immediate dentures Flashcards
Inflammatory papillary hyperplasia
“IPH”
(2)
A reactive tissue growth usually developing under a denture
Occurs on hard palate beneath denture base
IPH
What is it?
Directly related to …
Combination Syndrome?
— frequently present
Asymptomatic red or pink nodules on mucosa of hard palate and
occasionally the residual ridge
constant wearing of ill-fitting denture and poor oral hygiene
Candida
Immediate dentures- 2 popular protocols
Conventional
Interim
Conventional –
reline the immediate denture after
healing and ridge stable (6 months) ONE denture
relining/relifting is done
the denture is intended to be relined to serve as the long term prosthesis
Interim / transitional –
aim is to use for short
period, then it is replaced by the definitive
prosthesis when healing is complete TWO dentures
new CD is made
after healing is completed, a second, new complete denture is to be fabricated as the long term prosthesis
Immediate Complete Dentures
Advantages
(3)
Prevent patient embarrassment
Provide guide for optimal esthetics
Provide guide for OVD
maintenance of pt appearance
cicumoral support, muscle tone, OVD, 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
pt 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 are a more challenging
the anterior ridge undercut (by the presence of remaining teeth) may interfere with the impression procedures
the presence of different numbers of remaining teeth in various locations frequently leads to recording incorrectly CR
no dentures tooth try 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 pt 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
difficult to eat and speak initially
the esthetics may be unpredictable bc an anterior try in is not possible
immediate dentures (7)
exam/dx/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
two phase surgical regimen
1: remove posterior teeth, alveo, 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
(2)
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 teeth makes — more difficult
border molding
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
(3)
Confirm correct mounting of casts
Confirm OVD is correct
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
(2)
Required if any alveoloplasty or bone smoothing is anticipated
Fabricated at 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 abutments and place amalgam prior to extractions
Interim immediate denture
steps
(7)
- Make preliminary impressions for diagnostic casts
- Make a custom impression tray
- Border mold, make a final impression, mark the posterior seal, and
carve it into the maxillary cast - Make a record base/wax rim; make an interocclusal record, mount
casts - Set anterior denture teeth-alternating placement; complete posterior
tooth placement - Final wax, process, complete
- Request a clear surgical guide, at the time the denture is processed
explanation to the pt concerning immediate dentures
ID must be worn the first 24 hrs without being removed by the pt, 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
ID will loosen during healing, tissue conditioners will be required
6-9 mo after insertion at least a reline will need to be done, possibly a remake. the pt is responsible for fees
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.
do not remove until tomorrows appointment
if it comes loose/out put it back in place immediately
soft/liquid diet for 24 hours
avoid rinsing
take analgesic
expect red saliva
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
Retention
As tissue shrinks from denture contact, retention will usually decrease and
require tissue conditioner
Post-Insertion
Occlusal correction – remount – done when patient is comfortable (—)
Tissue conditioner changed as needed
Decision to reline/rebase/remake is made after —
2 –
3 weeks
4-6 months
follow up
(3)
use a tissue conditioner to refit as needed
remove any socket convexities to avoid healing defects
reline or remake in 6-9 mo
