6 - 3/6: Immediate Complete Dentures

Question 1

What is inflammatory papillary hyperplasia “IPH”?

Answer 1

A reactive tissue growth usually developing under a denture

Question 2

Where does IPH occur?

Answer 2

On a hard palate beneath denture base

Question 3

What is an IPH?

Answer 3

Asymptomatic red or pink nodules on mucosa of hard palate and occasionally the residual ridge

Question 4

What is IPH directly related to?

Answer 4

Constant wearing of ill-fitting denture and poor oral hygeine

Question 5

What is present in IPH combination syndrome?

Answer 5

Candida

Question 6

What are two popular protocols for immediate dentures?

Answer 6

Conventional
Interim/transitional

Question 7

What are conventional immediate dentures?

Answer 7

Reline the immediate denture after healing and ridge stable (6 months)
ONE DENTURE

Question 8

What are interim/transitional immediate dentures?

Answer 8

Aim is to use for short period, then it is replaced by the definitive prosthesis when healing is complete
TWO DENTURES

Question 9

What is hopeless?

Answer 9

Periodontal prognosis

Question 10

When are immediate dentures fabricated?

Answer 10

Prior to extracting natural teeth

Question 11

What did richardson JA view immediate complete dentures as?

Answer 11

Practical treatise on mechanical dentistry
- was considered “luxury treatment” for many years following

Question 12

What is done in conventional/classic immediate dentures?

Answer 12

Refining/refitting

Question 13

What is done in interim/transitional/nontraditional immediate dentures?

Answer 13

New CD is made

Question 14

What are advantages to immediate complete dentures?

Answer 14

Prevent patient embarassment
Provide guide for optimal esthetics
Provide guide for OVD

Question 15

What are advantages to immediate dentures as stated by the book?

Answer 15

• maintenance of patient’s appearance
• circumoral support, muscle tone, VDO, jaw relationship, face height maintained
• tongue will not spread out as a result of tooth loss
• less postoperative pain as extraction sites are protected
• easier to duplicate the natural tooth shape and position
• adaptation easier. Speech and mastication are rarely compramised, nutrition can be maintained
• availability of tissue-conditioning material
• patient’s psychological and social well being is preserved

Question 16

What are disadvantages to immediate dentures?

Answer 16

• Increased complexity - impressions, CJR
• lack of clinical evaluation of trial denture-anterior esthetics
• increased maintenance
• greater number visits = more cost

Question 17

What are disadvantages to immediate dentures as stated by the book?

Answer 17

• more challenging
• undercut anterior ridge
• incorrect recording of CRP
• no denture tooth try in
• more chair time = additional appts

Question 18

What are explanations to the patient concerning immediate dentures?

Answer 18

• Do not fit as well
• pain of extraction and sore spots
• initial difficulty eating and speaking
• unpredictable esthetics

Question 19

What are the steps taken when making an immediate denture?

Answer 19

• exam/diagnosis/ tx plan
• preliminary impressions
• secondary impressions
• maxillo mand. relationship records
• posterior trial placement
• extractions - insertion
• post insertion care

Question 20

What should you examine and diagnose in a patient?

Answer 20

Tori
Tuberosities
Frenal attachments

Question 21

What are the steps taken in two-phase surgical regiment?

Answer 21

Phase 1: remove posterior teeth, alveoloplasty, tuberosity reduction
Fabricate Denture
Phase 2: extract anterior teeth at denture insertion appointment

Question 22

What occurs during phase 1 surgery?

Answer 22

Removal of posterior teeth
Surgical correction of tuberosities
Wait 6-8weeks, begin fabricating the immediate denture

Question 23

What occurs during phase 2 surgery?

Answer 23

Extract anterior teeth
Labial frenectomy, if needed

Question 24

What are benefits of 2 phase surgery?

Answer 24

Simplifies clinical procedures
Reduces post-placement care
Improves denture comfort and retention

Question 25

What should you do during the diagnosis step?

Answer 25

- determine patient's expectations - educate patient about limitations of complete dentures and his/her role in successful outcome

Question 26

What are secondary impression techniques?

Answer 26

Stock tray Custom impression tray Combination Campagna technique

Question 27

What makes border molding more difficult?

Answer 27

Presence of teeth

Question 28

What may make OVD determination easier?

Answer 28

Presence of anterior teeth

Question 29

What may make CJR registrations more difficult?

Answer 29

Malposed, drifted, mobile teeth

Question 30

What do you do during posterior trial placement?

Answer 30

Confirm correct mounting of casts Confirm OVD is correct Midline and incisal plane location - mark cast for reference

Question 31

How should you set anterior teeth?

Answer 31

Midline and incisal plane marked Alternate tooth arrangement - set every other tooth Minimal alveolar ridge modification

Question 32

When is the surgical template required?

Answer 32

If any alveoloplasty or bone smoothing is anticipated Fabricated at wax elimination stage of processing

Question 33

When should you not schedule a surgery/insertion?

Answer 33

On a friday or day before a holiday or vacation

Question 34

What are the steps of extracting remaining teeth?

Answer 34

Alveoloplasty, frenectomy in anterior, if needed

Question 35

When should you reduce abutments and place amalgam?

Answer 35

Prior to extractions

Question 36

What are interim immediate denture steps?

Answer 36

1. Make preliminary impressions for diagnostic casts 2. Make a custom impression tray 3. Border mold, make a final impression, mark the posterior seal, and carve it into the maxillary cast 4. Make a record base/wax rim, make an interocclusal record, mount cast 5. Set anterior denture teeth - alternating placement; complete posterior tooth placement 6. Final wax, process, complete 7. request a clear surgical guide, at the time the denture is processed

Question 37

How long should immediate dentures be worn for?

Answer 37

24 hours If removed, may not be able to be reinserted for 3-4 days

Question 38

What will happen to immediate dentures during healing?

Answer 38

Loosen

Question 39

What are instructions for a patient who got extractions?

Answer 39

Soft diet Some bleeding to be expected may have swelling 3-4 days Return to clinic next day; 24 hours post op

Question 40

What are instructions for a patient after surgery?

Answer 40

Do not remove until tomorrows appt If it comes loose/out put it back in place immediately Soft/liquid diet for 24 hours avoid rinsing take analgesic expect red saliva

Question 41

What do you do during the 24 hour appointment?

Answer 41

remove and rinse denture relieve any obvious pressure areas evaluate retention and occlusion

Question 42

What do you do during the 72 hour appointment?

Answer 42

Evaluate extraction sites Evaluate tissue, denture retention, oral hygeine

Question 43

What happens as tissue shrinks from denture contact?

Answer 43

Retention will usually decrease and require tissue conditioner

Question 44

What is decided after 4-6 months?

Answer 44

Reline/rebase/remake

Question 45

What should you do during the follow up?

Answer 45

- use tissue conditioner to refit as needed - remove any socket convexities to avoid healing defects - reline or remake in 6-9 months