Complete immediate dentures

Question 1

Conversion from dentate to edentulous state

Answer 1

Inadequate dentition –> negative attitude and high disease progress –> immediate complete denture –> ‘permanent’ complete denture
Inadequate dentition –> transitional partial denture –> transitional complete denture –> ‘permanent’ complete denture
Inadequate dentition –> good attitude and slow disease progress –> partial overdenture –> complete overdenture –> ‘permanent’ complete denture

Question 2

Edentulousness - the size of the problem

Answer 2

Now 5%

in 1968 was 30%, has been declining since

Question 3

Indications for immediate dentures

Answer 3

a. When remaining teeth are a health risk
(infection, radiotherapy).
b. When fewer visits are essential (cost, time).
c. Where teeth are so misaligned or overerupted
that transitional dentures are impossible to
provide.
d. When the status & prognosis for the remaining
teeth is hopeless

Question 4

Contraindications to immediate dentures

Answer 4

1. The elderly
2. Large bony undercuts
3. Difficult extractions

Question 5

Types of immediate complete dentures

Answer 5

1. Labial flange
2. No labial flange
   - conventional flange ideal to aim for
   - lack of security sometimes leads to repeated denture replacement in fruitless quest for retention

Question 6

Significant factors in assessment

Answer 6

1. Current partial denture - use as
transitional
2. History of nausea - test with partial
denture first
3. Undercuts - if severe prolonged surgery
will be needed

Question 7

Prior to treatment

Answer 7

1. Warn patient that the immediate denture that
   will be provided will not be permanent; it
   will need to be replaced by a permanent
   denture when resorption has slowed down
   and further expense will be incurred.
2. Ensure that there is adequate emergency
   follow-up – post insertion pain is frequent,
   so don’t do them on Friday!

Question 8

Unsaveable teeth

Answer 8

Posterior teeth have
been extracted and
procedure commences
when healing is
complete (2-3 months)

Question 9

Process

Answer 9

After impressions (take care to avoid inadvertent
extractions), a
registration is carried out
as for a partial denture,
then a wax-try in
The positions of
the anterior teeth
are recorded by
means of a
silicone putty
template which is
adapted as far
back as the
molars.
It is then retained
to allow
reproduction of
the site of the
anterior teeth prior
to processing
When try-in has been
approved and the template made, the plaster teeth are
cut from the model – level with the gingival margins
In the region of the
removed teeth, residual undercuts removed and
sharp edges
sandpapered smooth
The modified models are duplicated and clear, acrylic surgeon’s
guides are prepared and processed
The teeth are
extracted with
minimal trauma
The surgeon’s guides
are placed over the
extraction sockets and where blanching of the underlying tissues occurs, bone is removed
The process is
repeated with the
lower teeth
The dentures are
inserted, and any
defects in the occlusion corrected
The pt is reviewed the following day, one week later, then according to programme

Question 10

Programme of review

Answer 10

• 1st day – adjust fitting surface and occlusion
• 1st week – correct pain, advise use of denture
fixative if security is a problem
• 1st month – further corrections, autopolymerising
additions, temporary soft lining
• 6th month – permanent reline
• 12th month – replace with permanent dentures