Dental prostheses are designed to restore function, aesthetics, and oral health, but when they are poorly fitted or inadequately maintained, they may become a significant source of chronic trauma and oral disease.
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Understanding which lesions are associated with each type of prosthesis is essential for early diagnosis, prevention, and appropriate clinical management.
✅ Etiology: Why Do Dental Prostheses Cause Oral Lesions?
The main etiological factors include:
▪️ Poor marginal adaptation
▪️ Overcontoured prosthetic surfaces
▪️ Incorrect occlusal contacts
▪️ Prosthetic instability or overextension
▪️ Inadequate oral hygiene
▪️ Long-term use without professional follow-up
👉 Chronic mechanical irritation remains the primary mechanism leading to tissue damage.
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Poorly adapted crowns, bridges, and implant-supported restorations can cause localized but progressive tissue damage.
Common lesions include:
▪️ Traumatic gingivitis caused by overhanging margins
▪️ Chronic periodontal inflammation due to plaque accumulation
▪️ Violation of the biologic width, leading to persistent bleeding and attachment loss
▪️ Gingival recession associated with improper emergence profiles
▪️ Secondary caries at restoration margins
▪️ Periapical lesions related to occlusal overload
▪️ Oral ulcerations caused by sharp or overcontoured prosthetic edges
👉 Poor marginal fit is a major risk factor for biological failure of fixed prostheses.
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Ill-fitting removable partial dentures and complete dentures affect larger mucosal areas and are strongly associated with chronic inflammatory conditions.
Common lesions include:
▪️ Denture stomatitis, characterized by erythematous palatal mucosa
▪️ Traumatic ulcers due to instability or overextension
▪️ Epulis fissuratum caused by chronic flange irritation
▪️ Inflammatory papillary hyperplasia, especially in long-term denture wearers
▪️ Angular cheilitis, often related to reduced vertical dimension
▪️ Residual ridge resorption due to uneven force distribution
▪️ Denture-associated oral candidiasis, particularly in elderly or immunocompromised patients
👉 Continuous use of ill-fitting dentures significantly increases mucosal pathology risk.
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Patients with prosthesis-related lesions may present with:
▪️ Persistent oral pain or discomfort
▪️ Erythema and swelling
▪️ Ulcerations that do not heal
▪️ Bleeding during brushing
▪️ Burning mouth sensation
▪️ Difficulty chewing or speaking
Early recognition is key to preventing progression.
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Diagnosis is based on:
▪️ Detailed clinical examination
▪️ Evaluation of prosthesis fit, contours, and occlusion
▪️ Assessment of oral hygiene status
▪️ In selected cases, biopsy to rule out dysplastic or malignant lesions
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Management depends on lesion type and severity and may include:
▪️ Prosthesis adjustment or replacement
▪️ Removal of traumatic factors
▪️ Improvement of oral hygiene protocols
▪️ Topical antifungal therapy for denture-related candidiasis
▪️ Anti-inflammatory or protective agents
▪️ Temporary discontinuation of denture use in severe cases
Treating the lesion without correcting the prosthesis will lead to recurrence.
💬 Discussion
Poorly fitted dental prostheses remain a preventable cause of oral lesions. Fixed prostheses tend to cause localized periodontal and biological complications, while removable dentures are more frequently associated with extensive mucosal inflammation and chronic trauma.
Routine follow-up and patient education are essential to reduce long-term complications.
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▪️ Always evaluate prosthesis fit during recall visits
▪️ Educate patients on proper prosthesis hygiene
▪️ Replace or reline dentures periodically
▪️ Avoid prolonged use of unstable or damaged prostheses
▪️ Investigate non-healing lesions promptly
✍️ Conclusion
Dental prostheses should improve oral health—not compromise it. Poorly fitted fixed and removable prostheses can cause serious oral lesions if not properly designed, monitored, and maintained. Early intervention and regular professional care are essential to prevent long-term damage.
📚 References
✔ Budtz-Jørgensen, E. (1990). Oral mucosal lesions associated with the wearing of removable dentures. Journal of Oral Pathology & Medicine, 19(2), 65–70.
✔ Felton, D. (2016). Edentulism and comorbid factors. Journal of Prosthodontics, 25(Suppl 1), S2–S20.
✔ Goodacre, C. J., Bernal, G., Rungcharassaeng, K., & Kan, J. Y. (2003). Clinical complications in fixed prosthodontics. The Journal of Prosthetic Dentistry, 90(1), 31–41.
✔ Gendreau, L., & Loewy, Z. G. (2011). Epidemiology and etiology of denture stomatitis. Journal of Prosthodontics, 20(4), 251–260.
✔ Lang, N. P., & Berglundh, T. (2011). Periimplant diseases. Journal of Clinical Periodontology, 38(Suppl 11), 178–181.
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