Immediate denture

1. Immediate Denture

2. Introduction
 Dentures constructed before and placed immediately following extraction of
natural teeth.
 More challenging than conventional dentures because try-in is not possible to
verify the arrangement of anterior natural teeth.
2 types are recognized:
 1) conventional immediate denture
 2) Interim immediate denture

3. Advantages
 Maintenance of patient appearance as they are not without teeth even for one day.
 Acts as bandage or splint to control bleeding.
 Less post operative pain as bleeding site is protected
 Vertical dimension, jaw relation ,muscle tone ,facial height and tongue position is maintained.
 Speech and chewing habits and digestive function are not compromised and nutrition is
maintained.
 Adjustment to new denture is quicker than conventional denture.
 Patient’s social ,professional and psychological status is not hampered.
 There is less resorption and better preservation of residual ridge as they are subjected to early
function


4. Disadvantages
 Anterior try-in not possible , patient has no idea how denture looks on day of
insertion.
 Requires more chairside time , additional appointments and cost.
 Bone resorption and shrinkage of unhealed tissue is greater and faster than
changes in healed tissues
 Cannot restore the stimulation tat was supplied to bone by natural teeth.
 Anterior ridge undercut , commonly present when only anterior teeth remain May
produce inaccurate impression.
 There will be temporary impairment of speech and mastication.

5. Indications
 A dentulous or partially edentulous patient , whose remaining natural teeth are
indicated for extraction.
 Patients for whom complete extractions are required and aesthetics cannot be
compromised even for short period due to social and professional commitments.

6. Contraindications
 Patient with poor health or debilitating disease.
 Patients who are poor surgical risk-multiple extractions might be unwise because
of systemic condition like cardiac disease , uncontrolled diabetes , blood dyscrasis
and those with slow healing potential.
 Emotionally disturbed individuals with psychological disorders.
 Uncooperative patients.

7. Conventional Immediate Denture
 Diagnosis and treatment planning:
Similar to CD patient.
posterior teeth are extracted and impression procedures are started after
healing period of 6-8 weeks.
For better esthetic and 0cclusion upper and lower immediate dentures should be
fabricated simultaneously.

8. Impressions
 Preliminary impressions are made with irreversible hydrocolloids.
 Preliminary cast is poured and custom tray is fabricated.

 Final impressions made using 2 methods:
 Single impression technique using a custom tray covering the teeth and
edentulous ridge.
 Dual impression technique using a custom tray covering only edentulous space
and lingual surface of anterior teeth.

10. Single impression technique
 Custom tray is fabricated in Auto polymerizing acrylic resin as follows:
 Spacer: one sheet of baseplate wax(2mm) covers the edentulous ridge while two sheets
of(4mm) wax covers the natural teeth.
 Stops: one anteriorly and two posteriorly on either side-in 1st molar area
 Peripheral extension-2mm short of vestibule
 Border moulding of entire border is performed using low fusion green stick
compound. The interdental spaces between the anterior teeth are blocked with wax.
 Final impression is made with regular/medium body elastomeric material.


12. Dual impression technique
 Similar to the pick of impressions described for rpd
 Custom tray is fabricated covering only the edentulous space and lingual surface of anterior teeth.
 Custom tray is inserted only on edentulous section is border moulded with green stick compound.
Final impression
 Is made of edentulous area and lingual part of anterior teeth with ZOE paste or
regular/medium body elastomeric material.
 After this material sets ,impression is removed from mouth and tray handle is cut off:
 The impression is reseated in the mouth and a secondary impression is a made over edentulous
impression and anterior teeth with stock tray using irreversible hydrocolloids.
 A master cast is made and record base with occlusal rim is fabricated for edentulous posterior
region

15. Jaw Relation Records
 Similar to conventional CD
 Facebow transfer used to mount maxillary cast.
 Static centric relation is obtained at vertical dimension of occlusal and lower cast is
articulated.

16. Teeth selection and posterior teeth
arrangement
Acrylic resin denture teeth are indicated as they are easy to trim and adjust.
Posterior teeth are arranged with tight multiple contact in centric relation. Bilateral
balancing contacts are given in eccentric movements.

17. Try-in
 Try-in of posterior teeth is scheduled.
 Cenric relation,vertical dimension and occlusion are verified.

18. Waxing and processing of denture
Insertion of dentures
Post insertion care
1) Patient is seen 24hr after denture insertion.
2) Denture is remove and cleaned. Patient is asked to rinse with mouthwash
3) Evaluation for over extension and pressure spots which are corrected
4) Patient is instructed how to insert and remove the denture and instructed to rinse after every meal
and clean the denture.
5) Patient is next seen after 1week and definitive occlusal correction is done. Tissue conditioner are used
to reline the denture .
6)Patient is then recalled after 1month and a clinical remount can be done to refine occlusion.
7)A functional technique is used to perform a definitive relining.

19. 2)Interim Immediate Denture
 Usually indicated with periodontally involved natural teeth which can be removed
without any surgical trauma.

20. Advantages
 Similar to advantages of conventional immediate dentures.
 Cab be worn during the construction of new dentures.
 Patient has benefit of having spare denture.
 Procedure is quick as patient’s existing teeth or old partial dentures are used to
replicate the artificial teeth.

21. Procedure
 Maxilla and mandibular impressions are made using irreversible hydrocolloids
after blocking out of the interdental spaces with wax.
 2sets casts poured
 Base plate wax is melted and poured into impressions of teeth up to gingival
margin . After wax hardens the rest of impression is poured in dental stone . This
cast will be used to process the denture maintaining shape of patients original
teeth.
 After 1st cast sets ; it is carefully removed from impression and a 2nd cast is poured
entirely in dental stone. This is used to make record base for jaw relatons and also
as reference cast whilemaking new denture

22.  Record base made with occlusal rims and static centric record is obtained similar
to that rpd.
 Cast articulated and missing teeth are arranged using acrylic teeth.
 Cast flasked and dewaxed.
 Denture is deflasked, undercuts trimmed and boarders shortened, thinned and
rounded.
 Dentures finished and polished.

25. conclusion
Immediate denture has many advantages and it is constructed before and placed
immediately following extraction of natural teeth which maintains esthetic , chewing
and digestive function and nutrition is not compromised and provide psychological
benefits to the patient .

26. References
 Text book of prosthodontics-v rangarajan(2nd edition)
 Prosthodontic treatment for edentulous patients(13th edition)