21. immediate denture

• An immediate denture is “a complete denture or removable partial denture fabricated for placement immediately after the removal of natural teeth”

(Zarb,. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9).

Immediate Dentures:

Immediate Complete DentureImmediate Complete Denture

• Conventional immediate denture

-the denture is intended to be relined to serve as the long-term prosthesis.

• Interim (or transitional) immediate denture (IID):

-after healing is completed, a second, new complete denture is to be fabricated as the long-term prosthesis.

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

Immediate RPDImmediate RPD

• Normally made of acrylic with “ball clasps”

• No posterior teeth –only acrylic “bite pads”

• Transitional

• Replaced after healing with cast RPD

AdvantagesAdvantages

• Maintenance of a patient's appearance

• Circumoral support, muscle tone, vertical dimension of occlusion, jaw relationship, and face height can be maintained. The tongue will not spread out as a result of tooth loss

• Less postoperative pain is likely to be encountered because the extraction sites are protected

• Easier to duplicate (if desired) the natural tooth shape and position

• Adaptation easier. Speech and mastication are rarely compromised, and nutrition can be maintained

(Zarb, George A. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.2.1).

DisadvantagesDisadvantages

• Immediate dentures are a more challenging

• The anterior ridge undercut that is caused by the presence of the remaining teeth may interfere with the impression procedures

• The presence of different numbers of remaining teeth in various locations frequently leads to recording incorrectly the centric relation position

• No denture tooth try-in in precludes knowing what the denture will actually look like on the day of insertion

• more chair time, additional appointments, and therefore increased costs

(Zarb, George A. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.2.2).

Explanation to the Patient Explanation to the Patient Concerning Immediate DenturesConcerning Immediate Dentures

• Do not fit as well as normal complete dentures.

• The pain of the extractions, in addition to the sore spots caused by the immediate denture, will make the first week or two after insertion difficult.

• It will be difficult to eat and speak initially

• The esthetics may be unpredictable because an anterior try-in is not possible

(Zarb, George A. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.4.3.1).

Explanation to the Patient Explanation to the Patient Concerning Immediate DenturesConcerning Immediate Dentures

• Immediate dentures must be worn for the first 24 hours without being removed by the patient. If they are removed, they may not be able to be reinserted for 3 to 4 days. The dentist will remove them at the 24-hour visit

• Immediate dentures will “loosen” during healing, tissue conditioners will be required

• 6 to 9 months after insertion at least a reline will need to be done, possibly a remake . The patient is responsible for fees.

TechniqueTechnique

• Examination/Diagnosis/Treatment Plan

• Informed consent

• Oral hygiene procedures

• Extract (usually all) posterior teeth

• Wait 4 weeks for healing

TechniqueTechnique

• Preliminary impressions

• Final impressions

• Jaw relation records

• Tooth set up and try in

• Extraction and insertion

• Post insertion care

Examination/Diagnosis/Treatment PlanExamination/Diagnosis/Treatment Plan

• Assess tissue undercuts (especially in the anterior maxilla

-reduce during extractions-use 2 piece tray for impression

• Is VDO correct?• Imitate or change tooth arrangement

for esthetics or denture stability-midlines, occlusal plane, vertical

overlap, length of maxillary incisors• Conventional or transitional

TechniqueTechnique

• Examination/Diagnosis/Treatment Plan

• Informed consent

• Oral hygiene procedures

• Extract (usually all) posterior teeth

• Wait 4 weeks for healing

Preliminary impressionsPreliminary impressions

• Use dentate or partially edentulous stock trays

Final ImpressionsFinal Impressions

• Normally need to use 2 piece custom tray

• If no large tissue undercuts may be able to us 1 piece custom tray

2 piece tray2 piece tray

1 piece tray1 piece tray

Jaw relation recordsJaw relation records

Tooth set up and try inTooth set up and try in

Extraction and insertionExtraction and insertion

• Have lab complete set up and modify cast as directed.

-use perio probing to guide cast modification

Extraction and insertionExtraction and insertion

• Request a surgical stent (guide)

Extraction and insertionExtraction and insertion

• Extract teeth• Use surgical guide to contour ridge• Seat the denture

-try not to use of PIP-check for over extensions

THE DENTURE MUST BE FULLY SEATED

• Adjust occlusion• Give post insertion instructions

Timeline for insertion appointmentTimeline for insertion appointment

0-15 (min)-review med history and LA

15-60-extractions

60-75-move patient to pros cluster

75-120-insert and adjust-instructions

Instructions to patientInstructions to patient

• Do not remove until tomorrow's appointment

• If it comes loose/out put it back in place immediately

• Sot/liquid diet for 24 hours• Avoid rinsing• Take analgesic• Expect red saliva

24 hour appointment24 hour appointment

• Remove and clean denture

• Relieve sore spots

• Do not use PIP

1 week1 week

• Relieve sore spots

• Use PIP

• Refine occlusion

Follow upFollow up

• Use tissue conditioner to refit as needed

• Remove any socket convexities to avoid healing defects

• Reline or remake in 6 to 9 months