Immediate Dentures (complete denture)...

.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................thank youuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................NEW HORIZON DENTAL COLLEGE AND RESEARCH INSTITUTE DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE








TOPIC : BLOOD

GUIDED BY- PRESENTED BY-
Dr. TUSHAR TANWANI (PROFESSOR & HOD) DR.L.KEERTHI ROHINI
Dr. GAURAV TRIPATHI(PROFESSOR)
Dr. GAURAV AGRAWAL(READER)
Dr. SUDEEPTI SONI(READER)







CONTENTS
 Introduction
 Properties
 Functions
 Composition
 Plasma proteins
 Red blood cells
 White blood cells
 Platelets
 Coagulation of blood
 Bleeding disorders

INTRODUCTION
• Blood is a connective tissue in fluid form. It is called as fluid of life as it carries oxygen from lungs to all parts of the body and carbon dioxide from all parts of the body to lungs.
• It is also called fluid of growth as it helps in transport of nutrient substances from digestive system & hormones from endocrine gland to all the tissues.
• It protects the body against the diseases and gets rid of the waste products & unwanted substances hence it is called as fluid of health.

PROPERTIES OF BLOOD
 COLOUR – Arterial blood is scarlet red & venous blood is purple red
 VOLUME – 5 Litres for Males and 4.5 Litres for Females
 REACTION & PH

1. SEMINAR BY
Shivangi Gajwani

2. CONTENTS
Definitions
Reasons for immediate denture replacement
Physical factors
Physiological factors
Psychological factors
Advantages and disadvantages of immediate dentures

3. Contraindications of immediate dentures
Preliminary points to be noted while
fabricating an immediate denture prosthesis
Basic over view of an immediate denture
fabrication
Surgery and Immediate Denture Insertion
Surgical template

4. Review of literature
An approach to immediate denture treatment
Explanation to the Patient Concerning Immediate
Dentures
Conclusion
References

5. Definition
The glossary of prosthodontic terms‘defines an
immediate denture as a complete or removable
partial denture constructed for insertion
immediately following the removal of natural
teeth.

6. TheGlossaryofProsthodonticTermsdefines
interimprosthesisasaprosthesisdesignedto
enhanceesthetics,stabilizationand/orfunction
foralimitedperiodoftime,afterwhichitis
replacedbyadefinitiveprosthesis(Academyof
Prosthondontics,1999).

7. Interim Immediate Denture
An immediate denture after healing can be relined
and refitted to be used as a definitive denture but an
Interim immediate denture is worn only during the
healing period to be replaced with a new prosthesis
as soon as healing is complete.

8. Oneofthefirstreferencestoimmediatedenturesinthe
literaturewasthatofRichardsonin1860(Seals,
1999).

9. Jiffy dentures;Raczka and
Esposito ,1995
Itissimilartointerimimmediatedenture
becauseitisreplacedbyaseconddentureafter
healing.Itdiffersfrominterimimmediate
dentureinthatthedenture“teeth”areusually
madewithtoothcoloredauto-polymerizing
acrylicresin.Thedisadvantageinthese
materialsarenotlonglasting(inwearandcolor
stability).

10. Immediatedenturesaremorechallengingtomakethan
routinecompletedenturesforboththedentistandthe
patient,becauseatry-inisnotpossiblebeforehand,the
patientmaynotbecompletelycomfortablewiththe
resultingappearanceandfitonthedaytheimmediate
dentureisinserted.
Thedentistmustexplainandthepatientmustfully
understandthelimitationsoftheprocedurebefore
beginningtreatment.

11. PHYSICAL FACTORS:
1) Disuse atrophy of the bony base
2) Unfavourable trabeculation of the repairing
bone
3) Possible damage to the ligaments
surrounding TMJ
Reasons for immediate denture replacement

12. PHSYIOLOGICAL REASONS
Abnormal functioning of the mouth and mandible
Impaired communication
Abnormal deglutition
PSYCHOLOGICAL REASONS:
Humiliation.
Adverse subjective reactions

13. ADVANTAGES ANDDISADVANTAGES OF
IMMEDIATEDENTURES

14. Advantages
Theprimaryadvantageofanimmediatedentureisthe
maintenanceofapatient'sappearancebecausethereis
noedentulousperiod.
Circum-oralsupport,muscletone,verticaldimensionof
occlusion,jawrelation,andfaceheightcanbe
maintained.Thetonguewillnotspreadoutasaresult
oftoothloss.

15. Lesspostoperativepainislikelytobeencountered
becausetheextractionsitesareprotected.
Someauthorshavediscussedwhetherimmediate
denturesreduceresidualridgeresorption(Heartwell,
1965;Johnson,1966;Kelly,1958;Campbell,1960;
Carlsson,1967).
Itiseasiertoduplicate(ifdesired)thenaturaltooth
shapeandposition,plusarchformandwidth.

16. If desired, the horizontal and vertical positions of
the anterior teeth can be more accurately
replicated.
The patient is likely to adapt more easily to
dentures at the same time recovery from surgery is
progressing. Speech and mastication are rarely
compromised, and nutrition can be maintained.

17. Theavailabilityoftissue-conditioningmaterial
allowsforconsiderableversatilityinthecorrection
andrefinementofthedenturefittingsurface,bothat
theinsertionstageandatsubsequentappointments.
Overall,thepatient'spsychologicalandsocialwell-
beingispreserved.

18. Themostcompellingreasonsfortheimmediatedenture
prescriptionarethatapatientdoesnothavetogo
withoutteethandthatthereisnointerruptionofa
normallifestyleofsmiling,talking,eating,and
socializing.

19. Disadvantages
Immediate dentures are a more challenging
modality than complete dentures because the
presence of teeth makes impressions and
maxillomandibular positions more difficult to
record.

20. Specific disadvantages include the following:
1.Theanteriorridgeundercut(oftensevere)thatis
causedbythepresenceoftheremainingteethmay
interferewiththeimpressionproceduresand
thereforeprecludealsoaccuratelycapturinga
posteriorlylocatedundercut,whichisimportantfor
retention.
2.Thepresenceofdifferentnumbersofremainingteeth
invariouslocations(anteriorly,posteriorly,orboth)
frequentlyleadstorecordingincorrectlythecentric
relationpositionorplanningimproperlythe
appropriateverticaldimensionofocclusion.

21. 3.Anocclusaladjustment,orevenselectivepretreatment
extractions,maybeneededtomakeaccuraterecordsat
theproperverticaldimensionofocclusion.
4.Theinabilitytoaccomplishadenturetoothtry-inin
advanceprecludesknowingwhatthedenturewill
actuallylooklikeonthedayofinsertion.

22. 5.Carefulplanning,operatorexperience,attentionto
detailsofthetechnique,andexplanationtothepatient
bestaddressthisinherentproblem.
6.Becausethisisamoredifficultanddemanding
procedure,morechairtime,additionalappointments,
andthereforeincreasedcostsareunavoidable.
7.Functionalactivities(e.g.,speechandmastication)are
likelytobeimpaired.However,thisisatemporary
inconvenience.

23. A few patients are not good
candidates for immediate
dentures.

24. They include:
Patients who are in poor general health or who are
at poor surgical risks (e.g., post irradiation of the
head and neck regions, systemic conditions that
affect healing or blood clotting and psychological
disorders).
Patients who are identified as uncooperative as
they cannot understand and appreciate the scope,
demands, and limitations to the course of
immediate denture treatment

25. Preliminary points to be noted while
fabricating an immediate denture prosthesis:

26. 1.Thepatient'sexistingmidlineandneedfor
modificationofitsposition(existingteethmayhave
drifted,especiallyifanearbytoothhasbeenlostfor
sometime).

27. 2.Thedesiredverticaldimensionofocclusion
andamountofinterocclusaldistance(freeway
space)fortheimmediatedenturesandtheneed
forconformingittoorchangingitaccordingto
thepatient'sexistingmaximuminter-occlusal
position.

28. 3. The present amount of horizontal and vertical
overlap of anterior teeth.
4. An estimate of the Angle's classification of
occlusion for the patient.
5. Display of posterior tooth in the buccal
corridor.

29. Basic over view of an immediate denture
fabrication

30. Preliminaryexamination….

31. Preliminary Impressions and
Diagnostic Casts
Impressionsaremadeinirreversible
hydrocolloid(alginate)instockmetalorplastic
trays..

32. Therearetwobasicwaystofabricatethefinal
impressiontray,dependingonthelocationofthe
remainingteethandoperatorpreference.Bothare
successfulaslongastheyaredoneproperly.

33. The process for tray fabrication is as follows:
1.Theareasofthecastswithremainingteeth
areblockedoutwithtwosheetwaxthicknessas
forafixedpartialdenturecustomimpression
tray;undercutsintheedentulousareasare
blockedoutasforacompletedenturecustom
tray.….

34. A –undercuts in the edentulous area
blocked out:

35. Campagna impression Technique:

36. Location of Posterior Limit and Jaw Relation Records
Theproceduresforlocatingthe
posteriorlimitandjawrelationrecords
areidenticaltothoseforcomplete
dentures.

37. The occlusion rims are trimmed to the desired vertical
dimension of occlusion. A face-bow transfer and a
recording of centric relation are made.
The casts are mounted on the articulator.
Protrusive relation records are made,
if desired, to transfer to the articulator
in order.

38. Theanteriorplaneofocclusion(usingtheinter-pupilaryline
asaguide)isdeterminedtosimulatethenaturalappearance.
Theremainingcaninesmaynotbecoincidentwiththisplane.
Twoteethshouldbefoundthatareparalleltothedesired
anteriorplaneofocclusion.
Posteriorplaneofocclusionwiththeala-tragusplaneshould
belocatedandnoted.

40. If posterior teeth are still present at this stage, they
may be extruded, which would distort the desired
occlusal plane.
If posterior teeth are missing at this stage, it is easy
to establish and record the ala-tragus line with the
posterior tooth set up.

41. Setting the Denture Teeth/Verifying Jaw Relations
and the Patient Try-in Appointment
Thearticulatedcastsareusedforsettingany
anterior/posteriorteeththataremissingsothat
atry-incanbeaccomplishedwiththepatient.

42. The midline or newly selected midline is recorded on
the base area of the master casts.
A discussion of placement of diastema, rotated teeth,
notches, and other natural arrangements should occur
so that the patient is actively involved in the esthetic
decisions.

43. Surgery and Immediate Denture Insertion
1. The patient can see the practitioner first
for reduction of any overdenture abutments
2. The dentist performing the operation then
extracts the remaining teeth, taking care to
preserve the labial plate of bone where
usually, no bone trimming is done.

44. 3.Thesurgicaltemplateisusedasaguidetoensure
thattheprescribedbonetrimmingisdone
adequately.
4.Thetemplateshouldfitandbeincontactwithall
tissuesurfaces.Inadequatelytrimmedareas
plannedforbonereductionwillblanchfromthe
pressureandbeseenthroughthecleartemplate.

45. Processing and Finishing
The immediate dentures are processed and finished
in the usual manner of complete dentures.
If desired, a laboratory remount can be accomplished
before removing the dentures from their casts and
finishing.

46. Keeptheundercutareasofthedentureslightlythick
atthispointtoallowforinsertionoverundercuts.
Usinganupward/backwardpathofinsertionofthe
immediatedentureatplacementmayallowinsertion
withouttrimming;regardless,theseareascanbe
thinnedlaterbeforesendingthepatienthome.

47. Itisbesttokeepallposteriorundercutsatthis
pointbecauseoftentheydonotneedreductionbut
canbewellmanagedbyselectinganalternatepath
ofinsertionandwithdrawalofthedenture
combinedwithjudicioustrimmingofthewidthof
theinsideoftheresinflangeintheseareasatthe
placementvisit.

48. Anybumpsinsidetheimmediatedentureresulting
fromovertrimmingofthecastshouldbereducedto
allowforaconvexridgehealing.Theseprocedures
areduplicatedonthesurgicaltemplate.
Theproceduresforfabricationofimmediatedentures
processingissimilartothoseformakingcomplete
dentures,withsomemodifications.

49. Ifoverdentureabutmentsareplanned,endodontic
treatmentispreferablycompletedcoincidentwiththe
immediatedentureprocedures.
Theabutmentscanbemorphologicallymodified
whenthedentureisreadytobeinserted.

50. Information Concerning An Immediate
Denture:
* Biting pressure on the denture will promote
clotting and will decrease the initial flow of blood.
Slight bleeding can last up to 2-3 days.
* Use an ice compress on affected side for 20
minutes on repeatedly for the first 36 hours.

51. * Diet has to be limited to soft nourishing foods and
plenty of fluids for the first week.
* The denture should not be taken out on the day of
insertion, but patient is advised to rinse the mouth
with warm saline water before going to bed.

52. * After the first 24hours,patient should carefully remove
the denture twice a day and clean the denture with a
toothbrush and a low abrasive toothpaste or denture
cleanser.
* Due to the bone resorption leading to shrinkage that
occurs within the first 6 months, patient may go through
periods of loose fitting denture. Denture adhesives may
be used during this time. A temporary reline of the
denture may be done to provide a better fit.

53. * Following the bone resorption period
(approximately 6 to 12 months) a more permanent
reline will be placed.
* Patients experience sore spots caused by uneven
pressure being applied to the healing tissues by the
denture. Therefore adjustments are made regularly.

54. Surgical Template

55. Surgical Templates:
Asurgicaltemplateisathin,transparentform
duplicatingthetissuesurfaceofanimmediate
dentureandisusedasaguideforsurgically
shapingthealveolarprocess(Farmer,1983).
Itisaprescriptionforthesurgicalprocedure
andisessentialwhenanyamountofbone
trimmingisnecessary.

56. Review of literature:

57. Walter j Demer1972
“Minimising problems in placement of immediate
dentures” …

58. Distolingual undercut
Buccal and lingual undercuts in the bicuspid region
Sublingual undercuts
Incisive fossae and canine eminences
Distolingual and anterior combinations
Labial and lingual undercuts

59. Extractions without alveoloplasty
Extraction with alveoloplasty
Septal alveolectomy
Radical alveolectomy

60. John P Dahlberg(1965)
“Reconstructing the Natural Appearance By
Immediate dentures

61. Antony S Gotlieb(2001)
“An atypical chairside
immediate denture”

63. Jonkman RE,van Waas MA, van 't Hof MA, Kalk W
in 1997
The purpose of the study was to investigate denture
satisfaction related to treatment modality, age, gender,
denture quality, chewing ability, denture experience and
patients' attitude towards denture wearing.
CONCLUSIONS: They concluded that with respect
to satisfaction the technical quality of the dentures,
as well as patients' previous attitude towards
wearing dentures are the most important factors in
immediate denture treatment.

64. Ashok Soni et al (2000)
Trial anterior artificial tooth arrangement for an
immediate denture patient :A clinical report
A technique is described that allows the esthetic
try-in of the maxillary anterior artificial tooth
before the extraction and completion of an
immediate denture

65. Intra oral view
Posterior artificial tooth try
in done with modified
anterior wax up in anterior
labial flange area.

66. Try in of posterior artificial tooth
arrangement with processed maxillary
denture.

67. To relate the maxillary
denture to remaining
teeth and supporting
tissues, an
impression of the
adjusted denture was
made and a new
maxillary cast
fabricated.

68. The maxillary
artificial anterior
teeth were
arranged to reflect
the position of the
patients natural
teeth.

69. After decoronating
anterior teeth the
denture could be tried
in the patients mouth.
Labial index of the
completed anterior
artificial tooth
arrangement was
made with impression
plaster.

70. After the
separation of the
index the teeth
were fixed using
autopolymerizing
acrylic resin.
Denture was
finished and
inserted
immediately after
the extraction.

71. Majid B et al (2004)
Described fabrication of a clear surgical template
that minimizes pressure caused by immediate
complete dentures on a surgical area. The
trimmed areas on the maxillary definitive stone
cast were further trimmed on the duplicated stone
cast for making the clear surgical template. The
procedure provided proper seating of the
immediate denture and reduced post operative
soreness and denture adjustments.

73. Michael M Woloch (1998)
Presented a clinical report which describes a
procedure in which instead of extracting the
remaining teeth at the time of denture placement,
the teeth are decoronated and the immediate
prosthesis placed as a conventional complete
denture. Extractions can be performed at the
clinician’s discretion.

74. Postoperative
intraoral view
Master cast

75. Teeth trimmed from
master cast 1mm above
the gingival margin
Teeth sectioned at
gingival margin

76. Denture placed with
pressure indicating paste
Immediate denture in
place over remaining
roots

77. An approach to Immediate Denture
Treatment
A common situation is the immediate
maxillary denture that will oppose a partially
edentulous mandibular arch
Following is a step by step description of
the construction of an immediate maxillary
denture and an opposing mandibular partial
denture

78. Partial Denture
mouth preparations
framework
fabricated.

79. Immediate Denture
-maxillary custom tray
made
-border moulding of the
posterior edentulous area
done
-final impression made

80. tray
Over impression with
stock tray

81. Over impression with stock tray

82. Try in of framework

83. Record bases made
on maxillary final cast
and mandibular
framework.
Jaw relation records

84. posterior teeth set for
try in and check
record
anterior teeth set in
stone sockets for
patient viewing

85. Arrangement of anterior teeth,done after the
posterior try-in.
The anterior teeth are removed one at a time from
the master cast.
Each tooth is reduced to the gingival margin with
a rotary instrument and smoothened with a hand
instrument .
Denture tooth is placed in its place this procedure
is repeated with each tooth.

86. Cast trimming

87. Rule of Thirds

88. Master cast ready for tooth removal

89. Teeth removed, cast ready for
trimming

90. Trimming and smoothening
Incisive papilla is never
trimmed
Minimal trimming

91. Surgical template fabrication:

92. Denture is waxed up.
Final waxing
and carving
done.

93. Denture is processed in the
conventional manner

94. Flasking the denture

95. Dewaxing

96. Flasks ready for packing with acrylic

97. Dentures are cured and recovered

98. Surgery phase:
Anaesthetize teeth to
be extracted
extract teeth

100. Maxillary ridge after extraction and
placement of sutures if required.

101. Delivery Appointment
Adjust maxillary denture for fit using
template as a guide.

102. Surgical template

103. Immediate Denture Insertion done

104. patient returns in 24
hours to have
immediate denture
removed
check for over
extension, pressure
spots, premature
contacts

105. Post delivery appointments
Patient remount in 7-10 days
Weekly or biweekly adjustments for several
weeks
Temporary relining if necessary
Laboratory reline within 1 year

106. Remount Record
Centric relation record
Open incisal guide pin
Facebow if necessary
Remount index

107. Conclusion
• Patient education.
• Meticulous treatment planning.
• Staging extractions.
• Good impression technique.
• Tissue conditioners and remounts.
____________________________
= improve the predictability of the outcome.

108. Explanation to the Patient Concerning Immediate
Dentures
1.Theydonotfitaswellascompletedentures.They
mayneedtemporaryliningswithtissueconditioners
andmayrequiretheuseofdentureadhesives.
2.Theywillcausediscomfort.Thepainofthe
extractions,inadditiontothesorespotscausedby
theimmediatedenture,willmakethefirstweekor
twoafterinsertiondifficult.
3.Itwillbedifficulttoeatandspeakinitially.

109. 4.Theestheticsmaybeunpredictable.Withoutan
anteriortry-in,theappearanceoftheimmediate
denturemaybedifferentfromwhatthepatientorthe
dentistexpected.
5.Manyotherdenturefactorsareunpredictablesuch
asthegaggingtendency,increasedsaliva.

110. 6. Immediate dentures must be worn for the first 24
hours without being removed by the patient. If they
are removed, they may not be able to be reinserted
for 3 to 4 days. The dentist will remove them at the
24-hour visit.
7.Becausesupportingtissuechangesare
unpredictable,immediatedenturesmaybecome
looseduringthefirst6-8months.

111. As have been discussed, inspite of the
difficulties faced by the dentist while
fabricating the immediate denture
prosthesis and the patient in getting
adapted to it, this treatment modality
still remains a very important form of
prosthodontic treatment as it instills
confidence in patients which is
reflected in their smile..

112. References :
1.BOUCHER
,
S–prosthodontictreatmentforedentulouspatients9
th
edition&11
th
edition.
2.CHARLESHEARTWELL &ARTHURORAHN–Sylabussof
completedentures4
th
edition.
3.DENTALCLINICSOFNORTHAMERICA-Completedentures,april
1977,21;2
4.JOHNJSHARRY-Completedentureprosthodontics2
nd
edition.
5.JOHNNADERSON,ROYSTORER–Immediatedentures&
replacementdentures3
rd
edition

113. 6.SHELDONWINKLER-Essentialsofcompletedentures2
nd
edition
7.RUDD&MURROW–Dentallabprocedures,completedenturesvol
1
8.ZARB,BOLENDER–Prosthodontictreatmentforedentulouspatients
12
th
edition.
9..MM Devan “THE TRASITION FROM NATURAL TO ARTIFICIAL
TEETH" JPD 1960 vol-1

114. 10.WilliamBLineberg“SURGICALPREPARATIONOFMOUTH FOR
IMMEDIATEDENTURES“1963vol13no1
11.JohnPDahlberg“ReconstructingtheNaturalAppearanceByImmediate
dentures”JPD1965;205-210
12..MHeartwellIMMEDIATECOMPLETEDENTURE;ANEVALUATION
1965vol15no4
13.AsokSoni“Trialanteriorartificialtootharrangementforanimmediate
denturepatient:AClinicalreport,JPD2000;84:260-263

115. 14.Anton S Gotleib “An atypical chairside immediate denture :A clinical
report
JPD 2001 :86 :241-243
15.Masjid Bissasu “A simple procedure for minimising adjustmentsof
immediate complete denture :Aclinical Report :JPD 2004 ;92: 125-127
16.Jonkman RE, van Waas MA, van 't Hof MA, Kalk W
J Dent. 1997 Mar;25(2):107-11.

116. Thank you..