1. IMMEDIATE COMPLETE DENTURES

2. 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

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

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

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

6. Impression Techniques

7. 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.

8. 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

9. 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)

10. 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

11. DUPLICATING THE PATIENT'S NATURAL TEETH

12. 1-
Preliminary alginate impressions poured twice (once with teeth in wax and once in stone)

13. 2-
Anterior tray is formed over a wax blockout present no undercuts, and a strong wire handle is attached

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

15. All material above the dotted line can be trimmed away

17. 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

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

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

20. 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

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

22. 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

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

24. 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.

25. 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.

26. 1- Immediate Denture Final Impression
Single tray with modeling compound
and rubber base- most commonly used
Use wax to block out
large interdental
embrasures

27. 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.

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

29. 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

30. 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.

31. 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

32. 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

33. 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

34. Putty-Index Technique

35. Putty-Index Technique

36. Putty-Index Technique

37. Split Impression Tray- Putty-Index Technique

38. Maxillomandibular Relation Records
3rd Appointment:
Maxillomandibular Relation Records

39. 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

40. 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

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

42. 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

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

44. 3rd Appointment:
Maxillomandibular Relation Records
1. Face bow record

45. 3rd Appointment: Maxillomandibular Relation Records Evaluate the VDO
Face bow record
Evaluate the VDO

46. 3rd Appointment: Maxillomandibular Relation Records Evaluate the VDO
Face bow record
Evaluate the VDO

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

48. 3rd Appointment: Maxillomandibular Relation Records CR record
Face bow record
Evaluate the VDO
CR record
Adequate teeth to support
the bite registration material

49. 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

50. 3rd Appointment: Maxillomandibular Relation Records Protrusive record
Face bow record
Evaluate the VDO
CR record
Protrusive record

51. 3rd Appointment: Maxillomandibular Relation Records Mark and transfer
Face bow record
Evaluate the VDO
CR record
Protrusive record
Mark and transfer
the postpalatal
seal

52. 3- Maxillo-mandibular relation record
4- Selecting & Arranging anterior teeth:

53. 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.”

54. 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

55. 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.

56. You Have To Work Hard To Get A Good Mark

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

58. And Arranging anterior teeth
Selecting
And Arranging anterior teeth

59. 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

60. 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

61. Different Methods For Cast Trimming

62. 1-
The teeth are removed from the cast in a manner that They are not cut below the gingival crest

63. 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

64. 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

65. 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

66. 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

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

68. 15 mm
Complete the anterior
teeth setup

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

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

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

72. 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

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

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

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

76. 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

77. 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

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

79. Post Insertion Management
Remount when:
Healing edema resolved
Traumatized mucosal lesions healed
Usually within days

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

81. When you do your best God does the rest

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

83. 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.

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

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

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

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

88. Disadvantages of Alveoloplasty
Accelerates bone loss
Increased post-operative pain

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

90. Surgical techniques include:
Simple Excision
Cryosurgery
Electrosurgery