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IMMEDIATE DENTURES

Definition
An Immediate denture is a complete or removable partial denture that is constructed prior to the extraction of teeth, which it will replace and is, inserted immediately following the removal of natural teeth. .

The glossary of Prosthodontic terms

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Requirements of immediate dentures

Compatibility with surrounding oral environment. Restoration of masticatory efficiency within limits. Function in harmony with speech, respiration and deglutition. Esthetic acceptability. Preservation of remaining tissues.
La vere,A.M. and Krol,A.J. immediate denture service . J Prosthet Dent 29:10vere,A. Krol,A. 29:1015,1973 15,

advantages of immediate dentures 1-Maintenance of appearance.

2-Tooth selection and arrangement can be easily duplicated. 3-Maintenance of the masticatory movement patterns of the mandible by enabling the existing reflexes to continue. 4-Maintenance of vertical & maxillo-mandibular relationship so changes in the facial muscle tone and supporting structures are reduced

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5-Superior neuromuscular control. 6-The patient does not develop undesirable masticatory habits. 7-Minimum interference with speech (good speech (artificial anterior teeth are correctly positioned) 8-Fast adaptation to immediate denture, and acceptance to transition to edentulous state with minimal psychological trauma.

9 - Prevention of tongue enlargement 10 - Possible control on alveolar ridge resorption as well fitting immediate denture contributes to healing of surgical site after extraction of teeth. 11 - Healing period with teeth. 12 - a bandage or splint to control bleeding 13 - improve appearance.

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14-Prevent patient embarrassment after extraction 15-Hasten patient adaptation to dentures.

Disadvantages of immediate dentures

People who are in poor health may be subject to infection or edema following extraction of teeth. The additional expense of relining immediate dentures three to six months after insertion. Additional treatment time (post-insertion care and adjustments). The immediate denture cannot be assessed fully until it is placed in the mouth. Less retention is expected.

Heatwell. Heatwell.c. and salisbury.f.w immediate complete denture , j prosthet dent salisbury.

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Contraindication
Patient with general medical condition which make them poor surgical risks such as cardiovascular diseases Patient with acute infections (per apical or periodontal) which may need surgical drainage Patient under radiation therapy Patient with limited or no neuromuscular control Patient with sever gag reflex (training appliance before teeth removal) Extensive bone loss

CLASSIFICATION OF IMMEDIATE DENTURES

-Conventional immediate denture -Delayed immediate denture - transitional immediate denture

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Immediate denture
1- conventional: Flanged and socketed

Conventional immediate denture divided into

-socketed: Removable partial denture complete denture (open faced) - flanged: 1- without

Alveolectomy:
Partial-flange (cd or RPD) Complete flange (cd or RPD)

2- with

Alveolectomy.:
Septal (cd or RPD) radical (cd or RPD)

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-socketed
Removable partial denture

Socketed (Open-face/flangeless) Denture

Simplest type of immediate dentures Artificial teeth are set in the sockets of their extracted natural teeth without a labial flange.

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Indications
When sufficient retention can be obtained from the rest of the denture-bearing area Deep undercuts on the facial surface . A high lip line and hyperactive lip.

Contraindications
Periodontal disease with excessive amount of bone loss (unsatisfactory esthetics) An uneven contour of the anterior residual ridge.

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Advantages

Exact reproduction of tooth position Easier to set teeth in lab No interference with the lip movements Very natural appearance
Easy insertion in the presence of undercut.

Disadvantages
Poor retention and support Natural appearance isnt long maintained After few months the denture may need relining or remake. The necks of the teeth interfere with healing of the sockets Irregularities of anterior ridge may developed.

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2- flanged
Flanged Denture without alvolectomy a) Partial flange flange.

Flanged Denture without alveolectomy

Partial flange. Extension of the partial flange is just beyond the maximum contour of the alveolar process. It ends as a knife edge between the gingival margin and vestibular sulcus, blending with the surrounding mucosa near the mucogingival junction.

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Indications
undercuts are present on the labial and

buccal sections of the residual ridge and it is considered undesirable to create room for a complete flange by alveoloplasty .

Advantages
Good stability, support and retention Rapid healing with smooth ridges Easy rebasing Stronger denture

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Disadvantages
Difficult in case of undercuts Often thin making it weak knife edge often traumatizes mucosa

2- flanged
Flanged Denture without alveolectomy b) complete flange.

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Complete Labial flange.

Indications:
no large anterior bony undercuts are present the lip line and lip activity are normal the teeth are periodontally involved and supporting bone is lost

Contraindications
pronounced undercuts are present in the anterior labial region of the alveolar residual ridge, and fullness of the lip would produce an unaesthetic result

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Flanged Denture with alveolectomy

Where theres marked protrusion of the upper alveolus, both appearance and denture function can be improved by reshaping the alveolar bone at the time of extraction. .

Alveoloplasty is achieved by septal or radical alveolectomy

Septal alveolectomy
Interdental septa are removed after teeth extraction and the outer cortical plate is collapsed lingualy onto the inner.

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Advantages
Reduces labial undercut Creates enough room for complete labial flange Reduces size of the sockets have to be subsequently filled with new bone

Advantages:
No cortical bone is removed post-surgical resorption is reduced Surgery is less traumatic than radical alveolectomy

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Radical alveolectomy
Indications Prominent premaxilla eg. Angle class II, . Short and thin upper lip with prominent labial alveolar ridge . Limited anterior interalveolar space and deep overbite When diametrically opposed alveolar undercuts are present

Socketed denture - Appearance:

Flanged denture - Appearance:

-Stability and retention.

-Stability and retention

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Socketed denture
- Strength.

Flanged denture
-Strength.

-Maintenance: -Maintenance.

-Homeostasis. -Homeostasis

-Remodeling of the ridge. -Remodeling of the ridge. .

Delayed immediate complete denture

Inserted after or days of teeth extraction. It can be used to replace posterior and anterior teeth at the same time. The trial dentures are prepared on the casts where the teeth have been cut off and the ridge smoothed. The teeth are then extracted and, after a day or two, the waxed-up dentures are tried in the mouth with a zinc-oxide eugenol paste or elastomeric wash impression made in the closed-mouth position. Dentures are then processed and inserted in the same day.

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Interim complete immediate denture:

A temporary dental prosthesis . i.e. the denture is placed at the same appointment of extraction. It is used for a short interval of time for reasons of : esthetics, mastication, occlusal support, or convenience.

it is worn only during the healing period until more definitive prosthetic therapy can be provided.

Construction of immediate denture

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Procedure
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Impressions of both jaws in are taken in alginate hydrocolloids Impressions are best taken in trays whose peripheries have been built up with compound and functionally adapted The result casts are mounted on an articulator by means of a wax interocclusal record. Duplicate of casts are made for reference when setting the teeth The teeth are removed from the cast and ridge are trimmed Duplication of the cast are made Making a clear acrylic templates on the duplicated casts. The artificial teeth are set up and the denture is cured and completed The teeth are extracted and ridge are trimmed with the aid of the templates Denture then inserted