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Chapter [21:
Post-insertion problems& complainis.
These problems may be attributed to one or more of the following reasons:
1. Patient's dissatisfaction and unacceptance.
hye
2. Settling of the dentures, -fin
3. Incorrect previous procedures.
1. Patient's dissatisfaction:
Many patients experience difficulties in wearing dentures.
Denture patients can be élassified into>
A) Patients who can accept even badly constructed dentures and who can easily adapt
to new dentures without complaints.
b) Patients who are hardly satis fied even with well-constructed dentures.
e) Patients who are easily pleased by reasonably good dentures. [Majority]
2. >Settling of the dentures:
Due to varying mucosal displaceability, the use of these dentures may allow denture
b settling in areas more than others: This may result in:
6 o ) . Local irritation of the tissues. Presu dug musttton
" Varying degrees of occlusal discrepancies, (nevan
3. Incorrect previous procedures:
> This error may pass unnoticed during thetry-in and insertion stages and becomes
manifested in the post insertion phase resulting in problems and patient's complaints.
Post-insertion problems and complaints:
> The detection, diagnosis, management and the elimination of patient's discomfort and
complaints are important for success of dentures and for preservation of tissues.
Agood method for diagnosis and treatment of most of complete denture problems
depends on identifying in which of the four essentials of complete dentures is the
deficiency.
These four essentials are adequate support, (retention, Omuscle balance and
Wocclusalbalance.
º For example, a denture may be well retained and firm when attempting to remove it
but may become loose only during eating,then most probably the cause is related to
occlusal balance and nÍt to retention.
> Ifthe patient complains of pain on occluding the teeth, the cause will either be related
to occlusal imbalance or inadequate support.

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either be:
The complaining patient maypost-insertion
denture wearer in the phase. B. Old denture wearer.
A. New
associated with new dentures:
A. Complaints
1) Pain.
2) Poor appearance.*
3) Poor masticatory efficiency. [Inefficiency]*
4) Poor denture fittentio o
5) Clattering or noisy teeth.
6) Nausea and gagging.
7) Discomfort.
8) Altered speech.
9) Cheek, lip and tongue biting.
10) Food under the denture.
11) Loss of taste sensation.
12) Halitosis. baohyt
[1- Pain: Causes:
1-Over extension of peripheries: as an
In new dentures: due to incorrect molding of impression, It appears
area of hyperaemia that is converted into an ulcer later on.
> In old dentures: due to alveolar bone resorption. It appears in the form of
local hyperplasia.
> It causes pressure-on soft tissues of vestibules pain
Diagnosis: it's visible in mouth as: Hyperemia, red line or spot or ulcer.
How to detect overextended area:
Cover the periphery be P.l.P or thin mix of alginate &ask pt. to perform some
functions by denture’ the paste will be wiped- off at over extended areas.
tt If new denture: trimming by a stone then polishing.
If old denture: ’ re-make.
2- Poor fit:
Rocking, titing and inability to seat the denture accurately in its position>
rubbing of MM resulting in pain and red patches.
All these possibilites must be examined when the patient complains of
soreness on the ridges.
> According to the cause of mucosal irritation, dentures are either corrected by
remade

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3- Insufficient relief:
How to detect?
" Rocking of denture on hard areas causing pain,
" Painful areas are red or ulcerated. removal
tooth paste to Suspected area & seat the denture’ on
APply P.I.P or
the area easily marked’ grinding. be due to :
4 Incorrect centric occlusion: This is may
a- Wrong antero-posterior relationship:
with centric relation.
centric occlusion doesn't coincide
more ’make a new denture.
ttt:* if slight’selective grindiñ.if
b-Uneven pressure
ridge.
Heavy one- sided pressure pain in crest of lower
diameter.
You can see small white areas 4-6 mm in
how to detect ?
sides.autiloring PPer
" Pulling celluloid strips from biting molars.
" Trying to inserta spatula between occluded 4
ttt:if detectable by spatula ’ make a new denture.
’If detectable by celluloid strip ’ spot grinding.
- High vertical dimension: over open
> How to detect ?
’ Pt. complaint : teeth clatter, too high.
’ Small white patches & painful area ’ if you do relief pt. come fev days with
the same condition but at different site.
> ttt: if upper Occlusal plane is correct make a new lower denture with
CIV.D.
At upper occlusal plane is incorrect’ neW upper &lower denture.
Reduced vertical dimension:over-closure
cause:: It is almost always the result of lower alveolar bone resorption so it is
rarely associated with new dentures..
henlre
ºDiagnosis : neuralgia of a cheek on one or both sides. tn old
>KCosten's syndrome.:; f no treted
Mild deafness +tender T.M.J. +burning tonque, throat& nose. tdryness of mouth.
ttt: new denture with proper V.D.)

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5- Cuspal interference:
On moving teeth while they're in contact:
SPainin well fit denture. >Instability: in poor fit denture.
fingers on canines ’ ask pt. to grind
Diagnosis: Hold the upper denture by
his teeth ’ feel dragging.
Spa tath 33
Cause: cusped posterior teeth are used:
a) With simple hinge articulator.
occlusion.
b) With an adjustable articulator without balanced
incisalangle.
c) With an excessive overbite or an incorrect alveolar
may sometimes be found on the labial or buccal surfaces of the
Sore spots
ridges.
ttt: if small interferences selective grinding or abrasive paste.
if gross ( more ) new denture correctly articulated.
^ore bus
K6- Teeth-off the ridge:buccal a
Pain is felt in uppersulci & tuberosities.
Cause: teeth of upper denture are setfar buccally.
(ttthnew upper denture with cross bite.
7-Retained roots Or un-erupted tooth Or sharp bony spicules:
Cause: due to pressure of denture on them.
ttt:Extraction of root or tooth ’ relining.
Relief of that area’ ifextraction is contra-indicated.
8- Usually
V-shaped ridge:
seen in lower denture due pressure of mastication.
tt: Alveolectomy is the proper line of treatment then relining. A0 plusy
9- Pressure on the mentalforamen:
Due to ridge resorption ’ mental foramen become on crest of lower ridge
denture pressure on it causing pain.
Painis localized or referred& is felt as neuralgic pain in face side or lips &chin
Diagnosis :apply firm pressure on mental foramen ’ pain ttt: relief.
s0- Pathological condition :
As infection with monilia albicans.
4-Allergy:
Pt. allergic to acrylic resin another material issued for new denture.
12- Rough fitting surface:
> Pimples [small acrylicnodules] on fitting surf ace due to poor cast.
ttt: remove roughness.

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L13- Difficulty on swallowing (tonsilitis) &sore throat: PTgmanot

on soft palate
Cause: in upper denture :-over extendedhamular From noh to
Dpresure on notch.
lingual pouch. mane
extended distolinqually in
In lower denture: - over ditobucai in
of over extension. etenton
ttt: reduction mafsetec
14- Undercuts:
& removal of denture.
Pt complaints: pain during insertion or
Diagnosis: the maximum bulge area of undercut is : Red, painful
ulcerated.
ttt:
area, take care not
1. Grind [relief] fitting surface opposite the maximum bulge
to periphery height
2 Alveolectomy (surgical removal of maximum bulge area) th¡relining.
3 If the undercut is unilateral teach the pt. to insert the denture on the side
eher
of undercut first, then rotate it to other side &remove in reverse.SPecial n.
4. Resilient liner to engage the undercut smoothly.

2- Poor appearance:
Complaints may be:
1-Cause:VD
Nose &chinassociated
approximation l
with drooling @mouth corners (angular cheilitis)
ttt: new denture with proper V.Dand thickening of lower labial flange @modiolus.
2-Sunkencheeks &lips [faling-in]: dge
Cause: Loss of facial muscles tone.
Labial& buccal resorption of maxillary ridge.
tt:t thickness of flanges of upperdenture for compensation at canine &premolar
area (region of modulus) pun
3-Shade, shape& position of anterior teeth:
Color pt. excepts a lighter teeth.
Shape - replaced by others attached by wax until satisfaction of pt. - processing
Position teeth are too far back ar forward than formers ttt: new denture.
AAmount of tooth showing:
*make a new denture with longer or shorter anterior teeth.
5 General dissatisfaction:
Usually with woman in middle-aged spinsters or menopausal. need kindness and
patience.

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f- Lack of saliva.
more lingually, definite labial
g Tight lips ’ setting lower anterior teeth retromolar pad.
extension to
concavity of lower denture &maximum
sneezing: it's unavoidable.
2- Poor denture fit when coughing or
3. Poor denture fit when speaking:
change in the capacity of the resonance chamber
> This alters the produced sound due to
(oral cavity). the tongue becomes busy to reseat the
> This also affects the fluency of speech because
denture.
4. Poor denture fit while eating: of food debris beneath the denture.
> This impedes mastication and permits collection retained:
5. Poor denture fit several hoursandafter being initially
> This is usually due to character flow of saliva especially in new denture wearers.
of foreign body reaction
> Excessive, thick, ropy, mucous saliva accumulates as a result
to the denture.
> Denture becomes loose when the displacing forces acting on the denture
are greater
than the retaining forces, Hence dentures may attain poor retention due to:
1 Reduced retentive forces: as a result of:
a. Lack of peripheral seal.
b. Under extension of the border in depth.
c. Under extension of the border in width.
d. Lack of posterior palatal seal.
e. Poor fit.
f.Excessive relief.
g. Xerostomia.
h. Deficient neuromuscular control.
i.Improper occlusal plane.
2. Inereased displacing forces: as a result of:
a. Over extension of the border in depth.
b. Over extension of the border in width.
c. Tissue recoil in case of flabby ridge under compression.
d. Occlusal errors:
i. Uneven occlusal contact
ii. Disharmony between CO and CR.
ii. Lack of freedom in intercuspal position.
iv. Lack of occlusal balance in eccentric positions.
v. Excessive anterior vertical overlap.
e. Pressure from upper lip especially when anterior teeth are too labially placed.
[labial surface of central incisors is placed 6-10mm in front of incisive papilla]

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3. Lack of adequate supporting tissues:

resorbed ridges> little resistance to horizontal forces> loss of
a. Excessively
peripheral seal.
b. Presence of fibrous displaceable tissues. mucosa ’ tissue irritation& rocking
bony prominences covered by thin
C. Presence of
’loss of peripheral seal.
denture supporting area.
d. Presence of non-resilient soft tissues covering the forces:
Poor fit due to decrease in retaining
Diagnosis Treatment
Cause
Pulling down anterior teeth > Proper border molding
1. Lack of followed by relining or
peripheral seal: (examines anterior labial flange)
> Pull out on incisors (examines the rebasing the denture.
posterior palatal seal).
Pull out on canines (examines the
tuberosity region).
2. Under extension> Tracing compound added will Re-molding in mouth.
of the border in remain beyond the border. Change to acrylic resin
depth: either: self-cure or tissue
conditioning material.
3. Under extension> By tracing compound. Re-molding by
of the border in Lack of contact between polished allowing the patient to
width surface and cheeks especially in move mandible from
tuberosity area. side to side.
4. Post P. Seal: Clinical examination: Reduce border, add post
A. Over extension Broken seal by speech. dam and reline.
on movable
tissues. Extend with tracing
B. Under . Under extended border. compound, mold, wash
extension on non impression, make post
displaceable dam on cast and then
tissues.
reline.
|5. Poor fit due to: Clinically, gap is seen between
Deficient imp.
Relining or rebasing.
Damaged cast. denture base and tissues.
Warped denture. Pressure indicating paste reveals
Grinding tissue uniformity in thickness.
surface.

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Achieve even contact or
4.Occlusal errors Ask patient to close slowly in harmonious jaw relation by:
i. Uneven occ. contact centric until teeth touch.
1. Chair side tooth
occlusal errors
ii. Disharmony bet. CO& Presence of grinding.
CR. iii. Lack of freedom may be masked by:
2 Remounting.
in intercuspal position. a. Displacement of the 3. Remake dentures.
iv. Lack of occ. balance mucosa.
in eccentric positions. b. Tilting of dentures.
v. Excessive anterior
vertical overlap.
5- Clattering teeth: Causes:
1-‘ VD. 2-‘ Cuspal interference 3- loose denture 4 porcelain teeth.
6- Nausea:
Causes
1. Overextended upper denture over the soft palate> Excess is removed and re
post dam.
2. Overextension of the disto-lingual border of the lower denture
3. Under extended upper denture causing the denture to sag on the dorsum of
the tongue.
4. Thick posterior palatal border that make it conspicuous with the tongue. The
posterior palatal border should be thin and embedded in the compressible
mucous membrane.

5. Psychogenic factor.-The patient through nausea is subconsciously rejecting

the dentures, which are a symbol of his unacceptance to the state of
edentulism.

7- Discomfort: Causes:
1- Cramped tongue.
2- Altered V.D. (t or | )
3- Altered occlusal plane.
4 Psychogenic factor.
8- Biting cheek &tongue:
1- Biting cheek& lip: Causes:
1- insufficient horizontal overlap over jet buccally
2- V.D.
ttt: ‘ buccal over jet by grinding buccal surface of lower posterior teeth
& plump.
2- Biting the tongue Cause: tongue space. Or VD.
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Relining or rebasing,
6. Excessive relief Pressure indicating paste reveals after forming proper
excessive thickness in this area.
thickness for relief.

complains of dry mouth and The patient is advised to

7. Xerostomia Patient ofuse artificial saliva,
reduced taste. Clinically, presence frequent fluid intake,
sticky dry mouth. chew gums.
Patient is advised to use
8. Decreased > Clinically evident through
improper speech and denture fixatives until he
neuromuscular
develops denture skills.
control due to: mastication.
Facial palsy
Lower molars
placed too far
lingually.
Convex polished Correction of errors in
surface.
High lower the occlusal plane.
occlusal plane.
+Poor fit due to increase in displacingforces.
Cause Diagnosis Treatment
1. Over extension in Direct vision Reduce over extension and
depth: Elevation of lower denture re-polish the denture.
when mouth opens slowly.
2. Over extension in Patient complainsof bulk and Reduce over extension and
width: food entrapment. re-polish the denture.
> In lingual flange Denture will lift by tongue.
> Lower labial flange Mentalis muscle lifts denture.
Upper labial flange Denture displaced by upper lip
Tuberosity area Cheek soreness and denture
displacement.
3. Recoil of supporting Denture falls when teeth are Reline or rebase using
tissues. not in contact’ impression minimum pressure
without tissue rest from old impression technique.
denture.
Muco-compressive imp. Tech.

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13- Halitosis:
with
complain of a bad mouth odor associated
Occasionally, patients will
wearinq of the dentures. and denture hygiene and should be
neglect their oral times a day.
These patients usually mucosa and tongue several
instructed to clean the dentures,
Problems of old denture:
1) Loose fit: Epulus Fissuratum.
Anterior sulcus ’
hyperplasia.
Hard palate > Papillary
Flabby ridge.
Ridge
2) Over extension:
3) Low VD [over closure]: due to
Ridge ’ Resorption
Denture ’ Settling
V Teeth ’ Wear
contact, concentration of load anteriorly’
This result in loss of posterior tooth
which in turn may result in either:
a. Resorption of the ridge anteriorly. forwards as an attempt to occlude
b. Displacement of the mandible upwards and
teeth and eat on anterior teeth.
the condyles and causes T.MJ.
This may result in change in the position of
disorders.
Chief complaint of old denture:
Discomfort.
Discoloration.
V Abraded Denture Base.
Treatment of Old Denture:
Loose fit: Tissue conditioning material, Relining. Rebasing or Remake.
Hyper plastic tissue: Tissue rest, Tissue conditioning or Surgery.
Pressure area & Over extension: Relieved.
(Low VD) over closure: Occlusal Pivot: Increase VDO in lower 2nd premolar
&lower 1" molar by adding acrylic resin on their occlusal surface.

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9- Food under the denture:

unskilled pt.
Causes1-Under-extension 2- Lack of peripheral seal. Or

10- Altered speech:

CD. may effect phonation As
1- Lisping [S> th]: Causes:
due to limited space between the palate and tongue.
a Anterior teeth are placed too far back.
b- Thick ant. Part of denture covering palate.
- Lack of near contact of upper & lower incisors.
2- Whistling |S> sh]: Causes:
due to excessive space between the tonque and the palate.
a- Ant. Teeth are placed too far forward.
b- Too high palatal vault.
C- Cramped tongue.
d Too narrow dental arch.
3- Difficulty in pronouncing the consonants E. V& Ph. [labio-dental sounds] TH:
Causes: -Occ. plane is too high or too low.
-Anterior teeth placed too far palatally
11-Repeated midline fracture of upper denture
Causes ttt:
1- Bone resorption’ rocking’ repair then relining.
2- Presence of tours palatinus ’ surgical removal.
3- Insufficient relief of midline proper relief.
4- Teeth outside the ridge ’resetting or new denture.
12- Loss of taste sensation:
> Taste buds begin to atrophy at about the same time the dentures are first
Worn.

> The patient is told that most of the taste buds are on the tongue and are not
covered by denture.
> However, there is some interference with the taste sensation when food is not
felt on the palate and upon the natural teeth.
>Acast metal palate, because of the thermal conductivity, often enhances the
sensation of taste,
Patients should be encouraged to flavor their food. Consuming very hot or
very cold food will also help to stimulate the remaining taste buds.

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3- Poor masticatory efficiency:

"insufficiency"
Complaints may be:
1- in abilityto eat anything:
" In pt with 1 time to wear dentures and are impatient at tinme.
ttt persuade pt. to take time to learn a new HOW TO EAT.
2-Inability to eat meat:Cause
1- Flattening of cusps of posterior teeth.
2- The use ofCusplessteeth.
3- . V.D.
4 Use of acrylic posterior teeth. (resilient)
5- Unbalanced occlusion.
6- Cuspal interference
7- Inexperience.
ttt good diagnosis of the cause to treat it.
3- Dentures dislodged by eating :Cause:
1- Cuspal interference.
2- Unbalanced occlusion.
ridae E noyk
3- Upper teethoutside the
+ insufficient tongue space. mped touemare linguelly Toh
5- Over-extended periphery.
6 In experience.
4- Poor denture fit:
> Looseness of dentures or poor fit results from lack of retention and/or stability.
º Associated with lower dentures rather than upper dentures due to lack of
enough denture supporting area, presence of saliva in the floor of the mouth,
and due to tongue movements along the borders of the lower denture.
> Patient complaint: loose denture, too big or bulky denture, rocking denture or
that the denture occupies too much space in his mouth.
LPoor denture fit during mouth qpening:Causes :
Opening mouth widely, as in yavwning, causes the denture to fall, however,
normal opening results in denture dislodgment in the folowing cases:
Over extension or insufficient relief of the frenae.
b- Thick distobuccal flange of upper denture interferes with coronoid process.
C- Under extension.
d- Lack of peripheral seal.
e- Crampedtongue.Causes& tt.
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