Immediate denture and additions

Question 1

how many routes are there to provide immediate denture ?

Answer 1

4

Question 2

1. what are the adv and disadvantages of removing all remaining teeth and provide a denture ?

Answer 2

• This type of immediate denture involves extracting all remaining natural teeth and providing the patient with a complete denture immediately after extraction.

1. only one Surgical Procedure
2. Poor Initial Fit: as they are fabricated based on preliminary impressions before tooth extraction and alot of guess work, also swelling from sockets and tissues can make fit poor and unretentive.
3. Rapid Bone Loss
   - Following tooth extraction, there is rapid resorption of the alveolar bone, leading to changes in the shape and volume of the underlying bone (first 6 months)
4. Loose and Ill-Fitting Dentures
   - Due to the rapid bone loss, the dentures soon become loose and ill-fitting as the underlying bone and soft tissues heal and remodel.
5. a lot of guess work for lab tech to trim models
6. a lot of teeth may need extracting in one appt maybe cause discomfort for pt

Question 3

2. what are the adv and disadvantages of extracting posterior teeth first and then subsequently replacing anterior teeth with dentures ?

Answer 3

1. Full Healing of Posterior Sockets
   is beneficial for the overall healing process and is well tolerated by patients.
2. Economical
3. Well-Fitting Final Denture: By allowing the posterior sockets to heal first, the final denture should ideally have a better fit, especially in the posterior region and less task for tech
4. pt can retain anterior teeth for longer and go for no period of time without anterior teeth
5. tongue may spread to fill edentulous spaces esp in lower arch and when denture fitted in tongue may feel slight changes causing issues with retention and stability due to change to neutral zone

Question 4

3. what are the adv and disadvantages of providing a post immediate denture ?

Answer 4

• teeth extracted then left to heal before denture made

1. a lot of healing sockets whilst taking primary and secondary impressions
2. bone a tissue are still healing
3. pot has little to interest in remaining teeth
4. pt unable to cooperate or accept provisional dentures
5. very poor neglected mouth

Question 5

4. what are the adv and disadvantages of taking out worst teeth, make a transitional partial denture and progressively add to it ?

Answer 5

• pt keen to save as many teeth as possible
• task can be completed over a number of yrs
• minimal clinical charges
• a planned training appliance
• not many big changes to pts mouth
• some pts can’t tolerate denture so gives time for pt to get used to denture

Question 6

what will the denture fit be like immediately after extraction ?

Answer 6

• pt will be numb so won’t be able to tell you if its sore in any areas
• we need to check occlusion ie when pt bites together are there any obvious premature contacts that would cause discomfort for pt

Question 7

what will the next 24hrs be like ?

Answer 7

• The next 24 Hours 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 have been removed they can be very difficult to re-insert due to swelling
• so we advise to keep denture in for at least 24hrs

Question 8

what do we do after 24hr review?

Answer 8

Remove dentures
Look for any areas where they have been rubbing
Check occlusion
Can use tissue conditioner if loose or sore

Question 9

what do we do during 1 week review ?

Answer 9

• 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.

Question 10

what do we do in 3 month review ?

Answer 10

• Patient will complain that the dentures
  feel loose and food gets under the
  denture.
• A chairside reline may be required.
• The occlusion will require further
  adjustments due to gum changes underneath it
• A gap is often present between denture
  and underlying soft tissue. This indicates
  the degree of alveolar resorption.

Question 11

what do we do in the 6 month review ?

Answer 11

• Patient complains of looseness and food
  getting under the denture.
• A further chairside reline may be
  required, or if fit is very poor commence
  new denture construction.
• The occlusion needs adjustments.
• A gap is often present between denture
  and underlying soft tissue. This indicates
  the degree of alveolar resorption.

Question 12

what do we warn the pt about in terms of replacement?

Answer 12

warn them at the start that they will need a replacement set of dentures after 6 months

Question 13

overall, what are the advantages of immediate dentures ?

Answer 13

• Tooth size, shape, position can be
  maintained
• Jaw relationship maintained
• No period without teeth
• Sockets protected

Question 14

what will happen to lip support once you extract upper teeth?

Answer 14

• lip support lost due to alveolar bone resorption as time goes on

Question 15

why can we do about the lost lip support ?

Answer 15

we can change the different anterior flange types ?

Question 16

which of the anterior flanges give the most natural appearance ?

Answer 16

socket fitted flange

Question 17

benefits of full flange ?

Answer 17

Full Flange
Aids healing & protects clot.
Increased retention & stability.
Easy to reline & adjust.
Reduced alveolar bone loss.
Improved lip support.
protects socket

Question 18

benefits of socket fitted?

Answer 18

Socket Fitted
Used if marked bony undercut present. (bony anterior undercut will reduce overtime as the. bone resorbs and remodels)
Can help with aesthetic problems such as too much lip support.
Often looks very natural.
Reduced retention & stability.
Not so easy to reline & adjust.
Not suitable for lower jaw

Question 19

benefits of part flange ?

Answer 19

Used if marked bony undercut present.
Can help with aesthetic problems such as too
much lip support.
Aids healing & protects clot.
Reduced retention & stability.
Easy to reline & adjust.
bets if both worlds

Question 20

overall, what are some common complications of providing immediate?

Answer 20

• Poor Fit due to bone loss
• Long periods of discomfort
• Food getting under dentures due to gaps forming
• may increase Bone loss if denture dopant evenly distribute pressure
• Ridge damage from poorly designed
  dentures.

Question 21

what are the disadvantages of immediates compared to conventional ?

Answer 21

• 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 implication
• Problems with bony undercuts due to alveolar bone of freshly extracted teeth os still there which can cause bony undercuts = can create problems with path of insertion for a denture

Question 22

what is an immediate addition ?

Answer 22

when someone already has a denture and they about to loose another tooth

• we can add a tooth onto their existing denture the day that we extract that other tooth

Question 23

clinically how do we go about immediate additions ?

Answer 23

need 2 appts
warn pts that they will be without their denture for 48hrs

• first appt= take impressions
• second appt- to extract tooth and fit denture

Question 24

what instructions do we give the lab?

Answer 24

Specify if you want a flange.- to make a decision we need to se if there will be any anterior bony undercut that may happen
Take care to specify which tooth is to be extracted
Opposing model, record of occlusion
- also give tech idea of the pocket depths around the tooth thats been extracted so they know how much or how little they can trim the model

Question 25

what do we do in the second visit for immediate additions ?

Answer 25

• Check the correct tooth has been added to the denture before performing the extraction!!!
• Put the denture in Perform for 10 minutes, then rinse well.
• Extract the tooth, compress the socket , achieve haemostasis.
• Fit denture – it will be numb so look for tissue blanching
• Check occlusion