IMMEDIATE COMPLETE DENTURES

Immediate Denture Pre-extraction Records Master Impression Maxillo-mandibular Relation Records Cast trimming Setting of teeth Try-in of posterior teeth Surgical template Extraction of anterior teeth Delivery Post Insertion Management

Pre-extraction Records A diagram of the anterior teeth indicating shading, restorations, etching, and so on Profile wire record and facial measurements

Pre-extraction Records A hand-drawn chart for the locations of stains in the anterior teeth

The vertical overlap may be measured in this manner to serve as a pre-extraction record of the vertical relation

Impression Techniques

Fundamentals for impression making: Area coverage Borders Valve seal without interference of function Accurate adaptation of the underlying tissues without injurious displacement. Preserve the maximum ridge bulk.

Immediate Denture Preliminary Impression: 1st appt: Preliminary impression-Alginate & Stock Tray Armamentarium: Dentulous stock tray Soft peripheral wax Alginate and adhesive Water measure, rubber mixing bowl and alginate spatula

Immediate Denture Preliminary Impression: 1st appt: Preliminary impression-Alginate & Stock Tray Select proper size of stock tray—3-4mm space for the alginate Use rope wax to ensure proper extension Must include entire arch ( vestibules,tuberosities, retromolar pads)

Immediate Denture Preliminary Impression: 1st appt: Preliminary impression-Alginate & Stock Tray Add the soft peripheral wax onto the maxillary tray to provide a tissue stop Avoid gagging reflex resulted from excessive alginate

DUPLICATING THE PATIENT'S NATURAL TEETH

1- Preliminary alginate impressions poured twice (once with teeth in wax and once in stone)

2- Anterior tray is formed over a wax blockout present no undercuts, and a strong wire handle is attached

The anterior tray is not perforated and no adhesive is used because the impression material will have to be removed and replaced later

All material above the dotted line can be trimmed away

ID Final Impression: Immediate Denture Impression: 1st appt: Preliminary impression 2nd appt: Final impression Fabrication of custom tray ID Final Impression: Single custom tray technique: most commonly used Two-piece tray technique: for very divergent teeth or severe ridge undercuts

Immediate Dentures Impression Techniques 2nd Appointment: Immediate Dentures Impression Techniques

Immediate Dentures Impression Techniques Single custom tray Split impression technique Posterior segment Anterior segment Stock tray Putty index

1. Outline the extension of the tray on the cast Fabrication of Custom Tray for Single Tray Technique 1. Outline the extension of the tray on the cast 2-3mm short of the vestibules to permits accurate border molding Cover the retromolar pads & tuberosities Provide extra clearance for any frenum

2. Block-out soft, hard tissue undercut areas. Fabrication of Custom Tray for Single Tray Technique 2. Block-out soft, hard tissue undercut areas.

Fabrication of Custom Tray for Single Tray Technique 3- Apply wax spacer based on your selected impression material Elastomeric Material: 2 mm Alginate: minimum 3-4 mm

Tray Resin Manipulation Check Consistency Sandy Stage Mixing Stringy Dough Completed Tray

1- Fabrication of Custom Tray for Single Tray Technique Carefully remove all wax from the tissue surface of the tray with hot water. The impression materials we use will not stick to the wax and there is risk of the impression material separating from the tray distorting the impression.

Fabrication of Custom Tray for Single Tray Technique Fabricate the custom tray according to the marked outlines with tray acrylic 24 hrs before the master impression appt. Remove the wax spacer from the tray. Extra relieve the teeth portion of the tray to allow ease of insertion and removal.

1- Immediate Denture Final Impression Single tray with modeling compound and rubber base- most commonly used Use wax to block out large interdental embrasures

Boxing the Final Impression Made With Rubber Base Material Mark Denture Base Extensions The mark should be placed 3-4 mm above the peripheral roll.

Boxing the Final Impression Made With Rubber Base Material Apply sticky wax to marked border.

Boxing the Final Impression Made With Rubber Base Material Placement of Wax Boxing Strips To Beaded Areas Soft Tissue Undercut And Tongue Areas Beading Wax To All Borders

Boxing the Final Impression Made With Rubber Base Material Box and Pour Master Cast Carefully remove salivary residues and dry the cast. Polysulfide casts need to be poured within 30 minutes.

2- Immediate Denture Final Impression Single tray with alginate is only used when considerable tooth misalignment or great mobility present. Perforate the custom tray for the mechanical retention of alginate

Immediate Denture Final Impression Single tray with alginate Indications: For considerable malalignment or excessive mobility Precautions: 1. Require more vigorous border movements. 2. Must be poured immediately 3. Two-stage pour technique for master cast

Immediate Denture Impression: 1st appt: Preliminary impression 2nd appt: Final impression Single tray technique Two-piece tray technique: for very divergent teeth or severe ridge undercuts

Putty-Index Technique

Putty-Index Technique

Putty-Index Technique

Split Impression Tray- Putty-Index Technique

Maxillomandibular Relation Records 3rd Appointment: Maxillomandibular Relation Records

The centric occluding relation is recorded at a proper occlusal vertical dimension guided by retained occlusal stops that will be extracted after making this record

The normal vertical overlap is maintained by the molar teeth One should not rely on their occlusal relation for vertical dimension, because the overlap may well be greater than that which existed previous to the extraction of the posterior teeth

The occlusion rims are the only reliable index of inter-arch distance in an immediate denture.

Record Base & Wax Rim Rigidity Accurate fit Comfort Extend the record base onto the proximal, palatal/lingual surfaces of the teeth to enhance the retention, stability, and support of the record base

Selectively adding the wire clasps can improve the retention & stability of the record base for accurate jaw record (or a denture adhesive)

3rd Appointment: Maxillomandibular Relation Records 1. Face bow record

3rd Appointment: Maxillomandibular Relation Records Evaluate the VDO Face bow record Evaluate the VDO

3rd Appointment: Maxillomandibular Relation Records Evaluate the VDO Face bow record Evaluate the VDO

Vertical Dimension of Occlusion = Vertical Dimension of Rest – Interocclusal Space Average Interocclusal Space is 2-4mm

3rd Appointment: Maxillomandibular Relation Records CR record Face bow record Evaluate the VDO CR record Adequate teeth to support the bite registration material

3rd Appointment: Maxillomandibular Relation Records CR record Face bow record Evaluate the VDO CR record Inadequate teeth to support the bite registration material Record base and wax rim is necessary for CR record

3rd Appointment: Maxillomandibular Relation Records Protrusive record Face bow record Evaluate the VDO CR record Protrusive record

3rd Appointment: Maxillomandibular Relation Records Mark and transfer Face bow record Evaluate the VDO CR record Protrusive record Mark and transfer the postpalatal seal

3- Maxillo-mandibular relation record 4- Selecting & Arranging anterior teeth:

Special Lab PR. for ICD For tooth set-up: Anterior teeth: “Cut anterior teeth off cast at gingival level.” Set anterior teeth on cast for patient viewing.” Posterior teeth: “Arrange posterior teeth on record base in (balanced/monoplane/lingualized) occlusion and wax-up for try-in evaluation.”

3- Maxillo-mandibular relation record 4- Selecting & Arranging anterior teeth: At this stage there are two opinions: School 1: To do processing, finishing, polishing & delivery of the partial denture with st. st. wrought wire clasp, & ask the patient to be accustomed to the new denture & recall after 2 4 weeks, after this, extraction of the remaining anterior teeth is done & attachment of the artifical acylic resin ant. Teeth is performed to the already finished partial denture

4-Selecting & Arranging anterior teeth: School 2: We complete our stages normally & perform selecting of anterior teeth after removal from the plaster cast & the patient got a complete immediate denture delivered with the anterior teeth in one time.

You Have To Work Hard To Get A Good Mark

Immediate Denture Laboratory Project Setup the anterior teeth Setup the posterior teeth

And Arranging anterior teeth Selecting And Arranging anterior teeth

Use a sharp pencil to mark the gingival outline buccally and lingually Preserve the incisal edge position and tooth angulation information prior removal of stone teeth. Use a sharp pencil to mark the gingival outline buccally and lingually

a horizontal line which is 15 mm apical to the Preserve the incisal edge position and tooth angulation information prior removal of stone teeth. Use Boley gauge to mark a horizontal line which is 15 mm apical to the incisal edge of each tooth 15 mm Then mark the long axis of each tooth

Different Methods For Cast Trimming

1- The teeth are removed from the cast in a manner that They are not cut below the gingival crest

2mm The terminal 5 mm of gingiva should be trimmed in the manner shown above so that the denture gingiva may not appear too thick

2- Place a subgingival esthetic convenience groove at the labial gingival sulcus to aid in esthetic positioning of the denture teeth Esthetic convenience groove Remove stone tooth without obliterating the gingival outline mark and shape into a gentle convex shape

Shape the stone extraction site into gentle convex Create esthetic convenience groove Modify the undersurface of denture tooth Until the desired incisal edge position is reproduced in the setup

3-The Alternating Tooth Setup Technique Trim and set only one anterior tooth at a time Alternate from side to side to keep natural neighboring tooth as angulation,length, and contour orientation

Alternating Tooth Setup Technique Reshape the cervical ridge laps of the denture teeth to set them back to the original incisal edges, angulations, & contours

15 mm Complete the anterior teeth setup

Setting-up of Anterior teeth: The study model can be used to compare the tooth arrangement incorporated in the replacement teeth.

Immediate Denture Laboratory Project Setup the anterior teeth Setup the posterior teeth

Mark the occlusal contacts with articulating paper, remove the high contacts until the pin touches the table

Continue the posterior teeth setup on pt’s R’t side Follow the same principle to customize the occlusal surfaces of the denture teeth to obtain the best possible occlusal contacts For pt’s R’t side set 2nd molar at the first molar position result in better occlusal contacts. Spacing and trimming the distal of #4 are anticipated to get the best centric contacts

Today’s goal: Complete the posterior teeth setup that obtain solid bilateral even centric contacts

ICD Try-In Sectional wax-up Anterior segment for patient viewing Posterior segment for check record

ICD Try-In Posterior “removable” section used for: Confirmation of horizontal and vertical relationships Tooth shade

Post Extraction Instructions Do not remove denture Keep head elevated Small amounts of blood in saliva is normal Diet: soft and warm, not hot Avoid: Spitting, rinsing Strenuous activity Alcohol, smoking

Post Insertion Management Recall next day Remove denture Apply topical anesthetic to traumatized mucosa Locate over extensions and pressure areas and adjust Reappoint 1 week

Post Insertion Management Healing, shrinkage, resorption Patient remount Relines Interim – within first 12 months Definitive – 12 months +

Post Insertion Management Remount when: Healing edema resolved Traumatized mucosal lesions healed Usually within 14-21 days

Post Insertion Management Reline Short term – tissue conditioners Mid-term – intermediate direct liners Long-term – standard reline protocol

When you do your best God does the rest

Immediate C. D. Construction Procedures There are 2 main methods of construction A Without surgery (No Alveoloplasty) B with surgery (surgical alveoloplasty)

Unless it is necessary, one should avoid alveolectomy in the anterior region. If it must be performed because of marked undercuts, a transparent tray should be prepared for use during the surgical procedures. It must be adapted to the cast after the necessary - cast alveolectomy" has been performed.

Alveoloplasty “The recontouring or reduction of a portion of the alveolar process”

Alveoloplasty Conservative contouring of the Alveolar process, In Preparation for Immediate Or Future Denture construction.

Goals of alveoloplasty: Eliminate bony projections that result in undercuts Improve the path of insertion of the prosthesis Eliminate bony sources of irritation

Goals: Increase space between the residual ridges (inter arch space I.R.S) Improve denture stability by removal of excess tissue

Disadvantages of Alveoloplasty Accelerates bone loss Increased post-operative pain

Types of Alveoloplasty: Simple alveoloplasty Buccal or labial cortical reduction Intraseptal alveolectomy and cortical plate in-fracture - Buccal or Labial Cortical Recontouring

Surgical techniques include: Simple Excision Cryosurgery Electrosurgery