immediate denture part 2 (2021)

Beeding &boxing:
All the impression must be beeded before pouring. Wax may not stick to the alginate impression materials, therefore care must be taken to insure proper beeding. Once you fix beeding wax, boxing wax sheets can be easily stick to the impression. In the sectional impression, be careful to seat the sections properly on the indices. Pour the impression &remove the tray as in the conventional manner.
Record base and occlusion rim:
If the patient have enough number of remaining ant. &post. teeth no need for record base or bite rim as in most of interim ID while if there isn t enough number of remaining teeth as in all of conventional ID &some of the interim ID cases; bite rim must be constructed.
After record base &occlusal rim are constructed, leveling of the wax must depend on some anatomical landmarks as the retromolar area &you may use the remaining teeth but not always. Record base extension &occlusal rim height must be evaluated clinically. Lip lines: high &low must be determined &marked on the cast, in this way any correction or modifications can be done or marked on the cast to be considered in the teeth setting.

? If we have vertical stops between two opposing posterior teeth, these relation are maintained unless further corrections are needed to improve esthetic or function. Evaluation of the existed OVD must be accomplished &dentist must decide if this going to be restored or modified.
? If the ID complete; leave first premolars bilaterally to maintain vertical &horizontal relations &facilitate recording of the jaw relations.
? Doing that by using record bases and occlusion bite rims , and the vertical dimension recorded , centric relation is recoded also and transferring to articulator in the normal procedure used with complete or partial denture. Setting the posterior teeth, verifying jaw relation ,and try-in of posterior teeth appointment.

? A try-in procedure is not always possible (when all teeth or number of posterior teeth are present). But the mounting casts should still be confirmed at patient visit.
1.Set the posterior teeth .
2.the denture base and posterior teeth are try-in the mouth :
-verifying vertical dimension of occlusion
-centric relation as with complete denture
3.record land marks on the cast to confirm the patient s esthetic
A : midline or newly selected midline is recorded on the base area of the master cast.
B :the anterior plane of occlusion
C :ala-tragus plane should be located and noted .
D :high lip line should be determined on the cast.
4.anterior teeth selection is confirmed with patient.
Cast trimming guideline( rule of third):
It’s a modification of the rule of third as suggested by Kelly who recommends dividing the labial aspect of the ridge into 3 equal bands of space between the gingival line and the depth of the vestibular space.
• Remove tooth at gingival level: cut away those parts of crowns of the teeth that are visible (the cut is made at a line drawn around the teeth at free gingival margin.

Step 1 step 2 step 3 step 4 step 5 step 6
• Recess Socket 1 mm :trim the cast so that the site of the previously removed crown are recessed approximately 1mm.
• Labial edge recess to incisal third mark :flat cut across the facial surface of the ridge ,starting the cut at the labial depth of the recess made in the cast during step 2 ,the removal of this amount of stone represent the collapse of the labial gingival tissue towards the alveolus.
• Mid-point recess to mid-width labial cut : another flat cut across the facial portion of the ridge .this cut begins at the crest of the ridge (labio-lingual center) and extends to the mid width point of the cut made in step 3 .this procedure begins the contouring of the labial surface of the ridge.
• Round over lingual aspect of socket :trim the part of the crest which is lingual to the teeth ,most casts present a reproduction of the continuous roll of the gingival tissue. Note that the amount of grinding is very minimal on the palatal side, this is because the remodeling after extraction is usually minimal in this side.
• Round off labial to middle third, sand smooth : shape and smooth the surface of the cast that have been trimmed in the previous steps.
• Do not change or trim the essential landmarks as incisive papilla or any frenum.
In case of elimination moderate labial alveolar undercut (alvealoplasty)
The denture is constructed on a working cast which is trimmed to the anticipated contour of the ridge after surgery.
1.the gingival margins are marked and teeth removed.
2.guidlines are drawn on the cast .
3.all the part of the cast contained within these two lines is trimmed away and the edges are rounded over.
4.a clear acrylic template is processed on a duplication of this cast and is used as a guide to control the amount of bone removal at operation .
Waxing &flasking:
Generally ID is thinner than the conventional CD , but be careful at time of insertion &in the presence of undercut the acrylic must be thick enough to be adjusted. In this step you have to custom any selected personalization criteria must be caved.
Surgical Template:
? A thin, transparent form duplicating the tissue surface of an immediate denture and used as a guide for surgically shaping the alveolar process . it is essential when there is a need to do some alveolar corrections after teeth extraction or ridge recontouring or correction of the interseptal bone or in multiple teeth extraction. Make alginate impression to the cast after trimming, pour the impression, make the clear template processes either by heat or light, vacuum from &sprinkle-on method can be used also.
? Advantages: help to remove any expected pressure area at the sight of extraction thus minimize insertion time &adjustment at the insertion time.








If the arrangement of the natural anterior teeth is to be reproduced in denture a recording of their position must be obtained in one of the following ways:
? First way: produce a labial index of the natural teeth before they are cut off the cast.
? The index can be produced quite simply by molding silicone putty against the labial surface of the teeth and ridge on the cast.
? Then the artificial teeth are then set into the index while its held against the cast.
? Second way: remove teeth singly from the cast and immediately wax an artificial teeth into position so that the adjacent teeth serve as a guide to the position of the artificial replacement.
Arrangement of the anterior teeth in open face denture:
1.prepertion of tooth socket on the cast, 2-5mm depth depending on the amount of the gingival retraction which depend on the degree of pocketing and bone loose that is present around the natural teeth.
2.the neck of the artificial tooth is placed in preparation site.
3.at the time of insertion the neck will just enter the socket of natural tooth after extraction.
Processing &finishing:
It is the same as in the conventional CD ;do not remove posterior undercut &try to modify the path of insertion. Keep both the denture &the splint template in the disinfectant to delivery.