immediate denture part 1 (2021)

Immediate denture
When many of teeth are loose or painful, they may be beyond saving. This condition is usually caused by advanced periodontal disease or by decay. Periodontal disease causes bone to be lost; if it s not caught in time, there s so little support for the teeth that they have to be removed. Removing teeth &replacing them with a denture may be the best way to eliminate the infection &restore the health of patient s mouth. When the entire procedure is completed in one day, it s called an immediate denture.
Immediate denture is "any removable dental prosthesis fabricated for placement immediately following the removal of natural tooth.
Immediate denture are more challenging to make than routine complete denture for both the dentist and the patient because the try –in is not possible beforehand ,the patient may not be completely comfortable with the resulting appearance and fit on the day of immediate denture is inserted . Immediate dentures may be either single immediate dentures or upper and lower immediate dentures in the same patient. The latter should be made together to ensure optimal esthetics and occlusal relationships.
PATIENT SELECTION:INDICATION
1. Hopeless remaining teeth(caries, periodontal disease or malocclusion).
2. Educated patient with daily social .
3. patient with stable health condition(the patient for immediate denture is the philosophical type, their motivation for denture is the maintenance of health &appearance).
4. patient don t mind some additional visits or cost.
CONTRAINDICATIONS
1. patients who are in poor general health or who are poor surgical risks (e.g., post irradiation of the head and neck regions & cardiac or endocrine gland disturbances).
2. patients who are identified as uncooperative because they cannot understand and appreciate the scope, demands, and limitations to the course of immediate denture treatment.
3. patients is not willing to accept the treatment mentally &psychologically.
4. patient at risk from bacteremia.
5. patient with recurrent history of post extraction hemorrhage.
6. the presence of oral sepsis, acute periapical or periodontal diseases, extensive bone loss.
7. patient don t mind being edentulous for a period of time till complete healing.
Types of immediate dentures: According to treatment plan:
1. Conventional (or classic) immediate denture (CID): After this ID is placed and after healing is completed, the denture is refitted or relined to serve as the long-term prosthesis.
2. Interim (or transitional or nontraditional) immediate denture (IID): After this ID is made and after healing is completed, a second new CD is fabricated as the long-term prosthesis. The interim prosthesis designed to enhance esthetics, stabilization and/or function for a limited period of time, after which it is replace.
Comparison between these types of ID:
Conventional Immediate Denture (CID) Interim Immediate Denture (IID)
1. Intended as definitive or long-term prosthesis
2. After healing is complete, it is relined.
3. Esthetics of the CID cannot be changed.


4. At the end of the treatment, the patient has one denture.

5. If all posterior teeth are initially removed, the OVD is not preserved, opposing premolar can be maintained for this purpose.

6. Indicated when two extraction visits are feasible. 1. Transitional or short-term prosthesis
2. After healing, a second denture is made.
3. The second denture procedure after the IID allows an alteration of esthetics and any other factors if indicated .
4. At the end of the treatment, the patient has a spare denture to use in case of extenuating circumstances.
5. Because posterior teeth need not be removed before fabrication of the IID, the vertical dimension of occlusion may be preserved.
6. Indicated when only one surgical visit is preferable to maximize insurance benefits.
Advantages for all types of IDs :
A. Related to the patient:
1. The primary advantage of an immediate denture is the maintenance of a patient s appearance because there is no edentulous period.
2. Circumoral support, muscle tone, OVD, jaw relationship, and face height can be maintained. The tongue will not spread out as a result of tooth loss.
3. Less postoperative pain &bleeding is likely to be encountered because the extraction sites are protected.
4. The patient is likely to adapt more easily to dentures.
5. Speech and mastication are rarely compromised, and nutrition can be maintained.
6. Overall, the patient s psychological and social well-being is preserved.





B. Related to the dentist:
1. It is easier to duplicate (if desired) the natural tooth shape and position, plus arch form and width. If desired, the horizontal and vertical positions of the anterior teeth can be more accurately replicated.
2. Achieving good appearance.
3. Hemostasis, when ID are inserted, they act as a bandage &help to reduce bleeding.
DISADVANTAGES FOR ALL TYPES OF IDs
It is important for the dentist to fully explain to the patient the limitation of ID :
1. 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.
2. The presence of different numbers of remaining teeth in various locations (anteriorly, posteriorly, or both) frequently leads to recording incorrectly the centric relation position or planning improperly the appropriate vertical dimension of occlusion.
3. The inability to accomplish a denture tooth try-in in advance on extractions precludes knowing what the denture will actually look like on the day of insertion. Careful planning, operator experience, attention to details of the technique, and explanation to the patient best address this inherent problem.
4. Because this is a more difficult and demanding procedure, more chair time, additional appointments, and therefore increased costs are unavoidable.
5. Increased maintenance &more clinical visits.
6. Functional activities as speech or mastication are likely to be impaired, however this a temporary convenience.
DIAGNOSTIC STEPS MUST INCLUDE:
- Good oral hygiene is essential before starting any prosthodontics treatment.
- Patient s systemic condition is very important to check the general health of the patient because multiple extraction may not be tolerated by all patients. Patient under medical control &do not interfere with the steps of denture construction including several teeth extraction can be included, medical consultation is advisable.
- Full dental history must be recorded in the case sheet.
- Periodontal condition of the remaining teeth must be assess, this must include teeth mobility, measurement of the pockets; because this might affect surgical step of treatment course. Severe cases of periodontal disease may suggest some surgical correction after extraction to have well contoured residual ridge covered with firmly attached mucosal tissue.
- Radiographic examination is essential for immediate denture patients. Periapical radiograph may be useful for localized area; OPG view give general view for both jaws in single image.
- Teeth mold &shade must be recorded, proper communication with the patient about his teeth shade &form is essential furthermore teeth alignment &any individual variations as diastema, spacing, rotation of the teeth if the patient like to preserve same appearance or improvement could be suggested by you for better appearance.
- Occlusal plane adjustment is necessary because the factors that necessitate tooth extraction are often associated with occlusal discrepancies. These also interfere with the centric relation record as well as with the proper determination of occlusal vertical relation. Proper location of the low &high lip lines must be determined to determine the required changes in teeth position or angulations.
- Presence of any infection or inflammation in the soft &hard tissues. Periapical abscess, granuloma &cysts may make the estimated tissue changes at the time of extraction &healing &remodeling process unpredictable, this may increase of the risk of unfitted.
- Previous prosthesis: if present must be checked as an additive reference for the jaw relations or teeth selection. It also may help the dentist to explain some of treatment or correct some errors.
- Diagnostic cast is essential, that could serve a lot in the treatment plan &communication with the patient, also can be used as pre-extraction record.
- All ID patients must have good oral prophylaxis, proper scaling &good oral hygiene, this will reduce post-operative edema &infection. Other treatment as restoration crown &bridges or even RPD all must be one coincidence with ID planning.
- In the diagnosis step; with all the collected information you have to decide type of surgical procedure, ID can be constructed with one of the surgical procedure:-
1. Extraction of teeth only.
2. Extraction of teeth with alveoloplasty. In some cases simple correction may be needed at the sight of extracted teeth to improve the shape of the alveolar process in order to facilitate &improve denture objectives, in this cases surgical splint construction important.