6 - 3/6: Immediate Complete Dentures Flashcards
What is inflammatory papillary hyperplasia “IPH”?
A reactive tissue growth usually developing under a denture
Where does IPH occur?
On a hard palate beneath denture base
What is an IPH?
Asymptomatic red or pink nodules on mucosa of hard palate and occasionally the residual ridge
What is IPH directly related to?
Constant wearing of ill-fitting denture and poor oral hygeine
What is present in IPH combination syndrome?
Candida
What are two popular protocols for immediate dentures?
Conventional
Interim/transitional
What are conventional immediate dentures?
Reline the immediate denture after healing and ridge stable (6 months)
ONE DENTURE
What are interim/transitional immediate dentures?
Aim is to use for short period, then it is replaced by the definitive prosthesis when healing is complete
TWO DENTURES
What is hopeless?
Periodontal prognosis
When are immediate dentures fabricated?
Prior to extracting natural teeth
What did richardson JA view immediate complete dentures as?
Practical treatise on mechanical dentistry
- was considered “luxury treatment” for many years following
What is done in conventional/classic immediate dentures?
Refining/refitting
What is done in interim/transitional/nontraditional immediate dentures?
New CD is made
What are advantages to immediate complete dentures?
Prevent patient embarassment
Provide guide for optimal esthetics
Provide guide for OVD
What are advantages to immediate dentures as stated by the book?
- maintenance of patient’s appearance
- circumoral support, muscle tone, VDO, jaw relationship, face height maintained
- tongue will not spread out as a result of tooth loss
- less postoperative pain as extraction sites are protected
- easier to duplicate the natural tooth shape and position
- adaptation easier. Speech and mastication are rarely compramised, nutrition can be maintained
- availability of tissue-conditioning material
- patient’s psychological and social well being is preserved
What are disadvantages to immediate dentures?
- Increased complexity - impressions, CJR
- lack of clinical evaluation of trial denture-anterior esthetics
- increased maintenance
- greater number visits = more cost
What are disadvantages to immediate dentures as stated by the book?
- more challenging
- undercut anterior ridge
- incorrect recording of CRP
- no denture tooth try in
- more chair time = additional appts
What are explanations to the patient concerning immediate dentures?
- Do not fit as well
- pain of extraction and sore spots
- initial difficulty eating and speaking
- unpredictable esthetics
What are the steps taken when making an immediate denture?
- exam/diagnosis/ tx plan
- preliminary impressions
- secondary impressions
- maxillo mand. relationship records
- posterior trial placement
- extractions - insertion
- post insertion care
What should you examine and diagnose in a patient?
Tori
Tuberosities
Frenal attachments
What are the steps taken in two-phase surgical regiment?
Phase 1: remove posterior teeth, alveoloplasty, tuberosity reduction
Fabricate Denture
Phase 2: extract anterior teeth at denture insertion appointment
What occurs during phase 1 surgery?
Removal of posterior teeth
Surgical correction of tuberosities
Wait 6-8weeks, begin fabricating the immediate denture
What occurs during phase 2 surgery?
Extract anterior teeth
Labial frenectomy, if needed
What are benefits of 2 phase surgery?
Simplifies clinical procedures
Reduces post-placement care
Improves denture comfort and retention
What should you do during the diagnosis step?
- determine patient’s expectations
- educate patient about limitations of complete dentures and his/her role in successful outcome
What are secondary impression techniques?
Stock tray
Custom impression tray
Combination
Campagna technique
What makes border molding more difficult?
Presence of teeth
What may make OVD determination easier?
Presence of anterior teeth
What may make CJR registrations more difficult?
Malposed, drifted, mobile teeth
What do you do during posterior trial placement?
Confirm correct mounting of casts
Confirm OVD is correct
Midline and incisal plane location - mark cast for reference
How should you set anterior teeth?
Midline and incisal plane marked
Alternate tooth arrangement - set every other tooth
Minimal alveolar ridge modification
When is the surgical template required?
If any alveoloplasty or bone smoothing is anticipated
Fabricated at wax elimination stage of processing
When should you not schedule a surgery/insertion?
On a friday or day before a holiday or vacation
What are the steps of extracting remaining teeth?
Alveoloplasty, frenectomy in anterior, if needed
When should you reduce abutments and place amalgam?
Prior to extractions
What are interim immediate denture steps?
- Make preliminary impressions for diagnostic casts
- Make a custom impression tray
- Border mold, make a final impression, mark the posterior seal, and carve it into the maxillary cast
- Make a record base/wax rim, make an interocclusal record, mount cast
- Set anterior denture teeth - alternating placement; complete posterior tooth placement
- Final wax, process, complete
- request a clear surgical guide, at the time the denture is processed
How long should immediate dentures be worn for?
24 hours
If removed, may not be able to be reinserted for 3-4 days
What will happen to immediate dentures during healing?
Loosen
What are instructions for a patient who got extractions?
Soft diet
Some bleeding to be expected
may have swelling 3-4 days
Return to clinic next day; 24 hours post op
What are instructions for a patient after surgery?
Do not remove until tomorrows appt
If it comes loose/out put it back in place immediately
Soft/liquid diet for 24 hours
avoid rinsing
take analgesic
expect red saliva
What do you do during the 24 hour appointment?
remove and rinse denture
relieve any obvious pressure areas
evaluate retention and occlusion
What do you do during the 72 hour appointment?
Evaluate extraction sites
Evaluate tissue, denture retention, oral hygeine
What happens as tissue shrinks from denture contact?
Retention will usually decrease and require tissue conditioner
What is decided after 4-6 months?
Reline/rebase/remake
What should you do during the follow up?
- use tissue conditioner to refit as needed
- remove any socket convexities to avoid healing defects
- reline or remake in 6-9 months
