IMMEDIATE DENTURES and their classification

immediate dentures and their classification

1. IMMEDIATE DENTURES Presented by; Dr. Chaithanya S II MDS Department of Prosthodontics

2. contents Introduction Definition Advantages and disdvantages Classification Diagnosis and treatment planning Clinical and laboratory procedure Post insertion care and instructions Conclusion references

3. introduction For the patient facing the loss of all his or her remaining natural teeth, there are three treatm ent options. Option 1: teeth extracted and wait six to eight weeks to heal then complete denture Option 2: to convert an existing removable partial denture into an interim complete denture Option 3: to make a conventional immediate complete denture

4. definition Imediate denture : “ a complete or removable partial denture constructed for insertion immediately following the removal of natural teeth .” - (GPT9) An immediate complete denture is a dental prosthesis constructed to replace the lost dentition and associated structures of the maxillae and/or mandible and inserted immediately following removal of the remaining teeth. - (HEARTWELL)

5. ADVANTAGES No edentulous period Easier adaption Circum-oral support, muscle tone Easier to duplicate the natural tooth Speech and mastication are rarely compromised, and nutrition can be maintained. Controls bleeding - bandage Less post operative pain Ridge preservation patient’s psychological and social well-being is preserved. DIADVANTAGES Presence of anterior undercut of remaining teeth i nterfere with the impression procedures More chances of incorrect vd / cr Inability to accomplish a try in in advance Increased maintenance and adjustments Increased chair side time Shorter service life

6. Zarb GA, Bolender CL, Eckert SE, Jacob R, Fenton A, Mericske -Stern R. Prosthodontic treatment for edentulous patients. Complete dentures and implant-supported prostheses. 12th. ed. St. Louis: Mosby. 2004.

7. Classification Conventional (or classic) immediate denture (CID): Interim (or transitional or non traditional ) immediate denture (IID): TWO TYPES

8. Interim immediate denture The Glossary of Prosthodontics Terms defines ; interim prosthesis as a prosthesis designed to enhance esthetics, stabilization and/or function for a limited period of time, after which it is replaced by a definitive prosthesis

9. Major Difference between Conventional and Interim Immediate Denture The CID is usually selected when only anterior teeth remain or if the patient is willing to have the posterior teeth extracted before immediate denture procedure begins . The IID is indicated when both anterior and posterior teeth are to be extracted at the same time and immediate dentures are provided. New complete dentures are again fabricated after the healing period.

10. “JIFFY” DENTURE ( Raczka and Esposito, 1995). An abbreviated type of IID has been called the “jiffy” denture indication ; when the immediate denture needs to be fabricated very quickly (in one day or session ) because of extenuating emergency circumstances or medical indications. It differs from IID in that the denture “teeth” are usually made with tooth-colored, autopolymerizing acrylic resin or portions of the patient’s preexisting fixed or removable partial denture(s) Disadvantage ; materials used are not as long lasting (e.g., in wear and color stability) as conventional denture teeth and processed bases.

11. Difference CID Long term prosthesis Can be relined Only anterior teeth remaining Good stability and retention at placement to maintain during healing Cost is less Longer time taking IID Transitional/short term prosthesis New denture after healing Both anterior and posterior teeth present Fair stability and retention which must be improved by reline{tissue conditioning} during healing Cost effective Less time consuming

12. Indication CID Only anterior teeth remain or few posterior that do not support existing R.P.D. Two extraction visits are feasible IID When multiple anterior & posterior teeth are present or existing r.p.d that patient wish to retain until insertion due to esthetics or functional concern Only one surgical visit is preferable.

13. Disadvantage of CID CID Esthetics cannot be changed. End of treatment pt. has one denture. If all posterior teeth remove V.D. is not maintained. So opposing premolar maintained. Can not convert from r.p.d IID Second denture allow an alteration of esthetics. Pt. has spare denture to use in extentuating circumstances. Posterior teeth are present V.D of occlusion is preserved. Can be converted from r.p.d

14. A /c to Arthur M. Lavere and A rthur J K rol - (a) C onventional immediate dentures, (b) Transitional denture, and, (C) Diagnostic denture [splint]. Each classification is further divided into groups of immediate dentures having a - ( i ) with Labial flange. ( Ii ) with Partial labial flange. ( Iii ) Flangeless LaVere AM, Krol AJ. Immediate denture service. The Journal of prosthetic dentistry. 1973 Jan 1;29(1):10-5. Classification of immediate denture

15. Diagnostic dentures (splint) the anterior segment contains the artificial teeth, while the posterior segment consists of flat occlusal blocks made of plastic resin indicated for patients with advanced periodontal disease . By reducing or adding to the flat acrylic resin posterior segment, the correct centric relation and occlusal vertical dimension can be restored .

16. Labial flange type ADVANTAGE; Aid stability of the denture Healing of the tissues The labial flange is made very thin to avoid fullness of the lip and present the desired esthetic effect. DISADVANTAGE; Poor esthetic value Source of irritation to tissue

17. Indications; Bony undercuts not present. 2. The lip line and lip activity are normal. 3. The teeth are periodontally involved and supporting bone is lost. Contraindications; Pronounced undercuts are present. 2. Fullness of lip would produce an unaesthetic result.

18. Partial flange type As resorption takes place, the flange is extended with cold- curing acrylic resin placed directly in the mouth for maintaining proper esthetics and healing Alveolectomies are not needed Very little irritation is expected

19. Indications; Undercuts are present on the labial and buccal section of residual ridge. 2. It is desirable that flange serve as a surgical splint Contraindications; Economic condition of the patient renders multiple corrective procedures impractical. Unusual active lip line.

20. Flangeless type/socketed dentures Indications: - When deep undercuts on the anterior and buccal residual ridge. 2. A high lip line and an active lip, that would expose an unesthetic flange. 3. Minimal amount of surgery is desirable Contraindications :- Substantial amount of bone loss. 2. Uneven contour of anterior residual ridge

21. Diagnosis and treatment planning I) DIAGNOSIS : Explanation to the patient : Diagnostic procedure: The diagnostic procedures are divided into two phases: (A) Patient examination (B) Consultation interview

22. Patient examination

23. Consultation interview

24. Clinical and laboratory procedures

25. First extraction/surgical visit If a decision of preliminary extractions (CID technique), the patient should have the identified (usually posterior) teeth removed as soon as possible. Opposing premolars- retained to preserve the VDO . The posterior teeth extraction sites and other areas are allowed to heal 3 to 4 weeks before prelimnary impression

26. Preliminary / diagnostic impression

27. preliminary impressions for the CID Diagnostic cast

28. preliminary impressions for the IID Diagnostic cast

29. Protect the loose teeth Blockout - to fill these areas with wax, petrolatum (Lubricating medium) Placing a vaccum - formed plastic over teeth By placing copper bands

30. Single arch custom impression tray It can be used in the CID technique. It is the only tray that can be used for the IID technique Effective when only anterior teeth are remaining or both anterior and posterior teeth are remaining

31. Wax blockout (IID) Custom tray

32. Final cast for IID

33. Two tray or sectional custom impression tray Posterior teeth have been removed (CID). It can not be used in IID technique.

34. Final cast for CID

35. Different final impression techniques

36. Dual impression technique

37. Gardener Gregory technique custom posterior impression tray that once border molded and impressed Anterior segment impression is made by placing thoroughly mixed putty (Vinyl Poly Siloxane) in the labial vestibular space in the region of anterior teeth

38. Campagna combination impression The acrylic resin impression tray has been border-molded with green stick compound. The opening allows the tray to pass over the remaining teeth. final impression is made in a zinc-oxide and eugenol paste and The Alginate (irreversible hydrocolloid) impression of the remaining anterior teeth

39. Jaw relation Record bases and occlusal rims are made on the master casts. An evaluation of patient existing vertical dimension in accomplished. A face bow transfer and record of centric relation are made. If there are enough anterior and posterior teeth remaining (in some patients with IIDs), there may not be a need for a record base and occlusion rim.

40. Setting the Denture Teeth/Verifying Jaw Relations and the Patient Try-in Appointment

41. Setting the Anterior Teeth: Laboratory Phase

42. Cast modifications

43. Standard’s cast modification technique

44. Jerbi’s cast modification technique

45. drawback Overzealous reduction at the facial, lingual, and interproximal Denture bases would “bind” in these areas during placement Binding at time of prosthesis insertion occurs Binding at lingual aspect occurs less often

46. Cast modification based on spatial modeling

47. Cast modification based on spatial modeling

48. comparison 3 methods of cast modification are similar at the lingual surface, but different as they project facially.

49. Wax contouring, flasking and boil-out

50. Surgical template A surgical template is a thin, transparent form duplicating the tissue surface of an immediate denture and is used as a guide for surgically shaping the alveolar process (Farmer, 1983).

51. Surgery and immediate denture insertion During extraction take care to preserve the labial plate of bone. Surgical template is used as a guide The template should fit and be in contact With all tissue surfaces. Sutures are placed if required

52. Immediate dentures should be disinfected Denture should be tried in and checked The denture should be checked for retention, support and stability. Pressure areas inside the denture (indicated by rocking) can be located with pressure-indicating paste and trimmed.

53. POST INSERTION CARE AND INSTRUCTIONS Ice packs Rinsing Soft diet Removal of the dentures Expect minimum blood Drinking hot liquids, alcohol FIRST 24 HOURS

54. The following should occur at the 24-hour visit Ask the patients where they feel sore, remove the denture and wash it. Check the tissue for sore spots Adjust any gross occlusal discrepancy Re-evaluate the denture for retention, - tissue conditioner Counsel the patient to continue wearing dentures at night - 7 days after extraction (until swelling reduce) After one week suture can be removed

55. During the first month after extraction. After the healing of tissues, a recall programme. Denture adhesives can be used during this period as an aid if retention is lost between visits. Patients with CID frequently prefer to have a definitive reline within the first 3-6 months. Patients with iids can have their second denture started within 3-6 months . FOLLOW UP CARE SUBSEQUENT CARE

56. Denture reline Several relines may be required during the first 8-12 month, following the removal of the natural teeth Soft reliners should be used as it promotes healing due to cushioning effect.

57. conclusion Immediate dentures fulfil an important role in today's treatment modalities by providing the patients with esthetics , function, and psychological support after extractions and during the healing phase. Proper follow-up care is essential to the success of an immediate denture

58. References Winkler, S. Ed., 1988.  Essentials of complete denture prosthodontics . Year book medical pub. Zarb g, bolender c, eckert s. Prosthodontic treatment for edentulous patients. St. Louis: mosby ; 2004. Heartwell , c.M. And rahn , A.O., 1986.  Syllabus of complete dentures . Lea & febiger . Lavere , a. M., & Krol , A. J. (1973).  Immediate denture service. The journal of prosthetic dentistry, 29(1), 10–15. Srivastava, A.K., Chaterjee , U., Ranjan, M. And singh , A., 2016. Dual impression technique for fabrication of maxillary complete immediate denture.  The saint's international dental journal ,  2 (2), p.42. Campagna, sebastian j. "An impression technique for immediate dentures."  The journal of prosthetic dentistry  20.3 (1968): 196-203. Cast modification for immediate complete dentures: traditional and contemporary considerations with an spatial modelling. Young jr , L., Gatewood, R.R., Moore, D.J. And sakumura , J.S., 1985. Surgical templates for immediate denture insertion.  The journal of prosthetic dentistry ,  54 (1), pp.64-67.

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