Management of RPD Problems at Review Flashcards
What are the two components of a diagnosis?
good patient history
thorough examination
When does the review appointment happen?
1-2 weeks after delivery
What are the common issues?
- Pain
- Retention
- Occlusion
- Vertical Dimension
- Patient acceptance
At what points during impression taking, can things go wrong?
- Size/type of tray
- Material selected
- Not surveyed
- Poor design
What does an inaccurate impression affect?
poor fitting special tray
poor master impression
poor fit of denture
At the tooth trial, what should be assessed?
- Occlusion
- Tooth position
- Over/under extension
- Appearance (shade, mould, buccal corridors)
- Record in notes
What factors of the fit should be assessed?
- Correct denture
- Roughness/blebs
- Undercuts – difficulty/pain inserting/removing
- Over-extension - only to functional depth of sulcus
- Fraenal relief
- Muscle attachments
- Occlusion
- Speech
What should you check if patient is in pain?
- Check soft tissues for areas of trauma and ulceration
- Check the denture to see if anything obvious on it that corresponds eg acrylic nodules/pearls
Why would there be pain on insertion/removal of denture?
Acrylic is rubbing against patient’s mucosa
How can acrylic rubbing be fixed?
- Pressure indicating paste
- Insert and remove denture
- Bare spots where paste has rubbed off in areas of excess pressure
- Relieve - acrylic trimming bur
- Repeat until paste is no longer rubbing off
Why would there be denture digging in?
Overextended peripheries impinging on muscle attachments
How can you fix denture digging in?
- Insert denture and move muscles by “muscle trimming” and see if denture dislodges
- Can pinpoint specific area with pressure indicating paste – adjust and repeat to check
- When happy - polish
Why would patient complain of pain with/out ulceration on or around fraenum?
- Acrylic encroaching on fraenal attachment
- Inadequate space for fraenum
How can pain in fraenal attachment be solved?
- Make fraenal relief more pronounced
- Re-insert denture and check fraenum has space to move
What is pain on biting due to?
Occlusion incorrect causing pressure points in certain areas
How can pain on biting be fixed?
- Use articulating paper to identify “high spots”
- Use an acrylic trimming bur to reduce
- Recheck and repeat as necessary
Why would the denture dislodge when eating/speaking?
Flanges overextended and impinging upon muscle attachments – when muscles move denture gets in the way and dislodges
How can denture dislodging be fixed?
- Check for overextension
- Manipulate muscles/use pressure indicating paste
- Relieve with acrylic bur in straight handpiece
Why would the denture not feel “tight”?
- Clasp tip not contacting enough with tooth surface
How can you fix the clasp?
- Use Adams Pliers to adjust clap so that tip is sitting on tooth surface, engaging undercut
- Do not adjust the clasp tip
- Very small, careful movements
- If no success check design – was there an undercut on this tooth?
What tool is used to fix clasps?
adam pliers
Why would the denture dislodge due to occlusion?
Early occlusal contact – occluding on this causes the denture to tip around this point – dislodges
How can early contacts be fixed?
- Identify early contacts with articulating paper
- Selectively grid these chairside with acrylic
- Recheck
Why would there be an unstable (usually lower) denture?
- Lower teeth have not been set in a “neutral” position over the ridge
- Tongue/muscles are interfering with denture “space” causing it to dislodge
How can a unstable lower denture be fixed?
- If mild may be able to adjust buccal or lingual surfaces of denture teeth
- May need to remove denture teeth, replace with wax and re-record bite. Send to lab to reset teeth
What can issues with vertical dimension cause?
- Pain over entire denture bearing area
- Pain/discomfort worsens as day goes on
- Struggling to speak – teeth clattering together
- TMJ/MOM pain
How can you fix reduced/ no freeway space?
- Take note of OVD with new denture in
- Remove denture teeth and add wax in their place (bite block)
- Re-record occlusion to a smaller OVD that is less than resting face height (generate freeway space)
What does trouble with sounds (s) usually mean?
Tip of tongue and palatal aspect of upper teeth not harmonious
How can you fix unharmonious tongue/palatal aspect?
- Add a small amount of acrylic on polished surface between upper central incisors (incisive papilla area)
- Remove teeth, replaced with wax, re-record occlusion and reset teeth
- Remake
How can retching be fixed?
- Reduce palatal extension
- Have multiple post dams if this is identified at assessment
- Warn patient of potential reduced retention
Why may a patient never accept dentures?
- Unrealistic expectation of dentures – plastic prosthesis
- Poor neuromuscular control
