1. Immediate Dentures
Complete or removable partial denture fabricated for placement at the same appointment as extraction of natural teeth

2. Occlusion May be Mutilated
Makes Jaw Relations Difficult

3. OVD, Midline & Incisal Edges May Require Change

4. After Extractions, Prior to Placement

5. Final Result

6. Immediate Complete Denture
Conventional immediate denture
intended to be relined to serve long-term
Interim immediate denture (IID) (transitional):
after healing a second new complete denture is fabricated as a long-term prosthesis (Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, )

7. Advantages Maintenance of
Appearance
Circumoral support
Muscle tone
Occlusal vertical dimension
Jaw relationships
Facial height
Tongue will not spread out as result of tooth loss
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier,

8. Advantages Less postoperative pain & bleeding
extraction sites protected
Pressure from denture base
Easier to duplicate natural tooth shape & position (if desired)
Easier Adaptation
Speech, mastication rarely compromised
Nutrition can be maintained
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier,

9. Disadvantages More challenging to set teeth
Less space for teeth as ridge resorption hasn’t occurred
Alveolar ridge undercuts around remaining teeth may make impressions more difficult
Unstable or inadequate occlusion can make recording centric position difficult
Unstable Occlusion

10. Explanation to Patients
Fit is usually not as good as traditional dentures (estimate ridge form)
Extractions and sore spots from immediate denture can result in more discomfort after initial insertion
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier,

11. Explanation to Patients
Takes time to adapt to chewing and speaking
Appearance may be unpredictable if anterior try-in not possible
(Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, )
No Anterior Try-in

12. Explanation to Patients
Should be worn for first 24 hours without removal
If removed, reinsertion can be difficult if significant swelling occurs
Patient should return to dental office for initial removal at 24-hours

13. Explanation to Patients
Immediate dentures will normally “loosen” during healing due to ridge resorption & soft tissue remodeling
Relines/tissue conditioners will be required to improve the retention
Normally a permanent reline will be required 4-6 months after insertion

14. Explanation to Patients
In some cases a remake may be required
Significant change in jaw position
Significant esthetic problem
May be cheaper/better to remake
Patient is responsible for fees for relines
Explain prior to beginning
Include reline fee in estimate for immediate denture

15. Dalhousie Faculty of Dentistry Policy
Immediate denture fee at Dalhousie includes
tissue conditioner
Additional fee for permanent reline of each denture

16. Dalhousie Protocols Online on Removable Prosthodontics Website

17. Too Difficult No opposing occlusal contacts
Severely collapsed occlusal vertical dimension
Can’t register a repeatable jaw relationship (check at treatment planning appointment)
Vestibule too short - vestibuloplasty would be required
Refer

18. Dalhousie Protocols Sugery & Insertions Thursday afternoons only
Book at least 2 weeks prior to surgery
Book with Patient Services Staff
Identify as a Immediate Dent at time of booking
Only 2 immediate denture bookings per day
Dr. Knechtel to advise him of booking
date of booking
# of teeth to be extracted
CD (single or set)
RPD

19. Dalhousie Protocols
At least one week prior, students must review medical history & clinical surgical details with supervising surgeon
At beginning of clinic inform both attending Surgeon and Dr. Knechtel that your patient has an immediate denture
This ensures the patient moves to top of rotation, so that insertion is as early in clinic as possible

20. Dalhousie Protocols
Students must see patient the day after delivery, Friday morning to ensure patient comfortable
All immediate dentures insertions supervised by Dr. Knechtel.

21. Technique Examination/Diagnosis/Treatment Plan Informed consent
Alternatives
Pros/cons
Prognosis
Timing
Costs

22. Examination/Diagnosis/Treatment Plan
Beware of tissue undercuts
Especially anterior maxilla & tuberosities
Make notes to reduce at time of extractions
Compress socket
Bony reduction if necessary
If not reduced, denture may not seat
2 piece tray for impression

23. Examination/Diagnosis/Treatment Plan
Determine if OVD requires change at diagnosis appointment
Use physiologic rest, interocclusal space measurements

24. Examination/Diagnosis/Treatment Plan
To improve esthetics & ensure adequate stability:
Decide whether you will need to imitate or change tooth arrangement prior to beginning
Helps avoid unexpected surprises

25. Technique Oral hygiene procedures Reduce inflammation to speed healing
Reduced discomfort after extractions
Less soft tissue changes – better fit

26. Technique Preliminary extractions - posterior teeth
Keep one set of opposing teeth on each side of arch if OVD and centric are to be preserved
Wait 4 weeks for healing
If very few teeth remain
Consider extracting all at once
Skip preliminary extraction step
Less morbidity
Extract All Teeth Single Appointment

27. Technique After Preliminary Extractions
Preliminary impressions - alginate
Final impressions – 1 or 2 step
Jaw relation records
Tooth set-up and try-in
Final extractions and insertion
Post insertion care

28. Examination/Diagnosis/Treatment Plan
Reconfirm decision to imitate or change tooth arrangement
Determine midlines, occlusal plane, vertical overlap, length of maxillary incisors
Mark on cast for laboratory to use for setup

29. Preliminary impressions
Stock trays
Dentate or partially-edentulous
Irreversible Hydrocolloid
Mark vibrating line & hamular notches prior to impression
Can’t reseat intraorally

30. Final Impressions
Use 2 piece custom tray if significant undercuts
If no large tissue undercuts use one piece custom tray

31. Mark Posterior Border Prior to Impression
Vibrating line & hamular notches
Not able to reseat intraorally
tooth & tissue undercuts, embrasures
If don’t have correct posterior border, denture will not be retentive

32. 2 Piece Impression Stock Tray
Custom Tray – Ensure Alginate Not Too Thin
Stock Tray

33. 1 Piece Impression Block out minor undercuts
Ensure tray flange not too far from vestibule
After border molding, should not lock into place

34. Jaw relation records
Record base & occlusion rim used if unstable cast/contacts (wobbles, rocks)
Make facebow record with dentate bitefork
Use for centric & protrusion
If stable contacts, record base not needed

35. Jaw Relation Records Determine OVD
Use physiologic rest, interocclusal space measurements
Do NOT incorporate an overbite in occlusion rims
if anterior teeth are missing, use rims only to determine OVD, not incisal display
Once mounted, determine overbite, incisal display required

36. Use occlusion rims for OVD, Jaw Relations Records

37. Centric Record
Dentate Bitefork wth Wax/PVS
Use PVS Bite Registration Material, NOT Wax

38. Tooth Set-up and Try-in
Anterior Try-in Only Possible if Anterior Teeth Missing

39. Extraction and Insertion
Have lab complete set up & modify cast as directed
use probing depths & radiographs to guide cast modification

40. Do not create large socket convexities – grind teeth

41. Final Setup Usually will not allow for Full Wax Try-in

42. Extraction and Insertion
Always request a surgical stent (guide)
Prescribe fabrication of stent when sent for processing
Allows for identifying areas of impingement (blanching)

43. Extraction and Insertion
Extract teeth
Prior to insertion, use surgical guide to assess ridge
Place pressure but DONOT Flex during insertion
check for over extensions, pressure (blanching)
Seat the denture
After stent show full seating, no blanching

44. Extraction and Insertion
THE DENTURE MUST BE FULLY SEATED
Otherwise occlusion will be unacceptable
Once fully seated, adjust occlusion as needed
Provide post insertion instructions
Verbal
Written – patient brochure

46. Dalhousie Timeline for Insertion
0 -15 min
- Inform surgeon & Dr. Knechtel patient is receiving an immediate denture
- review med history
- provide local anaesthesia
min - extractions
1 - 2 hour - insert and adjust - instructions

47. Instructions to Patient
Do not remove until 24 hour appointment
If it comes loose/out replace immediately
Soft/liquid diet for 24 hours
Avoid vigorous rinsing
Take analgesic as prescribed
Expect red saliva

48. 24 Hour Appointment
Remove and clean denture
Relieve sore spots
Do not use PIP – use indelible stick
Gross occlusal adjustment

50. 1 Week Recall Appointment
Relieve sore spots
Use PIP
Refine occlusion – possible remount

51. Continuing Care Tissue conditioner to improve retention as needed
Remove any socket convexities to avoid healing defects
Reline or remake in 4 to 6 months
Postpone as long as patient can tolerate to ensure most of initial resorption complete

52. X X
Remove denture base convexities to avoid healing defects X