Management of RPD Problems at Review

Question 1

What are the two components of a diagnosis?

Answer 1

good patient history
thorough examination

Question 2

When does the review appointment happen?

Answer 2

1-2 weeks after delivery

Question 3

What are the common issues?

Answer 3

• Pain
• Retention
• Occlusion
• Vertical Dimension
• Patient acceptance

Question 4

At what points during impression taking, can things go wrong?

Answer 4

• Size/type of tray
• Material selected
• Not surveyed
• Poor design

Question 5

What does an inaccurate impression affect?

Answer 5

poor fitting special tray
poor master impression
poor fit of denture

Question 6

At the tooth trial, what should be assessed?

Answer 6

• Occlusion
• Tooth position
• Over/under extension
• Appearance (shade, mould, buccal corridors)
• Record in notes

Question 7

What factors of the fit should be assessed?

Answer 7

• Correct denture
• Roughness/blebs
• Undercuts – difficulty/pain inserting/removing
• Over-extension - only to functional depth of sulcus
• Fraenal relief
• Muscle attachments
• Occlusion
• Speech

Question 8

What should you check if patient is in pain?

Answer 8

• 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

Question 9

Why would there be pain on insertion/removal of denture?

Answer 9

Acrylic is rubbing against patient’s mucosa

Question 10

How can acrylic rubbing be fixed?

Answer 10

• 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

Question 11

Why would there be denture digging in?

Answer 11

Overextended peripheries impinging on muscle attachments

Question 12

How can you fix denture digging in?

Answer 12

• 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

Question 13

Why would patient complain of pain with/out ulceration on or around fraenum?

Answer 13

• Acrylic encroaching on fraenal attachment
• Inadequate space for fraenum

Question 14

How can pain in fraenal attachment be solved?

Answer 14

• Make fraenal relief more pronounced
• Re-insert denture and check fraenum has space to move

Question 15

What is pain on biting due to?

Answer 15

Occlusion incorrect causing pressure points in certain areas

Question 16

How can pain on biting be fixed?

Answer 16

• Use articulating paper to identify “high spots”
• Use an acrylic trimming bur to reduce
• Recheck and repeat as necessary

Question 17

Why would the denture dislodge when eating/speaking?

Answer 17

Flanges overextended and impinging upon muscle attachments – when muscles move denture gets in the way and dislodges

Question 18

How can denture dislodging be fixed?

Answer 18

• Check for overextension
• Manipulate muscles/use pressure indicating paste
• Relieve with acrylic bur in straight handpiece

Question 19

Why would the denture not feel “tight”?

Answer 19

• Clasp tip not contacting enough with tooth surface

Question 20

How can you fix the clasp?

Answer 20

• 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?

Question 21

What tool is used to fix clasps?

Answer 21

adam pliers

Question 22

Why would the denture dislodge due to occlusion?

Answer 22

Early occlusal contact – occluding on this causes the denture to tip around this point – dislodges

Question 23

How can early contacts be fixed?

Answer 23

• Identify early contacts with articulating paper
• Selectively grid these chairside with acrylic
• Recheck

Question 24

Why would there be an unstable (usually lower) denture?

Answer 24

• Lower teeth have not been set in a “neutral” position over the ridge
• Tongue/muscles are interfering with denture “space” causing it to dislodge

Question 25

How can a unstable lower denture be fixed?

Answer 25

• 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

Question 26

What can issues with vertical dimension cause?

Answer 26

• Pain over entire denture bearing area
• Pain/discomfort worsens as day goes on
• Struggling to speak – teeth clattering together
• TMJ/MOM pain

Question 27

How can you fix reduced/ no freeway space?

Answer 27

• 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)

Question 28

What does trouble with sounds (s) usually mean?

Answer 28

Tip of tongue and palatal aspect of upper teeth not harmonious

Question 29

How can you fix unharmonious tongue/palatal aspect?

Answer 29

• 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

Question 30

How can retching be fixed?

Answer 30

• Reduce palatal extension
• Have multiple post dams if this is identified at assessment
• Warn patient of potential reduced retention

Question 31

Why may a patient never accept dentures?

Answer 31

• Unrealistic expectation of dentures – plastic prosthesis
• Poor neuromuscular control