Immediate Dentures and Their Challenges

Immediate Dentures

• Immediate dentures are prostheses placed immediately after tooth extraction.
• Four treatment options exist for patients who have lost all their teeth.
• Option 1: All teeth are extracted, and the extraction sites heal for 6-8 months before the final dentures are made.
• Option 2: Existing partial dentures are converted into immediate full dentures.
• Option 3: Conventional removable immediate dentures are made.
• Option 4: Implants are placed, allowing for a fixed immediate denture supported by the implants.

Stress-Reducing Materials for Complete Dentures

• Tissue conditioners are used to reduce stress on the oral tissues.
• They are temporary soft lining materials.
• Their maximum use period is typically 1 week to 10 days.
• Prolonged use can lead to a loss of their softness and increase pressure on the tissues.
• They are used to treat damaged oral mucosa.
• If trauma from old dentures isn't treated, it makes it harder to adapt new dentures.
• The contours of the tissues must be in a proper arrangement prior to taking the impression for new complete dentures.

Advantages of Immediate Dentures

• Alveolar bone resorption is reduced.
• Bone resorption slows down, as the dentures maintain the function.
• The gum becomes more stabilized, thus preventing post-operative pain
• It prevents the gum from swelling
• It aids in the healing process by preventing clotting from being disrupted.
• A faster healing process
• Oral function is maintained.
• Speaking and eating remain unaffected.
• Patients find it easier to adapt to the dentures.
• The dentist's prestige is elevated in the patient's perspective.

Disadvantages of Immediate Dentures

• Laboratory-made dentures cannot exactly replicate the shape of natural teeth, gums, or roots
• The dentures might cause tissue irritations, especially at the initial stages.
• These irritations can be manageable with appropriate postoperative care.
• Patients with systemic conditions like anemia, kidney problems, cardiovascular issues, or diabetes may not be suitable candidates for immediate dentures.
• Difficulty in determining the post-extraction centric occlusion becomes a disadvantage in cases with deep centric relation.
• Time and cost factors can be relevant in situations where multiple teeth extraction are needed.
• The lack of a trial denture prior to immediate placement causes possible aesthetic concerns.
• Difficulty with post-extraction care in cases of multiple extractions can be a disadvantage.

Indications for Immediate Dentures

• The dentures are made to prevent dislodgment caused by pathological or traumatic reasons.
• Can be used to preserve the alveolar ridge in young patients after a traumatic tooth loss incident.
• Help achieve appropriate occlusal relationships.
• They can be used for post-surgical soft tissue management
• They can serve as a temporary prosthesis to ease the transition to other types of dentures (like splinting).

Contraindications for Immediate Dentures

• Poor general health conditions
• Inefficient or prolonged healing process
• History of diabetes, immune issues, or osteoperosis
• Severe oral inflammation
• Poor oral hygiene
• Uncooperative patients
• Various medical conditions, such as blood diseases, kidney or cardiovascular problems, etc.
• The patient's emotional condition
• Severe oral lesions or ulcerations in the area where the dentures are to be placed.
• Conditions such as psoriasis and pemfigoid that could cause ulcerations
• Cases involving extreme bone loss and/or severe oral trauma
• Cases where there is a high degree of bone resorption that will negatively influence prosthesis retention/stability.

Classification of Immediate Dentures (Types)

• This section presents various classifications of immediate dentures in a hierarchical structure.
• It highlights the different categories, types, and designs and their characteristics in the respective classifications.

Post-Operative Instructions

• The patient needs to be instructed regarding the postoperative process.
• They should be advised about not removing dentures for the first 24 hours.
• Alcohol and hot drinks are forbidden during this time frame.
• Rinsing the mouth should be avoided.
• Ice packs should be applied for about 20 minutes every 20 minutes.
• The first checkup is scheduled for 24 hours after the surgery.
• Any problematic areas of the dentures need to be corrected.
• Occlusion is checked.

Post-operative Care

• The patient should be advised on not removing dentures for the initial seven days, including at night.
• The patient should rinse their dentures with water three to four times a day.
• They should discontinue use of their dentures during night time from day seven onwards.
• Initial stages of bone reabsorption are noticed typically during the first three months.
• Full bone ossification might take 8–12 months.
• Soft lining materials might be applied during the initial period.
• Definitive dentures are usually placed approximately 3–6 months post-extraction.

Diagnosis and Treatment Planning for Immediate Dentures

• Patients should be informed about their responsibilities during the treatment.
• Any limitations imposed on the treatment process should be explained accurately.
• The possibility of re-lining or replacing the dentures should be discussed with the patient.

Types of Immediate Complete and Partial Dentures

• This section details various subtypes of immediate complete and partial dentures.
• This includes detailed explanations of the Open Vestibule, Closed Vestibule, and other designs.

Methods for Immediate Denture Fabrication

• A description of the procedures for various types of immediate dentures.
• This segment includes step-by-step procedures specific to each category of immediate dentures, such as the controlled/staged procedure for the manufacturing of an immediate upper denture and the procedure steps for a lower denture.

Other Important Aspects

• Different materials used, design features, indications and contraindications are mentioned in the document.

This quiz explores the various aspects of immediate dentures, including their disadvantages compared to lab-made dentures, patient hesitance, and their impact on a dentist's reputation. Additionally, it evaluates tissue modifiers and their application in mucosal environments, providing a comprehensive overview of immediate denture considerations.