Immediate Denture Done by:Hadeel Mohammed Ali Supervised by: Dr. Adel Ahmed
INTRODUCTION An immediate denture is defined as a denture that ismade prior to the extraction of the natural teeth andinserted into the mouth immediately after theextraction of those teeth. It may involve total or partialreplacement. In many society, it is important thatpeople are seen with teeth, and generally it isunacceptable that patients should be renderededentulous without any replacement prosthesis. Asoverall dental health has improved, the total removalof teeth followed by the provision of completedentures has been uncommon. It is now more usual toprovide simple immediate addition to existingdentures or to provide an immediate partial denture.
INDICATIONS1.Educated patient with daily social activities/Doctors, Lawyers, Teachers.2.Patient with stable health condition.3.hopless remaining teeth: a. advanced periodontal disease. b. advanced carious non vital teeth. c. sever tilted teeth.CONTRAINDICATIONPatient is not willing to accept the treatmentmentally and psychologically or due to cost.
ADVANTAGES1 . Maintenance of the soft tissue contour of the face2. Denture will support the soft tissue around the face in their correct position once teeth are lost.3. Prevent collapse of tissues together with the occurrence of infection such as angular cheilitis.4 . Maintenance of mental and physical well being the patient is not to be edentulous, this is important for business, domestic and social purposes.5 . Esthetic are maintained by placing the artificial teeth in a position similar to natural teeth or improved by changing the position.6 . Adaptation to denture is aided: a - Maintain tooth position. b - Maintain muscles balance. c - Prevent the formation of abnormal mandibular movement. d - Aids chewing and mastication.e .Patients adapt to immediate dentures provided at the time of extraction.
There are also advantages for the dentist:1. The use of existing occlusion for jaw registration procedure: teeth may act as occlusal stop, which will provide the intercuspal position and the correct occlusal vertical dimension.2. Esthetic consideration : shape and size of the teeth are known, which will assist in selection a teeth .3. Haemorrhage control.
Disadvantages1. No trial denture stage possible: this is a big disadvantage as it is not possible to show the patient what the teeth will eventually look like.2. Increased cost: the provision of relines and further denture provision makes treatment costly.3. After care may require many visits including reline/rebase/new denture.4. Good cooperation is require,with the need for closed supervision.5. Gross irregularities of teeth make processing difficult, e.g. class 2 division 2, bulbous tuberosities/tori. surgical difficulties: Cyst/osteosclerosis may present difficulties in planning shape of ridge. Special care of infective endocarditis/diabetes/coronary heart disease. Dilaceration. Multirooted teeth.
Types Of Immediate Denture a. Flanged Denture b. Socket fit Denture
Flanged denture1. Retentive2. Easier to reline and rebase3. May be difficult to place where there is an undercut.
Socket Fit Denture are:1.The teeth sit into sockets of the extracted teeth, gives more natural appearance2 . Esthetically good initially3.Contraindicated in mandible because of poor stability of lower denture during function4 . Prone to loss of esthetic as resorption continues5. Difficult to reline/rebase or changed to flanged type6 . Have poor retentionWherever possible, a flange denture should always be designed.
DIAGNOSIS The difficulties with immediate dentureprovision must be explained to patients. Thepatient need: 1. Cleared explained of technique. 2. Visits to be planned. 3. To know which teeth are to be removed. 4. Motivation.
The health of the oral and facial tissues must be assessed : Soft tissues: basic periodontal evaluation, probing depth give an indication of initial collapse/retraction of soft tissues, pre-extraction scaling and polishing. Hard tissue: edentulous area, charting of teeth, use orthopantomograph and periapical radiographs of the teeth to be removed.
Treatment Planning For a few teeth immediate denture when no denture is present:1.Primary and/or master impressions, usually in alginate.2.Select shape and shade of tooth.3.Extraction of tooth/teeth and delivery of dentures.
For a few teeth addition to an existing denture:1.Impression of mouth with denture in situ.2.Addition of denture tooth/teeth as soon as possible.3.Extraction of tooth/teeth and delivery of denture(preferably within 1 to 2 days).
Advantages of addition:1. quick.2. Economic.3. No need for period of adjustment or change in esthetic.
For multiple teeth immediate denture, one of following option is possible:1. Extract all teeth at one time and insert immediate dentures.2. Extract posterior teeth prior to making immediate dentures to replace anterior teeth (disadvantage is that it may lead to tongue spread).
Clinical StagesThe clinical stages are:1.Primary impressions in alginate with or without impression compound (sectional impression technique)2.Master impression in alginate.3.Occlusal record rims for existing edentulous area record vertical dimension and jaw relation: If all teeth are present enough to be articulated, no need to construct bite rim. If remaining teeth are scattered , bite rim is constructed.4.Trial stage. If remaining anterior and posterior teeth, try-in cannot be made. If only anterior teeth remaining jaw relation and vertical dimension can be made. If only anterior teeth to be extracted, try-in cannot be made.
5. Surgery and insertionof the denture:The first step: preparing the patient for the surgery in case patients that suffering from systemic diseases such as diabetes and hypertension and other systemic diseases precautions should be taken before this surgical procedure so the appropriate dental managements for each patient with systemic diseases should be preformedThe second step: Extraction of the teeth that were decided to be extracted in the first appointement and in case of multiple extraction of the posterior teeth start extracting of the posterior teeth toward the anterior teeth to prevent damaging the wound to and allow healing of posterior area and improve the adaptation of the denture over the alveolus and tuberosity.
The third stage: After extraction alveolectomy is done in the area by simple recontouring or an interseptal aleveoloplasty preserving as much as possible of the vertical height and cortical bone that bony recotouring and elimination of gross irregularity is compeleted the tissue is approximated with digital pressure and surgical guide is inserted and any area of tissue blanching or irregularity are then reduce until surgical guide is adapted to the alveolar ridge in all areas.The forth stage: Incision are closed with continuous or interrupted suture and the use of suture will depend on the number of extracted teeth.The fifth stage: Use of tissue conditioner in the denture for better retention and faster healing.The final step: Insertion of the immediate denture.
6.Review appointment. It is important to review a patient with an immediate denture at regular intervals especially in the first few weeks and months. The initial days are primarily concerned with the postoperative care of the healing tooth sockets, while the later reviews are directed at the management of resorption.A simple time table for reviewing a patient is as following: at 24 hours, a general check is made of the over all comfort and borders of the dentures and to ensure no major ulceration has occurred and that the socket are healing well, try to avoid occlusal adjustment. at 48 hours, patient is seen for sore spot. at 1 week, a more detailed check and occlusal adjustment of dentures can be made, removal of suture and changing of tissue conditioning material. at 1 month, the socket has healed and chair side temporary reline may required. at 3 to 6 month, the management of loss of fit of the denture owing to bone resorption is undertaken, this may involve relines and /or rebases, which are taken either chair side or with aid of the laboratory. at 1 year, a new denture is made.
Laboratory Stage Trimming of casts between try-in and before processingof dentures. The cast must be prepared by the dentalsurgeon as he/she alone has seen the patient andundertaken the clinical examination. In socket fit denture thecast is marked with a pencil to show the gingival margin, thelong axis of the teeth and the length of the teeth. Preparedroot socket(5mm depth on the stone model in the directionof the root) and then the neck of the artificial teeth isplaced in the preparation and at the time of insertion theneck of the artificial teeth will just enter socket of the toothafter extraction. Depth that is predetermined by probingdepth around the teeth and information from anyradiographs. In a flanged denture, the stone is trimmed tosimulate the ridge following tooth extraction.
Post-operative instructions1. You must leave your dentures in your mouth for the first 24 hours. Removing the dentures will not decrease pain due to the extractions. Swelling may occur, and if you remove your dentures, you may not be able to reinsert them. Holding ice packs against your face in the area of the extractions (no more than 20 minutes/hour for the first 24 hours may reduce swelling). After 24 hours, use a wet heat compress). Take prescribed medications as directed. The denture will act as a bandage and help to limit bleeding and prevent breakdown of the blood clots that form in the sockets. Although bleeding is normally minimal, you must remember that a few drops of blood will color your saliva pink.2. Your diet for the first 24 hours should be restricted to liquids or soft foods.
3. After the 24 hour appointment, your dentures should be removed for cleaning after meals. Always hold the dentures over a sink partially filled with water while cleaning them (should you accidentally drop them, the water will break their fall and damage will be less likely). Scrub the tissue surface (inside) of the dentures with a denture brush, liquid soap, and water. Brush the external surfaces and the teeth of the dentures and, for maximal cleanliness, brush your tongue and the roof of your mouth. Always keep the dentures wet while they are out of your mouth.4. After 24 hours, you should begin removing your dentures at night. Removing the dentures allows small blood vessels to enlarge and provide nourishment to the tissues supporting the dentures.