uwo school of dentistry immediate dentures ztransitional complete zconventional complete zpartial...
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UWO School of Dentistry
Immediate Dentures
Transitional CompleteConventional CompletePartial
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UWO School of Dentistry
Objectives Immediate Dentures
Know: Describe and prescribe appropriate types of
ID Clinical protocols associated with each type Laboratory protocols Post-insertion care
UWO School of Dentistry
Immediate Transitional Dentures
Complete clearanceIndications
Multiple extractions Patient needs/demands
UWO School of Dentistry
ImmediateTransitional Denture
A denture made without prior extraction of teeth
Synonyms: Interim Temporary Provisional
UWO School of Dentistry
Immediate Transitional Dentures
Indications Multiple extractions Esthetics Function Conventional ICD
contraindicated
UWO School of Dentistry
Immediate Transitional Dentures
Technique: Alginate impressions Lab or office pour
Gypsum modelHybrid model
Mounted models Arbitrary estimation of contour
UWO School of Dentistry
Immediate Transitional Dentures
UWO School of Dentistry
Immediate Transitional Dentures
AfterBefore
UWO School of Dentistry
ImmediateTransitional Denture
UWO School of Dentistry
Immediate Transitional Dentures
Problems Intensive post insertion care Short-term solution More expensive
UWO School of Dentistry
Conventional Immediate Dentures
Maxillary six anteriors Posterior teeth extracted 8-
12 weeks previouslyPredictable, stable ridge
contour
UWO School of Dentistry
“Conventional” Immediate Complete Dentures
Concept Remove all posterior teeth about 3 months before making immediate denture
UWO School of Dentistry
“Conventional” Immediate Complete Dentures
Rationale Allows for posterior segment to heal and stabilize
Maintains anterior teeth for appearance, some function
UWO School of Dentistry
“Conventional” Immediate Complete Dentures
Indications Maxilla anterior teeth present Cooperative patient
Not Recommended Both jaws
simultaneously Mandibular arch
UWO School of Dentistry
Immediate Dentures Impression Techniques
Single custom traySplit impression technique
Posterior segment Anterior segment
Stock trayPutty index
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Split Impression Tray - Alginate
Retention lugs
Handle
UWO School of Dentistry
UWO School of Dentistry
Stock Tray Technique
Short-comings Small oral opening Proclined maxillary
anterior teeth Anatomic accuracy of
vestibule
UWO School of Dentistry
Split Impression Tray-Putty-Index Technique
Tray extends to and contacts incisal edge of anterior teeth
UWO School of Dentistry
Putty-Index Technique
UWO School of Dentistry
UWO School of Dentistry
UWO School of Dentistry
Putty-Index Technique
UWO School of Dentistry
Putty-Index Technique
UWO School of Dentistry
Conventional Immediate Dentures
Cast trimming guidelines “Normal” periodontal condition
“Rule” of Thirds Advanced periodontal deterioration X-ray & probing measurements
UWO School of Dentistry
Conventional Immediate Dentures
Rule of thirds Normal gingival/bone relationship
Rule of Thirds – Cast Trim
Recess Socket 1 mm
Remove tooth at gingival level
Step 1 Step 2
Rule of Thirds – Cast TrimStep 3 Step 4
Labial edge recess to incisal third mark
Mid-point recess to mid-width labial cut
Rule of Thirds – Cast TrimStep 4 Step 5
Round over lingual aspect of socket
Rule of Thirds – Cast TrimStep 5 Step 6
Round off labial to middle third, sand smooth
UWO School of Dentistry
ICD Master Cast Trim
Trimmed areas sanded smooth
Avoid removing incisive papilla
UWO School of Dentistry
ICD Surgical Template
Fabricated after cast trim
Used to locate pressure areas on mucosa at time of surgery
Denture trimmed according to blanched mucosa observed under template
UWO School of Dentistry
Immediate Partial Dentures
Framework incorporates wrought wire retentive loops for tooth attachment
Loops bent into place at processing stage, after cast trim
UWO School of Dentistry
Special Lab Rx for ICD
For tooth set-up: Anterior teeth:
“Cut anterior teeth off cast at gingival level.”Set anterior teeth on cast for patient viewing.”
Posterior teeth:“Arrange posterior teeth on record base in
(balanced/monoplane/lingualized) occlusion andwax-up for try-in evaluation.”
UWO School of Dentistry
Special Lab Rx for ICD
For processing and cast trim: Refine occlusion Complete wax-up Flask and return lower half of flask
for cast trim Make surgical template in clear acrylic resin
UWO School of Dentistry
Post Extraction Instructions
Do not remove dentureKeep head elevatedSmall amounts of blood in saliva is normal Diet: soft and warm, not hotAvoid:
Spitting, rinsing Strenuous activity Alcohol, smoking
UWO School of Dentistry
Post Insertion Management
Recall next dayRemove dentureApply topical anesthetic to
traumatized mucosaLocate over extensions and pressure
areas and adjustReappoint 1 week
UWO School of Dentistry
Post Insertion Management
Healing, shrinkage, resorptionPatient remountRelines
Interim – within first 12 months Definitive – 12 months +
UWO School of Dentistry
Post Insertion Management
Remount when:Healing edema resolvedTraumatized mucosal lesions healed
Usually within 14-21 days
UWO School of Dentistry
Post Insertion Management
Reline Short term – tissue conditioners Mid-term – intermediate direct liners
E.g. Kool liner™
Long-term – standard reline protocol
UWO School of Dentistry
Immediate Denture Appendix
Review clinic & lab protocols Try in cast trimming
UWO School of Dentistry
Special Lab Rx for ICD
For tooth set-up: Anterior teeth:
“Cut anterior teeth off cast at gingival level.”Set anterior teeth on cast for patient viewing.”
Posterior teeth:“Arrange posterior teeth on record base in
(balanced/monoplane/lingualized) occlusion andwax-up for try-in evaluation.”
UWO School of Dentistry
ICD Try-In
Sectional wax-up Anterior segment for
patient viewing Posterior segment for
check record
UWO School of Dentistry
ICD Try-In
Posterior “removable” section used for: Confirmation of
horizontal and vertical relationships
Tooth shade
UWO School of Dentistry
Special Lab Rx for ICD
For processing and cast trim: Refine occlusion Complete wax-up Flask and return lower half of flask
for cast trim Make surgical template in clear acrylic resin
UWO School of Dentistry
IDC Master Cast Trim
Invested maxillary model in lower flask half: Teeth removed Sockets recessed Ready for “Step 3” Ready for arbitrary
posterior palatal seal
UWO School of Dentistry
ICD Master Cast Trim
Trimmed areas sanded smooth
Avoid removing incisive papilla
UWO School of Dentistry
ICD Surgical Template
Fabricated after cast trim
Used to locate pressure areas on mucosa at time of surgery
Denture trimmed according to blanched mucosa observed under template