Immediate Denture
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Transcript of Immediate Denture
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Dr. Mahmoud Ramadan
Rem. Prosthodontics502
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Dr. Mahmoud Ramadan
Immediate Denture
*Indication-: To avoid loss of appearance& function for the short time between
extraction of teeth& fitting of denture.
*Advantages-:1-maintenance of appearance.
2-minimise the interference with speech.3-excellent psychological effect upon the patient.
4-maintain adequately the important vertical& horizontal relation ship.5-↓ possibility of development of abnormal mandibular movement.6-preservation of vertical dimension, prevent muscle of mastication
from losing tone& Shortening and the ligaments from being stretched.7-prevent possible movement of remaining natural teeth.
8-control post extraction hemorrhage (stents).9-controlling effect upon the resorption of the alveolar process.
*Disadvantages-:1-can't retain fit for a longer than few weeks.
2-Relining or remaking is usually twice during period of alveolar resorption .
*Classification-:1-Socketed or Flanged immediate dentures.
N.B. upper denture may be Socketed or with partial or full extension labial flange.
2-Partial or Complete immediate dentures.
Socketed type immediate partial denture*Indication-:
→Replacement of upper anterior teeth with-:1-limited periodontal disease.
2-little change in tooth position.
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Dr. Mahmoud Ramadan
*Advantages-:1-position of anterior teeth may be exactly duplicated.
2-Apperance of denture is natural.3-Presence of labial undercut doesn't complicate denture insertion.4-Difficult in obtaining correct amount of cast trimming is avoiding.
5-Necessity for providing the surgeon with a resien base of the trimmed area is avoided.
*Disadvantage-:1-absence of labial flange ↓ retention& stability.
2-recession of the gums may expose the necks of the artificial teeth.3-↓ healing& conservation of ridge than with labial flange.
4-gum margins& sockets must be preserved without injury at time of extraction.
5-unexpected difficulty during extraction make the method uncertain.
*Technique-:→ At the Clinic-:
1-perform scaling& extract any remaining roots.2-make alginate impression of upper& lower casts.
3-record the shade of extracted teeth.4-make inter-occlusal record to mount the casts.
→ At the Laboratory-:1-pour the impression.
2-pour the upper impression twice or duplicate it for comparison between the positioning of artificial teeth with the original position of teeth to be replaced.
3-mount casts on articulator.4-selection of suitable anterior teeth (form, size, shade) to natural tooth.
5-cut off one of the teeth to the level of the cervical margin.6-dig a socket about 2mm apical to gingival margin.
7-adapt the wax to the palate& set the artificial teeth.8-compare the anterior teeth with the reference cast.
9-trial of the waxed up denture isn't possible as tooth still in situ.10-missing posterior teeth on the cast may be replaced& clasps are fitted
around the suitable teeth.
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Dr. Mahmoud Ramadan
11-waxed up denture is processed into acrylic resien, finished& polished.12-denture kept in mild antiseptic solution until required.
→ Fitting of Socketed type-: 1-extraction is carried out under block or infiltration local anesthesia
with minimal trauma not to break roots or lacerate the soft tissue.2-allow 10min for initial blood clotting.
3-Insert denture in place& check fit, retention& occlusion with opposing teeth.
4-pt. instructed to return in not more than 48hour for adjustments.5-pt. instructed to keep the denture in mouth in all times except when
using a mouth wash& cleaning the denture after meals.6-pt. encouraged to commence mastication with denture as soon as
possible.7-root part must be reduced gradually to allow for normal gum healing.
Flanged type Immediate partial denture→ Immediate denture is made with a full or partial labial flange.
*Indications-:1-lower immediate denture:- using of labial flange allows some relief of
the sockets without compromising esthetics.2-upper immediate denture:- replacing upper anterior teeth with
superior protrusion or advanced periodontal disease.
*Advantages-:1-retention& resistance to antero-posterior movement of the denture.
2-providing lip support.3-allow freedom in changing position of anterior teeth.
4-protection of the healing sockets.
*Disadvantages-:1-Thickness of the flange limits the length of artificial teeth.
2-Difficulity in insertion& removal if the flange engages a deep labial undercut.
3-Accomodation of the relieved labial flange is difficult.4-The ridge needs surgical trimming to reduce the labial undercut.
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Dr. Mahmoud Ramadan
♥ 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 Laboratory procedure→ The same as Socketed type to have
the master cast .
Without bone trimming With bone trimming
a) Replacing teeth with bone trimming (upper anterior teeth) -: 1-Cut the lower teeth off the cast 1mm occlusal to the cervical margins.
2-Trim the ridge labially& also may need reduction in height .3-Adapt a layer of base plate wax on cast to out line the denture.
4-Set the artificial teeth& check its relation.5-Remove teeth, wax& make impression for the trimmed cast& pour it.
6-Adapt a layer of base plate wax to the plaster cast, flask& process to have a transparent template.
7-Fix the artificial teeth& base plate wax to the trimmed master cast again, add suitable clasps, waxing up& processing.
b) Replacing teeth without bone trimming (lower anterior teeth) -: 1-Cut the lower teeth off the cast 1mm occlusal to the cervical margins.
2 -Adapt a layer of base plate wax on cast to out line the denture base including labial flange→ It should limited to non undercut area of ridge.
3-Set the artificial teeth& and suitable clasps, waxing up& processing.
→ Fitting of flanged type immediate dentures-:a) With bone trimming-:
1-Teeth are extracted after raising labial& buccal gum flaps.2-Trim the labial& buccal alveolar bone to the same amount as in the
trimmed cast.
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Dr. Mahmoud Ramadan
3-Close gum flaps by Stitches& insert denture.4-Post-operative instructions& follow up after 48hours.
b) Without bone trimming-:
1-Extract teeth then squeeze the bone plates between fingers.2-Insert immediate denture& use P.I.P. to check pressure areas.
3-pt. should come after 24hours to recheck sore spots.
Complete Immediate Denture→ Used when clearance of remaining anterior& posterior teeth is
indicated.
1st treatment plane 2nd treatment plane *Immediate replacement of all * Immediate replacement of anterior
upper& lower teeth. Teeth only.
→ Immediate replacement o f all the teeth -: 1(Make upper& lower alginate impression and pour in stone plaster.
2(Mount casts on articulator using inter-occlusal record blocks.3(Cut off the teeth on the upper cast& trim the ridge to the required
form.4(Make alginate impression for the trimmed cast& pour a duplicate cast
in plaster.5(Fix wax base to the full denture area of the duplicate cast.
6(Flask this base& reproduce it in clear acrylic resien.7(Fit a new base to the edentulous cast on the articulator& set teeth. If a
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.
8(Process the upper denture& finish.9(The pt.'s teeth are extracted after of labial& buccal gum flaps-:
→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).
10(Check occlusion.
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Dr. Mahmoud Ramadan
11(following the insertion of the upper plate by several weeks, the lower 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-:
1(Return in not more than 48hours for adjustment& inspection.2(Keep the denture in mouth in all times except for cleaning purposes.
3(Commence mastication with denture as soon as possible.→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-:
1-Extract upper& lower posterior teeth.2-Allow healing period for 6 – 8 weeks.
3-Make upper& lower alginate impression and pour in stone plaster.4-Make posterior record bases& wax rims.
5-Record centric Maxillo-mandibular relation& mount on articulator.6-Set posterior teeth& waxing up.
7-Break the upper& lower anterior teeth on the casts.8-Do sockets or trim the ridge to receive flanges, If trimming is extensive
duplicate the trimmed cast to make the transparent acrylic template.9-Set artificial anterior teeth& wax up the complete denture(s).
10-Extract remaining anterior teeth& Insert the complete denture.
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Dr. Mahmoud Ramadan
♥ Alternative Technique -: → 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-:1-Extract upper& lower posterior teeth.
2-Allow healing period for 6 – 8 weeks.3-Make upper& lower alginate impression and pour in stone plaster.
4-Make posterior record bases& wax rims.5-Record centric Maxillo-mandibular relation& mount on articulator.
6-A distal extension temporary partial denture is processed& delivered to the pt.(Allow one or two weeks for accommodation to partial denture)
7-Make a corrective impression for the partial denture. Check& reinsert and make an over all impression in alginate stock tray .
8-The partial denture will come out as a part of the whole impression. Pour in stone plaster.
9-Mount the cast with the upper denture on an articulator with the cast of the opposite arch.
10-Break the upper& lower anterior teeth on the casts.11-Do sockets or trim ridge to receive flanges, If trimming is extensive
duplicate the trimmed cast to make the transparent acrylic template.12-Set artificial anterior teeth& wax up teeth with the temporary partial
denture. Process, finish& polish .13-Extract remaining anterior teeth& Insert the complete denture.
♥ Duplication of anterior teeth-:→Size, form& shade of the teeth must be copied exactly by construction
of heat cure acrylic teeth.
*Technique-:1-after recording the shade of the natural teeth, an alginate impression
of the teeth to be extracted is taken.2-Any of these teeth have cavities should be filled with temporary filling
or wax to restore contour before taking the impression.3-there is no need for the impression to extend too much beyond the
cervical margins of teeth.
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Dr. Mahmoud Ramadan
4-Teeth impression are cast immediately in molten wax.5-As soon as the wax is quite hard, it is removed& examined carefully to
ensure that it has reproduced the natural teeth correctly.6-Trim away the excess wax, small amount of root is allowed to remain
in each pattern.7-It's better to separate the large pattern into small sections to facilitate
trimming, it may be divided into single teeth to correct irregularities of pt.'s teeth that may be founded.
8-Flask the wax patterns. Posterior or single shaded teeth may be flasked in upright position, but multicolored teeth must have their labial surfaces exposed for packing.
9-After processing, teeth are deflasked, cleaned, and excess is trimmed away, care being taken to preserve the small root on the anterior teeth.
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