Patients Complaints Following Partial Denture Insertion

a) Soreness under the base

I- Pain or discomfort arising from the soft tissues or the underlying edentulous ridge
Nodules of acrylic resin on the tissue surface of the prosthesis. An excellent method of checking for roughness or small nodules of acrylic resin on the tissue surface is by passing the tip of the finger on the tissue surface of the denture.
Damage to the model resulting in prominence in the fitting surface of the denture. Uneven contact or premature occlusion may also result in pain or soreness under the base. Excessive displacement of the mucosa during impression making may lead to pain under the base. A high vertical dimension of occlusion will also result in pain under the base.

I- Pain or discomfort arising from the soft tissues or the underlying edentulous ridge
b- Redness, laceration or ulceration at the ridge area

Rough tissue surface of the denture: This condition will usually start as an area of slightly increased redness or translucency and then actual ulceration occurs. Presence of occlusal discrepancies or prematurities

When the ridge is covered by a thin atrophic mucosa.

IRRITATION OF THE PALATAL BEARING AREA

I- Pain or discomfort arising from the soft tissues or the underlying edentulous ridge
c- Soreness at the area of denture borders
This is usually encountered as an inflammatory or ulcerated area at the site of tenderness. The most common causes of this condition : Over-extension of the denture borders. Presence of sharp areas or roughness at the denture borders may be another cause. After reduction of the offending area from the denture borders, the surface must be re-polished perfectly. The common sites of peripheral soreness occur in the lingual flanges of lower partial dentures and buccally at the anterior end of lower partial dentures and also buccally in case of upper dentures.

I- Pain or discomfort arising from the soft tissues or the underlying edentulous ridge
d- Pain arising from a tooth or group of teeth:
This indicates that a continuous load greater than the physiologic limit of the periodontium is being placed upon the tooth or group of teeth concerned.

The retentive arm is exerting too much pressure on the tooth, which is not being adequately reciprocated, and thus excessive stress is applied to the tooth. In these conditions, the clasp arm is re-adjusted into its correct position. (disclosing wax will be helpful to pinpoint the area of metal or resin that requires relief)
Occlusal interference between the metal of the denture in one arch and a natural tooth in the opposing arch may result in pain (These areas can be determined using articulating paper or occlusal indicator wax strips).

II- Difficulties during mastication

Encountered in patients who lost their posterior teeth for many years and thus they lost the neuromuscular skills required to use the posterior teeth in grinding the food. These patients should be informed that a reasonable time is required to relearn the masticatory process. The patient taking too much food into the mouth at once or the use of sticky food during the early period of adjustment.

Lack of sharpness of artificial teeth. In this case additional sluiceways and grooves should be added to the occlusal surface to increase the cutting efficiency.
Unbalanced articulation or inefficient clasping of the denture can result in slight movement of the base away from the mucosa causing some difficulties during mastication. Food lodgment around the denture during mastication is annoying to the patient and is usually due to the denture movement during function or to an improper denture design.

III- Movement of the denture during function

When the retentive clasp tips were not adjusted properly into the retentive undercuts. (Use suitable pliers at the chair-side). Premature contact may result in denture movement during function. Over-extension of the base peripheries may result in denture movement during mastication especially in case of long distal extension bases. Improper positioning of artificial posterior teeth relative to the tongue or cheek muscles or encroachment of the lower teeth on the tongue space. This may occur in distal extension bases.

When the retention of the partial denture is partially dependant upon peripheral seal as in case of long class I upper denture, any deficiency in the peripheral extension may markedly affect the retention, particularly during mastication.

PAIN ASSOCIATED WITH MOVEMENT OF THE PROSTHESIS

BIOLOGIC FACTORS

If designed properly, the clasp should utilize both tissue systems without placing undue stress on either system.

IV-Difficulties during speech

Associated with the placement of maxillary artificial anterior teeth. If the teeth are not being placed far enough labially, the speech will be adversely affected. Also, the contour of the maxillary major connector over the rugae area (the anterior part of the palate) may also affect the speech. The position of maxillary or mandibular premolars too far lingually will impede the action of the tongue and thus, pronunciation will be affected. However, the placement of these teeth too far buccally, air will escape between the tongue and the teeth and whistling may result. Give reasonable time to adapt to the partial denture and to the position of artificial teeth (about one to two weeks). Reading aloud is one of the best methods in helping the patient to adapt to the partial denture. If speech disturbance continues, consideration should be given to repositioning of artificial teeth or decreasing the thickness and altering the contour of the palatal major connector.

V- Tongue or cheek biting

Lack of horizontal overlap Inexperience Lower occlusal plane too high Excessive vertical dimension

VI- Nausea or gagging

Overextension of connector/base Shallow posterior palatal seal Thick connectors Factors interfering with normal tongue position

GAGGING
1. Overextension of connector/base 2. Shallow posterior palatal seal 3. Thick connectors 4. Factors interfering with normal tongue position

VII- Excess salivation

Presence of the denture in the mouth will result in stimulation of the salivary glands. The secretion returns to normal after a short period of accommodation to the denture.

VIII- Teeth clattering or noise

This complaint may be due to a high occlusal vertical dimension and inadequate retention causing the denture to move during function and clattering against the opposing teeth. Uneven occlusion and presence of occlusal discrepancies may cause this problem. Acrylic resin teeth are usually less noisy in function than porcelain teeth

VIII- Burning sensation

This condition is a local manifestation of a general condition. It is common in females in the menopause stage. Sometimes the patient may be allergic to acrylic resin but this condition is very rare.

X- Appearance
This usually occurs due to insufficient care during the try-in stage specially if a large number of anterior teeth have been replaced. The bulk of the denture labially may cause the patient to feel fullness of the lips but the musculature may accommodate to the changed condition after a short time period

The meticulous replacement Of what is missing is far less Important than the perpetual Preservation of the remaining Structures. M.M. DeVan

CONNECTOR SHOULD NOT

Cause tissue impingement Interfere with moving tissues Extend into undercuts End on crests of rugae

FOOD COLLECTING BENEATH THE DENTURE BASE

CHEEK AND TONGUE BITING

1. Lack of horizontal overlap 2. Inexperience 3. Lower occlusal plane too high 4. Excessive vertical dimension