9 - Immediate dentures

Question 1

Define an immediate denture.

Answer 1

Any removable prosthesis fabricated for placement immediately following the removal of a natural tooth/teeth

Question 2

What are the advantages of immediate dentures? (9)

Answer 2

• guide for permanent denture
• guide for OVD
• maintains speech and function
• self esteem
• avoids drifting or over-eruption of surrounding teeth
• better adaptation to denture wearing
• ridge form preservation
• post-extraction healing
• prevents collapse of facial musculature

Question 3

What are the disadvantages of immediate dentures?

Answer 3

• temporary due to bone level resorption (MANAGE expectations)
• only last 6-12 months
• poor adaptation to ridge occurs quickly
• increased complexity of prosthetic stages
• ongoing maintenance required (eg relines)
• increased cost and patient visits
• undercut areas can be problematic

Question 4

What influences the complexity of the prosthetic stages of an immediate denture?

Answer 4

• index teeth can present issues if malpositioned to record occlusion
• design is limited to acrylic plate and wrought clasps in partials
• try in is limited to those teeth that are already missing, extensions etc can be checked here

Question 5

When are immediate dentures contraindicated?

Answer 5

• ORN or MRONJ
• pre-chemo/radiotherapy
• when a denture is not required (eg function and aesthetics are sufficient)
• pathological issues eg large cyst
• major fractures
• dementia

Question 6

What are the stages of constructing an immediate denture?

Answer 6

• same as for other dentures
• exam and assessment for which teeth are to be removed (clinical and radiographic)
• MH important (MRONJ/ORN risks or anticoagulants)

Question 7

What is the initial aftercare of immediate dentures?

Answer 7

• denture should be kept in for 24hrs post op to prevent pocket swelling
• can be unpleasant so warn patient
• ideally review next day
• remove denture to assess inflammation and clot formation
• after 24hrs, warm saline mouthwash and patient to remove denture after mealtimes, rinse mouth and clean denture

Question 8

What is the longer term aftercare of immediate dentures?

Answer 8

• review 1-2 weeks
• may need fixative
• review 1 month
• consider reline as resorption begins
• usually replace after 6 months