There are several advantages of an immediate denture. The most important factor is that you will never need to appear in public without teeth. ... When an immediate denture is inserted at the time of extraction, it will act as a Band-Aid to protect the tissues and reduce bleeding.

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DR.NOOR ADDEEN ABO ARSHEED
Clinical Lecturer and Specialist Prosthodontist
Head of LUC Dental Center
BDS, HD Prostho, MDS , DOI (Germany)
NBDE (USA) , FICOI (USA).
LINCOLN UNIVERSITY COLLEGE
Facebook.com/AboarsheedNasa

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IMMEDIATE COMPLETE
DENTURES

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After the extraction of teeth the edentulous ridges undergo bone resorption and
remodelling, as well as soft tissue changes.
The greatest changes are observed in the first few months after extraction after
which it usually slows down.
Denture construction is often delayed to allow for proper healing of the tissues
and bone remodelling.
However, some patients cannot afford to be seen in public without teeth for the
period required for this process.
Such patients are provided with immediate replacement of teeth after total
extraction. Immediate dentures reduce the psychological trauma and shame
associated with the loss of teeth.

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DEFINITION
1. Any removable dental prosthesis
fabricated for placement immediately
following the removal of a natural
tooth/teeth (GPT-8).
2. Immediate dentures are dentures
constructed before all the remaining teeth
have been removed and inserted
immediately after the removal of the
remaining teeth (Boucher)

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TYPES
There are currently two types of immediate
dentures:
1. Conventional immediate denture (CID)
2. Interim immediate denture (IID)

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Conventional immediate denture
1- Used as a long term prosthesis after the healing period by relining it.
2- Teeth extracted in two surgical phases - posterior teeth extracted
initially, followed by the anteriors.
3- indicated if patient can function without posterior teeth for 3-4 weeks
as the posterior ridge heals.

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Interim immediate denture
1- Replaced by a new definitive prosthesis after the healing
period
2- All teeth - anterior and posterior extracted in single visit.
3- Indicated if a patient is unwilling to function without any teeth.

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INDICATIONS
Any person whose remaining teeth are
indicated for extraction is a potential
candidate for an immediate denture.
However, such a candidate must be
physically and mentally prepared to
undergo the increased number of visits
to the dentist, as well as the greater
cost.

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Cost and appointments
The immediate denture requires more
appointments than a conventional denture.
Because of the rapid tissue changes the
denture would need frequent adjustment
and occasional relining. Soon the changes
are so great that an entirely new denture
has to be made within a short span of time.
All this makes the immediate denture far
more expensive than the conventional
denture.

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CONTRAINDICATIONS
1
Basically any patient who
is not fit to undergo
multiple extraction.
2
In acute periapical or
periodontal infection
3
Debilitating diseases.
4
Patients incapable of
showing responsibility
towards the treatment, .

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CONTRAINDICATIONS
5
Extensive bone loss adjacent to
remaining teeth. (This would
indicate that loss of fit and
occlusion expected during the
treatment)

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ADVANTAGES
1. The primary advantage of the immediate denture is the preservation of
esthetics as there is little or no change in facial appearance. There is no
edentulous period.
2. The patient learns to manipulate the dentures while recovering from the
surgery Thus the patient regains oral functions faster.
3. Serves as a splint. .

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ADVANTAGES
4. Nutrition is maintained.
5. It is more compatible with the oral surroundings as the tongue, lips
and cheeks have not yet changed position.
6. The natural teeth aid in vertical relation positioning and selecting
artificial teeth.

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ADVANTAGES
7. Less TMJ disturbance.
8. It aids in contouring the healing residual ridge.
9. Psychological benefit. The patient is spared the inconvenience
and stress of an edentulous period.
10. Easy to refit by relining.

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DISADVANTAGES
1
The technique is
precise and time
consuming.
2
More appointments
are needed.
3
More costly
because of the
increased chair
time.
4
There is no opportunity for
try-in of anterior teeth.

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DISADVANTAGES
5
Undercuts can be severe
and can interfere with
seating and removal

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EXAMINATIONAND
TREATMENT PLANNING
The examination should be done to determine the suitability of the
patient for immediate dentures and to determine any influencing
factors:
• To determine mental attitude.
• To find out local or systemic factors that may contraindicate
surgery or make extraction difficult.

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EXAMINATIONAND
TREATMENT PLANNING
• Roentgenograms: Panoramic radiograph are examined for
hypercementosis, multiple or curved roots, or other pathologies that can
cause problems during extraction and subsequent treatment.
• Facebow mounted articulated casts are also used to aid treatment
planning.
• A scaling is done if severe deposits of calculus is present. This helps to
reduce the inflammation and improves healing and accuracy.

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PREATMENT RECORDS
1. Photographic records: Intraoral
and extraoral photographs aid in
reconstruction.
2. The existing vertical dimension is
recorded and noted down.

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TREATMENT OPTIONS
SINGLE STAGE
The single stage treatment is reserved for patients having extremely
poor oral health.
All teeth are extracted in one sitting. These dentures are currently
referred to as interim immediate denture (IID).
The disadvantage is that, it is less accurate.
• Two Stage or
• Single stage surgical procedures.

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TRETMENT OPTIONS
TWO STAGE
Posterior teeth (excepting premolars) are removed in the first stage. After 4 – 6
Weeks, the anterior teeth are extracted and the dentures inserted. The dentures
with this technique are referred to as conventional immediate dentures (CID)
and is the widely preferred method.
• Two Stage or
• Single stage surgical procedures.

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TRETMENT OPTIONS
IMPRESSIONS
Primary impression
The primary impression is made 4-6 weeks after extraction of the posterior
teeth
It is made with alginate in a stock tray for the purpose of constructing
a custom tray.

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TRETMENT OPTIONS
IMPRESSIONS
Final impression
There are two techniques for making the final impression
First technique : A custom tray is made which covers the edentulous ridges and the anterior
teeth.
Stops are provided on the incisal edges anteriorly and in the buccal shelf and palatal seal areas
posteriorly.
The borders are molded and a final impression is made using rubber base (elastomers).

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TRETMENT OPTIONS
IMPRESSIONS
Final impression
Second technique : An acrylic tray is adapted to the edentulous region only (it slightly covers
the lingual surface of anterior teeth). Stops are placed as in the first technique except
that the anterior stop is on the lingual surface of the anterior teeth.

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TRETMENT OPTIONS
Occlusal ramps can be made with impression compound. These act as handles and
also assure positive seating of the alginate impression.
The borders are molded and a zinc oxide eugenol impression is made of the
edentulous region.
Alginate is loaded in a stock tray
The tray is seated first posteriorly and then anteriorly (to prevent displacement of the
zinc oxide eugenol impression).

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TRETMENT OPTIONS
MAXILLOMANDIBULAR RECORDS
Jaw relations are determined and recorded using occlusal rims.
Protrusive and lateral records are also made to adjust condylar
guidances. The casts are mounted using a face bow transfer (to
balance the occlusion).

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TRETMENT OPTIONS
ARRANGEMENT OF POSTERIOR TEETH AND TRY IN
The posterior teeth are arranged first and a trial is done. Since the
anterior teeth have not yet been extracted, such a trial would be useful
only to check the occlusion and the vertical relation.

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TRETMENT OPTIONS
ARRANGEMENT OF ANTERIOR TEETH
There are two methods for arranging the anterior teeth.
1. Alternate removal and arrangement of teeth
2. Arrangement of one side and then the other

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TRETMENT OPTIONS
First method
Alternate teeth are numbered, cut away (starting with the central incisor).
The labial root portion of the teeth are excavated to a depth of approximately
1 mm on the labial side and flush with the gingival margin on the lingual side.
As the stone teeth are cut away, prosthetic teeth are set in its place.
Advantage: Good duplication of the position of teeth, especially if Original .
or irregularities have to be duplicated (except of course if the patient does not
wish the original arrangement to be duplicated exactly).

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TRETMENT OPTIONS
Second method
A line is drawn corresponding to the sulcus depth (labial - 3 mm, palatal -
2 mm).
The teeth are removed from one half of the cast, retaining the other side
guide.
The cast is trimmed to the marked gingival line.
Occlusion
Acrylic teeth are preferred. The occlusion is balanced

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TRETMENT OPTIONS
WAXING, FLASKlNG AND PROCESSING
The labial border is thickly waxed (thin borders may cut the swollen post surgical
tissues).
The denture is then flasked and cured In the usual manner.
After processing, the denture is returned to the articulator and the centric occlusion
corrected.
Eccentric occlusal errors are not corrected at this stage.it is left for a later period when
the tissues have healed sufficiently.

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TRETMENT OPTIONS
SURGICAL TEMPLATE
A surgical template is a clear acrylic plate used to determine the areas that
interfere with the seating of the immediate denture prosthesis.
It is especially indicated when a lot of bone or tissue trimming is planned or
expected.
Construction The trimmed edentulous cast is duplicated with alginate and a
heat cured Clear acrylic template is constructed. Tin foil is used for
separation. Sodium alginate separating medium can cause cloudiness.
A vacuum formed Clear thermoplastic sheet can also be used.

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Surgical Templates

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SURGERY AND PLACEMENT
The remaining anterior teeth are extracted
Using the template as guide, Surgical trimming of bone and soft tissue is
done (areas of excess pressure is indicated by blanching of the tissues)
until complete seating of the template is achieved.
Excess tissue removal is avoided, as the fit may get affected.

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TEETH REMOVAL

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IMMEDIATE DENTURE INSERTION

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SURGERY AND PLACEMENT
POSTOPERATIVE INSTRUCTIONS
Dentures should not be removed for the first 24 hours following the insertion.
Reseating may be painful because of the swelling. Removal of the dentures may not help alleviate
any pain.
• lce packs may be used to reduce swelling up to 15 minutes per hour.
• A liquid or soft diet is prescribed. The patient is advised not to chew and not to perform any oral
hygiene procedures for 24 hours.
• Smoking should be avoided

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POST PLACEMENT RECALL
The first recall is after 24 hours. The dentures are removed and
the wound irrigated.
Border impingement and pressure spots are relieved.
Pressure spots are indicated by areas of redness.

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POST PLACEMENT RECALL
A second recall is done after 48 hours and the same procedures
are repeated.
The swelling would have subsided. The occlusion can be perfected
now or postponed for up to 2 weeks. Occlusal correction is done
on the articulator after suitable interocclusal records are made.

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POST PLACEMENT RECALL
By around 3 days the swelling should have subsided sufficiently
for the patient to leave the dentures out at night. At this point, the
patient can go on to a more solid but soft diet like soft cooked
vegetables.
The denture should be cleaned several times a day and the patient
is instructed to use warm saline mouth rinses.

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POST PLACEMENT RECALL
the third recall is around 7 days after the denture insertion.
The sutures are removed and the area is again irrigated. Areas of
pressure are relieved.
If a tissue conditioner has been used it should be replaced (tissue
conditioners should not be used for more than a week).

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POST PLACEMENT RECALL
The fourth recall can be done at 3 to 4 weeks after placement.
The tissue conditioner is changed if required.
A clinical remount is used to correct the occlusion on the articulator.
The number of post placement recalls a patient will need depends
on many factors like sensitivity and emotional state of the patient,
rate of resorption, general health, etc.

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FOLLOW UP
After every 3 months, the patient is
recalled to evaluate the fit.
Relining or remaking can be considered
within six months due to changes in the
residual alveolar ridges.
Some studies indicate that post
extraction bone takes from 8 to 12
months to mature and complete
remodeling.

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CONCLUSION
The immediate rehabilitation Of a patient
following total extraction has proved to be a
valuable option in prosthodontic practice.
Unfoortunately, its use is not as widespread
as it Should be.
For some Patients it is absolutely distressing
to stay without teeth even for a single minute.
For such patients and for Other informed
patients, the immediate denture provides a
transition to the edentulous state.
However, the patient should be informed
about the greater cost and frequency of visits
necessary for the successful completion of
the rehabilitation.

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