Adapting to bugel prosthesis.
After insertion of the removable denture, further correction is needed in most cases. It is explained by different degree of the mucous membrane compliance of the prosthetic bed and impossibility to take this factor into consideration while constructing removable dentures. Every dentist should carry out these additional stages.
The following inspection of the patient should be made the next day. Asking the patient the dentist gets to know his complaints and condition. Both in presence or absence of complaints the oral mucosa should be thoroughly examined. It is necessary to control the occlusion once more and correct its drawbacks. The pain in the alveolar process is often of uncertain localization and occurs in uneven distribution of the masticatory pressure.
At first, the patient’s complaints are thoroughly analyzed including complaints on phonetic, esthetic and functional character (bad fixation in biting or mastication), pain (in conversation, during meal), etc. Special attention should be paid to the pain syndrome determining its character, localization, degree. At first the dentures are inspected in the mouth without taking them out. Attention is paid to the character of occlusion relationship, degree of fixation and stabilization of the dentures. The drawbacks found are eliminated by correction of the occlusion contacts, activation of the retaining elements. Then the prosthetic bed is thoroughly inspected. The revealed areas of hyperemia of the mucous membrane, erosion or ulcer are outlined by the chemical pencil and transferred on the denture base, and then they are ground off. At present our industry manufactures a special indication paste. This paste is applied to the area of the damaged mucous membrane and covered with a denture. It leaves exact visible trace on the base indicating the area which needs correction. The contrast between a lot of patient’s complaints and absence of visible, pathological changes of the mucous membrane indicates that the patient might not wear the similar constructions of the dentures . The patient is told about complexity and individuality of the adaptation process to the removable dentures and explained the rules of their wearing.
There is no common opinion among the specialists as to removal of the dentures during night sleep. On one hand, removal of the removable dentures at night when there are separateteeth in the mouth with affection of the supporting apparatus may result in their injury and quick loss. On the other hand, permanent compression of the vessels of the submucous layer by the denture base may lead to disturbance of the tissue trophicity and enhancement of the atrophic processes. Therefore the dentist should select the most optimal variant in every case.
While treating patients with the aid of removable dentures there may be complications due to dentist’s and technical mistakes or side effects of the denture materials. In this case the patients may have the following typical complaints: unsatisfactory denture fixation, speech dysfunction, pain or burning sensation, breakdown of some denture elements, esthetic defects.
Unsatisfactory fixation (stabilization) of the removable denture may be a consequence of a number of causes: atypical shape of the abutment teeth, incorrect localization of the retainers as to the examination line, drop of the removable plate denture of the upper jaw with porcelain masticatory teeth; sagittal localization of the clamp line; dotted fixation; denture balance on the upper jaw due to sharply marked torus and absence of isolation; taking of compression impression in the atrophic mucous membrane; incorrect position of the artificial teeth in all phases of all kinds of occlusion. The abutment teeth in clasp fixation of the removable dentures must have well-expressed equator and sufficient height of the crown, otherwise the artificial dentures on them should be constructed beforehand, without plastic covering as the latter is worn out in time and retention is worsened. In case the abutment teeth are of atypical shape, e.g. triangular or of reverse cone restored with fillings on the vestibular side or affected by a wedge-shaped defect, they should be covered with crowns.
Unsatisfactory fixation of the removable plate denture may be associated with incorrect position of the retention part of the retainer as to the medium survey line, i.e. it is near to the masticatory surface or comes under the line by less than 0.25 mm in depth. To prevent atrophy under the removable dentures with unfavorable state of fixation (dotted, sagittal unilateral) it is necessary to use light plastic masticatory teeth instead of porcelain one, if possible, using telescope system of fixation – a bar of Rumpel – Dolder, clip attachments, intraroot magnets, functional formation of the base borders. It is undesirable to extract the remaining teeth on the upper jaw, especially in II and IV type of the mucous membrane by Suppley; they are devitalized, shortened to the level of the gingival margin and intraroot attachment is used: clip – in stable root, without atrophy of the parodont; magnetic – in the mobile root with signs of the parodont affection. Such additional fixation in combination with the functional formation the denture base borders contributes to improvement of its stabilization to prevent its drop (in cough, sneezing, etc).
The toxic effect of the plastic base of the removable denture on the mucous membrane may be due to bad quality of plastic polymineralization and , as a result, excessive presence of free monomer, which exerts the toxic influence. On examination of the patient there is hyperemia of the mucous membrane of the prosthetic bed but it is not of local but of the diffuse character. To eliminate increased content of the monomer there are proposed different methods of depolymineralization – repeated thermoprocessing in the cuvette, ultraviolet, ultrasound irradiation.
Hypersensitivity of the patients to the acrylic resin, which is used for removable denture base as well as to the dyes, is encountered quire frequently. Such complication cannot be considered dentists’ or technician’s mistake as it is associated with a side effect of the removable dentures, especially of the plate type.
The denture should not be dropped. In case of its breakdown the patient should go to the dentist immediately. Clasps, especially wire, may become weakened in time; therefore patients should consult a dentist once or twice a year to their straightening. In 3-4 years the denture should be changed. During the first three days after insertion the patient should visit the dentist. The follow up continues till the dentist is sure of the patient’s adaptation to the denture. Some specialists recommend the patients to refer to the dentist in case of development of pain. It is a mistake resulting in serious complications.
Pain is tolerated in different ways. Some people experience pain in considerable size of the decubital ulcer as a feeling if discomfort, the others develop pain in the slightly marked decubital ulcer, and the pain is so bad that the patient cannot sleep. In most cases ulcers heal forming a cicatrix that deforms the transition fold resulting in complicated prosthesis. Pains may disappear after correction of the artificial teeth occlusion.
The transition fold should be thoroughly examined ion the upper jaw, in the area of the alveolar tubers and the line “A”. The decubital ulcers located behind the alveolar tuber, at the site of transition of the hard palate into the soft one cause pains in swallowing. On the lower jaw the sublingual space needs careful examination starting from the tongue root to its frenulum. The decubital ulcers in the sublingual space interfere with the tongue movements, and the decubital ulcers of the lip frenulum – movements of the lips and cheeks. In some cases it helps the dentist in seeking the causes of pain.
Vomiturition is associated with irritation of the mucous membrane of the soft and rarer hard palate. Shortening the denture borders always gives a good result. Only in some cases it is difficult to struggle with this reflex. The patient is the best helper in struggle with this reflex. It may be suppressed by training.
Oral mucosal lesions associated with the wearing of removable dentures.
Lesions of the oral mucosa associated with wearing of removable dentures may represent acute or chronic reactions to microbial denture plaque, a reaction to constituents of the denture base material, or a mechanical denture injury. The lesions constitute a heterogeneous group with regard to pathogenesis. They include denture stomatitis, angular cheilitis, traumatic ulcers, denture irritation hyperplasia, flabby ridges, and oral carcinomas. Denture stomatitis is the most common condition which affects the palatal mucosa in about 50% of wearers of complete or partial removable dentures. Most of the lesions caused by chronic infection (Candida albicans) or mechanical injury whereas allergic reactions to the denture base materials are uncommon. Angular cheilitis (lesions of the angles of the mouth) is characterized by maceration, erythema and crust formation. The prevalence is about 15% among wearers of complete dentures. The lesions have an infectious origin but several local, including prosthetic, or systemic predisposing conditions are usually present. Traumatic ulcers caused by dentures with overextended or unbalanced occlusion are seen in about 5% of denture wearers. Denture irritation hyperplasia, which is caused by chronic injury of the tissue in contact with the denture border, is present in about 12% of denture wearers. Flabby ridge, which is replacement of alveolar bone by fibrous tissue, is present in 10-20%. Finally, there is evidence that chronic injury of the oral mucosa by dentures in rare instances may predispose to development of carcinomas. Most types of lesions are benign and quite symptomless. However, diagnosis may be difficult and the more severe and dramatic tissue reactions to dentures may indicate underlying systemic diseases. In order to prevent or minimize the extent of the lesions, denture wearers should be recalled regularly for an examination of the oral cavity and the dentures. It is important that the examination is carried out by a person who has adequate medical knowledge
Prior to imposing clasp dentures in the mouth it is necessary to look at it carefully, paying attention to the surface that is adjacent to the mucosa, which should be smooth and polished.
Often, denture on grafted is not imposed as plastic base is limited by defect of the dentition from aproximal side, at gum edge is wider and comes in the niche under the tooth equator. It can be explained by the following- the parallelity of aproximal sides is artificially created on the working models when casting frame. When the skeleton has been casted, it is set on a working model in occludars and have retention points on the teeth. Base plastic fills them when casting and prevents the imposition of denture on the jaw. These plots are removed with mill.
When the prosthesis has been applied to abutment teeth correlation of artificial teeth and antagonists is checked. If an increase of bite or second violation of articulation is observed, they are eliminated by general rules. Prosthesis mustn’t cause pain, and if it does the prosthesis correction must be done..
Preferably,first day the patient removes the prosthesis only for oral cavity hygienic examination. This regime is possible only by industrious hygienic care of mouth and dentures. Not less than 2 times a year the patient should contact a doctor to check the status of the remaining teeth and mucosa. It is known that clasp dental prostheses, held on teeth, which are not covered by artificial crowns, require careful hygienic examination to prevent teeth from caries in areas of base attachment from the proximal side of the tooth. Because of this each day after meals they should be thoroughly cleaned with a toothbrush and toothpaste – teeth and clasp dental prosthesis.
Patients with periodontal disease and general organism disease with their manifestations in the mucous membrane of the mouth should not use the prosthesis every day, and must take them off at night to reduce the load on the supporting tissue. Often such patients’ mucous membrane becomes inflamed, injured by prosthesis, often ulcers appear. In such cases, if the prosthesis usage regulation does not address complications it should be along with the general treatment to change the design of prosthesis.
Prosthesis in the mouth causes to a range of subjective sensations with the patient. As usual in its fixing day only gross defects in prosthesis design are eliminated – improving occlusion with occlusive pads or the other frame parts and artificial teeth. Only on the second day one may conduct more diligent preparation of clasp dental prosthesis. Often on the prosthesis fixing day the frame do not precisely embraces teeth,there is a gap between occlusive pads and clamps shoulders . After daily use such frame begins to be exactly adjacent to the prosthetic bed. It is explained by tooth physiological mobility.
The patient must know that in the early days clasp dental prostheses can lead to nausea, vomiting, enhanced salivation, speech impaired and disorder of taste sensations, polluted nibble and food chewing . All of this suggests that the prosthesis causes local and general tissue and nerve endings irritation.
Adaptation of the patient to clasp dental prosthesis occurs gradually. Note the three phases of adaptation to the denture. The first phase – irritation. It is observed on a fixing day of clasp dental prosthesis in the patient mouth. Phase II – partial inhibition: salivation comes to standards, the purity of the language is restored, the nausea disappears, increasing of chewing efficiency. The second period is short and takes 2-3 days. The third phase -full braking phase, it comes from the time when the patient ceases to feel the prosthesis as foreign body. Chewing efficiency is at maximum. This period, depending on the type of nervous activity continues 1-2 weeks.
For faster patients adaptation to clasp dental prostheses is advised not to take off them at night for 3-4 days, limiting only to hygienic care.
Adaptation period when using the clasp dental prostheses twenty-four-hour is shorter. Good adaptation promotes rapid restoration of masticatory efficiency.
Looking After your Dentures
You need to care for complete and partial dentures as carefully as you would look after natural teeth.
Clean them every day. Plaque and tartar can build up on false teeth, just like they do oatural teeth.
Take them out every night. Brush your teeth and gums carefully, using a soft toothbrush. Be sure to clean and massage your gums. If your toothbrush hurts you, run it under warm water to make it softer OR try using a finger wrapped in a clean, damp cloth.
Soak them overnight. They can be soaked in a special cleaner for false teeth (denture cleanser), in warm water or in a mix of warm water and vinegar (half and half). If your denture has metal clasps, use warm water only for soaking. Soaking will loosen plaque and tartar. They will then come off more easily when you brush.
Sore Areas With Partial Dentures
An appointment will be made for you 24 to 48 hours after insertion of your new partial dentures. Sore areas may develop within this time period and it is important to find and adjust the cause of the sores. Your new partial is made of two parts. The first is the framework made of cobalt-chromium. The teeth and gums are made of an acrylic material.
Do not attempt to adjust the partial dentures yourself because they can very easily be made worthless by a do-ityourself adjustment. As patients use the partials, they will settle on the soft tissues and remaining teeth. This will necessitate additional adjustment appointments, as the occurrence of new sores is certainly possible. If you find it necessary to remove your partial because of excessive soreness, reinsert it 24 hours preceding your appointment for the adjustment. This will make it possible to see the pressure areas on the tissue and pinpoint accurately where to adjust the partial.
Speaking With Partials
Learning to talk with your partial in place requires practice and perseverance. Reading aloud is a very helpful method of learning to pronounce words distinctly. Practice those words or sounds that seen to give you the most difficulty. It
takes time for the tongue to learn the different positions necessary to make good speech sounds with new dentures.
Chewing With Partials
Learning to chew with partials will probably take six to eight weeks. Patience is required to learn to eat with your dentures. At first, limit your diet to soft foods that are easy to chew. Gradually learn to eat foods that are more difficult.
Cut food into small pieces. Take small bites and chew slowly, trying to overcome the difficulties as they appear. If possible, learn to chew on both sides of your partial. Since the muscles of the cheeks, lips, and tongue will tend to
displace your dentures, do not develop the habit of displacing them with these muscles. Rather, train these muscles to assist in keeping your partial dentures in place.
Increased Saliva With Partials
Do not be alarmed at the greater amounts of saliva in your mouth during the first few weeks of wearing your partial.
This condition will correct itself, as you become accustomed to wearing them.
Oral Hygiene With Partials
Your partial should be left out of your mouth at least eight of every twenty-four hours to allow the tissues to rest from the pressures placed on them by the partial. Failure to allow the tissues to rest can result in chronic irritation to the
tissues, the development of certain fungal infections and more rapid loss of bone. (Remember that this bone is desperately needed to provide support for the dentures in future years so it must be conserved.)
It is important to clean your partial and rinse your mouth after every meal. The tissues of the mouth and tongue should be brushed daily with a soft bristle toothbrush. This provides stimulation for increased circulation and removes debris
that could cause irritation and offensive odors.
Good oral hygiene is a must to save the remaining teeth and prevent further bone loss. Brush twice daily and floss at least once a day.
Longevity of Partials
The assumption that partials will last a lifetime is incorrect. Take into consideration that both the partial and tissues will change over a period of time. It is suggested that your mouth is examined and the fit of your partial be evaluated by a dentist on a yearly basis.
Shrinkage or resorption of your ridges is a normal occurrence. This results in a loosening of your dentures and perhaps a change in facial expression due to a settling of the partial on the ridges. Sometimes you will notice these changes within a few weeks. In some people it may not occur for many months or even years. Never try to repair, reline, or adjust the partial yourself. This could be destructive to the tissue and underlying bone on which the partial rests.
Limitation of Partials
Do not expect your partial to function as your natural teeth once did. Learn to know the limitations of your partials and adjust your living habits accordingly.
How To Care For Your Partials
It is important that your partials be kept clean. Accumulation of food debris around the teeth and under the partial can result in irritation to the tissue and unpleasant odors.
Insert and remove the partial as instructed. Do not bend the clasps. Even though the metal is strong, it is still brittle.
Grabbing hold of the metal wires while trying to remove the partial may cause a stress fracture of the framework.
Partials should be cleaned after every meal by rinsing them thoroughly under running water and rinsing your mouth.
Different commercial denture cleansers are available for cleaning your partial dentures. It’s preferable to use a nonabrasive cleanser, as you do not want to alter the surface of the dentures. Never use bleach or any products containing
corrosive material which could ruin the surface of the metal framework. If you choose to use a commercial cleanser it is important to closely follow the instructions given with the product. These cleansers are not designed for use in the
mouth. Typically, the denture should be soaked in the rinse for a maximum of 15 minutes and rinsed thoroughly before placing the denture back in the mouth. Dentures should only be soaked overnight in clean water.
Post-Op Period
Any follow-up appointments or adjustments to your new partial will be done at no charge to you for three months from the date of delivery. After this period, office visits will incur an additional charge.
How to Care for Your Denture or Partial
1. Rinse the denture/partial and brush away plaque and food debris regularly (once to twice a day). Place denture/partial into container of cleaning solution to continue the cleansing and disinfection process. Denture tablets for soaking are available at many stores and any brand will work, does not have to be expensive. (follow directions on container)
2. While denture is soaking, use a dampened washcloth or very soft toothbrush, dampened with warm water (or salt water solution) to wipe the inside of the mouth. Making sure to wipe the ridges (where dentures sit), tongue, lips, cheeks and roof of the mouth. If you wear a partial, use a soft toothbrush and make sure to clean all the teeth and tissues in your mouth thoroughly. This should be done at least once or twice each day.
3. After denture/partial soaking, remove from solution. Using a moistened denture brush or regular soft bristled toothbrush with toothpaste, gently clean inside of denture, outside of denture and teeth. Use a mouthwash to give fresh taste and clean feeling.
4. Next, thoroughly rinse the denture/partial with water and re-insert into the mouth.
5. At night, we recommend that you remove the denture/partial. This allows the tissue to breathe and heal by removing the pressure that is placed on the gums and tissues. Dentures/partials should be kept in water or mouthwash when out of the mouth to prevent drying out of the materials, which can cause distortion. We understand that some are uncomfortable leaving them out at night. In those instances, making sure to keep the mouth and denture/partial extremely clean is very important to maintain healthy tissue.
Remember that the gum tissue is in constant state of change, but the dentures are not. Over time your dentures may loosen and need to be professionally adjusted or relined. We recommend that you have a dentist check your dentures annually, as well as having an oral cancer screening examination.
Partial dentures are replacement teeth for people who have lost one or more of their teeth. Partial dentures can be taken in and out of the mouth and consist of a denture base, which closely resembles the color of your gums and denture teeth, which are attached to a supporting framework. The partial denture then attaches to the existing teeth via a clasp or some other retentive device.
Partial dentures are made using a model of your mouth.
Making a partial denture requires about 6-8 weeks, however this can vary from one patient to another. It also could depend on the type of denture and the technique your dentist or the laboratory technician uses.
Partial Denture Treatment
The first step in making a partial denture is the preparation of the teeth. During this phase your dentist may prepare the teeth that the partial denture will use for support. Next, your dentist will take an accurate impression of the upper and lower arches of your mouth and records your bite. The impressions are then sent to the dental laboratory.
At the subsequent visits your dentist will evaluate your bite, test your speech and check the appearance and function of the partial denture teeth and gums.
After the final satisfactory fit and appearance are achieved, the denture is then sent back to the laboratory for final fabrication.
Partial Denture Complication
While every effort is made to make a good and functional partial denture, it may require a few adjustment visits and a little time for you and your partial denture to adapt to each other. The most important point to remember is that adjusting to your partial denture is a process; in some cases, it takes weeks to get used to a partial denture.
A new partial denture can also alter your eating and speaking habits and it may require a bit of practicing before you get comfortable.
Different Types Of Partial Dentures
There are newly developed techniques in making partial dentures. One such advance is an implant-supporting partial denture that helps give additional support to the partial denture. While it offers additional support it also requires the placement of implants in your mouth before making the denture.
There is also a partial denture that uses a special material called valplast which is more aesthetically pleasing to the eye. This kind of partial does not use metal as its base and has hooks that are made with a flexible plastic material.
Getting used to your new dentures
A new feel with new dentures
Many of our denture patients need a bit of time to get used to wearing dentures – especially if they are wearing dentures for the first time. In our experience, it can take longer to adjust to complete lower dentures, as there is usually less retention and the tongue may feel constricted for while. It will take your tongue, lips and cheeks several days or even weeks to get used to the shape of your new dentures. Any problems usually resolve themselves within a short time. During this stage, you will play a more active role in adapting to your new dentures than your clinical dental technician.
Appearance
At Changing Faces, it is our aim to create the dentures that will improve your overall appearance with a more natural and youthful look. By positioning your front denture forward, in keeping with where your natural teeth once were, your new dentures will provide essential support for your lips and cheeks. With this, Changing Faces® dentures can actually reverse the signs of aging caused by tooth loss.
With complete dentures, it is normal for your mouth and face to look and feel different. After a few days this feeling will disappear and you will enjoy new confidence in your appearance. To ensure that you are happy with your new look and feel, we go through a number of stages before your final fitting.
Speech
Throughout the different stages of treatment we use a number of tried and testedtechniques to make sure that your new dentures have a positive effect on your speech. In fact, we find that our dentures often help to improve speech overall. As your tongue and lips get used to the shape of your new dentures, any initial difficulties you experience will soon subside. Reading aloud is very effective and can help speed up the process. Try counting from 65 – 70, as these sounds can be the hardest to get used to.
It is common to salivate more (which can affect speech) when your new dentures are fitted. As your mouth gets used to presence of the dentures, this will soon subside. Try sipping water to thin down your saliva and try swallowing more often.
Eating
Getting used to chewing can take more time and practice until your cheeks, lips and tongue adapt to their new interaction with your new denture base. Many of ourpatients experience a reduction in the length of their face, which caused by many years of wearing ill-fitting and worn down dentures. By returning your jaw to its natural position, your new dentures may temporarily affect your chewing and biting ability. Rest assured that things will soon return to normal. With your facial length restored to what it once was, your eating should actually improve.
When wearing your new dentures for the first time, begin eating with small bites of finely sliced foods. This will help you begin to control your new bite and tooth position. Avoid tough, hard and sticky foods until you become more accustomed to your replacement dentures. Biting on the front teeth of even the best made denture can cause your denture to lever away from your gums. Biting slightly to the side more towards your back teeth causes less leverage.
New dentures take time to get used to and you may feel that it was easier to eat with your old dentures. However, most of our patients feel their new Changing Faces dentures offer them more freedom to enjoy the foods they love.
If you are a complete denture wearer, try following these basic principles to make your adjustment period much easier:
· Chew up and down, rather than from side to side
· Cut your food into small pieces and eat slowly
· Chew on both sides of your mouth at the same time
· Avoid bringing the lower front denture teeth forward against the upper front denture teeth
· If you find that it is necessary to bite using the front teeth on your denture, hold your tongue against the back of the upper denture to keep it in place
Everyday wear
When it comes to the period of time you wear your new dentures, it is a matter of personal choice. However, we do recommend that you leave your dentures out at night, as this is often the most convenient time to allow your mouth to rest. If this is not possible, we suggest that you remove your dentures whenever you are in private, as even a short break will allow your mouth to rest. Whenever you remove your dentures, make sure you keep them soaked in water.
Sore areas
Your mouth may have changed a great deal since your last set of dentures were fitted. The size and shape of your new dentures will be created to fit precisely with the contours of your mouth. As a result, pressure points and sore spots can develop under and around your new dentures during the first few days of wear. This is perfectly normal but should it continue, we can alleviate any discomfort you experience by adjusting the denture surface. If the irritation is very painful, stop wearing your dentures and consult your clinical dental technician.
In most cases, a new partial denture will be supported by your natural teeth and gums. If you are wearing a partial denture for the first time, you may experience some slight soreness while you adjust. Designed to be as comfortable as possible, our partial dentures will minimise any potential for soreness. Try not to bite your partial dentures into place as this may loosen and break the clasps and damage your mouth. Instead, follow the insertion and removal advice provided by your clinical dental technician.
• mucosal inflammation (allergy to metal, plastic)
• fracture of the abutment tooth.
1. Complete tolerance to the removable prosthesis ranges in 10-30 days. Nausea, increased salivation, blurred pronunciation can disturb you during this period. These disadvantages disturb patients who firstly use dentures.
2. If you feel any pain under the prosthesis, immediately go to a dentist for the correction of the prosthesis.
3. For the improvement of pronunciation it is advised to read aloud.
4. To shorten the period of adjustment in the first 7-10 days, the prosthesis is best to leave at night in the mouth, brushing and rinsing it. Repeat the procedure in the morning.
5. Later, the prosthesis should be stored in an aqueous environment at night, clean it using special brushes and disinfecting tablets for dentures.
6. During the first day it is recommended to eat soft food, better pureed. In the future, follow the normal diet, avoiding solid products.
DENTURE TROUBLESHOOTING
Overextension of Denture Borders
Slight overextension is preferred to slight underextension.
Remember, however, overextension is prejudicial to denture retention.
To examine the lower denture for overextension:
· Instruct patient to protrude tongue slightly until the tip rests upon the lower lip
· Place your index fingers on the occlusal surfaces of the lower teeth to determine if the lower denture remains firmly seated on the denture-supporting structures
If the denture lifts, consider 3 possiblities:
· Overextension in the region of the genioglossus muscle (contracts w/ forward movement of the tongue to dislodge denture) Anterior portion of denture lifts
· Overextension in the region of the premolar-molar area (denture dislodges by contraction of mylohyoid) Entire denture lifted from position
· Overextension of the extreme distolingual border of the lower denture (dislodgement of the forward movement of the retromylohyoid curtain) Entire denture dislodged from position and moved forward
To test buccal and labial flanges of the lower denture for retention, cheeks and lips are drawn outward. Keep index finger of the other hand on occlusal surface of the teeth on the same side. If denture lifts, border may be overextended.
Test buccal and labial flanges of the upper denture for retention the same way except hold index finger of the opposite hand in contact with palatal vault
Wharton’s (submaxillary duct)
· Occasionally a lower denture can cause complete or partial closure of Wharton’s duct
· This is clinically manifest by enlargement of the submaxillary gland
· The gland will usually return to normal soon after removal of the denture
· If mild duct closure, mild discomfort often disappears by itself during the adjustment period
· Sometimes a reduction of the lingual flange thickness, without disturbing the border, gives relief (avoid excessively reducing the border)
Faulty Vertical Dimension
- One of the most common denture faults
- Always check for this regardless of how remote the patient’s complaint may be
- Vertical Dimension is a combination of relaxed muscles, lips at rest, varying freeway space, harmony between lower and middle 1/3 of the face, ability to speak without bite rims contacting, tongue room for making the “th” sound, satisfaction of the patient’s tactile sense, and a consistent rest position measurement
- Two types of patient’s need a freeway space far in excess of the 2 – 3 mm generally recommended
- The patient accustomed to occluding in a very over-closed relationship for a long period of time (not a good idea to open a patient 10 – 12 mm all in one operation – important to rely on patient judgement, too)
- The mouth breather – lower jaw has been in an opened relationship for a long period of time (a tactile closure into soft wax is a good way to determine the vertical dimension in this case)
- In these 2 instances, don’t try to get proper VDO by subtracting 3 mm from rest position
- Determine the vertical component of centric occlusion which meets the requirement of the case, without regard to the extent of freeway space
- A good way to check VDO (provided the upper incisors are set in a normal position) = Push the lower lip with your index finger with the joints in centric occlusion. If the lower lip tends to slide under the incisors instead of impinging on them the VDO is generally opened too far ( however, horizontal overlap may do the same thing)
- The “th” sound is a good phonetic cue to correct vertical dimension.
- When the patient says words beginning with “th” his tongue should pop forward between the bite rims. If the VDO is excessive, the forward movement of the tongue, is restricted by the height of the rims or set teeth
Speech Problems
It takes patients from 2 – 3 weeks to accustom themselves to dentures, so it is difficult to judge this early on, but some things to think about are:
- Patients are adaptable and generally will correct speech difficulties (not directly related to technical error) within 2 or 3 weeks, so most patients can be assured they will get past the difficulty
- The pronunciation of the letter “s” is the most common speech problem; the patient may even have involuntary hissing or whistle. This can be caused by:
- Rugae area too thick or too thin or the maxillary anterior teeth may be set too far lingually. If the patient has a heavy anterior ridge and the denture is thick, the rugae area should be thinned to allow more space for air to escape. If the anterior ridge is small and thin, likely too much air is escaping and wax on the palatal surface should correct the problem (autopolymerizing resin can then be added if the wax shows this to be an effective correction). If the maxillary anterior teeth are set too lingually, they must be reset or you may try heavy festooning just lingual to the teeth. If these remedies don’t work, sometimes adding a median ridge will help.
- Inability to speak clearly may be due to the lack of tongue room posteriorly on the mandibular denture.
- Overextension of the upper denture onto the soft palate results in speech difficulties, as the patient has to make a conscious effort to keep the denture in position when talking.
Physiologic Failures
- Weight loss can affect denture fit. Clothes get loose; dentures can get loose
- Patients with diabetes or periodontal disease are subject to rapid loss of supporting structures when dentures are inserted and should be forewarned of frequent re-fittings
- Malignant growths can cause dentures to be ill-fitting
- Sometimes patients just can’t successfully wear dentures; check to see if they are using good denture “tricks” such as tightening the corners of the mouth against the lowerflange when the mouth is opened wide, trying to chew in an up and down motion with a minimum of lateral excursion, and keeping the tongue low and well forward in the mouth to stabilize the lower denture.
Mucosal Irritations
- Frenum impingement is common; the upper frenae need the most room to move
- Mucosal soreness is often seen on the buccal surface of the R and L maxillary tuberosities. Careful adjustment of the tissue surface of the denture in this area usually solves problem. The size of the ulceration will correlate to the size of the prominence in the denture, ie pointed, or broad and shallow.
- Sharp, bony projections should be removed prior to denture construction, but only remove the sharp point; avoid extensive aveolectomy!
- To relieve a sore spot on the mucosa, it must be correlated exactly with the corresponding spot on the denture that is causing the trouble – try marking the area with a Thompson stick and transferring it to the denture
- Expect to have adjustments with a flat or concave ridge and forewarn your patient
Sialorrhea (hypersalivation)
- May be a short-term major problem; patient may actually refuse to wear denture
- Usually lasts only a few days and gradually tapers off to normal
- Dentist must maintain calm, kind attitude and offer emotional support
- Physiologic symptoms noted are a flow of blood through the salivary glands and their excessive stimulation
- Etiology is emotional stress, pain in the oral cavity, reflex stimulation by the dentures, or a combination
- Causes arising from the dentures are:
- Incorrect centric jaw relation registrations
- Excessive VDO
- Overextension of denture borders
- Pain and excessive pressure on the oral mucosa
- Pressure upoerves
- Excessive stimulation of the salivary glands from the denture acting as a foreign body
- Excessive thickness of the dentures restricting the tongue in its static state, as well as in function
- The patient’s anxiety about possible failure of the dentures
- Treatment options:
- Small doses of opiates or atropine sulfate for the first day may be desirable
- Kind, sympathetic treatment with understanding and reassurance are essential (this alone may effect the cure)
Xerostomia
- Possible causes:
- Insertion of new dentures
- Diabetes
- Chronic infection
- Drugs (antianxiety, antidepressant, antihistamine, antihypertensive, diuretic, decongestant, antiparkinsonism, antipsychotic, anorexiant)
- Biological aging
- Sjogren’s Syndrome
- Vitamin deficiencies
- Stress and depression
- Treatment:
- Address etilogic factors
- Prescribe a balanced diet rich in vitiamins and essential minerals
- Moisturizing gel such as Oralbalance
- Saliva substitutes
- Sugar free candy to stimulate saliva production
Stomatopyrosis (burning mouth)
- This is a tough one!
- Affects menopausal and post-menopausal women more than men
- Etiology is unknown in many cases
- Definite psychological component in many cases (All the articles I’ve read suggest this)
- Onset often connected with major adverse life event
- Possible causes
- Systemic/ oral disease (candida, fissured tongue, geographic tongue, foliate papillitis, carcinoma-burning is localized vs. more widespread as in BMS-burning mouth syndrome)
- Nutritional deficiencies
- Emotional disturbances (this is a big one)
- Allergy (very small percentage due to this! Another type of denture acrylic probably will not work; could be due to excess monomer)
- May be neuralgia—consider help from neurology department
- Treatment:
- All systemic sources of inflammation (i.e. candida) should be eliminated
- All sources of local irritation and undue pressure by the dentures should be thoroughly eliminated
- Centric relation should be checked and double-checked. A new centric occlusion that is in harmony with centric relation should be established. The dentures should be remounted on an adjustable articulator to correct occlusal disharmony.
- Border extension and stability of the dentures should explored with utmost care
- When indicated, hormones should be administered
- Balanced diet rich in vitamins and minerals should be prescribed
- Psychotherapy by a psychiatrist (in order for this to work, the dentist must be fully acquainted with the past history of the patient)
- Don’t undertake or continue the treatment of burning mouth unless you are sure of the utmost confidence and cooperation of the patient.
- Reassurance is an important factor
- Some patients just need to know they don’t have a malignancy and therefore don’t insist on any type of treatment
The Complete Denture Remount Procedure
Purpose: Correction of denture occlusion under controlled conditions no matter what the cause of the occlusal disharmony.
Reasons:
· Reduces patient participation
· Done on solid base
· Dry field
· Clear visibility
· Corrections made away from patient
Procedure to remount a denture begins at the time the processing of the denture is complete. It can be broken into four phases: two laboratory and two that involve patient manipulation. The sequence would be initial laboratory correction, patient interocclusal records, laboratory correction, and finally patient evaluation and finalization of denture occlusion. The first laboratory phase may not be done by you, the dentist, and can be done by the laboratory technician, depending on your laboratory directions and philosophy.
The basic procedures are as follows:
· Preliminary laboratory occlusal adjustment
· Patient chairside tissue surface and peripheral extension evaluation and adjustment
· Laboratory occlusal adjustment utilizing interocclusal records to mount complete dentures
· Denture insertion and post insertion care
Preliminary laboratory occlusal adjustment involves occlusal adjustments resulting from processing error that occurs in the laboratory. Adjustments are done in the labs before delivery to the dentist.
Patient participation involves the evaluation and necessary adjustment done by the dentist on the tissue surface and periphery of the complete denture which results in a properly fitting prosthesis. At this time interocclusal records, using the patients new and properly adjusted maxillary and mandibular dentures are made for remounting these complete dentures.
Laboratory occlusal adjustment is the procedure of denture adjustment done at the laboratory bench after remounting the prosthesis on the articulator
Denture insertion is the final delivery of the denture. It includes intraoral inspection for accuracy of laboratory occlusal adjustment and review of home care instructions for the prosthesis and the patient’s mouth. These instructions are sent home with the patient.
More detailed breakdown of this remount procedure is as follows:
Procedure
1. Preliminary laboratory occlusal adjustment
· Unflask complete denture
· Reattach indexed maxillary and mandibular dentures to articulator and correct processing errors
· Preserve facebow relationship with remount index
· Remove, finish and polish complete denture
· Make maxillary and mandibular denture remount casts with plaster blocking out undercuts
· Mount maxillary denture cast to articulator using facebow index
1. Patient participation
· Try-in, evaluate, and adjust complete denture bases and extensions
o Undesirable pressure spots – PIP adjustment
o Complete basal seat with no over or under extension by using disclosing wax or PIP
· Make centric relation occlusal index on patient
· Mount mandibular complete denture remount cast with denture to the articulator
· After mounting, verify index by repeating centric relation and checking this with the remounted prostheses on the articulator
· 3. Laboratory occlusal adjustment
· Adjust centric relation discrepancies
· Adjust eccentric movements – lateral working, balancing, and protrusive to develop
o Smooth movement
o Balanced occlusion (when desired)
· Mill in denture (monoplane teeth set flat only)
o Use a maximum of 10 strokes each
o Right lateral (RL), left lateral (LL), and protrusive
· The end result is contact between the incisal guide pin and incisal table
1. Denture insert
· Re-evaluate
· Re-adjust and remount wheecessary
· Reinforce previous instructions and oral hygiene instructions.
The following is a step by step laboratory occlusal adjustment that will result in elimination of occlusal errors of anatomic teeth. A different procedure is used with monoplane teeth set flat.
· Adjustment is accomplished by selective grinding permitting both tooth form and occlusion to be retained.
· Articulating paper/ribbon of minimum thickness is used, thicker paper gives inaccurate markings and deceptive results.
· Centric relation deflective contacts are adjusted first.
· Complete dentures cannot be loose on the remount casts. It may be necessary to sticky wax the denture to the casts to prevent movement.
· Place articulating paper between complete denture teeth and lightly tap together. Both sides can be done at same time by fastening paper together in from with a paper clip.
· Basic rule: Grind fossas and deflective inclines and not cusp tips.
· Repeat marking and grinding until posterior teeth have contact in centric occlusion.
· During centric occlusion marking and grinding, incisal guide pin is raised 1 mm out of contact to compensate for the thickness of the wax interocclusal record.
· REMEMBER: After centric occlusion has been perfected the centric cusps must not be shortened.
· REMEMBER: The maxillary lingual cusps and the mandibular buccal cusps are usually centric cusps.
· After centric occlusion, deflective contacts are eliminated. The incisal guide pin is placed in contact with the incisal guide table and kept in contact during elimination of eccentric deflective movements, working and balancing.
· Place articulating paper between teeth on both sides of the arch and move articulator into lateral movement. I f the pin raises form the incisal table, reduce the appropriate marking.
· Reduce the appropriate non-functional cusp inclines on the working side first – lingual incline of maxillary buccal cusps or buccal incline of mandibular lingual cusps.
· Reduce the appropriate cusp inclines on the balancing side. The lingual incline of mandibular buccal cusps are reduced before the buccal inclines of the maxillary lingual cusps.
· Marking and grinding is continued in lateral movement until the incisal pin stays flat and contact is made on as many posterior teeth as possible. Contact on all posterior teeth is ideal
· REMEMBER: Grinding to correct occlusion in lateral movement is usually limited to non centric cusp inclines. These include the lingual inclines of the upper buccal cusps and the buccal inclines of the lower lingual cusps on the working side. The lingual inclines of the lower buccal cusp on the the balancing side are reduced before the buccal inclines of the upper lingual cusps.
· After correction of right and left lateral movement, deflective contacts in protrusive are addressed.
· Relief is accomplished for protrusive interference on the distal inclines of maxillary cusps and mesial inclines of mandibular cusps.
· Light posterior contact is desirable in protrusive movement as long as the incisal guide pin stays on the incisal guide table.
· Anterior teeth should just clear without interference. This is usually addressed during the trial arrangement, but adjustment may be necessary
· Elimination of occlusal errors with rational teeth set to a flat occlusal plane is accomplished on the lower arch. The maxillary teeth are sanded flat with “220 wet or dry” sandpaper on a flat surface. This arch is then maintained while adjustment are made on the mandibular teeth.
· Finalization of the adjustment can be accomplished with milling past. All ground teeth should then be light polished to provide smooth movements.
Action of the Denture as a Foreign Body
- Some patients experience hypersalivation and some xerostomia (not due to technical problems with the denture; consider other things first)
- You may also see considerable redness of the palate not associated with pain or discomfort
- Disturbances that complete dentures cause as a foreign body are usually within the limits of tolerance of the tissues. Re-adaptation of the mucosa to a newly established physiologic pattern is the rule. Everyone is different, however, and it is impossible to predict these type of reactions and may be difficult to manage them – no good answers here.
Contraindications to a Denture Reline
- Unresolved TMJ dysfunction and myofacial pain
- Unsuccessful resolution of inflamed tissue caused by pathologic basal seat on mucosa
- Malposition of artificial teeth that results in unfavorable mechanics, poor phonetics and unacceptable/esthetics
- Multiple-fractured and severely worn artificial teeth (cause of this should be determined!)
- Unfavorable occlusal plane that produces a poor appearance
- Artificial teeth that are grossly malpositioned in relation to the residual alveolar ridge
- A vertical dimension that must be increased more than 3 mm
- A vertical dimension that is too great
· Denture repair.
· Denture bases repair is necessary if:
· 1)basis cracks or complete fracture ,
· 2) partial or full fracture of an artificial tooth,
· 3) clamp failure ,
· 4) removal of an abutment tooth,
· 5) replacing the removed artificial tooth with an artificial one.
Depending on the nature of the damage repair may be done by obtaining an impression with or without prosthesis. In the case when there is a crack or full fracture of the base and when it is not possible to make the prosthesis and stick together, do not get an impression. But if denture parts caot be composed or there is lack of some of them an impression must be obtained along with prosthesis parts . In the laboratory, after casting models or, as is said, “pouring”, the prosthesis parts are removed, their edges are grinded off, removing plastic from each end 2-3 mm ; grinding off is conducted with dental mills. On the boundary of the fracture surface is polished with files, burins and mills , giving roughness. Fragments are put on the model, the gap between the parts of the prosthesis is filled with wax and basis simulation is conducted.
After the simulation model is plastered by direct method in flask basis, the entire prosthesis is filled with liquid plaster, leaving open only part of the wax. having cast a contraform after crystallization of gypsum flask is opened and wax is smelted with hot water. After cooling flask plastic preparation is made. For one correction on average 4.3 g polymer and 2 ml of monomer are needed. Before forming the plastic dough break lines are wiped with a monomer, the required number of plastic dough is imposed , covering its wet with cellophane, and pressing is done. After the control cellophane is removed, plastic residues are removed , if necessary,plastic dough is added and final pressing is done. Having checked the flask fixation on a clasp it is dipped into the bowl with water and polymerization is done. After treating and polishing denture again isfixed in the mouth.
In the case when there is breakage or fracture of artificial teeth or clamps, when there is a need for clamps transfer to another place because of loss of abutment teeth the denture fining is done. Its essence is that an impression is obtained from the jaw with prosthesis put on it , and then model is cast.The position of central occlusion is fixed with thwe help of blocks from the warm wax. Model is plastered in occludor. The clamp full bending is done , and if necessary setting an artificial tooth is conducted. Model is plastered in a flask and wax is replaced on plastic by conventional methods.After the prosthesis is treated, polished, grinded and sent to a clinic for fitting and fixing.
Separately we will stiop at denture bases fining with selfhardening plastics. This method is widely used in clinical prosthodontics, but necessary to recall that the conditions of its application is to conduct polymerization in the apparatus under pressure to reduce residual monomer.
Description of fining is to glue parts with dichlorineethan denture glue, which is contained in complex of selfhardening plastics ‘Protacryl’ and ‘Redont’.
Parts of the prosthesis are placed along the fracture line, having glued them before and are kept in this position for 2-4 min.
On cemented prosthesis plaster model (‘pidlytok’) is cast. having smeared prosthesis and plaster with vaseline , a contramodel is obtained with the new portion of densely mixed plaster. After, the prosthesis is removed from the model and broked through bonding line, the fracture is grinded each side for 1-2 mm, making the notch.
Model and contramodel are smeared with insulating varnish ‘Izokol’, then part of the prosthesis is placed on the model.
Plastic dough is prepared with selfhardening plastic, strewing powder in monomer tu full, covering wuth glass pot on top to prevent weathering monomer.
The process of maturation of plastic dough goes 3-5 minutes, depending on air temperature. Fracture line is greased with monomer. Polymerization should be in a special apparatus under pressure for 8-10 minutes. After machining, grinding and polishing dentures are passed on for fitting and fixing in the mouth
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Common Denture Problems and Solutions |
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Older dentures can wear or “sink” in the mouth as the underlying gum shrinks over time. The teeth in some dentures are set too far back and too near the gum. This happens many times because if the teeth were set in the ideal position the denture would be more unstable. This can be corrected by support for the denture being provided by dental implants with either studs or bar snap on connections. These devices, which the loose denture is clipped onto, can significantly improve the stability of the denture and allow denture teeth to be positioned more optimally. This will allow for the more ideal positioning of the teeth without the risk of destabilising the denture as it is snapped on to the implant. This can significantly improve the opportunity to improve lip support, tooth visibility and overall facial height leading to a less collapsed appearance. |
The adjustment period for partial dentures varies greatly from patient to patient. Some are quick to adapt and others struggle. My advice is to be stubborn and don’t give up. The more you wear your partial, the quicker you will get used to it. Do not get frustrated and see your dentist for adjustments that may be needed.
A removable partial denture is a device with artificial teeth that connects to the remaining teeth. It fills in the gaps of missing teeth, enabling you to comfortably chew food. It can also improve your speech and provide support for the lips and cheeks that might otherwise sag. If your denture is uncomfortable or creating a lot of pressure in a particular area, it may need to be adjusted to prevent that spot from becoming sore and more uncomfortable
· Remove the denture from your mouth and clean it thoroughly. Brush it with a denture brush that has bristles specifically designed for dentures. You can wash it with hand soap to clean away any debris or food particles that may result in discomfort. Then put the partial denture back into your mouth and see if it is still uncomfortable. If it is, it might need to be professionally adjusted.
· Bring the partial removable denture to your dentist, who can refit it to your mouth and make any necessary adjustments. Trying to adjust it on your own without the proper tools or knowledge could break it and incur an extra cost for you in repairs.
· Maintain the position of the dentures by keeping them in a glass or container of soaking solution or water. Dentures must be kept moist to maintain the proper shape of your mouth. Failure to do so could result in them needed to be adjusted more often.
· Consult the dentist if your dentures become loose. Over time the partial removable dentures will loosen due to changes in your gum and bone. Partial dentures that are loose can cause sores and infections and should be adjusted as soon as possible by your dentist.
· Partial & Full Dentureі
· An important step in maintaining a healthy smile is to replace missing teeth. When teeth are missing, the remaining ones can change position, drifting into the surrounding space. Teeth that are out of position can damage tissues in the mouth. In addition, it may be difficult to clean thoroughly between crooked teeth. As a result, you run the risk of tooth decay and periodontal (gum) disease, which can lead to the loss of additional teeth.
A removable partial denture, also called a removable bridge, fills in the space created by missing teeth and fills out your smile. It can be made of acrylic resin, metal or a combination of both. Complete or full dentures replace all the teeth in the upper or lower jaw.
Complete dentures are either “conventional” or “immediate.” A conventional denture is placed in the mouth about 4 to 8 weeks after all of the teeth are removed to allow for proper healing. A conventional denture is also made to replace an existing denture. An immediate denture is placed as soon as the teeth are removed. The drawback with an immediate denture is that it may require more adjustments after the healing has taken place.
A denture helps you to properly chew food, a difficult task when you are missing teeth. In addition, a denture may improve speech and prevent a sagging face by providing support for lips and cheeks.
Here are answers to common questions about partial and full dentures:
How do you wear a removable partial denture?
Removable partial dentures usually consist of replacement teethattached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and they are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Dentures with precision attachments generally cost more than those with metal clasps but fit and stay in place much better. Dr. Chetan Bhole can advise you to find out which type is right for you.
Who needs a denture?
Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teethremaining. While missing one or two adjacent teeth can often be best restored with a fixed or cemented bridge, partial dentures work best to replace multiple missing teeth. A denture improves chewing ability and speech, and appearance and smile.
What happens when you get a denture?
A full conventional denture can be made when all teeth have been lost or all extraction sites have healed (up to eight weeks or longer.) The denture process takes about one month and five appointments. New denture wearers need time to get accustomed to their new “teeth” because even the best fitting dentures will feel awkward at first. While most patients can begin to speak normally within a few hours, many patients report discomfort with eating for several days or a few weeks. To get accustomed to chewing with a new denture, start with soft, easy-to-chew foods. In addition, denture wearers ofteotice a slight change in facial appearance, increased salivary flow, or minor speech difficulty.
How do you care for a denture?
A denture is fragile, so it is important to handle it with care. Remove and brush the denture daily, preferably with a brush designed specifically for cleaning dentures, using either a denture cleanser or toothpaste. Never use harsh, abrasive cleansers, including abrasive toothpastes, because they may scratch the surface of the denture.
Don’t sterilize your denture with boiling water because it will cause it to become warped. If you wear a partial denture be sure to remove it before brushing your natural teeth. Wheot in use, soak it in a cleanser solution, diluted mouthwash or in water. Get in the habit of keeping the denture in the same safe and handy place to reduce the likelihood of misplacement.
· There are a few important considerations when leaving the dental office with a new partial denture. Expect that the partial will feel funny. This is a sizable object. Its presence may cause increasing salivation during the adjustment period. The tongue and lips must become accustomed to using this device to form words and to chew food.
· Learn to speak with the new partial by practicing. Try reading the newspaper out loud to a large mirror. Try not to dwell on the sound at first. People naturally adjust to new feel of the teeth, metal and pink acrylic. There may be some change in speech at first; speech may even improve with properly positioned, rebuilt teeth.
· Eat soft foods at first. Noodles, soup, tofu, and bananas are good foods to begin with. Later, add small pieces of firm, chewy and crunchy foods. Do not expect to eat large bites of sandwiches and steak with partial dentures. Never use the plastic front teeth of dentures to tear or bite into foods. Front denture teeth are weak bits of plastic that will tend to come loose under pressure. Instead, tear off pieces of a sandwich or pizza and chew it will back or side teeth.
· Careful design and systematic care of partial dentures will support and extend the life of associated natural teeth. That care must include impeccable hygiene (brushing and flossing), regular professional care, and adjustment of the partial as the teeth and gums change over time. Leave partials soaking in a container of water at night; dry acrylic may warp or crack.
