Interim Dentures Flashcards
definition of interim denture
when is it inserted?
NOT definitive - it is a provisional prosthesis that is inserted day of extractions designed to enhance estehtics, stablize, and/or function for a limited period of time, after which it is to be replaced by a definitive denture
can be partial or complete - as they are healing from extractions
inserted DAY OF EXTRACTIONS
provisional definition
differ from interim?
these are provisionals used to assist in determiniation of the therapeutic effectiveness of a specific treatment plan or in the form and function of the planned definitive prosthesis.
usually used for a shorter period of time
synoym for an interim prostheses
doesnt necessarily get inserted day of extractions - may come to us with edentulous spaces already and can give them this today
what are the 4 non definitive prostheses we discussed
- interim
- provisional
- transitional
- treatment denture
immediate denture - definitive or non definitive
DEFINITIVE
- inserted day of extraction but will be a follow up with a reline or rebase after the tissue and bone are healing
immediate denture - definitive or non definitive
DEFINITIVE
- inserted day of extraction but will be a follow up with a reline or rebase after the tissue and bone are healing
extractions are “___”
STAGED
- removed in two separate appointments to allow for healing time between appointments and access to a partially healed ridge for final impressions
when is staging of extractions required
if there is extensive pre-prosthetics tx to be done
- torus removal
- tuberosity reduction
- alveoplasty
stage 1 extractions
all except?
generally posterior extractions - not holding VDO (leave a stop) along with bone recontouring is done
teeth NOT HOLDING VERTICAL and or teeth NOT desired for aesthetics
allows for beginning of the healing process
- all posteriors except 1 pair of vertical stops
- root tips (anterior or posteriors)
- bone recontouring
what is ‘repriducible’ when patient has teeth
CO/MIP
- so find a set of stops
- this is the occlusion we restore in for INTERIM OR IMMEDIATE
so find a set of stops where they occlude in every time
stage 2 extractions
take everything else out
also time you insert denture
transitional definition
provisional that can be partial or complete that is used for a longer period of time (maybe 6-8 months)
a prosthesis that may undergo the addition of teeth over time as natural teeth are lost – it may become an interim complete removable when all of the natural teeth have been extracted
NOT DEFINITIVE
treatment denture
a dental prosthesis used for the purpose of treating or conditioning the tissues that is called upon to support and retain it
is immediate denture definitive
yes - with a realign at end of healing time.
can we get vertical dimension in edentulous posterior patient?
YES – think about how you get the vertical dimension – we can put wax in the posterior and adjust accordingly
SO WE CAN TRY FOR VDO
- VDR
- closest speaking space
- sibliant sounds
what is the same in an interim vs immediate denture?
- When – immediatley after extractions
- Consent - pt. education and consent signature with faculty witness in EDR
***3. Post-op – post-insertion adjustment s and soft tissue relines as needed
(immediate – definitive/ rebase in 68 months) VS (interim – definitive denture 6-8 months)
- Relines – can become a treatment denture if relined with tissue conditioner
torus removable indicates for what?
interim denture
- post-op is MORE CHALLENGING
We will replace this with a more definitive
outcome of interim?
less predicatable
what is different in an interim vs immediate denture?
- Definitive?
- Tx plan?
- Procedures?
- Outcome?
what is different in an interim vs immediate denture? in terms of definitive
Immediate – relined or rebased within 6-8 months and becomes the defintive denture — NO SPARE
Interim – replaced by new definitive denture after 6-8 months – will have a spare that can be relined at the end of the definitive tx.
what is different in an interim vs immediate denture? in terms of when to use which one?
Immediate – tx plan this one if FEWER teeth need to be extracted (1-2) OR minimal pre-prosthetic surgery over one visit
Interim – tx plan this type if many teeth need to be extracted and there are more extensive hard tissue removal surgeries to be done/ surgical stent is required
what is different in an interim vs immediate denture? tx plan codes?
Immediate – immediate denture and lab processed reline or rebase
Interim – interim complete denture/ complete denture
what is different in an interim vs immediate denture? outcome?
Immediate – can be more predictable since less remodeling/ contouring of the ridge is required
Interim – less predictable outcome because more remodeling of ridge is required
key to suceess of immediate/ interim extractions
stage the extractions – so remove what the patient doesnt need in the next month or so
if restoring the maxillary arch how much is reproducible
2/3
general 4 steps in fabricating interim
- extract posteriors
- replace posteriors
- try in posteriors
- replace anteriors
if didnt extract posterior teeth what would be the only thing the same in denture?
palate
after extractions - what do you do
making a record base for the edentulous spaces - trimed to the AVL
think about what you would do in complete dentures –
FINAL IMPRESSIONS– W/ CUSTOM TRAY – using 2 layers of block out
PVS border molding
final cast is created with all folds, teeth, and land
then proceed with occlusion rims extending to the beginning of tuberosity and made parallel to the ridge
if no posterior teeth are present- what determines the posterior plane?
the retromolar pad
take a CR record when?
once the occlusion rims are in – CR is used because there are now no vertical posterior teeth to hold vertical
big problem when go from natural to denture occlusion?
significant anterior horizontal overbite
compensate in the posterior (cusps and curves)– so 20 degree teeth will be selected to assist with anterior overjet/overbite
anterior set up for immediate/ interims if want to DUPLICATE what they had? to CHANGE?
- DUPLICATE=set ONE TOOTH at a time
- CHANGE= set ONE SIDE at a time
- This is done so we do not lose control over the esthetics
split try in?
When the anteriors are SET TO THE CAST – and we can try in the psoterior part that we made a record base to
if tooth is going to be extraced in anterior what do you do on the cast?
you grind it off and set the teeth directly to cast – this is referred to as surgerizing the cast
when surgerizing the cast what shape?
we want a CONVEX contour of the site
what shape socket do we want in cast?
convex shape
what do you need to make sure you fill in on the cast when recontouring and placing teeth?
the papillas with wax – because if not you will create a food trap
surgical guide definition
any device used as a guide for surgically shaping the alveolar process or positioning of gingival tissues
surgical guide use
HELPS TO RESHAPE/CONTOUR INSIDE OF THE DENTURE
used by the surgeon in order to re-contour the soft and hard tissue by viewing blanching of the tissue when it is placed over the post extraction site to ensure adequate trimming of the bone and tissue
IS TRANSPARENT AND 2MM THICK– so surgeon can easily visualize and inspect areas of stress
if blanching occurs in surgical guide?
needs to reduce further
bone recontouring template?
cast surgerized for teeth and for tissue bilaterally and we can do a suck down on it when there is
- tuberosity reduction
- alveoloplasty
- torus removal
this is made to the final cast of the denture so it is the exact same
lab rx for processing interim complete
what is needed?
SAME as before but need the ADDITION OF SURGICAL GUIDE/ RECONTOURING TEMPLATE
interim denture must be processed by when?
PRIOR to surgery.
main difference between complete vs. immediate/interim denture
what step and describe
usually biggest difference occurs at try-in
Complete – you are doing both anterior and posterior
with interim/ immediate you are doing posterior only
also with INSERTION
COMPLETE=KNOWN DATE
interim/intermediate not fully known because of healing
definition of delayed immediate denture? definitive?
it is definitive but needs to be re-lined
pt. doesnt qualify for immediate denture but gets extractions – now edentoulist — and cannot have denture put in on same day – but need teeth so we start making a denture WAY TOO SOON. start around 6-8 weeks after all extractions and surgery is completed
must be relined within 6-8 months of insertion
usually a patient compliance problem
primary closure
we must wait aroun 4-6 weeks before we start final impressions with patients – the SURFACE of tissue must be intact for impressions to be taken safely
SURFACE INTACT = primary closure (even though interior is still unstable)
3-6 days after wounding
if take impressions - the clot may be disturbed.
the suction from an impression prematruely will remove the blood clot that forms in the extraction socket
6-12 days after extraction/wounding?
surface unstable and interior unstable
12-24 days after wounding?
SURFACE INTACT – this is primary closure
BUT INTERIOR UNSTABLE (bone needs to fill in)
months to a year after wounding?
surface intact and the interior is stable
how long wait before PRELIMINARY IMPRESSIONS?
MINIMUM OF 2/3 WEEKS –
a delayed immediate denture becomes complete denture made with processed reline impression
how long wait before FINAL IMPRESSIONS?
MINIMUM OF 4-6 WEEKS – but healing is NOT standard and when there is a health issue that complicates thinds and slows the healing process we need to take this into consideration – like diabetes and immunocompromised patients
when does something become treatment detnure?
when interim or immediate is lined with tissue conditioner
**there is NO MINIMAL time required to pass before you use this material
‘ideal’ healing time for complete denture impressions
6-8 months
interim denture replaced by complete denture made with tray impression
contraindications for immediate dentures
- pt. is in overall poor general health or those with mental instability or incapacity that would prevent any cooperation mishaps during the post-surgical healing phase
- pts. with increased surgical risks or a history of surgical complications
- pts. with uncooperative nature or too high of expectations
- pts. who cannot understand or appreciate the scope, demands, limitations of course of tx.
- serious medical issues, systemic disease, blood coagulation disorders, wound healing problems, radiation in head and neck
- elderly and ill that cannot endure tx plans
- extensive reductions of risidual ridges
two main populations discussed that are contraindications for immediate dentures
- UNCONTROLLED DIABETIC (difficulty in healing b/c when put denture over the spot of extractions – will actually decrease the wound healing)
- UNCONTROLLED HYPERTENSIVE
**patients that are controlled diabetic, hypertensive, on coumadin, or immuno-compromised need to be consulted with PCP
treatment dentures - main definition
- used to condition or medicate soft tissue
- treatment dentures are interim or immediate dentures that are lined with tissue conditioner in preparation for future therapy
general uses for tissue conditioner
- RETAIN the dentures (of interum or immediates that are ill-fitting)
- To condition tissues that are red or redundant
- to diagnose problems
- Pressure
_VDO - to impress tissues
- relines
- rebases
white tissue conditioner
Coe comfort
lynal
THESE ARE EXTRA SOFT
ONLY LAST ABOUT A WEEK AND MUST BE REPLACED AFTER THIS
pink tissue conditioner
Coe soft
REGULAR SOFT
PINK
lasts about a month
rules for replacing conditioner?
POROUS AND ABSORBS ODORS
- need to use opposing occlusion during impression to MAINTAIN CO AND VDO IN FUNCTION
IF BOTH U/L NEED IT NEED TO DO ONE AT A TIME
tissue conditioner components
steps to putting in mouth
- liquid (mma– acrylic)
- powder
- lubricant
turns into gel and coat it on — immerse in cool water prior to seating
patient needs to occlude - go into function and at VDO
where do you lubricate?
BELOW denture border so conditioner does not adhere or stick to the tissues that we do not want it to
implications of leaving tissue conditioner in too long?
it gets hard and begins to DESSICATE – which can cause mechanical injury to the tissues
also old tissue conditioner can cause INFECTION due to colonization
consequences of placing tissue conditioner WITHOUT occluding?
if denture has occlusion – need to make sure we go into it because if we dont then they will NOT have occlusion after.
