Immediate Denture PDF 2024

 An immediate denture is “a complete denture or removable partial denture fabricated for placement immediately after the removal of natural teeth” It is constructed before extraction of teeth and placed immediately after the natural teeth are extracted.  Compatibility with the su...

 An immediate denture is “a complete denture or removable partial denture fabricated for placement immediately after the removal of natural teeth” It is constructed before extraction of teeth and placed immediately after the natural teeth are extracted.  Compatibility with the surrounding oral tissues. Restoration of masticatory efficiency within limits Harmony with the functions of speech, respiration, and deglutition Esthetic acceptability Preservation of remaining tissues. 1. Maintenance of appearance 2. Maintenance of masticatory movement patterns of the mandible. 3. Maintenance of maxillomandibular relation. 4. Tooth selection & arrangement can be easily duplicated 5. Superior neuromuscular control of dentures 6. Better denture foundations 7. Prevention of tooth movement 8. Minimum interference with speech 9. Shorter learning period 10. Protection against trauma 11. The denture acts as a stent (Ideal applicator for medicines), controls bleeding and aids healing. There is usually less pain.  More chair time, additional appointments, and therefore increased costs Less accuracy of fit, less retention No anterior try-in. Increased patient discomfort More postoperative care The procedure cannot be done on all patients.  Indications – Multiple extractions – Esthetics – Function – Conventional CD contraindicated Contraindications: − Patients with debilitated disease − patients for whom multiple extraction might be unwise because of systemic condition − Hemophilic patient − Patient who had undergone radiation therapy − Indifferent or hysterical patient − patient with Bad oral hygiene  Partial Immediate Denture (P.I.D) - Socketed (P.I.D) - Flanged (P.I.D): - without alveoloplasty - with alveoloplasty Complete Immediate Denture (C.I.D) - One step ( Interim C.I.D) - Two steps ( Conventional C.I.D)  1. Partial Immediate Denture : a. Socketed type (flangeless). b. Flanged Type. 9  Partial Immediate denture Socketed (flangless- open face ) The artificial teeth are set in the sockets of the extracted natural teeth without labial flange. Indications: 1. Deep Labial or buccal undercut 2. High lip line & active upper lip 3. Minimal amount of surgery is desirable. Contraindications: Periodontal disease with bone loss which makes an acceptable cosmetic effect difficult. It is not recommended in the lower denture because the retention is very poor Advantages: Exact reproduction of tooth position Easier to set teeth in laboratory Easy to insert No interference with lip musculature Very natural appearance Disadvantages: Poor retention and inadequate support Natural appearance is not long maintained as the neck of teeth will be exposed. After few months the denture may need relining or remake Denture is not as strong as the conventional denture. Irregularities of anterior ridge & flabby mucosa may develop 1. Stone teeth are cut off the cast. The gingival margin reference line is used as a guide. 2. A socket is prepared with an excavator to be deeper labially (2-3 mm) than palatal aspect. 3. The direction of socket should follow the long axis of tooth. 4. The artificial tooth is ground to fit the labial wall of socket. 5. The artificial tooth is attached to cast by wax.  The artificial teeth are set in the sockets of the extracted natural teeth without labial flange.  Flanged P.I.D Immediate denture with labial flange is used in cases of alveolar bone loss following periodontal disease. Indications: Periodontally involved teeth with loss of bone. No anterior undercut When it is desirable to use flange as a surgical splint. Normal lip Contraindications: Undercut in anterior labial region of the ridge Active lip Advantages: Strong denture with good retention & support Rapid healing with resulting smooth ridges Relining is easy Disadvantages: The flange may cause labial fullness with poor esthetic The flange border may traumatized the mucosa as it is often thin. Technique of flanged type  The stone teeth are removed , the ridge is contoured to resemble the ideal ridge.  A marked protrusion of upper alveolar process, can be improved by alveoloplasty (reshaping of alveolar bone) at time of extraction The stone teeth are removed , the ridge is trimmed nearly equivalent to the proposed reduction in size and shape of the alveolar ridge. A clear surgical template is constructed on the modified cast to guide in shaping alveolar process. Complete Immediate denture  Complete Immediate denture One step (Intrim I.I.D) A temporary dental prosthesis. The denture is placed at the same appointment of extraction. It is used for a short interval of time for reasons of: esthetics, mastication, occlusal support, or convenience. it is worn only during the healing period until more definitive prosthetic therapy can be provided.  Complete Immediate denture One step (Intrim C.I.D)  Extraction of both anterior and posterior teeth done at one visit at the time of denture insertion.  Indicated if the anterior teeth are causing pain or excessively loose or if the patient wishes to shorten the number of visits.  Should only be employed if the patient can be treated in hospital.  Procedure for construction Alginate impressions of both jaws are taken. The resulting casts are mounted on an articulator by interocclusal wax record. Duplication of casts are done (reference when setting teeth) The teeth are removed from the casts, the ridges are trimmed, clear acrylic templates are fabricated. The artificial teeth are set up and the denture cured and completed with normal flange. In hospital, the teeth removed and the ridges trimmed with the aid of templates and the dentures inserted.  Complete Immediate denture Two steps (Conventional C.I.D) It is constructed 2 months after extraction of posterior teeth & inserted at the time of extraction of anterior teeth. C.I.D insertion usually follows a two stage surgical approach: - posterior teeth are first extracted leaving only two opposing posterior teeth bilaterally as centric stops to maintain vertical dimension of occlusion. - After healing , jaw relation & setting of posterior teeth, Try in was performed - Then the plaster anterior teeth are broken from the cast and a complete immediate denture is prepared. ICD Try-In  Procedure for construction Diagnosis & mouth preparation, preextraction record: - intraoral& extra oral examination - Scaling& curettage - Occlusal adjustment of the remaining teeth Extraction of the posterior teeth: - leaving only two opposing posterior teeth bilaterally as centric stops to maintain vertical dimension of occlusion.  Final Impression , 1- Single final impression: Alginate impression in stock tray----- special tray------ final impression - 2- Two stage final impression: - Zno impression in acrylic tray is made for posterior edentulous segment - Overall alginate impression in stock tray is made. The two sections are removed together Final impression  Jaw Relation: The lower natural teeth can be used as a guide in establishing the heights of occlusal plane of wax rim. Face bow record is made to mount the upper cast. Centric relation records is made to complete the articulator mounting. Selection of teeth: Selection of teeth is facilitated by presence of remaining natural teeth. Posterior teeth are arranged Try in is made to verify the arrangement of posterior teeth.  Modification of master cast A) In case of simple extrctions without alveoloplasty): Removal of remaining anterior stone teeth Contouring the residual ridge to conform to postsurgical contours It is prepared for socketed or flanged denture according to the condition B) Extraction of anterior teeth & labial plate alveoloplasty: The master cast is modified by cutting off the teeth & trimming the part of labial alveolar bone required to eliminate the undercut or the protruded area. The edentulous cast is duplicated to construct clear acrylic template upon it. This template is used as a guide during surgery to determine the amount of bone to be contoured.  The selected teeth are placed in position & secured with wax to the trial denture base.  Denture constuction: processing of denture Laboratory remounting is done to eliminate occlusal errors. Finishing & polishing  Extraction of teeth followed by surgical contouring of alveolar ridge (alveoloplasy) is only performed in patients with maxillary protrusion & to eliminate deep undercut. Insertion of the immediate complete denture  Technique of immediate denture (summary) Patient examination: medical History- Dental history – patient mental attitude.. Preoperative records: photo graphs- articulated study casts- labial impression for anterior teeth. Mouth preparation: scaling & curettage Clinical & laboratory procedures Preliminary impressions Final impressions Jaw relation records Tooth set up and try in Extraction and insertion Post insertion care labial index  Clinical procedure : include final impression, labial impression, jaw relation. Laboratory procedure : include pouring the impression, mounting the cast on articulator, cast preparation, arrangement of teeth& denture processing.