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IMMEDIATE DENTURES

Definition

•• An Immediate denture is a complete or removable An Immediate denture is a complete or removable partial denture that is constructed prior to the partial denture that is constructed prior to the extraction of teeth, which it will replace and is, extraction of teeth, which it will replace and is, inserted immediately following the removal of inserted immediately following the removal of natural teeth.natural teeth.

.

The glossary of Prosthodontic termsThe glossary of Prosthodontic terms

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Requirements of immediate dentures

• Compatibility with surrounding oral

environment.

• Restoration of masticatory efficiency within

limits.

• Function in harmony with speech, respiration

and deglutition.

• Esthetic acceptability.

• Preservation of remaining tissues.LaLa vere,Avere,A..MM.. andand Krol,AKrol,A..JJ.. immediateimmediate denturedenture serviceservice .. JJ ProsthetProsthet DentDent 2929::1010--

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advantages of immediate

dentures1-Maintenance of appearance.

2-Tooth selection and arrangement can be easily

duplicated.

3-Maintenance of the masticatory movement patterns of

the mandible by enabling the existing reflexes to

continue.

4-Maintenance of vertical & maxillo-mandibular

relationship so changes in the facial muscle tone and

supporting structures are reduced

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5-Superior neuromuscular control.

6-The patient does not develop undesirable

masticatory habits.

7-Minimum interference with speech (good

speech (artificial anterior teeth are correctly

positioned)

8-Fast adaptation to immediate denture, and

acceptance to transition to edentulous state

with minimal psychological trauma.

9 - Prevention of tongue enlargement

10 - Possible control on alveolar ridge resorption

as well fitting immediate denture contributes to

healing of surgical site after extraction of teeth.

11 - Healing period with teeth.

12 - a bandage or splint to control bleeding

13 - improve appearance.

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14-Prevent patient embarrassment after

extraction

15-Hasten patient adaptation to dentures.

Disadvantages of immediate

dentures

• People who are in poor health may be subject to infection or

edema following extraction of teeth.

• The additional expense of relining immediate dentures three to

six months after insertion.

• Additional treatment time (post-insertion care and adjustments).

• The immediate denture cannot be assessed fully until it is placed

in the mouth.

• Less retention is expected.

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Contraindication

• Patient with general medical condition which make them poor surgical risks such as cardiovascular diseases

• Patient with acute infections (per apical or periodontal) which may need surgical drainage

• Patient under radiation therapy

• Patient with limited or no neuromuscular control

• Patient with sever gag reflex (training appliance before teeth removal)

• Extensive bone loss

CLASSIFICATION OF IMMEDIATE DENTURES

�-Conventional immediate denture

�-Delayed immediate denture

- transitional immediate denture

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Immediate denture

1- conventional:conventional:

FlangedFlanged and socketedsocketed

Conventional immediate denture divided

into

�-socketed:

Removable partial dentureRemovable partial denture

complete denture (open faced)complete denture (open faced)

!- flanged:

1-without Alveolectomy:Partial-flange (cd or RPD)

Complete flange (cd or RPD)

2-with Alveolectomy.:Septal (cd or RPD)

radical (cd or RPD)

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�-socketed

• Removable partial denture

Socketed (Open-face/flangeless) Denture

• Simplest type of immediate dentures

• Artificial teeth are set in thethe socketssockets of their

extracted naturalnatural teethteeth without a labial flange.

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Indications

– When sufficient retention can be obtained from

the rest of the denture-bearing area

– Deep undercuts on the facial surface .

– A high lip line and hyperactive lip.

Contraindications

– Periodontal disease with excessive amount

of bone loss (unsatisfactory esthetics)

– An uneven contour of the anterior residual

ridge.

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Advantages

– Exact reproduction of tooth position

– Easier to set teeth in lab

– No interference with the lip movements

– Very natural appearance

– Easy insertion in the presence of undercut.

Disadvantages

• Poor retention and support

• Natural appearance isn’t long maintained

• After few months the denture may need

relining or remake.

• The necks of the teeth interfere with healing

of the sockets

• Irregularities of anterior ridge may

developed.

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2- flanged

Flanged Denture without Flanged Denture without alvolectomyalvolectomy

a) a) Partial flangePartial flange.

Flanged Denture without alveolectomy

Partial flange.

• Extension of the partial flange is just

beyond the maximum contour of the

alveolar process.

• It ends as a knife edge between the

gingival margin and vestibular sulcus,

blending with the surrounding mucosa near

the mucogingival junction.

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Indications

– undercuts are present on the labial and

buccal sections of the residual ridge and

it is considered undesirable to create

room for a complete flange by

alveoloplasty .

Advantages

• Good stability, support and retention

• Rapid healing with smooth ridges

• Easy rebasing

• Stronger denture

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Disadvantages

– Difficult in case of undercuts

– Often thin making it weak

– knife edge often traumatizes mucosa

2- flanged

Flanged Denture without alveolectomy

b) complete flange.

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Complete Labial flange.

Indications:

– no large anterior bony undercuts are present

– the lip line and lip activity are normal

– the teeth are periodontally involved and

supporting bone is lost

Contraindications

– pronounced undercuts are present in the anterior

labial region of the alveolar residual ridge, and

fullness of the lip would produce an unaesthetic

result

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Flanged Denture with alveolectomy

• Where there’s marked protrusion of the upper

alveolus, both appearance and denture function

can be improved by reshaping the alveolar

bone at the time of extraction.

.

Alveoloplasty is achieved by septal or radical alveolectomy

• Septal alveolectomy

Interdental septa are removed after teeth

extraction and the outer cortical plate is

collapsed lingualy onto the inner.

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Advantages

– Reduces labial undercut

– Creates enough room for complete labial

flange

– Reduces size of the sockets have to be

subsequently filled with new bone

Advantages:

– No cortical bone is removed

– post-surgical resorption is reduced

– Surgery is less traumatic than radical

alveolectomy

.

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Radical alveolectomy

Indications

• Prominent premaxilla eg. Angle class II, .

• Short and thin upper lip with prominent labialalveolar ridge .

• Limited anterior interalveolar space and deepoverbite

• When diametrically opposed alveolar undercutsare present

Socketed denture Flanged denture

�- Appearance:

!-Stability and retention.

�- Appearance:

•

• !-Stability and retention

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Socketed denture Flanged denture

7- Strength.

"-Maintenance:

�-Homeostasis.

�-Remodeling of the ridge.

.

7-Strength.

"-Maintenance.

�-Homeostasis

�-Remodeling of the ridge.

Delayed immediate complete denture

• Inserted after � or ! days of teeth extraction.

• It can be used to replace posterior and anterior teeth at thesame time.

• The trial dentures are prepared on the casts where the teethhave been cut off and the ridge smoothed.

• The teeth are then extracted and, after a day or two, thewaxed-up dentures are tried in the mouth with a zinc-oxideeugenol paste or elastomeric wash impression made in theclosed-mouth position.

• Dentures are then processed and inserted in the same day.

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Interim complete immediate denture:

A temporary dental prosthesis .

i.e. 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.

Construction of immediate Construction of immediate

denturedenture

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Procedure

1. Impressions of both jaws in are taken in alginate hydrocolloids

2. Impressions are best taken in trays whose peripheries have been built up with compound and functionally adapted

3. The result casts are mounted on an articulator by means of a wax interocclusal record.

4. Duplicate of casts are made for reference when setting the teeth

5. The teeth are removed from the cast and ridge are trimmed

6. Duplication of the cast are made

7. Making a clear acrylic templates on the duplicated casts.

8. The artificial teeth are set up and the denture is cured and completed

9. The teeth are extracted and ridge are trimmed with the aid of the templates

10. Denture then inserted