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Techniques for Overcoming Problems in Complete Dentures

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Title: Techniques for Overcoming Problems in Complete Dentures


1
Techniques for Overcoming Difficulties in
Complete Dentures
  • Dr. Shujah a Khan
  • Mds resident clinical prosthodontics
  • Dikiohs - duhs

2
Techniques for Overcoming Difficulties in
Complete Dentures
  • The results of many errors made during the
    fabrication of complete dentures may not be
    recognizable when they occur.
  • Many of the inaccuracies are because of the
    errors in denture construction steps.
  • This may lead to a vicious cycle of a failed
    prosthesis.
  • Need Rectification of the errors.

3
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4
ERRORS IN DIAGNOSIS
  • ERROR 1 Looking for the need of a prosthesis
    only and not recognizing any other problems.
  • SOLUTION Look for the residual ridges anatomy,
    presence of tori, kind of palatal vault, arch
    form, maxillary tuberosities, mandibular
    undercuts.

5
  • ERROR 2 Not making a set of diagnostic casts for
    each patient.
  • SOLUTION Always make diagnostic casts and
    evaluate them thoroughly before committing to
    treatment.

6
ERRORS DURING PRIMARY IMPRESSION
  • ERROR 1 Failing to pick out the right material
    for recording fine details, depending on the
    anatomy of ridge and presence of extra flabby
    tissue.
  • SOLUTION Muco-static, muco-compressive and
    selective pressure techniques where required.

7
  • ERROR 3 Using too much powder in a mix of stone.
  • SOLUTION Always use the exact amount of powder
    (by weight) and water recommended by the
    manufacturer to make a smooth, creamy mix with
    the correct consistency.

8
  • ERROR 4 Adding a stone mix to the impression too
    rapidly. Air may be trapped between the stone and
    the impression, resulting in air voids in the
    cast.
  • SOLUTION Add the stone mix in small increments
    vibrate each addition before adding more.

9
ERRORS IN SECONDARY IMPRESSION
  • ERROR 1 Using a custom-tray that is a little too
    over-extended.
  • SOLUTION Making sure the tray is 2-3 mm short of
    the sulcus area so as to be able to incooperate
    low-fusing material for border moulding.

10
  • ERROR 2 Incorrect technique to mold the borders.
  • SOLUTION Make sure the patient does proper
    muscle and tongue movements, the resulting
    borders should look smooth and continuous.

11
  • ERROR 5 Not being able to record the required
    areas of interest.
  • SOLUTION A record of buccal and labial flanges
    for maxilla, buccal and lingual flanges for
    mandible is a must.

12
  • ERROR 6 Incorrect position of the recorded
    posterior palatal seal.
  • SOLUTION The anterior vibrating line can be
    recorded by Valasalva maneuver or by asking
    patient to make AH sound, once out loud while
    you visualize the area.

13
ERRORS IN MAKING OCCLUSAL RIMS
  • ERROR Failing to maintain the relationship of
    occlusal rims to edentulous area.
  • SOLUTION The maxillary occlusal rim should be
    22mm high from the depth of sulcus region to
    canine eminence, likewise the mandibular rim
    should be 18mm high and should cover two-third
    part of the rmp area.

14
ERRORS DURING VERTICAL JAW RELATION
  • ERROR 1 Being poor at orientation.
  • SOLUTION We should use scales and proper gauges
    to orient the campers plane and inter-pupillary
    line.

15
  • ERROR 2 Not being able to record CR while
    relating jaws at occlusion.
  • SOLUTION CR is a reproducible relation and
    should be produced with accuracy since failure to
    record it will lead to improper relation and
    eventually effects teeth setup.

16
ERRORS WHILE MOUNTING CASTS
  • ERROR 1 Failing to mark the casts to ensure
    unmistakable articulation even though they can be
    hand articulated.
  • SOLUTION Mark casts by holding them in occlusion
    and drawing 3 widely separated vertical lines on
    the facial aspect of the land area between the
    maxillary and mandibular casts.

17
  • ERROR 2 Failing to use a face-bow to mount a
    maxillary cast in an articulator.
  • SOLUTION An accurate face-bow recording must be
    made used to mount maxillary cast in an
    articulator.

18
ERRORS DURING SETUP AND TRY-IN
  • ERROR 1 Poor phonetics of the patient during
    anterior setup trial.
  • SOLUTION Esthetics and phonetics must be
    considered, guidelines to be followed.

19
  • ERROR 2 Failing to follow single concept to
    occlusion.
  • SOLUTION For CDs, balanced occlusion is to be
    replicated keeping in mind the height of
    occlusion and compensating curves.

20
  • ERROR 3 Failing to evaluate the trial tooth
    arrangement, as to where it lacks.
  • SOLUTION It is a good practice to arrange the
    teeth on the framework and try them in the mouth
    regardless of whether the anterior teeth are
    involved. It is far easier and less expensive to
    alter the tooth arrangement or change the teeth
    before the prosthesis goes to processing.

21
ERRORS AT THE INSERTION PHASE
  • ERROR 1 Failing to determine that the denture
    borders are overextended.
  • SOLUTION Have the patient protrude the tongue
    and extend it into each cheek. All movements
    should be made to the maximum extent. A pressure
    indicating paste may help, for that matter.

22
  • ERROR 2 Polishing areas not adjusted.
  • SOLUTION Take time to smooth and highly polish
    the edges of the denture base

23
  • ERROR 3 Failing to adjust the occlusion
    intra-orally.
  • SOLUTION Adjust the occlusion first in the
    centric relation position, then in protrusive,
    right lateral, and left lateral excursions, an
    articulating paper strip can be used for that
    matter.

24
  • ERROR 4 Failing to instruct the patient how to
    seat his dentures and how to care for them.
  • SOLUTION Proper demonstrations as to how to use
    the prosthesis and how to maintain it for the
    long term use.

25
  • ERROR 5 Failing to make a follow-up appointment
    for the patient.
  • SOLUTION Schedule the first follow-up
    appointment for the day after the patient
    receives the denture. When the patient returns
    for that visit, thoroughly examine the entire
    mouth, look for red spots or cuts in the soft
    tissues. Most potential problems can be
    eliminated before the patient is aware that a
    problem exists.

26
Thank You
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