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Amar bhimavarapu

Immediate dentures

Immediate Denture

*Indication:
To avoid loss of appearance & function for the short time between extraction of teeth & fabrication of denture. *Advantages: Maintenance of appearance. Minimise the interference with speech. Excellent psychological effect upon the patient. Maintain adequately the important vertical& horizontal relationship. Possibility of development of abnormal mandibular movement. Preservation of vertical dimension, prevent muscle of mastication from losing tone & Shortening and the ligaments from being stretched. Prevent possible movement of remaining natural teeth. Control post extraction haemorrhage (stents). Controlling effect upon the resorption of the alveolar process.

*Disadvantages: Cant retain fit for a longer than few weeks. Relining or remaking is usually twice during period of alveolar resorption.

Classification:
a) Socketed or Flanged immediate dentures. N.B. upper denture may be Socketed or with partial or full extension labial flange. b) Partial or Complete immediate dentures.

Amar bhimavarapu

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Immediate dentures

Socketed type immediate partial denture

Indication:
Replacement of upper anterior teeth with: Limited periodontal disease. Little change in tooth position.

Advantages:
Position of anterior teeth may be exactly duplicated. Appearance of denture is natural. Presence of labial undercut doesn't complicate denture insertion. Difficult in obtaining correct amount of cast trimming is avoided. Necessity for providing the surgeon with a resin base of the trimmed area is avoided.

Disadvantages:
Absence of labial flange retention & stability. Recession of the gums may expose the necks of the artificial teeth. Healing & conservation of ridge than with labial flange. Gum margins & sockets must be preserved without injury at time of extraction. Unexpected difficulty during extraction makes this method uncertain.

Technique:
At the Clinic: Perform scaling & extract any remaining roots. Make alginate impression of upper & lower arches. Record the shade of extracted teeth. Make inter-occlusal record to mount the casts.

Amar bhimavarapu

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Immediate dentures
At the Laboratory: Pour the impression. Pour the upper impression twice or duplicate it for comparison between the positioning of artificial teeth with the original position of teeth to be replaced. Mount casts on articulator. Selection of suitable anterior teeth (form, size, shade) to natural tooth. Cut off one of the teeth to the level of the cervical margin. Dig a socket about 2mm apical to gingival margin. Adapt the wax to the palate & set the artificial teeth. Compare the anterior teeth with the reference cast. Trial of the waxed up denture isn't possible as tooth still in situ. Missing posterior teeth on the cast may be replaced & clasps are fitted around the suitable teeth. Waxed up denture is processed into acrylic resin, finished & polished. Denture kept in mild antiseptic solution until required. Fitting of Socketed type: Extraction is carried out under block or infiltration local anaesthesia with minimal trauma not to break roots or lacerate the soft tissue. Allow 10min for initial blood clotting. Insert denture in place & check fit, retention & occlusion with opposing teeth. Pt. instructed to return in not more than 48hour for adjustments. Pt. instructed to keep the denture in mouth in all times except when using a mouth wash & cleaning the denture after meals. Pt. encouraged to commence mastication with denture as soon as possible. Root part must be reduced gradually to allow for normal gum healing.

Amar bhimavarapu

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Immediate dentures
Flanged type immediate partial denture
(Immediate denture is made with a full or partial labial flange)

Indications:
Lower immediate denture: using of labial flange allows some relief of the sockets without compromising aesthetics. Upper immediate denture: replacing upper anterior teeth with superior protrusion or advanced periodontal disease.

Advantages:
Retention & resistance to antero-posterior movement of the denture. Providing lip support. Allow freedom in changing position of anterior teeth. Protection of the healing sockets.

Disadvantages:
Thickness of the flange limits the length of artificial teeth. Difficulty in insertion & removal if the flange engages a deep labial undercut. Accommodation of the relieved labial flange is difficult. The ridge needs surgical trimming to reduce the labial undercut.

Partial labial flange: The last 3 disadvantages overcome with using the partial labial flange. It is extended very little beyond the maximum contour of the ridge. It should adapt perfectly to the ridge for aesthetic reasons.

Amar bhimavarapu

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Immediate dentures
Technique

Clinical procedure the same as Socketed type to have the master cast.

Laboratory procedure

Without bone trimming

With bone trimming

a) Replacing teeth with bone trimming (upper anterior teeth): Cut the lower teeth off the cast 1mm occlusal to the cervical margins. Trim the ridge labially & also may need reduction in height. Adapt a layer of base plate wax on cast to outline the denture. Set the artificial teeth & check its relation. Remove teeth, wax & make impression for the trimmed cast & pour it. Adapt a layer of base plate wax to the plaster cast, flask & process to have a transparent template. Fix the artificial teeth & base plate wax to the trimmed master cast again, add suitable clasps, waxing up & processing.

b) Replacing teeth without bone trimming (lower anterior teeth): Cut the lower teeth off the cast 1mm occlusal to the cervical margins. Adapt a layer of base plate wax on cast to outline the denture base including labial flange it should limited to non undercut area of ridge. Set the artificial teeth & and suitable clasps, waxing up & processing.

Amar bhimavarapu

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Immediate dentures
Fitting of flanged type immediate dentures:a) With bone trimming: Teeth are extracted after raising labial & buccal gum flaps. Trim the labial & buccal alveolar bone to the same amount as in the trimmed cast. Close gum flaps by Stitches & insert denture. Post-operative instructions & follow up after 48hours.

b) Without bone trimming: Extract teeth then squeeze the bone plates between fingers. Insert immediate denture & use P.I.P. to check pressure areas. Pt. should come after 24hours to recheck sore spots.

Complete Immediate Denture

(Used when clearance of remaining anterior & posterior teeth is indicated.)

1st treatment plane (Immediate replacement of all upper & lower teeth.)

2nd treatment plane (Immediate replacement of anterior Teeth only.)

Immediate replacement of all the teeth: Make upper & lower alginate impression and pour in stone plaster. Mount casts on articulator using inter-occlusal record blocks. Cut off the teeth on the upper cast & trim the ridge to the required form.

Amar bhimavarapu

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Immediate dentures
Make alginate impression for the trimmed cast & pour a duplicate cast in plaster. Fix wax base to the full denture area of the duplicate cast. Flask this base & reproduce it in clear acrylic resins. Fit a new base to the edentulous cast on the articulator & set teeth. If a lower tooth is malposed or over-erupted, trim or cut it from the lower stone cast to allow setting of the upper teeth in proper position. Process the upper denture& finish. The pt.'s teeth are extracted after of labial & buccal gum flaps: Trim the alveolar bone labially & buccally in amount scrapping done on the cast. The clear acrylic plate acts as a guide to amount of bone trimming. Close gum flaps by stitches & Insert complete denture(s). Check occlusion. Following the insertion of the upper plate by several weeks, the lower teeth are reproduced on complete lower plate by the same technique& inserted in the mouth. Fitting of the immediate denture: Extraction of many teeth is best carried under General Anaesthesia. The localized swelling of the tissues that results from infiltration anaesthesia makes it impossible to fit the denture until several hours after extraction. The must always be removed without trauma, care being taken not to break roots or lacerate the soft tissues. As soon as the pt. has recovered from the operation, the denture is inserted. Pt.'s will very rarely complain from any discomfort from denture insertion but they must be instructed to: Return in not more than 48hours for adjustment & inspection. Keep the denture in mouth in all times except for cleaning purposes.
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Immediate dentures
Commence mastication with denture as soon as possible. The root part must be reduced gradually to allow for normal gum healing till the tooth is left with a well fitting cervical margin.

Immediate replacement of anterior teeth only:Technique: Extract upper & lower posterior teeth. Allow healing period for 6 8 weeks. Make upper& lower alginate impression and pour in stone plaster. Make posterior record bases & wax rims. Record centric Maxillo-mandibular relation & mount on articulator. Set posterior teeth & waxing up. Break the upper & lower anterior teeth on the casts. Do sockets or trim the ridge to receive flanges, if trimming is extensive duplicate the trimmed cast to make the transparent acrylic template. Set artificial anterior teeth & wax up the complete denture(s). Extract remaining anterior teeth & Insert the complete denture. Alternative Technique: If pt. accommodation to artificial denture is doubted. It is better to replace posterior teeth with a partial denture & anterior teeth are replaced few weeks later. Technique: Extract upper & lower posterior teeth. Allow healing period for 6 8 weeks. Make upper& lower alginate impression and pour in stone plaster. Make posterior record bases & wax rims. Record centric Maxillo-mandibular relation & mount on articulator. A distal extension temporary partial denture is processed & delivered to the pt.(Allow one or two weeks for accommodation to partial denture)
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Immediate dentures
Make a corrective impression for the partial denture. Check & reinsert and make an overall impression in alginate stock tray. The partial denture will come out as a part of the whole impression. Pour in stone plaster. Mount the cast with the upper denture on an articulator with the cast of the opposite arch. Break the upper& lower anterior teeth on the casts. Do sockets or trim ridge to receive flanges, if trimming is extensive duplicate the trimmed cast to make the transparent acrylic template. Set artificial anterior teeth & wax up teeth with the temporary partial denture. Process, finish& polish. Extract remaining anterior teeth & Insert the complete denture. Duplication of anterior teeth:Size, form & shade of the teeth must be copied exactly by construction of heat cure acrylic teeth. * Technique: After recording the shade of the natural teeth, an alginate impression of the teeth to be extracted is taken. Any of these teeth have cavities should be filled with temporary filling or wax to restore contour before taking the impression. There is no need for the impression to extend too much beyond the cervical margins of teeth. Teeth impressions are cast immediately in molten wax. As soon as the wax is quite hard, it is removed & examined carefully to ensure that it has reproduced the natural teeth correctly. Trim away the excess wax, small amount of root is allowed to remain in each pattern. It's better to separate the large pattern into small sections to facilitate trimming, it may be divided into single teeth to correct irregularities of pt.'s teeth that may be founded.

Amar bhimavarapu

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