Presentation is loading. Please wait.

Presentation is loading. Please wait.

Differential Diagnosis of Post-Insertion Problems.

Similar presentations


Presentation on theme: "Differential Diagnosis of Post-Insertion Problems."— Presentation transcript:

1 Differential Diagnosis of Post-Insertion Problems

2 Post Insertion Problems Minimal problems if remount Most problems will be occlusal if denture base has been adjusted Minimal problems if remount Most problems will be occlusal if denture base has been adjusted

3 Principles of Diagnosing Denture Problems Never adjust unless you can see exactly where to adjust Use indicator medium –(PIP, indelible marker, articulating paper, etc.) Loney & Knechtel, J Prosthetic Dent 2009;101: Never adjust unless you can see exactly where to adjust Use indicator medium –(PIP, indelible marker, articulating paper, etc.) Loney & Knechtel, J Prosthetic Dent 2009;101:

4 Place Paste with Streaks Mostly colour of Paste

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

6 Principles of Diagnosing Denture Problems Patients frequently wrong in exactly locating source of problem

7 Principles of Diagnosing Denture Problems Spend time to look and think

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

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

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

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

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

13 OcclusionOcclusion One of most common problems –Pain gets worse through day –Difficult to determine, intraorally - reflex avoidance of pain –Interferences - especially in protrusive One of most common problems –Pain gets worse through day –Difficult to determine, intraorally - reflex avoidance of pain –Interferences - especially in protrusive

14 OcclusionOcclusion –Fingers on canines - should feel smooo oo ooo oo th –Sore when bite –Fit changes or comfort deteriorates through day –Remount –Fingers on canines - should feel smooo oo ooo oo th –Sore when bite –Fit changes or comfort deteriorates through day –Remount

15 Retention Problems Short flanges –PIP - still streaky –Fingers on canines outwards (post palatal seal) Short flanges –PIP - still streaky –Fingers on canines outwards (post palatal seal)

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

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

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

19 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 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

20 Occlusal Vertical Dimension (OVD) Excessive –Continual and generalized pain and fatigue or muscle soreness Insufficient –No power Excessive –Continual and generalized pain and fatigue or muscle soreness Insufficient –No power

21 Allergies and Infections Rare allergies - –General inflammation Hygiene –Generalized inflammation Rare allergies - –General inflammation Hygiene –Generalized inflammation

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

23 Tooth Position Esthetic, phonetic problems May have to change position of teeth Esthetic, phonetic problems May have to change position of teeth

24 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) Maxillary –Hamular notches - ulceration can occur if over-extended –Labial frenum - requires adequate relief (often feels too bulky to the patient)

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

26 Most Common Areas Requiring Adjustments Maxillary –Mid-line fulcrum on the bony raphe –Zygomatic impringement Maxillary –Mid-line fulcrum on the bony raphe –Zygomatic impringement

27 Most Common Areas Requiring Adjustments Mandibular –Lingual frenum - impingement can cause displacement of the denture of ulceration Mandibular –Lingual frenum - impingement can cause displacement of the denture of ulceration

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

29 Most Common Areas Requiring Adjustments Mandibular –Retromylohyoid overextensions Sore throat Denture moves when swallowing –Buccal shelf overextension Mandibular –Retromylohyoid overextensions Sore throat Denture moves when swallowing –Buccal shelf overextension

30 Most Common Areas Requiring Adjustments Phonetic problems –Wait and allow time for adaptation –Add soft wax to palate and check –If anterior poorly positioned, then remove and replace Phonetic problems –Wait and allow time for adaptation –Add soft wax to palate and check –If anterior poorly positioned, then remove and replace


Download ppt "Differential Diagnosis of Post-Insertion Problems."

Similar presentations


Ads by Google