Immediate Dentures

1. Immediate Dentures • Transitional Complete • Conventional Complete • Partial الملتقى المصرى لأطباء الأسنان www.egydental.com

2. Objectives Immediate Dentures • Know: • Describe and prescribe appropriate types of ID • Clinical protocols associated with each type • Laboratory protocols • Post-insertion care

3. Immediate Transitional Dentures • Complete clearance • Indications • Multiple extractions • Patient needs/demands

4. ImmediateTransitional Denture • A denture made without prior extraction of teeth • Synonyms: • Interim • Temporary • Provisional

5. Immediate Transitional Dentures • Indications • Multiple extractions • Esthetics • Function • Conventional ICD contraindicated

6. Immediate Transitional Dentures • Technique: • Alginate impressions • Lab or office pour • Gypsum model • Hybrid model • Mounted models • Arbitrary estimation of contour

7. Immediate Transitional Dentures

8. Immediate Transitional Dentures Before After

9. ImmediateTransitional Denture

10. Immediate Transitional Dentures • Problems • Intensive post insertion care • Short-term solution • More expensive

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

12. “Conventional” Immediate Complete Dentures • Concept • Remove all posterior teeth about 3 months before making immediate denture

13. “Conventional” Immediate Complete Dentures • Rationale • Allows for posterior segment to heal and stabilize • Maintains anterior teeth for appearance, some function

14. Indications Maxilla anterior teeth present Cooperative patient Not Recommended Both jaws simultaneously Mandibular arch “Conventional” Immediate Complete Dentures

15. Immediate Dentures Impression Techniques • Single custom tray • Split impression technique • Posterior segment • Anterior segment • Stock tray • Putty index

16. Split Impression Tray - Alginate Retention lugs Handle

18. Stock Tray Technique • Short-comings • Small oral opening • Proclined maxillary anterior teeth • Anatomic accuracy of vestibule

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

20. Putty-Index Technique

23. Putty-Index Technique

24. Putty-Index Technique

25. Conventional Immediate Dentures • Cast trimming guidelines • “Normal” periodontal condition • “Rule” of Thirds • Advanced periodontal deterioration • X-ray & probing measurements

26. Conventional Immediate Dentures • Rule of thirds • Normal gingival/bone relationship

27. Rule of Thirds – Cast Trim Step 1 Step 2 Remove tooth at gingival level Recess Socket 1 mm

28. Rule of Thirds – Cast Trim Step 3 Step 4 Labial edge recess to incisal third mark Mid-point recess to mid-width labial cut

29. Rule of Thirds – Cast Trim Step 4 Step 5 Round over lingual aspect of socket

30. Rule of Thirds – Cast Trim Step 5 Step 6 Round off labial to middle third, sand smooth

31. ICD Master Cast Trim • Trimmed areas sanded smooth • Avoid removing incisive papilla

32. 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

33. Immediate Partial Dentures • Framework incorporates wrought wire retentive loops for tooth attachment • Loops bent into place at processing stage, after cast trim

34. Special Lab Rx 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.”

35. Special Lab Rx 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

36. 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

37. 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

38. Post Insertion Management • Healing, shrinkage, resorption • Patient remount • Relines • Interim – within first 12 months • Definitive – 12 months +

39. Post Insertion Management • Remount when: • Healing edema resolved • Traumatized mucosal lesions healed • Usually within 14-21 days

40. Post Insertion Management • Reline • Short term – tissue conditioners • Mid-term – intermediate direct liners • E.g. Kool liner™ • Long-term – standard reline protocol

41. Immediate Denture Appendix • Review clinic & lab protocols • Try in • cast trimming

42. Special Lab Rx 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.”

43. ICD Try-In • Sectional wax-up • Anterior segment for patient viewing • Posterior segment for check record

44. ICD Try-In • Posterior “removable” section used for: • Confirmation of horizontal and vertical relationships • Tooth shade

45. Special Lab Rx 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

46. 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

47. ICD Master Cast Trim • Trimmed areas sanded smooth • Avoid removing incisive papilla

48. 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