Tutorial 8 - Insertion

Question 1

Before inserting the dentures (final fitting), have a careful look at them and at the master casts for any potential problems.
What problems may you identify?

Answer 1

Sharp edges on the acrylic work.

Acrylic resin covering the metal guide planes.

Damage to the cast, such as scratching and glued on teeth.

Acrylic pearls (blobs) on the fit surface - should be adjusted prior to trying in the denture

Question 2

Once fully seated, is there anything else that you need to check?

Answer 2

Occlusion – how will you check this?

Appearance

Comfort – does the patient feel any discomfort - if so it will only get worse unless you correct it.

Retention – how will you check this?

Question 3

How will you know whether the denture is fully seated?

Answer 3

Visual inspection

Occlusal contacts - use articulating paper

Pressure indicating paste for soft tissues

Patient feedback

Functional movements test - asp pt to speak, swallow, open and close etc.

Question 4

What are the possible causes of an unretentive partial denture?

Answer 4

CLASP - inadequate engagement of the terminal 1/3 of the clasp wth the undercut on the abutment/clasped tooth

CLASP - insufficient flexibility

CLASP - distortion

Incorrect guide plane preparation

Insufficient undercuts for abutment teeth

Poorly designed rests and reciprocation

Inaccurate impressions caused improper seating

Occlusal interferences may cause dislodgement

Flanges not extended far enough into the sulcus

Insufficient saliva production - especially for maxillary

Question 5

If your patient complains that they do not like the appearance of their new denture, what will you do?

Answer 5

1. Remain calm and professional - it is understandable that the patient is not happy as they see their face every day
2. Ask the patient why they do not like the denture
3. Manage expectations
4. If they do not like the shade of the teeth, they can be replaced??

It is important to note that during the trial insertion stage the teeth were set in wax so the patient should have brought up any concerns at that stage if they had any.

DO NOT TRY TO CONVINCE YOUR PATIENT THAT THEY WILL LIKE THEIR DENTURE - THEY WILL NOT!!

Question 6

Give your patient denture care instructions – what will these include?

Answer 6

Avoid sleeping with them ideally

Keep them clean!! Includes rinsing them after meals and using a soft denture brush.

AVOID any hypochlorite cleaners to CO-CR - can cause corrosion! Also dont use abrasive toothpaste or hot/boiling water

Keep them wet when not wearing!!!

Question 7

How to clean dentures?

Answer 7

Use soft bristled tooth brush and soap twice per day and after meals as necessary

Can use denture cleaning tablets in a container too but remeber to rinse them before replacing in mouth!! Reiterate that this must be used EXTRAORALLY!!!

Examples are STERADENT for Co-cr and DENTURAL for acrylic (dont use on cocr as has hypochlorite)

Question 8

How can denture stains be removed by patients themselves?

Answer 8

Can use proprietary cleaners to remove staining - follow manufacturers instructions

Question 9

What cleaners should be avoided for Co-Cr dentures?

Answer 9

Hypochlorite containing cleaners may stain / corrode metal-based dentures .
Also avoid hot/boiling water as can distort the denture.

Question 10

Why do we need to arrange a review appt?

Answer 10

Assess patient satisfaction
Assess fit and comfort - irritation, spots, ulcers, pain
Evaluate occlusion and function - if incorrect, could compromise the natural teeth and prevent eating
Monitor soft tissue health - plan for future adjustments or relining if needed
Reinforce denture hygeine and maintainance