Post-insertion complaints

and management in
complete denture patients

Compiled by:
Nupur kapoor
B.D.S final year
Roll No.46
 Appointment schedule

According to Boucher:
An appointment for 1 to 3 day adjustment should be made routinely .
Subsequent appointments should be made during the first few weeks
because during this time the acrylic resin absorb water and saliva,
which may lead to a dimensional change of 1 to 3 % and can alter the
relationship of the cusps inclined plane . This can result in small
changes in the size and shape of the dentures .

According to Sharry:
First appointment : 10 days after the placement appointment
“the patient is told that he has much to gain if subsequent adjustments
are kept to a minimum ,and that many pressure areas will disappear
automatically following continued wear. If a sore spot persists for three
days, he should call for an appointment.”
2nd appointment: 3 weeks from the first
3rd appointment: 6 weeks after the second
4th appointment: 3 months after the third
Examination Procedures
The sequence of examination
Visual and digital examination of oral
mucosa –
Maxilla – labial and buccal vestibules,
hamular notches
Mandible- labial and buccal vestibules
lingual vestibules
After attending to the patients chief
complaint
Occlusal examination
Classification of Post-Insertion Denture
problems:
According to MORSTAD & PETERSON

Complaints about comfort of the denture:

•Sore spots
•Burning sensation
•Redness
•Pain in TMJ
•Tongue & cheek biting
•Swallowing & sore throat
•Nausea & gagging
•Deafness
•Fatigue of the muscles of mastication.
 Complaints about function of the denture:

•Instability or poor fit

•Interference
1.When swallowing
2.Clicking

Complaints about esthetics:

•Fullness under the nose

•Depressed philtrum or naso-labial sulcus
•Upper lip sunken in
•Too much of teeth exposed
•Artificial look
Complaints about phonetics:
•Whistle on “S” sounds
•Lisp on “S” sounds
•Indistinct “TH” & “T” sounds
•“T sound like “TH”
•“F” & “V” sounds indistinct
 Discomfort related to the error in occlusion
Signs/symptoms- Soreness on the
crest of the residual ridge or
slopes of the residual ridge
Cause- Pressure created by heavy
contact of opposing teeth in the
same region or shifting of the
denture bases due to deflective
occlusal contact
Treatment- Observe the occlusion
carefully in the mouth and on
the articulator and correct it.
Heavy balancing side
contacts may cause rotation of
the mandibular denture base
and should be removed.
Signs/symptoms -Pain on eating

Cause –anterior prematurity

- Posterior prematurity
- Incisal locking
- Lack of balanced occlusion

Treatment- Ask the patient to close slowly in RCP and

watch for slide into ICP .
Adjust occlusion by selective grinding .
If severe error are present reset using facebow and new
inter-occlusal records.
 Signs/symptoms- Pain or ulceration lingual to the
mandibular anterior ridge

 Cause - protrusive slide from RCP to ICP

 Treatment- Mark deflective inclines of posterior teeth

with articulating paper; these will be the mesial
slopes of the maxillary buccal cusps and the distal
facing slopes of the lower buccal cusps.
Signs/symptoms: Pain at the peripheries of
dentures, in depth of sulci, in muscles of
mastication e.g. masseter and posterior
fibres of temporalis, pain intensify as day
progresses

Cause- Excessive vertical dimension of

occlusion

Treatment- If the excess VDO is less than

1.5mm, grind to provide adequate freeway
space.
If it is more than 1.5mm, re-register and
reset at new vertical dimension of
occlusion.
Provide free way space commensurate
with age and functional capability of patient.
Signs/symptoms: Cheek or lip biting
Cause - Insufficient overjet
This problem may also occur in patient with
flaccid cheeks e.g. following stroke
Treatment- Round appropriate buccal cusps of
mandibular molar to provide suitable buccal overjet.
For lips, mark trip line on lower incisors and grind to
give more appropriate incisal guidance angle
Cheek support need to be increased in
some patients to ensure tooth placement in harmony
with function
Signs/symptoms: Tongue biting
Cause - Teeth generally placed lingual to lower ridge

Treatment - Grind the mandibular lingual cusps

In case where tongue is large, use posterior cross-bite or
place narrow posterior teeth
Signs/symptoms: Dentures are tight first but loosen
after several hours – this problem may develop 1to 3
day of insertion, it is more likely to be seen a little
later

Cause - Deflective occlusal contact

Treatment- Corrected after new interocclusal records

are made, the dentures are remounted and the
occlusion is adjusted on the articulator
A collection of calculus on the teeth on one side of the
denture also indicates the need for correcting the
occlusion.
Discomfort related to the error of
impression surface
Signs/symptoms: Pain when dentures are
removed and/or inserted
Cause- Denture base not relieved in the
area of undercut
Management-Use disclosing material on
localized area of denture and relieve
denture in the region of wipe off .
Or place the disclosing material over
ulcerated or erythematous area and pick
up material on offending area of denture
and relieve it.
 Pressure indicator paste should be used to evaluate
pressure areas on the basal surface, regardless of
whether sores or ulcerations are evident. When pressure
areas are found, they need to be adjusted and the entire
denture disclosed again, additional pressure areas will
present and need relieving.
 Use of indelible pencil placed on the ulcerative tissue as
pressure transfer should never be used as the only
means of tissue recall evaluation. Only focusing on the
acute problem will more likely to move the pressure to
another area of the denture , causing another acute ulcer
later

Pressure spot represents the part of the denture

base that is placing excessive pressure on the
buccal shelf.
Signs/symptoms- Soreness or ulceration on the denture bearing
area
Cause - Pressure areas arising as a result of
-faulty impression ,
-Damage to working cast,
-Warpage of denture base during processing
Treatment - Use pressure indicating paste to locate pressure area
and relieve denture
If upon examination the mucosa underneath the denture base is
found to be inflamed, the patient should be questioned
concerning
1 nocturnal wear of dentures
2 incising with the anterior teeth
3 use of resistive food
A definite inflammation pattern is found when patient incises with his
artificial anterior teeth. The posterior palatal area (post dam area)
and the anterior ridge region will be found inflamed.
When inflammation is found without an obvious reason , bruxism
should be suspected .
Signs/symptoms: Denture lifts when
tongue is protruded, ulcers on
mucosa overlying mylohyoid ridge
or pain during swallowing
Cause -Overextension of lingual flange
Treatment-Use disclosing material to
identify the position and extent of
over-contour and relieve
appropriately . Thoroughly polish
the trimmed acrylic .

Signs/symptoms: Soreness and lesion

on the mucosa lining the
retromylohyoid region
Cause –Excessive length and pressure
from the denture base.
Treatment- Both the flange and the
basal surface will require
adjustment.
Signs/symptoms: Lesions in the hamular
notch region and difficulty in
swallowing and sore throat
Cause - Post dam too deep, or the
denture base too long
Treatment- Relieve the post dam
appropriately
Following are the three steps to evaluate
the post dam with pressure indicating
paste –
1. One notch with adjustment
2. The other notch with adjustment
3. Denture surface with adjustment
This will minimize making an error in
reading the pressure paste and over
reducing the seal. The remainder of
the border are shortened and
rechecked with paste again.
Discomfort related to polished surfaces
 Pain felt at the posterior
aspect of the maxillary
denture , associated with
opening movement
or denture becoming loose on
opening wide
Cause - Flange too thick and
constraining coronoid process
Treated by disclosing the
offending area on denture
periphery, relieving as
required and repolishing
Loosening of the maxillary
denture while smiling
indicates excessive thickness
or height of the flange of
maxillary denture in the region
of the buccal notch or distal to
the notch .
Discomfort related to systemic conditions

Signs/symptoms: Burning sensation over maxillary

denture supporting tissues, e.g. tongue
Cause -Burning mouth syndrome often seen in
middle aged or elderly females. Also general
organic and psychogenic factor
Treatment- Correction of any denture faults,
multivitamin/nutrition advice and counseling
Signs/symptoms: Beefy red tongue and glossodynia
Cause - Vitamin B 12 / folate deficiency
 Refer for medical treatment
Signs/symptoms: Frictional lesions related to
dentures, mucosa may adhere to probing finger,
may be complaint of dry mouth xerostomia.
Management : Where some saliva flow is
present, sugar free citrus lozenges may help.
When obvious paucity of saliva, artificial saliva
may be considered
Signs/symptoms: Painless erythema of mucosa
related to support of maxillary denture, may be
accompanied by angular cheilitis
Cause - Denture related stomatitis .
Often has frictional element due to ill fitting
denture plus opportunistic candidal infection,
occasionally related to iron or folate deficiency
Treatment - Leave denture out until condition
clears, correct denture faults
Signs/symptoms: Tongue thrusting and empty mouth
chewing

Cause - May have psychological or neurological

aspects

Treatment- Difficult to manage.

Treatment may include occlusal adjustment and or
occlusal pivots
Signs/symptoms: Painful click related to TMJ on
opening and closing mouth and or tenderness of
muscles of mastication

Cause - TMJ pain dysfunction syndrome may be

related to rapid change on OVD,
psychological problem or
general joint disease

Treatment - If denture faults present careful

adjustment with special care to register the vertical
dimension
Problems in relation to the adaptation

Noise on eating and speaking :

May be apparent on first insertion
or may appear as alveolar resorption occurs and denture
loosen
Cause- Unfamiliarity with new appliance
Excessive vertical dimension of occlusion
Occlusal interference
Too great incisor overlap
Loose dentures
Treatment - Reassurance,
Free way space should be sufficient to preclude
tooth contact during speech
Gagging
Cause – Loose dentures.
Thick distal border of maxillary denture ,
Lingual placement of maxillary
posterior teeth
or low occlusal plane causing
contact with dorsal aspect of tongue
inadequate posterior palatal seal or
Overextended border of
improperly extended border of maxillary
a maxillary denture
denture. caused patient to gag
Treatment - modeling compound can be
added to reshape this part of the maxillary
denture ,
psychological assesment if
indicated, or condition appliance for home
use.
Uncommon Complaints
 Whistling –
Cause – may be unfamiliarity with the new denture
Treatment – usually disappear as the patient
becomes adept in handling the denture
If problem persists the upper denture should be
examined to determine whether the vault of the
palate is too high.
Lowering the palatal contour
 Earache – it is probably TMJ pain due to
prematurity associated with excessive vertical
opening
 Difficult swallowing –
May be due to overextended
peripheral contours or
increased vertical
dimension
May also be due to decreased
salivary flow.
Pain is usually not associated
Excessive length and pressure
with this condition and the from denture base leads to
patient can minimize this soreness on swallowing and the
difficulty by an increased feeling of sore throat
fluid intake.
 Loss of taste sensation-
Cause – in elderly patients because of the atrophy of the taste
buds
Treatment – patient should be told that the most of the taste buds
are on the tongue and are not covered by the dentures.
A cast metal plate, because of the rapid transfer of heat, often
enhances the sensation of taste.

 Peculiar taste –
Cause- poor oral hygiene
A vigorous program of cleaning the dentures, mucosa , and
tongue several times daily will solve the problem in few days
Certain diseases may alter the taste sensation e.g.
fusospirochetosis, (rare in edentulous patients) produce
metallic tastes
Salty taste may result from draining cyst or hemorrhage .
 Food under dentures-
There is no satisfactory solution to this problem. Most
commonly encountered during the initial period of
adaptation.
 Saliva under the dentures –
May be because the mucous glands in the posterior of
the palate are stimulated because of the dentures.
Management – ask the patient to remove the denture
frequently and rinse the palate with ice water.
 Dislodgement of denture on sneezing-
A forceful blast of air on the posterior border can conceivably
dislodge the most retentive denture.
 Drooling at the corners of the mouth –
Due to decreased VDO
If VDO is correct thicken the labial flange of the mandibular
denture in the area of modiolus.
 Dull teeth -
Patient which lacks neuromuscular skill will complain that the
teeth are dull when actually they are sharp. Speech in
such patients is poor with slurring of words.
Rehabilitating these patients take time and they need to be
counseled a lot .
 Tingling of lower lip –
Seen where the mandibular ridge is extremely resorbed.
Pressure placed on the area where mental nerve emerges
from mandibular canal causes tingling and mild
paresthesia of the lower lip.
Relieve the denture in the area of the mental foramen.
Instructions to the Patients
 Appearance with the new denture-
Repositioning of the orbicularis oris muscle and a
restoration of the former facial dimension and
contour by the new dentures may seem like too great
a change . This can be overcome only with the
passage of time .
 Mastication with the new dentures-
Learning to chew satisfactorily with new dentures usually
require at least 6- 8 weeks.
The muscles of the tongue, cheeks and lips must be trained
to maintain the new dentures in place on the residual
ridges during mastication.
Patients are instructed to chew on both sides of the mouth
at the same time, by doing so tendency of the dentures to
tip will be reduced.
When biting , the patients should be instructed to place the
food between their teeth toward the corners of the mouth,
rather than between the anterior teeth. Then the food is
pushed inward and upward rather than downward and
outward as done with natural teeth.
 Oral hygiene with dentures-
Once a day, it is essential that the dentures be removed
and placed in a soaking type of cleanser for a
minimum of 30 min
 Preserving the residual ridges-
Patients are advised to remove the denture and rest the
mouth for some time. Dentures must be left out of
the mouth at night to provide needed rest from the
stresses they create on the residual ridges.
Periodic Recall for Oral
Examination
 Patients with some of the more difficult problems
should be scheduled for appointments periodically,
at 3 or 4 months interval.

 A 12 month interval is the suggested time between

recall appointment for most patients with complete
dentures.
Conclusion

Resolving the post insertion

problems associated with the prosthesis
plays an important role in success of a
prosthodontic treatment.
References
•Winkler S: Essentials of complete Denture Prosthodontics. Second
Edition,India 1996,A.I.T.B.S Publishers.

• Manappallil JJ: Complete Denture Prosthodontics. First Edition,India

2004,Arya Publishing House.

• Rahn AO, Heart well CM: Textbook of Complete Detures. fifth edition,
London1993, Lea and Febiger Publication.

• Zarb GA, Bolender CL, HickeyJC, CarlssonGE: Boucher’s

Prosthodontic treatment for edentulous patients. Twelfth Edition, India
2004, Mosby Inc.

•SharyJJ: Complete Denture Prosthodontics. Third Edition, NewYork

1974, Mcgraw Hill– Book Company.

• Morstad AT, Peterson AD: post insertion problems

J Prosthet Dent 1968 :19 ;126-132.