Immediate Denture

Dr. Mahmoud Ramadan

Rem. Prosthodontics 502

I

Dr. Mahmoud Ramadan

Immediate Denture -:Indication* To avoid loss of appearance& function for the short time between .extraction of teeth& fitting of denture

-:Advantages* .maintenance of appearance-1 .minimise the interference with speech-2 .excellent psychological effect upon the patient-3 .maintain adequately the important vertical& horizontal relation ship-4 .possibility of development of abnormal mandibular movement ↓-5 preservation of vertical dimension, prevent muscle of mastication from-6 .losing tone& Shortening and the ligaments from being stretched .prevent possible movement of remaining natural teeth-7 .(control post extraction hemorrhage (stents -8 .controlling effect upon the resorption of the alveolar process-9

-:Disadvantages* .can't retain fit for a longer than few weeks-1 Relining or remaking is usually twice during period of alveolar-2 .resorption

-:Classification* .Socketed or Flanged immediate dentures-1 N.B. upper denture may be Socketed or with partial or full extension .labial flange .Partial or Complete immediate dentures-2

Socketed type immediate partial denture -:Indication* -:Replacement of upper anterior teeth with→ .limited periodontal disease-1 .little change in tooth position-2

II

Dr. Mahmoud Ramadan -:Advantages* .position of anterior teeth may be exactly duplicated-1 .Apperance of denture is natural-2 .Presence of labial undercut doesn't complicate denture insertion-3 .Difficult in obtaining correct amount of cast trimming is avoiding-4 Necessity for providing the surgeon with a resien base of the trimmed-5 .area is avoided

-:Disadvantage* .absence of labial flange ↓ retention& stability-1 .recession of the gums may expose the necks of the artificial teeth-2 .healing& conservation of ridge than with labial flange ↓-3 gum margins& sockets must be preserved without injury at time of-4 .extraction .unexpected difficulty during extraction make the method uncertain-5

-:Technique* -:At the Clinic → .perform scaling& extract any remaining roots-1 .make alginate impression of upper& lower casts-2 .record the shade of extracted teeth-3 .make inter-occlusal record to mount the casts-4 -:At the Laboratory → .pour the impression-1 pour the upper impression twice or duplicate it for comparison-2 between the positioning of artificial teeth with the original position of .teeth to be replaced .mount casts on articulator-3 .selection of suitable anterior teeth (form, size, shade) to natural tooth-4 .cut off one of the teeth to the level of the cervical margin-5 .dig a socket about 2mm apical to gingival margin-6 .adapt the wax to the palate& set the artificial teeth-7 .compare the anterior teeth with the reference cast-8 .trial of the waxed up denture isn't possible as tooth still in situ-9 missing posterior teeth on the cast may be replaced& clasps are fitted-10 .around the suitable teeth

III

Dr. Mahmoud Ramadan .waxed up denture is processed into acrylic resien, finished& polished-11 .denture kept in mild antiseptic solution until required-12 -:Fitting of Socketed type → extraction is carried out under block or infiltration local anesthesia-1 .with minimal trauma not to break roots or lacerate the soft tissue .allow 10min for initial blood clotting-2 Insert denture in place& check fit, retention& occlusion with opposing-3 .teeth .pt. instructed to return in not more than 48hour for adjustments-4 pt. instructed to keep the denture in mouth in all times except when-5 .using a mouth wash& cleaning the denture after meals pt. encouraged to commence mastication with denture as soon as-6 .possible .root part must be reduced gradually to allow for normal gum healing-7

Flanged type Immediate partial denture .Immediate denture is made with a full or partial labial flange →

-:Indications* lower immediate denture:- using of labial flange allows some relief of-1 .the sockets without compromising esthetics upper immediate denture:- replacing upper anterior teeth with-2 .superior protrusion or advanced periodontal disease

-:Advantages* .retention& resistance to antero-posterior movement of the denture-1 .providing lip support-2 .allow freedom in changing position of anterior teeth-3 .protection of the healing sockets-4

-:Disadvantages* .Thickness of the flange limits the length of artificial teeth-1 Difficulity in insertion& removal if the flange engages a deep labial-2 .undercut .Accomodation of the relieved labial flange is difficult-3 .The ridge needs surgical trimming to reduce the labial undercut-4

IV

Dr. Mahmoud Ramadan

V

-:Partial labial flange ♥ .The last 3 disadvantages overcome with using the partial labial flange→ .It is extended very little beyond the maximum contour of the ridge→ .It should adapted perfectly to the ridge for esthetic reasons→

Technique:-

It includes *

Clinical procedure The same as Socketed type to have → .the master cast Without bone trimming

Laboratory procedure

With bone trimming

-:(a) Replacing teeth with bone trimming (upper anterior teeth .Cut the lower teeth off the cast 1mm occlusal to the cervical margins-1 .Trim the ridge labially& also may need reduction in height-2 .Adapt a layer of base plate wax on cast to out line the denture-3 .Set the artificial teeth& check its relation-4 .Remove teeth, wax& make impression for the trimmed cast& pour it-5 Adapt a layer of base plate wax to the plaster cast, flask& process to-6 .have a transparent template Fix the artificial teeth& base plate wax to the trimmed master cast-7 .again, add suitable clasps, waxing up& processing -:(b) Replacing teeth without bone trimming (lower anterior teeth .Cut the lower teeth off the cast 1mm occlusal to the cervical margins-1 Adapt a layer of base plate wax on cast to out line the denture base -2 .including labial flange→ It should limited to non undercut area of ridge .Set the artificial teeth& and suitable clasps, waxing up& processing-3 -:Fitting of flanged type immediate dentures → -:a) With bone trimming .Teeth are extracted after raising labial& buccal gum flaps-1 Trim the labial& buccal alveolar bone to the same amount as in the-2 .trimmed cast .Close gum flaps by Stitches& insert denture-3

Dr. Mahmoud Ramadan .Post-operative instructions& follow up after 48hours-4 -:b) Without bone trimming .Extract teeth then squeeze the bone plates between fingers-1 .Insert immediate denture& use P.I.P. to check pressure areas-2 .pt. should come after 24hours to recheck sore spots-3

Complete Immediate Denture Used when clearance of remaining anterior& posterior teeth is → .indicated 1st treatment plane Immediate replacement of all .upper& lower teeth.

2nd treatment plane * Immediate replacement of anterior * Teeth only

-:Immediate replacement of all the teeth → .Make upper& lower alginate impression and pour in stone plaster(1 .Mount casts on articulator using inter-occlusal record blocks(2 Cut off the teeth on the upper cast& trim the ridge to the required(3 .form Make alginate impression for the trimmed cast& pour a duplicate cast(4 .in plaster .Fix wax base to the full denture area of the duplicate cast(5 .Flask this base& reproduce it in clear acrylic resien(6 Fit a new base to the edentulous cast on the articulator& set teeth. If a(7 lower tooth is malposed or over-erupted, trim or cut it from the lower .stone cast to allow setting of the upper teeth in proper position .Process the upper denture& finish(8 -:The pt.'s teeth are extracted after of labial& buccal gum flaps(9 Trim the alveolar bone labially& buccally in amount ═ scrapping done→ .on the cast .The clear acrylic plate acts as a guide to amount of bone trimming→ .(Close gum flaps by stitches& Insert complete denture(s→ .Check occlusion(10

VI

Dr. Mahmoud Ramadan following the insertion of the upper plate by several weeks, the lower(11 teeth are reproduced on complete lower plate by the same technique& .inserted in the mouth -:Fitting of the immediate denture * .Extraction of many teeth is best carried under General Anesthesia → The localized swelling of the tissues that results from infiltration→ anesthesia makes it impossible to fit the denture until several hours after .extraction The must always be removed without trauma, care being taken not to→ .break roots or lacerate the soft tissues As soon as the pt. has recovered from the operation, the denture is→ .inserted Pt.'s will very rarely complain from any discomfort from denture→ -:insertion but they must be instructed to .Return in not more than 48hours for adjustment& inspection(1 .Keep the denture in mouth in all times except for cleaning purposes(2 .Commence mastication with denture as soon as possible(3 The root part must be reduced gradually to allow for normal gum→ .healing till the tooth is left with a well fitting cervical margin -:Immediate replacement of anterior teeth only →

-:Technique* .Extract upper& lower posterior teeth-1 .Allow healing period for 6 – 8 weeks-2 .Make upper& lower alginate impression and pour in stone plaster-3 .Make posterior record bases& wax rims-4 .Record centric Maxillo-mandibular relation& mount on articulator-5 .Set posterior teeth& waxing up-6 .Break the upper& lower anterior teeth on the casts-7 Do sockets or trim the ridge to receive flanges, If trimming is extensive-8 .duplicate the trimmed cast to make the transparent acrylic template .(Set artificial anterior teeth& wax up the complete denture(s-9 .Extract remaining anterior teeth& Insert the complete denture-10

-:Alternative Technique ♥

VII

Dr. Mahmoud Ramadan . If pt. accommodation to artificial denture is doubted → It is better to replace posterior teeth with a partial denture& anterior → .teeth are replaced few weeks later

-:Technique* .Extract upper& lower posterior teeth-1 .Allow healing period for 6 – 8 weeks-2 .Make upper& lower alginate impression and pour in stone plaster-3 .Make posterior record bases& wax rims-4 .Record centric Maxillo-mandibular relation& mount on articulator-5 A distal extension temporary partial denture is processed& delivered to-6 (the pt.(Allow one or two weeks for accommodation to partial denture Make a corrective impression for the partial denture. Check& reinsert-7 .and make an over all impression in alginate stock tray The partial denture will come out as a part of the whole impression.-8 .Pour in stone plaster Mount the cast with the upper denture on an articulator with the cast-9 .of the opposite arch .Break the upper& lower anterior teeth on the casts-10 Do sockets or trim ridge to receive flanges, If trimming is extensive-11 .duplicate the trimmed cast to make the transparent acrylic template Set artificial anterior teeth& wax up teeth with the temporary partial-12 .denture. Process, finish& polish .Extract remaining anterior teeth& Insert the complete denture-13

-:Duplication of anterior teeth ♥ Size, form& shade of the teeth must be copied exactly by construction→ .of heat cure acrylic teeth

-:Technique * after recording the shade of the natural teeth, an alginate impression of-1 .the teeth to be extracted is taken Any of these teeth have cavities should be filled with temporary filling-2 .or wax to restore contour before taking the impression there is no need for the impression to extend too much beyond the-3 .cervical margins of teeth .Teeth impression are cast immediately in molten wax-4

VIII

Dr. Mahmoud Ramadan As soon as the wax is quite hard, it is removed& examined carefully to-5 .ensure that it has reproduced the natural teeth correctly Trim away the excess wax, small amount of root is allowed to remain in-6 .each pattern It's better to separate the large pattern into small sections to facilitate-7 trimming, it may be divided into single teeth to correct irregularities of .pt.'s teeth that may be founded Flask the wax patterns. Posterior or single shaded teeth may be flasked-8 in upright position, but multicolored teeth must have their labial surfaces .exposed for packing After processing, teeth are deflasked, cleaned, and excess is trimmed-9 .away, care being taken to preserve the small root on the anterior teeth

IX