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An Assessment of Common Problems Associated with Complete Denture

Based on A Survey of Complaints Made by the Patients Reporting to Dental
College in Lucknow(BBDCODS)

Article · November 2024

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 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

HEB JOPD

Journal of Prosthodontics Dentistry

An Official Publication of Bureau for Health & Education Status Upliftment
(Constitutionally Entitled as Health-Education, Bureau)
An Assessment of Common Problems Associated with Complete Denture
Based on A Survey of Complaints Made by The Patients Reporting to
Dental College in Lucknow (BBDCODS)

Dr. Namra Kausar Zaidi, Dr. Manoj Upadhyay, Dr. Garima Agarwal,
Dr. Amrita Upadhyay, Dr. Kaushitaki Bhaumik, Dr. Barkha Bhoneja

Dr. Namra Kausar Zaidi, Postgraduate student, Dept. Of Prosthodontics, BBD College of Dental
sciences
Dr. Manoj Upadhyay, Professor,Dept of Prosthodontics, BBD College of Dental Sciences
Dr. Garima Agarwal, Professor, Dept of Prosthodontics, BBD College of Dental Sciences
Dr. Amrita Upadhyay, Senior lecturer, Dept of Prosthodontics, BBD College of Dental Sciences
Dr. Kaushitaki Bhaumik, Senior lecturer, Dept of Prosthodontics, BBD College of Dental Sciences
Dr. Barkha Bhoneja, Senior lecturer, Dept of Prosthodontics, BBD College of Dental Sciences

ABSTRACT
Introduction
One important prosthodontics treatment option is complete denture prosthodontics. Making a
complete denture without any challenges has proven difficult, especially for certain people, despite
the enormous amount of research and development that has been done in this area. This is primarily
caused by the variety of techniques and materials employed in the fabrication process, as well as, to
some extent, by the various patient circumstances. Several authors have examined complete denture
complaints in great detail, but the most common method used to evaluate typical post-insertion issues
is survey-based analysis. This study aims to close that gap by offering a structurofunctional evaluation
of complete dentures and linking post-insertion issues to certain demographic parameters.
Material and methods
A straightforward, convenient sampling technique was employed in this cross-sectional analytical
survey. Results were recorded using a customised questionnaire. Three main causes were identified
after a structural-functional examination of the complaint was completed. Version 20.0 of the
Statistical Package for Social Sciences (SPSS) program was used to statistically analyse the collected
data.
Results
Most participants voiced at least one grievance. The most common complaints were related to retention
and discomfort, with the mandibular posterior region accounting for the majority of these problems.
There were complaints categorized by gender, with more complaints coming from women than from
men. When it came to the three SFA variables as a reason for complaints, there were clinically

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 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

significant differences. The primary reason behind all complaint categories was an error in the denture
base.
Conclusion
We can draw the conclusion that complete denture complaints are a common occurrence. Patients
have voiced a variety of concerns, but the two main ones are discomfort and retention loss. There is a
pronounced difference between sexes in the quantity and nature of complaints, with females reporting
more concerns pertaining to discomfort and appearance. Additionally, denture base error is the most
common cause of complaints involving complete dentures, with occlusion error and
physiopsychological error being less common.
KEYWORDS: denture wearer, post insertion complains, retention, discomfort, stability

Access this Article Online

Website:[Link]
Received on 8/08/2024
Accepted on 24/09/2024 © HEB All rights reserved

July to December 2024-Vol. 19, Issue-2, (September Addendum-3), Journal of Prosthodontics Dentistry, Page No.-15
 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

Introduction
Post insertion complaints are as old as dentures. Stories of suffering and agony abound regarding the
ivory dentures crafted by hand throughout ancient times, with the exception of a few exceptional
examples of artistry1. Despite extensive research and development in this sector, and with a greater
understanding of human anatomy and evolution in the material sciences, fabricating a problem-free pair
of complete dentures has proven challenging, especially for some patients.
The nature of the complaint, its length, and its type are all subject to numerous changes. Smith 2 et al.
discovered that discomfort and looseness were the most common complaints made by patients. Four
main categories of difficulties were identified by Morstad3 et al: phonetics, comfort, aesthetics, and
function. On the other hand, Brunello4 listed pain, discomfort, trouble eating, and looseness as
complaint kinds. As a result, the complaints can range from soreness, looseness, and discomfort 5 to
6,7,8
phonetics, esthetic dissatisfaction, and phonetics . Additionally, the type of complaints may differ
based on factors including age, sex, health, length of use, prosthesis accuracy, patient psychology,
rapport and relationship between the dentist and patient, etc.9-14 The patient's happiness with his
complete dentures doesn't seem to be determined by a single cause, but rather by a coordinated action
of technical, anatomical, biological, and psychological aspects.15-18
There are complaints about one or more parts of the functioning of a complete denture, even with the
dental surgeon and technician paying the highest attention to detail.19,3,4,14,20,21 As a result, evaluating
these concerns necessitates a deep understanding of the numerous interrelated variables involved. They
can be roughly categorized as prosthetic factors and patient factors.
Murray 22,23 highlighted the significance of the denture base in retention, and denture fabrication errors
were explained by Laurina et al.20 Role of tongue in mandibular denture stability was elaborated upon
by Bohnenkamp6
24
Nassif has noted that questions answered on a questionnaire can be used to conduct targeted,
structured interviews, and that reviewing a completed questionnaire can immediately identify issues
that warrant additional investigation. A number of variables, including inter-rater bias, questionnaire
style, question type, patient selection strategy, and others, may have an impact on the survey's outcome.
The literature describes a variety of questionnaire forms and their variants, which can be altered to meet
25-31.
specific needs It can be stated that post-insertion problems with complete dentures are a part of
complete denture therapy, even though they may be minimized by careful manufacture and patient
variables consideration. There are, however, few research that examine this problem in an Indian
community
Furthermore, a thorough investigation of the causality of post-insertion symptoms has not been
conducted. The research is made more complex by the claim that social and psychological variables
have an equal role in explaining post-insertion complaints as do physical elements 32. By offering a
structurofunctional assessment of full dentures complaints as stated by patients and a correlation
between the most often reported complaints and numerous social and demographic characteristics in
the Lucknow region of Uttar Pradesh state in India, the current study aims to close this gap.
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 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

Materials and methodology

The investigation was conducted from January 2022 to December 2023. This cross-sectional analytical
investigation employed a straightforward, convenient, random sampling technique. In other words, the
study covered all patients who came to the department within the specified time frame and met the
inclusion and exclusion criteria. Inclusion criteria was 1. Individuals with edentulous maxilla and
mandible 2. Individuals who consistently wear their complete dentures. 3. Individuals who had a
complete denture manufactured in the previous five years.
Exclusion criteria was
[Link] with impaired health.
2. Individuals with neurological and psychological conditions such as dementia, Parkinson's disease,
motor neuron illnesses, etc.
3. Patients who had underwent jaw restructuring surgeries.
For the study's objectives, a specially designed questionnaire was created. General information,
complete denture-related information, and complaint-related information
The questionnaire produced information. All complaints were categorized into four groups:
miscellaneous, retention, discomfort, and aesthetics. These were then further categorized according to
the anatomical location, the type of complaint, and any relevant clinical observations. Based on location,
complaints of retention and discomfort were separated into maxillary and mandibular, then further into
anterior and posterior. In the case of retention, questions regarding the location and frequency of
retention loss were asked from the patient.
Before beginning any procedure or completing the survey, all patients gave their informed consent A
single operator conducted the survey by asking questions in the patient's mother tongue. Thus, in order
to check for defects in structure and functional deficiencies in the intraoral and extraoral structures, the
same operator examined the patient's complete dentures. Operator bias was removed with a single
operator. The causal link between the complaint and denture-related factors was explored, and this was
termed as “structurofunctional analysis(SFA) factors” of the complaint.
SFA is an attempt to find out the causes of the complaints which were reported by the patients. Structural
component deals with a structural defect of the denture (pain due to a sharp nodule or edge on the
denture, faulty design, incomplete finishing and polishing, etc.) and functional component with other
problems such as physiological (patient’s low-pain threshold), psychological dysfunction, or even error
in occlusion which prevent optimal denture use. In addition, it was seen that the same complaint (say
painful lower denture) was reported in multiple ways by different patients based on their verbosity.
Furthermore, the same problem on many occasions had multiple causative agents, (for example, pain
in lower posterior region due to faulty occlusion, nodule on the tissue surface, or denture roughness).
As a result, all the possible causes were condensed into three SFA factors, namely, error in denture base,
error in occlusion, and physio-psychological

There were a total of 12 codes allocated to each complaint (R1, R2, and R3 for complaints connected
to retention, D1, D2, and D3 for complaints related to discomfort, and so forth). R1 indicated that the
patient's retention issue was brought on by a denture base error, which might have been caused by a

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 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

variety of factors, including a rough denture base, nodules, an unpolished denture base, a broken edge,
and so on.
In the same way, let's imagine that E3 intended to imply that physio-psychological problems contributed
to the aesthetic complaint in that instance.
In this case, since there was no obvious mistake in the denture base, occlusion, or tooth selection and
the patient still complained, the explanation was determined to be altered physiology (muscle tone,
saliva flow, and quantity) or psychological.

Results
Among the 100 (100%) subjects there are 62 males and 38 females. The primary reason for using
denture is mastication in 64 patients, aesthetics in 27 and phonetics in 9 patients. Among 100, no
previous denture was used in 45, 1 previous denture was used by 49 and more than 1 denture was used
by 6 patients. Out of 100, 78 patients have been using denture for less than 1 year, 19 patients have been
using for 1-3 years and 3 patients have been using for 3-5 years. Mandible has maximum complaint i.e
in 54 patients, maxillary complaint in 24 while complaint for both maxilla and mandible. Satisfaction
with the current denture was shown by 61, while 33 patients did not show any satisfaction. Retention
related complaints was seen maximum in the mandibular posterior region i.e in 37, 28 in maxillary
anterior, 25 in maxillary posterior and minimum 10 in mandibular posterior. (Table-1)
TABLE 1
Number of Percent of
subjects total (%)
Total number of subjects 100 100
Gender Male 62 62
Female 38 38
Primary reason for using dentures Mastication 64 64
Esthetics 27 27
Phonetics 9 9
Number of previous denture 0 45 45
1 49 49
More than 1 6 6
Duration of current denture use 0-1 years 78 78
1-3 years 19 19
3-5 years 3 3
Complaint related to Maxillary 24 24
Mandibular 54 54
Both 22 22
Satisfaction with current denture Yes 61 61
No 33 33
Cant say 6 6
Retention related complaints Maxillary anterior 28 28
Maxillary posterior 25 25
Mandibular anterior 37 37
Mandibular posterior 10 10

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 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

The table-2 result shows the relative mean rank based on kruskal wallis test. According to this test errors
in denture base was statistically significant as far as retention, discomfort and miscellaneous related
complaints were concerned (p<0.05). although the same factor was high for aesthetics it was not found
to be statistically significant (p>0.05).
TABLE-2 : Structurofunctional analysis (Kruskal-Wallis test)
Mean rank Kruskal-wallis test
(p-value)
Retention R1 192.50 <0.001
R2 134.00
R3 125.00
Discomfort D1 182.50 <0.001
D2 142.00
D3 127.00
Esthetics E1 150.50 0.615
E2 153.50
E3 147.50
Miscellaneous M1 165.50 <0.001
M2 140.00
M3 146.00

TABLE-3 : Chi Square analysis of complains according to the gender

The table-3 shows parson chi-square value for the variables- retention, discomfort, aesthetics and
miscellaneous based on the gender of the patient. It was seen that overall majorly complain was seen
from the females as compared to the males but the difference was not statistically significant (p>0.0.5).
Gender Chi-square (p-
Male Female value)
Retention No complaint 10(26.3%) 10(16.1%) 0.216
Complaint 28(73.7%) 52(83.9%)
Discomfort No complaint 6(15.8%) 8(12.9%) 0.686
Complaint 32(84.2%) 54(87.1%)
Esthetics No complaint 25(65.8%) 48(77.4%) 0.204
Complaint 13 (34.2%) 14 (22.6%)
Miscellaneous No complaint 28 (73.7%) 45 (72.6%) 0.904
Complaint 10 (26.3%) 17 (27.4%)

TABLE-4: Chi Square analysis of complains according to primary reason for using denture.
The table-4 shows parson chi-square value for the variables- retention, discomfort, aesthetics and
miscellaneous based on the primary reason for using denture. The result shows that during mastication
retention was the most common complaint which was also statistically significant (p<0.05). The
remaining variables- discomfort, aesthetics and miscellaneous do not show statistically significant
difference (p>0.05).

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 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

Primary reason for using denture Chi-square

Mastication Esthetics Phonetics (p-value)
Retention No complaint 6 (9.4%) 10 (37%) 4(44.4%) 0.002
Complaint 58(90.6%) 17 (63%) 5(55.6%)
Discomfort No complaint 7(10.9%) 4 (14.8%) 3 (33.3%) 0.191
Complaint 57(89.1%) 23 (85.2%) 6 (66.7%)
Esthetics No complaint 49 (76.6%) 21 (77.8%) 3 (33.3%) 0.019
Complaint 15 (23.4%) 6 (22.2%) 6 (66.7%)
Miscellaneous No complaint 43 (67.2%) 24 (88.9%) 6 (66.7%) 0.094
Complaint 21 (32.8%) 3 (11.1%) 3 (33.3%)

TABLE-5: Chi Square analysis of complains according to number of previous denture used
The table-5 shows parson chi-square value for the variables- retention, discomfort, aesthetics and
miscellaneous based on the number of previous denture used. The result shows that patients who have
used more than 1 denture complained of more aesthetics and the result was statistically significant.
(p<0.05). The remaining variables-retention, discomfort and miscellaneous do not show statistically
significant difference (p>0.05).
Number of previous dentures used Chi-square
0 1 More than 1 (p-value)
Retention No complaint 9(20%) 8(16.3%) 3(50%) 0.150
Complaint 36(80%) 41(83.7%) 3(50%)
Discomfort No complaint 7(15.6%) 7(14.3%) 0(0%) 0.586
Complaint 38(84.4%) 42(85.7%) 6(100%)
Esthetics No complaint 30 (66.7%) 43 (87.8%) 0 (0%) 0.001
Complaint 15 (33.3%) 6 (12.2%) 6 (100%)
Miscellaneous No complaint 30 (66.7%) 40 (81.6%) 3 (50%) 0.112
Complaint 15 (%) 9 (%) 3 (50%)

TABLE-6: Chi Square analysis of complains according to duration of use

The table -6 shows parson chi-square value for the variables- retention, discomfort, aesthetics and
miscellaneous based on the duration of use. The result shows that patients who have used denture for
less than 1 year has more complaint related to retention and the result was statistically significant.
(p<0.05). The patients using denture for 3-5 years had more compliant related to aesthetics with
statistically significant result (p<0.05). The remaining variables- discomfort and miscellaneous do not
show statistically significant difference (p>0.05).

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 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

Duration of use Chi-square

0-1 year 1-3 year 3-5 year (p-value)
Retention No complaint 13(16.7%) 4(21.1%) 3(100%) 0.002
Complaint 65(83.3%). 15(78.9%) 0(0)
Discomfort No complaint 14(17.9%) 0(0%) 0(0%) 0.101
Complaint 64(82.1%) 19(100%) 3(100%)
Esthetics No complaint 54 (69.2%) 19 (100%) 0 (%) <0.001
Complaint 24(30.8%) 0(0%) 3(100%)
Miscellaneous No complaint 54 (69.2%) 16 (84.2%) 3 (100%) 0.237
Complaint 24 (30.8%) 3 (15.8%) 0 (0%)

TABLE-7 :Chi Square analysis of complains according to the complains related.

The table-7 shows pearson chi-square value for the variables- retention, discomfort, aesthetics and
miscellaneous based on the complaints related to maxilla, mandible or both. The result shows that
patients retention related issue more with maxilla, less complaints in maxilla aesthetically and more
miscellaneous complaint related to maxilla and the result was statistically significant (p<0.05). The
remaining variables- discomfort do not show statistically significant difference (p>0.05).
Complaints related to Chi-square
Maxilla Mandible Both (p-value)
Retention No complaint 0(0) 15(27.8%) 5(22.7%) 0.017
Complaint 24(100%) 39(72.2%) 17(77.3%)
Discomfort No complaint 3(12.5%) 7(13%) 4(18.2%) 0.814
Complaint 21(87.5%) 47 (87%) 18 (81.8%)
Esthetics No complaint 24(100%) 35(64.8%) 14(63.6%) 0.003
Complaint 0(0%) 19 (35.2%) 8 (36.4%)
Miscellaneous No complaint 12 (50%) 42 (77.8%) 19 (86.4%) 0.011
Complaint 12 (50%) 12 (22.2%) 3 (13.6%)

TABLE-8: Chi Square analysis of complains according to the satisfaction with the current
denture
The table-8 shows pearson chi-square value for the variables- retention, discomfort, aesthetics and
miscellaneous based on the satisfaction with current denture. The result shows that patients who does
not show satisfaction with the current denture had complaints related to retention and aesthetics and the
result was statistically significant. (p<0.05). The remaining variables- discomfort and miscellaneous do
not show statistically significant difference (p>0.05).

July to December 2024-Vol. 19, Issue-2, (September Addendum-3), Journal of Prosthodontics Dentistry, Page No.-21
 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

Satisfaction with current denture Chi-square

Yes No Cant say (p-value)
Retention No complaint 17(27.9%) 0(0) 3(50%) 0.001
Complaint 44(72.1%) 33(100%) 3(50%)
Discomfort No complaint 11(18%) 3 (9.1%) 0(0%) 0.292
Complaint 50 (82%) 30(90.9%) 6 (100%)
Esthetics No complaint 47 (77%) 26 (78.8%) 0 (0%) <0.001
Complaint 14 (23%) 7 (21.2%) 6 (100%)
Miscellaneous No complaint 44 (72.1%) 26 (78.8%) 3 (50%) 0.334
Complaint 17 (27.9%) 7 (21.2%) 3 (50%)

TABLE 9: Description of SFA data according to the subcategories

Retention Discomfort Esthetics Miscellaneous

R1 R2 R3 D1 D2 D3 E1 E2 E3 M1 M2 M3
[Link] 59 20 14 55 28 17 9 11 7 20 3 7
cases
% of 63.5 21.5 15 55 28 17 33.3 40.7 26 66.6 10 23.4
cases

KEY:-
RETENTION ESTHETICS
R1- error in denture base E1- error in denture base
R2- error in occlusion E2- error in occlusion
R3- pathophysiological E3- pathophysiological
DISCOMFORT MISCELLANEOUS
D1- error in denture base M1- error in denture base
D3- error in occlusion M2- error in occlusion
D4- pathophysiological M3- pathophysiological

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 Reg. No: RJ17D0105798 ISSN NO: 2582-0362

120

100
15 17
26 23.4
80
21.5 10
28 Physiopsychological
60
40.7 Error in occlusion

40 Error in denture
63.5 66.6
55
20
33.3

0
Retention Discomfort Esthetics Miscellaneous

FIGURE 19: Graph showing distribution of SFA sub factors in relation to different
complaints

CONCLUSION
We can draw the conclusion that complete denture complaints are a common occurrence. Patients have
voiced a variety of concerns, but the two main ones are discomfort and retention loss. male attendance
was higher than female attendance. The finding that males have a higher incidence of full edentulism
can be used to explain the higher male attendance.
Error in denture base was the most common reason identified in all four categories of complaints during
the evaluation of the complaints' causes (SFA factors). There was an obvious dominance of error in
denture base factor in retention, discomfort, and miscellaneous. In aesthetics related complaint the
second category (error in occlusion and teeth selection) was dominant.
It was seen that overall majorly complain was seen from the females as compared to the males.
Retention related problems was more commonly seen in mandibular anterior region while discomfort
related problems was more commonly seen in mandibular posterior region.

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