1. IMMEDIATE DENTURE
Dr. Monia MN Kandil

2. WHAT IS AN IMMEDIATE DENTURE?

4. Advantages of Immediate Dentures

5. Challenging Factors and disadvantages of Immediate Dentures

6. Contraindications of Immediate Dentures

7. Immediate Dentures include:
Partial Immed. Dent.
Transitional Immed. Dent.
Conventional Complete Immed. Dent.

8. Differentiate between Immediate & Interim Dentures !

9. Immediate Partial Denture

13. Immediate treatment partial
support
stability
retention

14. Immediate Transitional Denture

15. Immediate Transitional Dentures
Indications
Multiple extractions
Esthetics
Function
If conventional ICD contraindicated

16. Immediate Complete Denture

17. Immediate Complete Dentures
Concept Condition:
Maxillary six anteriors are still.
Remove all posterior teeth about 1-3 months before making immediate denture.

18. Immediate Complete Dentures
Rationale
Allows for posterior segment to heal and stabilize.
Maintains anterior teeth for appearance, some function.
After healing, it is relined with acrylic resin.

19. Immediate Complete Dentures
Not Recommended
Both jaws simultaneously
Mandibular arch

20. Immediate Denture Treatment Sequence

21. Examination, Diagnosis & Data Collection

22. Limited inter-arch space as result of enlarged maxillary tuberosity
Oral Examination
Existing VDO: over-closed
Limited inter-arch space as result of enlarged maxillary tuberosity

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

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

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

26. Impression Techniques

27. Immediate Denture Preliminary Impression:
At the 1st appointment:
Immediate Denture Preliminary Impression:
With
Alginate & Stock Tray

28. Immediate Denture Preliminary Impression:
Add the soft peripheral wax onto inner surface of
maxillary tray to provide a tissue stopper to
Avoid gagging reflex resulted from excessive
alginate

29. Criteria for Acceptable Preliminary Casts
Capture All hard and soft tissue landmarks
All peripheral vestibules

30. 1st appt: Preliminary impression
2nd appt: Final impression
Fabrication of custom tray

31. Immediate Dentures Final Impression:
2nd Appointment:
Immediate Dentures Final Impression:
Which has two techniques:
Single custom tray technique: most commonly used
Two-pieces tray technique:
(Split impression technique)
for very divergent teeth or severe ridge undercuts

32. Single tray with rubber base1-
Immediate Denture Final Impression
Single tray with rubber base
most commonly used

33. 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

34. Split Impression Tray - Alginate
Retention lugs
Handle

35. Split Impression Tray - Alginate
Short-comings
Small oral opening.
Proclined maxillary anterior teeth.
Anatomic accuracy of vestibule.

36. Split Impression Tray- Putty-Index Technique
Tray extends to and contacts incisal edge of anterior teeth

37. Putty-Index Technique

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

39. 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

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

41. 3rd Appointment:
Maxillomandibular Relation Records
Face bow record

42. 3rd Appointment: Maxillomandibular Relation Records Evaluate the VDO
Face bow record
Evaluate the VDO

43. 3rd Appointment: Maxillomandibular Relation Records CR record
Face bow record
Evaluate the VDO
CR record
Adequate teeth to support
the bite registration material

44. 3rd Appointment: Maxillomandibular Relation Records Protrusive record
Face bow record
Evaluate the VDO
CR record
Protrusive record

45. 3rd Appointment: Maxillomandibular Relation Records Mark and transfer
Face bow record
Evaluate the VDO
CR record
Protrusive record
Mark and transfer
the post-palatal
seal

46. Selecting & Arranging artificial teeth:

47. Special Lab work for Immed. Comp. Dent.
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.

48. Set-up the anterior teeth:
Immediate Denture Laboratory Project
Set-up the anterior teeth:

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

51. Different Methods For Cast Trimming
Immediate Denture Laboratory Project
Different Methods For Cast Trimming

52. 1-
The teeth are removed from the cast in a manner that They are not cut below the gingival crest

53. 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.

54. 2-
Place a subgingival esthetic convenience groove at the labial gingival sulcus to aid in esthetic positioning of the denture teeth.
Esthetic convenience groove

55. 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.

56. 15 mm
Complete the anterior
teeth setup

57. During the Setting-up of Anterior teeth:
The study model can be used to compare the tooth arrangement.

58. Set-up the posterior teeth:
Immediate Denture Laboratory Project
Set-up the posterior teeth:

59. Sectional wax-up Anterior segment for patient viewing.
Posterior segment for check record.

60. Immediate Complete Denture
Try-In

61. Insertion & Post Extraction Instructions

62. Post Insertion Management
Occlusal adjustment & Remount when:
Healing edema resolved
Traumatized mucosal lesions healed
Usually within days

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

64. THERE ARE 2MAIN METHODS OF CONSTRUCTION
Immediate Denture
2 Types

65. 1 Without surgery (Without Alveoloplasty).
A- Partially flanged type
B- Socket type
C- Completely flanged type
2 with surgery (Surgical Alveoloplasty)
Must be …Completely flanged type

66. 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 (surgical stent).
It must be adapted to the cast after the necessary - cast alveolectomy" has been performed.

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

68. Goals of alveoloplasty In this case

69. Disadvantages of Alveoloplasty

70. Types of Alveoloplasty:
Simple alveoloplasty:
Buccal or labial cortical reduction:
Intra-septal alveolctomy and cortical plate in-fracture:
(Buccal or Labial Cortical Re-contouring)

71. Immed. Comp. Dent. Master Cast Trim
Trimmed areas sanded smooth
Avoid removing incisive papilla

73. THANK YOU