This document discusses different types of immediate dentures. It defines an immediate denture as any removable dental prosthesis fabricated for placement immediately following tooth extraction. There are two main types: conventional (classic) immediate dentures and interim/transitional immediate dentures. The conventional type is intended to serve as the long-term prosthesis after refitting, while the interim type is replaced by a second denture after healing. The document outlines the advantages, disadvantages, indications, and contraindications of each type. It also describes the diagnostic and treatment planning process, including clinical and laboratory procedures, for fabricating immediate dentures.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
Neutral Zone
In dentistry, the neutral zone refers to that space in the oral cavity where the forces exerted by the musculature.of.the tongue are equal and balanced with the.forces exerted by the buccinators.muscle of the cheek.laterally and the orbicularis.oris muscle anteriorly
An immediate complete denture is a dental prosthesis constructed to replace the lost dentition and associate structure of the maxillae and/or mandible and inserted immediately following removal of remaining teeth.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
Neutral Zone
In dentistry, the neutral zone refers to that space in the oral cavity where the forces exerted by the musculature.of.the tongue are equal and balanced with the.forces exerted by the buccinators.muscle of the cheek.laterally and the orbicularis.oris muscle anteriorly
An immediate complete denture is a dental prosthesis constructed to replace the lost dentition and associate structure of the maxillae and/or mandible and inserted immediately following removal of remaining teeth.
immediate denture According to Glossary of Prosthodontics terms It is a partial or complete denture, that’s fabricated to replace natural teeth immediately after extraction
There are several advantages of an immediate denture. The most important factor is that you will never need to appear in public without teeth. ... When an immediate denture is inserted at the time of extraction, it will act as a Band-Aid to protect the tissues and reduce bleeding.
Relining & rebasing / dental implant courses by Indian dental academy Indian dental academy
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. • Advances in therapy have helped patients with periodontal
disease retain part of their natural dentition for an extended
period of time. These patients can be well served by properly
designed removable partial dentures.
• For the patient facing the loss of all his/her remaining natural
teeth, there are three treatment options .
One is for the patient to have all remaining teeth extracted and
wait six to eight weeks for the extraction sites to heal.
The complete denture is made following healing, leaving the
patient without teeth not only during the healing phase , but
also during the time required for the fabrication of the
complete denture.
2
INTRODUCTION
86
3. • A second option is to convert an existing removable partial denture
into an interim complete denture.
• A third option is to make a ‘ immediate complete denture’.
386
4. Definitions
• IMMEDIATE DENTURE:
Any removable dental prosthesis fabricated for placement
immediately following the removal of a natural tooth/teeth.
GPT-8
486
5. TRANSITIONAL DENTURE: GPT-8
A removable dental prosthesis serving as an interim prosthesis to
which artificial teeth will be added, as natural teeth are lost and that
will be replaced after post extraction tissue changes have occurred. A
transitional denture may become an interim complete dental
prosthesis when all of the natural teeth have been removed from the
dental arch.
586
6. A fixed or removable dental prosthesis, or maxillofacial prosthesis,
designed to enhance esthetics, stabilization and/or function for a
limited period of time, after which it is to be replaced by a definitive
dental or maxillofacial prosthesis. Often such prostheses are used to
assist in determination of the therapeutic effectiveness of a specific
treatment plan or the form and function of the planned definitive
prosthesis.
Also called as PROVISIONAL PROSTHESIS
GPT-8.
6
INTERIM PROSTHESIS:
86
7. TYPES OF IMMEDIATE DENTURES
(Prosthodontic treatment for edentulous patient-Zarb and Bolender)
1.CONVENTIONAL (CLASSIC) IMMEDIATE DENTURE (CID):
This is a type of immediate denture which, after it is made and
healing is completed, the same denture is refitted or relined to serve
as a long term prosthesis.
786
8. 2. INTERIM OR TRANSITIONAL OR NON TRADITIONAL
IMMEDIATE DENTURE (IID):
This is a type of immediate denture in which after the healing is
completed, a second new complete denture is fabricated as the long
term prosthesis.
886
9. JIFFY DENTURES (Raczka and Esposito 1995)
• It is similar to interim immediate denture because it is replaced by a
second denture after healing.
• It differs from interim immediate denture in that the denture “teeth”
are usually made with tooth coloured auto-polymerizing acrylic resin
or portions of the patient’s preexisting fixed or removable partial
denture.
• The disadvantage with this is that the denture teeth are not long
lasting (in wear and color stability).
986
10. According to Heartwell, to attain maximum degree of success the
following requirements should be satisfied
• Compatibility with surrounding oral environment.
• Restoration of masticatory efficiency within limits.
• Harmony with the Function of speech, respiration and deglutition.
• Esthetic acceptability.
• Preservation of remaining tissues.
10
REQUIREMENTS
Textbook of Complete Dentures, Arthur O. Rahn, Charles M. Heartwell 5th edition
86
11. ADVANTAGES AND DISADVANTAGES FOR
ALLTYPES OF IMMEDIATE DENTURES
ADVANTAGES
1. The maintenance of a patient’s appearance
because there is no edentulous period.
2. The denture acts as a bandage or splint to help
control bleeding, to protect against trauma and
contamination.
3. Circumoral support, muscle tone, VDO, jaw
relationship, and face height can be maintained.
4. The tongue will not spread out as a result of tooth
loss.
5. Less postoperative pain is likely to be
encountered because the extraction sites are
protected.
6. Reduced RRR due to early function
1186
12. 7. It is easier to duplicate (if desired) the natural tooth shape and
position, plus arch form and width.
8. Ease of adaptability to new dentures at the same time that recovery
from surgery is progressing. Speech and mastication are rarely
compromised, and nutrition can be maintained.
9. Overall, the patient’s psychological and social well-being is
preserved.
1286
13. 1. The presence of variable number of teeth makes impressions
and maxillo-mandibular positions more difficult to record.
2. Resorption of the ridges leading to reline or remake of denture
in six month or a year following insertion.
3. The anterior ridge undercut (often severe) that is caused by the
presence of the remaining teeth may interfere with the
impression procedures ; hinders in accurately capturing a
posteriorly located undercut, which is important for retention.
4. Inability to predict esthetics as anterior try in prior to insertion
is not carried out.
5. More chair side time, increased treatment cost
6. Temporary inconvenience of impairment of functional
activities
13
DISADVANTAGES
86
14. (1) patients who are in poor general health or who are poor
surgical risks
• Post-irradiation of the head and neck regions
• Systemic conditions that affect healing or blood clotting
• cardiac or endocrine gland disturbances
• psychological disorders
(2) patients who are identified as uncooperative because they
cannot understand and appreciate the scope, demands, and
limitations to the course of immediate denture treatment.
14
CONTRAINDICATIONS
86
15. 15
Conventional immediate
denture ( CID)
Interim Immediate denture
(IID)
Definitive or long term
prosthesis
Transitional or short term
Only anterior teeth are
remaining ( and premolars)
Usually both anterior and
posterior teeth are remaining
Good retention and stability Only fair retention and
stability; improved by
provisional relines during
healing
Overall cost is less than IID Includes cost of interim
denture and a second denture
Long treatment time due to
healing period of posterior
teeth extraction areas
Treatment time is shorter
86
16. 16
Conventional immediate
denture ( CID)
Interim Immediate denture
(IID)
At placement of CID only
anterior teeth are extracted.
At placement of IID , both
anterior and posterior teeth
are extracted
Esthetics of the CID cannot be
changed
The second denture
procedure after the IID allows
an alteration of esthetics.
Contradicted for a patient
who has a complex treatment
plan or for changes in the
vertical dimension of
occlusion
Indicated in complex
treatment cases
Not useful for converting
existing prostheses
useful for converting existing
prostheses to an IID
86
17. DIAGNOSIS and TREATMENT PLANNING
1. Explanation to the patient :
A careful explanation to the patient of the limitations of immediate
denture service should always be given.
The list includes:-
They do not fit as well as complete dentures. They may need
temporary lining with tissue conditioner and may require the
use of denture adhesive.
They will cause discomfort.
It will be difficult to eat & speak initially.
86 17
18. The esthetics may be unpredictable.
Many other denture factors are unpredictable such as gagging
tendency, increased salivation, and facial contour.
It may be difficult or impossible to insert the immediate denture on
the first day.
Immediate denture must be worn for the first 24 hours without
removal by the patient.
Because supporting tissue changes are unpredictable, immediate
denture may loosen up during the first 1 to 2 years.86 18
19. 2. Diagnostic procedure :
The diagnostic procedures are divided into two phases:
(A) Patient examination
(B) Consultation interview.
86 19
20. (A) Patient examination: -
The examination of the patient
should include:
a) Findings of local and systemic
status.
b) Roentographic study.
c) Visual and digital examination.
d) Accurately articulated cast.
86 20
23. a) Local & systemic status :-
Condition of teeth to be extracted.
Position of teeth.
Presence of foreign bodies.
The presence of bony or tissue undercuts that must be reduced or
eliminated.
Exostoses.
Bone loss adjacent to remaining teeth.
Muscle co-ordinations.
86 23
24. (b) Examination of existing prosthesis:-
Any existing prosthesis should be examined for shade,
mold, tooth position, lip support, and smile line.
86 24
26. (3) Tooth Modification : -
As occlusal discrepancies can affect correct registration of centric
relation and can also interfere with the proper determination of
the occlusal vertical dimension.
So these tooth modification should be made in advance to the final
impression.
Many immediate dentures will
require modification of
opposing teeth to correct the
occlusal plane or to eliminate
prematurities in centric
relation.
86 26
28. Diagnostic mounting of the cast:
• Initial discussion of esthetics (tooth mold & shade selection)
• Plane of occlusion.
• Patient existing midline and modification of its position.
• Patient existing vertical dimension of occlusion and amount
of inter occlusal distance.
86 28
29. To evaluate whether patients existing maximum occlusal position
coincides with the planned centric relation position for immediate
dentures.
To estimate the angles classification of occlusion for the patient
and a note of the display of posterior tooth in buccal corridor.
86 29
30. (4) Oral prophylaxis :-
The patient should have a general scaling of the teeth to minimize
calculus deposits. This will reduce the post operative oedema and
chance of infection.
(5) Other treatment needs :-
Often patients with single immediate dentures also require
restorations, crown or removable partial dentures; restorations are
usually performed coincident with the immediate denture
procedures.86 30
31. • WHAT TYPE OF IMMEDIATE DENTURE SHOULD BE
PRESCRIBED?
• Extracting the posterior teeth and performing other necessary
procedures first in patients can lead to predictable results for the
CID.
• However for other patients, the idea of a period without posterior
teeth is impossible to imagine hence, more and more patients are
opting for the convenience of the IID choice.
• If the dentist performs the technique meticulously and the patient is
cooperative, the resulting IID can be very successful and the second
denture procedures allow optimization of the end result.
3186
32. CLINICAL AND LABORATORY PROCEDURES
FIRST EXTRACTION / SURGICAL VISIT
• If a clinical decision is made to undertake preliminary extractions
(CID technique), then posterior teeth should be first identified for
extraction.
• Any other required hard and soft tissue operation.
• Short healing time, usually only 3 to 4 weeks, before the preliminary
impressions are made.
3286
33. PRELIMINARY IMPRESSIONS AND DIAGNOSTIC
CASTS
33
• Impression material- irreversible hydrocolloid (alginate)
• Impressions should be free of voids and should record the full
extensions planned for the denture prosthesis.
• Impressions are poured in stone and are used to make custom trays
for the final impressions.
• If an IID is planned, these preliminary impressions and casts will
contain all of the remaining teeth and If a CID is planned, these will
contain only anterior teeth
86
36. MANAGEMENT OF LOOSE / MOBILETEETH
1. Using periphery wax at the cervical areas
2. Applying a lubricating medium to the teeth
3. Placing copper bands over the loose teeth
(Soni, 1999)
4. Placing a vacuum-formed plastic over the
teeth (Vellis, Wright, Evans et al., 2001)
5. Placing holes in the tray and using an
amalgam condenser to release the tray
over loose teeth (Goldstein, 1992).
6. By using elastomeric impression materials
and irreversible hydrocolloid to make an
accurate preliminary impression of
extremely mobile and misaligned teeth
3686
37. CUSTOMTRAYS, FINAL IMPRESSIONS, AND FINAL CASTS
There are two basic ways to fabricate the final impression tray,
depending on the location of the remaining teeth and operator
preference.
TYPE ONE: SINGLE FULLARCH CUSTOM IMPRESSION
TRAY
• The type one method more closely resembles a routine custom
impression tray for removable partial dentures.
• It can be used in the CID technique. It is the only tray that can be
used for the IID technique
• This type of tray is effective when only anterior teeth are remaining
or when anterior and posterior teeth are remaining.
3786
38. 3886
A Stop effect is established by
providing holes through the wax
anteriorly or posteriorly
The tray is outlined to be 2 to 3 mm.
short of the vestibular roll and to
extend and include the posterior limit
i.e. posterior palatal seal and hamular
notch.
40. TYPETWO:TWO-TRAY OR SECTIONAL CUSTOM
IMPRESSIONTRAY
The type two method is used only when the posterior teeth
have been removed (CID.
• It involves fabricating two trays on the same cast—one
in the posterior, which is made like a complete denture
tray, and one in the anterior (backless tray).
4086
41. 41
• Use melted wax to block out undercuts and interdental
spaces.
• Note: A double sheet of wax is not used because intimate
adaptation of the tray is desired.
• Adapt autopolymerizing acrylic resin or light-cured resin to
the posterior edentulous areas, covering the lingual surfaces
of the teeth (only) and extend up beyond the incisal edges of
the teeth to include a handle86
42. :
.
* CAMPAGNA TRAY-( CAMPAGNA 1968)
42
A full arch tray with a hole cut out where the
remaining anterior teeth are (CID technique).
A stock tray is used over the full arch tray to
capture the anterior teeth in the impression.86
For the anterior section or tray there
are varying techniques; one is to
adapt a custom tray, and another is to
cut and modify a plastic stock tray.
Alternately, instead of the tray, adapt
plaster impression material or a
heavy mix of an elastomeric
impression material directly in the
patient mouth.
The anterior section/impression
material must cover the labial
surfaces of the teeth and the
vestibule.
46. JAW RELATION RECORDS
46
• Identical to those for complete dentures.
• The remaining teeth and anatomical landmarks can serve as a
guide to the height of the rim.
• Record bases be stable and strong enough to record jaw
relations.
• An evaluation of the patient’s existing vertical dimension of
occlusion is accomplished.
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47. • A face-bow transfer and a recording of centric relation
are made.
• The casts are mounted on the articulator
47
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48. SETTINGTHE DENTURETEETH/VERIFYING JAW
RELATIONS ANDTHE PATIENTTRY-IN APPOINTMENT
• Set the posterior teeth in centric relation.
• The trial denture bases are tried in the mouth and used to verify vertical
dimension of occlusion and centric relation
• Followed by arrangement of anterior teeth.
• Now it is important to take time with the patient to record landmarks on
the casts and to confirm the patient’s esthetic desires as follows:-
• The midline or newly selected midline is recorded.
• The anterior plane of occlusion using the interpupillary line as a guide is
determined and marked on the base of the cast.
48
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49. • The high lip line should be determined.
• A discussion of placement of diastemata, rotated teeth, notches,
and other natural arrangements should occur so that the patient
is actively involved in the esthetic decisions.
• The existing anterior vertical and horizontal overlap should be
noted
• The casts are marked with all the information gathered which
should include pocket depths, free gingival margins, a line
marking the interproximal of each tooth, and a drawing of
where the new tooth position should be.
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50. 50
CAST MODIFICATIONTECHNIQUE
Phoenix RFleigel J. Cast modification for immediate complete dentures: Traditional and contemporary
considerations with an introduction of spatial modeling. The Journal of Prosthetic Dentistry. 2008;100(5):399-405.
86
Cast modification technique proposed by Standard
2mm
apical
51. 86 51
Cast modification technique proposed by Jerbi
52. Cast modification based upon spatial modeling
52
Phoenix RFleigel J. Cast modification for immediate complete dentures: Traditional and contemporary
considerations with an introduction of spatial modeling. The Journal of Prosthetic Dentistry. 2008;100(5):399-405.86
54. ¤ Mark the every other anterior tooth with
an “X” and remove with a saw or cutting
disk from the cast, leaving at least one
canine, central incisor and lateral
incisor.
¤ Trim the extraction site on the cast with
a carbide bur, as if the tooth had been
removed and a small clot had formed in
the site.
¤In other words, the resulting area
should be concave and not convex.
Use pocket depth as a guide.
•ANTERIOR TEETH ARRANGEMENT:
The following teeth arrangement technique is suggested:
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54
56. WAX CONTOURING, FLASKING, AND BOIL-OUT
• Adequate wax is added to provide a thickness of material for strength
during future deflasking.
• Thickness of the acrylic resin is needed to provide room to trim from the
inside to relieve the sore spot or to seat the denture
• A remount cast to preserve the face bow, should be done for later patient
remounting, 2 to 4 week after delivery.
56
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57. SURGICALTEMPLATES
• A surgical template is a thin, transparent form duplicating the
tissue surface of an immediate denture and is used as a guide for
surgically shaping the alveolar process (Farmer, 1983).
• It is a prescription for the surgical procedure and is essential
when any amount of bone trimming is necessary
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58. 1. Make an irreversible hydrocolloid (alginate)
impression of the edentulous ridge after the
cast has been trimmed at boil-out.
2. Pour the impression in stone.
3. Make a clear resin template on this duplicate
cast by any of these four methods:
a. Vacuum form method (a hole is placed in the
center of the cast and a clear sheet is vacuumed
onto the cast)
b. Sprinkle-on technique (a clear acrylic
[orthodontic] resin is used)
c. Process template in clear acrylic resin (created
by waxing up, flasking, and heat processing)
d. Fabricate the template in light-cured, clear
material
PROCEDURE
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59. PROCESSING AND FINISHING
The immediate dentures are processed and finished in the usual
manner of complete dentures.
Both the immediate denture and the surgical template should be
placed in a chemical sterilizing solution in a bag for delivery.
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60. SURGERY AND IMMEDIATE DENTURE INSERTION
• The dentist performing the operation then extracts the
remaining teeth, taking care to preserve the labial plate of bone.
• The surgical template is used as a guide to ensure that the
prescribed bone trimming is done adequately
• The template should fit and be in contact with all tissue
surfaces.
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61. • Inadequately trimmed
areas planned for bone
reduction will blanch from
the pressure and be seen
through the clear template,
indicated by rocking or
with pressure-indicating
paste.
• Sutures are placed where
necessary
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62. • The dentist or surgeon places the denture so that it seats well
with good firm bilateral occlusion and no gross deflective
contacts.
• If the occlusion is not correct, the denture should be rechecked
for seating, particularly distally, the so-called denture heel
areas, which are checked for interference.
• When occlusal prematurities are verified, a quick occlusal
correction is done to allow simultaneous bilateral contact
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63. • If the denture is found to be
poorly adapted or lacking in
retention & stability, a tissue
conditioner can be placed, but
the material should not be
allowed to project into the
extraction sites.
• Burlew foil can be used to
cover the extraction sites for
this procedure..
63
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64. First 24 hours
• The patient should avoid rinsing, drinking hot liquids or alcohol and
not remove the immediate dentures during the first 24hrs.
• Inflammation, swelling and discoloration are likely to occur, their
partial control can be helped with ice packs on the first day.
• Premature removal of immediate denture could make its reinsertion
impossible for 3-4 days or until swelling is reduced.
• The patient should be reminded that the pain from trauma of
extraction will not be eliminated by removal of dentures from the
mouth.
• Minimum blood on pillow can be expected
• Stick to a soft diet
64
POST OPERATIVE CARE AND PATIENT
INSTRUCTIONS
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65. ATTHE 24 HOURVISIT
• Ask the patient where they feel sore.
• Quickly check the tissues for sore spots related to denture;
appearing as strawberry red spots usually seen at cuspid
eminences, lateral to tuberosities, posterior limit areas,
and retromylohyoid under cuts as well as any other under
cut ridge areas
• These areas may be related to the denture bases visually or
with the adjunctive use of pressure indicator paste.
• Adjust any gross occlusal discrepancy in centric relation
or excursions
• Reevaluate the denture for retention .Place a tissue
conditioner if denture retention is unsatisfactory. 65
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66. FIRST POST-OPERATIVE WEEK
• Counsel the patient to continue to wear the immediate denture at
night for 7 days post extraction or until the swelling is reduced.
• This ensures that a recurrence of nocturnal swelling will not
preclude reinserting the denture in the morning.
• Starting immediately after the 24hr visit, the patient should be
shown how to remove the denture after eating to clean it, and to
rinse the mouth at least 3-4 times daily to keep the extraction
site clean.
The denture should then be quickly reinserted and worn
continuously.
• After 1 week, sutures can be removed, and the patient can begin
removing the denture at night.
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67. • During the first month after extraction, patient is asked to visit the
dental office weekly for sore spots adjustments.
• After 2 weeks, remount casts are poured, the maxillary denture is
adjusted to the articulator using remount matrix, made before
flasking.
• A centric relation record is used to remount the mandibular denture
and refinement of occlusion is done.
67
FOLLOW UP CARE
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68. SUBSEQUENT SERVICE FOR THE PATIENT WITH AN
IMMEDIATE DENTURE
• After the sore spots are eliminated & the tissues have healed, a
recall program for changing the tissue conditioner liner is
organized.
• Patients with Coonventional immediate denture’s frequently
prefer to have a definitive reline done within the first 3-6
months.
• Patients with IIDs can have their second denture started within 3
to 6 months.
• Advantage: IID can be worn as a spare if a laboratory reline is
selected for the second denture.
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69. CHANGE INTREATMENT PLAN
• New denture – conversion of CID to IID
• In case of unsatisfactory results- processing errors or unmet
expectations for the CID.
• A planned IID can turn out to be the final prosthesis
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70. A Nontraditional Technique for Obtaining Optimal Esthetics for an
Immediate Denture: A Clinical Report
J Prosthodont 2001;10:97-101.
Bimaxillary protrusion and severe labioversion of anterior teeth complicate
impression procedures and increase the difficulty in making esthetic
predictions for the immediate complete denture patient.
The presented technique, performed in reverse order of traditional methods, is
accomplished in stages in which the anterior and nonessential posterior teeth
are extracted and interim removable partial dentures placed.
An opportunity is thus created to evaluate esthetics, phonetics, and anterior
tooth function before extraction of the remaining dentition and delivery of
immediate complete dentures.
This technique facilitated the determination of the need for alveoplasty of the
anterior maxilla.
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CROSS REFERENCES
74. AN ALTERNATIVE APPROACHTOTHE IMMEDIATE
OVERDENTURE
Ilan Gilboa, DMD1 & Harold S. Cardash, BDS, LDS RCS
Journal of Prosthodontics 18 (2009) 71–75
A procedure is described for fabricating an immediate complete
overdenture where several teeth retain an interim fixed partial
denture (FPD) until the complete denture is finished.
This procedure allowed better control over the esthetic result and
the occlusion and was less traumatic for the patient.
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82. CONCLUSION
82
• Immediate dentures fulfil an important role
in today’s treatment modalities by
providing the patients with esthetics,
function, and psychological support after
extractions and during the healing phase.
• The success of immediate complete
dentures greatly depends on a correct
diagnosis, detailed treatment planning and
precise execution of fabrication procedures.
• If the patient is well prepared and the
appropriate type of immediate denture is
selected (conventional or interim), the
resulting prosthesis can be a success.
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83. REFERENCES
Prosthodontic Treatment For Edentulous Patients: Complete Dentures And
Implant-supported Prostheses – 12th edition
Syllabus of Complete Denture.Heartwell. 5th edition
Essential of Complete Denture Prosthodontics. Winkler 2nd Edition.
Academy of Prosthodontics Editorial Staff.The glossary of prosthodontic
terms: seventh edition, J Prosthet Dent 81:76, 78, 1999.
Campagna SJ: An impression technique for immediate dentures, J Prosthet Dent
20:198-202, 1968.
Campbell RL: A comparative study of the resorption of the alveolar ridges in
denture wearers and non-denture wearers,J Amer Dental Ass 60: 146-148, 1960.
Farmer JB: Surgical template fabrication for immediate dentures, J Prosthet
Dent 49:579-580, 1983.
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84. Heartwell CM and Salisbury FW: Immediate dentures: an evaluation, J
Prosthet Dent 15(4): 616-618, 1965.
Jerbi FC:Trimming the cast in the construction of immediate dentures, J
Prosthet Dent 16(6): 1048-1051, 1966.
Khan Z, Haeberle CB: One appointment construction of an immediate
transitional complete denture using visible lightcured resin, J Prosthet Dent
68:500-502, 1992.
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85. McGarryTJ, Nimmo A, Skiba, JF et al: Classification system
for partial edentulism, J Prosthodont 11:181-193, 2002.
RaczkaTC, Esposito SJ:The “jiffy” denture: a simple solution
to a sometimes difficult problem, Compendium of Continuing Education in
Dentistry 16: 914, 1995.
Seals RR Jr, KuebkerWA, Stewart KL: Immediate complete dentures, Dent Clin
North Am 40:151, 1996.
Soni A: Use of loose fitting copper bands over extremely mobile teeth while
making impressions for immediate dentures, J Prosthet Dent 81:638-639, 1999.
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Hemorrhagic tendencies.
Excessive swelling.
Excessive post operative pain.
Allergic reaction to local anesthetics.
Opposing premolars may be retained to preserve the VDO
two sheets wax thicknesses, undercuts in the edentulous areas are blocked out
Care must be taken not to distort this assembly during removal from the mouth and during pouring of the impression. Boxing is done and
Jerbi using the pocket depths as guides
One-mm-deep recess is created in area occupied by root. D, Vertical cut extending from facial extent of prepared socket to line denoting junction of cervical
and middle thirds of facial surface. E, Cut extending from faciolingual center of socket to midway point of cut described in Figure 2, D. F, Floor of prepared socket is extended lingually.
Two lines are placed on surface of cast. One line arcs from mesiofacial line angle to distofacial line angle, and is located 2 mm lingual to midfacial
surface. Second line is parallel to and 4 mm from gingival margin. D, Sharp blade or laboratory engine is used to connect
lines drawn in Figure 5, C. E,
Two lines also guide lingual reduction. One line arcs from mesiolingual line angle
to distolingual line angle, and is located 2 mm facial to midlingual surface. Second line is parallel to and 2 mm from
gingival margin.
Set every other tooth in the maxilla first and then mandible, referring to the notes and marks made at the try in visit.
Then remove the remaining teeth.
And complete the entire teeth arrangement in balanced occlusal as per need.
The casts are flasked in the usual manner for complete dentures and boil carried out
The template is removed and the bone or soft tissue trimmed until the template seats uniformly and completely.
Interim prosthesis was worn by patient for 3 mnths but unsatisfactory esthetic. Five natural teeth in each arch were retained, maintaining the existing occlusal vertical dimension. Additional try-in was done prior to surgery.
The disadvantages of this technique are that additional time, an interim prosthesis, and a wax try-in are required. The patient’s cost of treatment is also increased.
Nonessential posterior teeth were first extracted. An interim fixed restoration
was fitted to five strategic teeth, and the four maxillary incisors were reduced to the gingival margin.
The reduced teeth and the maxillary right molars were extracted at subsequent visits. After 3 months of healing, an immediate prosthesis was fabricated using the interim restoration as a guide. Artificial teeth were tried in the mouth and approved by the patient, and the prosthesis was completed.
As no extractions were performed at this time, the prosthesis was delivered in a clean, bloodless field. The remaining five strategic teeth were fitted with dome-shaped metal copings.