Presented by:- Dr.

Mayura Badgujar

Guided by:-Dr. Rajani Dable& Dr .Girish Nazirkar

1.Defination. 2.Types. 3.Indications. 4.Contraindications. 5.Advantages. 6.Disadvantages. 7.Requirements of immediate dentures. 8.Diagnosis and treatment planning. 9.Preimpression procedures. 10.Primary impression. 11.Secondary impression. 12.Jaw relation records. 13.Tooth selection and arrangement of teeth. 14.Insertion procedures. 15.Post insertion care.

a complete or removable partial denture constructed for insertion immediately following the removal of natural teeth-GPT. a dental prosthesis constructed to replace the lost dentition and associated structures of maxilla and mandible and inserted immediately after the removal of remaining natural teeth - Heartwell

1.Conventional or Classic Immediate denture:immediate denture is placed after the removal of natural teeth and after the healing is completed , the denture is relined or refitted to serve as a long term prosthesis. 2.Interim or Transitional Immediate denture:immediate denture is made after the removal of natural teeth and after the healing is completed,a second,new complete denture is fabricated as long term prosthesis

Socially active. Prognosis of the remaining teeth is poor. Wishes to retain natural appearance with minimal bone loss. Good general health prognosis. Available time and can afford multiple visits as well as the expenses.

Patient is unavailable for appointment or financially underprivileged. Patient is in debilitated condition. Systemic condition preclude multiple extractions. Emotionally disturbed or diminished mental capacity. Indifferent /uncooperative patients. Patient with extensive bone loss.

Maintenance of patients appearance because there is no edentulous period. Denture acts as a bandage or a splint over the extraction site ,as well as promotes healing. Circumoral support,muscle tone,vertical dimension of occlusion,jaw relationship and face height can be maintained. Regaining of adequate function by the pateint. Less post-operative pain and swelling. Patients psychological and social well-being is preserved.

Procedures are time consuming and precise thus increased costing is unavoidable. Anterior ridge undercut due to presence of teeth may interfere with impression procedures. Esthetic result cannot be evaluated. Functional activities are likely to be impaired temporarily. Presence of different numbers of remaining teeth in various location may lead to incorrect recording of the centric relation.

Should be compatible with surrounding oral tissue. Should restore the masticatory efficiency within limits. Esthetically it should be acceptable. Function in harmony with the activity necessary for speech, respiration and deglutition. Preservation of remaining structures.

REASONS FOR IMMEDIATE REPLACEMENTS

Physical factors

Physiological factors

Psychological factors

PHYSICAL FACTORS
Prevents disuse atrophy of the bony base Provides favourable trabeculation of the repairing bone Prevents possible damage to the ligaments surrounding TMJ abnormal neuromuscular pattern in absence of dentures

PHSYIOLOGICAL REASONS
When the teeth are removed, the beautifully effective teamwork between the various parts of stomatognathic system is broken up abnormal functioning of the mouth and mandible. Impaired communication. Abnormal deglutition

PSYCHOLOGICAL REASONS
Humiliation. Adverse subjective reactions minimized by immediate substitution.

Diagnostic procedures include:1.Patient examination:-local factors studied using x-rays , visual and digital examination, accurately articulated casts. 2.Consultation interview:- patients expectations , mental attitude , systemic status , past dental history.

Patients mental attitude:

The best for immediate denture is the philosophical type. A careful explanation to the patient of the limitations of immediate denture service should always be given.

Systemic status
Any systemic complications that adversely affects the formation of the essential components of healing and of tissue regeneration, both hard and soft , will offer a poor prognosis for the immediate complete denture therapy.

Past dental history:

Hemorrhagic tendencies and allergic reaction to local anesthesia when the teeth are extracted must be evaluated.

Local factors
Condition of the teeth to be extracted

Position of the teeth:-especially of the maxillary arch

Position of any foreign bodies

Presence of bony or tissue undercuts that must be reduced or eliminated.

exostosis

Bone loss adjacent to the remaining teeth. Muscle co-ordination.

Plan two stage extraction:-removing the posterior teeth first ,allowing it to heal for a short time , usually 3 to 4 weeks , before the preliminary impression is made. All the posteriors are extracted except unilateral or bilateral premolars. Sometimes occlusal adjustments of the remaining natural teeth is indicated. Any other required hard and soft tissue operation is also done in the first surgical visit.

Impression are made in irreversible hydrocolloid(alginate) in stock metal or plastic trays.

Good impression of vestibular areas

Peripheral Roll on Cast as a result of capturing the area well with the impression

First Step : Get a good alginate impression and cast

Impression Capturing Peripheral Rolls and Lateral Throat Form

Resulting Cast Showing Vestibular Area

The Lower Alginate Impression & Resulting Cast

Single custom tray Split impression technique

Posterior segment Anterior segment

Stock tray Putty index

Split impression tray using alginate . Split impression tray using putty- index technique.

Short-comings
Small oral opening Proclined maxillary anterior teeth Anatomic accuracy of vestibule

Tray extends to and contacts incisal edge of anterior teeth

Cast trimming guidelines:In case of normal periodontal condition rule of thirds is followed. Advanced periodontal deterioration - x-rays and probing measurements.

Step 1

Step 2

Remove tooth at gingival level

Recess Socket 1 mm

Step 3

Step 4

Labial edge recess to incisal third mark

Mid-point recess to midwidth labial cut

Step 4

Step 5

Round over lingual aspect of socket

Step 5

Step 6

Round off labial to middle third, sand smooth

Trimmed areas sanded smooth Avoid removing incisive papilla

Form ,size ,shade selection is easily done using patients natural teeth. Arrangement of anterior teeth:a .Duplication of patients natural teeth arrangement. b.Arrangement with maximum cosmetic result.

SURGICAL TEMPLATE
It is a thin ,transparent form duplicating the tissue surface of an

immediate denture and is used as a guide for surgically shaping

the alveolar process (Farmer,1983)

Surgery and immediate denture Insertion

The dentist extracts the remaining teeth taking care to preserve labial cortical plate. The surgical template is used as a guide bone trimming adequately until the template seats uniformly and completely. In cases of simple extractions without alveoplasty, the denture is inserted after digital compression of the socket walls. In cases of alveolectomy the dentures are inserted after mucosal margins are sutured. Gross occlusal error is corrected .

Post-insertion instructions:Not to remove for first 24 hrs. Premature removal of the dentures could make its reinsertion impossible for 3-4 days or until reduction of swelling. Avoid vigorous mouth washing. Avoid hot food& drinks , alcohol. Analgesics are prescribed. Soft /Liquid diet.

EXAMINATION AFTER 24 HOURS

Irrigated with warm saline. Check tissues for sore spots & relieve them. Gross occlusal discrepancy is corrected. Reevaluate for retention. Mouthwash prescribed 3-4 times/day. Patients are encouraged to use dentures for mastication- helps to improve blood supply and assists rapid healing.

EXAMINATION AFTER ONE WEEK

Suture removal . Necessary denture adjustments. Patient must be encouraged for regular examination.

FURTHER FOLLOW UP RATE

During first post insertion month, the patient is seen on regular or else weekly as required for sore spot adjustments. After 2 weeks remount the dentures on the articulator and refinement of occlusion is done.

SUBSEQUENT SERVICE FOR IMMEDIATE DENTURE PATIENT

After the sore spots are eliminated and the tissues have healed, a recall programme for changing the tissue conditioner liner is organized. Research has shown that complete socket calcification is complete at 8 to 12 months following tooth extraction and the bone volume of the ridge is reduced 20 to 30% during first 12 months. After the early rapid resorption (3 months), the subsequent change in contour of the alveolar bone will necessitate correction of the fitting surface of the denture (relining/rebasing) at intervals. Patients with IIDs can have their second denture started within 3 6 months if desired.

CONCLUSION
They fulfill an important role in today's treatment modalities by providing the patient with esthetics, function & psychological support after extraction & during healing phase . The technique is more demanding than regular CD for both patient & dentist . If the patient is prepared & appropriate type of immediate denture is selected the resulting prosthesis can be a success.

26-004. Jerbi, F.C. Trimming the Cast in the Construction of Immediate Dentures. J Prosthet Dent 16: 1047-1053,1966. Rule of Thirds: Kelly Divides the facial aspect of the alveolar ridge into three equal bands of space between the gingival line and the depth of the vestibular space.

One appointment construction of an immediate transitional complete denture using visible light-cured resin - JPD 1992 Vol 68 Used for physically compromised individuals.

Trial anterior artificial tooth arrangement for an immediate denture patient : A clinical report - JPD 2000 Vol 84

Bibliography
BOUCHER,S prosthodontic treatment for edentulous patients 9th edition & 11th edition . CHARLES HEARTWELL & ARTHUR O RAHN Syllabus of complete dentures 4th edition. SHELDON WINKLER Essentials of complete dentures 2nd edition. RUDD & MURROW Dental lab procedures , complete dentures vol 1. ZARB, BOLENDER Prosthodontic treatment for edentulous patients . Journal of prosthetic dentistry 1966 vol 26 Journal of prosthetic dentistry 1992 vol 67,68 Journal of prosthetic dentistry 2000 vol 84