Immediate Dentures

Question 1

Definition of Immediate Dentures

Answer 1

Any removable dental prosthesis fabricated for placement immediately following the removal of a natural tooth/teeth.

Question 2

Conventional vs Interim immediate dentures

Answer 2

Conventional: Fabricated to be immediately placed after extraction of natural teeth, used as definitive or long term prosthesis, after healing the denture is refitted and refined.

Interim: Used for short time after tooth extraction, after healing, replaced with new final long term prosthesis

Question 3

Indications

Answer 3

CID: only when anterior teeth remain, also if pt is willing to have posterior teeth extracted before dentures fabrication process begin

IID: When anterior and posterior teeth remain until the day of extraction and placement of the immediate dentures.

Question 4

Merits

Answer 4

1. Maintain appearance
2. Maintain circumoral support, muscle tone, VD of occlusion, jaw relationships, face height, tongue won’t spread out
3. Less post op pain- extraction sites protected
4. Adapt to dentures same time as healing/recovery from surgery
5. Tissue-conditioners for correction and refinement of fitting surface, at insertion and subsequent appointments
6. Preserve psychological and social wellbeing

Question 5

Demerits

Answer 5

1. Challenging, teeth and jaw registration harder to record
2. Anterior 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 lead to wrong centric relation record and VDO
4. No try in
5. More difficult and demanding, more chair time, greater costs, more appointments

Question 6

Contraindications

Answer 6

1. Poor general health and surgical risks
2. Uncooperative
3. Patients who do not object to going through edentulous healing period

Question 7

Explanation to the Patient Concerning Immediate Dentures

Answer 7

1. Don’t fit as well as completes, require temp lining and adhesives
2. Will cause discomfort
3. Speech and eating difficulty initially,
4. Unpredictable esthetics
5. Other factors unpredictable: Gagging, salivation, chewing sounds, facial contour
6. Difficult or impossible to insert denture on first day
7. Wear dentures for first 24 hours, dentist will remove after a day
8. Denture will loosen, patient responsible for all fees involved in refitting and relining

Question 8

Insertion

Answer 8

Seat well with bilateral occlusion
Pressure areas located with indicating paste
Unretentive-tissue conditioner liner
Only brief occlusal adjustments
Further refinement later date
Frena properly relieved

Question 9

Post op care and instruction

Answer 9

Avoid rinsing, hot liquids or alcohol
No denture removal during first 24 hours
Inflammation, discoloration likely to occur
Manage with ice packs (20 min on 20 minutes off) on first day
Premature removal, reinsertion impossible for 3/4 days
Reinserted cause further sore spots
Pain not managed by removal
Denture aids hemostasis
Soft diet first 24 hours

Question 10

Review Appointment

Answer 10

After 24h
Pt warned before denture removal
Sore spots appear strawberry red
Pressure indicating paste to help diagnose
Relieve areas, replace denture asap
Check centric and lateral excursions
Tissue conditioner if retention is unsatisfactory

Question 11

First Postoperative Week

Answer 11

Wear denture at night for either 7 days or until swelling reduction
Recurrence of nocturnal swelling may preclude morning denture reinsertion
After day 1, extraction sites kept clean and mouth cleaned 3-4 times daily
Denture reinserted quickly, worn continuously
Suture removal after 1 week then dentures removed at night

Question 12

Further Follow up Care

Answer 12

Further sore spots adjusted
After 2 weeks, remount cast are poured, maxillary denture related to its semi adjustablenarticulator using the remount matrix made before flashing
A centric relation record is used to remount the mandibular denture, and refinement of occlusion

Question 13

Subsequent service for the patient with an immediate denture

Answer 13

Ridge resorption fastest during first 3 months
Recall schedule for liner
New light cure conditioners long lasting
Complete socket calcification after 8-12 months
Bone volume of ridge reduced 20-30% during first 12 months
Lower ridge resorption is about twice that for upper ridge
CID get definitive reline within 3-6 months
Regular visits and adjustments needed throughout the first year
IID 2nd dentures started within 3-6 months
2nd denturesnrelined after tissues healed
CID might fail and require a new denture

Question 14

Over denture tooth attachments, implants or implant attachments

Answer 14

Attachments accomplished after healing and before the definitive prosthesis so that attachment components can be processed into second denture
Implants: healing under immediate denture
Avoid wearing prosthesis 1-2 weeks after implant surgery
Denture reinserted after relieving and tissue conditioning procedures
Healing abutments relieved