Immediate Dentures.ppt [Autosaved]

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

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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 wellbeing is preserved.

Disadvantages 

More challenging modality than complete dentures

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The presence of teeth makes impressions and maxillomandibular positions more difficult to record.

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Expensive, time consuming, adjustments

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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).

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uncooperative, cannot understand and appreciate the scope, demands, and limitations to the course of immediate denture treatment

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Basic over view of an immediate denture fabrication

History taking 

Dental history patients needs & expectations

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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

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Two part impressions

Campagna impression Technique:

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Putty-index technique

Jaw Relation 

Identical to those for complete dentures

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Denture base & wax occlusal rims

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Vertical dimension is established

Face bow transfer

Jaw relation records 

Notches 5mm deep cut into the rims

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Centric relation registration

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Protrusive records made

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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 tryin 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.

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A discussion of placement of diastema, rotated teeth, notches, and other natural arrangements should s hould occur so that the patient is actively involved in the esthetic decisions.

Cast trimming & anterior teeth arrangement 

Ridge lapping

Rule of Thirds – Cast Trim Step 1

Step 2

Remove tooth at gingival level

Recess Socket 1 mm

Step 3

Labial edge recess to incisal third mark 

Step 4

Mid-point recess to midwidth 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 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.

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Keep the undercut areas of the denture slightly thick  at this point to allow for insertion over undercuts.

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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. 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.

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Review of literature:

Walter j Demer

1972

“Minimising problems in placement of immediate dentures” …

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Distolingual undercut Buccal and lingual undercuts in the bicuspid region

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Sublingual undercuts

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Incisive fossae and canine eminences

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Distolingual and anterior combinations

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Labial and lingual undercuts

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Extractions without alveoloplasty

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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

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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

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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.

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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.

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The maxillary artificial anterior teeth were arranged to reflect the position of the patients natural teeth.

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Labial index of the completed anterior artificial tooth arrangement was made with impression plaster.

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After the separation of the index the teeth were fixed using autopolymerizing acrylic resin.

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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 prosthodontic treatment for edentulous patients

9th

edition & 11th edition . 2.

CHARLES HEARTWELL & ARTHUR O RAHN  – Sylabuss Sylabuss of  complete dentures 4 th 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 3 rd edition

6.

SHELDON WINKLER- Essentials of complete dentures 2 nd 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 11

dentures”JPD 1965;205-210 12..M 12.. M

Heartwell

IMMEDIATE

EVALUATION 1965 vol 15

COMPLETE

DENTURE;

AN

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  adjustmentsof  immediatee complete denture :Aclinical Report :JPD 2004 ;92: 125-127 immediat 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

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