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KARNAADA.pptx made by - saransh dwivedi ( SD ) - SHALAKYA TANTRA - ENT - 4...
Post insertion complaints / orthodontic continuing education
1. POST INSERTION
COMPLAINTS AND
THEIR TREATMENT AND
FAILURES IN CD
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. Most complaints will fall under one of the following
headings though frequently a patient will have more than one
complaint:
1. Pain.
2. Appearance.
3. Inefficiency.
4. Poor retention.
5. Instability.
6. Chattering teeth.
7. Nausea.
8. Discomfort.
9. Altered speech.
10. Biting the cheek and tongue
11. Food under the denture.
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3. I. PAIN
(a) Overextension of the Periphery
It is due to incorrect moulding of the impression or incorrect
outlining of the denture on the model and is visible in the mouth as
an area of hyperaemia, an angry red line or an ulcer, depending
upon how continuously the denture has been worn, or how gross
the overextension.
Treatment: Mark with an indelible pencil on the denture the
exact position and extent of the area or use easing paste and
reduce the periphery at that spot.
If the denture is an old one, the overextension may be due to
alveolar resorption and the slow, chronic irritation may have
caused a local hyperplasia.
In this case cut the denture away freely and when the hyper
plasia has absorbed, or been removed surgically, construct a new
denture www.indiandentalacademy.comwww.indiandentalacademy.com
6. (d) Incorrect Centric Occlusion
This may be anyone of the following faults, or a
combination of them.
(i) Wrong Anteroposterior Relationship
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16. (l) Allergy
Treatment: New dentures must be constructed in another
material.
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17. (m) Rough Fitting Surface
Treatment. Remove the offending roughness from
the denture.
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18. (n) Infection with Monilia albicans
Treatment is to polish the fitting surface of the denture
and instruct the patient to apply daily to the fitting surface for 10
days a fungicide such as Nystatin ointment or Fuchsonium. The
patient should also be instructed to remove the denture at night
without fail and place it in a dilute solution of hypochlorite such as
Milton.
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19. (o) Swallowing and Sore Throat
Treatment: The patient will usually know which
denture is at fault and examination of the regions
described will show a slight redness. Reduction of the
overextension is all that is required.
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20. (p) Undercuts
Treatment: It may be possible to insert this side of
the denture first quite painlessly, and then the opposite
side removing it in reverses order. If this manoeuvring is
not successful the fitting surface must be cut way until
the denture can be inserted comfortably but the
periphery must not be reduced in height.
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21. 2. APPEARANCE
In spite of the greatest care on the part of the
operator to obtain the patients full approval of his
appearance at the “try-in” stage, there will always be
some patients who are dissatisfied with their appearance
when wearing the finished dentures. The number of
patients who are dissatisfied with their appearance with
the final dentures can be much reduced if the operator
insists on a relation or a friend being present at the try-in
stage.
The following examples of complaints about
appearance are by no means comprehensive but will be
found to cover the main points.www.indiandentalacademy.comwww.indiandentalacademy.com
22. (a)Nose, and chin Approximating
This complaint may be made of new dentures, or of
old ones, and is due to a so-called closed bite, which
term is synonymous with excessive free-way space.
Treatment. As previously described for over closure.
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23. (b) Cheeks and Lips Falling In
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24. (c) Angular Cheilitis or Soreness of the
Corners of the Mouth
As descried previously this is frequently the result of
loss of vertical dimension and muscle tone and the
corners of the mouth fall in and become bathed in saliva
and develops fissures. Frequently however, as with
traumatic damage to the palate, a secondary infection
with Monilia albicans supervenes, especially if such an
infection already exists in the mouth. The vertical
dimension should be restored (but never opened) and
the upper denture 'plumped' to help restore the muscle
tone.
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25. (d) Colour, Shape and Position of
Anterior Teeth
Colour: This complaint is almost invariably that the teeth are
too dark or too yellow, but before changing them it must be
explained to the patient that natural teeth darken with age and that
very light-shaded teeth look more artificial than darker ones.
Treatment: Comply if possible with the patient's request for
lighter teeth, usually by a compromise between the shade chosen
by the operator and that chosen by the patient.
Shape: Few people are sufficiently observant to be able to
describe the shape of their, lost teeth and are likely to say
vaguely, when referring to their dentures, that they don't look right.
Artificial teeth usually look larger than natural teeth of identical
size, probably because their mesial and distal surfaces are not so
rounded, and so the eye is able to focus on their width more
accurately, ' www.indiandentalacademy.comwww.indiandentalacademy.com
26. Treatment: Remove the teeth complained of and replace them
with others mounted in wax, until by a process of trial and error
mutually suitable ones are obtained, which are then permanently
attached.
Position: the complaint under consideration is that the teeth
are too far back in the mouth, or are too far forward, more often
the former. Stability will be jeopardized much more by
encroaching on the tongue, than by setting the teeth in the neutral
zone where pressures of tongue and lip are equalized.
Treatment: New dentures will almost certainly have to be
made. If only the anterior teeth of the existing denture are moved
forward, larger ones will be required if proximal contact is to be
maintained and this is contra-indicated if the teeth originally
chosen were correct; if the teeth are to be moved back the
converse is equally true.
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27. (e) Amount of Tooth Showing
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29. (b) Inability to Eat Meat
This is a complaint which may be made of new-dentures, never
old ones, It may be due to'
(i) Flattening of the cusps of the posterior teeth by over
enthusiastic spot-grinding to correct an unbalanced denture.
(ii) The Use of Cusp less Posterior Teeth.
(iii) Over closure.
(iv) The Use of Acrylic Posterior
(v) Unbalanced Articulation
(vi) Cuspal Interference preventing free lateral movements, under
which heading is included, too great an overjet for the degree of
overbite, or an incorrect incisive angle.
(vii) Inexperience on the part of a patient wearing his first full
dentures
Treatment: Having discovered which of these faults is the
cause of the complaint, the remedy is sufficiently obvious to
require no further mentionwww.indiandentalacademy.comwww.indiandentalacademy.com
34. 4. POOR RETENTION
(a)When opening the Mouth Patients more often
complain that the lower denture lifts than that the upper one
drops. If this lifting only occurs when the mouth is widely opened,
as in yawning, it should be explained that this is normal. The
following are the usual causes:
(i)Overextension
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35. (ii) Tight Lips .
(iii) Tongue Cramped
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37. (v) Lack of Peripheral Seal
(vi) Lack of saliva
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38. (b) When Coughing or Sneezing
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39. 5. INSTABILITY
This question has already been discussed in relation to its two
main causes:
(a) When Eating:
Under the heading of inefficiency.
(b) When Talking:
(c) The Defensive Tongue:
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40. 6. CLATTERING TEETH
The noise appears to be considerable to: the patient and it
is, in fact, frequently audible to his fellow diners. There are two
main causes for this complaint of which the first mentioned is the
most common.
(a) Too Great a Vertical Height .
This will cause the teeth to come into contact sooner than
expected and therefore noisily.
Treatment: Reduce the height.
(b) Gross Cuspal Interference
Complaints from this cause are rarely met without the
accompanying complaint of instability, but in either case it is
easily' distinguished from too great a vertical height.
Treatment: This is as already described under the heading of
pain. www.indiandentalacademy.comwww.indiandentalacademy.com
41. 7. NAUSEA
Although this subject has been discussed from the point of
view of impression taking, there are some essential differences
when considering nausea in relation to wearing a full upper,
denture. The cause of the sickness is the same in both cases,
light or intermittent contact on the soft palate or back of the
tongue, and the patient's complaint is almost invariably 'that the
upper denture goes too far back and makes me feel sick'. The
causes are:
(a)Denture Slightly Overextended
Rare, but, if it does exist, the movements of the soft palate
will 'cause it to make intermittent contact with the denture. Easily
diagnosed by observing the relation of the posterior border to the
vibrating line.
Treatment: Remove the excess and re-post-dam if
necessary www.indiandentalacademy.comwww.indiandentalacademy.com
42. ( b ) Denture Underextended
If the posterior palatal border of the upper denture does
not extend, at least very slightly, beyond the termination of the
hard palate It can' rarely compress the soft tissues sufficiently to
maintain close contact with them under all normal conditions, and
this will often cause nausea for the following reasons:
(i) Intermittent Contact
The denture moves owing to an inadequate air seal.
(ii) A Palpable Edge
The edge is-detected by the dorsum of the tongue,
owing to its being insufficiently embedded in the mucous
membrane.
Treatment: Extend the denture almost to the vibrating
line and post-dam adequately.
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43. (c) Thick Posterior Border
This is a very common cause of nausea resulting from
the dorsum of the tongue being irritated by the thick
edge. The palatal edge of the upper denture should be
thin, and slightly embedded in the compressed mucous
membrane, so that the tongue is unable to detect any
definite junction of denture and mucosa.
Treatment: Thin down the posterior border of the
denture.
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44. 8. DISCOMFORT
Patients sometimes complain that new dentures are not
comfortable but can give no specific cause for complaint. These
cases are difficult to diagnose since they are not accompanied by
pain, and retention appears to be satisfactory, but as the patient
has nearly always previously worn dentures a careful comparison
of the new with the old will generally give a clue to the cause. The
causes may be:
(a) Cramped Tongue Space
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46. 9. ALTERED SPEECH
When full dentures are first worn there is always some
temporary alteration in" speech owing to the thickness of
the denture covering the palate, necessitating slightly
altered positions of the tongue. Commonly this is only a
temporary inconvenience, most rapidly overcome by
reading aloud; when there is an altered position of the
upper incisors, a change in their palatal shape, or any
reduction of tongue space, adaptation may be very
difficult even with perseverance.
Treatment: The dentures must be re-made.
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47. 10. BITING THE CHEEK AND TONGUE
(1) Cheek Biting
Two common causes for this condition exist:
(i) Insufficient Overjet
The normal occlusal relationship of the posterior teeth is with the
buccal cusps of the upper teeth outside those of the lower teeth;
this arrangement normally prevents the cheeks getting caught
between the teeth and bitten. If for any reason this arrangement
has been altered, or if a patient has very lax cheeks, cheek biting
may occur.
Treatment: Increase the buccal overjet and plump the
denture; in some cases it maybe necessary to remove the last
molar teeth or grind the buccal surfaces of the lower posterior
teeth so that the lingual cusps only will make contact with the
upper teeth www.indiandentalacademy.comwww.indiandentalacademy.com
48. (ii) Reduced Vertical Height
If the vertical occlusal dimension is grossly reduced, the
resultant bunching of the cheeks allows of their being
caught between the occlusal surfaces of the teeth as
they occlude.
Treatment: Restore the vertical dimension or, if this is
impossible, grind off the buccal cusps of the lower teeth.
(2)Biting the Tongue
This is almost invariably due to a decrease in the
tongue space occurring when fitting new dentures for
patients already wearing dentures.
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49. 11. FOOD UNDER THE DENTURE
This complaint is usually made by patients wearing dentures for
the first time and who have not yet learnt how best to control the
food. Undoubtedly a perfect peripheral seal will prevent 'the
ingress of food beneath the denture but perfection is rarely
attained and, owing to alveolar absorption, never maintained.
Scraping a groove in the model, along and near the entire
periphery of the denture, is sometimes carried out but this food-
line, as it is termed, usually causes some inflammation and
ulceration until it is finally established as a groove in the mucous
membrane; it is rarely completely successful.
Treatment: This usually consists of covering the maximum
possible area and obtaining an adequate peripheral seal;
thereafter, only perseverance by the patient can bring about any
'improvement.
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50. THE SIX COMMONEST CAUSES OF
DENTURES FAILING ARE:
(I) Incorrect antero-posterior relationship of the mandible
to the maxilla.
(2) Uneven and locked occlusion - this is always present
unless a careful check record has been carried out.
(3) Open vertical dimension - not necessarily gross but
sufficient to deprive the patient of a freeway space.
(4) A cramped tongue.
(5) Poor retention - due to incorrect outline usually
underextension of the periphery.
(6) Failure to copy existing dentures when making new
ones for an experienced denture wearer.
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