▪ On the basis of what you know so far, what are the likely diagnoses and why?

The patient has successfully worn a denture and the transition to an overdenture from an upper acrylic partial denture should have been relatively straightforward. It might have been more difficult if the previous denture had been metal based. If the patient has persevered for 3 months without success she almost certainly has a valid complaint.

There appears to be no problem of displacement of the denture during eating, speaking or other facial movements. This makes it unlikely that the overdenture is poorly adapted, overextended or that the teeth lie outside the neutral zone. Occlusal discrepancies of some kind would appear to be the most likely cause and the vagueness of the complaint, predominantly inability to tolerate the denture, is consistent with an occlusal problem. A further reason to suspect an occlusal problem is the difficulty arising from a complete upper denture occluding against a lower natural arch.

It must also be borne in mind that some denture patients are particularly conscious of appearance and the construction of dentures that satisfy the expectations of such patients can be very demanding. Sometimes a mismatch between the denture appearance and desired facial self-image may manifest as dislike of the denture or complaints about relatively minor features. There is always a potential cosmetic problem of an overcontoured labial flange when canine roots support an upper overdenture because the roots preserve the labial aspect of the alveolar bone.

▪ What specific features of the dentures would you examine and how?

All features of the denture should be reviewed (Table 24.1). Denture complaints may be multifactorial and only by examining all features can an accurate diagnosis be made.