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An immediate denture is a complete denture or removable partial denture fabricated for placement immediately after the removal of natural teeth
(Zarb,. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9).
Immediate RPD
Normally made of acrylic with ball clasps No posterior teeth only acrylic bite pads
Transitional
Replaced after healing with cast RPD
Advantages
Maintenance of a patient's appearance Circumoral support, muscle tone, vertical dimension of occlusion, jaw relationship, and face height can be maintained. The tongue will not spread out as a result of tooth loss Less postoperative pain is likely to be encountered because the extraction sites are protected Easier to duplicate (if desired) the natural tooth shape and position Adaptation easier. Speech and mastication are rarely compromised, and nutrition can be maintained
(Zarb, George A. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.2.1).
Disadvantages
Immediate dentures are a more challenging
The anterior ridge undercut that is caused by the presence of the remaining teeth may interfere with the impression procedures
The presence of different numbers of remaining teeth in various locations frequently leads to recording incorrectly the centric relation position No denture tooth try-in in precludes knowing what the denture will actually look like on the day of insertion more chair time, additional appointments, and therefore increased costs
(Zarb, George A. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.2.2).
The pain of the extractions, in addition to the sore spots caused by the immediate denture, will make the first week or two after insertion difficult. It will be difficult to eat and speak initially
The esthetics may be unpredictable because an anterior try-in is not possible
(Zarb, George A. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.4.3.1).
Immediate dentures will loosen during healing, tissue conditioners will be required
6 to 9 months after insertion at least a reline will need to be done, possibly a remake . The patient is responsible for fees.
Technique
Examination/Diagnosis/Treatment Plan Informed consent Oral hygiene procedures Extract (usually all) posterior teeth Wait 4 weeks for healing
Technique
Preliminary impressions Final impressions Jaw relation records Tooth set up and try in Extraction and insertion Post insertion care
Examination/Diagnosis/Treatment Plan
Assess tissue undercuts (especially in the anterior maxilla -reduce during extractions -use 2 piece tray for impression Is VDO correct? Imitate or change tooth arrangement for esthetics or denture stability -midlines, occlusal plane, vertical overlap, length of maxillary incisors Conventional or transitional
Technique
Examination/Diagnosis/Treatment Plan Informed consent Oral hygiene procedures Extract (usually all) posterior teeth Wait 4 weeks for healing
Preliminary impressions
Final Impressions
Normally need to use 2 piece custom tray If no large tissue undercuts may be able to us 1 piece custom tray
2 piece tray
1 piece tray
Have lab complete set up and modify cast as directed. -use perio probing to guide cast modification
0-15 (min) -review med history and LA 15-60 -extractions 60-75 -move patient to pros cluster 75-120 -insert and adjust -instructions
Instructions to patient Do not remove until tomorrow's appointment If it comes loose/out put it back in place immediately Sot/liquid diet for 24 hours Avoid rinsing Take analgesic Expect red saliva
24 hour appointment
Remove and clean denture Relieve sore spots Do not use PIP
1 week
Follow up
Use tissue conditioner to refit as needed Remove any socket convexities to avoid healing defects Reline or remake in 6 to 9 months