Prosthodontics

82 DentalUpdate March 2010

Geoffrey St George
Immediate Dentures: 1. Treatment
Planning
Abstract: The treatment planning, clinical stages and construction of immediate dentures pose challenges to both dentist, dental
technician and patient. In this two-part series, the various principles for successfully providing patients with immediate dentures will be
discussed. This first paper examines the advantages and disadvantages, as well as the treatment planning involved in providing immediate
dentures.
Clinical Relevance: Although the provision of immediate dentures is common in dental practice, it is a treatment option which is not
without problems. This article will show how careful planning, prior to treatment starting, can prevent unforeseen complications occurring.
Dent Update 2010; 37: 8291
An immediate denture is a complete or
partial removable denture constructed for
insertion immediately, following the removal
or alteration of natural teeth. It is an effective
way of maintaining aesthetics and function
when transferring from a natural to artificial
dentition. An immediate denture can also be
termed a transitional denture owing to its
limited life span. This is in contrast to what
is sometimes called a classic immediate
denture, where teeth are removed and
dentures are constructed and fitted after a
short healing period.
The 1998 UK Adult Dental Health
Survey
1
showed that the population of the
UK was retaining its teeth for longer, with a
corresponding decrease in the proportion of
the population which was edentulous. Despite
this, there are patients who, even with modern
preventive and restorative dentistry, will still
lose teeth because of caries, periodontal
disease, or other causes, eg trauma.
Immediate dentures, whilst
offering a solution for patients with a failing
dentition, present problems clinically. Teeth
requiring extraction are often in unfavourable
positions, mobile, and create difficulties
with accurate impression-taking and jaw
registration. There also may be limited or no
opportunity to assess aesthetics, or phonetics,
prior to insertion of the dentures. However,
their construction for those about to be
rendered edentulous, or partly-dentate is
considered essential owing to the aesthetic
and functional demands of the patient.
Advantages and disadvantages
Advantages
There are many reasons why
immediate dentures are prescribed following
the extraction of teeth:
n Maintaining appearance
Most patients would prefer
extraction of teeth and immediate placement
of a denture, following tooth extraction.
For many, this is the primary reason they
Geoffrey St George, BDS, DGDP(UK),
MSc, FDS(Rest Dent), Consultant in
Restorative Dentistry, Sela Hussain,
BDS, MSc, MFGDP(UK), MFDS RCS(Edin)
FDS(Rest Dent), Consultant in Restorative
Dentistry and Richard Welfare, BDS, MSc,
FDS RCS(Eng), Consultant in Restorative
Dentistry, Endodontic Unit, Eastman
Dental Hospital, University College
Hospitals NHS Trust, 256 Grays Inn Road,
London WC1X 8LD.
are fitted. Appearance is maintained, which
benefits patients psychologically, and allows
them to face everyday life without the
embarrassment of missing teeth.
n Duplication of existing teeth and jaw
relationship
The existing tooth shapes,
colour, position, arch form and inter-occlusal
relationship can all be replicated by copying
the patients natural dentition directly into an
immediate denture. This also maintains the
existing occlusal vertical dimension, if correct,
and soft tissue support.
n Maintain function
The patient is never without
teeth, so has to adapt less to the shape of
an immediate denture than when fitted
with a new denture after resorption of
their edentulous ridges has occurred. This
is particularly important in patients with
large numbers of teeth missing in multiple
quadrants of the mouth. They allow a gentle
introduction to denture wearing, prior to the
construction of complete dentures.
n Prevention of tongue spread
Loss of posterior teeth may
allow the tongue to relax and expand into
edentulous sites, making future denture
wearing difficult to tolerate.
Despite the benefit of preventing
tongue spread, and the minimal interference
Sela Hussain and Richard Welfare
March 2010 DentalUpdate 83
Prosthodontics
with function already mentioned, a survey
of denture wearers showed that immediate
dentures resulted in more problems
than dentures fitted after a period of
edentulousness.
2
This may have been due to
the problems associated with socket healing
and bony remodelling.
n Reduction in resorption of alveolar bone
There is some evidence
3,4,5
that
an immediate denture, whether partial or
complete, can reduce the rate of alveolar
resorption around extraction sites.
n Protection of tooth sockets
Sockets are covered with denture
flanges, reducing blood clot disturbance and
bleeding.
Disadvantages
n Discomfort
Owing to the difficulty in
predicting exactly the pattern of tissue
changes following extraction, denture
fitting surfaces often cause trauma to the
healing sockets. These are easily adjusted at
subsequent visits. With careful planning, most
patients find this a small problem and are
generally satisfied.
6
n Increased cost and number of visits
Construction of immediate
dentures requires longer laboratory and
chair-time, and additional appointments for
adjustments and relines, as hard and soft
tissues remodel following tooth loss. In the
longer term, a definitive denture will also need
to be constructed. These extra stages result in
increased costs to dentist and patient.
n Inability to assess aesthetics at the try-in
stage
A try-in stage is only possible
when teeth are missing, which then allows
some assessment of aesthetics. However,
when teeth are extracted at the time of
denture insertion, no prior check can be
made. The best that can be achieved is the
copying of the existing natural tooth set-up,
if it is deemed satisfactory. If the remaining
teeth are in an unfavourable position (Figure
1a) or missing, then photographs taken prior
to tooth movement (Figure 1b) may help in
copying the appearance of missing natural
teeth, as well as helping communication with
the technician.
Treatment planning
A number of factors need to be
considered before treatment starts:
n Dental history;
n Medical history;
n Oral examination;
n Jaw relations and occlusion;
n Radiographic investigation;
n Surgical procedures.
Dental history
It needs to be established if the
patient is a regular attender, and is keen to
retain some teeth, or whether removal of
all remaining teeth is in the patients best
interest. It is important to evaluate each
patients needs and expectations, as well
as how he/she would cope psychologically
to being rendered edentulous. Immediate
dentures may allow patients to cope with the
transition to edentulousness less traumatically.
It is imperative to discuss the
limitations of complete and partial immediate
dentures, the patients thoughts about having
teeth extracted, and when this should occur.
It is the authors experience that treatment is
generally more successful when the patient
requests to have the teeth extracted than
when they are told to have them extracted.
Financial aspects also need to be discussed, as
a new definitive prosthesis may be needed at
a later stage.
Medical history
A thorough medical history
needs to be taken, as many patients who
require immediate dentures are elderly and
suffering from diseases which need special
management as a result of their impact on
health, or their control with medications.
When teeth are to be extracted, the following
needs to be borne in mind:
Bleeding disorders and patients receiving warfarin
Patients with a bleeding disorder
or taking a medication such as warfarin can
still have multiple extractions, provided there
is careful treatment planning, atraumatic
extractions, and liaison with their physician
is carried out. However, if, following careful
consideration, the patients general dental
practitioner feels there are additional medical
reasons why the patient should be cared for
in a hospital setting, then a referral should be
made.
Immediate dentures may
encourage haemorrhage in patients with
these disorders, despite their perceived
protection of blood clots in extraction sockets.
This is more likely with poorly supported
open-faced dentures, which are pushed into
healing sockets. Well-supported prostheses
are more likely to protect denture sockets and
assist in rapid healing.
Patients at risk of bacterial endocarditis
There is no evidence to show
that patients who are at risk of developing
bacterial endocarditis go on to develop
the signs and symptoms of this disease
more frequently following the wearing
of immediate dentures. Despite this, all
precautions should be taken to minimize
a bacteraemia
7
by ensuring good oral and
denture hygiene, providing good post-
operative care, and ensuring that sensible
denture design is provided.
Oral examination
The oral examination of the
patient needs to be thorough, and the
following factors need to be assessed.
Figure 1. (a) Teeth in an unfavourable position
prior to extraction and denture construction.
(b) Using photographs taken prior to tooth
movement, an assessment of future denture
aesthetics can be made.
a
b
Prosthodontics
84 DentalUpdate March 2010
Presence of oral disease
The tissues of the mouth need to
be examined for the presence of any disease,
as well as any local factors that may affect the
design of the dentures, eg the presence of tori
or other bony undercuts.
Many patients who require
immediate dentures may have failing
dentitions. A thorough examination of the
remaining teeth should be performed.
Carious lesions and restorations need
to be investigated, both clinically and
radiographically. Untreated periodontal
disease may have little long-term significance
if teeth are to be extracted. However, if
periodontal treatment is performed prior to
impression-taking, any subsequent gingival
shrinkage will occur prior to impression-
taking and denture construction, ensuring the
completed denture is better adapted to the
underlying soft tissues at the time of insertion.
Number of teeth and their prognosis
If dental arches are intact, then
the number of clinical stages prior to insertion
of dentures are limited to impression-taking
and shade-taking, as no try-in is possible.
However, careful planning is needed when
the vast majority of teeth will eventually need
extraction, as a decision has to be made of
how to stage the extractions.
The staged extraction of teeth
over more than one visit allows the healing of
tooth sockets, which can provide areas of firm
support after a complete immediate denture
is fitted. After the first wave of extractions,
edentulous spaces may or may not be
restored with partial immediate dentures.
When an immediate denture is provided after
the first wave of extractions, the patient can
accommodate to a smaller, better retained
denture and develop his/her denture wearing
skills before being provided with the final
complete denture.
Traditionally, when rendering a
patient edentulous, the posterior teeth were
extracted first then the anterior teeth were
extracted at a later date. This approach is
unhelpful as the temporary retention of a few
occluding posterior teeth is advantageous
as it maintains both the existing jaw relation
and occlusal face height. In practice, a
combination of anterior and posterior
teeth with the worst prognoses are usually
extracted first, whilst teeth with better
prognoses are extracted at a later stage.
Teeth missing and no previous denture
If the patients remaining teeth
need extracting, then edentulous ridges
will provide good tissue support for the
immediate dentures. The exact benefit will
depend on the number of teeth needing
extraction, compared to the size of any ridges
present.
Partial denture present
A decision needs to be made
whether to use the patients existing denture
and add additional denture teeth to it, or
construct a completely new denture. This
will depend on the condition of the existing
denture, and whether the patient is willing
to part with it for a day or more, for the
laboratory stages to be completed. The design
of denture also influences decision-making,
as cobalt-chrome dentures with a skeleton
design, and little acrylic in areas of proposed
tooth replacement, may not be suitable for
the addition of extra teeth.
Presence of bridgework
Edentulous ridges under bridge
pontics provide firm areas of support for
the future denture, following removal of the
bridge. However, extra time has to be devoted
to sectioning bridges at the extraction
appointment.
Overdentures
If strategic teeth have a good
prognosis, and the patient is able to maintain
them, then these teeth can be retained,
reduced in height, and can be kept as
overdenture abutments. Depending on
the size of the pulps, root canal treatment
may be necessary to prevent endodontic
complications, as well as offering the
possibility of additional retention of the
prosthesis, if an intra-radicular precision
attachment is cemented. The retention of
roots benefits the patient psychologically, as
well as maintaining alveolar bone.
Future planning
Teeth with a guarded prognosis
should always be treatment planned when
designing immediate dentures. It should
be possible to add extra teeth to dentures
relatively easily, whether they are made from
acrylic or metal, by incorporating features
which will allow further acrylic additions.
Jaw relations and occlusion
The recording of jaw relations
involves decision making as to whether an
existing relationship is to be maintained,
or changed. This is best achieved with
mounted diagnostic casts, which enables
static and dynamic occlusion to be
evaluated. As was previously mentioned,
patients attending for extraction and
immediate dentures often suffer from
periodontal disease, multiple carious
lesions, drifting and overeruption of teeth.
This results in occlusal discrepancies and
interferences in the retruded contact
position (RCP). This may need to be
addressed prior to impression-taking and
subsequent jaw registration, to facilitate
accurate record-taking. When a number
of natural teeth are to be retained, a
conformative approach is chosen, which
maintains the existing jaw relationship.
Problems arise when patients with
unsatisfactory jaw relationships are
rendered edentulous, and where existing
jaw relations are unsatisfactory in patients
requiring partial immediate dentures.
Maintaining jaw relations
Maintaining the jaw relationship
is an option when a satisfactory occlusal
vertical dimension (OVD) is already present,
and removal of teeth will not result in the
displacement of the mandible posteriorly,
ie when the patients intercuspal position
(ICP) is equal to his/her retruded contact
position. The jaw relationship may also
be maintained where only some of the
remaining teeth are to be removed, and
the intercuspal position will be retained
by the remaining teeth. When all the
posterior teeth have already been lost, the
mandible may have fully re-positioned so
that any slide between RCP and ICP has
been eliminated. Therefore, the current
jaw relationship can be replicated into
immediate dentures, following the removal
of the patients remaining teeth.
Changing jaw relations
Where natural tooth-to-tooth
contacts occur, approximately 90% of
dentitions have a small discrepancy (1.25
mm +/- 1.00 mm) between ICP and RCP.
8

This presents as a slide when the mandible
is manipulated into the RCP, and jaw closure
Prosthodontics
86 DentalUpdate March 2010
results in re-positioning anteriorly into the ICP.
Ideally, this slide should be eliminated before
jaw relations are taken by tooth adjustment,
if the teeth maintaining the current ICP are
removed.
With a reduced OVD the jaw
relation will need to be established on record
blocks, which extend on to the occlusal
surfaces of posterior teeth to establish the
correct dimension. If a few posterior teeth
are missing, then this is not necessary as
the natural teeth can be temporarily left
separated.
When posterior teeth are missing,
the mandible may re-position posteriorly, as
previously mentioned or, if anterior teeth have
lost bony support as a result of periodontal
disease, the teeth may splay, resulting in
an anterior displacement. Any tendency to
posture forwards should be prevented, and
the mandible should be gently manipulated
posteriorly to a reproducible position, ie RCP
(Figure 2).
Radiographic investigation
It is important to ensure a full
radiographic survey is made of the dentition
and jaws prior to starting treatment. Particular
attention needs to be paid to prospective
abutment teeth in terms of root length, size
and shape, as well as crown:root ratios. The
extent of any carious lesions in these teeth
and restorations present need to be assessed,
to ensure that the teeth will still be viable as
abutments, or better suited as overdenture
teeth, or even extracted. The residual ridge,
including the extent of the tuberosity, and
superficial location of the mental nerve should
also be evaluated. Alveolar bone height and
width can also be assessed for future implant
therapy.
Denture types
There are basically two types of
immediate denture in common use, based on
the presence or absence of a flange:
n Socketed design and
n Labial flange.
Socketed design
The denture teeth are set in
the sockets of the extracted teeth after
preparation of the cast (Figure 3). This
approach allows tooth position to be
copied exactly and can produce a natural
looking appearance. The absence of a
flange eliminates problems of insertion and
subsequent adjustment in areas of undercut.
It also reduces a possible source of retention
if an undercut is engaged, peripheral seal
in a complete denture, and support for the
denture. A lack of support may result in
damage to the residual ridge in the mandible,
so this design of denture is best avoided
in this case. Despite a natural appearance
initially, resorption of the underlying ridge
soon produces a space between the teeth and
the ridge (Figure 4), which is compounded if
removal of teeth has been traumatic. This is
corrected with a reline, which is more difficult
to perform than if a flange was present.
Labial flange
As previously mentioned, a flange
may contribute to the retention and support
of an immediate denture at the expense
of aesthetics, owing to its increased bulk if
located anteriorly, which may plump out the
lips. The extra acrylic of the flange increases
the strength of the denture, and is easier to
reline. Deep undercuts may mean the path
of insertion needs to be carefully selected, or
the flange relieved to allow the denture to be
inserted, which may reduce its contribution
to retention. Stone models should always
be analysed on a dental surveyor to see if
a flange can still pass into an undercut, as
undercuts less than 2 mm are usually covered
with displaceable tissue.
Surgical procedures
Radiographic examination
and clinical findings are used to assess the
complexity of any extractions planned. The
type of extraction will influence the design
of the denture, and laboratory procedure
carried out. A complex surgical extraction
is likely to produce a greater surgical defect
whose final shape will be more difficult to
predict. Therefore, the denture in this case
should be planned to have a flange, which is
more easily relined if more supporting tissues
are removed than anticipated. Problematic
extractions, or those associated with large
pathological lesions, may produce denture-
bearing areas which rapidly lose their close fit.
More advanced surgical procedures, including
alveolectomy or alveolotomy, require
careful planning and greater surgery time to
complete.
Simple extraction
The residual ridge shape following
this type of extraction is predictable, and
allows a well-fitting denture to be constructed
immediately after extraction. However, the
a
b
Figure 2. (a) Lack of posterior support, resulting in
a patient posturing forward. (b) The same patient
manipulated into the retruded contact position.
Figure 3. A socketed denture.
Figure 4. Space that has occurred between
a denture and the edentulous ridge after
extraction.
March 2010 DentalUpdate 87
Prosthodontics
depth of pocket around each tooth will
influence the collapse of soft tissue into
the socket. This is taken into account by
measuring probing depths around teeth
scheduled for extraction, and appropriately
preparing the stone model on which the
denture is made.
Surgical extraction
Bone removal during extraction
will reduce the denture-supporting areas
of the mouth immediately post-extraction.
Removing one tooth may have little effect,
if the denture is well supported elsewhere.
However, in an aesthetic area, a space
appearing between a denture and the
extraction site may be unacceptable (Figure
4). In this case, the cast should be prepared
to a greater extent, to anticipate greater soft
tissue collapse into the surgical defect. Over-
preparation can always be corrected by the
removal of excess acrylic from the dentures
fitting surface. A localized reline may be
indicated earlier with a surgical extraction.
Alveolotomy
Alveolotomy and alveolectomy
were routinely carried out when tooth
extraction was common. The alveolotomy
allowed a flange to be fitted to a denture in
the presence of a prominent pre-maxilla. The
removal of interdental septae with Rongeur
forceps and the collapse of the labial plate
require careful cast preparation. A surgical
template was commonly constructed from
the altered cast produced, to enable the ridge
to be contoured to fit the denture. Nowadays
it is rarely carried out, owing to the reduced
numbers of immediate dentures being
made, which replace all anterior teeth at the
same time. This technique has been largely
abandoned in preference for altering the
denture design to cope with the undercuts,
which prevents unnecessary destruction of
the alveolar ridge.
Alveolectomy
This procedure involved the
removal of the anterior cortical plate, which
was a particularly destructive technique
and has therefore fallen out of favour. It
was also used to reduce a prominent pre-
maxilla. This technique also needed careful
cast preparation. An alternative to both the
alveolectomy and alveolotomy is to construct
an open-face denture, and gradually to
extend its anterior flange with chemically
or light-cured acrylic as bony resorption
occurs. Alternatively, the anterior flange can
be extended to the most prominent part of
the maxilla, and extended following further
resorption.
Immediate dentures and implants
Patients who require extraction of
their remaining teeth and implant placement
may have the implants and a conventional
denture inserted following a period of healing
and the patient remaining edentulous.
Alternatively, the implants can be placed
at the time of tooth extraction in the tooth
sockets, or in the adjacent edentulous sites,
and a denture inserted immediately. In both
these scenarios, once implants have been
placed, care needs to be taken in the design,
construction and fitting of the immediate
denture. Finally, it is also possible to consider
immediate loading of the implants and using
them to support an immediate fixed bridge,
but this is beyond the scope of this paper.
When placing implants, a one-
stage or a traditional two-stage surgical
approach can be adopted. One-stage
implant placement involves the simultaneous
placement of healing abutments at the time
of fixture insertion (Figure 5). A two-stage
procedure is when fixtures are submerged
below soft tissues at the time of surgery,
then a further surgical procedure to connect
the healing abutment is required. In this
case, loading of the implant is said to be
minimized during healing, which favours
osseo-integration. This is because forces
are dissipated through soft tissues and not
applied directly to the implant via the healing
abutment.
Both one-stage and two-stage
implants present problems when immediate
dentures are used.
One-stage surgery
It can be difficult to estimate soft
tissue and healing abutment contours after
surgery, and then construct an accurately
fitting immediate denture. This problem
is compounded by swelling which occurs
post-operatively. Invariably, relining of the
denture will need to be carried out. However,
experienced operators may be better at
predicting soft tissue changes. Failure or
inability to make the denture sufficiently thick
could result in a denture that is too thin once
adjustments are carried out, increasing the
chance of fracture.
To aid adjustment, light-bodied
silicone impression material is used as a
pressure-indicating paste to prevent contact
of the denture with the implant.
9
A healing abutment which
extends above the gingiva in a patient with a
reduced inter-occlusal space may allow only a
thin section of denture acrylic to fit between
the healing abutment and the opposing
tooth. This can result in the denture tooth
fracturing from the denture. This is a particular
problem with single tooth implants.
Aesthetics may be poor if an
incorrectly placed implant or excessively
long healing abutment is chosen. A gap of at
least 1.5 mm is required between the fitting
surface of the pontic and the cover screw/
healing abutment of the implant.
10
This can
lead to poor aesthetics and cause food debris
to accumulate underneath the prosthesis if a
temporary reline is not used.
Overloading of the implant
can occur unless the denture is accurately
adjusted. The exposed implant fixture is
subjected to biomechanical stimuli and micro-
movement from the denture, which has been
shown to induce a fibrous connective tissue
interface between the implant and the bone,
affecting successful osseointegration.
11
Lower success rates have been
reported for immediately loaded mandibular
implants (80%) compared to those for a
two-stage protocol (96%).
12
It has also been
shown that more crestal bone is lost in the
one-stage group. This has been attributed
to early occlusal loading during the healing
phase, interfering with new bone formation.
11

It has also been shown that, with immediately
placed and loaded implants, there is
Figure 5. One-stage implant placement.
Prosthodontics
88 DentalUpdate March 2010
more crestal bone loss if the prosthesis is
insufficiently adjusted and fitting incorrectly.
12
Submerging the implants also
prevents infection and epithelial down-
growth.
12
If the overlying soft tissues are
thin then, by having the immediate denture
overlying the implant surgical site, there is a
risk of exposure of the cover screw (Figure 6).
Two-stage surgery
If soft tissue management is poor,
there is the potential for tissue conditioner
to flow into the wound and delay or prevent
healing.
Despite the absence of a healing
abutment, there is often a change in the
soft tissue contour, even with a submerged
implant, which is difficult to predict
completely.
Although the factors that facilitate
osseo-integration are more favourable with
this form of surgery, some of the previous
problems discussed which are associated with
one-stage surgery simply re-appear at the
second surgical stage.
Soft-tissue borne immediate
prostheses can cause uncontrolled implant
loading. This can lead to implant exposure,
marginal bone loss and/or failed integration,
as well as prosthesis fracture.
13
Two-stage surgery allows for soft
tissue shaping of the extraction site to be
carried out (Figure 7a). This is achieved by
ensuring the fitting surface of the denture
teeth of the immediate denture are ovate in
shape (Figure 7b). The fitting surface can be
added to with chairside acrylic or visible light-
cured composite.
In cases where denture retention
has been poor, eg complete dentures, patients
can see a dramatic increase in retention if the
tops of the healing abutments are above the
crest of the edentulous ridge. If the denture
is then relined with a tissue conditioner, the
restricted path of removal of the prosthesis,
in combination with the restriction in
lateral movement, gives the patient his/her
first experience of the benefits of implant
treatment (Figure 8).
If a more rigid relining material is
used at the time of fit, or is used to replace a
soft-lining material at the chairside or in the
laboratory, then care should be taken if the
healing abutments are undercut relative to
each other. At the chairside, a snap-setting
material can prevent the dentures removal
or re-insertion. A slow-setting material, eg
self-cured, can be repeatedly removed and
re-inserted to distort and eliminate the
undercuts.
With patients now demanding
fixed restorations to replace extracted teeth
at the time of surgery, modern alternatives to
immediate dentures have included:
n Immediate same day teeth
Implants such as the Brnemark
Novum or 3i Diem systems allow the
immediate loading of implants with a fixed-
prosthesis at the time of extraction.
n Conventional bridgework
This is only realistic when implants
are to be placed and there are suitable
adjacent teeth which require crowning.
n Resin-retained bridgework
This option has gained in
popularity,
14
owing to the predictable
retention rates possible with resin-retained
bridgework
15
(Figure 9).
Conclusion
Despite these alternatives,
immediate dentures still have a place in
modern dentistry, including implant therapy.
It is important to remember though that
the transition from an immediate denture to
an implant-retained fixed prosthesis is not
without problems. It can be impossible to
provide the same degree of lip support
and replacement of interdental papillae
with the fixed prosthesis as that provided
by the flange of a denture. Therefore,
the patient should be warned of this
difference, or a transitional denture
constructed which doesnt provide soft
tissue replacement to the same degree
as a conventional denture with a flange.
This will aid transition to the final fixed
prosthesis.
The second paper in this series
will discuss the clinical and laboratory
stages necessary to construct a successful
immediate denture.
Figure 6. Exposure of a cover screw due to thin
overlying mucosa.
a b
Figure 7. (a) Gingival contour following placement of a denture with ovate pontics. (b) Ovate pontics
on a denture.
Figure 8. Relined denture over healing
abutments.
Figure 9. Resin-retained bridge over implants.
March 2010 DentalUpdate 91
Prosthodontics
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College of Medical and Dental Sciences
General Dental Practice
MSc (part-time)
With the demanding schedule ol a
practising dentist in mind, this modular
course is taught lor 4 hours per week on
Wednesday alternoons over 3-5 years via
small group interactive teaching. Students
travel lrom all over the country to our easily
accessible, central Birmingham location.
ln addition, limited places are available
on individual modules including
Periodontology, Endodontology,
Management ol the Anxious Patient,
Aesthetic Dentistry, lmplant Theory
and Fixed/Pemovable Prosthodontics.
Designed lor General Dental Practitioners and dentists
working in Primary Dental Care and taught by leading
academics in the held, this programme will enhance your
clinical skills and knowledge and the quality ol patient care.
www.mds.bham.ac.uk
Learn more
To listen to a podcast about
the programme and lor lurther
inlormation including details ol
all modules and how to apply please visit:
www.mds.bham.ac.uk/dentalpractice
or speak to the Programme Director,
Prolessor Trevor Burke on 0121 23? 2?6?
or email l.j.t.burke_bham.ac.uk