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Reduction of residual ridges varies in
rate, amount and location from individual to
individual and within the same individual.
The bone of the maxilla and mandible will
experience external resorption and
endosteal deposition as the residual ridge
gradually rounds off once the teeth are
lost.

Modal Rate Of Change In The Denture
Bearing Area Following The Extraction Of
Maxillary Teeth In 25 Patients.
40% By the end of the first post-extraction month.
65% By the end of the third post-extraction month.
80% By the end of the sixth post-extraction month.
90%By the end of the twelfth postextraction month

Immediate dentures tt new prosthodontics.pdf

An Immediate denture may be defined as a
denture that is made prior to the extraction
of the natural teeth and which is inserted
into the mouth immediately after the
extraction of those teeth.

Advantages of IM Dentures
Maintenance of the soft tissue contour of
the face
Maintenance of mental and physical well
being
Aid the process of adaptation to denture

The use of existing occlusion for jaw
registration procedures
Aesthetic Considerations

Disadvantages of IM Dentures
Co-operation of the Patient
Increased Cost
No trial denture stage possible
Gross Irregularities of Teeth
Surgical and Anaesthetic Difficulties

Immediate dentures
either
additions to partial dentures
or
new dentures, complete or partial,
to replace teeth that are missing
and/or to be extracted

Immediate Dentures (IM)
? Transitional (Interim) IM Complete Denture
? Conventional IM Complete Denture
? IM Partial Denture

When Immediate Dentures are proposed,
patients should be advised of the
necessity for early relining and/or
remaking with associated additional visits
and extra costs

Transitional Immediate Complete
Denture
? A denture made without prior extraction of teeth
? A complete Clearance is followed.
? Synonyms:
Interim
Temporary
Provisional

Transitional Immediate Complete Denture
?Indications
– Multiple extractions
– Esthetics
– Function

Transitional Immediate Complete Denture
Problems:
Intensive post insertion care
Short-term solution
More expensive

Conventional Immediate Complete
Dentures
Maxillary six anteriors
Posterior teeth extracted 8-12 weeks
previously
Predictable, stable ridge contour

Conventional Immediate Complete Dentures
Concept
Remove all posterior teeth about 3
months before making immediate
denture

Rationale
–Allows for posterior segment to heal
and stabilize
–Maintains anterior teeth for
appearance, some function

Indications
– Maxilla
– anterior teeth present
– Cooperative patient

?Single custom tray
?Split impression technique
?Posterior segment
?Anterior segment
? Stock tray
? Putty index
Impression Techniques

Split Impression Tray
Posterior Custom Tray: ZnO Eug.
Over all Stock Tray: Alginate

The most important short coming is the
anatomic inaccuracy of the vestibule at the
junction point

Split Impression Tray
Putty Index Technique
Tray extends to and contacts incisal edge of anterior teeth

? If sufficient tooth contact for jaw
relationship, interocclusal record is
taken with shade and mould of teeth
? If insufficient tooth contact, occlusal
rims will be required

Special Lab recommendations for
Immediate Conventional Complete Denture
(ICCD)
?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.”

ICCD Try-In
?Sectional wax-up
?Anterior segment
for patient viewing
?Posterior segment
for check record

?Posterior “removable”
section used for:
?Confirmation of
horizontal and
vertical
relationships
?Tooth shade

Special Lab recommendations for ICCD
?For processing and cast trim:
? Refine occlusion
? Complete wax-up
? Flask and return lower half of flask
for cast trim
? Make surgical template in clear acrylic resin

Cast Trimming Guidelines
Step 1 Step 2
Remove tooth at
gingival level
Recess Socket 1 mm

?Invested maxillary
model in lower flask
half:
?Teeth removed
?Sockets recessed
?Ready for “Step 3”
?Ready for arbitrary
posterior palatal
seal

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

?Trimmed areas
sanded smooth
?Avoid removing
incisive papilla

ICCD Surgical Template
?Fabricated after cast
trim
?Used to locate
pressure areas on
mucosa at time of
surgery
?Denture trimmed
according to blanched
mucosa observed
under template

Designs of Immediate Dentures
? Labial flange
Complete
Partial
? Open-faced (socketed)
*Final decision is deferred until study casts are available

Advantages of a Labial flange
? Increased stability & retention
? Improved strength
? Tooth arrangement can be altered
? No interference with sutures
? Stable appearance
? Easier relining

Disadvantages of a
Labial flange
? May produce unnatural fullness of
lip and patient may not like appearance
? Bony labial undercuts may prevent use
of flange unless they are surgically
removed

Advantages of a Socketed IM
?Teeth sit into sockets of the extracted
teeth
? Aesthetics good initially

Disadvantages of a Socketed IM
? Uneven ridge - Contra-indicated in Mandible
? Loss of aesthetics as resorption continues
? Difficult to reline/rebase or addition of flange
? Retention poor

Post Extraction Instructions
? Do not remove denture
? Keep head elevated
? Small amounts of blood in saliva is normal
? Diet: soft and warm, not hot
? Avoid:
– Spitting, rinsing
– smoking

Fitting the denture
Avoid trauma to the anesthetized tissues
Remove
acrylic pearls and spicules
undercuts (helps insertion of denture)
Obvious occlusal discrepancies &
overextension must be corrected
Definitive adjustment of occlusion is not
always possible because of swelling

Post Insertion Management
? Recall next day
? Remove denture
? Apply topical anesthetic to
traumatized mucosa
? Locate over extensions and pressure
areas and adjust
? Reappoint 1 week

? Relines
– Interim – within first 12 months
– Definitive – 12 months +

Remount when:
? Healing edema resolved
? Traumatized mucosal lesions healed
– Usually within 14-21 days

Additions Of Teeth To Partial
Dentures
? Alginate impression in stock tray
? Impression taken over correctly seated
denture in situ
? Full functional width and depth of the sulcus
recorded
? Mark teeth to be added with indelible pencil
to avoid confusion and mistakes

? Wax or silicone interocclusal record
? Opposing alginate impression
? Cross infection
? Send to laboratory with correct patient
and clinical information
? Appointment arranged for both tooth
extraction and insertion of denture at same
visit

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Immediate dentures tt new prosthodontics.pdf

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