Immediate dentures

Question 1

Definition

Answer 1

An immediate denture is “any removable dental prosthesis fabricated for placement immediately following the removal of a natural tooth/teeth.”

Question 2

Types of immediate dentures

Answer 2

1. Conventional immediate dentures
2. Interim immediate dentures

Question 3

Conventional (or classic) immediate denture

Answer 3

• Fabricated to be immediately placed after extraction of natural teeth.
• Can be used as the definitive or long-term prosthesis.
• After healing, denture is refitted or relined to serve as long-term prosthesis.

Indications
1. Selected when only anterior teeth remain
2. Also if patient is willing to have posterior teeth extracted before denture fabrication processes begin.

Question 4

Interim (or transitional or non-traditional) immediate denture

Answer 4

• Used for a short time after tooth extraction.
• After healing, this immediate denture is replaced with a new final long-term prosthesis.

Indications
1. Used when anterior and posterior teeth remain until the day of extraction and placement of the immediate denture.

Question 5

Advanatges of immediate dentures

Answer 5

1. Maintenance of the patient’s appearance because there is no edentulous period.
2. The tongue will not spread out as a result of tooth loss.
3. Muscle tone, vertical dimension of occlusion, jaw relationship, and face height can be maintained
4. Less post-operative pain likely to be encountered because the extraction sites are protected
5. Patient likely to adapt more easily to dentures at the same time as recovery from surgery is progressing
6. Tissue-conditioners for correction and refinement of the denture’s fitting surface, at the insertion and subsequent appointments.
7. The patient’s psychological and social well-being is preserved

Question 6

Disadvantages of immediate dentures

Answer 6

1. More challenging than complete dentures because teeth make impressions and jaw registration harder to record.
2. Anterior ridge undercut caused by remaining teeth may interfere with impression procedures and hamper accurate record of any posteriorly located undercut, that may be important for retention.
3. Remaining teeth in various locations may lead to wrong centric relation record and VDO.
4. Occlusal adjustment, selective pre-treatment extractions, may be needed to make accurate records at the proper VDO.
5. No try-in.
   Careful planning, operator experience, attention to details of the technique, and explanation to the patient best address this problem.
6. More difficult and demanding procedure, more chair time, additional appointments; greater cost implications.

Question 7

Interim immediate denture (IID) Advantages

Answer 7

**Advantages **
* The IID technique results in two dentures, which is advantageous for some patients.

• The IID has only one surgical visit.
• The IID procedure takes less overall time, from the dentist’s meeting the patient to placing the denture.
• Patient with IIDs can use all their teeth or wear their existing removable partial denture(s) up until the day of extraction.
• The IID lends itself better to complex treatment plans, especially in a patient who needs an upper immediate denture opposing a lower transitional removable partial denture.
• The IID is better for less experienced practitioners because a second denture can correct any imperfections.

**Disadvantages **
* The single surgical visit for the IID is more involved and lengthy than for a CID.

• The retention and stability of the IID is less at insertion.
• However, modern tissue conditioning techniques negate this disadvantage.

Question 8

Conventional immediate denture (CID) advanatges

Answer 8

Advanatges
* The CID will usually have better initial retention and stability because fewer teeth are usually extracted on the day of placement.

• The CID has an easier surgical session on the second surgical (denture placement) date.
• The overall cost of the CID is less.

Disadvanatges
* The CID technique requires two surgical visits.

• The CID technique includes a period of posterior partial edentulism, which impairs mastication and compromises esthetics
• The CID takes longer to fabricate, especially in complex treatment plans.

Question 8

CONTRAINDICATIONS OF IMMEDIATE DENTURES

Answer 8

• Poor general health and surgical risks.
• Uncooperative.
• Do not appreciate scope, demands, and limitations of immediate dentures.
• Patients who do not object to going through edentulous healing period.
  -Do extractions then conventional complete dentures.
  -Simpler and less expensive.

Question 8

Clinical procedures

Answer 8

1. History, examination, diagnosis
2. Primary impressions
   Vibrating line, fovea palatine and hamular notch are marked with an indelible pencil
3. Custom tray fabrication
4. Secondary impressions
5. Jaw registration- Teeth selection
6. Surgical procedure
7. Fitting the denture

Instructions to the laboratory
A. Teeth for extraction should be indicated on the working casts.

B. If the immediate restoration is a partial denture, specify undercuts which must be blocked out.

C. Instructions to set up the artificial teeth in the edentulous spaces for trial insertion in the mouth.

D. Indicate whether flange or open-faced design

E. The trial denture with the replacement teeth is processed.

5. Fitting the denture
   Cold packs are suggested for the first several hours. The patient must not remove the denture in the first 48 hours.

Tissue inflammation and edema may prevent the reinsertion of the denture. A soft diet is preferred. Appropriate pain control medication is prescribed as needed.