Immediate Complete Dentures Flashcards
What’s immediate denture?
- Any removable dental prosthesis fabricated for placement immediately following the removal of a natural tooth/teeth (GPT-7).
What are indications of ICD?
Any person whose remaining teeth are indicated for extraction is a potential candidate for an immediate denture. However, such a candidate must be physically and mentally prepared to undergo the increased number of appointments as well as the greater cost (see box).
Talk about cost and appointments in ICD
The immediate denture requires more appointments than a conventional denture. Because of the rapid tissue changes the denture would need frequent adjustment and occasional relining. Soon the changes are so great that an entirely new denture has to be made within a short span of time. All this makes the immediate denture far more expensive than the conventional denture.
What are contraindications of ICD?
- Basically any patient who is not fit to undergo multiple extraction e.g blood dyscrasias and cardiac disease.
- In acute periapical or periodontal infection.
- Debilitating diseases.
- Patients incapable of showing responsibility towards the treatment, eg senile, mentally retarded and indifferent patients.
- Extensive bone loss adjacent to remaining teeth. (This would indicate that a rapid loss of fit and occlusion can be expected during the treatment).
What are advantages of ICD?
- Serves as a splint i.e. reduces pain, controls bleeding, and protects from trauma during the healing period.
- The patient regains functions faster e.g. speech, mastication etc.
- The patient is spared the inconvenience and stress of an edentulous period. The patient can learn to manipulate the dentures while recovering from the surgery.
- It is more compatible with the oral surroundings as the tongue, lips and cheeks have not yet changed position.
- The natural teeth aid in vertical relation positioning and selecting artificial teeth.
- There is less change in facial appearance, and so it is more esthetic.
- Less TMJ disturbance.
- It aids in contouring the healing residual ridge.
- Psychological benefit.
- Easy to refit by relining.
What are disadvantages of ICD?
- The technique is precise and time consuming.
- More appointments are needed.
- More costly.
- There is no opportunity for try-in of anterior teeth.
How do we examine and plan treatment for ICD patients?
EXAMINATION AND TREATMENT PLANNING
The examination should be done to determine the suitability of the patient for immediate dentures and to determine any influencing factors.
- To determine mental attitude.
- To find out local or systemic factors that may contraindicate surgery or make extraction difficult e.g. poorly controlled diabetes mellitus.
- Facebow mounted articulated casts are also used to aid treatment planning.
PRETREATMENT RECORDS
- Photographic records: Intraoral and extraoral (profile and frontal showing teeth) photographs aid in reconstruction.
- The existing vertical dimension is recorded and noted down.
What are types of treatment for ICD?
SINGLE STAGE The single stage treatment is usually reserved for patients having extremely poor oral health. All teeth are extracted in one sitting. The disadvantage is that, it is less accurate.
TWO STAGE This is the widely preferred method. Posterior teeth (excepting premolars) are removed in the first stage. After 4 - 6 weeks, the anterior teeth are extracted and the dentures inserted.
Talk about types of impressions and techniques in ICD
Primary impression The primary impression is made 4 - 6 weeks after extraction of the posterior teeth. It is made with alginate in a stock tray for the purpose of constructing a custom tray.
Final impression There are two techniques for making the final impression
First technique A resin custom tray is made which covers the edentulous ridges and the anterior teeth. Stops are provided on the incisal edges anteriorly and in the buccal shelf and palatal seal areas posteriorly. The borders are molded and a final impression is made using alginate or rubber base.
Second technique A resin tray is adapted to the edentulous region only (it slightly covers the lingual surface of anterior teeth). Stops are placed as in the first technique except that the anterior stop is on the lingual surface of the anterior teeth.
Occlusal ramps can be made with impression compound. They act as handles and also assure positive seating of the alginate impression.
The borders are molded and a zinc oxide eugenol impression is made of the edentulous region. Alginate is loaded in a stock tray. The tray is seated first posteriorly and then anteriorly (to prevent displacement of the zinc oxide eugenol impression).
How do we take records for ICD?
Jaw relations are determined and recorded using occlusal rims. Protrusive and lateral records are also made to adjust condylar guidances. The casts. are mounted using a face bow transfer (to balance the occlusion).
Talk about arrangement of anterior and posterior teeth
ARRANGEMENT OF POSTERIOR TEETH AND TRY IN The posterior teeth are arranged first and a trial is done. Since the anterior teeth have not yet been extracted, such a trial would be useful only to check the occlusion and the vertical relation.
ARRANGEMENT OF ANTERIOR TEETH There are 2 methods for arranging the anterior teeth.
- Alternate removal and arrangement of teeth
- Arrangement of one side and then the other
Talk about methods of anterior teeth arrangement in ICD
First method Alternate teeth are numbered, cut away (starting with the central incisor).
The labial root portion of the teeth are excavated to a depth of approximately 1 mm on the labial side and flush with the gingival margin on the lingual side. As the stone teeth are cut away, prosthetic teeth are set in its place.
Advantage Good duplication of the position of teeth, especially if original minor irregularities have to be duplicated (except of course if the patient does not wish the original arrangement to be duplicated exactly).
Second method A line is drawn corresponding to the sulcus depth (labial - 3 mm, palatal 2 mm). The teeth are removed from one half of the cast, retaining the other side as a guide. The cast is trimmed to the marked gingival line.
Talk about waxing in ICD?
The labial border is thickly waxed (thin borders may cut the swollen post surgical tissues). The denture is then flasked and cured in the usual manner. After processing, the denture is returned to the articulator and the centric occlusion corrected. Eccentric occlusal errors are not corrected at this stage. It is left for a later period when the tissues have healed sufficiently.
What’s a surgical template?
A surgical template is a clear acrylic plate used to determine the areas that interfere with the seating of the immediate denture prosthesis. It is especially indicated when a lot of bone or tissue trimming is planned or expected.
Talk about surgery and placement
The remaining anterior teeth are extracted. Using the template as guide, surgical trimming of bone and soft tissue is done (areas of excess pressure is indicated by blanching of the tissues) until complete seating of the template is acheived. Avoid excess tissue removal also, as the fit may get affected. It is best to restrict alveoloplasty to what is absolutely essential.
Excessive removal of alveolar bone can lead to increased ridge resorption later.
The wound is sutured and dentures inserted. Gross occlusal errors are also corrected. If dentures are loose, a relining material can be used to improve the fit.
