IMMEDIATE DENTURES in complete denture .

1. IMMEDIATE
DENTURES
PLANNING AND EXECUTION
Dr. Dhitika Handa

2. 01
04
03
06
02
05
Introduction, Basics
Case selection
Pros and Cons
Recent Advancement
Rationale
Techniques
Contents
Conclusion
07

5. Introduction
GPT 9: Immediate denture: Any fixed or removable dental prosthesis fabricated
for placement immediately following the removal of a natural tooth/teeth.
.

6. WHY
IMMEDIATE
DENTURES?

7. RATIONALE
It is made prior to the extraction of the natural
teeth, and is inserted into the mouth immediately
after the extraction.
It is seen as a provisional prosthesis.
It helps maintain the soft tissue contour of the
face, aids in function, assists the traumatic and
difficult emotional process.

8. ADVANTAGES
1
Maintenance of
appearance- Viz
circumoral support,
muscle tone,
vertical dimension
and facial height ,
jaw relation.
2
Prevents
overgrowth of
tongue.
3 Acts as a surgical
stent, protect
extraction sites by
preventing foreign
body entry.
4 Aids easier
adaptation to
dentures.
5 Helps guide healing
tissues.
6 Maintains function-
masticatory, speech
and esthetic.

9. DISADVANTAGES
1 Challenging
impression making-
especially in case
of anterior ridge
undercuts
2
Immediate
dentures require
re-lining or a
comletely new set
of dentures
3 Variable position of
remaining teeth my
lead to incorrect
jaw relation
4
More office visits are required
during the first few months, to
watch for changes in the gums and
in the mouth function. Also the
original good fit and occlusion of
the denture will be lost as healing
takes place.
5 No anterior try in
means there’s no
way to accurately
judge the esthetics
before actual final
denture delivery

10. CONVENTIONAL ID
Placed after healing is complete in the posterior region and
denture is relined to serve as the long-term prosthesis.
INTERIM ID
Given immediately after extraction of all teeth on the same day,
without waiting for all extraction sockets to heal.

11. Initially, the remaining posterior teeth are
extracted.
This is followed, within 6 to 8 weeks, by the
removal of the remaining anterior dentition.
EXTRACTION SEQUELAE

12. Nedelman and others report histochemical findings that indicate
a chronic inflammatory condition in the submucosa of tissue
covering an edentulous ridge, but not of tissue supporting a
denture.
They speculate as to whether such a condition may cause an
increase in bone loss when compared with an edentulous ridge
that is covered by a prosthesis.
The interim denture procedure usually requires one surgical
appointment. All of the remaining teeth are extracted during this
session.
In addition to reducing patient apprehension and eliminating the
discomfort of a second series of extractions, the simultaneous
removal of all remaining teeth allows more uniform healing.
REFERENCE: The practical dynamics of the interim denture concept: a comparison with the conventional immediate denture technique Marc B. Appelbaum, DDS

13. Occlusion and Jaw Relation
When posterior tooth contacts are missing for a time, the
anterior teeth perform both incision and comminution.
When the anterior teeth serve to comminute
food, the resultant force vectors of the muscles of
mastication are altered, as the forces of occlusion are in a
more anterior position.
The mandible assumes a new
postural position, usually more anterior to the pre-extraction
position.
This habitual repositioning is evident when the dentist
attempts to record the centric relation position—an accurate
record often cannot be obtained.

14. Occlusion and Jaw Relation
With the immediate denture technique, not only are the chances of
accurately recording the centric relation position decreased, but
shifting the masticatory forces anteriorly increases both mobility and
migration.
This further complicates the recording of the centric relation position.
Extruded or migrated teeth create an irregular plane of occlusion,
thereby complicating the task of properly positioning the prosthetic
replacements.

15. If posterior tooth contacts are present, the vertical dimension can be more
accurately maintained when the master casts are articulated.
If the posterior teeth are not grossly malposed, duplicating them in the
processed denture ensures their correct placement within the neutral zone.
Maintenance of occluding posterior tooth contacts also protects the
temporomandibular joints from additional stress.

16. SOFT TISSUE RECONTOURING

17. TEMPLATE
Allows the surgeon to visualize areas of ischemia,
which would otherwise become tissue irritations
beneath the denture base
CLEAR ACRYLIC
VACUUM FORMED
too flexible to serve as accurate indicators of tissue undercuts
and potential areas of denture base irritation
SOFT RELINERS
The use of tissue conditioning material obviates the need for a
surgical template. It is a less costly, more accurate method of
ensuring equal distribution of pressures to the denture bearing
tissues. Furthermore, it provides the rigid denture base with the ability
to negotiate small tissue undercuts that may otherwise recontour
during the initial period of ridge resorption. This is a more conservative
and prudent approach to ridge preservation
Surgical
The ischemia demonstrates to the surgeon areas that require
recontouring.
Whenever gross changes in the denture-bearing surface are expected,
whether cause advanced periodontal disease or surgical recontouring,

19. PPS
Although there is no opportunity to evaluate the correct
posterior palatal seal placement with interim dentures, the
use of tissue conditioning material will correct any inherent
errors in retention.
It may be argued that a posterior palatal seal need not be
incorporated into the interim denture as the voids between
denture base and tissue will be filled with tissue conditioning
material and soft liners.
lack of seal placement and
concomitant use of a lining
material increase the thickness
of the posterior denture
border that may aggravate the
gag reflex and, in turn, prolong
the adjustment period.

20. DIET
Interim dentures do not require a substantial
alteration in the patient’s daily eating habits.
Although periodontal disease may have already
compromised chewing efficiency, no further
reduction in the comminuting surface area occurs.
Detrimental masticatory patterns develop with
strong tongue thrusting movements, leading to
repositioning of anterior teeth and inaccurate jaw
relation.
Patients are not forced to consume a soft diet
because they have no posterior teeth. This also
reduces any further psychologic inconvenience.

21. Musculature
When posterior teeth are lost and the
replacements are not forthcoming for six to
eight weeks, the muscles of the lips, cheek, and
tongue may be altered because of a lack of
adequate tooth support and a compromise of
the vertical dimension.
The intrinsic muscles of the tongue can
become hypertrophied, affecting all the
important coordination necessary to control
and maintain the mandibular denture in its
proper relationship to the basal seat.
The muscles of mastication may also undergo
changes that can create abnormal chewing and
swallowing habits.
The interim denture procedure ensures that
the tongue and perioral musculature are not
altered by replacing the posterior teeth
immediately on extraction of the remaining
natural teeth.

22. IMPRESSION
TECHNIQUES

23. METHOD 1 METHOD 3
METHOD 2
METHOD 4
stock trays with irrevetsible
hydrocolloid but does not record the
proper height, length and width of
the labial and as well as buccal
vestibules since the material
displaces unattached mucosa.
The combination impression
technique with double custom
impression trays creates an over-
extended labial flange.
custom impression trays with rubber
base matedala which distotts the
lips and unattached mucosa
resulting in inaccurate imptession of
labial vestibule because of excessive
size of the tray.
a custom tray with a labial flange
without covering the remaining
anterior teeth which allows for
accurate border molding. An
irreversible hydrocolloid impression
is then made over the custom tray to
record the remaining teeth.

26. STEP 1

27. STEP 2 STEP 3

29. VIDEO OF SECTIONAL IMPRESSION TECHNIQUE

30. LAB STEPS

31. TRIMMING OF TEETH
REFERENCE: Cast modification for immediate complete dentures: Traditional and contemporary considerations with an
introduction of spatial modeling
Rodney D. Phoenix, DDS

32. TRIMMING OF TEETH
REFERENCE: Cast modification for immediate complete dentures: Traditional and contemporary considerations with an
introduction of spatial modeling
Rodney D. Phoenix, DDS

33. Maxillomandibular relationship records careful assessment of the dentition in the opposing arch
must be made and any alterations in its form, so as to establish a more favorable occlusion. The
centric relation record is made directly at the established vertical dimension using the clinician's
material of choice like bite registration wax, plaster or zinc oxide and eugenol.
JAW RELATION

34. Denture teeth arrangement The posterior teeth may then be used in a clinical trial of
the wax trial denture to ensure that the appropriate vertical dimension and centric
occlusion positions have been established. Once again phonetics and facial support
will all be considered when conrming the vertical and horizontal positions
POSTERIOR TEETH ARRANGEMENT

35. Digital
immediate
denture
CONCEPT:
WHAT’S NEW?
Digital immediate denture: A clinical report
Jing-Huan Fang, DDS Xueyin An,
DDSSeung-Mi Jeong, DDS, PhD Byung-Ho
Choi, DDS, PhD
Published:September 16, 2017DOI

37. CONCLUSION
Immediate dentures form a significant part of
prosthetic dentistry and continue to provide
patients with replacement of their natural
teeth in the post-extraction period.
They not only allow maintenance of appearance
and function, but also help to prepare patients
psychologically for the edentulous phase of
their life.
With the use of correct techniques, immediate
dentures can be quite retentive and stable in
the interim period and provide a rewarding
experience both for the clinician as well as the
patient.

38. GOAL PLAN ACHIEVEMENT
To maintain hard
and soft
tissuehealth,
Planning for both
clinical and
laboratory steps is
crucial
Results are worth
the additional
appointments and
lab steps and keep
the morale of the
patient high
TAKE HOME MESSAGE

39. Conventional or Interim?
What would you choose?

40. The practical dynamics of the interim denture concept: a comparison with the
conventional immediate denture technique Marc B. Appelbaum, DDS
IMMEDIATE DENTURE SERVICE* By D A Y TO N D . CAM PBELL, D .D.S.
Modification of immediate denture sectional impression technique using vinyl
polysiloxane L. Kirk Gardner, D.D.S
An impression technique for immediate dentures Sebastian J. Campagna, Colonel,
DC, USA
Double custom tray procedure for immediate dentures Ali Boiouri, D.M.D., D.D.S.
Digital immediate denture: A clinical report Jing-Huan Fang, DDS,
GPT 9
Immediate denture fabrication: a clinical report Sergio Caputi
Immediate denture: A Review - Dr. Dipti Nayak
REFERENCES

41. THANK YOU