Immediate dentures

IMMEDIATE DENTURES

DR. HIRA MUSHARRAF

An immediate denture is complete or removable partial denture fabricated for placement at the same appointment as

extraction of natural teeth

Any patient whose remaining teeth are indicated for extraction is a potential candidate for an immediate denture.

However such a candidate must be physically and mentally be prepared to undergo the

increased number of visits to the dentist as well as greater cost

•Any patient unable to undergo multiple extractions. Example: blood dyscrasias and cardiac disease•In acute or periodontal infection•Patients incapable of showing responsibility towards the treatment e.g. senile, mentally retarded and indifferent patients.•Extensive bone loss adjacent to remaining teeth

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

Easier AdaptationSpeech, mastication rarely compromised

Less postoperative pain & bleeding•extraction sites protected•Pressure from denture base

Easier to duplicate natural tooth shape & position (if desired)Tongue will not spread out as result of tooth lossNutrition can be maintained

More challenging to set teeth•Less space for teeth as ridge resorption hasn’t occurred

Alveolar ridge undercuts around remaining teeth may make impressions more difficult

Unstable or inadequate occlusion can make recording centric position difficult

•CONVENTIONAL IMMEDIATE DENTURES•INTERIM IMMEDIATE DENTURES

•intended to be relined to serve long-term

•after healing a second new complete denture is fabricated as a long-term

prosthesis

CONVENTIONAL IMMEDIATE DENTURES

INTERIM IMMEDIATE DENTURES

Definitive or long-term prosthesis Transitional or short-term prosthesis

After healing is complete, it is relined

After healing, a second denture is made

Patient usually has only anterior teeth (plus possibly premolars)

Patient usually has both anterior and posterior teeth

Usually has good retention and stability at placement, which is possible to maintain during healing

Usually has only fair retention and stability at insertion, which must be improved by provisionalrelines (tissue conditioning) during healing

The overall cost of CID treatment is less than IID treatment because it is the cost of the CID plus a reline

The overall cost of treatment is greater than ClD treatment because it includes the cost of the interimdenture and a second denture



Longer time for treatment completion

Lesser time than CID

Generally indicated when anterior teeth remain.

Generally indicated when both anterior and posterior teeth remain

indicated when patient can function without posterior teeth for 3 months

indicated when the patient cannot or will not go without posterior teeth

At placement of the ClD, usually only anterior teeth are extracted

At placement usually both anterior and posterior teeth are extracted

Indicated when two extraction visits are feasible

Indicated when only one surgical visit is preferable



Esthetics of the CID cannot be changed

The second denture procedure after the allows an alteration of esthetics

At the end of the treatment, the patient has one denture

At the end of the treatment, the patient has a spare denture

OVD is usually not preserved as posterior teeth are extracted (preserved if premolars are retained)

OVD is preserved as posterior teeth will not be removed before fabrication of IID

Contraindicated for a patient who has a complex treatment plan

Indicated when the patient will become edentulous one arch and partially edentulous in the opposing arch for the first time or complex procedures are needed

Not useful for converting existing prostheses such asremovable partial dentures

Can be useful in converting existing prostheses to an IlD

•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•Takes time to adapt to chewing and speaking

•Appearance may be unpredictable if anterior try-in not possible•Should be worn for first 24 hours without removal

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

• Immediate dentures will normally “loosen” during healing due to ridge resorption & soft tissue remodeling

•Relines/tissue conditioners will be required to improve the retention

•If removed, reinsertion can be difficult if significant swelling occurs

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

1) Plan two stage extractions removing posterior teeth first leaving only six anterior teeth2) Allow 4-6 weeks healing time3) Preliminary impression4) Custom tray fabrication5) Final impression6) Fabrication of record bases

7) Jaw relationship records and tooth selection8) Laboratory fabrication of dentures9) Second stage surgery and delivery of dentures10) Post insertion adjustments11) Reline denture after 6-12months

SINGLE IMPRESSION TRAY TECHNIQUE

SECTIONAL TRAY IMPRESSION TECHNIQUE

FINAL IMPRESSIONS

SECTIONAL TRAY IMPRESSION TECHNIQUE

•Dentures should not be removed for 24 hours after inserion.•Ice packs may be used to reduce swelling.•A liquid diet or soft is prescribed.•Smoking should be avoided.

•Patient will be seen in 24 ours to evaluate denture retention, support and stability.•Patient may need to be for a series of visits during the initial 2 to 3 weeks after insertion.•There is gradual remodelling of bone over a period of 3 to 6 months.•A reline or rebase procedure is usually needed during the first year of clinical service.

Science

Immediate dentures