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
• Clinically
• No discomfort when press firmly on 1st molars

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 displaces lingually.
• 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 LoosenessCD RPD Denture Base

• Typical History
• Loose/discomfort immediately on insertion
• Clinically
• Discomfort when press firmly on 1st molars
• Pressure up/outward from lingual of canine causes
  looseness

11
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.
12
Denture LoosenessCD RPD Denture Base

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

13
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

14
Denture LoosenessCD RPD Denture Base

• If flange too thick
• Seal may be maintained at rest
• Pulls during function - drops
• If flange is short or long
• Displacement as lips or cheeks move
• Allows air to break vestibular seal

15
Denture LoosenessCD RPD Denture Base

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

16
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

17
Denture LoosenessCD RPD Denture Base

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

18
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
19
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

20
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)

21
(No Transcript)
22
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

23
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

24
Denture LoosenessDenture Base Palatal Cleft

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

25
Denture Looseness or Pain CD RPD

• Principle
• Always have the patient rate improvement (0-100)
  after adjustment. If below 90, more
  diagnosis/adjustment is required

26
Denture LoosenessCD RPD

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

27
Denture LoosenessCD RPD Poor Anatomy

• Many sets of dentures
• Use articulator
• More involved/precise impression jaw relation
  procedures
• Implants
• Refer

28
Overview

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

29
Phonetic Problems

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

30
Difficult Denture Patients

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

31
Difficult Denture Patients

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

32
Difficult Denture Patients

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

33
Difficult Denture PatientsAdaptive Problem

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

34
Difficult Denture PatientsAdaptive Problem

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

35
Difficult Denture PatientsAdaptive/Psychologic
Problem

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

36
Adaptive, Psychologic ProblemPrevention

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

37
Adaptive, Psychologic ProblemPrevention
Interview

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

38
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

39
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

40
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

41
Adaptive, Psychologic ProblemPrevention
Interview

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

42
Adaptive, Psychologic ProblemPrevention
Interview

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

43
Adaptive, Psychologic Problem

• Rule out objective findings
• Chart findings objectively

44
Overview

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