Complete Dentures: Immdediate Dentures/additions

Question 1

What is the definition of an immediate denture?

Answer 1

Is one that is constructed prior to the extraction of the natural teeth & inserted immediately after their removal

Question 2

How many types of immediate dentures are there? What are they?

Answer 2

1. Remove all remaining teeth and provide immediate c/c dentures(would be allot of XTN and a lot of guess work to simulate gums)
   2.Extract posterior teeth first & let that area heal up before taking impressions of the mouth - Final stage remove anteriors and then place an denture immediately (would mean less guess work from technician and patient will retain anterior teeth for longer.
2. Provide a post immediate denture - so we extract teeth and then start taking impressions for construction of denture ( sockets will need to heal and the ones will be resorting/healing (so rare satisfactory option.
3. Take out worst teeth (Most mobile/causing pain) and then make a transitional partial denture and progressively add to the denture until it becomes a C/C denture,(as more teeth become of poor prognosis

Question 3

What are the factors with regards to removing all remaining teeth and providing a denture?

Answer 3

-> Only one surgical required
-> Initial fit of denture will be poor (guess work with shape of jaw, open sockets from ex , bleeding ands swelling from ex and LA)
-> Rapid bone loss and remodelling of jaws
-> Dentures often soon become loose and & ill-fitting

Question 4

What’s re the factors with regards to the option of removing all posterior teeth first and then removing anterior and providing a denture?

Answer 4

This will help the final denture to be well fitting especially in the posterior due to the healed sockets
negative the tongue wont have any teeth or denture present therefore will take advantage of this and spread around the area so later on when denture is present tongue may feel tight

Question 5

What’s are the factors with regards to option 3 of post-immediate denture and when would you consider this?

Answer 5

In this case the teeth are extracted and sockets are left to heal before denture is made
*when this will be done**
If a patient has no interest in keeping there dentition
They have a poor or neglected mouth - multiple problems where we think it isn’t worth having the teeth any longer
Patient doesn’t want to bother with or accept provisional or partial dentures

Question 6

When would you consider option 4 and what is it?

Answer 6

Tends to be used most often
MAke partial dentures for the gaps that are already existing
Or to extract teeth of hopeless prognosis first and then make partial denture and then add more teeth as patiant loses more and more teeth
advantages
Patient keeps there natural teeth for longer, which helps with retention and stability of partial denture (will also maintain OVD therefore help with aesthetics
Task can be completed over years (gives patient the chance to improve with OHI)
It is planned so nothing too big for the dentist and technician to deal with at once. (Also helps determine if pt actually can wear dentures before its too late)

Question 7

What will you do in the first visit when providing immediate dentures?

Answer 7

• History
• Exam
• Radiographs (of teeth we are thinking of extracting)
• Primary impressions as though were making partial dentures so (modify stock trays with silicone putty or impression compound in the edentulous areas, Extend stock tray where it is under extended. And take an alginate impression) then send these off for a special tray.

Question 8

What would you do after hours have completed all the checks in visit 1?

Answer 8

You will look at all the checks and then decide which type of immediate denture you want, i.e option 1,2,3 or 4.

Question 9

What would you do in visit 2?

Answer 9

If pt has posterior teeth, extract.
If no posterior teeth are present then take secondary impressions just like partial dentures. We will carry out border moulding, and green/pink stick to extend the trays to pick up functional impression of sulcus’s
Send these off for record rims

Question 10

What would we do in visit 3 for immediate dentures?

Answer 10

Record occlusion with the record rims - e.g Ala travel plane… (add more)

Question 11

What would you do in visit 4 of providing a immediate denture?

Answer 11

You will now do a try in
Can only do try in for the teeth already missing,
(although we are going to extract anterior we don’t get a chance to do them, just posterior to check to see balanced occlusion and balanced articulation on those teeth and check if they have got the correct OVD)

Question 12

What will the technician have to do after the patients try in session in visit 4? And what will they use to do this?

Answer 12

The technician will have to convert the study cast they have of the patients mouth to what they think the pt mouth will look like after extraction. They will user chisels and sandpaper to remodel it. (They maintain a long line to see long axis of tooth and they also have a horizontal line showing the level of the bone , pocket depths are also sent to technician) once rounded off, they will make a complete denture off that and we done get a chance to do a complete denture try in anterior teeth with patient

Question 13

What happens in visit 5?

Answer 13

Extraction and fit
The extractions are done carefully to reduce trauma and preserve bone. (Pt will be numb)
Denture will be checked and patient will be numb

Question 14

What issues will the patient have and how long for? What can you do about this?

Answer 14

Review the patient after 24hrs - we should be the first ones to take dentures out. Check occlusion rubbing and can use tissue conditioner if loose or sore to make denture comfortable.
Pt will be uncomfortable for the 24hrs, swelling, post op pain and trauma from denture making eating difficult.
Pt may complain of pain and excess salivation, loss of taste and unable to eat.
If dentures removed will be difficult to insert back in due to swelling
Should have Emphasised dentures should stay in for the previous 24hrs

Question 15

Why should you see the patient after 1 week?

Answer 15

Initial swelling will be reduced and dentures will become loose.
Occlusion can be more assessed more accurately and adjustments can be made
Contaminated tissue conditioner may need replacement
Pt should be free of most pain and discomfort

Question 16

What should you do in the 3 month review?

Answer 16

Pt may complain of denture feeling loose and food gets under the denture (due to bone resorption)
Chairside reline may be required
Occlusion will need further adjustments
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Question 17

What would you do in a 6months review

Answer 17

Majority of healing of gums would have happened
Pt may complain of looseness and food getting stuck (reline may be required again, if fit very poor start a new denture construction)
Occlusion may need adjusting
Gap may be present due to resorption

Question 18

What should you warn the pt about before starting immediate dentures?

Answer 18

Warn them that they will need a replacement set of dentures after 6 months (with attendant costs)

Question 19

What are the advantages of immediate dentures?

Answer 19

Tooth size, shape and position can be maintained
Jaw relationship maintained
No period without teeth
Sockets protected (from food or anything which may cause infection or discomfort)

Question 20

What is an open face denture? What do they come about? Why do we do them and what are the issues they solve?

Answer 20

Alveolar bone will resorb , the bridge will remodel and lip support will be lost causing the lip to fold in a little????

Question 21

What are the different types of anterior flange?

Answer 21

Full flange
Part Flange
Socket fitted

Question 22

What are the benefits of a full flange?

Answer 22

-> Aids healing and protects clot - prevents food getting stuck in sockets
-> increased retention and stability because of border seal
-> easy to reline & adjust
-> Reduced alveolar bone loss (study’s show)
-> Improved lip support - because the flange will be there after the bone is resorted. (Issue can occur if full flange is put in before resorption as it will give too much lip support.- feel bulky and uncomfortable fore patient as replacing something which hasn’t been lost yet

Question 23

When are socket (fitted denture) filled design of immediate dentures used? And what can be disadvantages?

Answer 23

Used when there’s a marked bony anterior undercut present???
Useful where anterior flange is too bulky as too much lip support
Disadvantages
Reduced retention and stability
Not so easy to reline and adjust
Not suitable for the lower Jaw - because bony ridge is thinner
An gap will appear over time between denture and ridge

Question 24

When would a Part Flange be used? And what are the advantages or disadvantages?

Answer 24

This can be used to prevent the gap appearing of the Socket filled flange
It’s not to the full functional width and depth of the sulcus ( just covers sockets area)
Not so bulky that it pushes top lip out
After a certain amount of bone resorption gaps will start to appear and it wont look natural anymore

Question 25

What are the complications of providing Immediate dentures?

Answer 25

Poor fit - because shape of mouth is an estimation of when the teeth have been taken out, Moreover there will be bone loss after a period so even if they did fit originally they will soon become **ill-fitting** Ill fitting denture- can be uncomfortable for the patient Gaps will form - patient will get food sticking -> May increase bone loss due to pressure in some areas over others -> Ridge damage due to poorly designed dentures for example socket filled dentures can cause this.

Question 26

What are the disadvantages of immediate pets compared to conventional?

Answer 26

*No proper try in for anteriors - Guess work involved and we need to hope the aesthetics the technician has created the patient likes * If we are replacing many teeth, patient wont get the chance to see whether or not they can tolerate wearing dentures * Usually poor initial fit which subsequently Deteriorates * High maintenance, money and time temporary relines will be needed. * Problems with Bony undercuts due to the extractions

Question 27

What are Immediate additions?

Answer 27

Immediate additions are when the patient already has a denture but is going to have an extraction done. Therefore we can add this tooth onto that existing denture on the day that they are having that tooth extracted

Question 28

How many appointments do we need for Immediate additions?

Answer 28

2 appointments (Will need to check how long the lab will need) (Will need to warn the patient they will have to be without their denture for 48 hours )

Question 29

What is done on the first appointment of Immediate additions?

Answer 29

Impressions will be taken of the patients denture inside the patients mouth ( full arch and opposing arch) and then send the denture and the impression to the lab

Question 30

What is done on the second appointment of Immediate additions?

Answer 30

We extract the tooth and fit the denture which has the tooth added onto it

Question 31

What instructions do you send along side the denture and impression (all in one) for immediate additions?

Answer 31

1. Specify whether or not we want the flange (need to think if there is any anterior bony undercut going to happen 2. Need to give the technician any idea of pocket depths around the tooth being extracted so they know how much or how little they can trim the model 3. Need to tell them which tooth’s being extracted 4. Will need an opposing impression and record the occlusion as well to make sure bite is right

Question 32

What do you need to make sure to check in the second visit of immediate additions?

Answer 32

1. Make the the **Correct Tooth** has been added to the denture **BEFORE** performing the extraction 2. Put the denture in perform for 10 minutes, and rinse well. 3. Extract the tooth, compress the socket achieve haemostasis. 4. Fit denture - the area will be numb so look for tissue blanching (if any tissues are going white under pressure) we need to do this as the patient wont be able to tell us if anything is uncomfortable or not or if it’s fitting correctly ** IT IS OUR DUTY TO CHECK** 5. Check occlusion

Question 33

Can immediate dentures be done Chairside as well?

Answer 33

Yes, and this allows for the patient to not be without their denture too and doesn’t involve the technician (is possible if patient really really doesn’t want to be without their denture) (Not really done )

Question 34

How is a Immediate Addition done chairside?

Answer 34

An impression of the denture is done in situ. Then the teeth are made like a temporary crown an acrylic material is used to place into the impression where those teeth are leaving an acrylic version of those two teeth (polishing will be needed and excess removed) then can be fitted as a denture after the extraction

Question 35

Disadvantages of Chair side Acrylic denture ?

Answer 35

1.Can’t really get the colour of the teeth right 2. No opportunity to adjust or greater the flange 3. Looks rough 4. In time where bone resorption occurs will have a gap.