An immediate denture is a complete or partial denture fabricated and placed immediately following the extraction of natural teeth. It aims to maintain jaw relationships and support during healing. However, occlusion may be difficult to set due to limited tooth positioning and unstable ridges. The denture will require relines as the ridges resorb during healing. Patients are advised the fit will not be optimal initially and further adjustments may be needed. The denture should be inserted carefully following extractions and not removed for 24 hours to allow proper seating and healing. Follow up appointments in 1 week and 1 month allow for adjustments and improving retention as the ridges adapt.

1. Complete or removable partial denture fabricated for
placement at the same appointment as extraction of
natural teeth
Immediate Dentures

2. Makes Jaw Relations Difficult
Occlusion May be Mutilated

3. OVD, Midline & Incisal Edges May Require Change

4. After Extractions, Prior to Placement

5. Final Result

6. Immediate Complete Denture
• Conventional immediate denture
• intended to be relined to serve long-term
• Interim immediate denture (IID) (transitional):
• after healing a second new complete denture is fabricated
as a long-term prosthesis
(Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.1)

7. Advantages
• Maintenance of
• Appearance
• Circum oral support
• Muscle tone
• Occlusal vertical dimension
• Jaw relationships
• Facial height
• Tongue will not spread out as result of tooth loss
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.2.1

8. Advantages
• Less postoperative pain & bleeding
• extraction sites protected
• Pressure from denture base
• Easier to duplicate natural tooth shape &
position (if desired)
• Easier Adaptation
• Speech, mastication rarely compromised
• Nutrition can be maintained
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.2.1

9. Disadvantages
• More challenging to set teeth
– Less space for teeth as ridge resorption hasn’t occurred
• Alveolar ridge undercuts around remaining teeth may make
impressions more difficult
• Unstable or inadequate occlusion can make recording
centric position difficult
Unstable Occlusion

10. Explanation to Patients
• Fit is usually not as good as traditional
dentures (estimate ridge form)
• Extractions and sore spots from
immediate denture can result in more
discomfort after initial insertion
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2013. 9.4.3.1

11. Explanation to Patients
• Takes time to adapt to chewing and speaking
• Appearance may be unpredictable if anterior try-in
not possible
(Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2013. 9.4.3.1)
No Anterior Try-in

12. Explanation to Patients
• Should be worn for first 24 hours without removal
• If removed, reinsertion can be difficult if
significant swelling occurs
• Patient should return to dental office for initial
removal at 24-hours

13. Explanation to Patients
• Immediate dentures will normally “loosen” during healing
due to ridge resorption & soft tissue remodeling
• Relines/tissue conditioners will be required to improve the
retention
• Normally a permanent reline will be required 4-6 months
after insertion

14. Explanation to Patients
• In some cases a remake may be required
• Significant change in jaw position
• Significant esthetic problem
• May be cheaper/better to remake
• Patient is responsible for fees for relines
• Explain prior to beginning
• Include reline fee in estimate for immediate denture

15. Too Difficult
• No opposing occlusal contacts
• Severely collapsed occlusal vertical dimension
• Can’t register a repeatable jaw relationship
(check at treatment planning appointment)
• Vestibule too short - vestibuloplasty would be
required
• Refer

16. Technique
• Examination/Diagnosis/Treatment Plan
• Informed consent
• Alternatives
• Pros/cons
• Prognosis
• Timing
• Costs

17. Examination/Diagnosis/Treatment Plan
• Beware of tissue undercuts
• Especially anterior maxilla & tuberosities
• Make notes to reduce at time of extractions
• Compress socket
• Bony reduction if necessary
• If not reduced, denture may not seat
• 2 piece tray for impression

18. Examination/Diagnosis/Treatment Plan
• Determine if OVD requires change at diagnosis
appointment
• Use physiologic rest, interocclusal space
measurements

19. Examination/Diagnosis/Treatment Plan
• To improve esthetics & ensure adequate stability:
• Decide whether you will need to imitate or change
tooth arrangement prior to beginning
• Helps avoid unexpected surprises

20. Technique
• Oral hygiene procedures
• Reduce inflammation to speed healing
• Reduced discomfort after extractions
• Less soft tissue changes – better fit

21. Technique
• Preliminary extractions - posterior teeth
• Keep one set of opposing teeth on each side of arch if
OVD and centric are to be preserved
• Wait 4 weeks for healing
• If very few teeth remain
• Consider extracting all at once
• Skip preliminary extraction step
• Less morbidity
Extract All Teeth Single Appointment

22. Technique After Preliminary Extractions
• Preliminary impressions - alginate
• Final impressions – 1 or 2 step
• Jaw relation records
• Tooth set-up and try-in
• Final extractions and insertion
• Post insertion care

23. Examination/Diagnosis/Treatment Plan
• Reconfirm decision to imitate or change tooth
arrangement
• Determine midlines, occlusal plane, vertical
overlap, length of maxillary incisors
• Mark on cast for laboratory to use for setup

24. Preliminary impressions
• Stock trays
• Dentate or partially-edentulous
• Irreversible Hydrocolloid
• Mark vibrating line & hamular notches
prior to impression
• Can’t reseat intraorally

25. Final Impressions
• Use 2 piece custom tray if significant
undercuts
• If no large tissue undercuts use one
piece custom tray

26. Mark Posterior Border Prior to Impression
• Vibrating line & hamular notches
• Not able to reseat intraorally
• tooth & tissue undercuts, embrasures
• If don’t have correct posterior border, denture
will not be retentive

27. 2 Piece Impression
Stock Tray
Custom Tray – Ensure
Alginate Not Too Thin

28. 1 Piece Impression
• Block out minor undercuts
• Ensure tray flange not too
far from vestibule
• After border molding,
should not lock into place

29. Jaw relation records
• Record base & occlusion rim
used if unstable cast/contacts
(wobbles, rocks)
• Make facebow record with
dentate bitefork
• Use for centric & protrusion
• If stable contacts, record base
not needed

30. Jaw Relation Records
• Determine OVD
• Use physiologic rest, interocclusal space
measurements
• Do NOT incorporate an overbite in occlusion rims
• if anterior teeth are missing, use rims only to
determine OVD, not incisal display
• Once mounted, determine overbite, incisal display
required

31. Use occlusion rims for OVD, Jaw Relations Records

32. Use PVS Bite Registration Material, NOT Wax
Dentate Bitefork wth Wax/PVS
Centric Record

33. Tooth Set-up and Try-in
Anterior Try-in Only Possible if Anterior Teeth Missing

34. Extraction and Insertion
• Have lab complete set up & modify cast
as directed
• use probing depths & radiographs to
guide cast modification

35. Do not create large socket convexities – grind teeth

36. Final Setup Usually will not allow for Full Wax Try-in

37. Extraction and Insertion
• Always request a surgical stent (guide)
• Prescribe fabrication of stent when sent for processing
• Allows for identifying areas of impingement (blanching)

38. Extraction and Insertion
• Extract teeth
• Prior to insertion, use surgical guide to assess ridge
• Place pressure but DONOT Flex during insertion
• check for over extensions, pressure (blanching)
• Seat the denture
• After stent show full seating, no blanching

39. Extraction and Insertion
THE DENTURE MUST BE FULLY SEATED
• Otherwise occlusion will be unacceptable
• Once fully seated, adjust occlusion as needed
• Provide post insertion instructions
• Verbal
• Written – patient brochure

41. Timeline for Insertion
0 -15 min
- Inform surgeon & Dr patient is receiving
an immediate denture
- review med history
- provide local anaesthesia
15 - 60 min
- extractions
1 - 2 hour
- insert and adjust
- instructions

42. Instructions to Patient
• Do not remove until 24 hour appointment
• If it comes loose/out replace immediately
• Soft/liquid diet for 24 hours
• Avoid vigorous rinsing
• Take analgesic as prescribed
• Expect red saliva

43. 24 Hour Appointment
• Remove and clean denture
• Relieve sore spots
• Do not use PIP – use indelible stick
• Gross occlusal adjustment

45. 1 Week Recall Appointment
• Relieve sore spots
• Use PIP
• Refine occlusion – possible remount

46. Continuing Care
• Tissue conditioner to improve retention as
needed
• Remove any socket convexities to avoid healing
defects
• Reline or remake in 4 to 6 months
• Postpone as long as patient can tolerate to
ensure most of initial resorption complete

47. Remove denture base convexities to avoid healing defects
X
X X