Question . Enumerate various post-insertion problems in complete denture wearers, their causes, and their management of them, and add a note on laboratory remounting.
Answer:
1. Post-insertion complaints are corrected in the one to three-day adjustment period. This is the critical period in the denture-wearing experience of the patient. The most common complaint is tissue irritation and ulceration.
- In the upper denture soreness may develop on the borders, mucosa, and crest of the residual ridge and slope of the residual ridge.
- The cause of this can be overextension, error in impressions, tissue surface irritant, occlusion, pressures created by heavy contacts of opposing teeth in the same region, and shifting of the denture bases from defective occlusal contacts.
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Read And Learn More: Complete Dentures Question and Answers
Complete denture wearers Adjustment for overextension: Locate the overextension and reduce and polish the overextended area.
Complete denture wearers Adjustment for defective occlusion is done by first observing dentures in the mouth. Then the mandible is guided into centric relation by placing a thumb directly on the anteroinferior portion of the chin and directing the patient to open and close until the first feather touch of the back teeth occurs and close tight.
- If the teeth touch and slide there is an error in centric occlusion, remount dentures and if the same error is found on the articulator, it is eliminated by selective grinding. If the error is too gross reset your teeth.
- If the patient complains of burning or numbness in the anterior part of the jaw, the incisive papilla needs to be relieved as the nasopalatine nerves are compressed.
- In the mandibular denture, tissue irritation and ulceration occur on the lingual flange posteriorly due to tissue surface irritant, defective occlusion, and loose tissue entrapment.
- Anteriorly too this occurs on the lingual flange. This is due to excessive loading from posterior occlusion shifting the mandibular base forward. This needs to be corrected by checking the balance for protrusive movement.
- If the patient complains of tingling or numbness at the corner of the mouth or lower lip, this is due to impingement on the mental nerve and this area in the lower denture needs to be relieved.
2. Denture looseness: This can be due to poor retention of mandibular denture due to improper impression technique, poor adaptation of bases, lack of seal in the maxillary denture, the excessive thickness of distobuccal flange which interferes with the normal movement of the coronoid process, the excessive thickness of height of flange of an upper denture in the region of buccal notch or distal to notch. Adjustment of denture looseness can be managed by reimpression, rechecking posterior palatal seal, and occlusion.
3. Defective speech: This is due to the excessive opening of vertical dimension, deficient palatal contour, arch form incorrect anteriorly, posteriorly, or both, and increased tongue size.
This can be managed by resetting to a closed vertical dimension, repairing by adding material or removing material, recontouring lingual surfaces, and resetting teeth.
4. Inability to eat: Increased or decreased vertical dimension and incorrect centric relation. This is corrected by setting teeth to correct vertical dimension, and selective grinding in case of occlusal errors.
5. Gagging: This is due to the upper posterior border seal being inadequate or too long. Managed by adding modeling compound which is later replaced with acrylic resin in case of short border and reducing length/depth in case of long border.
In mandibular dentures, this can be due to posterior lingual flange extension. This is managed by reducing and polishing the extended area.
6. Cheek biting: This is due to the incorrect arch form in the posterior segment. This can be managed by providing horizontal overlap by resetting teeth of the maxillary or mandibular denture or both. Or buccal contours of the lower denture may be ground if excessive.
7. Food catching: This is due to poor finishing/contouring, occlusal interference, poor processing, and insufficient patient instruction.
This can be managed by recontouring, polishing, correcting occlusion, repairing, and replacement of teeth, and re-educating the patient.
8. Faulty esthetics:
- The patient complains of a puffy look. This is due to an expanded anterior or posterior arch.
- The patient complains of a collapsed appearance. This is due to a constricted arch form. These are managed by resetting teeth and remaking the denture.
- Lip wrinkles. This is usually anatomic, does not require treatment, and needs only an explanation to the patient.
Complete denture wearers Remounting
- Remounting is done to check for any occlusal errors which could have taken place in the denture after the wax up and processing.
- These occlusal errors are corrected by selective grinding after remounting and verifying with interocclusal check records.
- Ideally, a face bow index is made before separating the denture from the cast. This helps to reseat the maxillary denture in the same relationship as the articulator.
Complete denture wearers Advantages of Remounting
- No patient participation.
- Able to visualize the occlusion better.
- Provides a stable working foundation without resilient tissues affecting the occlusion.
- The absence of saliva makes possible more accurate markings with the articulating paper.
- Objections from patients, when they see their dentures being ground, are avoided.
Complete denture wearers Procedure
A mandibular denture is oriented to the maxillary denture in centric relation by means of an interocclusal record.
Complete denture wearers Interocclusal Check Record
Two thicknesses of softened passive-type wax are placed on the occlusal surfaces of the mandibular teeth. The patient is instructed or guided to close into the wax when the jaws are in centric relation.
Complete denture wearers Verifying Record
The teeth should not penetrate to make contact. Chill with cold air and remove. Trim the wax with slight indentations remaining, and expose the facial side to visualize the seating of the maxillary denture.
Complete denture wearers Mounting
Orient the mandibular denture to the maxillary denture by means of the interocclusal record and secure it with sticky wax. After seating the mandibular cast in the denture, complete mounting by attaching it to the mandibular member with plaster.
Complete denture wearers Rechecking Records
Make another wax interocclusal record and check on the articulator after placing the dentures on the cast. While checking the condylar elements should be freed and place the teeth in the wax record indentations. The condylar elements should rest against the stops. Repeat with three records to confirm.
Complete denture wearers Selective Grinding Procedures
- In anatomic tooth forms to attain balanced occlusion, bilateral tooth contacts of the posterior teeth are required to evenly distribute the forces.
- A cusp fossae marginal ridge relation of maximum intercuspation, when the jaws are in a terminal hinge position, is needed to attain balance. There should be no occlusal interference when jaw movements occur to and from centric and eccentric positions.
- If selective grinding is done maximum intercuspation is when the jaws are in centric relation, and balanced centric occlusion is achieved.
- If selective grinding is done to make simultaneous cusp tip-to-cusp tip contact on both sides of the arch when the jaws are in a right or left lateral position, balanced occlusion in a static eccentric position exists.
- When the anterior teeth make an incisal edge to incisal edge contact in a straight protruded relation, and if the posterior teeth are altered to make cusp contacts at the same time balanced occlusion in protrusion exists.
- The buccal cusps of the mandibular posterior teeth and the lingual cusps of the maxillary posterior teeth maintain the vertical dimension of jaw separation by contact in the fossae and on the marginal ridges of their antagonists.
- Generally, the functional cusp of the upper (lingual cusp) and functional cusp of the lower (buccal cusp ) are never ground.
- The non-functional cusps, deepening of fossae, and the cuspal inclines are the ones that are altered to achieve balance.
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