1. Immediate Denture
Done by:
Hadeel Mohammed Ali
Supervised by:
Dr. Adel Ahmed

2. INTRODUCTION
An immediate denture is defined as a denture that is
made prior to the extraction of the natural teeth and
inserted into the mouth immediately after the
extraction of those teeth. It may involve total or partial
replacement. In many society, it is important that
people are seen with teeth, and generally it is
unacceptable that patients should be rendered
edentulous without any replacement prosthesis. As
overall dental health has improved, the total removal
of teeth followed by the provision of complete
dentures has been uncommon. It is now more usual to
provide simple immediate addition to existing
dentures or to provide an immediate partial denture.

3. INDICATIONS
1.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.
CONTRAINDICATION
Patient is not willing to accept the treatment
mentally and psychologically or due to cost.

4. ADVANTAGES
1 . Maintenance of the soft tissue contour of the face
2. 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.

5. 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.

6. Disadvantages
1. 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.

7. Types Of Immediate Denture
a. Flanged Denture
b. Socket fit Denture

8. Flanged denture
1. Retentive
2. Easier to reline and rebase
3. May be difficult to place where there is an
undercut.

9. Socket Fit Denture are:
1.The teeth sit into sockets of the extracted teeth, gives
more natural appearance
2 . Esthetically good initially
3.Contraindicated in mandible because of poor stability
of lower denture during function
4 . Prone to loss of esthetic as resorption continues
5. Difficult to reline/rebase or changed to flanged type
6 . Have poor retention
Wherever possible, a flange denture should always be
designed.

10. DIAGNOSIS
The difficulties with immediate denture
provision must be explained to patients. The
patient need:
1. Cleared explained of technique.
2. Visits to be planned.
3. To know which teeth are to be removed.
4. Motivation.

11. 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.

12. 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.

13. 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).

14. Advantages of addition:
1. quick.
2. Economic.
3. No need for period of adjustment or
change in esthetic.

15. 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).

16. Clinical Stages
The 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.

17. 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 preformed
The 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.

18. 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.

19. 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.

20. Laboratory Stage
Trimming of casts between try-in and before processing
of dentures. The cast must be prepared by the dental
surgeon as he/she alone has seen the patient and
undertaken the clinical examination. In socket fit denture the
cast is marked with a pencil to show the gingival margin, the
long axis of the teeth and the length of the teeth. Prepared
root socket(5mm depth on the stone model in the direction
of the root) and then the neck of the artificial teeth is
placed in the preparation and at the time of insertion the
neck of the artificial teeth will just enter socket of the tooth
after extraction. Depth that is predetermined by probing
depth around the teeth and information from any
radiographs. In a flanged denture, the stone is trimmed to
simulate the ridge following tooth extraction.

21. Post-operative instructions
1. 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.

22. 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.

23. A case requiring immediate
dentures

24. Completion of the extractions

25. Immediate denture in
place