IMMEDIATE COMPLETE DENTURES : AN EVALUATION

IMMEDIATE COMPLETE DENTURES : AN EVALUATION AUTHORS :- C. M. HEARTWELL & F.W. SALISBURY

Journal of Prosthetic Dentistry, July-August 1965, Pg No.615 624.

Brief OutlineDefinitionRequirements of Immediate Complete Dentures (ICD)Diagnosis of PatientsAdvantages of ICDAdvantages which warrant careful evaluationBone Contouring by ICDContraindications of ICD.Surgical preparations of Mouth for Insertion of ICD.

NomenclatureIt has been suggested that transitory or temporary dentures would be more appropriate terminology for immediate dentures.

The term treatment denture has been suggested, although this term seems more appropriate for a prosthesis used in diagnosis or during surgical procedures.

The term temporary could be applied to any denture since no denture should be considered to be permanent.

DefinitionAn 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 natural teeth

Requirements of Immediate Complete Dentures

To attain the maximum degree of success the following requirements should be satisfied:

(1) Compatibility with the surrounding oral environment.

(2) Restoration of masticatory efficiency within limits. (3) Function in harmony with the activity necessary in speech, respiration, and deglutition.

(4) Esthetic acceptability.

(5) Preservation of the tissues that remain.

Diagnosis of PatientsMany dentists give very little consideration to the diagnostic phase of immediate denture service.

The diagnostic procedures are not the same for completely edentulous patients as for partially edentulous patients.

In partially edentulous patients, the retention of the remaining teeth must be evaluated by dentists who use the most recent knowledge of histology, anatomy, physiology, and psychology.

Diagnosis is based on findings of a diseased condition by an examination to recognize and identify disease.

Severe Periodontitis leading to tooth mobility

Grossly Carious Tooth Non Restorable

Patient CounsellingDo not fit as well as normal complete dentures.

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

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

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.

Step by Step ProcedurePreliminary impressionsFinal impressionsJaw relation recordsTooth set up and try inExtraction and insertionPost insertion care

Examination/Diagnosis/Treatment Plan

Assess tissue undercuts (especially in the anterior maxilla-reduce during extractions-use 2 piece tray for impressionIs VDO correct?

Imitate or change tooth arrangement for esthetics or denture stability -midlines, occlusal plane, vertical overlap, length of maxillary incisors

Conventional or transitional

Preliminary impressions

Use dentate or partially edentulous stock trays

Final ImpressionsNormally need to use 2 piece custom trayIf no large tissue undercuts may be able to us 1 piece custom tray

1 piece tray

One Piece Tray

Two Piece Tray

Alternate Two Piece Technique

Jaw Relation

Face Bow Recording

Facebow Transfer and Centric Relation Recording

Teeth Arrangement and Try-In

Extraction and InsertionHave lab complete set up and modify cast as directed.-Use perio probing to guide cast modification

Surgical Stent (Guide)

Extraction and InsertionExtract teethUse surgical guide to contour ridgeSeat the denture-Check for over extensions and do necessary modifications.

THE DENTURE MUST BE FULLY SEATED

Adjust occlusionGive post insertion instructions

Denture Insertion

Instructions to patientDo not remove until tomorrow's appointmentIf it comes loose/out put it back in place immediatelySoft/ Liquid diet for 24 hoursAvoid rinsingTake analgesic and prescribed antibiotics.

24 hour appointmentRemove and clean dentureRelieve sore spots and check for overextensions

Follow upUse tissue conditioner to refit as neededRemove any socket convexities to avoid healing defects Reline or remake in 6 to 9 months

Advantages of Immediate Complete Denture( 1) The denture acts as a bandage or splint.(2) The splinting and bandage action promotes rapid healing as it protects the blood clot. (3) Patients seem to function in speech, deglutition, and mastication much sooner.(4) Many patients are not as reluctant to have diseased teeth removed if they can have them replaced immediately.

1) to help control bleeding, to protect against trauma from the tongue, food, or teeth if present in the opposing arch, and to keep mouth fluids and particles of food from entering the tooth sockets.

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Advantages of Immediate Complete Denture(5) There is less difficulty in making the polished surface of the dentures compatible with the surrounding structures. The tongue, lips, and cheeks have not altered their positions because of the lack of tooth support.

(6) Psychologically, there are two advantages a) Patients afforded immediate complete denture service rarely relinquish their dentures. b) Carry on social and business activities without embarrassment.

Advantages which warrant careful evaluationThe Vertical Dimension is retained.Critics : a) Continous eruption and attrition. b) Overclosure and discrepancy c) Natural tooth contacts and guideline

2) Teeth in immediate dentures can be replaced in the same positions as the natural teeth.Critics :- Centric Occlusion and Centric relation is not in harmony.

Bone is Contoured by Immediate Dentures. 1) Belief that the forces applied by any denture replace the stimulation which was supplied to the bone by the natural teeth. But forces may be of severe magnitude and act in different directions.Osteoclastic action accompanies this change in structure in healed bone.

Lytle demonstrated the reparative change of bone between the buccal and lingual cortical plates in a young patient when a slight extension of the denture base was allowed to remain in an incompletely healed socket.

Clinical observations suggests that stresses exerted by dentures, even those which are considered to be well constructed, are so variable that it is impossible to render a definite prognosis.

The atrophy is proportional to the extent of the disuse.

Campbells investigation revealed much more loss of bone by the denture patient than by the non-denture patient.

Contraindications of Immediate Complete DentureImmediate dentures are contraindicated for patients with diseases of a debilitating nature. Patients for whom multiple extractions might be unwise because of systemic conditions. Immediate dentures are contraindicated for emotionally disturbed individuals.Patients whose mental capacities do not allow them to comprehend their responsibility in this service.

Contraindications of Immediate Complete Denture5) Patients with acute periapical or periodontal pathosis.6) Immediate dentures are contraindicated for patients who have extensive bone loss adjacent to the remaining teeth.

ConclusionImmediate complete dentures may be regarded as Temporary denturesThey must meet certain special requirements of Oral Funtions.Removal of osseous structures is not advisable.Studies suggest that it may not act as a stimulus for formation of bone.Literature is still insignificant about the justified use of Immediate dentures.

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