4 - Post Insertion Appt Flashcards
When should all patients with new dentures be seen after insertion of dentures?
24-48 hours after insertion
When should patients wear dentures prior to appt?
Several hours to better evaluate mucosal irritations
Patients who are seen for denture adjustment appt 24-48 hours post-insertion do __________ with the dentures
Better
“In many instances, the most crucial time in the patient’s perception of success or failure of dentures is the _____ period”
Adjustment
What is the single most significant factor in the successful manipulation of complete dentures under function?
Neuromuscular control
What are important prognostic indicators?
Tongue function and denture wearing experience
What are common problems with the mandibular denture?
Discomfort
Poor retention and stability
Lack of support
What are common problems with the maxillary denture?
Poor retention and stability
Esthetics and phonetics
What are 4 major areas of post-insertion?
Esthetics
Phonetics
Tissue irritations
Loss of retention and stability
What can be the cause of vague complaints abotu dentures?
Pt unhappy with esthetics
When is the time to remedy esthetic problems?
At trial placement appt
Most pts adapt and learn to speak with new dentures quickly unless…
The teeth are improperly located in the vertical, horizontal, or frontal plane
What should you do if there are problems with phonetics?
- check the thickness of the max palatal portion. A common problem is excessive thickness
- reevaluate the position of the max anterior teeth
- if everything appears normal it may be a matter of time for the pt to adapt
- open vertical dimension of occlusion
What are causes of tissue irritations?
*sore spot may be far removed from its cause
- overextension
- truama from faulty occlusion
- pressure from the denture base
- tissue abrasion from prosthesis movement
What are causes of poor retention and stability?
occlusion, base contours, teeth not in “neutral zone”, posterior palatal seal, overextension or underextension, salivary flow and character
What should you do to contacts during the post insertion appt?
Check occlusal contacts
Remount to adjust occlusion if error is detected
Much of the selective grinding done in the mouth accoridng to articulating paper marks made actually _____ the amount of error in the occlusion
Increases
What should you evaluate once removing the dentures?
Palate and residual ridges throughout
Vestibular reflections for red areas
What should you ask the patient to do in the post insertion appt?
- point to areas of soreness
- cotton tip application (not finger) to touch area
- address 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 the cause of a sore on crest of ridge or ridge slope?
- occlusion error usually
- pressure spot (tray show through) in secondary impression
What is the cause of a sore frenum?
Frenal notch too shallow or sharp
What is the cause of soreness of tissue overlying coronoid process?
Too much thickness at distobuccal corner of max denture; PIP on cameo surface
Wha tis the cause of numbness or burning sensation in anterior palate?
Pressure on incisive papilla
What is the cause of swallowing soreness?
Irritation at mylohyoid ridge
What is the cause of swallowing soreness?
Retromylohyoid flange extension
What is the cause of numbness or burning in lower premolar areas?
Pressure over mental nerve due to an atrophied alveolar ridge
What can happen if the buccal mucosa is at the occlusal plane level?
- biting cheek –> increase horizontal overlap to prevent
- trapping mucosa between bases
What is the cause of teeth contacting during speaking?
OVD too far open
Too little IOD (Freeway space)
What can happen to ridges if the teeth contacting during speaking?
Ridges sore due to constant pressure
What happens if the dentures fit fine at first insertion, but loosen after wearing them for 3 or 4 hours?
Occlusal errors likely
What is the cause of the maxillary CD disloging when yawning or opening wide?
DB corner too thick
What is the cause of smiling causing max CD to dislodge?
Denture flange too thick posterior to buccal frenum
What is the suspect of max CD dislodging when eating?
Posterior palatal seal too deep
Occlusion needs correction
What is the suspect of whistling with S sounds?
Anterior palatal contours incorrect
uses PIP on the cameo surface to check phonetics/tongue contact on denture
What is the suspect of dentures dislodging easier than expected?
Overextension of borders - “toaster denture”
form of external flanges
Teeth locations violating “neutral zone”
What is the suspect of these complaints:
Dentures feel too large
Feels like a mouthful
Difficult to speak or eat
Tongue space is too small and dentures crowd the tongue
Could be tooth position, denture contours, or both
Think “neutral zone”
What is the neutral zone?
Area where forces applied by the tongue is equal or neutralized by the force applied by 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)
An excessive OCD
Psychogenic factors
What does tissue trauma manifest as?
Hyperemia
Inflammation
ulceration
pain
What is used as a paste to detect improper adaptation?
Zinc oxide paste
Who i sPIP spray used in?
Pts with xerostomia in order to prevent the PIP from sticking to mucosa
What should you do in a denture adjustment?
- dry denture and brush thin layer of PIP on intaglio
- spray with separator if mouth dry and insert
- dry tissue with gauze
- touch irritated area with thompson marker
- insert denture to transfer mark
- acrylic resin cutters
- # 8 round bur
- polisheres
- smooth surfaces with rubber wheel/point
- polish cameo surface and borders on slow speed (rag wheel w pumice and high shine)
