A loose upper denture in a patient with a resorbed ridge
A 72-year-old man has worn an upper complete denture for 18 years. He reports that it now rocks, food collects under it, and he has stopped eating in company. He has a history of type 2 diabetes managed with metformin, and hypertension. On examination the maxillary ridge is severely resorbed with a flat anterior region and a prominent, non-mobile torus palatinus; the denture has a thin, cracked palate and worn posterior teeth with loss of vertical dimension. The lower arch has a few standing teeth with good bone support. He is not keen on implants and asks whether a new denture would help.
1. What are the causes of his current problems, and how would you assess the denture-bearing tissues and the denture itself?
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The rocking and food trapping are consistent with tissue changes under a long-standing denture, loss of retention from a resorbed ridge, and a denture base that no longer fits. The cracked thin palate and worn teeth suggest the denture is at the end of its life. Loss of vertical dimension can contribute to angular cheilitis, reduced masticatory efficiency and altered facial appearance. The torus palatinus limits the palatal relief that can be provided and may be a pressure point.
Assessment: examine the mucosa for erythema, hyperplasia, ulceration and candidiasis, and check for denture stomatitis, which is common in diabetes. Palpate the ridge for displaceable tissue and check the border seal and extensions. Assess the torus and whether relief is needed. Examine the existing denture for fit, border extension, occlusion, wear, cracks and cleanliness, and check the occlusion against the lower teeth. Take a dietary and social history given his avoidance of eating in company, and consider his diabetes control. If there is any ulceration that does not resolve with denture rest, refer for assessment rather than simply adjusting.
2. He agrees to a new upper denture. Outline the treatment sequence and the key decisions, including how you would manage the torus and his expectations.
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Sequence: first, advise leaving the denture out as much as possible for 1–2 weeks to allow tissue recovery, and treat any candidiasis. Take primary impressions with a suitable tray and a material that records the ridge without distortion, then a special tray and wash impression with border moulding to capture the functional sulcus. Record the occlusion at an appropriate vertical dimension, using a facebow or average values as appropriate, and consider whether the vertical dimension needs increasing gradually rather than in one step.
Design decisions: a correctly extended base for seal, relief over the torus and the incisive papilla, adequate palatal thickness for strength while avoiding bulk, and a metal base or a reinforced design may reduce fracture risk given his history of a cracked palate. Posterior teeth should be chosen for his ridge and occlusal scheme; a balanced occlusion is helpful. Try-in to verify aesthetics, phonetics and occlusion before processing, then fit, adjust and review at 24 hours, 1 week and 1 month.
Expectations: explain that a severely resorbed ridge limits retention whatever is made, that a new denture may feel loose at first, and that implants or a copy denture are alternatives. Encourage denture hygiene and regular review, and discuss the effect of diabetes on mucosal health. Record his preference against implants and the risks discussed.