IMMEDIATE DENTURES

Khaled Q Al Hamad BDS MSc MRD RCSEd 4th year/removable Prosthodontics

OUTLINE
Definition, understanding the concept of immediate denture construction. Advantages & disadvantages. Types. Fabrication of Immediate denture.

History & examination. Treatment planning. Design of immediate dentures. Synopsis of clinical & laboratory procedures.

OUTLINE
Definition, understanding the concept of immediate denture construction. Advantages & disadvantages. Types. Fabrication of Immediate denture.

History & examination. Treatment planning. Design of immediate dentures. Synopsis of clinical & laboratory procedures.

Treatment Options:
Extract all teeth and wait 6-8 weeks for the extraction sites to heal. The CD is made following healing. Convert an existing RPD into an interim immediate CD. Make a conventional immediate CD.

Immediate Denture : a complete or partial denture constructed for insertion immediately following the removal of natural teeth.

OUTLINE
Definition, understanding the concept of immediate denture construction. Advantages & disadvantages. Types. Fabrication of Immediate denture.

History & examination. Treatment planning. Design of immediate dentures. Synopsis of clinical & laboratory procedures.

Advantages

The patient will have no time without teeth. Patients are therefore able to continue their social and business activities without embarrassment. The general appearance is less affected. Minimal changes in muscle tone and occlusal vertical dimension. Centric relation is easier to record. Minimal changes in speech and chewing habits.

Disadvantages

As healing proceeds and resorption occurs, the denture will not fit. The immediate denture needs to be relined or remade in 6 months to a year following insertion The treatment with immediate denture is more costly There is no Try-in; the esthetics of complete denture cannot be evaluated until the insertion appointment. The anterior ridge is undercut (often severe).

OUTLINE
Definition, understanding the concept of immediate denture construction. Advantages & disadvantages. Types. Fabrication of Immediate denture.

History & examination. Treatment planning. Design of immediate dentures. Synopsis of clinical & laboratory procedures.

Types

Interim Immediate Complete Dentures (IICD)

The IICD is replaced with new dentures once healing is completed. Usually all remaining teeth are extracted on the insertion visit. If an existing RPD is present, the teeth to be replaced are added to the denture with the necessary base material.

Conventional Immediate CD

OUTLINE
Definition, understanding the concept of immediate denture construction. Advantages & disadvantages. Types. Fabrication of Immediate denture.

History & examination. Treatment planning. Design of immediate dentures. Synopsis of clinical & laboratory procedures.

A full medical and dental history should be obtained from all patients requiring dentures. Details of past illnesses, present medication, difficulties with extractions, experience of anesthetics etc., assume a special significance in a patient for whom immediate dentures are planned. As a result of this examination, it is sometimes possible to divide the natural teeth into four classes:

Those teeth that are not to be extracted in the foreseeable future. The teeth may need conservative or periodontal treatment or selected teeth may be considered for overdenture abutments Those teeth that are to be extracted but no denture fitted in the extraction site for about 6 months. These teeth are usually posterior and not required for aesthetics or maintenance of the occlusal vertical dimension. The object is to provide a stable site for the immediate denture. Those teeth which are to be extracted and immediately replaced with a denture. These are usually anterior teeth. Teeth with a very limited prognosis which are worth retaining temporarily to aid the transition to denture wearing

OUTLINE
Definition, understanding the concept of immediate denture construction. Advantages & disadvantages. Types. Fabrication of Immediate denture.

History & examination. Treatment planning. Design of immediate dentures. Synopsis of clinical & laboratory procedures.

From the findings of the history and examination, the treatment plan may be:

No denture to be provided. The provision of temporary acrylic partial dentures to fill the posterior edentulous spaces. This may be a valuable training device if it is considered that the patient is likely to show poor adaptation to complete dentures. The provision of immediate dentures. These may take the form of:

additions to partial dentures . These are termed transitional immediate dentures. new dentures, complete or partial, to replace those teeth that are already missing and those to be extracted.

* When immediate dentures are proposed, patients should be advised of the necessity for early relining and/or remaking with associated additional visits and extra costs.*

OUTLINE
Definition, understanding the concept of immediate denture construction. Advantages & disadvantages. Types. Fabrication of Immediate denture.

History & examination. Treatment planning. Design of immediate dentures. Synopsis of clinical & laboratory procedures.

Design of Immediate Denture

Labial flange (complete or partial) or Open-faced (socketed). A final decision is usually deferred until study casts are available. Advantages of a labial flange: Greater stability and increased retention forces Improved strength Tooth arrangement can be altered No interference with sutures Stable appearance Easier relining Disadvantages of a labial flange: May produce unnatural fullness of the lip and the patient may not like the appearance. Bony undercuts labial to the alveolar ridge may prevent the use of a flange unless they are surgically removed.

(The use of a partial flange overcomes the disadvantages of a full flange while retaining most of the advantages. It is therefore important to assess each case comprehensively before the trial insertion stage.)

OUTLINE
Definition, understanding the concept of immediate denture construction. Advantages & disadvantages. Types. Fabrication of Immediate denture.

History & examination. Treatment planning. Design of immediate dentures. Synopsis of clinical & laboratory procedures.

Preliminary alginate impression for study casts. Request spaced perforated acrylic special trays. Decontaminate. The impression is poured with dental stone. A custom tray is fabricated with acrylic resin. The remaining teeth are covered with a double thickness of baseplate wax.

Working Impressions
the custom tray is checked in the patient mouth as normal. The posterior palatal seal can be determined and transferred to the cast. The final impression is taken with a suitable impression material. When the teeth are very mobile, care must be taken to avoid extracting the teeth with the impression. The undercuts and interproximal areas can be blocked out with wax and petrolatum. In sever cases; a vacuum formed resin stent can be utilized as a protective sheath while making the impression.
1.

Recording the Jaw Relationship

If there is sufficient tooth contact to establish the required jaw relationship, an interocclusal record should be taken together with the shade and mould of the teeth. If insufficient tooth contact, occlusal rims will be required. Procedure undertaken as for partial dentures construction. Take the shade and mould of the anterior teeth. Indicate the occlusal configuration, size and material of the posterior teeth

Decision as to whether openfaced or flange design

The depth of penetration of the labial portion of the cervical neck of the tooth is dependent upon the bone level around the teeth involved. This is determined by using a periodontal probe and radiographs. If a flange is to be provided, consider whether the surgical removal of bony undercuts is necessary. If a partial flange is indicated, the labial surface of the alveolar ridge should be surveyed relative to the path of insertion and a line drawn about 1mm beyond the survey line to indicate the extension of the flange.

Instructions to the laboratory

Teeth for extraction should be indicated on the working casts. If the immediate restoration is a partial denture, specify undercuts which must be blocked out. Instructions to set up the artificial teeth in the edentulous spaces for trial insertion in the mouth.

Trial Insertion

The teeth that are to be extracted and immediately replaced by the new denture are still in situ in the jaws. Thus the positioning and aesthetics of the replacement teeth cannot be checked in the mouth before the denture is processed. The trial dentures are checked for jaw relationship etc. The patient checks the appearance of any visible teeth. If appropriate, the post dam should be cut in the upper cast to the correct position, length, depth and width before decontamination. Arrangement are made for the tooth extractions and the fit of the immediate denture at the next patient appointment

Preparations of the cast before processing

The dentist is responsible for removing the teeth from the cast and preparing the cast to receive the artificial teeth. This will be dependent upon the bone levels and previous measurements.

Instructions to the laboratory

A clear acrylic surgical template is constructed on a duplicate of the trimmed cast if an alveolectomy is to be performed. Artificial teeth are fitted to the prepared working cast with any particular aesthetic requirement requested by the patient. Indicate whether flange or open-faced design The trial denture with the replacement teeth is processed.

Fitting the Denture

Great care must be taken to avoid trauma to the anaesthetised tissues. When fitting immediate dentures there are 3 common types of adjustment:

Removal of acrylic pearls and spicules Open-faced teeth that enter the lingual area of the socket Flanges which enter too far into bony undercuts

On insertion of the denture obvious occlusal discrepancies and overextension must be corrected. However, a definitive adjustment of the occlusion is not possible because of swelling. Cold packs are suggested for the first several hours. The patient must not remove the denture in the first 48 hours. Tissue inflammation and edema may prevent the reinsertion of the denture. A soft diet is preferred. Appropriate pain control medication is prescribed as needed.

Instructions to the patient Dentures should not be removed for 24 hours. Post extraction instructions are given as normal. Review at 24 hours Dentures are removed from the mouth and cleaned with a brush, soap and water. The mouth is examined for indications of border overextension or other excessive pressure from the denture base and adjusted accordingly. Obvious occlusal discrepancies are adjusted. Oral and denture hygiene is given together with a suitable patient handout. Identifying marks can be applied to the dentures. Review at 1 week All factors mentioned above at the 24 hour review should be checked again with proper evaluation and adjustment of the occlusion. Regular review appointments should be arranged - one month, three months, six months and then annually thereafter. Remind the patient that temporary relining will be necessary at a review in the near future and that permanent relining or the construction of new dentures will be necessary at a later stage.