Immediate-Dentures.pdf

Immediate Dentures Advanced Prosthodontics L. Jahangiri Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics  Definition of immediate denture, immediate transitional  Steps in fabrication  Challenges and disadvantages  Various impression techniques  Importance of follow up and...

Immediate Dentures Advanced Prosthodontics L. Jahangiri Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics  Definition of immediate denture, immediate transitional  Steps in fabrication  Challenges and disadvantages  Various impression techniques  Importance of follow up and recall 1 Immediate Dentures Advanced Prosthodontics L. Jahangiri Immediate Prosthesis: Definition A complete or removable partial denture fabricated for placement immediately after the removal of natural teeth. Maxillary Complete Immediate Denture Mandibular Partial Immediate Denture 2 Immediate Dentures Advanced Prosthodontics L. Jahangiri Advantages The patient has teeth at all times. Social and psychological gratifications are enormous. Easier establishment and maintenance of vertical dimension of occlusion. The denture can also act as a dressing to control Hemostasis after extraction. Disadvantages Esthetics and phonetics can not be assessed. Some pain associated with wearing the dentures after extraction. Frequent adjustments and regular recalls are necessary. The ridges will undergo resorption so the dentures need to be permanently relined, rebased or remade. 3 Immediate Dentures Advanced Prosthodontics L. Jahangiri Protocols for complete immediates Extraction of posterior teeth, allow healing, try-in the posterior teeth and verify the vertical, then extract the anterior teeth and deliver the complete immediate denture. Extract all at once and deliver. Not the preferred technique if there are too many teeth that require extraction. 4 Immediate Dentures Advanced Prosthodontics L. Jahangiri Protocol 1. Study models 2. Impression making 3. Establishing vertical dimension of occlusion 4. Selection and arrangement of teeth 5. Wax try-in and verification of centric record 6. Extraction and delivery of immediate dentures 7. Follow-up / recall 1. Study models – to assess • Arch shape, size and arch compatibility • Teeth shape/mold • Tissue undercuts • Plane of occlusion • Vertical dimension of occlusion 5 Immediate Dentures Advanced Prosthodontics L. Jahangiri Preliminary Impressions 4. Impression making • Closed tray technique • Sectional tray and composite impression • Open tray technique • All techniques require border molding and accurate impression of the tissues. [ many materials are available for impression making, you may choose whatever is accurate but are advised to consider some are too retentive and stiff for periodontally involved teeth!] 6 Immediate Dentures Advanced Prosthodontics L. Jahangiri Closed tray impression • Where there are NO large undercuts anteriorly • Teeth are not excessively mobile Steps in closed tray impression 1. Border mould 2. Make the impression 3. Box and bead and pour the impression 7 Immediate Dentures Advanced Prosthodontics L. Jahangiri Sectional Tray Fabrication Indication: Where there are large anterior undercuts Steps in making a sectional impression 1 1. Border mould 2. Make the impression of the edentulous area and palate 2 8 Immediate Dentures Advanced Prosthodontics L. Jahangiri Steps in making a sectional impression 3 4 3. Remove and assess the impression, cut impression tags in the anterior region and place back in the mouth. 4. Make the impression of the anterior region with alginate using a large stock tray. Steps in making an open tray impression 1 2 1. Border mould 2. Make the impression of the edentulous area and palate 3. Make the impression of the anterior region with alginate 3 9 Immediate Dentures Advanced Prosthodontics L. Jahangiri 3. Establishing vertical dimension of occlusion • Use existing vertical dimension of occlusion if available • If too many supra-erupted and tilted teeth establish VDO exactly like complete dentures, but may use existing teeth as a guide • Allow sufficient freeway space (at least 2-3 mm) 4. Selection and arrangement of teeth • Set Posterior Teeth first • You may select any shade in complete immediate dentures. • May use the exact mold of existing teeth. • May choose a mold that complements the patient but is not the exact matching mold. Use the patients existing teeth dimensions to select a mold. 10 Immediate Dentures Advanced Prosthodontics L. Jahangiri 4. Selection and arrangement of teeth • Use the existing plane of occlusion if adequate. • Use anterior “esthetics” to establish the maxillary anterior plane. • Posterior plane to be parallel to the Camper’s plane [Camper’s plane = alar-tragal line]. 5. Wax try-in and verification of centric record 1 2 1. Mount the maxillary cast on the articulator 2. Record vertical dimension of occlusion 3. Set posterior teeth 4. Verify intraorally 11 Immediate Dentures Advanced Prosthodontics L. Jahangiri We use CR solely because it’s a reproducible position. SO if we find another reproducible position can we use it? The answer is : CO can be used if it is reproducible. Must verify its reproducibility ! 5. Wax try-in and verification of centric record • Unlike complete dentures, the esthetics and phonetics Cannot be verified. • Wax-try in is performed to establish and verify the centric record. • To assess the plane of occlusion. • To assess the posterior occlusion. • Posterior palatal seal transfer 12 Immediate Dentures Advanced Prosthodontics L. Jahangiri Cast modification and anterior set-up 7. Extraction and delivery of immediate dentures Team work • Extract.[OMFS] • Septal alveolectomy or alveolotomy Use surgical template. [OMFS] • Suture [OMFS] • Achieve hemostasis [OMFS] • May use foil over the site before adjustments are complete. Examine flange extensions and adjust to fit as for complete dentures. Deliver the prosthesis. 13 Immediate Dentures Advanced Prosthodontics L. Jahangiri Extraction and assessment using the surgical template Delivery of prostheses 14 Immediate Dentures Advanced Prosthodontics L. Jahangiri 7. Extraction and delivery of immediate dentures Give post op instructions: 1. Do not remove dentures for 24 hours. 2. Eat soft food. 3. No rinsing or brushing for 12 hours. 4. Do not take hot drinks for 6-8 hours. It encourages bleeding. 5. Hot water rinse starts at 24 hour post op. Brings the blood supply to the area, once initial clotting is achieved and encourages healing. 8. Follow-up / recall Immediate follow up: 24 hrs, 48 hrs, 72 hrs Short term follow up / recall: 1 week, 2 weeks etc. to adjust the fit initially and later to reline with soft reline materials. Long term: At 6 months the ridge resorption considerably slows down. Permanent reline, rebase or remake. 15 Immediate Dentures Advanced Prosthodontics L. Jahangiri • Immediate denture construction is challenging and requires following all the steps for success • Mandibular immediate dentures are to be avoided • Two step technique is the preferred method for construction • Many follow up is necessary • Reline or remake is often indicated at 6 months • Possibility of a compromised esthetics or phonetics • Poor retention as the ridges resorb • Problems in fitting if cast adjustment is not done appropriately or if surgical template is not constructed or used • Reline can alter occlusion • Mandibular immediates are difficult 16 Immediate Dentures Advanced Prosthodontics L. Jahangiri Don’t Bite Chew Slow Swallow often Be patient ! 17