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

Click icon to add picture

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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