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Immediate denture- An important treatment

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KDJ – Kerala Dental Journal
Immediate denture - an important treatment
modality
* Kalpana Hasti, **Anurag Hasti, ***Rahul Sharma, ****Aprajita Mitra
Abstract
An immediate complete denture
is a restoration of the lost natural
teeth and associated tissues which
is inserted into the patients mouth
immediately following the extraction
of remaining teeth. The removal of all
the remaining teeth and placement of
the complete denture are important
in patients’ life. The transition from
dentulism to edentulism should be
psychologically atraumatic as far as
possible.
The cases presented here are
conventional (classic) immediate
denture and interim (transitional or
non transitional) immediate denture
which offer good esthetic and
functions.
Key words: conventional immediate
denture, interim immediate denture.
KDJ 2016 | Vol. 39 | No. 1 | Pg 27-29
►► Introduction
Patient increasing demand for
natural appearance of the lost teeth
has become a challenge to the dentist1.
The placement of complete denture
immediately following the removal of
natural teeth is not new. Richardson (in
the year 1860) emphasized on immediate
denture service, saying that “the value of
temporary sets of teeth to the patient on
the other hand is questionable.
They fulfill in a tolerable degree all
the requirements of artificial teeth under
any circumstances, if we expect that the
mastication, this function being more or
less imperfectly performed with such
pieces.” But late on in the year 1951
Sears said that “ in cases where some
of the natural teeth remain in place it
is wise to consider the advisability of
constructing dentures before the teeth
are removed”2.
Dental professionals have recognized
the patients wish and need to avoid an
edentulous period which resulted in the
fabrication of the denture that can be
placed in the patients mouth immediately
following the removal of last natural
teeth. The success of the immediate
denture depend on the correct indication
and precise execution of clinical and
laboratory procedure.
►► Case report 1 and occlusal rims were fabricated. Jaw
A 55 year old male patient was
referred to the department of
Prosthodontics for oral rehabilitation.
On intra-oral examination teeth present
were 12,14,15,21,22,23,31,32,33,34,36,3
7,38,42,44,46,47 (Fig I)
Orthopantomography was advised
(Fig 2). Upper and lower alginate
impressions were made; study models
were fabricated and articulated. All the
facial measurements were recorded.
* Reader, Dept. of Prosthodontics, Jaipur Dental College; **Reader, *** Senior Lecturer, ****P.G Student, Dept. of
Prosthodontics, School of Dental Sciences, Sharda University; Corresponding Author: Dr. Kalpana Hasti
Email- kalpanagupta78@yahoo.com
Case report
After the diagnosis of the cast,
radiograph evaluation and clinical
examination, a conventional immediate
denture was planned. The patient was
referred to the department of Oral and
Maxillofacial surgery for extraction of
36, 37, 38 and 44, 46, 47 and was advised
to report back after 6 – 8 weeks. When
the patient reported after 6 weeks, the
healing was found to be satisfactory.
(Fig 3 and 4)
►► Procedure
Upper and lower alginate impressions
were made. A custom tray was fabricated
for Camphagne’s3 impression technique.
Border molding was done using green
stick compound and final impression
was made using Zinc Oxide Eugenol and
dentulous area in Alginate as a pick-up
impression material.
A master cast (Fig 5), record base
relation was recorded. 14 and 34 were
used as a vertical stop. The records
were transferred on to the articulator,
Posterior Teeth arrangement was done
and upper 12 and 22 were arranged to
confirm esthetics, labial fullness, lower
lip line, size and shape of teeth. Try
–in was done. The cast modification
was done by the technique given by
Jerbi4. Flasking and curing was done
followed by finishing and polishing. On
the day of insertion all the remaining
KDJ – Vol. 39 • No. 1 • January 2016 27
 Kalpana Hasti

anterior teeth were extracted and denture insertion was periodontically involved with Grade II and Grade III mobility.
done. (Fig 6,7,8) (Fig 9 and 10)

Patient was advised to wear the denture overnight Orthopantography (OPG) was advised. Upper and lower
and for 3 consecutive days and recall was done after Alginate impressions were made and study models were
24 hours. Patient complained of ulceration in the upper evaluated. Patient was referred to department of Periodontics
canine region and in the posterior mylohyoid region and for opinion. The OPG revealed severe bone loss. Patient
the required trimming was done. Patient was advised to was diagnosed with aggressive periodontitis. After diagnosis,
continue wearing denture and called for suture removal examination and OPG evaluation an interim immediate denture
after a week. Patient was recalled after 6 months to check was planned. The custom tray is fabricated.
for the retention and stability of both the dentures and
assessed for relining. Border molding is done using low fusing impression
compound and final impression was made with medium
►► Case report 2 body rubber base impression material.(Fig 11) On the master
A 29 years old female patient was referred to department cast record base was fabricated and only anterior try-in was
of Prosthodontics for replacement of missing teeth. On done. The casts were articulated in the normal occlusion of
examination, the teeth present were 13.14,15,16,23,25,26,34, the patient. Posterior arrangement was done and the cast
35,36,37,45,47,48. All the remaining teeth were found to be modification was done by the technique given by Jerbi4.

Fig. 1: Pre operative Fig. 2: Diagnostic OPG Fig. 3: Maxillary acrh post extraction

Fig. 4: Mandibular arch post extraction Fig. 5: Master cast Fig. 6: Completely extracted mandibular arch

Fig. 7: Completely extracted maxillary arch Fig. 8: Post operative Fig. 9: Pre operative

28 KDJ – Vol. 39 • No. 1 • January 2016


Flasking and curing was done followed by finishing and
polishing. On the day of insertion all teeth were extracted
and denture insertion was done. Patient was advised to
wear the denture overnight and for 3 consecutive days and
recall was done after 24 hours (Fig 12,13,14,15). Patient was
advised to continue wearing denture and called for suture
removal after a week. Patient was recalled after 6 months
to check for the retention and stability of both the dentures
and assessed for relining.
►► Discussion
When removal of teeth becomes necessary an immediate
denture is an important treatment modality. There are many
advantages of immediate dentures as it acts as a matrix which
controls hemorrhage, prevents contamination and provide
protective covering over the wounds.
It provides restoration of phonetics and masticatory
functions and facilitates transition of the edentulous state5
It enables the patient to continue to engage in social and
business activities without an embarrassing period of staying
edentulous6. As in the case of conventional immediate dentures
there are many advantages of CID than IID. The use of
transitional partial denture to replace posterior teeth prior to
the removal of the anterior teeth is highly recommended. As
discussed in interim immediate complete denture case report,
successful treatment of aggressive periodontitis depends a lot
Fig. 10: Pre operative intraoral Fig. 11: Final impression
Fig. 13: Post extraction mandibular arch Fig. 14: Processed denture
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Immediate denture - an important treatment modality
in early diagnosis of the disease. When diagnosed in late stage
the treatment option is extraction. A young female patient
suffering from aggressive periodontitis and loss of all her teeth
has a devastating effect on functionally, and psychologically
so a fabrication of IID is useful method.
►► Conclusion
In the era of implant and immediate implant treatment,
immediate complete denture treatment should still be
considered as an important treatment modality. A detailed
extraoral and intraoral evaluation and correct treatment
planning will lead to a successful replacement of missing
structures with immediate dentures which is functionally
acceptable to the patient.
►► Reference
1. Puthanakar N.Y, Pappachan B, Patil A.G. Full mouth rehabilitation
by immediate denture prosthesis- A case report. Annals and
Essences of Dentistry.2012;4(4):28-33.
2. Goswami R, Singh M. Immediate denture- a spatial modeling way.
Guident. Sept 2012;42-44.
3. Campagna SJ. An impression technique for immediate dentures.
J Prosthet Dent. 1968;20: 196-203. 3
4. Jerbi.F.C Trimming the cast in the construction of immediate
denture J Prosthet Dent 16:1047-1053, 1966.
5. Wiebelt F.J. Two steps better immediate dentures. Quitessence
Int. 1980;5:27-30.
6. Gilboa I, Cardash H.S. An alternative approach to immediate
overdentures. J Prosthodont.2009:18;71-75.
Fig. 12: Post extraction maxillary arch
Fig. 15: Post operative
KDJ – Vol. 39 • No. 1 • January 2016 29