1. Differential Diagnosis of Post-Insertion Problems

2. Post Insertion Problems
Minimal problems if remount
Most problems will be occlusal if denture base has been adjusted

3. Principles of Diagnosing Denture Problems
Never adjust unless you can see exactly where to adjust
Use indicator medium
(PIP, indelible marker, articulating paper, etc.)
Loney & Knechtel, J Prosthetic Dent
2009;101:

4. Place Paste with Streaks
Mostly colour of Paste

5. Pressure 1st Molars Streaks - no contact (N)
No Paste - Impingement (I)
Paste, no streaks - normal contact (C)

6. Principles of Diagnosing Denture Problems
Patients frequently wrong in exactly locating source of problem

7. Principles of Diagnosing Denture Problems
Spend time to look and think

8. Principles of Diagnosing Denture Problems
Where?
Dentist needs to locate (PIP, tip of instrument, indelible stick)
When?
(Chewing only?)

9. Principles of Diagnosing Denture Problems
How long?
Anything makes it better or worse?
Have patient demonstrate problem

10. Limited number of problems:
Denture base
Occlusion -
Interferences - esp. protrusive
Retention
Vertical dimension
Allergies and infections
Tooth position

11. Denture Base Impingements, spicules, sharp edges
Diagnosis - PIP (never adjust unless burnthrough)

12. Denture Base Sore all time
If worsens throughout day may be occlusion, not denture base
May still be occlusal, if inflammation causes swelling

13. Occlusion One of most common problems Pain gets worse through day
Difficult to determine, intraorally - reflex avoidance of pain
Interferences - especially in protrusive

14. Occlusion Fingers on canines - should feel smooooooooooth
Sore when bite
Fit changes or comfort deteriorates through day
Remount

15. Retention Problems Short flanges PIP - still streaky
Fingers on canines outwards (post palatal seal)

16. Retention Problems Short flanges Look for space
May be retentive for a while if a lip seal established, until movements disturbs the lip seal

17. Retention Problems Long flanges Burn through (PIP)
Intrudes tissue when placed
May not dislodge if good seal, may loosen after much function

18. Retention Problems Post-palatal seal
If the denture is short of the vibrating line, the denture may bind on hard palate, (check with PIP)

19. Retention Problems Post-palatal seal Inadequate tissue contact
Food gets underneath
Bubbles as denture is placed (check with PIP)
If over-extended to moveable soft palate
denture loosens during speech, chewing

20. Occlusal Vertical Dimension (OVD)
Excessive
Continual and generalized pain and fatigue or muscle soreness
Insufficient
No power

21. Allergies and Infections
Rare allergies -
General inflammation
Hygiene
Generalized inflammation

22. Tooth Position Instability (teeth not over ridge)
Difficulty chewing (occlusal table not long enough - esp. rational teth)
Cheek and lip biting (insufficient overjet)

23. Tooth Position Esthetic, phonetic problems
May have to change position of teeth

24. Most Common Areas Requiring Adjustments
Maxillary
Hamular notches - ulceration can occur if over-extended
Labial frenum - requires adequate relief (often feels too bulky to the patient)

25. The maxillary labial frenum is the most common frenum to become irritated from denture overextension

26. Most Common Areas Requiring Adjustments
Maxillary
Mid-line fulcrum on the bony raphe
Zygomatic impringement

27. Most Common Areas Requiring Adjustments
Mandibular
Lingual frenum - impingement can cause displacement of the denture of ulceration

28. Lesions associated with anterior mandibular denture border correspond to the PIP pattern.

29. Most Common Areas Requiring Adjustments
Mandibular
Retromylohyoid overextensions
Sore throat
Denture moves when swallowing
Buccal shelf overextension

30. Most Common Areas Requiring Adjustments
Phonetic problems
Wait and allow time for adaptation
Add soft wax to palate and check
If anterior poorly positioned, then remove and replace