Complications in Patients
with Complete Dentures
adams CASTRO OKANDA
BDS 4
Objectives
• To describe the complications associated with long term denture use,
• Signs and symptoms that frequently prelude an adaptive complete denture
experience
Complications associated with Long term Denture use
• to assess satisfaction and prosthetic complications an experienced clinician should differentiate
between iatrogenic (denture faults like overextension of denture borders) and patient factors
(atrophy-based).
• loss of retention is the most frequent prosthetic complication, followed by mucosal irritation (in
terms of patient number):
- 85.9% - Loss of retention
- 44.2% - Ulceration
- 31.4% - Loss or fracture of artificial teeth
- 27.5% - Denture base fracture
- 8.3% - Denture stomatitis (Newton Types 1 and 2) (1 is localized pinpoint inflammation,
hyperemia; 2 is more diffuse erythema, all mucosa covered by denture.
- 4.2% - Epulis fissuratum
- 1.2% - Inflammatory papillary hyperplasia (Newton Type 3)
Loss of retention
-Retention and stability are negatively influenced by short denture borders.
Extension of the posterior borders can result in excessive pressure,
swallowing difficulties and even sore throat. Short and long borders are
often caused by inadequate molding of the periphery at the impression stage.
-wearing dentures that are more than 10 years old result in mucosal changes
and call need for denture replacement.
Ulceration
-morphological changes and the reduction of residual ridges occurs in long-
term wearers and when the fit is not exact, the forces are not distributed over
the greatest possible surface of the bone, but are concentrated on certain
spots and can cause ulceration.
Denture stomatitis & Inflammatory papillary hyperplasia
-inflammatory reaction (palate), - related to the wearing of dentures and
involves: -yeast (superimposed), mechanical trauma or allergic contact
reaction. Newton’s type I and Newton’s type II.
-Inflammatory papillary hyperplasia (Newton type 3) is localized, nodular
on central hard palate and alveolar ridge.
Epulis fissuratum
-a benign hyperplasia of fibrous connective tissue which develops as a
reactive lesion to chronic mechanical irritation produced by the flange of a
poorly fitting denture (continued resorption creates longer mandibular
denture borders over time, causing the denture borders to thrust into the
underlying soft tissue, resulting in low-grade trauma).
Loss or fracture of artificial teeth
-Fracture on dislodgement of one or more teeth from denture base.
-Debonding, Trauma? -result of residual wax on the surface or cross-linked
teeth that are incompatible with the particular denture base polymer,
preventing effective chemical union.
Denture base fracture
-Failure of the denture base (dentures about 3yrs old):
-Fracture types: -midline, multiple, cracks in the denture.
-Midline fracture of an acrylic denture: -may occasionally result from
careless handling by the patient (accidental dropping of the denture while
cleaning).
Patient Recall and follow-up
-The progressive long-term deterioration of dentures is not invariably
associated with a complaint, because adaptive changes can occur and a
tolerance can develop which allows patients to continue wearing the
dentures (insidious).
-tissue damage, reduction in RVD and the adoption of abnormal
mandibular postures create problems for both the clinician and the
patient.
Complete Denture Adaptive Experience
• it is true that older individuals take longer to adapt to new dentures but various
other factors may predict a patient’s dissatisfaction with dentures.
• studies show that the technical quality of dentures is certainly important, but
medical and psychological factors are also considered to be contributory.
Most frequently experienced signs and symptoms include:
- Noise on eating/speaking (OVD++)
- ‘Jaws close too far’ (OVD - -)
- ‘Cannot open mouth wide enough’ (OVD++)
- Eating difficulties
- ‘Blunt teeth’ (PICTURE)
Complete Denture Adaptive Experience
-Speech problems
-Gagging
-Appearance
-Too much visibility of teeth
-Creases at corners of mouth (OVD)
-Colour of denture base material ’unnatural’
Complete Denture Adaptive Experience
Adaptive Experience -challenges
Pain during Adaptive period
Pain
References
1. Journal of Oral Science, Vol. 55, No. 1, 29-37, 2013
2. Romanian Journal of Oral Rehabilitation Vol. 9, No. 2, April - June
2017
3. Prosthetic Treatment for Edentulous Patients, 13th Edition, Zarb H
and Eckert J.
4. BRITISH DENTAL JOURNAL, VOLUME 189, NO. 3, AUGUST
12 2000