RP 6 - Immediate dentures

Question 1

What are the technical advantages of immediate replacement dentures?

Answer 1

• maintain pre-extraction information
  
  • tooth mould, shade, arrangement
  • OVD
  • appearance

Question 2

What are the main advantages of immediate replacement dentures for the patient?

Answer 2

• maintenance of appearance (usually more important to pt)
• continuity of denture wearing - ensure maintenance of skills and familiarity of denture wearing to be maintained
• maintenance of vertical and horizontal jaw relationships
• denture covering extraction socket may protect initial bloodclot

Question 3

Immediate dentures require careful case selection before they are an option - what things must be taken into consideration?

Answer 3

• only straight forward extractions for IR - surgicals not ideal
• may need to coordinate around sedation or even GA appointments
• alway advise patient before starting treatment that denture will become loose and will require replacement - financial implication
• require regular review
• can patient cope? (financially, physically and emotionally)

Question 4

What must be considered before making an immediate denture?

Answer 4

• take molars out first and allow healing before providing an IR denture for other teeth
• number of teeth to be replaced
  
  • amount of bone resorption would increase if more teeth are being extracted
  • risk of haemorrhage
  • post extraction swelling
  • how much LA you may have to administer
• healed areas

Question 5

What are some exceptions to taking molars out and allowing healing before providing an IR?

Answer 5

exceptions inc. if molar was the one vital tooth dictating OVD and you wanted to copy that for the new denture or perhaps it had a clasp that was critical in retaining the existing denture

Question 6

What flange designs can be used with IR dentures?

Answer 6

• flanged
• part flanged
• open face

Question 7

What flange design is this, and when might it be used in an IR?

Answer 7

flanged
- ideally a full flange is placed and allows the denture to engage any undercut and maintain the border seal which is important in retention

Question 8

What flange design is this, and when might it be used in an IR?

Answer 8

part flanged
- when a full flange is not possible due to an undercut in the flange or bulkiness of the buccal bone

Question 9

What flange design is this, and when might it be used in an IR?

Answer 9

open face
- in situations where it isn’t possible to place a flange at all, possible due to an undercut in the buccal sulcus or when the bone is particular bulky
- this will have less retention

Question 10

In a situation where a surgical extraction must be undertaken before an IR is provided, what design should be used if possible?

Answer 10

flange should be used to maximise the seal and the retention of the denture if possible

Question 11

Why may an open face denture be used rather than a flange denture?

Answer 11

consider if bulky upper anterior alveolar ridge
- cannot utilise undercuts for retention as too deep
- flange would give too much support to upper lip - fat lip

Question 12

What are some of the slightly longer-term down sides of an open face denture?

Answer 12

• resorption of ridge will lead to gap between denture and ridge
• transition from flangeless area to flanged aesthetically difficult

Question 13

Can IR dentures only be complete dentures?

Answer 13

No - may do IR as new partial denture (usually one/two anterior teeth), or addition to existing partial denture if the current denture fits well

Question 14

When prescribing an IR, what instructions must be given to the lab?

Answer 14

• which teeth are to be extracted
• arrangement
• shade
• flange type
• material
• date for denture insertion/extractions

Question 15

What 24hr aftercare/post-op instruction is required for an IR?

Answer 15

• dentures to be kept in for 24hrs
• review appt ideally on day after insertion if feasible
• remove dentures - examine mouth for healthy clots. identify any areas of inflammation - ease denture
• after 24hrs - advise warm saline mouthwash and pt. to remove denture after mealtimes, to rinse mouth and clean denture - soft toothbrush, soap and water
• if 24 hour review is not possible, ensure patient has post-op instructions and details of how to make contact

Question 16

What is the after 24 hr aftercare required for an IR?

Answer 16

• review after 1 week - further adjustment as required
• review after 1 month - assess adaptation
• consider temporary reline
• need for regular recall - 6 months
• ? rebase of replace

Question 17

What are one stage IR dentures used for?

Answer 17

to replace one or two anterior teeth in an otherwise intact arch

Question 18

What steps are including in a one stage IR denture?

Answer 18

• upper and lower imps recorded
• wax squash bite if required to confirm occlusion
• choose shade
• prescription to lab including design
• extraction and insertion of denture at next visit

Question 19

What is usually the design of choice for a one-stage innediate denture?

Answer 19

modified spoon denture

Question 20

What kind of denture is this?

Answer 20

modified spoon denture
- often used as a one-stage IR denture (temporary)

Question 21

Summary of clinical stages for an IR denture

Answer 21

pretty much the same as for a normal partial denture