Journal Club Presentation

1. AUTHORS :- C. M. HEARTWELL & F.W. SALISBURY
Journal of Prosthetic Dentistry, July-August 1965, Pg No.615 – 624.

2. Brief Outline
1. Definition
2. Requirements of Immediate Complete Dentures (ICD)
3. Diagnosis of Patients
4. Advantages of ICD
5. Advantages which warrant careful evaluation
6. Bone Contouring by ICD
7. Contraindications of ICD.
8. Surgical preparations of Mouth for Insertion of ICD.

3. Nomenclature
 It has been suggested that “transitory” or “temporary” dentures
would be more appropriate terminology for immediate
dentures.
 The term “treatment denture” has been suggested, although
this term seems more appropriate for a prosthesis used in
diagnosis or during surgical procedures.
 The term “temporary” could be applied to any denture since no
denture should be considered to be permanent.

4. Definition
“An immediate complete denture is a dental prosthesis
constructed to replace the lost dentition and associated
structures of the maxillae and/or mandible and
inserted immediately following removal of the
remaining natural teeth”

5. Requirements of Immediate Complete Dentures
 To attain the maximum degree of success the following
requirements should be satisfied:
(1) Compatibility with the surrounding oral environment.
(2) Restoration of masticatory efficiency within limits.
(3) Function in harmony with the activity necessary in speech,
respiration, and deglutition.
(4) Esthetic acceptability.
(5) Preservation of the tissues that remain.

6. Diagnosis of Patients
 Many dentists give very little consideration to the diagnostic phase of
immediate denture service.
 The diagnostic procedures are not the same for completely
edentulous patients as for partially edentulous patients.
 In partially edentulous patients, the retention of the remaining teeth
must be evaluated by dentists who use the most recent knowledge of
histology, anatomy, physiology, and psychology.
 Diagnosis is based on findings of a diseased condition by an
examination to recognize and identify disease.

7. Severe Periodontitis leading to tooth mobility
Grossly Carious Tooth
Non Restorable

8. Patient Counselling
 Do not fit as well as normal complete dentures.
 The pain of the extractions, in addition to the sore spots
caused by the immediate denture, will make the first
week or two after insertion difficult.
 It will be difficult to eat and speak initially
 The esthetics may be unpredictable because an anterior
try-in is not possible

9.  Immediate dentures must be worn for the first 24 hours
without being removed by the patient. If they are
removed, they may not be able to be reinserted for 3 to 4
days. The dentist will remove them at the 24-hour visit
 Immediate dentures will “loosen” during healing, tissue
conditioners will be required
 6 to 9 months after insertion at least a reline will need to
be done, possibly a remake . The patient is responsible
for fees.

10. Step by Step Procedure
 Preliminary impressions
 Final impressions
 Jaw relation records
 Tooth set up and try in
 Extraction and insertion
 Post insertion care

11. Examination/Diagnosis/Treatment Plan
 Assess tissue undercuts (especially in the anterior
maxilla
-reduce during extractions
-use 2 piece tray for impression
 Is VDO correct?
 Imitate or change tooth arrangement for esthetics or
denture stability -midlines, occlusal plane, vertical
overlap, length of maxillary incisors
 Conventional or transitional

12. Preliminary impressions
 Use dentate or partially edentulous stock trays

13. Final Impressions
 Normally need to use 2 piece custom tray
 If no large tissue undercuts may be able to us 1 piece
custom tray

14. 1 piece tray
One Piece Tray

15. Two Piece Tray

16. Alternate Two Piece Technique

17. Jaw Relation

18. Face Bow Recording

19. Facebow Transfer and Centric Relation Recording

20. Teeth Arrangement and Try-In

21. Extraction and Insertion
 Have lab complete set up and modify cast as directed.
-Use perio probing to guide cast modification

24. Surgical Stent (Guide)

25. Extraction and Insertion
 Extract teeth
 Use surgical guide to contour ridge
 Seat the denture
-Check for over extensions and do necessary
modifications.
THE DENTURE MUST BE FULLY SEATED
 Adjust occlusion
 Give post insertion instructions

26. Denture Insertion

27. Instructions to patient
 Do not remove until tomorrow's appointment
 If it comes loose/out put it back in place immediately
 Soft/ Liquid diet for 24 hours
 Avoid rinsing
 Take analgesic and prescribed antibiotics.

28. 24 hour appointment
 Remove and clean denture
 Relieve sore spots and check for overextensions

29. Follow up
 Use tissue conditioner to refit as needed
 Remove any socket convexities to avoid healing
defects
 Reline or remake in 6 to 9 months

31. Advantages of Immediate Complete Denture
 ( 1) The denture acts as a bandage or splint.
 (2) The splinting and bandage action promotes rapid
healing as it protects the blood clot.
 (3) Patients seem to function in speech, deglutition,
and mastication much sooner.
 (4) Many patients are not as reluctant to have diseased
teeth removed if they can have them replaced
immediately.

32. Advantages of Immediate Complete Denture
 (5) There is less difficulty in making the polished
surface of the dentures compatible with the
surrounding structures. The tongue, lips, and cheeks
have not altered their positions because of the lack of
tooth support.
 (6) Psychologically, there are two advantages
a) Patients afforded immediate complete denture
service rarely relinquish their dentures.
b) Carry on social and business activities without
embarrassment.

33. Advantages which warrant careful evaluation
1) The Vertical Dimension is retained.
Critics : a) Continous eruption and attrition.
b) Overclosure and discrepancy
c) Natural tooth contacts and guideline

34. 2) Teeth in immediate dentures can be replaced in the
same positions as the natural teeth.
Critics :- Centric Occlusion and Centric relation is not in
harmony.

35. Bone is Contoured by Immediate Dentures.
 1) Belief that the forces applied by any denture replace
the stimulation which was supplied to the bone by the
natural teeth.
 But forces may be of severe magnitude and act in
different directions.
 Osteoclastic action accompanies this change in
structure in healed bone.

36.  Lytle demonstrated the reparative change of bone between the buccal
and lingual cortical plates in a young patient when a slight extension of
the denture base was allowed to remain in an incompletely healed
socket.
 Clinical observations suggests that stresses exerted by dentures, even
those which are considered to be well constructed, are so variable that
it is impossible to render a definite prognosis.
 The atrophy is proportional to the extent of the disuse.
 Campbell’s investigation revealed much more loss of bone by the
denture patient than by the non-denture patient.

37. Contraindications of Immediate Complete Denture
1) Immediate dentures are contraindicated for patients
with diseases of a debilitating nature.
2) Patients for whom multiple extractions might be
unwise because of systemic conditions.
3) Immediate dentures are contraindicated for
emotionally disturbed individuals.
4) Patients whose mental capacities do not allow them
to comprehend their responsibility in this service.

38. Contraindications of Immediate Complete Denture
5) Patients with acute periapical or periodontal pathosis.
6) Immediate dentures are contraindicated for patients
who have extensive bone loss adjacent to the
remaining teeth.

39. Conclusion
1) Immediate complete dentures may be regarded as
“Temporary dentures”
2) They must meet certain special requirements of Oral
Funtions.
3) Removal of osseous structures is not advisable.
4) Studies suggest that it may not act as a stimulus for
formation of bone.
5) Literature is still insignificant about the justified use
of Immediate dentures.