Immediate Complete Dentures Flashcards
Inflammatory papillary hyperplasia
“IPH”
A reactive tissue growth usually developing under a denture
Inflammatory papillary hyperplasia
“IPH” Occurs on
hard palate beneath denture base
what does IPH look like
Asymptomatic red or pink nodules on mucosa of hard palate and
occasionally the residual ridge
IPH
Directly related to (2)
constant wearing of ill-fitting denture and poor oral
hygiene
IPH
— Syndrome
Combination
IPH
— frequently present
Candida
Immediate dentures- 2 popular protocols
Conventional
Interim / transitional
Conventional
reline the immediate denture after
healing and ridge stable (6 months) ONE denture
Interim / transitional –
aim is to use for short
period, then it is replaced by the definitive
prosthesis when healing is complete TWO dentures
Immediate Dentures
Fabricated prior to
extracting natural teeth
conventional/classic immediate denture
— is done
relining/refitting
interim/transitional/nontraditional immediate denture
new CD is made
Immediate Complete Dentures
Advantages (3)
Prevent patient embarrassment
Provide guide for optimal esthetics
Provide guide for OVD
Immediate Complete Dentures More Advantages (7)
maintenance of a patients appearance
circumoral support, muscle tone, vertical dimension of occlusion, jaw relationship, and face height can be maintained. the tongue will not spread out as a result of tooth loss
less postoperative pain as extraction sites are protected
easier to duplicate (if desired) the natural tooth shape and position
adaptation easier. speech and mastication are rarely compromised, and nutrition can be maintained
availability of tissue conditioning material
patients psychological and social well being is preserved
Immediate Dentures
Disadvantages (4)
Increased complexity –impressions, CJR
Lack of clinical evaluation of trial denture-anterior esthetics
Increased maintenance
Greater # visits = more cost
Immediate Dentures More Disadvantages (5)
immediate dentures are more challenging
the anterior ridge undercut (by the presence of the remaining teeth) may interfere with the impression procedures
the presence of different numbers of remaining teeth in various locations frequently leads to recording incorrectly the centric relation position
no denture tooth try in in precludes knowing what the denture will actually look like on the day of insertion
more chair time, additional appointments, and therefore increased costs
explanation to the patient concerning immediate dentures (4)
do not fit as well as normal CD
the pain of the extractions, in addition to the sore spots caused by the immediate denture will make the first week or two after insertion difficult
it will be difficult to eat and speak initially
the esthetics may be unpredictable because an anterior try in is not possible
immediate dentures (7) steps
exam/diagnosis/tx plan preliminary impressions secondary impressions max-mand relationship records posterior trial placement extractions-insertion post insertion care
Exam & Diagnosis (3)
Tori
Tuberosities
Frenal attachments
Exception: An existing esthetic
RPD
Maintain
RPD abutment teeth
Exception: An existing esthetic
RPD
Maintain RPD abutment teeth
two phase surgical regimen:
1: remove posterior teeth, alveoloplasty, tuberosity reduction
fabricate denture
2: extract anterior teeth at denture insertion appointment
Phase 1 Surgery (3)
Removal of posterior teeth
Surgical correction of tuberosities, etc
Wait 6 –8 weeks, begin fabricating the immediate denture
Phase 2 Surgery at denture insertion (2)
Extract anterior teeth
Labial frenectomy, if needed
Benefits of 2-phase surgery (3)
Simplifies clinical procedures
Reduces post-placement care
Improves denture comfort & retention
Preliminary impressions
May need to customize
tray borders
Diagnosis
Determine patient’s expectations
Educate patient about limitations of complete dentures and his/her role
in successful outcome
Secondary impression
techniques (4)
Stock tray
Custom impression tray
Combination
Campagna technique
Border-molded custom tray
Presence of — makes border molding more difficult
teeth
Max. –Mand. registrations (2)
Presence of anterior teeth may make OVD determination easier
Malposed, drifted, mobile teeth would make CJR registrations more
difficult
Posterior trial placement
Confirm (2)
Confirm correct mounting of casts
Confirm OVD is correct
Posterior trial placement
Midline and incisal plane location-
mark the cast for reference
Set Anterior teeth (3)
Midline and incisal plane marked
Alternate tooth arrangement –set every other tooth
Minimal alveolar ridge modification
Surgical template
Required if
Fabricated at
any alveoloplasty or bone smoothing is anticipated
wax elimination stage of processing
Don’t schedule the
surgery/insertion on a
Friday or
day before a holiday or vacation!
Extraction of remaining teeth (2)
Simple extractions, hopefully
Alveoloplasty, frenectomy in anterior, if needed
Denture insertion (3)
PIP
Relieve any pressure areas
Bilateral occlusal contacts
Immediate Overdenture ?
Reduce — and place — prior to extractions
abutments
amalgam
immediate dentures must be work for the first — hours without being removed by the patient. if they are removed, they may not be able to be reinserted for 3-4 days. the dentist will remove them at the 24 hour visit
24
immediate dentures will “—” during healing, tissue conditioners will be required
loosen
6-9 mo after insertion at least a — will need to be done, possibly a remake. the patient is responsible for fees
reline
Patient instructions (4)
Soft diet
Some bleeding to be expected
May have swelling for 3 –4 days
Return to clinic the next day; 24-hour post-op.
Post-Insertion care
at 24-hr appnt (3)
Remove and rinse denture
Relieve any obvious pressure areas
Evaluate retention and occlusion
Post –Insertion Care
at 72 hr appnt (2)
Evaluate extraction sites
Evaluate tissue, denture retention, oral hygiene
As tissue shrinks from denture contact, — will usually decrease and
require tissue conditioner
retention
Occlusal correction –remount –done when
patient is comfortable (2 –
3 weeks)
— — changed as needed
Tissue conditioner
Decision to reline/rebase/remake is made after — months
4-6
