Immediate Dentures

Question 1

Define immediate denture

Answer 1

denture constructed to replace lost dentition and inserted immediately following extraction of remaining natural teeth

Question 2

Which patients may need immediate dentures? (4)

Answer 2

• perio with many mobile teeth
• generalised neglect - grossly carious teeth/rampant caries, drug induced
• collapsed dentition (overerupted teeth with very little interarch space)
• unaesthetic anteriors with severe bone loss (RPD wont improve appearance without major work to remaining teeth - might not be viable)

Question 3

Immediate dentures: Advantages (4) Disadvantages (2)

Answer 3

• no edentulous period (3m)
• usually less pain and swelling (protect exo sites)
• can masticate food
• immediate appearance improvement

however, some patients not impressed by appearance, may complain of speech problems, masticatory issues, lack of retention and stability etc
- pt has no opportunity to look at/trial aesthetics, lip support, speech etc
- mx denture may have no retention as no posterior seal has been made

Question 4

Clinical steps (6)

Answer 4

1. Alginate impressions for study models (APPT 1)
2. Secondary impressions (APPT 2)
3. Wax occlusal rim (LAB)
4. Jaw relation and shade selection (APPT 3)
5. Lab prescription to remove teeth to be exo’d
6. Exos (APPT 4)
7. Review in few days (APPT 5)

Question 5

Common problems encountered with immediate dentures (5)

Answer 5

• difficulty getting correct VDO
• incorrect CR
• lacks retention
• speech issues, masticatory issues
• aesthetics

Question 5

What to check for following immediate denture insert? (3)

Answer 5

occlusion

retention

relieve any obvious insertion difficulties

Question 6

What is COE-SOFT?

Answer 6

soft lining material may be applied during insert

leave for few mins, take out and trim excess

Question 7

Impression techniques

Answer 7

1. single custom tray (resembles routine custom tray for RPD)
2. split impression technique
   - posterior segment
   - anterior segment
   (only when posteriors not present - ZOE and greenstick w special tray for edentulous ridge, overall alginate for teeth)

Question 8

What is an open tray? what is the procedure for taking impression?

Answer 8

aka open face special or custom tray –> made exposing the teeth

• border moulding w greenstick, ZOE wash, overall aginate in stock tray

Question 9

Use of surgical clear stent

Answer 9

~2mm thick, made to allow for adjustment of bony undercuts - you can see through the stent and where tissue blanching –> remove bone

(note: stent made on dental cast which has been altered to remove undercuts, if model is trimmed of labial boney undercuts, a flanged denture can be used without distorting the upper lip unduly)

Question 10

Gum fitted teeth? pros and cons?

Answer 10

• no labial flange
• flange present posteriorly out of aesthetic zone
• avoids fullness of upper lip
• initally aesthetically pleasing
• but can have problems with retention and denture has no anterior seal