Patient Complaints &

Adjustments of the RPD

Patient Complaints .

Adjustments .

1. Pain or discomfort arising from the hard & soft tissue of

the edentulous ridge .

2. Soreness of one or more teeth .

3. Miscellaneous :

A. Instability of the prosthesis .

B. Cheek or tongue biting .

C. Speaking difficulties .

D. Eating difficulties .

Laceration or ulceration :

Generally produced by overextension base.

Complaints :

Soreness \ irritation may or may not associate with

discomfort .

Diagnosis :

Areas displaying redness or translucency just before

ulceration start .

Degree of overextension can be determined by visual

examination .

With the prosthesis in position , the cheek should be

manipulate in downward, outward, upward and in

anteriosuperior direction .

If the denture border overextended , tissue border

movement will be impeded .

If interference with tissue movement and a change in soft

tissue are evident , the denture flange must be reduced .

Overextension of the denture base in the lingual aspect

of the mandibular edentulous ridge maybe identified and

confirmed by manipulation of the patient tongue .

A forward or lateral thrust of the tongue usually will

disclose the location of the overextension .

Another method is using disclosing wax , but using with

caution .

Using of PIP is not generally indicated.

Dependable method for identifying an overextension is

through use indelible pencil.

Border extension is corrected with lab bur or an arbor

band.

Warm saline mouth wash.

No local anesthesia if patient

is seen in 24h.

Erythema ( Redness ) :

Generally caused by roughness of the denture base .

An excellent method of identifying irregularities on surface

is by passing fingertip or gauze pad over tissue surface

(observing snagging of gauze ) .

Redness may also cause by occlusal discrepancies or

prematuraties.

The lack of occlusal disharmony is the greatest factor in

prosthesis related discomfort .

After soft tissue irritation has been eliminated , teeth that

are in contact with the prosthesis should be evaluated.

With prosthesis out of mouth , mesial ,distal, buccal and

lingual pressure should be applied to the remaining

natural teeth. Pressure can be best applied using index

finger of each hand .

if the prosthesis has exerted undesirable forces on one

or more teeth, a painful response will result .

If patient is seen within 24h of delivery, he may not be

aware of discomfort until finger pressure is applied.

If a longer time has elapse , tooth or teeth may be painful.

Leave the prosthesis out till discomfort is over.

Later adjustment should be carried .

Using disclosing wax .

Wax will displace from area

causing pressure .

If soreness is not cause by pressure from RPD the next

obvious cause can be occlusal trauma .

One of the most common cause of discomfort for RPD is

occlusal interference between natural tooth in one arch

and a metal of the prosthesis in the opposing arch .

It is often difficult to identify articulating paper marks on

highly polished metal.

The surface of the metal may be roughened using a fine

stone or airborne particle abrasion system.

Articulating paper marks are readily identified on a

roughened surface.

Adjustments are made using a multifluted bur in a high-

speed handpiece.

Articulating paper is commonly used to locate area of

interference .

Rest and clasp should be at least 1mm thick .

1. Gagging .

2. Problems with Phonetics .

3. Cheek or Tongue biting .

4. Difficulty of Chewing .

5. Loose Denture .

Definition :

Is a reflex contraction of the back of the throat, evoked by

touching the roof of the mouth, the back of the tongue ,

the area around the tonsils and the back of the throat .

Causes :

Poor adaptation , can be due to :

1. Failure to modify the stock tray before making maxillary

master impression .

2. Faulty impression technique .

By using indelible pencil to mark the metal of the posterior major connecter border .

The prosthesis seated in the oral cavity .

The posterior border is transferred to the palatal tissue, evaluate the posterior border .

Shorten the overextended posterior border using a heatless stone in low speed handpiece or laboratory engine .

The bead line of the major connector which prevent the food impaction between the major connector and the palatal tissue may be loss during adjustment, which necessitate making new RPD .

When artificial teeth in the premolar area placed too far

palataly may interfere with the speech .

Correcting the placement of the artificial teeth will correct

the phonetics difficulties .

If these teeth are positioned too far facially, air may

escape between the tongue and teeth and a whistling or

slurring of the speech may occur.

If the latter error is present, soft utility wax adapted to the

lingual surfaces of the premolar teeth should decrease

the escape of air and the whistling or slurring effect .

Causes :

Cheek biting is usually caused by insufficient horizontal

overlap of the maxillary and mandibular posterior teeth.

Another contributing factor is the long-term absence of

posterior teeth. In this situation, the buccinator muscle

may sag into the space created by the missing teeth .

Cheek biting resulting in linear ulceration in the buccal

mucosa .

Cheek biting may be minimized by rounding the

mandibular buccal cusps .

Tongue tend to flattened and broaden when there are no

posterior teeth or appropriate prosthesis .

Tongue biting frequently means that the artificial teeth

have been positioned too far lingually and the tongue

space has been decreased.

By recontouring the lingual surfaces of the mandibular

posterior teeth .

The surface of the acrylic resin teeth may become

flattened and inefficient because improper polishing

technique or prolong wear .

By making additional grooves and sluiceways improve

mastication .

May be due to fatigue or mishandling the clasps .

You can do adjustments or remake .

Long term use may need reline .

Stewarts Removable partial Denture ( fourth edition ).

A color Atlas of Removable Partial Denture.( J.C.

Davenport, R.M. Basker , J.R. Heath, J.P. Ralph .

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