CONTENTS

Definitions

Advantages and disadvantages of immediate dentures

Contraindications of immediate dentures

Basic over view of an immediate denture fabrication

Surgery and Immediate Denture Insertion

Patient instructions

Review of literature

Conclusion

References

Definition

The glossary of prosthodontic terms ‘defines an immediate denture as a complete or removable partial denture constructed for insertion immediately following the removal of natural teeth.

Interim Immediate Denture/ Transitional Immediate Denture

An immediate denture after healing can be relined and refitted to be used as a definitive denture but an Interim immediate denture is worn only during the healing period to be replaced with a new prosthesis as soon as healing is complete.

One of the first references to immediate dentures in the literature was that of Richardson in 1860 (Seals, 1999).

ADVANTAGES AND DISADVANTAGES OF IMMEDIATE DENTURES 

Advantages

Maintenance of a patient's appearance

No edentulous period.

No interruption of a normal lifestyle of smiling, talking, eating, and socializing.

Circum-oral support, muscle tone, vertical dimension of occlusion can be maintained.

The tongue will not spread out as a result of tooth loss.

Less postoperative pain

Some authors have discussed whether immediate dentures reduce residual ridge resorption (Heartwell, 1965; Johnson, 1966; Kelly, 1958; Campbell, 1960; Carlsson, 1967).

Duplication of the natural tooth shape and position, plus arch form and width.

Adaptation to dentures

Speech, mastication and nutrition can be maintained.

Tissue-conditioning material allows for considerable versatility in the correction and refinement of the denture fitting surface

Overall, the patient's psychological and social well-being is preserved.

Disadvantages

More challenging modality than complete dentures

The presence of teeth makes impressions and maxillomandibular positions more difficult to record.

Expensive, time consuming, adjustments

Trial for anterior teeth not possible

Patients unsuitable for this treatment option: Poor general health or who are at poor surgical

risks (e.g., post irradiation of the head and neck regions, systemic conditions that affect healing or blood clotting and psychological disorders).

uncooperative, cannot understand and appreciate the scope, demands, and limitations to the course of immediate denture treatment

Basic over view of an immediate denture fabrication

History taking Dental history

patients needs & expectations

Medical history

Preliminary examination

Oral examination

Jaw relation and occlusion

Radiographic examination

Preliminary Impressions and Diagnostic Casts

Impressions are made in irreversible hydrocolloid (alginate) in stock metal or plastic trays..

Fabrication of custom tray and final impression Single full arch custom tray

Two part impressions

Campagna impression Technique:

Putty-index technique

Jaw Relation

Identical to those for complete dentures

Denture base & wax occlusal rims

Vertical dimension is established

Face bow transfer

Jaw relation records

Notches 5mm deep cut into the rims

Centric relation registration

Protrusive records made

Condylar guidance adjusted

Setting the posterior Denture Teeth/Verifying Jaw Relations and the Patient Try-in Appointment

The articulated casts are used for setting any anterior/posterior teeth that are missing so that a try-in can be accomplished with the patient.

Anterior teeth selection & positioning The midline or newly selected midline is recorded on

the base area of the master casts.

A discussion of placement of diastema, rotated teeth, notches, and other natural arrangements should occur so that the patient is actively involved in the esthetic decisions.

Cast trimming & anterior teeth arrangement Ridge lapping

Rule of Thirds – Cast Trim

Recess Socket 1 mmRemove tooth at gingival level

Step 1 Step 2

Step 3 Step 4

Labial edge recess to incisal third mark

Mid-point recess to mid-width labial cut

Step 4 Step 5

Round over lingual aspect of socket

Step 5 Step 6

Round off labial to middle third, sand smooth

Denture is waxed up.

Final waxing and carving done.

Processing and Finishing

Processed and finished in the usual manner of complete dentures.

If desired, a laboratory remount can be accomplished before removing the dentures from their casts and finishing.

Keep the undercut areas of the denture slightly thick at this point to allow for insertion over undercuts.

These areas can be thinned later before sending the patient home.

Surgery and Immediate Denture Insertion

Extraction of the remaining teeth, taking care to preserve the labial plate of bone

The surgical template is used as a guide to ensure that the prescribed bone trimming is done adequately.

Ridge after extraction and placement of sutures if required.

Patient instructions

Dentures must be left into the mouth during first 24 hours

Ice compress on face for 20 minutes on repeatedly for the first 24 hours.

No chewing, liquid diet

After the first 24hours, patient should carefully remove the denture twice a day

Recall after 24 hours

Occlusal corrections from 48hrs to 1-2weeks

Recall every 3 months, adjustments with tissue conditioning material

Following the bone resorption period (approximately 6 to 12 months) a more permanent reline will be placed.

Review of literature:

Walter j Demer 1972

“Minimising problems in placement of immediate dentures” …

Distolingual undercut

Buccal and lingual undercuts in the bicuspid region

Sublingual undercuts

Incisive fossae and canine eminences

Distolingual and anterior combinations

Labial and lingual undercuts

Extractions without alveoloplasty

Extraction with alveoloplasty

Septal alveolectomy

Radical alveolectomy

John P Dahlberg(1965)“Reconstructing the Natural Appearance By Immediate dentures

Antony S Gotlieb(2001)

“An atypical chairside

immediate denture”

Ashok Soni et al (2000)

Trial anterior artificial tooth arrangement for an immediate denture patient :A clinical report

A technique is described that allows the esthetic try-in of the maxillary anterior artificial tooth before the extraction and completion of an immediate denture

Intra oral view

Posterior artificial tooth try in done with modified anterior wax up in anterior labial flange area.

Try in of posterior artificial tooth arrangement with processed maxillary denture.

To relate the maxillary denture to remaining teeth and supporting tissues, an impression of the adjusted denture was made and a new maxillary cast fabricated.

The maxillary artificial anterior teeth were arranged to reflect the position of the patients natural teeth.

Labial index of the completed anterior artificial tooth arrangement was made with impression plaster.

After the separation of the index the teeth were fixed using autopolymerizing acrylic resin.

Denture was finished and inserted immediately after the extraction.

Majid B et al (2004) Described fabrication of a clear surgical template that

minimizes pressure caused by immediate complete dentures on a surgical area.

Conclusion

• Patient education.

• Meticulous treatment planning.

• Staging extractions.

• Good impression technique.

• Tissue conditioners and remounts.

____________________________

= improve the predictability of the outcome.

References :

1. BOUCHER,S –prosthodontic treatment for edentulous patients 9th

edition & 11th edition .

2. CHARLES HEARTWELL & ARTHUR O RAHN –Sylabuss of

complete dentures 4th edition.

3. DENTAL CLINICS OF NORTH AMERICA- Complete dentures, april

1977, 21;2

4. JOHN J SHARRY- Complete denture prosthodontics 2nd edition.

5. JOHN N ADERSON, ROY STORER – Immediate dentures &

replacement dentures 3rd edition

6. SHELDON WINKLER- Essentials of complete dentures 2nd edition

7. RUDD & MURROW – Dental lab procedures , complete dentures

8. ZARB, BOLENDER – Prosthodontic treatment for edentulous patients

12th edition.

9.. MM Devan “The Trasition From Natural To Artificial Teeth" JPD

1960 vol-1

10. William B Lineberg “SURGICAL PREPARATION OF MOUTH FOR

IMMEDIATE DENTURES “1963 vol 13 no 1

11. John P Dahlberg“Reconstructing the Natural Appearance By Immediate

dentures”JPD 1965;205-210

12..M Heartwell IMMEDIATE COMPLETE DENTURE; AN

EVALUATION 1965 vol 15 no 4

13. Asok Soni “Trial anterior artificial tooth arrangement for an immediate

denture patient : A Clinical report ,JPD 2000 ;84 :260-263

14. Anton S Gotleib “An atypical chairside immediate denture :A clinical report

JPD 2001 :86 :241-243

15. Masjid Bissasu “A simple procedure for minimising adjustmentsof

immediate complete denture :Aclinical Report :JPD 2004 ;92: 125-127

16. Jonkman RE, van Waas MA, van 't Hof MA, Kalk W

J Dent. 1997 Mar;25(2):107-11.

17. Geoffrey St George et al, Immediate Dentures: 1 diagnosis & treatment

planning. Dent Update 2010

18. Geoffrey St George et al, Immediate Dentures: 2 Clinical stages of

construction Dent Update 2010; 37: 154-160

Thank you..