media
as easily as firmer tissues.
11. To interpret nonsetting pastes,
examine the denture for 3 distinct pat-
terns in the media: areas where streaks
remain, representing areas where
there has been no contact with tis-
sues; areas with paste but no streaks,
where there has been acceptable con-
tact; and areas without paste, which
normally suggest excessive pressure or
impingement (Fig. 3).3,5,6
12. For polymerizing-type pastes,
areas of excess pressure will appear
as uncovered, or more lightly covered,
with media (Fig. 4). Although nonpo-
lymerizing pastes have been found to
be more accurate in some situations,2
use media of different thicknesses7 or
The Journal of Prosthetic Dentistry
2 Apply paste well over flange edge onto buccal surface.
extended or overcontoured areas. Note double line of
burn-through on facet where denture has already been
adjusted.
viscosities to identify problem areas
that might not be identified by anoth-
er media (Fig. 4).
13. Use caution when interpret-
ing lack of paste surrounding tissue
undercuts (Fig. 5).9,11 Note that when
the denture moves over an undercut,
paste will normally be removed from
the denture.9,13 Adjust the undercut
area only when there are signs or
symptoms of excess pressure or tissue
impingement. Similarly, expect slight-
ly more pressure on primary bearing
areas and do not adjust these areas
unnecessarily.1,11
14. Note that commonly adjusted
areas of complete dentures include
the incisive papilla,8 malar process
of the zygoma,9,13 median palatal
raphe,14 posterior palatal seal area,9
hamular notch8 (Fig. 6), pterygoman-
dibular raphe, mylohyoid ridge,8,9,12
border of the retromylohyoid space,8
distobuccal border of the maxillary9,13
and mandibular8,9 dentures, bony
prominences8,14 or spicules, mental
formina,9 buccal shelves,9 and frenal
attachments.8,9
15. Use pressure-indicating media
to detect and adjust other areas on
the oral, rather than the intaglio, sur-
face of a prosthesis. Note that func-
tional impingements of the coronoid
process against the distobuccal sur-
face of the denture8,9,14 (Fig. 7), bulky
buccal contours8 (Fig. 8), and teeth
Volume 101 Issue 2 February 2009 139
3 Areas with streaks remaining in paste have not con- 4 Slight flange overextension in retrozygomal area (ar-
tacted tissue (N). Areas of paste with no streaks represent rows) caused displacement of denture during function.
acceptable contact (C). Areas without paste represent Cream-type media failed to reveal overextension.
areas of tissue impingement (I).
placed too far buccally into the ves-
tibule (Fig. 8) can be identified using
pressure-indicating media.9
16. Diagnose speech problems,
when possible, with palatograms,
using paste and spray-type pres-
sure-indicating media to diagnose
tongue contact areas on the denture
palate.14,15 Instruct the patient to re-
peat problematic sounds with the
media covering the palate. Note that
different sounds result in different
contact patterns15,16 (Fig. 9), which
can be modified by selective removal 5 Undercut areas will cause paste to be wiped off and 6 Use of indicating medium for adjustment of hamular
from or additions to the palatal con- will appear to need adjustment. Use caution in these notch areas is critical, as removal of acrylic resin in incor-
tour. Note that the registration of the areas. rect areas can result in breach of posterior palatal seal,
tongue contact area on the palate us- resulting in decreased retention.
ing paste-type media may sometimes
require numerous repetitions of pho-
netic phrases before the registrations
are easy to interpret.
17. After identifying areas requir-
ing modification, adjust the denture
with an acrylic bur of appropriate size
and shape (H79E, H351E, H261E,
H251E; Brasseler USA, Savannah,
Ga). After adjustment, reapply me-
dia to ensure that the adjustment has
been effective or to determine if other
areas require modification.8
18. For cream-type media, use an
air syringe to blow off as much of the 7 Use indicating medium on nonbearing surfaces of
adjustment debris as possible, then dentures to disclose problems such as impingement by
wipe away6 any remaining debris in coronoid process in lateral excursions. Interferences can
the cream, prior to reapplying paste cause both pain and loosening of dentures.
with streaks.
Looney and Knechtel Looney and Knechtel
140 Volume 101 Issue 2 February 2009
nies a pressure spot, do not ask the
patient if the adjustment has made a
problem “better,” as the most likely re-
sponse will be “yes.” Rather, ask an un-
biased question, such as, “How does
that feel?” Then, if the patient states
that the problem feels “better,” ask
the patient to rate the improvement in
terms of a percentage.5 Note that the
patient should rate the improvement
in comfort at close to 100% when the
adjustment is complete, and, if the
A B patient does not, further adjustment
8 A, External contours of dentures can be evaluated with media. Bulky gingival contours around teeth have no is most likely warranted. 5
paste. B, After functional movements, bulky flanges have no paste. Thin these areas, if patient has problems with
loosening or discomfort. SUMMARY
Use of an indicating medium is one
of several strategies that clinicians can
employ for improving diagnosis and
correction of denture-related prob-
lems. Denture adjustments are more
accurate and effective when made
using an indicating medium. The
authors recommend that the use of
pressure-indicating media for adjust-
ing dentures should become routine.
Noteworthy Abstracts of the Current Literature
A B
9 A, Contour of palate can affect phonetics. Palatogram represents correct pattern for “S” sounds with minimal Single-tooth replacement in the anterior maxilla by means of immediate implantation
loss of pressure media behind central incisors. B, Palatogram represents correct pattern for “T,” “D,” “N,” “J,” and and provisionalization: A review
“Ch” sounds. Addition of wax or removal of palatal base material can be performed to modify contact areas and
improve phonetics. De Rouck T, Collys K, Cosyn J.
Int J Oral Maxillofac Implants 2008;23:897-904.
REFERENCES
1. Carr AB, McGivney GP, Brown DT. Mc-
Cracken’s removable partial prosthodontics.
11th ed. St. Louis: Mosby; 2004. p. 363-72.
2. Firtell DN, Arnett WS, Holmes JB. Pressure
indicators for removable prosthodontics. J
Prosthet Dent 1985;54:226-9.
3. Greenwood AH, Firtell DN. Pressure
indicators-a useful diagnostic aid. Quintes-
sence Int 1985;16:531-3.
4. Jankelson B. Adjustment of dentures at time
of insertion and alterations to compen-
sate for tissue change. J Am Dent Assoc
1962;64:521-31.
5. Loney R. Diagnosing denture pain:
principles and practice. J Can Dent Assoc
2006;72:137-41.
6. Phoenix RD, Cagna DR, DeFreest CF, Stew-
art KL. Stewart’s clinical removable partial
prosthodontics. 3rd ed. Chicago: Quintes-
sence; 2003. p. 431-7.
7. Stevenson-Moore P, Daly CH, Smith DE.
Indicator pastes: their behavior and use. J
Prosthet Dent 1979;41:258-65.
8. Zarb GA, Bolender CL, Eckert SE, Fenton
AH, Jacob, RF, Mericske-Stern R. Prost-
hodontic treatment for edentulous patients:
complete dentures and implant-supported
prostheses. 12th ed. St. Louis: Mosby; 2003.
p. 402-26.
9. Levin B. Impressions for complete dentures.
Chicago: Quintessence: 1984. p. 162-80.
10.Yeoman LR, Beyak BL. Patient’s ability to
localize adjustment sites on the mandibular
denture. J Prosthet Dent 1995;73:542-7.
141
11.Renner RP, Boucher LJ. Removable partial
dentures. Chicago: Quintessence; 1987. p.
335-45.
12.Boucher LJ. Insertion adjustment of denture
base surface contacting the mylohyoid ridge.
J Prosthet Dent 1992;67:900-1.
13.Rodegerdts CR. The relationship of pres-
sure spots in complete denture impressions
with mucosal irritations. J Prosthet Dent
1964;14:1040-9.
14.Grant AA, Heath JR, McCord JF. Complete
prosthodontics: problems, diagnosis and
management. London: Wolfe: 1994. p.
33-87.
15.Farley DW, Jones JD, Cronin RJ. Palatogram
assessment of maxillary complete dentures. J
Prosthodont 1998;7:84-90.
16.Kong HJ, Hansen CA. Customizing palatal
contours of a denture to improve speech in-
telligibility. J Prosthet Dent 2008;99:243-8.
Corresponding author:
Dr Robert W. Loney
Division of Removable Prosthodontics
Department of Dental Clinical Sciences
Faculty of Dentistry, Dalhousie University
5981 University Ave
Halifax, NS B3H 1W2
CANADA
Fax: 902-494-1662
E-mail: robert.loney@dal.ca
Copyright © 2009 by the Editorial Council for
The Journal of Prosthetic Dentistry.

Objectives: The objective of this study was to assess to what extent the outcome of immediate implantation and pro-
visionalization for replacing single maxillary teeth in the esthetic zone is favorable and predictable from biologic and
esthetic points of view.

Material and Methods: An electronic search (MEDLINE and Cochrane Oral Health Group Specialized Trials Register)
and a manual search were performed to detect studies concerning maxillary single-tooth replacements by means of
dental implants immediately placed into fresh extraction sockets and provisionalized within the first 24 hours. Only
full-text reports on clinical studies published in English up to June 2006 were included. Case reports and reviews on
the topic of interest were excluded.

Results: Eleven studies were selected. Based on a qualitative data analysis, implant survival and even management of
papilla levels seem predictable following immediate implantation and provisionalization. However, maintaining the
10 Well-adjusted denture base. Areas of tissue inflammation that do not correlate to areas of midfacial gingival margin may be more problematic, since postextraction bone remodeling and therefore marginal
burn-through are most likely caused by tilting of dentures, possibly due to occlusal problems. gingival changes will occur irrespective of the timing of the placement of an implant. The long-term impact of this
remodeling is currently unclear and needs to be elucidated in future research.
19. For elastomeric media, mark or pull away from the denture. adaptation of the base.9 If interpre-
the exposed areas of the denture us- 20. Adjustment is complete when tation of the indicating media is dif- Conclusion: The clinician is recommended to be reserved when considering immediate implant placement and pro-
ing a dampened tip of a disinfected the area being evaluated has a rela- ficult, avoid adjustment until signs or visionalization for replacing single maxillary teeth in the anterior zone. At the very least, a number of guidelines and
red or blue pencil, so that the area re- tively even pattern of contact (Fig. 10; symptoms appear, so as not to over- prerequisites need to be taken into consideration.
mains indicated, should the polymer- compare with Fig. 3). Note that it is adjust the denture.6,9
Reprinted with permission of Quintessence Publishing.
ized elastomer catch the bur and tear often not possible to achieve perfect 21. When discomfort accompa-
The Journal of Prosthetic Dentistry Looney and Knechtel Looney and Knechtel
140 Volume 101 Issue 2 February 2009
nies a pressure spot, do not ask the
patient if the adjustment has made a
problem “better,” as the most likely re-
sponse will be “yes.” Rather, ask an un-
biased question, such as, “How does
that feel?” Then, if the patient states
that the problem feels “better,” ask
the patient to rate the improvement in
terms of a percentage.5 Note that the
patient should rate the improvement
in comfort at close to 100% when the
adjustment is complete, and, if the
A B patient does not, further adjustment
8 A, External contours of dentures can be evaluated with media. Bulky gingival contours around teeth have no is most likely warranted. 5
paste. B, After functional movements, bulky flanges have no paste. Thin these areas, if patient has problems with
loosening or discomfort. SUMMARY
Use of an indicating medium is one
of several strategies that clinicians can
employ for improving diagnosis and
correction of denture-related prob-
lems. Denture adjustments are more
accurate and effective when made
using an indicating medium. The
authors recommend that the use of
pressure-indicating media for adjust-
ing dentures should become routine.
Noteworthy Abstracts of the Current Literature
A B
9 A, Contour of palate can affect phonetics. Palatogram represents correct pattern for “S” sounds with minimal Single-tooth replacement in the anterior maxilla by means of immediate implantation
loss of pressure media behind central incisors. B, Palatogram represents correct pattern for “T,” “D,” “N,” “J,” and and provisionalization: A review
“Ch” sounds. Addition of wax or removal of palatal base material can be performed to modify contact areas and
improve phonetics. De Rouck T, Collys K, Cosyn J.
Int J Oral Maxillofac Implants 2008;23:897-904.
REFERENCES
1. Carr AB, McGivney GP, Brown DT. Mc-
Cracken’s removable partial prosthodontics.
11th ed. St. Louis: Mosby; 2004. p. 363-72.
2. Firtell DN, Arnett WS, Holmes JB. Pressure
indicators for removable prosthodontics. J
Prosthet Dent 1985;54:226-9.
3. Greenwood AH, Firtell DN. Pressure
indicators-a useful diagnostic aid. Quintes-
sence Int 1985;16:531-3.
4. Jankelson B. Adjustment of dentures at time
of insertion and alterations to compen-
sate for tissue change. J Am Dent Assoc
1962;64:521-31.
5. Loney R. Diagnosing denture pain:
principles and practice. J Can Dent Assoc
2006;72:137-41.
6. Phoenix RD, Cagna DR, DeFreest CF, Stew-
art KL. Stewart’s clinical removable partial
prosthodontics. 3rd ed. Chicago: Quintes-
sence; 2003. p. 431-7.
7. Stevenson-Moore P, Daly CH, Smith DE.
Indicator pastes: their behavior and use. J
Prosthet Dent 1979;41:258-65.
8. Zarb GA, Bolender CL, Eckert SE, Fenton
AH, Jacob, RF, Mericske-Stern R. Prost-
hodontic treatment for edentulous patients:
complete dentures and implant-supported
prostheses. 12th ed. St. Louis: Mosby; 2003.
p. 402-26.
9. Levin B. Impressions for complete dentures.
Chicago: Quintessence: 1984. p. 162-80.
10.Yeoman LR, Beyak BL. Patient’s ability to
localize adjustment sites on the mandibular
denture. J Prosthet Dent 1995;73:542-7.
141
11.Renner RP, Boucher LJ. Removable partial
dentures. Chicago: Quintessence; 1987. p.
335-45.
12.Boucher LJ. Insertion adjustment of denture
base surface contacting the mylohyoid ridge.
J Prosthet Dent 1992;67:900-1.
13.Rodegerdts CR. The relationship of pres-
sure spots in complete denture impressions
with mucosal irritations. J Prosthet Dent
1964;14:1040-9.
14.Grant AA, Heath JR, McCord JF. Complete
prosthodontics: problems, diagnosis and
management. London: Wolfe: 1994. p.
33-87.
15.Farley DW, Jones JD, Cronin RJ. Palatogram
assessment of maxillary complete dentures. J
Prosthodont 1998;7:84-90.
16.Kong HJ, Hansen CA. Customizing palatal
contours of a denture to improve speech in-
telligibility. J Prosthet Dent 2008;99:243-8.
Corresponding author:
Dr Robert W. Loney
Division of Removable Prosthodontics
Department of Dental Clinical Sciences
Faculty of Dentistry, Dalhousie University
5981 University Ave
Halifax, NS B3H 1W2
CANADA
Fax: 902-494-1662
E-mail: robert.loney@dal.ca
Copyright © 2009 by the Editorial Council for
The Journal of Prosthetic Dentistry.

Objectives: The objective of this study was to assess to what extent the outcome of immediate implantation and pro-
visionalization for replacing single maxillary teeth in the esthetic zone is favorable and predictable from biologic and
esthetic points of view.

Material and Methods: An electronic search (MEDLINE and Cochrane Oral Health Group Specialized Trials Register)
and a manual search were performed to detect studies concerning maxillary single-tooth replacements by means of
dental implants immediately placed into fresh extraction sockets and provisionalized within the first 24 hours. Only
full-text reports on clinical studies published in English up to June 2006 were included. Case reports and reviews on
the topic of interest were excluded.

Results: Eleven studies were selected. Based on a qualitative data analysis, implant survival and even management of
papilla levels seem predictable following immediate implantation and provisionalization. However, maintaining the
10 Well-adjusted denture base. Areas of tissue inflammation that do not correlate to areas of midfacial gingival margin may be more problematic, since postextraction bone remodeling and therefore marginal
burn-through are most likely caused by tilting of dentures, possibly due to occlusal problems. gingival changes will occur irrespective of the timing of the placement of an implant. The long-term impact of this
remodeling is currently unclear and needs to be elucidated in future research.
19. For elastomeric media, mark or pull away from the denture. adaptation of the base.9 If interpre-
the exposed areas of the denture us- 20. Adjustment is complete when tation of the indicating media is dif- Conclusion: The clinician is recommended to be reserved when considering immediate implant placement and pro-
ing a dampened tip of a disinfected the area being evaluated has a rela- ficult, avoid adjustment until signs or visionalization for replacing single maxillary teeth in the anterior zone. At the very least, a number of guidelines and
red or blue pencil, so that the area re- tively even pattern of contact (Fig. 10; symptoms appear, so as not to over- prerequisites need to be taken into consideration.
mains indicated, should the polymer- compare with Fig. 3). Note that it is adjust the denture.6,9
Reprinted with permission of Quintessence Publishing.
ized elastomer catch the bur and tear often not possible to achieve perfect 21. When discomfort accompa-
The Journal of Prosthetic Dentistry Looney and Knechtel Looney and Knechtel
View publication stats