10 post insertion problems and complaints.

10- Post Insertion Problems and Complaints

1. 10- Post Insertion Problems and Complaints

2. Dr. Amal Fathy Kaddah Professor of Prosthodontic, Faculty of Oral &Dental Medicine, Cairo University Post insertion Problems and Complaints

3. Complaints Diagnosis Causes Treatment Managed by

4. Causes are attributed to Complaints Patient's dissatisfaction Denture settling Denture errors

5. Complaints Patient's dissatisfaction are attributed to Denture problems Types of patient Indifferent Philosophical Hysterical Exacting

6. Complaints Denture problems Old denture Loose fit New denture Over extension over closure (Low VD)

7. The majority of the patients with new denture may face one or more of the following problems:

8. I . Pain 1 . Overextension of the periphery 2. Poor fit 3. Insufficient relief 4. Incorrect occlusion and Cuspal interference 5. Teeth off the ridge 6. Retained roots, unerupted tooth or sharp bony spicules 7. Irregular and knife edge ridge, V- shaped ridge. 8. Pressure on the Mental foramen 9. Allergy 10. Rough fitting surface 11. Infection with Monilia Albicans (Pathological conditions) 12. Difficulty in swallowing and Sore throat 13. Severe Undercuts

9. Ridge VD Denture borders Over-extension Basal Seat Uneven pressure Occlusion Cuspal interference Poor fit Mental Foramen Pressure area Improper imp. Warpage of denture base Improper cast CO # CR Teeth off ridge Roughness Allergy DD Patch test Remaining Root undercut under-extension (disto- lingual area) I . Pain

10. Over extension interfere with muscle Under extension break the seal, Improper trimming Thick or thin border Borders Mylohyoid ridge movement

11. 1- Over extension of denture flange The most common cause of pain May be due to : I . Pain

12. Labial frenum Should be thin and deep, not broad Round internal and external angles

13. In the form of Ulceration Hyperaemia Cut in vestibule TISSUE IRRITATION

14. Identification of over extended denture flange by means of P.I.P.

15. Overextension of the periphery New denture Old denture Occlusal view of the edentulous mandible Epulis fissuratum

16. Never adjust without locating exact position of the problem Use P. I. paste

17. Poor denture retention, rocking, tilting and inability to seat the denture. Denture movement over the mucosa will cause pain and areas of inflammation might be present. Treatment: ???????? According to the case Relining of old denture or Construct a new denture. 2- Poor Fit I . Pain

18. Looseness of dentures or poor fit usually results due to lack of retention and/or stability of the denture.

19. Poor retention of Lower denture Less surface area Bathed in saliva Strong movements of the tongue

20. Related symptoms Normal Open wide (Yawing) Coronoid process. Cough& sneezing → New denture → Saliva. Abnormal Speaking Eating Pain

21. Poor Denture fit 1. Decreased retentive forces A. Lack of peripheral seal B. Under-extension border depth and width C. Excessive relief D. Xerostomea E. Lack of posterior seal 2. Increased displacing forces A. Over-extension border depth and width B. Excessive fit C. Occlusal errors D. Upper lip pressure on upper denture 3. Inadequate supporting structure negotiate A. Flat ridge B. Fibrous displaceable tissues C. Non resilient soft tissues

22. Areas to be relieved of the denture: Prominent bony areas (buccal canine region, Bony tori (maxillary or mandibular). Sensitive areas Treatment: Apply pressure indicating paste to demarcate the area on the fitting surface of the denture. Relief 3- Insufficient relief I . Pain

23. Correct Amount with Streaks Insufficient Amount Too Much w/o Streaks

24. Incisive papilla Insufficient relief Burning sensation

25. Pressure on Mental Foramen

26. Mental foramen With resorption , it becomes over the crest of ridge. Pressure from denture may elicit numbness , localized or referred pain. Treatment: Relief.

27. Insufficient relief

28. A denture border short of the mylohyoid ridge digs into the residual ridge and causes pain. If shortened, the denture border will impinge again upon the ridge . Insufficient relief

29. Poor base adaptation Fulcrum on bony structures

30. 4- Incorrect occlusion I . Pain

31. Occlusion VD CO # CR Uneven pressure Cuspal interference Teeth off ridge Tuberosity of opposite side In upper buccal sulcus of working side White sore area on the site of pressure VD (Neurological pain) VD (white patch) I . Pain

32. Adjusting Occlusion Reduces adjustment time Saves time removing & replacing dentures Remount denture on an articulator Eliminates denture movement Can visualize interferences easily Centric relation & protrusive records Mark centric & excursive contacts, adjust

33. Don ’ t Adjust Occlusion Intraorally Contact on inclines can cause denture movement May cause pain, or reflex avoidance May make interference difficult to mark Net Result Can ’ t see real Problem Can ’ t eliminate the Problem

34. Mounting the lower cast with new CJRR M ake sure the denture bases are not contacting posteriorly. Clinical Remounting Procedure

35. a- Incorrect vertical dimension Solutions ???

36. Gets worse during day Muscle/joint pain Small white patches + painful areas Pain returns within few days of immediate relief over patches Dentures ‘ click ’ Esthetic complaints: too full Sore over entire ridge. Treatment: new lower denture if upper occ. plane is correct or upper and lower denture I . Pain Excessive OVD

37. Indefinite pain location resembles neuralgia of cheek Lack of chewing power Minimal ridge discomfort Costen’s syndrome mild deafness, tenderness in TMJ, burning sensation of the tongue, throat and nose, dryness of the mouth. Insufficient OVD

38. Angular chelitis Esthetic complaints: Chin prominent Poor lip support Treatment: new denture. Insufficient OVD

39. b- Wrong anteroposterior relationship ( Incorrect centric occlusion)

40. Mismatch of ICP and RCP. The patient will not feel comfortable in that situation. Trials to retrude the mandible will rub the denture against the mucosa. This will cause pain and looseness. Treatment : If Mild error: Selective grinding of teeth. If Gross: N ew denture. Wrong anteroposterior relationship

41. c- Uneven pressure Lesser degrees of errors can be detected by a celluloid strip or articulating paper If more it is detected with a wax knife

42. Mild error: chair side occlusal spot grinding. Moderate errors: clinical remount. Severe errors either remake denture or replace posterior teeth . Treatment

43. d. Cuspal Interference

44. A Dragging action will be exerted on both dentures during lateral and protrusive movements with teeth in contact if cusped posterior teeth are used or if excessive incisal guidance angle has been used. Dragging will cause pain With Well Fitting Retentive Dentures Or Instability with poorly retained dentures. Pain is widely distributed, and only experienced on eating. Sore areas on buccal or lingual surfaces of ridges . Treatment Mild: chair side grinding or clinical remount. Gross: new dentures with balanced occlusion.

45. Error in Eccentric Excursions Irritation of the Crest of the Ridge Localized Lesion Generalized Lesion Hyperkeratotic Ridge Occlusal Prematurity Lesion – same side as error

46. Briefly Treatment Pain on eating- premature contacts |Lack of occlusal balance Use articulating paper to identify offending area Pain |ulceration lingual to lower anterior ridge CR and MIP do not coincide A slide from CR to MIP Selective grinding to correct

47. 5- Teeth off the ridge

48. Occlusal contact not centered over ridge Tilting forces cause displacement, abrasion, ulceration Worse if xerostomia, malnourished, debilitated or poor adaptability Clinical Exam Cause : Setting of teeth far buccally. I . Pain Pain Upper buccal sulci and maxillary tuberosities .

49. Clinical Exam Patient demonstrates problem by biting where pain occurs Treatment : New dentures . Ulcer or sore spots on sides of ridges

50. Pain in upper buccal sulci and tuberosities . Upper teeth are often too far buccally (to meet occlusion in cases of skeletal class III). During function, upper denture will tilt, digging the periphery into the mucosa on the working side, and pulling it down the tuberosity on the opposite side. Treatment: Remove the last four posterior teeth and reduce the bulk of acryl over the tuberosities and reset. New dentures

51. Avoid Contact on Inclines No teeth set over ascending portion of ramus I . Pain

52. 6- Retained root or unerupted tooth I . Pain

53. Pain results from direct pressure on an area already tender. Treatment: Extraction of the root or tooth, followed by relief over the area. OR relining of the denture.

54. 7. knife edge ( V-shaped) ridge Pressure during mastication causes pain . Treatment : Alveoloplasty + relining ( lower ( R elief over the crest ( upper ). I . Pain

55. Narrow resorbed ridge Often the lower ridge. The denture squeezes the mucosa against the sharp bony ridge. Pain may be accompanied with burning sensation. Worst after meals. Treatment : Relief over the sharp irregular ridge. Alveolectomy followed by relining the denture

56. 8. Irregular resorption I . Pain

57. Irregular resorption This results in rough area on the crest of ridge with sharp spicules of bone. Pain will be elicited when the intervening mucosa is pressurized. Similar to pain due to narrow resorbed ridge, but pain is localized. Treatment: Surgical smoothing of the affected area followed by relining the denture or; just relieve the denture.

58. 9. Rough fitting surface I . Pain

59. Rough contact or fitting surface Small pimples or blebs of acrylic over the fitting surface due to inaccuracies of the surface of the cast. Treatment: Remove roughness by acrylic bur.

60. 10. Infection with Monilia Albicans Treatment : T reating the condition + new denture Rare . I . Pain

61. Nicotinic Stomatitis (Smoker's Palate) is a lesion of the roof of the mouth. The concentrated heat stream of smoke from. tobacco products causes Nicotinic Stomatitis .

62. The upper denture revealing of either Over-extension Over The Soft Palate Or pressing in the hamular notch area or the postdam region. The lower will be Over-extended distally in the lingual pouch ( Pressure on the palatoglossal muscle ). There will be an area of slight redness or ulceration. 11. Difficulty in Swallowing and Sore throat I . Pain

63. Treatment: Reduction of the over extension.

64. Undercut Tuberosities 12. Severe Undercuts I . Pain

65. Pain on insertion and removal. Red and painful undercut area (ulcerated). Treatment: • Fitting Surface Cut Away With No Reduction Of Periphery. • Alveoloplasty + New Buccal Or Labial Flange. • Undercut on one side insert in one side then rotate.

66. Unilateral undercut

67. Hamular Notches Commonly sharp flange Sometimes long Use PIP

68. Bony Undercuts

69. Pain: Denture Base Severe Tissue Undercuts If the ridge is severely undercut, the flange cannot be placed to the depth of the vestibule, otherwise the denture will not seat or ulceration will occur

70. A denture border short of the mylohyoid ridge digs into the residual ridge and causes pain. If shortened, the denture border will impinge again upon the ridge .

71. Buccal Attachments To Hyoid Mylohyoid Ridge X-section through Mandibular ridge in 2nd Molar region Avoid Impinging on the Mylohyoid Ridge A problem if prominent or sharp

72. Pain: Denture Base Retromylohyoid Overextension Sore throat Denture moves when swallow From retromolar pad, flange should go straight down or angle forward, never backward

73. 13. Allergy

74. Nose and chin approximating Cheeks and lips falling in Angular cheilitis or soreness of the corners of the mouth Colour , shape, si z e and position of anterior teeth. General dissatisfaction---- who?---female middle age --- need kindness and patience. Poor Appearance

75. 1- Nose –chin approximation Poor Appearance Due to closed bite. Treatment: As reduced bite .

76. Nose and chin approximating (Closed-bite)

77. As the occlusal vertical dimension is too small, the vermilion border appears thin and wrinkles occur around the lips. The chin is apparently protruded.

78. 2. Cheeks and lips falling in: Plumping : Unsupported lip and cheek.  Due to lack of tone of facial muscles.  Due to labial and buccal resorption in max. ridge.  Teeth have been set too far lingually or  Having insufficient width of the buccal and labial flanges.

79. Sunken lips and cheeks Treatment: Building up of the upper denture .

80. Corner of Mouth 3- Angular cheilitis or soreness of the corners of the mouth Poor Appearance

81. Loss of muscular tone and decreased VD. Saliva bathed in the fissure secondary infection . Treatment : Restoration of VD. 3- Angular cheilitis or soreness of the corners of the mouth

82. 4. Colour : 5. Shape and Size: Too large or too small Teeth: too dark or too yellow Acrylic resin. Poor Appearance Treatment : Replace teeth or new denture .

83. 6. Arrangement and position: Even or irregular Too far forward or backward Cheeks& lip falling- in Poor Appearance Treatment : Replace teeth or new denture .

84. Irregular Occ. plan Cheeks& lip falling- in

85. Colour, shape and position of anterior teeth. Remember : there is upper labial resorption , making the teeth too far lingually ).

86. Shape, Shade and Position of teeth

87. 7. Amount of tooth showing : Treatment : New denture with corrected occlusal plane . Smile view of the patient and Amount of tooth showing :

88. Amount of teeth showing

89. 8- General dissatisfaction : Appearance Women Middle Aged Menopause .

90. البر لا يبلى .. و الذنب لا ينسى .. و الديان لا يموت ... فاعمل ما شئت ... كما تدين تدان

91. III- Poor Efficiency Inability to Eat Anything Inability to Eat Meat Dentures dislodged by eating Phonetics (speech difficulties)

92. Dislodgement during eating Borders New denture Anything Cuspal interference Unbalanced articulation Flat teeth Meat Improper tongue space Cuspal interference unbalanced articulation Tooth off ridge Inefficient Eating Occlusion Basal seat Eating experience Overextension Unstable denture

93. Borders Improper Unstable denture Blunt Flat teeth Inefficient Eating Occlusion Basal seat Pt cant open to get food Vertical Dimension Teeth Elevate the muscle & don’t work

94. Cuspless teeth ??? A- Poor Masticatory Efficiency

95. Cramped Tongue Improper tongue space

96. B- Inefficient Speech Anterior Teeth : Improper Labio -lingual positioning and Vertical overlap → "S" sound → (Whistling or lisping). • Encroachment on tongue space: a- Posterior teeth placed too far lingually . b- Too great Bucco -lingual width of posterior teeth. c- Excessive thickness of the lingual flange. d- Poor palatal contour (Rugae area) → "S" sound → P.I.P . Poor denture retention. Excessive salivation. Vertical dimension → P, B, F, V

97. Phonetic Problems Lisping: Too much overlap Teeth are set too far palataly Palatal contour too constricted Bulky Rugae Area Insufficient tongue space Improper occlusal plane

98. Lisping Bulky Rugae

99. The Linguo-alveolar S, Z, and, C (soft), sounds: Linguo-alveolar consonants: The S, Z and C sounds (sibilants): the formation of a narrow midline groove of the tongue through which air is directed against the incisal edge of the teeth; the lateral margins of the tongue contact the teeth and gingivae and the blade of the tongue nearly touches the alveolar ridge. The palatopharyngeal valve is closed so that the air stream for these continuants can be emitted orally

100. The upper and lower incisors should approach each other end-to-end, but they should not touch that indicate a possible error in the amount of horizontal overlap of the anterior teeth. Always check on the total length of the upper and lower teeth (including their vertical overlap )

101. If the channel formed between the hard palate and the tongue is too narrow and deep Whistling Lisping “ Sh ” sound if the depth of the channel is further decreased or obstructed Lisping and whistling are opposite phenomena If this channel is too shallow (broad and thin) Lisping (th or etts)

102. In the production of the fricatives f, v, and ph sounds, the lower lip is brought into contact with the incisal edges of the maxillary anterior teeth. The lip may curt over the labial surface of the maxillary teeth to a height of 1-2 mm . Labio-dental Consonants:

103. Effects of labiodental consonants in denture construction Upper anterior teeth too long or too far posterior or too far anterior. Position of the maxillary and mandibular anterior teeth Vertical dimension: Increasing or decreasing of the V.D. affects the pronunciation of the labio dental sounds.

104. What Comes Around Goes Around

105. Occlusion Denture base (fit & contour) Poor anatomy IV- LOOSE DENTURE Poor denture fit

106. Poor denture Fit

107. Looseness of dentures or poor fit usually results due to lack of retention and/or stability of the denture.

108. Oral And Facial Musculature The polished surfaces are properly shaped, The teeth are positioned in the neutral zone. The denture bases are properly extended to cover the maximum area possible. Occlusal plane levelled below the maximum convexity of the tongue. Muscular control is an important aspect of successful complete denture therapy. providing that:

109. The Polished Surface Contour

110. Addition of Post-dam

111. The denture base must be contoured to permit the modulus to function freely, to avoid displacement of the denture. The distobuccal corner of the mandibular denture: The buccal flange must converge medially to avoid displacement due to contraction of the masseter muscle

112. Denture Looseness Denture Base Dry Mucosa Periphery terminates on bony structures Hard palate Zygoma External oblique ridge Before retromolar pad No seal, discomfort Eventual resorption

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

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

115. Palatal Cleft In some patients midline soft palate fissure Can “ tent ” during function Allows air to leak under denture

116. Denture Looseness Anatomy

117. Xerostomia

118. POOR RETENTION Overextension Under-extension Tight lips will push the lower denture backwards and upwards Cramped Tongue Restricted tongue space Lack of peripheral seal adding tracing compound, then reline . When coughing or sneezing Denture base (fit & contour )

119. Check for Retention Pull outward & upward on lingual of canines Check for looseness in excursions with fingers on canines

120. Un-retentive denture Insufficient relief Incorrect centric occlusion Cuspal interference Unbalanced articulation Teeth off the ridge Insufficient tongue space Technical discrepancies INSTABILITY

121. Typical History Adequate stability initially Gets worse with time LOOSE DENTURE Occlusion

122. Loose Maxillary Denture Heavy anterior interferences can cause loosening at posterior Incisors placed too far labially Denture displaces lingually. Tilting/jiggling caused by: Contacts not centered over ridge Contacts on inclined portion of ridge Check centric position (articulating paper) LOOSE DENTURE Occlusion

123. Tooth Position Vertical height of mandibular posterior Teeth

124. When eating When talking INSTABILITY

125. V. Clattering of teeth (noisy teeth)

126. NOISY DENTURES

127. VI. Nausea and gagging

128. Causes Posterior border of upper denture Overextension Under extension ↑ Thickness Loose denture Over extended distolingual border of lower denture VI. Nausea and gagging

129. Treatment Upper denture slightly over-extended or under-extended: Thick posterior border: Protrusive imbalance: Remove over-extension and readapt post dam. under-extension causes intermittent contact with the tissues Irritates dorsum of the tongue. This will cause upper denture to dislodge posteriorly and tickle tissues there.

130. An involuntary series of uncoordinated spasmatic movements of the swallowing muscles due to stimulation of the swallowing receptors situated in the posterior pharyngeal wall . Causes : Systemic disorders . Psychologic factors. . GAGGING 3. Physiologic factors.

131. Psychological gagging is the most difficult to treat since it is out of the dentist's control. In such cases, an implant supported palate-less denture may have to be constructed or a hypnotist may need to be consulted. GAGGING

132. TRIGGER ZONES SENSITIVE AREA Tonsillar pillars Tongue Posterior pharyngeal wall Soft palate Hard palate

133. Physiologic factors: 1 . Extraoral stimuli 2 . Intraoral stimuli Improper denture contour, Overextended or underextended d. Too thick posteriorly. Inadequate denture retention . Inadequate free way space . Restricted tongue space . Disharmonious occlusion . Unfinished Surface of the denture . New complete denture wearers .

134. Managements Pre-prosthetic managements. The use of medications . During clinical procedures .

135. During clinical procedures Seat the patient in upright position . Tell the patient that little difficulty will be encountered. Ask the patient to breathe deeply. Never say the word GAG. Encourage physical and mental relaxation . Speak loudly and clearly to the patient . Ask the patient to rinse with astringent before the procedure. With impression procedures tilt the patient head forward.

136. 9. Start with the lower impression first. 10. Select the proper impression material, with fast setting time. 11. Use local surface anesthesia . 12. Bead the posterior border of the tray. 13. Mix the impression material out of the sight of the patient. 14. Use proper amount of the impression material 15. Seating the posterior part of the upper tray first !!!!!!!!!!!!!!?. 16. Direct the patient attention to other subject.

137. VII. Cheek, Lip and Tongue biting Cheek and lip biting could be due to: Lack of horizontal overlap: Premolar and molar teeth that occlude edge to edge… grinding the buccal cusps of the mandibular posterior teeth Reduced VDO cheeks tend to collapse into the occlusal area Incorrectly positioned occlusal plan Tongue biting could be duo to : Reduced VDO *(No Freeway Space) Cramped tongue Low occlusal plane

138. Monoplane Heavy Bite No Horizontal Overlap

139. Cramped tongue space Altered vertical dimension Altered occlusal plane Altered position of the upper incisors and thick palate. Unemployed ridge: difficult to wear lower denture. VIII- DISCOMFORT

140. Cramped tongue

141. High Plane of Occlusion

142. 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. IX- FOOD UNDER THE DENTURE

143. Food Collection Improper Flange Thickness

144. If the denture border is underextended in the buccal shelf area. Therefore, it will not be able to occupy the buccal pouch. A space will occur between the denture border and the lower muscle bundle of the buccinator, resulting in food accumulation. The fibers of the buccinator run anteroposteriorly so that the force dislodging the denture during mastication is minimal..

145. Alter Taste Acrylic Resin Explain to the P a tient Metal base. Patient instruction Bacterial growth Diagnosis: black area with bright light Oral Hygiene Hidden porosity X. Loss of taste sensation

146. XI. Halitosis Food may become lodged underneath dentures and can be the root of any potential bad breath. The plaque caused by the lingering food can form a layer around dentures, creating an unpleasant smell. Failing to clean dentures every day due to a build-up of bacteria, Wearing your dentures all the time. Soaking dentures in peroxide

147. Blood dyscrasia XII. Burning Sensation

148. XIII. Inability to keep the denture clean

149. Inadequate finishing of denture especially interdentally. Use of hard abrasives. Failure to clean dentures regularly. Incorrect use of denture cleansers. Reduced manual dexterity of the elderly (or ill) patient.

150. Loose fit Over extension over closure due to (Low VD) Anterior sulcus Epilus Fissuratum Hard palate Papillary hyperplasia Ridge Flabby ridge Problems of Old Denture Ridge resorption Denture Settling Teeth Wear Anterior Resorption TMJ Disturbances Lead to * Chief complaint of old denture -Discomfort - Discoloration - Abraded Denture Base.

151. Mouth with old dentures: sagging face Mouth with new dentures: notice the lift to the face and lips

152. Loose fit Pressure area & Over extension over closure (Low VD) Tissue conditioning material Relining Rebasing Remake Treatment of Old Denture Occlusal Pivot : Increase VDO in lower 2 nd premolar & lower 1 st molar by adding acrylic resin on their occlusal surface. Relieved Hyper plastic tissue Tissue rest Tissue conditioning Surgery

153. Angular cheilitis or soreness of the corners of the mouth

154. The primary cause of this condition is over extension of denture border which may be the result of sinking of the denture.

155. Epulis Fissuratum Ill fitting and over extended denture

156. The Labial Flange Of The Denture Produces A Low Grade Irritation In The Surrounding Soft Tissues, Resulting In Development Of Epulis Fissuratum , And Cause An Associated Overgrowth Of Fibrous Tissue Covering The Maxillary Tuberosities.

157. Prosthodontic Rehabilitation of abused oral tissues The rehabilitation of abused oral tissue is to improve its health and regain its original form before making a new denture: I- Remove the cause II- Recovery program

158. Remove the cause Removal of the denture from the patient's mouth for few days , with an appropriate recovery program to allow the inflammation to subside and to allow the tissues to regain its normal healthy form before making new impressions. Or, an alternative line of treatment is accomplished by denture correction and then, starting the recovery program.

159. Finger Massage of the soft tissues two or three times a day to stimulate the blood supply and aid recovery. Mouth wash: Instruct the patient to dissolve one-half teaspoon of table salt in a half glass of warm water and rinse vigorously. Tissue rest: Remove old dentures from the mouth for at least 8 hours every 24 hours for few days before making new impressions to allow the inflammation to subside. Recovery Program

160. 1. Detect and remove any pressure areas or sore spots using pressure-indicating paste. 2. Relining the old dentures with soft tissue conditioning materials to aid recovery before constructing new dentures 3. Correction of occlusal disharmonies by clinical remounting and Restoring (VDO) the occlusal vertical dimension 4.Elimination of any contact between natural anterior teeth and opposing artificial teeth. Denture correction

161. Tissue conditioning material application

162. Add tooth coloured self curing resin on the posterior occlusal surfaces of the mandibular denture When the patients closes the mouth with the mandible guided to the centric occlusal position, the occlusal surfaces of maxillary posterior teeth are recorded in the resin. Trim the resin to reestablish the contours of the teeth.

163. If the condition persists then the treatment may be either: Prosthetic approach to the flabby tissue OR Surgical removal of the flabby tissue .

164. Original appearance with upper and lower prosthesis in place demonstrating inadequate facial support and improper plane of occlusion.

165. At the conclusion there are six commonest causes of dentures failing are: Incorrect anteroposterior relation ship of the mandible to the maxilla. Uneven occlusion or unbalanced occlusion. High and low vertical dimension. A cramped tongue. Poor retention. An inexperienced denture wearer.

166. Thank You

167. Cause Diagnosis Treatment 1. Lack of peripheral seal - Pulling down the anterior teeth (examines the anterior labial flange) - Pull out on incisors (examines the posterior palatal seal). - Pull out on canines (examines the tuberosity region). Proper border molding followed by relining or rebasing the denture. 2. Under extension of the border in depth Tracing compound added will remain beyond the border. Remoulding the denture in mouth. Change to acrylic resin either: Directly by self cure resin or tissue conditioning material. 3. Under extension of the border in width By tracing compound. Lack of contact between polished surface and cheeks especially in tuberosity area. Remoulding by allowing the patient to move mandible from side to side. 4. Posterior palatal seal: a. Over extension on movable tissues. b. Under extension on non displaceable tissues. Clinical examination: a. Broken seal by speech b. Under extended border. a. Reduce border, add post dam and reline. b. Extend with tracing compound, mold, wash impression, make post dam on cast and then reline. 5. Poor fit due to: Deficient impression. Damaged cast Warped denture. Grinding tissue surface. Clinically, gap is seen between denture base and tissues. Pressure indicating paste reveals uniformity in thickness. Relining or rebasing. 6. Excessive relief Pressure indicating paste reveals excessive thickness in this area. Relining or rebasing. After forming proper thickness for relief.. 7. Xerostomia Patient complains of dry mouth and reduced taste. Clinically, presence of sticky dry mouth. The patient is advised to use artificial saliva, frequent fluid intake, chew gums. Denture with additional retentive means is preferred. 8. Decreased neuromuscular control due to: Facial palsy Mandibular molars placed too far lingually. Convex polished surface. High mandibular occlusal plane. Clinically evident through improper speech and mastication. Patient is advised to use denture fixatives until he develops denture skills. Correction of errors in the occlusal plane. Poor fit due to decrease in retaining forces.

168. Cause Diagnosis Treatment 1. Over extension in depth Direct vision Elevation of mandibular denture when mouth opens slowly. Reduce over extension and re-polish the denture. 2. Over extension in width In lingual flange Mandibular labial flange Maxillary labial flange Tuberosity area Patient complains of bulk and food entrapment. Denture will lift by tongue Mentalis muscle lifts the denture. Denture is displaced by maxillary lip Cheek soreness and denture displacement. Reduce over extension and re-polish the denture. 3. Recoil of supporting tissues. Denture falls when teeth are not in contact History of impression made without tissue rest from old denture. Muco compressive impression technique was used. Reline or rebase using minimum pressure impression technique. 4. Occlusal errors Uneven occlusal contact Disharmony between centric occlusion and centric relation. Lack of freedom in intercuspal position. Lack of occlusal balance in eccentric positions. v. Excessive anterior vertical overlap. Ask patient to close slowly in centric until teeth touch.. Presence of occlusal errors may be masked by: Displacement of the mucosa. Tilting of dentures. Achieve even contact or harmonious jaw relation by: Chair side tooth grinding. Remounting. Remake dentures. Poor fit due to increase in displacing forces .

169. In the form of Ulceration Hyperaemia Cut in vestibule TISSUE IRRITATION

170. Treatment Remove the cause Tissue rest TISSUE IRRITATION

171. Causes Pressure by denture Over extension Movement of denture Improper occlusion TISSUE IRRITATION

172. Types Generalized localized Acute chronic TISSUE IRRITATION

173. bruxism Increased VD CO # CR Oral hygiene Allergy Xerostomia Eccentric occlusal interference Generalized tissue irritation

174. Examination Xerostomia 24 h rest Oral hygiene Recurred Another denture Allergy Fluid TTT Bruxism Remove denture at night Tranquilizer Food debris Patient instruction Wear facets Generalized tissue irritation

175. Denture shifting anteriorly Increased VD CO # CR No contact on the other side Eccentric occlusal interference Clicking of teeth Another denture Grinding Grinding Generalized tissue irritation

176. Occlusion Occlusal interferences Over extension Border Ridge Spicules & remaining roots. Denture Pressure (PIP) Basal Seat Unpolished Localized tissue irritation Tooth off ridge