The problem
Moreover, it can cause the loss of integration of
As is often the case, after a day or so of wearing this
anterior implants and even cause implant fracture
fully extended mandibular denture, with its deeply
in some cases. It can also prematurely wear-out
extended lingual flanges that so effectively prevent
o-ring denture retainers and other denture retention
lateral displacement of the denture during function,
systems. It’s just like having a long cantilever arm
the patient complains of extreme pain and ulceration
connected to the anterior implants.
in the region of the lingual vestibules. After several spot-relieving appointments for these painful areas, none of which seem to help the situation, many clinicians acquiesce to a patient’s demands and trim away 50% of those wonderful stabilizing lingual flanges that took so much skill and perseverance to make. So what happened? The patient blames the denture for “cutting into my jaw.” However, exactly the opposite is true. The very sharp mylo-hyoid ridge cut through the oral mucosa from the lingual, pressing against the tissue side of the lingual denture flange which acted like a “cutting board.” The soft tissue was the “bread;” the
The solution The solution to this frustrating problem is to follow a strict denture examination protocol with every patient that requires either a reline of an existing full or partial lower denture, or an entirely new denture or a mandibular appliance device.. Remember, the cause of the pain is not the appliance, but the sharp mylo-hyoid ridge, and that ridge belongs to the patient. The patient’s mylo-hyoid ridge remodeled over the years and became knife-sharp as a result of bone resorption. It is as though a rainstorm and flood had washed all of the
mylo-hyoid ridge was
smaller gravel particles
the “knife; the lingual
from a dirt road leaving
flange was the bread
only the larger jagged
board.” The denture
rocks exposed. This is the
base was not the culprit,
patient’s problem, and you,
but now the stability of
the clinician, can solve it
this denture has been
and still have fully extended
compromised by its
lingual flanges. But first you
removal and that can
must recognize the problem,
be a serious problem to
demonstrate and explain it
clasped teeth, implants
to the patient before starting
and their superstructure
any appliance treatment.
retention screws. Basically, the lingual flanges are the only stabilizing
Protocol steps
feature against lateral displacement or “fishtailing”
Ask the patient to hold their breath (to keep from
of the denture base during function. The lingual
gagging), then place your index finger deeply into
surfaces of the mandible are vertical while the facial
the patient’s lingual vestibule and palpate the mylo-
surfaces are sloped. It’s just simple mechanics.
hyoid ridge.
This constant lateral movement can loosen, fatigue
If the ridge is sharp (it usually is) the patient will
or break the retaining screws that hold implant
experience acute pain and flinch.
supported attachments or bar-clip retainers in place. WWW.SLEEPGS.COM
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