Dr. Mahmoud Ramadan

Rem. Prosthodontics502

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Dr. Mahmoud Ramadan

Immediate Denture

*Indication-: To avoid loss of appearance& function for the short time between

extraction of teeth& fitting of denture.

*Advantages-:1-maintenance of appearance.

2-minimise the interference with speech.3-excellent psychological effect upon the patient.

4-maintain adequately the important vertical& horizontal relation ship.5-↓ possibility of development of abnormal mandibular movement.6-preservation of vertical dimension, prevent muscle of mastication

from losing tone& Shortening and the ligaments from being stretched.7-prevent possible movement of remaining natural teeth.

8-control post extraction hemorrhage (stents).9-controlling effect upon the resorption of the alveolar process.

*Disadvantages-:1-can't retain fit for a longer than few weeks.

2-Relining or remaking is usually twice during period of alveolar resorption .

*Classification-:1-Socketed or Flanged immediate dentures.

N.B. upper denture may be Socketed or with partial or full extension labial flange.

2-Partial or Complete immediate dentures.

Socketed type immediate partial denture*Indication-:

→Replacement of upper anterior teeth with-:1-limited periodontal disease.

2-little change in tooth position.

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Dr. Mahmoud Ramadan

*Advantages-:1-position of anterior teeth may be exactly duplicated.

2-Apperance of denture is natural.3-Presence of labial undercut doesn't complicate denture insertion.4-Difficult in obtaining correct amount of cast trimming is avoiding.

5-Necessity for providing the surgeon with a resien base of the trimmed area is avoided.

*Disadvantage-:1-absence of labial flange ↓ retention& stability.

2-recession of the gums may expose the necks of the artificial teeth.3-↓ healing& conservation of ridge than with labial flange.

4-gum margins& sockets must be preserved without injury at time of extraction.

5-unexpected difficulty during extraction make the method uncertain.

*Technique-:→ At the Clinic-:

1-perform scaling& extract any remaining roots.2-make alginate impression of upper& lower casts.

3-record the shade of extracted teeth.4-make inter-occlusal record to mount the casts.

→ At the Laboratory-:1-pour the impression.

2-pour the upper impression twice or duplicate it for comparison between the positioning of artificial teeth with the original position of teeth to be replaced.

3-mount casts on articulator.4-selection of suitable anterior teeth (form, size, shade) to natural tooth.

5-cut off one of the teeth to the level of the cervical margin.6-dig a socket about 2mm apical to gingival margin.

7-adapt the wax to the palate& set the artificial teeth.8-compare the anterior teeth with the reference cast.

9-trial of the waxed up denture isn't possible as tooth still in situ.10-missing posterior teeth on the cast may be replaced& clasps are fitted

around the suitable teeth.

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Dr. Mahmoud Ramadan

11-waxed up denture is processed into acrylic resien, finished& polished.12-denture kept in mild antiseptic solution until required.

→ Fitting of Socketed type-: 1-extraction is carried out under block or infiltration local anesthesia

with minimal trauma not to break roots or lacerate the soft tissue.2-allow 10min for initial blood clotting.

3-Insert denture in place& check fit, retention& occlusion with opposing teeth.

4-pt. instructed to return in not more than 48hour for adjustments.5-pt. instructed to keep the denture in mouth in all times except when

using a mouth wash& cleaning the denture after meals.6-pt. encouraged to commence mastication with denture as soon as

possible.7-root part must be reduced gradually to allow for normal gum healing.

Flanged type Immediate partial denture→ Immediate denture is made with a full or partial labial flange.

*Indications-:1-lower immediate denture:- using of labial flange allows some relief of

the sockets without compromising esthetics.2-upper immediate denture:- replacing upper anterior teeth with

superior protrusion or advanced periodontal disease.

*Advantages-:1-retention& resistance to antero-posterior movement of the denture.

2-providing lip support.3-allow freedom in changing position of anterior teeth.

4-protection of the healing sockets.

*Disadvantages-:1-Thickness of the flange limits the length of artificial teeth.

2-Difficulity in insertion& removal if the flange engages a deep labial undercut.

3-Accomodation of the relieved labial flange is difficult.4-The ridge needs surgical trimming to reduce the labial undercut.

IV

Dr. Mahmoud Ramadan

♥ Partial labial flange-:→The last 3 disadvantages overcome with using the partial labial flange.

→It is extended very little beyond the maximum contour of the ridge.→It should adapted perfectly to the ridge for esthetic reasons.

*Technique:- It includes

Clinical procedure Laboratory procedure→ The same as Socketed type to have

the master cast .

Without bone trimming With bone trimming

a) Replacing teeth with bone trimming (upper anterior teeth) -: 1-Cut the lower teeth off the cast 1mm occlusal to the cervical margins.

2-Trim the ridge labially& also may need reduction in height .3-Adapt a layer of base plate wax on cast to out line the denture.

4-Set the artificial teeth& check its relation.5-Remove teeth, wax& make impression for the trimmed cast& pour it.

6-Adapt a layer of base plate wax to the plaster cast, flask& process to have a transparent template.

7-Fix the artificial teeth& base plate wax to the trimmed master cast again, add suitable clasps, waxing up& processing.

b) Replacing teeth without bone trimming (lower anterior teeth) -: 1-Cut the lower teeth off the cast 1mm occlusal to the cervical margins.

2 -Adapt a layer of base plate wax on cast to out line the denture base including labial flange→ It should limited to non undercut area of ridge.

3-Set the artificial teeth& and suitable clasps, waxing up& processing.

→ Fitting of flanged type immediate dentures-:a) With bone trimming-:

1-Teeth are extracted after raising labial& buccal gum flaps.2-Trim the labial& buccal alveolar bone to the same amount as in the

trimmed cast.

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Dr. Mahmoud Ramadan

3-Close gum flaps by Stitches& insert denture.4-Post-operative instructions& follow up after 48hours.

b) Without bone trimming-:

1-Extract teeth then squeeze the bone plates between fingers.2-Insert immediate denture& use P.I.P. to check pressure areas.

3-pt. should come after 24hours to recheck sore spots.

Complete Immediate Denture→ Used when clearance of remaining anterior& posterior teeth is

indicated.

1st treatment plane 2nd treatment plane *Immediate replacement of all * Immediate replacement of anterior

upper& lower teeth. Teeth only.

→ Immediate replacement o f all the teeth -: 1(Make upper& lower alginate impression and pour in stone plaster.

2(Mount casts on articulator using inter-occlusal record blocks.3(Cut off the teeth on the upper cast& trim the ridge to the required

form.4(Make alginate impression for the trimmed cast& pour a duplicate cast

in plaster.5(Fix wax base to the full denture area of the duplicate cast.

6(Flask this base& reproduce it in clear acrylic resien.7(Fit a new base to the edentulous cast on the articulator& set teeth. If a

lower tooth is malposed or over-erupted, trim or cut it from the lower stone cast to allow setting of the upper teeth in proper position.

8(Process the upper denture& finish.9(The pt.'s teeth are extracted after of labial& buccal gum flaps-:

→Trim the alveolar bone labially& buccally in amount ═ scrapping done on the cast.

→The clear acrylic plate acts as a guide to amount of bone trimming.→Close gum flaps by stitches& Insert complete denture(s).

10(Check occlusion.

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Dr. Mahmoud Ramadan

11(following the insertion of the upper plate by several weeks, the lower teeth are reproduced on complete lower plate by the same technique& inserted in the mouth.

*Fitting of the immediate denture-: →Extraction of many teeth is best carried under General Anesthesia.

→The localized swelling of the tissues that results from infiltration anesthesia makes it impossible to fit the denture until several hours after extraction.

→The must always be removed without trauma, care being taken not to break roots or lacerate the soft tissues.

→As soon as the pt. has recovered from the operation, the denture is inserted.

→Pt.'s will very rarely complain from any discomfort from denture insertion but they must be instructed to-:

1(Return in not more than 48hours for adjustment& inspection.2(Keep the denture in mouth in all times except for cleaning purposes.

3(Commence mastication with denture as soon as possible.→The root part must be reduced gradually to allow for normal gum

healing till the tooth is left with a well fitting cervical margin.

→Immediate replacement of anterior teeth only-: *Technique-:

1-Extract upper& lower posterior teeth.2-Allow healing period for 6 – 8 weeks.

3-Make upper& lower alginate impression and pour in stone plaster.4-Make posterior record bases& wax rims.

5-Record centric Maxillo-mandibular relation& mount on articulator.6-Set posterior teeth& waxing up.

7-Break the upper& lower anterior teeth on the casts.8-Do sockets or trim the ridge to receive flanges, If trimming is extensive

duplicate the trimmed cast to make the transparent acrylic template.9-Set artificial anterior teeth& wax up the complete denture(s).

10-Extract remaining anterior teeth& Insert the complete denture.

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Dr. Mahmoud Ramadan

♥ Alternative Technique -: → If pt. accommodation to artificial denture is doubted .

→ It is better to replace posterior teeth with a partial denture& anterior teeth are replaced few weeks later.

*Technique-:1-Extract upper& lower posterior teeth.

2-Allow healing period for 6 – 8 weeks.3-Make upper& lower alginate impression and pour in stone plaster.

4-Make posterior record bases& wax rims.5-Record centric Maxillo-mandibular relation& mount on articulator.

6-A distal extension temporary partial denture is processed& delivered to the pt.(Allow one or two weeks for accommodation to partial denture)

7-Make a corrective impression for the partial denture. Check& reinsert and make an over all impression in alginate stock tray .

8-The partial denture will come out as a part of the whole impression. Pour in stone plaster.

9-Mount the cast with the upper denture on an articulator with the cast of the opposite arch.

10-Break the upper& lower anterior teeth on the casts.11-Do sockets or trim ridge to receive flanges, If trimming is extensive

duplicate the trimmed cast to make the transparent acrylic template.12-Set artificial anterior teeth& wax up teeth with the temporary partial

denture. Process, finish& polish .13-Extract remaining anterior teeth& Insert the complete denture.

♥ Duplication of anterior teeth-:→Size, form& shade of the teeth must be copied exactly by construction

of heat cure acrylic teeth.

*Technique-:1-after recording the shade of the natural teeth, an alginate impression

of the teeth to be extracted is taken.2-Any of these teeth have cavities should be filled with temporary filling

or wax to restore contour before taking the impression.3-there is no need for the impression to extend too much beyond the

cervical margins of teeth.

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Dr. Mahmoud Ramadan

4-Teeth impression are cast immediately in molten wax.5-As soon as the wax is quite hard, it is removed& examined carefully to

ensure that it has reproduced the natural teeth correctly.6-Trim away the excess wax, small amount of root is allowed to remain

in each pattern.7-It's better to separate the large pattern into small sections to facilitate

trimming, it may be divided into single teeth to correct irregularities of pt.'s teeth that may be founded.

8-Flask the wax patterns. Posterior or single shaded teeth may be flasked in upright position, but multicolored teeth must have their labial surfaces exposed for packing.

9-After processing, teeth are deflasked, cleaned, and excess is trimmed away, care being taken to preserve the small root on the anterior teeth.

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