Transcript
CONTENTS
Definitions
Advantages and disadvantages of immediate dentures
Contraindications of immediate dentures
Basic over view of an immediate denture fabrication
Surgery and Immediate Denture Insertion
Patient instructions
Review of literature
Conclusion
References
Definition
The glossary of prosthodontic terms ‘defines an immediate denture as a complete or removable partial denture constructed for insertion immediately following the removal of natural teeth.
Interim Immediate Denture/ Transitional Immediate Denture
An immediate denture after healing can be relined and refitted to be used as a definitive denture but an Interim immediate denture is worn only during the healing period to be replaced with a new prosthesis as soon as healing is complete.
One of the first references to immediate dentures in the literature was that of Richardson in 1860 (Seals, 1999).
ADVANTAGES AND DISADVANTAGES OF IMMEDIATE DENTURES
Advantages
Maintenance of a patient's appearance
No edentulous period.
No interruption of a normal lifestyle of smiling, talking, eating, and socializing.
Circum-oral support, muscle tone, vertical dimension of occlusion can be maintained.
The tongue will not spread out as a result of tooth loss.
Less postoperative pain
Some authors have discussed whether immediate dentures reduce residual ridge resorption (Heartwell, 1965; Johnson, 1966; Kelly, 1958; Campbell, 1960; Carlsson, 1967).
Duplication of the natural tooth shape and position, plus arch form and width.
Adaptation to dentures
Speech, mastication and nutrition can be maintained.
Tissue-conditioning material allows for considerable versatility in the correction and refinement of the denture fitting surface
Overall, the patient's psychological and social well-being is preserved.
Disadvantages
More challenging modality than complete dentures
The presence of teeth makes impressions and maxillomandibular positions more difficult to record.
Expensive, time consuming, adjustments
Trial for anterior teeth not possible
Patients unsuitable for this treatment option: Poor general health or who are at poor surgical
risks (e.g., post irradiation of the head and neck regions, systemic conditions that affect healing or blood clotting and psychological disorders).
uncooperative, cannot understand and appreciate the scope, demands, and limitations to the course of immediate denture treatment
Basic over view of an immediate denture fabrication
History taking Dental history
patients needs & expectations
Medical history
Preliminary examination
Oral examination
Jaw relation and occlusion
Radiographic examination
Preliminary Impressions and Diagnostic Casts
Impressions are made in irreversible hydrocolloid (alginate) in stock metal or plastic trays..
Fabrication of custom tray and final impression Single full arch custom tray
Two part impressions
Campagna impression Technique:
Putty-index technique
Jaw Relation
Identical to those for complete dentures
Denture base & wax occlusal rims
Vertical dimension is established
Face bow transfer
Jaw relation records
Notches 5mm deep cut into the rims
Centric relation registration
Protrusive records made
Condylar guidance adjusted
Setting the posterior Denture Teeth/Verifying Jaw Relations and the Patient Try-in Appointment
The articulated casts are used for setting any anterior/posterior teeth that are missing so that a try-in can be accomplished with the patient.
Anterior teeth selection & positioning The midline or newly selected midline is recorded on
the base area of the master casts.
A discussion of placement of diastema, rotated teeth, notches, and other natural arrangements should occur so that the patient is actively involved in the esthetic decisions.
Cast trimming & anterior teeth arrangement Ridge lapping
Rule of Thirds – Cast Trim
Recess Socket 1 mmRemove tooth at gingival level
Step 1 Step 2
Step 3 Step 4
Labial edge recess to incisal third mark
Mid-point recess to mid-width labial cut
Step 4 Step 5
Round over lingual aspect of socket
Step 5 Step 6
Round off labial to middle third, sand smooth
Denture is waxed up.
Final waxing and carving done.
Processing and Finishing
Processed and finished in the usual manner of complete dentures.
If desired, a laboratory remount can be accomplished before removing the dentures from their casts and finishing.
Keep the undercut areas of the denture slightly thick at this point to allow for insertion over undercuts.
These areas can be thinned later before sending the patient home.
Surgery and Immediate Denture Insertion
Extraction of the remaining teeth, taking care to preserve the labial plate of bone
The surgical template is used as a guide to ensure that the prescribed bone trimming is done adequately.
Ridge after extraction and placement of sutures if required.
Patient instructions
Dentures must be left into the mouth during first 24 hours
Ice compress on face for 20 minutes on repeatedly for the first 24 hours.
No chewing, liquid diet
After the first 24hours, patient should carefully remove the denture twice a day
Recall after 24 hours
Occlusal corrections from 48hrs to 1-2weeks
Recall every 3 months, adjustments with tissue conditioning material
Following the bone resorption period (approximately 6 to 12 months) a more permanent reline will be placed.
Review of literature:
Walter j Demer 1972
“Minimising problems in placement of immediate dentures” …
Distolingual undercut
Buccal and lingual undercuts in the bicuspid region
Sublingual undercuts
Incisive fossae and canine eminences
Distolingual and anterior combinations
Labial and lingual undercuts
Extractions without alveoloplasty
Extraction with alveoloplasty
Septal alveolectomy
Radical alveolectomy
John P Dahlberg(1965)“Reconstructing the Natural Appearance By Immediate dentures
Antony S Gotlieb(2001)
“An atypical chairside
immediate denture”
Ashok Soni et al (2000)
Trial anterior artificial tooth arrangement for an immediate denture patient :A clinical report
A technique is described that allows the esthetic try-in of the maxillary anterior artificial tooth before the extraction and completion of an immediate denture
Intra oral view
Posterior artificial tooth try in done with modified anterior wax up in anterior labial flange area.
Try in of posterior artificial tooth arrangement with processed maxillary denture.
To relate the maxillary denture to remaining teeth and supporting tissues, an impression of the adjusted denture was made and a new maxillary cast fabricated.
The maxillary artificial anterior teeth were arranged to reflect the position of the patients natural teeth.
Labial index of the completed anterior artificial tooth arrangement was made with impression plaster.
After the separation of the index the teeth were fixed using autopolymerizing acrylic resin.
Denture was finished and inserted immediately after the extraction.
Majid B et al (2004) Described fabrication of a clear surgical template that
minimizes pressure caused by immediate complete dentures on a surgical area.
Conclusion
• Patient education.
• Meticulous treatment planning.
• Staging extractions.
• Good impression technique.
• Tissue conditioners and remounts.
____________________________
= improve the predictability of the outcome.
References :
1. BOUCHER,S –prosthodontic treatment for edentulous patients 9th
edition & 11th edition .
2. CHARLES HEARTWELL & ARTHUR O RAHN –Sylabuss of
complete dentures 4th edition.
3. DENTAL CLINICS OF NORTH AMERICA- Complete dentures, april
1977, 21;2
4. JOHN J SHARRY- Complete denture prosthodontics 2nd edition.
5. JOHN N ADERSON, ROY STORER – Immediate dentures &
replacement dentures 3rd edition
6. SHELDON WINKLER- Essentials of complete dentures 2nd edition
7. RUDD & MURROW – Dental lab procedures , complete dentures
8. ZARB, BOLENDER – Prosthodontic treatment for edentulous patients
12th edition.
9.. MM Devan “The Trasition From Natural To Artificial Teeth" JPD
1960 vol-1
10. William B Lineberg “SURGICAL PREPARATION OF MOUTH FOR
IMMEDIATE DENTURES “1963 vol 13 no 1
11. John P Dahlberg“Reconstructing the Natural Appearance By Immediate
dentures”JPD 1965;205-210
12..M Heartwell IMMEDIATE COMPLETE DENTURE; AN
EVALUATION 1965 vol 15 no 4
13. Asok Soni “Trial anterior artificial tooth arrangement for an immediate
denture patient : A Clinical report ,JPD 2000 ;84 :260-263
14. Anton S Gotleib “An atypical chairside immediate denture :A clinical report
JPD 2001 :86 :241-243
15. Masjid Bissasu “A simple procedure for minimising adjustmentsof
immediate complete denture :Aclinical Report :JPD 2004 ;92: 125-127
16. Jonkman RE, van Waas MA, van 't Hof MA, Kalk W
J Dent. 1997 Mar;25(2):107-11.
17. Geoffrey St George et al, Immediate Dentures: 1 diagnosis & treatment
planning. Dent Update 2010
18. Geoffrey St George et al, Immediate Dentures: 2 Clinical stages of
construction Dent Update 2010; 37: 154-160
Thank you..
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