immediate complete denture Flashcards
reactive tissue growth usually developing under a denture
-occurs on hard palate beneath denture base
inflammatory papillary hyperplasia (IPH)
asymptomatic red or pink nodules on mucosa of hard palate and occasionally the residual ridge
-directly related to constant wearing of ill-fitting denture and poor oral hygiene
candida frequently present
IPH
inflammatory papillary hyperplasia
immediate dentures, 2 popular protocals
conventional and interim/transitional
reline the immediate denture after healing and ridge stable (6 months)
ONE DENTURE
conventional
aim is to use for short period, then it is REPLACED by the definitive prosthesis when healing is complete
TWO DENTURES
interim/transitional
fabricated prior to extracting natural teeth
immediate dentures
immediate denture advantages
prevent patient embarrassment
provide guide for optimal esthetics
provide guide for OVD
maintenance of a patient’s appearance, support, tongue will not spread out as a result of tooth loss, less pain since extraction sites are protected, easier to duplicate, speech and mastication rarely compromised, availability of tissue-conditioning material, patient’s psychological and social well being preserved
advantages of immediate dentures
lack of clinical evaluation of trial denture- anterior esthetics
immediate denture disadvantages
immediate denture disadvantages
increased complexity- impressions, CJR
increased maintenance
greater # of visits= more cost
**lack of clinical evaluation of trial denture- anterior esthetics
more challenging, anterior ridge is UNDERCUT, recording of incorrectly the CR position, more chair time
disadvantages of immediate dentures
explanation to the patient concerning immediate dentures:
- do not fit as well as normal complete dentures
- sore spots and pain from extractions will make first 2 weeks difficult
- difficult to eat and speak initially
- esthetics may be unpredictable since anterior try-in not possible
having an existing RPD abutment teeth: two phase surgical regimen:
phase 1: remove posterior teeth, alveoloplasty, tuberosity reduction
fabricate denture
phase 2: extract anterior teeth at denture insertion appointment
remove all posterior teeth
surgical correction of tuberosities
wait 6-8 weeks before fabricating the immediate denture
phase 1 surgery
extract anterior teeth
labial frenectomy if needed
phase 2 surgery at denture insertion
3 benefits of 2-phase surgery
simplifies clinical procedure, reduces post-placement care, improves denture comfort and retention
stock tray
custom impression tray
combination
campagna technique
secondary impression techniques
max-mand registrations
presence of ______ may make OVD determination easier
malposed, drifted, mobile teeth would make________ more difficult
anterior teeth easier
CJR registrations more difficult
no anterior esthetic verification
immediate dentures
confirm correct mounting of casts, confirm OVD is correct, midline and incisal plane location (mark cast for reference)
posterior trial placement
midline and incisal plane marked, alternate tooth arrangement (set every other tooth), minimal alveolar ridge modification
set anterior teeth
jerbi’s rule of thirds
minimal cast trimming
-required if any alveoloplasty or bone smoothing is anticipated
-fabricated at wax elimination stage of processing
surgical template
denture insertion:
PIP
relieve any pressure areas
bilateral occlusal contacts
with immediate overdenture, reduce abutments and place ____ prior to extractions
amalgam
immediate dentures must be worn for the first ___ hours. if removed, may not be able to be reinserted for ______days.
immediate dentures will _____ during healing, tissue conditioning will be required.
_____months after insertion at least a reline will need to be done, possibly a remake.
24 hours
3-4 days
6-9 months
patient instructions for immediate dentures:
soft diet
some bleeding
swelling for 3-4 days
return to clinic the next day, 24 hour post-op
post-insertion care at 24-hour appt
remove and rinse denture, relieve any obvious pressure areas, evaluate retention and occlusion
post insertion care at 72 hour appt
evaluate extraction sites, evaluate tissue, denture retention, oral hygiene
as tissue shrinks from denture contact, retention will usually decrease and require tissue conditioner
retention
post insertion.
occlusal correction - remount - done. when:
tissue conditioner changed as needed
decision to _____/____/____ is made after 4-6 months
patient is comfortable (2-3 weeks)
decision to reline/rebase/remake
complete denture therapy is not a
definitive treatment
the major etiological factor:
the presence of the denture
physiologic process after teeth extracted
variable process, dependent upon individual factors
residual ridge resorption
solutions to residual ridge resorption:
overdenture-tooth and implant prostheses
common with NEW dentures, if generalized on CREST OF RIDGE- suspect occlusal discrepancies, if in vestibule, suspect overextended or sharp border
traumatic ulcers
if traumatic ulcers are on crest of ridge
suspect occlusal discrepancies
if traumatic ulcers are in vestible
suspect overextended or sharp border
if ulcers are on crest of ridge, the solution would be to:
clinical remount
IPH treatment:
remove dentures at least 8 hours, clean denture well, tissue massage
reline, rebase or remake dentures for better fit
possible nystatin or other antifungals
IPH….avoid surgery.
for most patients, _______treatment is adequate prior to making new dentures
conservative treatment
15% of denture wearers
angular cheilitis (perleche)
inflammation of lip/lips with redness and fissures radiating from angles of mouth. candida albicans fungal infection
angular cheilitis
angular cheilitis is associated with
loss of OVD and candida albican and S. aureus
chronic inflammation of denture-bearing mucosa
may or may not be painful
redness; possible burning sensation
cause uncertain: poor oral hygiene, 24 hour wear without removing, clenching, xerostomia, medications???
denture stomatitis
angular cheilitis is caused by:
treated with
decreased OVD and vitamin deficiencies
usually see poor-fitting denture and abused tissue
nystatin
bizarre symptoms: may be itching, may be burning, may be pain
visual clinical signs often ABSENT
cause: may be metabolic, nutritional or psychologic
*consider lack of interocclusal space or clenching
denture sore mouth
mobile tissue
fibrous hyperplasia
“denture hyperplasia”
“inflammatory fibrous hyperplasia”
epulis fissuratum
single or multiple fold(s) of hyperplastic tissue in vestible
associated with the flange of an ill-fitting denture or flange is sharp/unpolished
epulis fissuratum
where do you usually see epulis fissuratum?
on facial/buccal in anterior area of mouth
epulis fissuratum is usually found in
women
treatment for epulis fissuratum
shorten denture border
often require surgical correction
reline, rebase or remake dentures
yeast-like fungus
candida
common oral microbe
-predisposing conditions: HIV, diabetes
candida
candida is more common on
max arch
candida- 3 presentations with HIV
angular cheilitis, erythematous candidiasis, pseudomembranous candidiasis
complete denture therapy is
NOT a definitive treatment
