Differential Diagnosis of Post-Insertion Problems

1. Differential Diagnosis of Post-Insertion Problems

2. Principles of Diagnosing Denture Problems • Never adjust unless you identify the location • Necessitates indicator medium • (PIP, indelible marker, articulating paper, etc.) Loney & Knechtel, J Prosthetic Dent 2009;101:137-141

3. Place Paste with Streaks Mostly Colour of Paste

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

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

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

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

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

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

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

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

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

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

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

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

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

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

18. 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

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

20. Allergies and Infections • Rare allergies - • General inflammation • Hygiene • Generalized inflammation

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

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

23. 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)

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

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

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

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

28. Most Common Areas Requiring Adjustments • Mandibular • Retromylohyoid overextensions • Sore throat • Denture moves when swallowing • Mylohyoid ridge • Buccal shelf overextension

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