Immediate Dentures Overview

Immediate Denture

• An immediate denture is a complete or removable partial denture fabricated to be placed immediately after natural teeth are extracted.
• It is constructed before tooth extraction and positioned after the natural teeth are removed.
• Compatibility with oral tissues is crucial.
• It restores masticatory function within limits.
• It must harmonize with speech, respiration, and swallowing.
• Aesthetically acceptable design is necessary.
• Preservation of existing tissues is important.

Advantages

• Maintains appearance.
• Preserves masticatory movement patterns of the mandible.
• Maintains maxillomandibular relations.
• Tooth selection and arrangement is easily duplicated.
• Superior neuromuscular control of dentures.
• Better denture foundations.
• Prevents tooth movement.
• Minimal interference with speech.
• Shorter learning period.
• Protection from trauma.
• Acts as a stent, controls bleeding, and aids healing. Usually causes less pain.

Disadvantages

• More chair time and additional appointments, increasing costs.
• Less accurate fit and less retention.
• No anterior try-in.
• Increased patient discomfort.
• More postoperative care.
• Not suitable for all patients.

Indications & Contraindications

Indications

• Multiple extractions.
• Aesthetics.
• Function.
• Conventional complete dentures are contraindicated.

Contraindications

• Patients with debilitated diseases.
• Patients for whom multiple extractions might be unwise due to systemic conditions, such as hemophilia.
• Patients who have undergone radiation therapy.
• Indifferent or hysterical patients.
• Patients with poor oral hygiene.

Types

Partial Immediate Denture (PID)

• Socketed (PID): no flange.
• Flanged (PID): without alveoloplasty; with alveoloplasty.

Complete Immediate Denture (CID)

• One-step (Interim CID).
• Two-steps (Conventional CID).

Partial Immediate Denture (Socketed)

• Artificial teeth are placed in extracted tooth sockets, without a labial flange.
• Indications include deep labial or buccal undercuts, high lip line, and minimal surgical intervention is desirable.
• Contraindications include periodontal disease with bone loss (difficulty in aesthetics) or lower dentures due to poor retention.

Partial Immediate Denture (Flanged)

• Used in cases of alveolar bone loss due to periodontal disease.
• Indications include periodontally involved teeth with bone loss, no anterior undercuts, using the flange as a surgical splint, normal lip.
• Contraindications include undercuts in the anterior labial region of the ridge, and active lips.

Advantages of Flanged

• Strong retention and support.
• Fast healing with smooth ridges.
• Relining is easy.

Disadvantages of Flanged

• Flange may cause labial fullness; poor aesthetics.
• Flange border may traumatize mucosa (often thin).

Technique of Flanged

• Stone teeth are removed. The ridge is contoured to resemble the ideal ridge.
• With alveoloplasty, upper alveolar process protrusion can be improved, alveolar bone reshaped at extraction time. The ridge is trimmed and shaped.
• A surgical template is then constructed on the modified cast as a guide for shaping the alveolar process.

Complete Immediate Denture (One-step- Interim)

• Used for a short period, as a temporary prosthesis for aesthetics, mastication, occlusal support, and convenience.
• Placed at the same appointment as tooth extraction.
• Worn during healing period until more definitive prosthetic therapy is available.
• Extraction of teeth from both the anterior and posterior done in one visit
• Appropriate if anterior teeth cause pain or looseness or patient wants fewer visits
• Should only be used if patient can be treated in hospital.
• Necessary record-keeping includes preliminary records, mouth preparation (scaling and curettage), clinical and laboratory procedures, jaw relation records, tooth setup and try in, and post-insertion care.

Complete Immediate Denture (Two-Step- Conventional)

• Constructed two months after extraction of posterior teeth; anterior teeth extracted and denture inserted at the same time.
• Two-stage surgical approach: posterior teeth extracted, leaving only opposing posterior centric stops; maintain vertical dimension.
• Post-extraction healing, posterior jaw relation set, then plaster anterior teeth are broken from the cast.
• Preparation of complete immediate denture follows.

Procedure for Construction

• Alginate impressions of both jaws are taken.
• Resulting casts are mounted on an articulator using interocclusal wax record.
• Cast duplication is done (reference when setting teeth).
• The teeth are removed from the casts, ridges are trimmed, acrylic templates fabricated.
• Artificial teeth are placed, the denture cured, and finished with a normal flange.
• In hospitals, teeth removal, ridge trimming, and denture insertion use templates.

Jaw Relation

• The lower natural teeth guide establishing the heights of the occlusal plane of the wax rim.
• Face bow record created to mount the upper cast.
• Centric relation records complete articulator mounting.

Selection of Teeth

• The presence of remaining natural teeth facilitates the selection process.
• Posterior teeth are arranged.
• Try-in is to verify the arrangement of the posterior teeth.

Modification of Master Cast

• Techniques for simple extractions without alveoloplasty: remaining anterior stone teeth are removed; residual ridge is contoured to conform to post-surgical contours.
• Denture type dictates the preparation.

Modification of Master Cast (Alveoloplasty)

• Master cast is modified by cutting off the teeth and trimming part of labioalveolar bone to eliminate undercuts or protrusion
• Duplicate edentulous cast to produce clear acrylic template, used as a guide during surgery to measure amount of bone to contour.

Other Procedures

• Selected teeth are placed and securely waxed to the trial denture base.
• Denture construction involves processing, laboratory remounting to eliminate occlusal errors, finishing, and polishing.
• Tooth extraction is followed by ridge contouring (alveoloplasty); typically in patients with maxillary protrusion, deep undercuts.
• Immediate complete denture is placed.
• Clinically, impressions, labial impressions, and jaw relation included.
• Lab work includes pouring impression, mounting casts (articulator), preparing the cast, arranging teeth, and processing the denture.

This quiz covers the concept of immediate dentures, including their design, advantages, and compatibility with oral tissues. You'll learn about how these dentures are constructed and their role in maintaining appearance, function, and comfort after tooth extraction.