CLINICAL TECHNIQUES FOR IMMEDIATE DENTURES RELINES/REBASES ADDITION OF TEETH TO PARTIAL DENTURES

TEACHING UNIT OF PROSTHETIC DENTISTRY

Immediates, relines and additions - 2002

IMMEDIATE DENTURES
PRELIMINARY IMPRESSIONS For jaw(s) where immediate dentures are to be provided preliminary impressions are recorded in alginate. For master impressions spaced light cured acrylic individual trays are requested. If one of the jaws does not require an immediate denture the relevant synopsis should be consulted. MASTER IMPRESSIONS These will normally be recorded in alginate material. RECORDING THE OCCLUSION If tooth contact is insufficient to demonstrate the occlusal relationship occlusal rims will be required. These will be constructed as wax occlusal rims with a shellac base plate. A decision is taken at this stage as to whether the denture is to have a flange or whether the replacement teeth are to be socketed. In general a flanged denture should be provided unless there are any specific contra-indications. The depth of socketing is influenced by the bone level round the teeth involved, this is determined by using a periodontal probe and any available radiographs. If an incomplete flange is indicated the labial surface should be surveyed relative to the path of insertion, and a line drawn about 1 mm beyond the survey line to indicate the extension of the flange. Indicate that you wish teeth to be set up in the edentulous spaces for trying in the mouth. Remember to record the shade and mould of anterior teeth. An average movement articulator is usually requested for the tooth articulation. Teeth for extraction should be recorded on the master cast at the earliest opportunity. The teeth that are to be extracted and immediately replaced by the denture are still in situ in the jaws. Thus the positioning and aesthetics of the replacement teeth cannot be checked in the mouth before the denture is processed. If the immediate restoration is a partial denture, remember to specify undercuts which must be blocked out. TRY-IN OF POSTERIOR TEETH The removal of those teeth to be extracted from the cast and the placement of the teeth in wax is the responsibility of the clinician. Therefore after the patient has been discharged, the student should carry out the task before giving the denture to the technician for processing. Any particular aesthetic requirement requested by the patient for the arrangement of the anterior teeth is noted. It is useful to have a duplicate cast with a diagnostic wax up to show the patient the amount of tooth repositioning that may be required.

RELINES/REBASES When the fit of a denture has deteriorated to an unacceptable degree and there are no other faults which require correction, re-lining or re-basing may be the treatment of choice. In the case of a rebase the patient must be willing to leave the denture to enable the laboratory work to be carried out. A reline is usually considered to be the replacement or restoration of the fitting surface of a denture and is often done at the chairside using autopolymerising resin. Generally it will increase the bulk of the denture. A rebase is replacement of the base of the denture (and other parts) by new material. It is a laboratory procedure produced in heat cured resin. An outline of the clinical procedure for a rebase is as follows:1. 2. Remove all undercuts: from the impression surface to allow the denture to be removed from the cast in the laboratory. Adjust the periphery of the denture by trimming or border moulding as necessary to correct over or under extension. Flanges can be added to open face dentures if required, using an appropriate chairside self curing acrylic. Pierce about six small diameter holes in the palate of an upper denture to allow excess impression material to escape. It is helpful to pierce the holes at an angle to the fit surface, so that the material does not drain out through them. Coat the fit surface of the denture with an even layer of silicone perfecting paste or zinc oxide impression paste of a low viscosity type and re-locate accurately in the mouth. Border moulding is then carried out. It is essential to get the patient to close the teeth gently together in intercuspal position so as to avoid altering the occlusal relationships. It also helps to take the impression in one denture at a time. Any minor deficiencies in the impression surface may be corrected by adding more impression material and re-inserting the denture in the mouth. Seat the denture firmly to avoid a step between the new and the original material.

3.

4.

5.

Laboratory instructions In the case of a rebase the following instructions are requested Pour cast in stone preserving land area Remove all old acrylic Rewax Process in heat cured resin

When fitting a re-based denture a check must be made on the occlusal relationships.

ADDITION OF TEETH TO PARTIAL DENTURES An impression is taken in alginate, using a stock tray. This impression is taken with the denture in situ so that its relation to the natural teeth is recorded, and should also record the functional depth of the sulcus in the relevant area for addition. The impression with the denture in place is sent to the laboratory for pouring. It is helpful to mark the teeth to be added to the denture with indelible pencil so as to avoid confusion. An impression of the opposing arch should also be recorded in order that the added teeth can be correctly positioned with reference to the relationship of opposing teeth. If necessary, a wax interocclusal registration should also be taken. Following pouring of the cast it is necessary for the clinician to remove the tooth for addition and prepare the socket. Indications should be given to the technician in relation to the placement of a flange. Arrangements must be made with both the reception and qualified nursing staff for the teeth to be extracted on the appropriate day and at the appropriate time, when the denture will be ready and you will be available to fit it. If the extractions are not to be undertaken on the prosthetics teaching unit (6E) then you are responsible for delivering the completed dentures to the appropriate surgical department immediately before your patient's appointment. After extraction and denture insertion the patient should be given a review appointment within 7 days.

This is a common procedure in general dental practice and students should familiarise themselves with the procedure whether or not they will undertake such treatment whilst a student.