4/1: The Post-Insertion Appointment Flashcards
When should all patients with new dentures be appointed and seen?
24-48 hours after insertion of the dentures
How long should patients wear dentures prior to post-insertion appt? Why?
Several hours to better evaluate mucosal irritations
Patients who are seen for denture adjustment appointment _______ hours post-insertion do better with the dentures
24-48 hours
When is the most crucial time in the patient’s perception of success or failure of dentures?
Post insertion adjustment period
What may be the single most significant factor in the successful manipulationof complete dentures under function?
Complete denture manipulation
What are important prognostic indicators?
Tongue function and denture wearing experience
What are common problems in the mandibular denture?
Discomfort
Poor retention and stability
Lack of support
What are common problems of the maxillary denture?
Poor retention and stability
Esthetics and phonetics
What are the 4 major areas of post-insertion?
Esthetics
Phonetics
Tissue irritations
Loss of retention and stability
What are vague complaints about the dentures?
Pt may be unhappy with esthetics
When is the time to remedy esthetic problems?
Trial placement appointment
Most patients adapt and learn to speak with new dentures quickly unless the teeth are improperly locaated in the ______, _______ or _________ plane
Vertical, horizontal, frontal
What are ways to check for problems with phonetics?
- check the thickness of the max palatal portion
- reevaluate the position of the max anterior teeth
- if everything appears normal it may be a matter for the patient to adapt
- open vertical dimension of occlusion
What is a common problem with phonetics in the max palatal portion?
Excessive thickness of the max palatal portion
What are causes of tissue irritation?
- overextension
- trauma from faulty occlusion
- pressure from the denture base
- tissue abrasion from prosthesis movement
What are many possible causes of a loss of retention and stability?
Occlusion, base contours, teeth not in “neutral zone”, posterior palatal seal, overextension or underextension, salivary flow and character
What should you check for in the post insertion appt?
Occlusal contacts
- remount to adjust occlusion if error is detected
Much of the selective grinding done in the mouth according to articulating paper marks made actually _____ the amount of error in the occlusion
Increase
- occlusal errors may be small, but the soreness they produce is very real and disturbing to the patient
What should you evaluate during the post-insertion appointment?
- remove dentures and evaluate palate and residual ridges throughout
- evaluate vestibular reflections for red areas
What should you ask patients to point out in the post insertion appt?
- point to areas of soreness
- cotton tipped applicator (not their finger) - touch area
- address the most urgent area first
What is soreness in depth of vestibule caused by?
Overextended border of flange (due to an overextended final impression)
What is this?
Sore on crest of ridge or ridge slope
What is a sore on the crest of ridge or ridge slope due to?
- occlusion error usually
- pressure spot (tray show through) in secondary impression
What is this?
Soreness at frenum
What is the cause of a sore frenum?
Frenal notch too shallow or sharp
What is the soreness of tissue overlying coronoid process due to?
Too much thickness at distobuccal corner of max denture
- PIP on cameo surface
What is numbness or burning sensation in anterior palate due to?
Pressure on incisive papilla
What is swallowing soreness due to?
Irritation at mylohyoid ridge
What is numbness or burning in lower premolar areas?
Pressure over mental nerve due to an atrophied alveolar ridge
What is buccal mucosa at occlusal plane level due to?
- biting cheek - increase horizontal overlap
- trapping mucosa between bases
What does it mean if teeth contact during speaking?
OVD is too far open
- too little IOD (Freeway space)
- ridges are sore due to constant pressure
What could be a sign of occlusal errors?
Dentures fit fine at first insertion, but loosen after wearing them for 3 or 4 hours
What does it mean if maxillary CD dislodges when yawning or opening wide?
DB corner too thick
What does it mean if smiling causes max CD to dislodge?
Denture flange too thick posterior to buccal frenum
What are suspects for maxillary CD dislodging when eating?
- posterior palatal seal too deep
- occlusion needs correction
What does it mean if there is a whistling with ‘s’ sounds?
Anterior palatal contour is incorrect
Uses PIP on the cameo surface to check phonetics/tongue contact on the denture
What is the cause of a denture dislodging easier than expected?
- Overextension of borders “toaster denture”
- form of external flanges
- teeth locations violating “neutral zone”
What are causes of these complaints:
“denture feels too large”
“feels like a mouthful”
“difficult to speak or eat”
Tongue space is too small and dentures crowd the tongue
- problem could be tooth position, denture base contours or both
- think “neutral zone”
What is the “neutral zone”?
Area where the forces applied by the tongue are equal or neutralized by the force applied by the cheeks and lips
What can gagging result from?
- loose dentures
- poor occlusion
- incorrect extension or contour of dentures
- incorrect teeth positions (too far lingual or occlusal plane too low)
- excessive OVD
- psychogenic factors
What does tissue trauma manifest as?
- hyperemia
- inflammation
- ulceration
- pain
What is used as a presure indicating paste (PIP) to detect improper adaptation?
Zinc oxide paste
What is PIP sprat used in?
Patients with xerostomia in order to prevent the PIP from sticking to the mucosa
How do you use PIP for denture adjustment?
- Dry denture and brush thin layer of PIP on intaglio surface
- Spray with separator if mouth is dry and insert denture
- Dry the tissue and denture with gauze
- Touch irritated area with indelible marker - Thompson marker
- Insert denture to transfer mark to denture base
What are instruments to use during a denture adjustment?
- acrylic resin cutters
- # 8 round bur
- polishers
How should you smooth the denture?
Rubber wheel/point
How should you polish the denture?
Cameo surface and borders (lathe on SLOW SPEED) - rag wheel with pumice and then high shine
