17 CASE REPORT

Immediate Denture Service Designed to Preserve the Oral Structures A Case Report
Dr. Rubina1, Dr. Manjit Kumar2, Dr. Rashim Garg3, Dr. Rishi Saini4, Dr. Shaveta Kaushal5
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Post Graduate Student Department of Prosthodontics and Crown & Bridge Genesis Institute of Dental Sciences and Research, Ferozepur, India E-Mail: bansalrubina87@gmail.com
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Professor and HOD Department of Prosthodontics and Crown & Bridge Genesis Institute of Dental Sciences and Research, Ferozepur, India E-Mail: manjitkiran@yahoo.co.in
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Abstract
The immediate complete denture is an accepted method of restoration for the patient whose last remaining teeth are to be removed. The prosthesis is fabricated before the removal of the teeth and is inserted immediately after the extractions. The patient is never without teeth, the muscles of facial expression remain virtually unchanged and the natural tooth position can be duplicated, if desired. Immediate denture also acts as a splint over the surgical area and promotes healing. Keywords: Impressions; polymethylmethacrylate resin; denture

Post Graduate Student Department of Prosthodontics and Crown & Bridge Genesis Institute of Dental Sciences and Research, Ferozepur, India
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Post Graduate Student Department of Prosthodontics and Crown & Bridge Genesis Institute of Dental Sciences and Research, Ferozepur, India E-Mail: rishisainibds@gmail.com
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Post Graduate Student Department of Prosthodontics and Crown & Bridge Genesis Institute of Dental Sciences and Research, Ferozepur, India E-Mail: shaveta.doc7@gmail.com Corresponding Author Dr. Rubina Post Graduate Student Department of Prosthodontics and Crown & Bridge Genesis Institute of Dental Sciences and Research, Ferozepur, India Contact No. +91-9988803825 E-Mail: bansalrubina87@gmail.com

Introduction
In an era of both preventive and conservative dentistry, it is rarely necessary for any dental patient to become edentulous. The placement of complete denture immediately following the removal of natural teeth is not new. As early as 1860, Richardson described the use of immediate dentures. In line with present day, immediate dentures are a necessity to prevent distress, anxiety and embarrassment to many people.

Case Report
A 52 years old male patient reported to the Department of Prosthodontics and Crown & Bridge with the chief complaint of loose lower denture and poor esthetics since 2 months. History of present illness revealed extractions of all the mandibular teeth and maxillary posteriors 2 years back due to pain and mobility. Patient got mandibular complete denture and maxillary transitional removable partial denture fabricated one and a half years back. There was no medical history relevant pertaining to

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the case. Past dental history revealed a 2 year period of completely edentulous mandibular arch and partially edentulous maxillary arch. The patient had wheatish complexion and normal gait. Intraoral examination revealed that teeth present were 11, 12, 13, 21, 22, 23, 24. Arch size of both maxillary and mandibular ridges was medium size and arch form of maxillary and mandibular ridges was square. Ridge form in maxillary ridge was U shaped and mandibular ridge was inverted U shaped (Fig. 1 & Fig. 2).1 An orthopantograph of the patient revealed bone loss in maxillary anterior region upto the middle thirds of the roots (Fig. 3). The diagnosis made was partially edentulous maxillary and completely edentulous mandibular arch. Fabrication of immediate maxillary complete denture prosthesis and conventional mandibular complete denture was planned. Maxillary primary impression was made with irreversible hydrocolloid (Tulip Alginate Impression Material, Cavex Holland BV, Holland) (Fig. 4) and mandibular impression was made with impression compound (Hiflex Impression Composition, Prevest Denpro Limited, Jammu) (Fig. 5). Spacers using modelling wax (Hiflex Modelling wax, Prevest Denpro Limited, Jammu) were adapted on the primary casts using the full spacer design. Special trays were fabricated with autopolymerizing polymethylmethacrylate resin (DPI-RR Cold Cure) 2 mm short of all the sulci. A window was given in the maxillary special tray in anterior region for the natural teeth and tray handle was made with impression compound (Fig. 6). The polymethylmethacrylate resin tray was seated in the mouth and adjusted so that the borders were 2-3mm short of reaching the unstrained tissue reflection of the mucobuccal fold and 2-3mm short of the gingival margins around the remaining teeth. The border moulding was then done with green stick impression compound (DPI Pinnacle Tracing Sticks). Maxillary secondary impression was made with zinc oxide eugenol (DPI Impression Paste) and pick-up or dual impression was made with irreversible hydrocolloid2 (Fig. 7). Mandibular secondary impression was made with zinc oxide eugenol (Fig. 8). Vertical and horizontal jaw relations were recorded. Teeth arrangement and trial was done (Fig. 9). Maxillary anterior teeth were then trimmed on the cast and cast was smoothened upto the level of posterior ridge with sandpaper (Fig. 10). Maxillary anterior teeth were then arranged (Fig. 11). The dentures were then processed with heat cure polymethylmethacrylate resin (Trevalon, Dentsply). All the teeth present were extracted and suturing was done (Fig. 12). Denture insertion was done at the same appointment after disinfecting the dentures in Povidone - Iodine solution (Pividine, Wockhardt Limited, Mumbai) (Fig. 13a & b & Fig. 14a & b). Post insertion instructions were given and patient recalled after 24 hours for follow up.

Discussion
DEFINITION Any removable dental prosthesis fabricated for placement immediately following the removal of natural tooth/ teeth.3 An immediate complete denture is a dental prosthesis constructed to replace the lost structure and associated structure of the maxillae and/or mandible and inserted immediately following removal of remaining teeth.4 CLASSIFICATION Conventional immediate denture Interim (or transitional) immediate denture5 ADVANTAGES Maintenance of patient's appearance, circumoral support, muscle tone, vertical dimension of occlusion, jaw relation and face height are the advantages of immediate dentures. The patients psychological and social well-being is preserved. There is less postoperative pain as extraction sites are protected. It is easier to duplicate natural tooth shape and position. Speech and mastication are rarely compromised and nutrition can be maintained.5 DISADVANTAGES Immediate dentures are more challenging modality than complete dentures because the presence of teeth makes impressions and maxillomandibular positions more difficult to record. The anterior ridge undercut caused by presence of remaining teeth may interfere with the impression procedures. Presence of different numbers of remaining teeth in various locations can lead to incorrect recording of the centric relation position. More chair time, additional appointments are required leading to increased cost.5 CONTRA INDICATIONS Immediate dentures are contraindicated in patients with poor general health, uncooperative and elderly patients, patients suffering from debilitating diseases and in patients with sound periodontal health.5 INSTRUCTIONS TO PATIENT The patient should avoid rinsing, drinking hot liquids and is instructed not to remove the immediate denture during the first 24 hours. The diet for the first 24 hours should be liquid or soft. Analgesics can also be prescribed if required.5

Conclusion
Immediate denture service, at its best, is one of the finest contributions that dentistry has to offer to

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patients.6 It fulfills an important role in todays treatment modalities by providing the patients with esthetics, function and psychological support after extractions and during the healing phase. This method for treating the patient who will become edentulous is preferred over the method that involves being edentulous for months together.

References
1. Engelmier, Phoenix. Patient evaluation and treatment planning for complete denture therapy. The Dental Clinics of North America 1996;40:1. Campagna, S. J. An impression technique for immediate dentures. J Prosthet Dent 1968;20:196- 203. The Glossary of Prosthodontic Terms. J Prosthet Dent 2005;94:10-92. Rahn AO, Heartwell CM. Textbook of complete dentures, 5th ed, 2006, USA, Elsevier,453-78. Zarb GA, Bolender CL. Prosthodontic treatment for edentulous patients, 12th ed, 2009, St. Louis, Mosby, 123-59. Demer WJ. Minimizing problems in placement of immediate dentures. J Prosthet Dent 1972;27:275-84.

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Figure 2 Square arch form and inverted U-shaped ridge form in mandible

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Figure 3 OPG showing bone loss in maxillary anterior region

Figure 1 Maxillary anterior teeth and U-shaped ridge form Figure 4 Maxillary primary impression

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Figure 8 Mandibular secondary impression

Figure 5 Mandibular primary impression

Figure 9 Try-in (Frontal view)

Figure 6 Maxillary special tray

Figure 10 Trimmed maxillary cast

Figure 7 Maxillary secondary impression

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Figure 14 Denture insertion (Left lateral view) Figure 11 Teeth arrangement Occlusal view

Figure 12 Extractions and suturing

Figure 15 Pre operative

Figure 13 Denture insertion (Right lateral view)

Figure 16 Post operative

INTERNATIONAL DENTAL JOURNAL OF STUDENTS RESEARCH| Feb 2013 May 2013| Volume 1| Issue 4