immediate dentures by me
TRANSCRIPT
IMMEDIATE COMPLETE DENTURES
Presented by:- Dr.Mayura Badgujar
Guided by:-Dr. Rajani Dable&
Dr .Girish Nazirkar
Index
1.Defination. 2.Types. 3.Indications. 4.Contraindications. 5.Advantages. 6.Disadvantages. 7.Requirements of immediate dentures. 8.Diagnosis and treatment planning. 9.Preimpression procedures. 10.Primary impression. 11.Secondary impression. 12.Jaw relation records. 13.Tooth selection and arrangement of teeth. 14.Insertion procedures. 15.Post insertion care.
Definition
“a complete or removable partial denture constructed for insertion immediately following the removal of natural teeth”-GPT.
“a dental prosthesis constructed to replace the lost dentition and associated structures of maxilla and mandible and inserted immediately after the removal of remaining natural teeth” - Heartwell
Types
1.Conventional or Classic Immediate denture:-
immediate denture is placed after the removal of natural teeth and after the healing is completed , the denture is relined or refitted to serve as a long term prosthesis.
2.Interim or Transitional Immediate denture:-
immediate denture is made after the removal of natural teeth and after the healing is completed,a second,new complete denture is fabricated as long term prosthesis
Indications
Socially active. Prognosis of the remaining teeth is poor. Wishes to retain natural appearance with
minimal bone loss. Good general health prognosis. Available time and can afford multiple
visits as well as the expenses.
Contraindications
Patient is unavailable for appointment or financially underprivileged.
Patient is in debilitated condition. Systemic condition preclude multiple
extractions. Emotionally disturbed or diminished
mental capacity. Indifferent /uncooperative patients. Patient with extensive bone loss.
Advantages
Maintenance of patient’s appearance because there is no edentulous period.
Denture acts as a bandage or a splint over the extraction site ,as well as promotes healing.
Circumoral support,muscle tone,vertical dimension of occlusion,jaw relationship and face height can be maintained.
Regaining of adequate function by the pateint. Less post-operative pain and swelling. Patient’s psychological and social well-being is
preserved.
Disadvantages
Procedures are time consuming and precise thus increased costing is unavoidable.
Anterior ridge undercut due to presence of teeth may interfere with impression procedures.
Esthetic result cannot be evaluated. Functional activities are likely to be impaired
temporarily. Presence of different numbers of remaining
teeth in various location may lead to incorrect recording of the centric relation.
Requirements of an immediate denture
Should be compatible with surrounding oral tissue.
Should restore the masticatory efficiency within limits.
Esthetically it should be acceptable. Function in harmony with the activity necessary for speech, respiration and deglutition.
Preservation of remaining structures.
REASONS FOR IMMEDIATE
REPLACEMENTS
Physical factors
Physiological factors
Psychological factors
PHYSICAL FACTORS
Prevents disuse atrophy of the bony base
Provides favourable trabeculation of the repairing
bone
Prevents possible damage to the ligaments
surrounding TMJ – abnormal neuromuscular pattern
in absence of dentures
PHSYIOLOGICAL REASONS
When the teeth are removed, the beautifully effective
teamwork
between the various parts of stomatognathic system is
broken up –
abnormal functioning of the mouth and mandible.
Impaired communication.
Abnormal deglutition
PSYCHOLOGICAL REASONS
Humiliation.
Adverse subjective reactions – minimized by
immediate substitution.
Diagnosis and treatment planning
Diagnostic procedures include:- 1.Patient examination:-local factors
studied using x-rays , visual and digital examination, accurately articulated casts.
2.Consultation interview:- patient’s expectations , mental attitude , systemic status , past dental history.
Patients mental attitude: The best for immediate denture is the philosophical type.
A careful explanation to the patient of the limitations of immediate denture service should always be given.
Systemic status Any systemic complications that adversely affects the formation of
the essential components of healing and of tissue regeneration, both hard and soft , will offer a poor prognosis for the immediate complete denture therapy.
Past dental history: Hemorrhagic tendencies and allergic reaction to local anesthesia
when the teeth are extracted must be evaluated.
Local factorsCondition of the teeth to be
extracted
Position of the teeth:-especially of the maxillary
arch
Position of any foreign bodies
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Presence of bony or tissue undercuts that must be reduced or
eliminated.
exostosis
Bone loss adjacent to the remaining teeth.
Muscle co-ordination.
Pre-impression procedures
Plan two stage extraction:-removing the posterior teeth first ,allowing it to heal for a short time , usually 3 to 4 weeks , before the preliminary impression is made.
All the posteriors are extracted except unilateral or bilateral premolars.
Sometimes occlusal adjustments of the remaining natural teeth is indicated.
Any other required hard and soft tissue operation is also done in the first surgical visit.
Primary impression
Impression are made in irreversible hydrocolloid(alginate) in stock metal or plastic trays.
First Step : Get a good alginate impression and cast
Good impression of vestibular areas
Peripheral “Roll” on Cast as a result of capturing the area well with the impression
The Lower Alginate Impression & Resulting Cast
Impression Capturing Peripheral “Rolls” and Lateral Throat Form
Resulting Cast Showing Vestibular Area
Immediate Dentures Final Impression Techniques
Single custom tray Split impression
techniquePosterior segmentAnterior segment
Stock tray Putty index
Single custom tray fabrication
Autopolymerizing resin is adapted over the cast
Split impression technique:-
Split impression tray using alginate . Split impression tray using putty- index
technique.
Split impression technique using alginate
Stock Tray Technique
Short-comings Small oral opening Proclined maxillary
anterior teeth Anatomic accuracy
of vestibule
Split Impression Tray-Putty-Index Technique
Tray extends to and contacts incisal edge of anterior teeth
Putty-Index Technique
Putty-Index Technique
Putty-Index Technique
Jaw relation records
Tooth set up and try in
Trimming of the cast
Cast trimming guidelines:- In case of “normal” periodontal
condition - ”rule” of thirds is followed.
Advanced periodontal deterioration - x-rays and probing measurements.
Rule of Thirds – Cast Trim
Recess Socket 1 mmRemove tooth at gingival level
Step 1 Step 2
Rule of Thirds – Cast TrimStep 3 Step 4
Labial edge recess to incisal third mark
Mid-point recess to mid-width labial cut
Rule of Thirds – Cast TrimStep 4 Step 5
Round over lingual aspect of socket
Rule of Thirds – Cast TrimStep 5 Step 6
Round off labial to middle third, sand smooth
Master Cast Trim
Trimmed areas sanded smooth
Avoid removing incisive papilla
Teeth selection and arrangement of anterior teeth
Form ,size ,shade selection is easily done using patients natural teeth.
Arrangement of anterior teeth:- a .Duplication of patient’s natural teeth arrangement.
b.Arrangement with maximum cosmetic result.
SURGICAL TEMPLATE
It is a thin ,transparent form duplicating the tissue surface
of an
immediate denture and is used as a guide for surgically
shaping
the alveolar process (Farmer,1983)
Surgery and immediate denture Insertion
The dentist extracts the remaining teeth
taking
care to preserve labial cortical plate.The surgical template is used as a guide – bone
trimming adequately until the template seats
uniformly and completely.
In cases of simple extractions without
alveoplasty,
the denture is inserted after digital
compression of
the socket walls.
In cases of alveolectomy the dentures are inserted
after mucosal margins are sutured.
Gross occlusal error is corrected .
Post-insertion instructions:-
Not to remove for first 24 hrs.
Premature removal of the dentures could make its
reinsertion
impossible for 3-4 days or until reduction of swelling.
Avoid vigorous mouth washing.
Avoid hot food& drinks , alcohol.
Analgesics are prescribed.
Soft /Liquid diet.
EXAMINATION AFTER 24 HOURS
Irrigated with warm saline.
Check tissues for sore spots & relieve them.
Gross occlusal discrepancy is corrected.
Reevaluate for retention.
Mouthwash prescribed 3-4 times/day.
Patients are encouraged to use dentures for
mastication- helps to
improve blood supply and assists rapid healing.
EXAMINATION AFTER ONE WEEK
Suture removal .
Necessary denture adjustments.
Patient must be encouraged for
regular
examination.
FURTHER FOLLOW UP RATE
During first post insertion month, the patient is seen on
regular or else weekly as required for sore spot
adjustments.
After 2 weeks remount the dentures on the articulator
and
refinement of occlusion is done.
SUBSEQUENT SERVICE FOR IMMEDIATE DENTURE PATIENT
After the sore spots are eliminated and the tissues have healed, a recall
programme for changing the tissue conditioner liner is organized.
Research has shown that complete socket calcification is complete at 8 to 12
months following tooth extraction and the bone volume of the ridge is reduced
20 to 30% during first 12 months.
After the early rapid resorption (3 months), the subsequent change in contour
of the alveolar bone will necessitate correction of the fitting surface of the
denture (relining/rebasing) at intervals.
Patients with IIDs can have their second denture started within 3 –6 months if
desired.
CONCLUSION They fulfill an important role in today's
treatment modalities by providing the patient
with esthetics, function & psychological support
after extraction & during healing phase . The
technique is more demanding than regular CD for
both patient & dentist . If the patient is prepared &
appropriate type of immediate denture is selected
the resulting prosthesis can be a success.
References
26-004. Jerbi, F.C. Trimming the Cast in the Construction of Immediate Dentures. J Prosthet Dent 16: 1047-1053,1966.
Rule of Thirds: KellyDivides the facial aspect of the alveolar ridge into three equal bands of space between the gingival line and the depth of the vestibular space.
One – appointment construction of an immediate transitional complete denture using visible light-cured resin - JPD 1992 Vol 68
Used for physically compromised individuals.
Trial anterior artificial tooth arrangement for an immediate denture patient : A clinical report - JPD 2000 Vol 84
BibliographyBOUCHER,S prosthodontic treatment for edentulous patients 9th
edition & 11th edition .
CHARLES HEARTWELL & ARTHUR O RAHN Syllabus of complete
dentures 4th edition.
SHELDON WINKLER Essentials of complete dentures 2nd edition.
RUDD & MURROW – Dental lab procedures , complete dentures vol 1.
ZARB, BOLENDER – Prosthodontic treatment for edentulous patients .
Journal of prosthetic dentistry 1966 vol 26 Journal of prosthetic dentistry 1992 vol 67,68 Journal of prosthetic dentistry 2000 vol 84
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