IMMEDIATE DENTURES

Dr.Sirisha.Sadupati
Dept. of prosthodontics
2nd M.D.S
CONTENTS
• Introduction • Clinical technique

• Classification • Post-operative instruction

• Ideal requirements • Conclusion

• References
• Indications and contraindications

• Advantages and disadvantages

• Diagnosis and treatment planning

INTRODUCTION
TERMINOLOGY
• IMMEDIATE DENTURES –
Any fixed or removable dental prosthesis fabricated for placement immediately
following the removal of a natural tooth/teeth.(GPT-9)

• INTERIM DENTURES – A fixed or removable dental prosthesis, or maxillofacial

prosthesis, designed to enhance esthetics, stabilization, and/or function for a limited
period of time, after which it is to be replaced by a definitive dental or maxillofacial
prosthesis; often such prostheses are used to assist in the determination of the
therapeutic effectiveness of a specific treatment plan or the form and function of the
planned for a definitive prosthesis .(GPT-9)
TERMINOLOGY
• TRANSITIONAL DENTURE: a removable partial denture serving as an
interim prosthesis to which artificial teeth will be added as natural teeth are lost
and that will be replaced after post-extraction tissue changes have occurred; a
removable transitional denture may become an interim complete removable
prosthesis when all of the natural teeth in the dental arch have been extracted
(GPT-9)
 REQUIREMENTS
Compatibility with the surrounding oral environment

Restoration of masticatory efficiency within limits

Harmony with the functions of speech, respiration, and deglutition

Preservation of the remaining tissues.

Esthetic acceptability

Syllabus of complete dentures by Charles M. Heartwell 5th edition(441-456).

INDICATIONS
• Socially active

• Available time and can afford multiple visits

• Good health

• Periodontally compromised teeth

CONVENTIONAL IMMEDIATE DENTURE VS INTERIM IMMEDIATE
DENTURE
Conventional immediate denture
The CID is usually selected when only
anterior teeth remain or if the patient is
willing to have the posterior teeth
extracted before immediate denture
procedures begin.
After this immediate denture is placed
and after healing is completed, the
denture is refitted or relined to serve as
the long-term prosthesis.
Interim immediate denture
Used most often when anterior and
posterior teeth remain until the day of
extraction and placement of the
immediate denture.
After this immediate denture is made and
after healing is completed second, new
complete denture is fabricated as the long-
term prosthesis.
 ADVANTANGES
1. The maintenance of a patient’s appearance
because there is no edentulous period.
2. Circumoral support, muscle tone, vertical
dimension of occlusion, jaw relationship,
and face height can be maintained.
3. Less postoperative pain is likely to be
encountered because the extraction sites are
protected.
DISADVANTANGES
1.More challenging than complete dentures
because teeth the presence of teeth makes
impression and maxillomandibular position more
difficult
2.The anterior ridge undercut (often severe)
that is caused by the presence of the remaining
teeth may interfere with the impression
procedures and therefore preclude also accurately
capturing a posteriorly located undercut, which is
important for retention.
3.Remaining teth in various locations may lead
to wrong centric relation record and VDO
 ADVANTANGES DISADVANTANGES

4. It is easier to duplicate (if desired) the natural 4.No try-in

tooth shape and position, plus arch form and
width.

5. The patient is likely to adapt more easily to 5. more difficult and demanding
dentures at the same time that recovery from procedure, more chair time, additional
surgery is progressing. appointments, and therefore increased costs
are unavoidable

6. Overall, the patient’s psychological and social 6. Functional activities (e.g., speech and
well-being is preserved mastication)are likely to be impaired
CLASSIFICATION

Immediate dentures

Conventional Interim immediate

immediate denture denture
CLASSIFICATION
According to Levere sub division
(i) Labial flange.
(ii) Partial labial flange.
(iii) No labial flange/open face /socketed type
(a) Conventional immediate denture
• Removal of all remaining posterior teeth (first premolars).

• After this immediate denture is placed and after healing is completed, the
denture is refitted or relined to serve as the long-term prosthesis.
(b) Interim immediate denture : -
• No teeth are extracted prior to the construction.
• Indicated for apprehensive patients.
• After an immediate denture is made and healing is completed,a second,
new complete denture is fabricated as the long-term prosthesis
CONVENTIONAL IMMEDIATE DENTURES INTERIM IMMEDIATE DENTURES

Definitive or long-term prosthesis. Transitional or short-term prosthesis.

After healing is complete, it is relined. After healing, a second denture is made.

Patient usually has only anterior teeth (plus possibly Patient usually has both anterior and posterior teeth.
premolars).

Usually has good retention and stability at placement, Usually has only fair retention and stability at insertion,
which is possible to maintain during healing. which must be improved by provisional relines (tissue
conditioning) during healing.

The overall cost of CID treatment is less than IID The overall cost of treatment is greater than ClD
treatment because it is the cost of the CID plus a treatment because it includes the cost of the interim
reline. denture and a second denture
 CONVENTIONAL IMMEDIATE DENTURES INTERIM IMMEDIATE DENTURES

Longer time for treatment completion. Lesser time than CID.

Generally indicated when anterior teeth remain. Generally indicated when both anterior and posterior
teeth remain.

Indicated when patient can function without posterior Indicated when the patient cannot or will not go without
teeth for 3 months. posterior teeth.

At placement of the ClD, usually only anterior teeth are At placement usually both anterior and posterior teeth
extracted. are extracted.

Indicated when two extraction visits are feasible. Indicated when only one surgical visit is preferable.
CONVENTIONAL IMMEDIATE DENTURES INTERIM IMMEDIATE DENTURES

Esthetics of the CID cannot be changed The second denture procedure after the allows an
alteration of esthetics

At the end of the treatment, the patient has one At the end of the treatment, the patient has a spare
denture denture

OVD is usually not preserved as posterior teeth are OVD is preserved as posterior teeth will not be
extracted (preserved if premolars are retained) removed before fabrication of IID

Contraindicated for a patient who has a complex Indicated when the patient will become edentulous
treatment plan one arch and partially edentulous in the opposing arch
for the first time or complex procedures are needed

Not useful for converting existing prostheses such as Can be useful in converting existing prostheses to an
removable partial dentures IlD
(i) Flangeless immediate denture –
Indications:
1. When deep undercuts are present on the anterior and buccal
residual ridge.
2. A high lip line and an active lip, that would expose an
unesthetic flange
3. Minimal amount of surgery is desirable
Contraindications:
1. When periodontal disease exists with a substantial amount of
bone loss which makes an acceptable cosmetic effect difficult.
2. When an anterior fixed partial denture has been worn resulting
in an uneven contour of the anterior residual ridge.
(ii) Partial flange type immediate denture
Indications:

1. Undercuts are present on the labial and buccal section of the

residual ridge and

2. It is desirable that the flange serves as a surgical splint.

Contraindications:

1 Economic condition of the patient renders multiple corrective

procedures impractical.

2. The patient has an unusually active lip line which would cause the
denture flange to be unaesthetic due to exposure of its labial
border
(iii) Labial flange type immediate denture:
Indications:

1. No large anterior bony undercuts are present.

2. The lip line and lip activity are normal.

3. The teeth are periodontally involved and supporting bone is lost.

Contraindications:

1. Pronounced undercuts are present in the anterior labial region of the

alveolar residual ridge.

2. Fullness of lip would produce an unaesthetic result.

 DIAGNOSIS, TREATMENT PLANNING
I) DIAGNOSIS • Tooth Modification

• Explanation to the patient : • Oral prophylaxis

• Diagnostic procedure • Other treatment needs

(A) Patient examination • Referrals / adjunctive care

(B) Consultation interview • Prognosis

EXPLANATION TO THE PATIENT:
1. Fit is usually not as good as traditional dentures.

2. Extractions and sore spots from immediate dentures can result in more

discomfort after initial insertion.

Takes time to adapt to chewing and speaking.

• Appearance may be unpredictable if anterior try-in is not possible.

• Should be worn for the first 24 hours without removal.

The patient should return to the dental office for initial removal at 24 hours
 EXPLANATION TO THE PATIENT:
1. Immediate dentures will normally “loosen” during healing due to ridge resorption & soft
tissue remodeling.

2. Relining / tissue conditioners will be required to improve retention.

3. If removed, reinsertion can be difficult if significant swelling occurs.

4. Normally a permanent reline will be required 4-6 months after insertion.

5. In some cases a remake may be required.

e.g.: Significant change in jaw position.

Significant esthetic problem

Examination/Diagnosis/Treatment Plan:
• A full-mouth radiographic series(periapical & bite-wing) is useful in evaluating the
extent of bone loss due to periodontal disease.

• A panoramic radiograph can be used to determine the presence of impacted teeth,

retained roots, foreign bodies, exostoses, cysts, and other pathology.

• Mounted diagnostic casts are a valuable aid in the evaluation of tooth position, jaw
relationships, undercuts, and occlusal plane discrepancies.
Examination of existing prosthesis:

• Any existing prostheses should be examined for shade, mold, tooth

position, lip support, and smile line.

• The shade of denture base should also be noted.

Tooth Modification:
• Modification of opposing teeth to correct the occlusal plane or to eliminate

prematurities in centric relation.

• Occlusal discrepancies can affect the correct registration of centric relation,

especially when they interfere with guiding the pt. in centric.

• They may also interfere with the proper determination of occlusal vertical dimension .
Oral Prophylaxis:
• The patient should have a general scaling of the teeth to minimize calculus

deposits. This will reduce postoperative edema and the chance of infection.
 II) Treatment planning
The procedures in the treatment plan are:
• First extraction\ Surgical visit
• Primary impression and preparation of
custom tray.
• Final impression.
• Recording of maxillomandibular relations.
• Positioning of posterior teeth.
• Tooth selection and Positioning of anterior
teeth
• Waxing and flasking
• Preparation of surgical template.
• Processing
• Surgery and insertion.
• Post operative instructions
• Perfection of occlusion.
1st surgical phase:
• In case of conventional immediate denture posterior teeth are
extracted in advance & any needed preprosthetic surgery is
performed at the initial appointment.

• A healing period of 6-8 weeks follows prior to starting impression

procedures.

• An immediate denture made in this manner will fit better because

there will be fewer surgical sites to heal.
(1) Preliminary impressions:-
The objective of the preliminary impression is to record the basal seat of the denture
and adjacent anatomic landmarks.

Type of tray for preliminary impression:

• A tray should be chosen that conforms reasonably well to the future denture
bearing area.

• Tray may be metal or plastic.

• Any tray is modified to obtain better adaptation.

Loose teeth:
• Loose teeth can be blocked out with adding periphery wax at the cervical areas,

• By generously applying a lubricating medium to the teeth

• By placing of copper bands over the loose teeth (Soni 1999)

• By placing a vacuum formed plastic over the teeth (vellis, wright, Evans et al
2001),or

• By placing holes in the tray and using an amalgam condenser to release the tray
over loose teeth (Goldstein 1992).
2.Custom trays :
According to Boucher:

There are two basic ways to fabricate the final impression tray, depending

on the location of remaining teeth and the operator’s preference –

Type (1) Single full arch custom impression tray

Type (2) Two tray or sectional custom impression tray

 Type (1) :- Single full arch custom impression

tray:-

 It can be used in CID technique. It is the only tray

that can be used for IID technique.

 This type of tray is effective when only anterior teeth

are remaining or both anterior and posterior teeth are

remaining.
 Type (2) :- Two tray or sectional custom impression

tray:-

 The type 2 method is used only when the posterior teeth

have been removed (CID).

 It can not be used in IID technique because usually there

are posterior teeth present.

 It involves fabricating two trays on the same cast-one in

the posterior, which is made like a complete denture tray,
and one in the anterior.
Campagna impression technique:

Campagna SJ. An impression technique for immediate dentures. The Journal of Prosthetic Dentistry. 1968 Sep 1;20(3):196-203.
• According to Swenson, kerr's utility wax added along the borders to extend
from tuberosity to tuberosity and centre of the palatal area.

• Wax is softened just before placement and alginate is added.

• Posterior part of tray is prepared with modelling compound. Tooth contact with
compound is avoided.

• A small amount of heated hydrocolloid is expelled with a syringe over anterior

portion of exposed tray. Additional amount of hydrocolloid is added over
remainder of the tray. Tray is placed in mouth and cooled through water jacket
3. Recording of Maxillomandibular
relation:-
• On the master cast trial denture base with wax occlusal rims are fabricated

• Centric relation recorded

• Notches of 5mm deep are made in rims and centric relation registration made

with quick-setting plaster, bees wax or ZOE paste

• Making of Protrusive relation record depends on whether we use cusp or

cuspless teeth
4. POSITIONING OF POSTERIOR TEETH

Posterior teeth are set up in tight centric occlusion and tried in the patient

mouth and centric relation is confirmed

5. TOOTH SELECTION

-Remaining natural teeth act as a guide for selecting the form, size, and

shape of teeth
• POSITIONING OF ANTERIOR TEETH:

• Positioning of anterior teeth depends on whether dentist wants to duplicate natural

teeth arrangement or not.

• When patient has unesthetic arrangement casts are made edentulous and desired

tooth arrangement is made irrespective of natural teeth

Setting of Anterior teeth :
Cast modification technique proposed by
Standard.
Cast modification technique proposed by
Standard.
CAST TRIMMING
THE RULE OF THIRDS - by KELLY
 Cast
modification
based upon
spatial
modeling.
Cast modification
based upon
spatial modeling
Cast modification
based upon
spatial modeling
7. Waxing and flasking

8.Preparation of surgical template:

• A transparent surgical template is made to be
used as guide for shaping of ridge at the time
teeth are removed and denture is inserted

• After cast is trimmed according to plan,

impression is made of alginate and cast is
poured with plaster
• Wax pattern of 2mm thickness is made on cast and it is half flasked and tinfoil adapted
over wax pattern.

• Flasking is completed and dewaxing is done.

• Packing with colorless acrylic resin is done

• Clear resin template can be made by vacuum formed technique sprinkle on technique,
using light cure material
9. Processing and final preparation of
dentures:

-Prominences on inner surface are trimmed.

-Deflective occlusal contacts are ground

10.Surgery and insertion of dentures:
• Surgical template placed in patient mouth and ensure that it has
seaten properly.

• Blanching is seen at the sites of excess pressure and it is

trimmed at that area.

• Tissue flaps are approximated, suturing is done, dentures are

placed and check for occlusion.

• Pt instructed to keep dentures for 24 hours.

• If dentures are loose, tissue conditioners can

• Be used at this stage for good fit

11.Post operative instructions:
The first 24 hours: -

• The patient is instructed, not to remove the denture from the mouth
during first 24 hours.

• Patients should avoid rinsing, avoid drinking hot liquids or alcohol.

• liquid or soft diet

• Occlusion is not perfected

24 hrs visit

• Check the tissue for sore spots and strawberry red spots. Usually these
area includes canine eminence, lateral to tuberosities and
retromylohyoid undercuts.

• Adjust any gross occlusal discrepancy in centric relation or

excursions.

• Reevaluate the denture for retention.

First postoperative week :-
› Counsel the patient to continue to wear the immediate denture at night for 7
days after extraction or until the swelling reduces.

› the patient should be shown how to remove the denture after eating for
cleaning and to rinse the mouth at least three to four times daily to keep the
extraction sites clean

› After one week suture can be removed and the patient can begin removing
the denture at night.
Further follow up care:-

• After 2 weeks, the maxillary denture is related to its semi- adjustable

articulator using the remount matrix made before flasking; a centric relation
record is used to remount the mandibular denture and refinement of
occlusion is performed.
Denture reline: -
• The changes that occur in ridge contour as the result of initial healing
of the soft tissues and also bone have definite effect on fit of the
denture.

• Several relines may be required during the first 8-12 month, following
the removal of the natural teeth.
12. Perfection of occlusion:
• Occlusion perfected at the end of 48 hour period after swelling is
disappeared
CONCLUSION

• Immediate dentures are an important treatment modality as they provide

instant esthetics and function to the patient after extraction of all the natural
teeth.

• The success of immediate dentures greatly depends on a correct diagnosis,

detailed treatment planning, and precise execution of the fabrication process
REFERENCES

• Boucher’S Prosthodontic Rx for edentulous patient 13thedition(284-

291).

• Syllabus of complete dentures by Charles M. Heartwell 4th edition 5th

edition(441-484).

• Essentials of complete Denture Prosthodontics by Sheldon Winkler-2nd

edition(182-189).
63
REFERENCES
• Jerbi FC. Trimming the cast in the construction of immediate
dentures. The Journal of Prosthetic Dentistry. 1966 Nov
1;16(6):1047-53.
• Phoenix RD, Fleigel JD. Cast modification for immediate
complete dentures: traditional and contemporary considerations
with an introduction of spatial modeling. Journal of Prosthetic
Dentistry. 2008 Nov 1;100(5):399-405.