The Post-Insertion Appointment Flashcards
post insertion (2)
all patients with new dentures should be appointed and seen 24-48 hours after insertion of the dentures
patient should wear the dentures for several hours prior to appointment to better evaluate mucosal irritations
patients who are seen for denture adjustment appointment — hours post-insertion do better with dentures
24-48
in many instances, the most crucial time in the patients perception of success or failure of dentures is the
adjustment period
—- may be the single most significant factor of CD under function
neuromuscular control
(2) are important prohnostic indications
tongue function
denture wearing experience
common problems w mand denture (3)
discomfort
poor retention and stability
lack of support
common problems w max denture (2)
poor retention and stability
esthetics and phonetics
post insertion 4 major areas
esthetics
phonetics
tissue irritations
loss of retention and stability
esthetics
vague complains about the dentures- pnt may be
unhappy w esthetics
the time to remedy esthetic problems is at the
trial placement appointment
most patients adapt and learn to speak with new dentures quickly unless
the teeth are improperly located in the vertical, horizontal or frontal plane
problems w phonetics (4)
check the thickness of the max palatal portion. a common problem is excessive thickness
reevaluate the position of the mac anterior teeth
if everything appears normal it may be a matter of time for the patient to adapt
open OVD
tissue irritations
sore spot may be far removed from its cause
tissue irritation causes (4)
overextension
trauma from faulty occlusion
pressure from the denture base
tissue abrasion from prosthesis movement
loss of retention and stability
many possible causes (6)
occlusion base contours teeth not in neutral zone posterior palatal seal overextension or underextension salivary flow and character
Post insertion (2)
Check occlusal contacts
Remount to adjust occlusion if error is detected
much of the selective grinding done in mouth according to articulating paper marks made actually — the amount of error in occlusion
increases
Post-insertion (2)
Remove dentures and evaluate palate and residual ridges throughout
Evaluate vestibular reflections for red areas
Post insertion appnt.
Ask patient to
point to area of soreness
Cotton tipped applicator (not their finger) –touch area
Address the most urgent area first
Soreness in depth of vestibule is usually caused by
overextended border
of flange.
Soreness in vestibule is usually caused by
overextended border of the
flange (due to an overextended final impression).
Sore on crest of ridge or ridge slope (2)
- occlusion error usually
- pressure spot (tray show through) in secondary impression
Frenal notch too (2)
shallow or sharp
Soreness of tissue overlying coronoid process –
too much thickness at
distobuccal corner of maxillary denture; PIP on cameo surface
Numbness or burning sensation in anterior palate –
pressure on incisive
papilla
Swallowing soreness (2)
Irritation at mylohyoid ridge
Retromylohyoid flange extension
Numbness or burning in lower premolar areas –
pressure over mental
nerve due to an atrophied alveolar ridge
Buccal mucosa at occlusal plane level (2)
- biting cheek - Increase horizontal overlap
- - trapping mucosa between bases
Teeth contact during speaking
OVD is too far open. Too little IOD
(freeway space). Ridges are sore due to constant pressure!
Dentures fit fine at first insertion, but loosen after wearing them for
3
or 4 hours –Occlusal errors likely
Maxillary CD dislodges when yawning or opening wide - -
DB corner too thick
Smiling causes maxillary CD to
dislodge
Denture flange too thick posterior to buccal frenum
Maxillary CD dislodges when eating
Suspect: (2)
posterior palatal seal too deep
Occlusion needs correction
Whistling with /S/ sounds
Anterior palatal contour(s) are incorrect. Uses PIP on the cameo surface
to check phonetics/tongue contact on the denture.
Dentures dislodge easier than
expected (3)
Overextension of borders-”toaster denture”
Form of external flanges
Teeth locations violating “Neutral Zone”
The “Neutral Zone”
That area where the forces applied by the tongue is equal or neutralized
by the force applied by the cheeks & lips
gagging may result from (6)
loose dentures
poor occlusion
incorrect extension or contour of dentures
incorrect teeth positions (too far lingual or occlusal plane too low)
an excessive OVD
psychogenic factors
Tissue trauma:
Manifests as: (4)
Hyperemia
Inflammation
Ulceration
Pain
zinc oxide paste (PIP)
used to detect improper adaptation
PIP spray
used in patients w xerostomia to prevent the PIP from sticking to the mucosa
Dry denture and brush thin layer of PIP on — surface.
intaglio
Spray with — if mouth is dry and insert denture.
separator
Dry the tissue and denture with —
gauze
Touch irritated area with indelible marker-
Thompson marker
Insert denture to transfer — to denture base
mark
Denture adjustment (3)
Acrylic resin cutters
#8 round bur
Scrapers (not used)
Smooth all adjusted surfaces with a
rubber wheel/point
Polish cameo surface & borders (lathe on SLOW SPEED) –
rag wheel
with pumice and then high shine
complaints about looseness (2)
denture may lack retention displacing forces (occlusion, muscle action) are significant enough to overcome normally adequate retention
lack of retention
disgnosed when
denture offers little or no resistance to removal along a path approx perp to occlusal plane
complaints
denture feels too large
feels like a mouthful
difficult to speak or eat
suspect:
tongue space is too small and dentures crowd the tongue, problem could be tooth position, denture base contours or both. think neutral zone
The Neutral Zone
“…..that area or position where the forces between the tongue and the
cheeks/lips are equal.” A zone of equilibrium.
