CAD - immediate complete dentures and additions Flashcards
What is an immediate denture?
A denture that is constructed prior to the extraction of natural teeth & inserted immediately after their removal.
What do we need to consider prior to immediate dentures? [timing]
Stages of constructing a denture needs to take place prior to tooth removal. E.g. primary, secondary imps, a record of PPD, aesthetics (shape & colour of teeth), record of midline, incisal level, occlusion etc.
How does the lab construct immediate dentures?
- Lab is taking an educated guess on model to make a denture. Teeth will be removed & gums are shaped to simulate what pts mouth will look like after xla.
- Lab can use recordings from a known distance- e.g. long axes of teeth, width of teeth, PPD, incisal level etc.
- It is an estimation of how denture will be fitted.
Not always well fitting for pt due to change in anatomy.
Why is PPD useful for the lab?
- Periodontal pocketing affects the amount of collapse of the tissues after extraction
- Ridge is rounded off to pocket depth.
List the 4 ways an immediate complete denture could be incorporated into a tx plan.
- Remove all remaining teeth & provide immediate C/C dentures [a lot of xla’s, and guess work by lab]
- Extract the posterior teeth first & then subsequently replace anterior teeth with dentures. [depends on mobility, over-eruption, aesthetics, function]
- Provide a post immediate denture - (teeth extracted, and conventional stages of denture making followed. Disadv: not accurate - healing sockets, bone remodelling- affects primary & secondary imps – cost)
- Take out worst teeth (e.g. painful, most mobile), make a transitional partial denture and progressively add to it
What are the adv of removing all teeth & providing an immediate complete denture?
- Only one surgical procedure required (xla’s).
- Dentures available straight away so patient can go away- able to speak, eat and good aesthetics.
What are the disadv of removing all teeth & providing an immediate complete denture?
- Initial fit of dentures will be poor [guess work with models and denture. Xla – open sockets, bleeding, swelling – denture fit compromised – poor retention]
- Rapid bone loss & remodelling of jaws – significant in first 6 months. Will soon become loose & ill fitting– warn pts in consent process. May need another denture.
What are the adv of removing all posterior teeth & then subsequently removing anterior teeth to provide an immediate complete denture?
- Full healing of posterior sockets & well tolerated by patients. Reasonably economical.
- The final denture should be well fitting especially posteriorly. * but still an issue anteriorly*
What are the disadv of removing all posterior teeth & then subsequently removing anterior teeth to provide an immediate complete denture?
- Tongue may spread to fill edentulous space if teeth not replaced. May feel like a constraint to pt if denture placed later on.
- Unprotected posterior sockets during healing.
What factors should be considered in tx planning for a post- immediate denture?
- Case selection
Case selection:
- patient has little or no interest in remaining dentition.
- Very poor neglected mouth.
- Patients unable to cooperate or accept provisional dentures.
- Poor attendance, poor OH, in pain, and understand they will have no teeth for a while. Consent important.
What are the adv of progressively adding teeth to partial dentures?
- Can remove hopeless prognosis teeth first, then add on to denture as pt loses more teeth.
- Patient keen to save as many teeth as possible. Pt can keep teeth for longer. Remaining teeth can maintain OVD & aesthetics.
- The task can be completed over a number of years. [more tolerable for pt, simpler procedures and better for lab in terms of guess work. Some pts can’t tolerate dentures – pt can get used to a denture so transition to ‘complete’ is easier].
- Minimal clinical charges.
- A planned training appliance.
List the process of providing immediate dentures.
Visit 1: History, exam, rads, periodontal indices, tx plan & consent. Primary imps.
Visit 2: XLa of teeth. Secondary imps
Visit 3: Record occlusion – may need record rims, record of alar-tragal plane etc.
Visit 4: Try in – check occlusion, articulation & OVD
Visit 5: Fit [may need to do xla & fit if initially removing posterior teeth, then anterior teeth as well]
How can XLA technique affect the denture?
- The teeth are carefully extracted to reduce trauma (prevent inflammation) and preserve bone (may affect fit of denture).
What areas are checked on the denture at the fit appt?
- The denture is fitted, care is taken to identify pressure areas & the denture adjusted. – the patient will be numb!
- The occlusion is checked and simple adjustments completed.
What are the post-op complicstion to pt after xla & fit of immediate denture?
- Can be very uncomfortable for the patient.
- Swelling, post operative pain & trauma from the denture make eating very difficult.
- Patients complain of pain, excess salivation, loss of taste, unable to eat.
- If denture has been removed they can be very difficult to re-insert. (due to swelling post-op)
What is the purpose of a 24 hr review after the immediate denture is fitted?
- Remove dentures & look for any areas where they have been rubbing
- Check occlusion
- Can use tissue conditioner if loose or sore – gel lining for comfort.
What changes can we expect at 1 week immediate denture review?
- Initial swelling will now be reducing and the dentures will become loose.
- At this stage the occlusion can be more accurately assessed and adjustments made.
- Contaminated tissue conditioner may need replacement.
- The patient should be free of most pain and discomfort. – may be able to eat during normal function.
What changes can we expect at 3 month immediate denture review?
- Patient will complain that the dentures feel loose and food gets under the denture.
- A chair side reline may be required.
- The occlusion will require further adjustments.
- A gap is often present between denture and underlying soft tissue. This indicates the degree of alveolar resorption.
What changes can we expect at 6 month immediate denture review?
- Patient complains of looseness and food getting under the denture.
- A further chair side reline may be required, or if fit is very poor commence new denture construction [initial consent important: after 6 months may need new denture due to healing -> cost, time].
- The occlusion needs adjustments.
- A gap is often present between denture and underlying soft tissue. This indicates the degree of alveolar resorption.
What are the benefits of immediate dentures?
- Tooth size, shape, position can be maintained
- Jaw relationship maintained
- No period without teeth
- Sockets protected (less likely for food trapping causing inflammation & discomfort)
What are the adv of open face immediate denture?
- Upper incisors may need extracting, to be replaced by immediate denture. ST are supported and bone in place.
- Over time, after xla, the alveolar bone resorbs and ridge remodels. Lip support is lost over time.
- Ideally a full flange placed for full lip support, border seal etc.
What are the 3 designs for an anterior flange?
- Full flange
- Part flange (covers socket)
- Socket fitted ( goes into xla socket – natural appearance)
[2 & 3 can be used when there’s a prominent alveolar bone anteriorly].
What are the adv of a full flange?
- Aids healing & protects clot.
- Increased retention & stability (border seal).
- Easy to reline & adjust.
- Reduced alveolar bone loss.
- Improved lip support.
What are the downsides of a full flange?
- If flange is placed where bone is not resorbed, it could push the top lip out – poor aesthetics, may not be comfortable for the patient. In these cases, a socket fitted denture may be a better option.
What is a socket fitted flange & when is it used?
- Used if marked bony undercut present.
- Can help with aesthetic problems such as too much lip support. Often looks very natural.
What are the disadv of a socket fitted flange?
- Reduced retention & stability (due to lack of flange)
- Not so easy to reline & adjust. (gap develops between denture and ridge over time as socket heals, bone remodels – poor aesthetics)
- Not suitable for lower jaw. (thinner bony ridge)
What are the disadv of socket fitting dentures & part flange dentures when they don’t spread the load fully over ST?
Socket fitted dentures & part flange dentures don’t spread the load well compared to full flange. Doesn’t allow healing of smooth ridge = may impact denture fit & future denture design – discomfort, aesthetics etc.
What are the adv of a part flange?
- Used if marked bony undercut present.
- Helps aesthetic problems - such as too much lip support.
- Aids healing & protects clot. Reduced retention & stability. Easy to reline & adjust.
What are the common complications of immediate dentures?
- Poor Fit - Shape of mouth was an estimation when making immediate dentures. Bone loss over months.
- Long periods of discomfort
- Food getting under dentures -Irritation, infections of mucosa
- Bone loss - may increase bone loss if denture not evenly supported over entire ridge. Pressure greater in some areas than others
- Ridge damage from poorly designed dentures.
What are the disadvantages of immediates compared to conventional?
- No proper try in of anteriors – guesswork involved
- No period for assessment of whether or not patient can tolerate dentures
- Usually poor initial fit which subsequently deteriorates
- High maintenance- temporary relines needed, cost, time
- Problems with bony undercuts (may affect path of insertion for denture)
*Requires planning with pt, dentist guide & lab – shade, mould, lip support, incisal level etc will ensure pt is happy.
What is an immediate addition to dentures?
- Denture present, and extraction is required.
- Can add tooth to existing denture, to fit on the day the tooth is planned to be extracted.
Describe the process of making immediate additions.
- Need to arrange 2 appropriate sessions on clinic. (check how long the lab will need)
*Warn patient they will have to be without their denture for 48 hours (check with lab).
- First appointment to take an impression [imp of denture in pts mouth – full arch & opposing arch with denture in place]. Imp and denture sent to lab, with relevant PPD. Specify which tooth is to be cut off model and added to denture, and if you want a flange, whether there is an anterior bony undercut etc. Need opposing model, record of occlusion for correct bite.
- Second appointment to extract tooth and fit the denture [check correct tooth added to denture prior to xla. Disinfect denture in perform for 10 mins & rinse well. Check for blanching when fitting denture as pt numb – can’t tell]. Check occlusion.
