Immediate Dentures

Transitional Complete
Conventional Complete
Partial

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 Objectives
Immediate Dentures

Know:
Describe and prescribe appropriate types of ID
Clinical protocols associated with each type
Laboratory protocols
Post-insertion care

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Immediate Transitional
Dentures

Complete clearance
Indications
Multiple extractions
Eg ; Periodontally weak teeth
Patient needs/demands
Eg ; socially active people, self conscious
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 Immediate
Transitional Denture

A denture made without prior extraction of

teeth
Synonyms:
Interim
Temporary
Provisional

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 Immediate
Transitional Dentures

Indications
Multiple extractions
Esthetics
Function
Conventional ICD
contraindicated

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 Immediate
Transitional Dentures

Technique:
Alginate impressions
Lab or office pour
Gypsum model
Mounted models
Arbitrary estimation of contour

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Immediate
Transitional Dentures

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Immediate
Transitional Dentures

Before After

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Immediate
Transitional Denture

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 Immediate Transitional
Dentures

Problems
Intensive post
insertion care
Short-term
solution
 More expensive

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Conventional Immediate
Dentures

Maxillary six anteriors

Posterior teeth extracted 8-12
weeks previously
Predictable, stable ridge
contour

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“Conventional” Immediate
Complete Dentures

Concept
Remove all posterior teeth about
3 months before making
immediate denture

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“Conventional” Immediate
Complete Dentures

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

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 “Conventional” Immediate
Complete Dentures

Indications Not Recommended

Maxilla Both jaws simultaneously
 anterior teeth present Mandibular arch
Cooperative patient

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Immediate Dentures
Impression Techniques

Single custom tray

Split impression technique
Posterior segment
Anterior segment
Stock tray
Putty index

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Split Impression Tray -
Alginate

Retention lugs

Handle

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UWO School of Dentistry
Stock Tray Technique

Short-comings
Small oral opening
Proclined maxillary
anterior teeth
Anatomic accuracy of
vestibule

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Split Impression Tray-
Putty-Index Technique

Tray extends to and contacts incisal edge of anterior teeth

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Putty-Index Technique

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UWO School of Dentistry
UWO School of Dentistry
Putty-Index Technique

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Putty-Index Technique

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Conventional Immediate
Dentures

Cast trimming guidelines

“Normal” periodontal condition
“Rule” of Thirds
Advanced periodontal
deterioration
X-ray & probing measurements

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Conventional Immediate
Dentures

Rule of thirds
Normal gingival/bone
relationship

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Rule of Thirds – Cast Trim
Step 1 Step 2

Remove tooth at Recess Socket 1 mm

gingival level
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Rule of Thirds – Cast Trim
Step 3 Step 4

Labial edge recess Mid-point recess to

to incisal third mark mid-width labial cut
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Rule of Thirds – Cast Trim
Step 4 Step 5

Round over lingual aspect of socket

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Rule of Thirds – Cast Trim
Step 5 Step 6

Round off labial to middle third

sand smooth UWO School of Dentistry
ICD Master Cast Trim

Trimmed areas sanded

smooth
Avoid removing incisive
papilla

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ICD 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

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Immediate Partial Dentures

Framework incorporates
wrought wire retentive
loops for tooth
attachment
Loops bent into place at
processing stage, after
cast trim

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 Special Lab procedure for ICD

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.”

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 Special Lab procedure for ICD

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

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 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
 Strenuous activity
 Alcohol, smoking
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 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
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 Post Insertion Management

Healing, shrinkage, resorption

Patient remount
Relines
Interim – within first 12 months
Definitive – 12 months +

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 Post Insertion Management

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

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 Post Insertion Management

Reline
 Short term – tissue conditioners
 Mid-term – intermediate direct liners
 Long-term – standard reline protocol

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 Immediate Denture Appendix

Review clinic & lab protocols

Try in
 cast trimming

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 Special Lab procedures for ICD

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.”

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ICD Try-In

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

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ICD Try-In

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

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 Special Lab procedures for ICD

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

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IDC Master Cast Trim

Invested maxillary model

in lower flask half:
Teeth removed
Sockets recessed
Ready for “Step 3”
Ready for arbitrary
posterior palatal seal

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ICD Master Cast Trim

Trimmed areas sanded

smooth
Avoid removing incisive
papilla

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ICD 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

UWO School of Dentistry