immediate denture

Dr. Monia MN Kandil

IMMEDIATE DENTURE

WHAT IS AN IMMEDIATE DENTURE?

Advantages of Immediate Dentures

Challenging Factors and disadvantages of Immediate Dentures

Contraindications of Immediate Dentures

Immediate Denturesinclude:

Partial Immed. Dent. Transitional Immed. Dent. Conventional Complete Immed. Dent.



Differentiate between Immediate & Interim Dentures !

Immediate Partial Denture

Immediate treatment partial support stability retention

Immediate Transitional Denture

Immediate Transitional Dentures
Indications Multiple extractions Esthetics Function If conventional ICD contraindicated

Immediate Complete Denture

Maxillary six anteriors are still. Remove all posterior teeth about 1-3 months before making immediate denture.
Concept Condition:
Immediate Complete Dentures



Rationale Allows for posterior segment to heal and stabilize. Maintains anterior teeth for appearance, some function. After healing, it is relined with acrylic resin.
Immediate Complete Dentures

Immediate Complete Dentures

Not Recommended Both jaws simultaneously Mandibular arch

Immediate Denture Treatment Sequence

Examination, Diagnosis &Data Collection

Oral Examination

Existing VDO: over-closed
Limited inter-arch space as result of enlarged maxillary tuberosity

Pre-extraction Records

A diagram of the anterior teeth indicating shading, restorations, etching, and so on Profile wire record and facial measurements


A hand-drawn chart for the locations of stains in the anterior teeth
Pre-extraction Records


The vertical overlap may be measured in this manner to serve as a pre-extraction record of the vertical relation

Impression Techniques

Immediate Denture Preliminary Impression:
At the 1st appointment:
With Alginate & Stock Tray


Add the soft peripheral wax onto inner surface of maxillary tray to provide a tissue stopper to Avoid gagging reflex resulted from excessive alginate
Immediate Denture Preliminary Impression:

Criteria for Acceptable Preliminary Casts

Capture All hard and soft tissue landmarks All peripheral vestibules



1st appt: Preliminary impression

2nd appt: Final impression

Fabrication of custom tray

Single custom tray technique: most commonly used

Two-pieces tray technique: (Split impression technique) for very divergent teeth or severe ridge undercuts
Which has two techniques:
2nd Appointment:

Immediate Dentures Final Impression:

Immediate Denture Final Impression
Single tray with rubber base most commonly used
1-

Immediate Denture Final Impression

Perforate the custom tray for the mechanical retention of alginate
Single tray with alginate is only used when considerable tooth misalignment or great mobility present.
2-

Split Impression Tray - Alginate

Retention lugs
Handle


Short-comings Small oral opening. Proclined maxillary anterior teeth. Anatomic accuracy of vestibule.
Split Impression Tray - Alginate

Split Impression Tray-Putty-Index Technique

Tray extends to and contacts incisal edge of anterior teeth

Putty-Index Technique

Maxillomandibular Relation Records
3rd Appointment:

Extend the record base onto the proximal, palatal/lingual surfaces of the teeth to enhance the retention, stability, and support of the record base
Rigidity Accurate fit Comfort
Record Base & Wax Rim



Selectively adding the wire clasps can improve the retention & stability of the record base for accurate jaw record (or a denture adhesive)

Face bow record

3rd Appointment: Maxillomandibular Relation Records

Face bow record Evaluate the VDO

3rd Appointment: Maxillomandibular Relation Records

Face bow record Evaluate the VDO CR record

Adequate teeth to support the bite registration material
3rd Appointment: Maxillomandibular Relation Records

Face bow record Evaluate the VDO CR record Protrusive record

3rd Appointment: Maxillomandibular Relation Records



Face bow record Evaluate the VDO CR record Protrusive record Mark and transfer the post-palatal seal
3rd Appointment: Maxillomandibular Relation Records

Selecting & Arranging artificial teeth:

Special Lab work for Immed. Comp. Dent.
For tooth set-up: Anterior teeth: Cut anterior teeth off cast at gingival level. Set anterior teeth on cast for patient viewing. Posterior teeth: Arrange posterior teeth on record base in (balanced/ monoplane/ lingualized) occlusion, and wax-up for try-in evaluation.

Set-up the anterior teeth:

Immediate Denture Laboratory Project

Use a sharp pencil to mark the gingival outline buccally and lingually

Preserve the incisal edge position and tooth angulations information prior removal of stone teeth.

Different Methods For Cast Trimming

Immediate Denture Laboratory Project



The teeth are removed from the cast in a manner that They are not cut below the gingival crest
1-


The terminal 5 mm of gingiva should be trimmed in the manner shown above so that the denture gingiva may not appear too thick.
2mm


Place a subgingival esthetic convenience groove at the labial gingival sulcus to aid in esthetic positioning of the denture teeth.
Esthetic convenience groove
2-


3-The Alternating Tooth Setup Technique Trim and set only one anterior tooth at a time. Alternate from side to side to keep natural neighboring tooth as angulation, length, and contour orientation.

15 mm

Complete the anterior teeth setup

During the Setting-up of Anterior teeth:

The study model can be used to compare the tooth arrangement.

Set-up the posterior teeth:

Immediate Denture Laboratory Project

Sectional wax-up Anterior segment for patient viewing. Posterior segment for check record.

Immediate Complete Denture Try-In

Insertion & Post Extraction Instructions

Occlusal adjustment & Remount when: Healing edema resolved Traumatized mucosal lesions healed Usually within 14-21 days
Post Insertion Management


Healing, shrinkage, resorptionPatient recallRelinesInterim – within first 12 monthsDefinitive – 12 months + Post Insertion Management



THERE ARE 2MAIN METHODS OF CONSTRUCTION Immediate Denture 2 Types

1 Without surgery (Without Alveoloplasty). A- Partially flanged type B- Socket type C- Completely flanged type2 with surgery (Surgical Alveoloplasty)Must be …Completely flanged type

Unless it is necessary, one should avoid alveolectomy in the anterior region. If it must be performed because of marked undercuts, a transparent tray should be prepared for use during the surgical procedures (surgical stent). It must be adapted to the cast after the necessary - cast alveolectomy" has been performed.

Alveoloplasty

“The recontouring or reduction of a portion of the alveolar process”

Goals of alveoloplastyIn this case

Disadvantages of Alveoloplasty

Types of Alveoloplasty:

Simple alveoloplasty: Buccal or labial cortical reduction: Intra-septal alveolctomy and cortical plate in-fracture:
(Buccal or Labial Cortical Re-contouring)



Immed. Comp. Dent. Master Cast Trim
Trimmed areas sanded smooth Avoid removing incisive papilla

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