An immediate denture is a complete denture or removable partial denture fabricated for placement imm

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Immediate Dentures

• An immediate denture is a complete denture or
  removable partial denture fabricated for
  placement immediately after the removal of
  natural teeth
• (Zarb,. Prosthodontic Treatment for Edentulous
  Patients, 12th Edition. Elsevier, 2003. 9).

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Immediate Complete Denture

• Conventional immediate denture -the denture is
  intended to be relined to serve as the long-term
  prosthesis.
• Interim (or transitional) immediate denture
  (IID) -after healing is completed, a second,
  new complete denture is to be fabricated as the
  long-term prosthesis. (Zarb, George A. Zarb.
  Prosthodontic Treatment for Edentulous Patients,
  12th Edition. Elsevier, 2003. 9.1).

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Immediate RPD

• Normally made of acrylic with ball clasps
• No posterior teeth only acrylic bite pads
• Transitional
• Replaced after healing with cast RPD

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Advantages

• Maintenance of a patient's appearance
• Circumoral support, muscle tone, vertical
  dimension of occlusion, jaw relationship, and
  face height can be maintained. The tongue will
  not spread out as a result of tooth loss
• Less postoperative pain is likely to be
  encountered because the extraction sites are
  protected
• Easier to duplicate (if desired) the natural
  tooth shape and position
• Adaptation easier. Speech and mastication are
  rarely compromised, and nutrition can be
  maintained
• (Zarb, George A. Zarb. Prosthodontic Treatment
  for Edentulous Patients, 12th Edition. Elsevier,
  2003. 9.2.1).

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Disadvantages

• Immediate dentures are a more challenging
• The anterior ridge undercut that is caused by the
  presence of the remaining teeth may interfere
  with the impression procedures
• The presence of different numbers of remaining
  teeth in various locations frequently leads to
  recording incorrectly the centric relation
  position
• No denture tooth try-in in precludes knowing what
  the denture will actually look like on the day of
  insertion
• more chair time, additional appointments, and
  therefore increased costs
• (Zarb, George A. Zarb. Prosthodontic Treatment
  for Edentulous Patients, 12th Edition. Elsevier,
  2003. 9.2.2).

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Explanation to the Patient Concerning Immediate
Dentures

• Do not fit as well as normal complete dentures.
• The pain of the extractions, in addition to the
  sore spots caused by the immediate denture, will
  make the first week or two after insertion
  difficult.
• It will be difficult to eat and speak initially
• The esthetics may be unpredictable because an
  anterior try-in is not possible
• (Zarb, George A. Zarb. Prosthodontic Treatment
  for Edentulous Patients, 12th Edition. Elsevier,
  2003. 9.4.3.1).

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Explanation to the Patient Concerning Immediate
Dentures

• Immediate dentures must be worn for the first 24
  hours without being removed by the patient. If
  they are removed, they may not be able to be
  reinserted for 3 to 4 days. The dentist will
  remove them at the 24-hour visit
• Immediate dentures will loosen during healing,
  tissue conditioners will be required
• 6 to 9 months after insertion at least a reline
  will need to be done, possibly a remake . The
  patient is responsible for fees.

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Technique

• Examination/Diagnosis/Treatment Plan
• Informed consent
• Oral hygiene procedures
• Extract (usually all) posterior teeth
• Wait 4 weeks for healing

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Technique

• Preliminary impressions
• Final impressions
• Jaw relation records
• Tooth set up and try in
• Extraction and insertion
• Post insertion care

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Examination/Diagnosis/Treatment Plan

• Assess tissue undercuts (especially in the
  anterior maxilla -reduce during
  extractions -use 2 piece tray for impression
• Is VDO correct?
• Imitate or change tooth arrangementfor esthetics
  or denture stability -midlines, occlusal plane,
  vertical overlap, length of maxillary incisors
• Conventional or transitional

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Technique

• Examination/Diagnosis/Treatment Plan
• Informed consent
• Oral hygiene procedures
• Extract (usually all) posterior teeth
• Wait 4 weeks for healing

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Preliminary impressions

• Use dentate or partially edentulous stock trays

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Final Impressions

• Normally need to use 2 piece custom tray
• If no large tissue undercuts may be able to us 1
  piece custom tray

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2 piece tray
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1 piece tray
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Jaw relation records
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Tooth set up and try in
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Extraction and insertion

• Have lab complete set up and modify cast as
  directed.
• -use perio probing to guide cast modification

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Extraction and insertion

• Request a surgical stent (guide)

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Extraction and insertion

• Extract teeth
• Use surgical guide to contour ridge
• Seat the denture
• -try not to use of PIP
• -check for over extensions
• THE DENTURE MUST BE FULLY SEATED
• Adjust occlusion
• Give post insertion instructions

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Timeline for insertion appointment

• 0-15 (min)-review med history and LA
• 15-60-extractions
• 60-75-move patient to pros cluster
• 75-120-insert and adjust-instructions

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Instructions to patient

• Do not remove until tomorrow's appointment
• If it comes loose/out put it back in place
  immediately
• Sot/liquid diet for 24 hours
• Avoid rinsing
• Take analgesic
• Expect red saliva

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24 hour appointment

• Remove and clean denture
• Relieve sore spots
• Do not use PIP

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1 week

• Relieve sore spots
• Use PIP
• Refine occlusion

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Follow up

• Use tissue conditioner to refit as needed
• Remove any socket convexities to avoid healing
  defects
• Reline or remake in 6 to 9 months

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