Denture Looseness CD

1
Denture LoosenessCD RPD

• Occlusion
• Denture base (fit contour)
• Poor anatomy

2
Denture LoosenessCD RPD Occlusion

• Typical History
• Adequate retention initially
• Gets worse with time

3
Denture LoosenessCD RPD Occlusion

• Perpetually Loose Maxillary Denture
• Heavy anterior interferences can cause loosening
  at posterior
• Tuberosity mucosa grows into space
• Space develops under midline of denture base

4
Denture LoosenessCD RPD Occlusion
Tuberosity

• Tilting Growth Loss of retention

5
Denture LoosenessCD RPD Occlusion

• Incisors placed too far labially
• Denture displaceslingually.
• Inclined ridge provides no resistance.

6
Denture LoosenessCD RPD Occlusion

• Tilting/jiggling caused by
• Contacts not centered over ridge
• Contacts on inclined portion of ridge

7
Denture LoosenessCD RPD Occlusion

• Check for looseness in excursions with fingers on
  canines

8
Denture LoosenessCD RPD Occlusion

• Check centric position (articulating paper)
• even, stable contacts both sides
• stop patient upon initial contact

9
Denture LoosenessCD RPD

• Occlusion
• Denture base (fit contour)
• Poor anatomy

10
Denture LoosenessMandibular lingual flange too
thick
Eyes in Your Fingers Blanchard, JPD 236
Tongue
Flange bulges into tongue space, lifts denture
during function. Flange is not too long.
11
Denture LoosenessCD RPD Denture Base

• Short flange
• PIP streaks
• Looks short of vestibule
• Often displaces easily

12
Denture LoosenessCD RPD Denture Base

• Long flange
• PIP burnthrough
• Retentive until speaking, eating
• Watch when seating denture
• Flange touches vestibular depth, denture
  continues to seat

13
Denture LoosenessCD RPD Denture Base

• If flange is too thick, seal may be maintained at
  rest
• If flange is also short or long, displacement may
  occur as lips or cheeks move, allowing air to
  break vestibular seal

14
Denture LoosenessCD RPD Denture Base

• Principle
• Always have the patient demonstrate how a denture
  loosens

15
Denture LoosenessCD RPD Denture Base

• Lack of post dam/ retrozygomal seal
• Pull upward and outward on canine
• Test hypothesis add compound/functional wax
  -opposite side

16
Denture LoosenessCD RPD Denture Base

• Poor base adaptation
• Fulcrum on bony structures
• Test hypothesis PIP

17
Denture LoosenessCD RPD Denture Base

• Periphery terminates on bony structures
• Hard palate
• Zygoma
• External oblique ridge
• Before retromolar pad
• No seal, discomfort
• Eventual resorption

Dry Mucosa
18
Denture LoosenessCD RPD Denture Base

• Principle
• Denture peripheries always terminate on
  displaceable soft tissues
• Retromolar pads, Vestibular tissues, Vibrating
  line (nonmoveble soft palate), Hamular notches

19
Gagging with Dentures

• Usually not soft palate contact
• Denture contact with tongue
• thick posterior border rubs on tongue
• posterior border drops onto tongue
• Occlusal interferences
• Terminates on hard palate (no seal)

20
(No Transcript)
21
Denture LoosenessDenture Base Coronoid
Interference

• Thick flange in retrozygomal area
• Coronoid gets closer to tuberosity as patient
  opens or moves jaw to side
• Dislodges maxillary denture

22
Denture LoosenessDenture Base Pterygomandibular
Raphe

• Raphe from area of hamular notch
• Very tight in some patients
• Easily displaceable, but raphe can displace
  denture opening wide

23
Denture LoosenessDenture Base Palatal Cleft

• In some patients midline soft palate fissure
• Can tent during function
• Allows air to leak under denture

24
Denture LoosenessCD RPD

• Occlusion
• Denture base (fit contour)
• Poor anatomy

25
Denture LoosenessCD RPD Poor Anatomy

• Many sets of dentures
• Use articulator, more complex impression and jaw
  relation procedures
• Implants
• Refer

26
Overview

• Deal with denture problems systematically
• Use a differential diagnosis
• Address probable causes until problem is
  eliminated
• If cant identify problem, refer

27
Phonetic Problems

• Lisping
• too much overjet
• triangular spaces between embrasures of max.
  mand. teeth
• palatal contour too constricted
• insufficient tongue space

28
Difficult Denture Patients

• Anatomic Problem
• Diagnosis Problem
• Adaptive Problem
• Psychologic Problem

29
Difficult Denture Patients

• Principle
• If you cant determine the problem using
  indicating medium
• 1. Tell the patient
• 2. Dont adjust
• 3. Refer

30
Difficult Denture Patients

• Principle
• Never pretend to adjust a denture
• Reinforces maladaptive behaviour - harder for the
  next guy

31
Difficult Denture PatientsAdaptive Problem

• Elderly take more time to adapt
• More teeth missing, less adaptation
  (loss of PDM receptors)
• Better perception - less adaptive

32
Difficult Denture PatientsAdaptive Problem

• Denture may be the cause of the problem
• Patient response may also be part of the problem

33
Difficult Denture PatientsAdaptive/Psychologic
Problem

• Dentists response to patient may also affect the
  patient response to the denture
• Laying on of Hands

34
Adaptive, Psychologic ProblemPrevention

• Good interview technique
• Tips
• Many dentures
• Disparaging previous dentures/dentists
• Body Language/ Deportment

35
Adaptive, Psychologic ProblemPrevention
Interview

• 1. Recognize Acknowledge Problem
• Open ended questions
• Let patient identify problem
• If you identify the wrong problem - fail

36
Adaptive, Psychologic ProblemPrevention
Interview

• 2. Explore and Identify Problems
• Let the patient talk (silence)
• Watch for nonverbal clues
• Short verbal clues may be significant
• (...and I guess the appearance)
• Dont be afraid of questions relating to
  emotional health

37
Adaptive, Psychologic ProblemPrevention
Interview

• 3. Interpret Explain Problems
• Advise patient of your view
• Use care in dealing with emotional problems
• Dont be afraid to address emotional component

38
Adaptive, Psychologic ProblemPrevention
Interview

• 4. Offer a Solution
• If chance denture will not be a success, state at
  outset
• If sense trouble, refer or address immediately
• If suggest a therapist, patient will run or say
  yes

39
Adaptive, Psychologic ProblemPrevention
Interview

• If bells go off in your head, listen to them,
  talk more, dont proceed past interview, until
  satisfied

40
Adaptive, Psychologic ProblemPrevention
Interview

• Remember Most patients are not problem patients
• 80-85 are satisfied
• Better adaptation than eyeglass wearers

41
Adaptive, Psychologic Problem

• Rule out objective findings
• Chart findings objectively

42
Overview

• Deal with denture problems systematically
• Use a differential diagnosis
• Address probable causes until problem is
  eliminated
• If cant identify problem, refer