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INI CET 2021 May
A 58 year old female patient wearing complete denture for more than 9 years, reported with a chief complaint of pain near the corners of her denture. O/E reveals growth in buccal flange. How will the prosthodontist proceed in this case?
a. Discontinue wearing the denture
b. Surgery for growth in the buccal flange
c. Conditioning of tissues using tissue conditioner/ Relining is done
d. Fabrication of new denture
• Patients who wear ill-fitting dentures for a prolonged period of time may
develop denture irritation hyperplasia, also known as epulis fissuratum.
• Such a mucosal hyperplasia develops slowly from chronic low-grade trauma, typically induced by unstable dentures or an overextended denture flange.
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• As a consequence of the resorption of the alveolar ridge, the denture moves further into the vestibular mucosa, creating inflammatory, yet usually asymptomatic, fibrous tissue in the form of folds that proliferate over the denture flange. The edge of the denture generally fits into the “fissure” or groove between the mucosal folds.
• Single or multiple lesions of variable size are usually observed at the facial aspect of the denture and appear primarily in the anterior regions of either the maxilla or mandible and may be found more commonly in men.
• The lesions may be small or may extend the entire length of the vestibule.
• Curative procedures include adjustment or replacement of the ill-fitting dentures and/or surgical excision of the hyperplastic tissue.
• Whenever possible, these tissues should be rested, massaged, or treated with an antifungal agent before their surgical excision. This often results in a considerable reduction in the edema, making the surgical procedure simpler and less extensive.
• Healing is faster, scarring reduced, patient comfort improved, and a better prosthodontic result achieved.
Very severe denture irritation hyperplasia in the mandible showing a central groove on the patient’s right side in which the denture flange rests (indicated by the arrow).
Key Concept:
• It is well recognized that denture-bearing tissues demonstrate microscopic evidence of inflammation, even if they appear clinically normal.
• Consequently, tissue rest for at least 24 hours plus the additional use of tissue conditioners are regarded as essential preliminaries to each prosthetic appointment.
• Tissues recover rapidly when the dentures are not worn or when treatment liners are used.
• If lesion does not subside, replacement of the ill-fitting dentures after surgical excision of the hyperplastic tissue is treatment of choice.
