Complete or removable partial denture

fabricated for placement at the same

appointment as extraction of natural teeth


Immediate Dentures

Makes Jaw Relations Difficult
Occlusion May be Mutilated

OVD, Midline & Incisal Edges May Require Change
After Extractions, Prior to Placement

Final Result
Immediate Complete Denture
Conventional immediate denture
intended to be relined to serve long-term

Interim immediate denture (IID) (transitional):
after healing a second new complete denture is fabricated
as a long-term prosthesis


(Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.1)

Advantages
Maintenance of

Appearance
Circumoral support
Muscle tone
Occlusal vertical dimension
Jaw relationships
Facial height

Tongue will not spread out as result of tooth loss


Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.2.1
Advantages
Less postoperative pain & bleeding
extraction sites protected

Pressure from denture base

Easier to duplicate natural tooth shape &
position (if desired)

Easier Adaptation
Speech, mastication rarely compromised
Nutrition can be maintained

Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.2.1

Disadvantages
More challenging to set teeth
Less space for teeth as ridge resorption hasnt occurred

Alveolar ridge undercuts around remaining teeth may make
impressions more difficult

Unstable or inadequate occlusion can make recording
centric position difficult

Unstable Occlusion
Explanation to Patients
Fit is usually not as good as traditional
dentures (estimate ridge form)

Extractions and sore spots from
immediate denture can result in more
discomfort after initial insertion

Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2013. 9.4.3.1

Explanation to Patients

Takes time to adapt to chewing and speaking
Appearance may be unpredictable if anterior try-in
not possible
(Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2013. 9.4.3.1)

No Anterior Try-in
Explanation to Patients
Should be worn for first 24 hours without removal

If removed, reinsertion can be difficult if
significant swelling occurs

Patient should return to dental office for initial
removal at 24-hours



Explanation to Patients
Immediate dentures will normally loosen during healing
due to ridge resorption & soft tissue remodeling

Relines/tissue conditioners will be required to improve the
retention

Normally a permanent reline will be required 4-6 months
after insertion



Explanation to Patients
In some cases a remake may be required
Significant change in jaw position
Significant esthetic problem
May be cheaper/better to remake

In practice, the patient is normally responsible
for fees for relines
Explain prior to beginning
Dalhousie Faculty of Dentistry Policy
Immediate denture fee at Dalhousie includes
tissue conditioners
one permanent reline within first year of receiving
immediate denture(s)
No additional fees for relines
Dalhousie Protocols
Online on Removable Prosthodontics Website
http://removpros.dentistry.dal.ca/RemovSite/Imm
ed_Dentures.html
Too Difficult
No opposing occlusal contacts
Severely collapsed occlusal vertical dimension
Cant register a repeatable jaw relationship
(check at treatment planning appointment)
Vestibule too short - vestibuloplasty would be
required
Refer
Dalhousie Protocols
Sugery & Insertions Thursday afternoons only
Book at least 2 weeks prior to surgery
Book with Patient Services Staff
Identify as a Immediate Dent at time of booking
Only 2 immediate denture bookings per day
Email Dr. Knechtel to advise him of booking
date of booking
# of teeth to be extracted
CD (single or set)
RPD
Dalhousie Protocols
At least one week prior, students must review
medical history & clinical surgical details with
supervising surgeon
At beginning of clinic inform both attending
Surgeon and Dr. Knechtel that your patient has
an immediate denture
This ensures the patient moves to top of rotation,
so that insertion is as early in clinic as possible
Dalhousie Protocols
Students must see patient the day after delivery,
Friday morning to ensure patient comfortable
All immediate dentures insertions supervised by
Dr. Knechtel.
Technique
Examination/Diagnosis/Treatment Plan
Informed consent
Alternatives
Pros/cons
Prognosis
Timing
Costs
Examination/Diagnosis/Treatment Plan

Beware of tissue undercuts
Especially anterior maxilla & tuberosities
Make notes to reduce at time of extractions
Compress socket
Bony reduction if necessary
If not reduced, denture may not seat
2 piece tray for impression
Examination/Diagnosis/Treatment Plan

Determine if OVD requires change at diagnosis
appointment
Use physiologic rest, interocclusal space
measurements
Examination/Diagnosis/Treatment Plan

To improve esthetics & ensure adequate stability:

Decide whether you will need to imitate or change
tooth arrangement prior to beginning
Helps avoid unexpected surprises
Technique
Oral hygiene procedures
Reduce inflammation to speed healing
Reduced discomfort after extractions
Less soft tissue changes better fit
Technique
Preliminary extractions - posterior teeth
Keep one set of opposing teeth on each side of arch if
OVD and centric are to be preserved
Wait 4 weeks for healing
If very few teeth remain
Consider extracting all at once
Skip preliminary extraction step
Less morbidity
Extract All Teeth Single Appointment
Technique After Preliminary Extractions
Preliminary impressions - alginate
Final impressions 1 or 2 step
Jaw relation records
Tooth set-up and try-in
Final extractions and insertion
Post insertion care
Examination/Diagnosis/Treatment Plan

Reconfirm decision to imitate or change tooth
arrangement
Determine midlines, occlusal plane, vertical
overlap, length of maxillary incisors
Mark on cast for laboratory to use for setup
Preliminary impressions

Stock trays
Dentate or partially-edentulous
Irreversible Hydrocolloid
Mark vibrating line & hamular notches
prior to impression
Cant reseat intraorally
Final Impressions
Use 2 piece custom tray if significant
undercuts
If no large tissue undercuts use one
piece custom tray
Mark Posterior Border Prior to Impression
Vibrating line & hamular notches
Not able to reseat intraorally
tooth & tissue undercuts, embrasures
If dont have correct posterior border, denture
will not be retentive
2 Piece Impression
Stock Tray
Custom Tray Ensure
Alginate Not Too Thin
1 Piece Impression
Block out minor undercuts
Ensure tray flange not too
far from vestibule
After border molding,
should not lock into place
Jaw relation records
Record base & occlusion rim
used if unstable cast/contacts
(wobbles, rocks)
Make facebow record with
dentate bitefork
Use for centric & protrusion
If stable contacts, record base
not needed
Jaw Relation Records
Determine OVD
Use physiologic rest, interocclusal space
measurements
Do NOT incorporate an overbite in occlusion rims
if anterior teeth are missing, use rims only to
determine OVD, not incisal display
Once mounted, determine overbite, incisal display
required
Use occlusion rims for OVD, Jaw Relations Records
Use PVS Bite Registration Material, NOT Wax
Dentate Bitefork wth Wax/PVS
Centric Record
Tooth Set-up and Try-in
Anterior Try-in Only Possible if Anterior Teeth Missing
Extraction and Insertion
Have lab complete set up & modify cast
as directed
use probing depths & radiographs to
guide cast modification
Do not create large socket convexities grind teeth
Final Setup Usually will not allow for Full Wax Try-in
Extraction and Insertion
Always request a surgical stent (guide)
Prescribe fabrication of stent when sent for processing
Allows for identifying areas of impingement (blanching)

Extraction and Insertion
Extract teeth
Prior to insertion, use surgical guide to assess ridge
Place pressure but DONOT Flex during insertion
check for over extensions, pressure (blanching)
Seat the denture
After stent show full seating, no blanching
Extraction and Insertion
THE DENTURE MUST BE FULLY SEATED

Otherwise occlusion will be unacceptable
Once fully seated, adjust occlusion as needed
Provide post insertion instructions
Verbal
Written patient brochure

Dalhousie Timeline for Insertion
0 -15 min
- Inform surgeon & Dr. Knechtel patient is
receiving an immediate denture
- review med history
- provide local anaesthesia
15 - 60 min
- extractions
1 - 2 hour
- insert and adjust
- instructions
Instructions to Patient
Do not remove until 24 hour appointment
If it comes loose/out replace immediately
Soft/liquid diet for 24 hours
Avoid vigorous rinsing
Take analgesic as prescribed
Expect red saliva
24 Hour Appointment
Remove and clean denture
Relieve sore spots
Do not use PIP use indelible stick
Gross occlusal adjustment

1 Week Recall Appointment
Relieve sore spots
Use PIP
Refine occlusion possible remount
Continuing Care
Tissue conditioner to improve retention as
needed
Remove any socket convexities to avoid healing
defects
Reline or remake in 4 to 6 months
Postpone as long as patient can tolerate to
ensure most of initial resorption complete


Remove denture base convexities to avoid healing defects
X
X
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