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 wellbeing 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 tryin 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

Step 1 Step 2

Remove tooth at gingival level

Recess Socket 1 mm

Step 3

Step 4

Labial edge recess to incisal third mark

Mid-point recess to midwidth 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 edition & 11th edition .

9th

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. 5.

JOHN J SHARRY- Complete denture prosthodontics 2nd edition. JOHN N ADERSON, ROY STORER Immediate dentures & replacement dentures 3rd edition

6.
7. 8.

SHELDON WINKLER- Essentials of complete dentures 2nd edition

RUDD & MURROW Dental lab procedures , complete dentures 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 DahlbergReconstructing the Natural Appearance By Immediate denturesJPD 1965;205-210 12..M Heartwell IMMEDIATE COMPLETE EVALUATION 1965 vol 15 no 4 DENTURE; AN

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..