Common problems and treatment of complete dentures

Complete denture prosthesis is a more difficult type of restorative method in oral prosthetics. There many problems that are prone to occur clinically, affecting the restoration effect. Improper handling can even lead to restoration failure, and serious cases can cause damage to oral tissue structure and physiological. The problems that often occur in the early stage of wearing a complete denture include poor retention, pain, mucosal injury, articulation disorders, nausea, cheek biting tongue biting, etc., and after wearing a complete denture for a period of time, the above symptoms can still occur, in addition, mucosal ulcers, weakness, flattening of the lingual surface, denture-induced stomatitis, reduced vertical distance, TMD, etc. The causes of the above symptoms are multifac, can be various problems that arise during fabrication, or may be symptoms that gradually appear over time as a result of changes in the use of the denture. For example, the and treatment of poor retention in the early stage of wearing dentures and poor retention after wearing dentures for a long time are different. If the above symptoms or signs appear, different methods should be taken according to different causes, and these conditions can occur when wearing dentures for the first time or after wearing them for a period of time. Due to various reasons symptoms and signs may appear, and it is necessary to make timely modifications to protect the health of oral tissues and restore oral function. After full adjustment and proper fit, regular followup examinations should also be performed after wearing a complete denture, so that problems can be discovered and dealt with in time. This article will introduce the etiology, examination, and of the above symptoms. 1. Pain Due to the pressure of the denture on the tissue, the mucosa is red, swollen, and ulated, and the pressure pain is obvious. (1) Local problems on the tissue surface In areas with bone spurs, ridges on the alveolar ridge; on the lateral side of the upper jaw protuberance, upper jaw tubercle; on the lingual protuberance of the lower jaw, etc.; in areas with undercuts; in areas where the mucosa covering the lingual ridge of the lower jaw is thinner, etc., which are prone to tissue pressure injuries after force application. the denture is put on or taken out, the edge of the denture base often causes abrasions to the mucosa in the undercut area. Due to uneven during the taking of the impression or damage to the model, the tissue can often be scratched. Handling: apply gentian violet to the abraded or pressureinjured mucosa, dry the tissue surface of the denture, put it in the mouth, and show purple color on the tissue surface of the base corresponding to the pressureinjured area. Use a peach-shaped or wheel-shaped stone to grind a little of the tissue surface of the base where the purple color is, so that there is proper gap between the tissue surface of the base and the tissue. This treatment is called buffering. You can also use a pressure indicator paste to check the area where the tissue is and give it a buffer. (2) Base edge If the extension is too long or the edge is too sharp, the base at the tie area is notered enough, and the soft tissue can be red, swollen, ulcerated, or cut in the transitional fold, tie area, etc., and the mucosa can grayish white in severe cases. When the posterior margin of the upper jaw denture is too long and the distal lingual margin of the lower jaw denture is long, pharyngeal pain or pain when swallowing can occur due to tissue compression. It is easy to find during clinical examination, and the symptoms can be relieved by grinding excessive and sharp edges short and round, but it is not appropriate to grind too much to avoid destroying the edge sealing。

(three) Malocclusion The denture has early contact or interference in the central occlusion and lateral the distribution of tooth force is uneven, and a diffuse red irritated area is produced on the crest of the alveolar ridge or on the oblique surface of the ridge. on the top of the ridge, it is due to the early contact of the cusp with excessive pressure. If on the side of the ridge, it is due to the interference of cusp during lateral movement, sometimes away from the irritation. For example, in the central relationship, the second molar has early contact, which causes the mandibular denture to forward and the lingual side of the mucosa of the alveolar ridge of the anterior mandible to be ulcerated, which is often mistakenly considered to be by the excessive length of the lingual edge of the base. If the edge is ground short and the symptoms still exist, it is necessary to carefully check and analyze where the problem. During the examination, the mandibular denture is placed in the patient's mouth, and the doctor places the thumb and index finger of his right hand or index finger of both hands on the buccal side of the mandibular denture, so that the mandibular denture is fixed on the mandibular alve ridge, and then let the patient's mandible recede, close in the central relationship position, do not move when the upper and lower teeth of the patient touch, then bite tightly, if the doctor finds that the mandibular denture or the mandible has sliding or torsion, it indicates that there is an early contact point in the bite and the position of the early contact point must be found and removed to achieve dental balance. It can also be taken out of the mouth, the central occlusion wax record is taken and the upper and lower jaw dentures are fixed on the relationship support to select grinding and adjust. (four) Instability of denture During the functional movement the denture, many places of pressure and ulceration are formed in the mouth due to the instability of the denture. The reasons for the instability are that the edge of denture is stretched too long, the position of the tooth arrangement is incorrect, the mandibular relationship is incorrect, or there is interference of the cusp during lateral movement,. When the patient's denture has retention and displacement of the denture occurs during speech, it indicates that the denture is unstable. The force that causes the of the denture is: 1. The central relationship is incorrect and there are early contact points, especially early contact points between the second molars. 2. position of the artificial tooth arrangement is incorrect, the upper rear teeth are arranged too far towards the buccal side, which causes the upper denture to rock, the lower rear are arranged too far towards the lingual side, which affects the tongue movement, and the lower occlusal plane is too high, which affects the tongue to send food to the occl surface and causes the denture to displace. 3. Lateral, there is interference between the teeth.

4. Continuous pressure points on the alveolar ridge, with no obvious pain, should be considered to be errors the proximal relationship, mostly due to incorrect centric relationship, or early contact of teeth, causing discomfort and pain due to interference. When analyzing the cause of pain, careful differential diagnosis is needed. It is necessary to distinguish whether the pain is caused by local pressure on the tissue surface of the denture, or by friction caused by the movement of denture due to occlusal factors. The methods of differentiation include visual observation of whether there is any movement of the denture after occlusion, feeling whether there is any sliding twisting of the denture after occlusion by hand, and also using pressure indicator paste for examination. The specific method is to dry the tissue surface of the denture, apply a amount of pressure indicator paste on the corresponding tissue surface of the denture at the painful site, then put the denture in the mouth, and press it in place with the fingers After a while, take it out and observe whether there are traces of pressure indicator paste squeezed out. If there are traces of pressure indicator paste squeezed out and corresponding to the painful site it indicates that the pain is caused by local compression. Use a peach-shaped stone needle to buffer this part, dry it, and then apply a small amount of pressure indicator, put it in the mouth, and repeat the above process until there are no traces of pressure indicator paste squeezed out. If, when the pressure indicator paste is applied to tissue surface, put in the mouth, and pressed in place with the fingers, there is no trace of pressure indicator paste squeezed out after removal, it can be put in the mouth, and the patient is instructed to bite, then the denture is taken out, and there are traces of pressure indicator paste squeezed out at this site, indicating that the pain at site is caused by the slight movement of the denture after occlusion. It needs to be selected and ground to adjust the occlusion, and it can not be solved by localering. This method of differential diagnosis and treatment often produces immediate results. (5) Vertical distance is too high After wearing the denture, the patient feels pain or pressure in the alveolar ridge of the lower jaw, can not wear the denture for a long time, the muscles of the cheek are sore, and there is burning sensation in the palate. There is no abnormal manifestation in oral mucosa. This condition is mostly caused by too high vertical distance of the denture or night grinding of teeth The treatment method is that when the anterior tooth overlap is not large, the vertical distance can be reduced when rearranging the lower jaw posterior teeth, or the whole denture can be made again.

2. Poor retention Poor retention of a complete denture is more common in the lower, and there are many reasons for this. On the one hand, due to poor oral conditions of the patient, such as the alveolar ridge becoming flat due to absorption, mucosa is thin, the lips and cheeks are depressed inward, and the tongue becomes larger. In this case, the patient needs to persist in wearing the denture, and retention of the denture will gradually strengthen after adapting and learning to use it. On the other hand, it is due to problems with the denture itself, and the common phenomena as follows: (a) When the mouth is at rest, the denture is prone to looseness and detachment. This is due to the fact that the surface of the base does not fit closely with the mucosa or the base edge is not stretched enough, and the edge sealing effect is not good. This should be solved by the method of re-lining or extending the edge. (b) When the mouth is at rest, the denture retention is still good, but it is easy tolocate when opening the mouth, speaking, or yawning. This is due to the fact that the base edge is too long and too thick, the base edge in the area the lingual frenulum is not stretched enough to affect the movement of the frenulum, the position of the artificial teeth is not correct, arranged on the top of the alolar ridge on the labial or lingual side, affecting the movement of the surrounding muscles, and the outline of the polished surface of the denture is not good. The sympt treatment should be adopted, such as grinding the edges of the base that are too long or too thick, cushioning the base in the area of the lingual frenulum, forming outline of the polished surface of the base, or appropriately grinding part of the labial and lingual surfaces of the artificial teeth; reducing the width of the artificial teeth, etc. (c) The retention is still good, but the denture is prone to dislocation when chewing food. This is due to the imbalance of the bite, the interference of cusps, which causes the denture to rock and destroys the edge sealing. In the case of the lower jaw molar post, the base is too thick, and it into contact with or is close to the base of the upper jaw nodule. The upper jaw bite plane is low, and when the lower jaw extends forward, the posterior edges of upper and lower jaw bases come into contact, or the mesial buccal cusp of the upper second molar comes into contact with the lower jaw too early and the cusp interference or the base edge is ground short or ground thin. 3. Articulation disorders In general, when wearing a complete denture for the first time, theulation is often unclear, but it can be adapted and overcome very quickly. If the position of the artificial teeth is incorrect, it will cause unclear articulation or whistling. The for the whistling is that the posterior dental arch is narrow, especially in the area of the double-pointed teeth, which reduces the space for the tongue to move and limits movement of the tongue, causing a small air escape passage between the dorsum of the tongue and the palatal surface, and the palatal surface of the anterior part of the is too smooth, and the lingual surface of the anterior teeth is too smooth, which also causes whistling. Treatment method: Form the anterior part of the upper into the shape of a palatal fold and the papilla of the incisor, form the shape of the lingual surface of the upper anterior teeth with a protuberance, lingual fossa, and a lingual expansion gap. A few patients have the tip of the tongue against the lingual surface of the anterior part of the lower base when pron the "S" sound, and the tongue body is against the upper palate, forming an air escape passage. If the lower anterior teeth are arranged too inclined toward the lingual side the tongue arches higher, which can reduce the air escape passage and also cause whistling. If the lingual side of the anterior part of the lower base is too thick, will also cause unclear pronunciation of the "S" sound. Modification method: The lower anterior teeth can be slightly inclined labially, and the lingual side of lower base can be thinned out to increase the space for the tongue to move.

Four, Nausea Some patients often experience nausea, even vomiting, when they first wear dentures. The reasons are that the posterior margin of the upper denture is too long or the posterior margin of the denture base does not fit closely with the oral mucosa. Nause can be caused by saliva stimulating the mucosa; when the upper and lower incisors come into contact, but the cusps of the posterior teeth do not, and posterior end of the denture bounces and stimulates the mucosa, it can also cause patients to feel nauseous; if the posterior margin of the upper denture base too thick, and the distal lingual base of the lower denture is too thick and presses the tongue, it can also cause nausea; patients in menopause are also to experience symptoms of nausea when wearing dentures. Modification method: The posterior margin of the base should be shortened according to the specific situation. If the posterior margin does fit closely with the mucosa, it can be rebounded with room temperature cured plastic to strengthen the sealing effect of the posterior margin of the upper lock denture, and adjustment method can eliminate the early contact point. Modify the thickness of the upper and lower jaw denture base. Five, Bite Cheek, Bite Tongue When the posterior teeth are missing for too long, the cheeks are depressed inward, or the tongue body becomes larger, which can cause biting the cheeks or biting the tongue. After for a period of time, it often can be corrected by itself. Thickening the buccal base may be necessary to push the cheek tissue outward if necessary. the posterior teeth are arranged too narrowly and biting the cheeks or biting the tongue occurs, the buccal cusp of the upper posterior teeth and the buccal cusp of the lower teeth can be modified to increase the overhang, which can solve the problem of biting the cheeks. Modify the lingual cusp of the upper posterior teeth and the buccal of the lower posterior teeth to solve the problem of biting the tongue. Sometimes the soft tissue of the cheek is also pinched between the upper and lower jaw base plates at site of the upper tuberosity and the molar post, in this case, the base plate can be thinned, and the gap between the upper and lower base plates can increased, and the base plate does not need to be shortened. Six, Poor Masticatory Function The reason for poor masticatory function of complete dent often lies in the small contact area between the upper and lower jaw teeth, or in the process of adjusting the bite, the functional occlusal anatomy shape is worn away. Due to low vertical distance, patients feel that they cannot exert force when eating, and eating is slow, etc. The modification method is to increase the contact area of the functional surface by adjusting occlusion, and to form a sharp concave anatomical shape and a food discharge channel. If the vertical distance is not enough and the height of the denture needs to increased, the central incisor record can be taken, and the upper and lower jaw dentures can be fixed on the stand according to the central record and re-arranged, the complete denture can be completed again.

7. Influence of Psychological Factors Patients believe that after wearing complete dentures, they should be able to speak and eat any problems, just like natural teeth. However, after wearing dentures, it often does not match the patient's original imagination completely. When wearing dentures for the first time they are prone to looseness and displacement, and cannot be used for eating, with unclear pronunciation and excessive saliva. Patients will think that the doctor's technology is good, and compare with other patients wearing complete dentures, which are very useful, and require the dentures to be redone. In this case, the doctor should carefully check there is any problem with the complete denture. If there is a defect, it should be carefully modified. If the patient is not adapted or does not know how to use theure, it should be patiently explained, or a patient who has worn a denture should be invited to talk to the patient to persuade him. Complete dentures are a treatment method requires the participation and cooperation of patients. The active use, active practice, and patience of patients are very important.