In what stages should you do full upper or full lower immediate dentures? Why?
- Extract posterior teeth first
- Wait a minimum of two months preferably 3 months for healing
- Proceed with immediate dentures
- Multirooted teeth have the most bone resorption due to being larger–> waiting for bone remodelling/healing can allow a better fit
- Less teeth to be remoed at final visit
- Allows pt to adapt to partial (easier to adapt to) before going on to fulls
What advantages are there in making immediate dentures?
To dentist:
- Jaw relation easier to obtain vs. extraction then dentures after as teeth are still present
- Tooth selection may be assisted + tooth arrangement guided by remaining teeth
- Patient cooperation generally good (as they like the idea of not having to go around without teeth)
To the patient:
- Post op haemorrhage control
- Protection for blood clot (denture acts as a bandage)
- Ridge resorption influenced
- Denture adaptation better vs having a period of no denture
- Psychological
- Natural appearance
- Reduces risk of disruption to normal speech
What sorts of cases can immediates not be done?
- Tipped (can’t be used to design denture)
- Very loose teeth (difficult to take impressions)
- Severe perio
- Bad position so can’t take bite records
What are the disadvantages to immediate dentures?
Dentist:
- Can’t do try in of teeth to replace extracted teeth (as these are still present)
- Insertion more complex (extracting teeth as well as inserting denture)
Patient:
- More post insertion problems (e.g. tender tissues)
- Need for temporary linings or adhesives due to resorption and denture coming loose
- Need for relining/rebasing after 6 months and in some cases new dentures may be needed
- Treatment over a long period of time (especially from first posterior extraction)
- Numerous visits
- Require time off work for exo’s (about 1 week)
What are the different classes of immediate dentures? When are they used?
Class 1: open face
- No labial flange (basically no base labially so you just seee the gingiva)
- Allows anterior teeth to be set a few mm into socket (so looks more natural)
- Not used for posterior teeth, as full flange is always used here
- Used for prominent anterior ridges of bone where undercut makes it difficult to get a flange underneath
- Only used for full uppers (not with partials or full lowers)
Class 2: Normal labial flange
2A: closed face without alveolar surgery (type normally used)
2B: closed face with alveolar surgery (reduce size of anterior alveolus to allow for comfortable insertion, eg. severe class 2 div 1 to allow teeth to set straighter)
-Labial flange is kept as thin as possible
What are some advantages and disadvantages of open face dentures?
- Good aesthetics
- Can be used with large labial undercut, tight upper lip (can’t bulge lip outward with flange), high smile line
- Gap may appear with healing and bone resorption between teeth and ridge
- Require good retentive and support factors
- Irregular scalloped ridge may compromise aesthetics
- Weaker
- Can’t make much change in appearance (as artificial teeth must be positioned in natural tooth sockets)
- Can only be used with full uppers not partials or full lowers
Whaat are the advantages and disadvantages of closed face immediate dentures?
Adv:
- Flange enhances retention
- Stronger
- Possible to alter position of artificial teeth
- Note: labial flange kept as thin as possible
What surgery is generally used for class 2A?
Interseptal alveolotomy:
- Extract canines first (if 3 to 3 left) as less chance to fracture labial plate, then incisors
- Remove interdental septa of bone
- Creates trough between inner and outer bony plates
- Remove wedges of bone distal to canines (vertical cut through buccal plate at midline and most distal sockets)
- Gently elevate labial plate outwards to fracture high up
- Manually press bone posteriorly (basically squash it backwards as removing the teeth gives you the space to do so
- Suture
- Test fit with clear acrylic surgical template
- Place dentures
What sort of education should be given to the pt re. immediate dentures?
- Often temporary
- If work out re-line after 6 months
- Require follow up placements of regular linings
- However may need new denture altogether
What are the post op instructions for immediate dentures?
- Keep in for 24 hours
- Minimal and gentle rinsing
- Painkillers every 4hrs as necessary
- Eat soft food
- Remove after 24 hours
- Warm salt water and garglee
- Clean and brush denture
- Return for post insertion check
What to look for at post insertion check?
Rinse with saline
Checking sore spots with pressure indicating paste
Adjust if necessary
What are the steps to immediate dentures?
Hx, exam, Tmt plan, Shade selection (shape left to technician) + primary impressions
- Pour primary models + construct CCA special tray + record bases (if necessary)
- Master impression + OPG + occlusal record (if necessary)
- Pour up master cast
- Survey + design denture + carve palatal seal (you do this)
- Mount primary models on articulator
- Construct wax denture of already missing teeth
- Try in wax denture on patient
- Extend wax denture to include teeth to be extracted/replaced (at this stage can use green wax as it is thinner)
- Present this to patient and check satisfaction
- Construct final denture
- Check completed denture: remove excess sockets from fitting surface, remove excess undercuts, make sure no sharp edges or pieces (NB: oral surgery won’t have equipment for adjustment, need to do this before)
- Oral surg consultation (book appointment)
- Present case notes, MHx, mounted models, OPG, any pre-prosthetic treatment required
- Extraction of teeth
- Insertion
- Post -op instructions
Review -24 hours -7 days Depending on how patinet goes: -1 month 3 months 6 months
How are teeth added to acrylic dentures?
- Take alginate impression over top of existing partial denture
- Ask laboratory to add the tooth
- May need to ask them to move clasps
What should you consider if patient already has acrylic denture?
- Can convert their current acrylic to a temporary immediate full
- Patient is already used to the feel of current dentures
What is the issue of putting immediate dentures in a patient with poor perio health? what can you do to accomodate this?
- Bone may collapse after extraction
- Cast may need to be trimmed to accomodate this
What should you inform patients for immediate dentures?
- Cost
- Procedure
- Will require re-line after 6 months if all goes well
- May require more than one reline, and sometimes new dentures necessary
- Benefits of immediate denture: can help with haemostasis and protect blood clot
T/F
Using a facebow while mounting on Dentatus articulator will lead to greater accuracy in creating immediate dentures.
F
What is a precaution when using wax base and rim for bite records?
-Careful heat does not distort wax base
How can cheek biting be fixed?
- Reset teeth more posteriorly
- Reset uppers more buccally
Why is the master model smoothed to remove the sockets when creating the final denture?
-So that gingiva heals up to shape of denture without socketing effect–>at this stage the master study cast should mimic shape that you wish the arch to heal up to form
What extra step is needed if surgery is required to adjust the arch size? How is it done and what is the purpose of this step?
Construction of clear acrylic template
- When sending wax denture back with instructions on construction of final denture, inform technician to construct a clear acrylic template
- Technician will take alginate impression of master cast once sockets have been smoothed (thus this impression mimics the shape of the final denture seating surface and thus the shape the arches will heal to)
- From alginate model technician will then pour up study model (again this mimics the final arch shape)
- Technician then use suck down template to create clear acrylic template (just like construction of ortho retainer)
- As the clear template mimics the shape of the final denture, can put this in after extracting teeth–>where it is tight the tissues will blanch thus indicating the need for surgery in the area
*NB: if possible, using pressure indicating paste on the denture and adjusting the denture is preferable to surgical intervention
When can the master cast not be given back to fit the denture on? Why?
- Any full dentures (including immediate fulls)
- To remove cast from denture requires a lot of trimming which results in destruction of cast
What POIG should be given to the patient after insertIon?
- Leave in for 24 hours
- Minimal and gental rinsing
- Painkilelrs every 4 hrs as necessary
- Eat soft food
On patient’s next visit in 24 hr review:
- Remove after 24 hours (you do this on patient’s next visit, and clean away any blood clots from gums)
- Warm salt water gargle: mouthwash
- Clean and brush denture (operator adjust denture as necessary)
- Return for post insertion check in 7 days
T/F
You need to adjust the denture until nothing shows through pressure indicating paste
F
Need to also consider that gingiva is swollen and inflamed
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Treatment Plan + Denture Design (clinic)17
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Tooth Preparation5
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Master Impressions (Clinic) + Master Cast and working cast (Lab)6
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-0
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Base and Rim (lab) + Occlusal Records (clinic)3
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-0
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Teeth fit in (Lab) + Trial (Clinic)17
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Frame Construction0
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Trial Frame2
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Materials5
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Set up teeth (lab) + Trial Frame and Teeth2
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Immediate Dentures42
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Relining and Rebasing20
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Lab Stages_Final Denture Processing/Fabrication5
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Copy Dentures8
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Chrome8
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Clasps0
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Acrylic3
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Valplast2
