immediate dentures

Question 1

Inflammatory papillary hyperplasia
“IPH”
(2)

Answer 1

A reactive tissue growth usually developing under a denture
Occurs on hard palate beneath denture base

Question 2

IPH
What is it?
Directly related to …
Combination Syndrome?
— frequently present

Answer 2

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

constant wearing of ill-fitting denture and poor oral hygiene

Candida

Question 3

Immediate dentures- 2 popular protocols

Answer 3

Conventional
Interim

Question 4

Conventional –

Answer 4

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

relining/relifting is done

the denture is intended to be relined to serve as the long term prosthesis

Question 5

Interim / transitional –

Answer 5

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

new CD is made

after healing is completed, a second, new complete denture is to be fabricated as the long term prosthesis

Question 6

Immediate Complete Dentures
Advantages
(3)

Answer 6

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

maintenance of pt appearance
cicumoral support, muscle tone, OVD, jaw relationship, and face height can be maintained, the tongue will not spread out as a result of tooth loss
less postoperative pain as extraction sites are protected
easier to duplicate (if desired) the natural tooth shape and position
adaptation easier, speech and mastication are rarely compromised, and nutrition can be maintained
availability of tissue conditioning material
pt psychological and social well being is preserved

Question 7

Immediate Dentures
Disadvantages
(4)

Answer 7

Increased complexity – impressions, CJR
Lack of clinical evaluation of trial denture-anterior esthetics
Increased maintenance
Greater # visits = more cost

immediate dentures are a more challenging
the anterior ridge undercut (by the presence of remaining teeth) may interfere with the impression procedures
the presence of different numbers of remaining teeth in various locations frequently leads to recording incorrectly CR
no dentures tooth try in precludes knowing what the denture will actually look like on the day of insertion
more chair time, additional appointments, and therefore increased costs

Question 8

explanation to the pt concerning immediate dentures (4)

Answer 8

do not fit as well as normal CD
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
difficult to eat and speak initially
the esthetics may be unpredictable bc an anterior try in is not possible

Question 9

immediate dentures (7)

Answer 9

exam/dx/tx plan
preliminary impressions
secondary impressions
max-mand relationship records
posterior trial placement
extractions -insertion
post insertion care

Question 10

Exam & Diagnosis
(3)

Answer 10

Tori
Tuberosities
Frenal attachments

Question 11

Exception: An existing esthetic
RPD

Answer 11

Maintain RPD abutment teeth

Question 12

two phase surgical regimen

Answer 12

1: remove posterior teeth, alveo, tuberosity reduction

fabricate denture

2: extract anterior teeth at denture insertion appointment

Question 13

Phase 1 Surgery
(3)

Answer 13

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

Question 14

Phase 2 Surgery at denture insertion
(2)

Answer 14

Extract anterior teeth
Labial frenectomy, if needed

Question 15

Benefits of 2-phase surgery
(3)

Answer 15

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

Question 16

Preliminary impressions
May need to customize

Answer 16

tray borders

Question 17

Diagnosis
(2)

Answer 17

Determine patient’s expectations
Educate patient about limitations of complete dentures and his/her role
in successful outcome

Question 18

Secondary impression
techniques
(4)

Answer 18

Stock tray
Custom impression tray
Combination
Campagna technique

Question 19

Border-molded custom tray
Presence of teeth makes — more difficult

Answer 19

border molding

Question 20

Max. – Mand. registrations
(2)

Answer 20

Presence of anterior teeth may make OVD determination easier
Malposed, drifted, mobile teeth would make CJR registrations more
difficult

Question 21

Posterior trial placement
(3)

Answer 21

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

Question 22

Set Anterior teeth
(3)

Answer 22

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

Question 23

Surgical template
(2)

Answer 23

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

Question 24

Don’t schedule the
surgery/insertion on a

Answer 24

Friday or
day before a holiday or vacation

Question 25

Extraction of remaining teeth (2)

Answer 25

Simple extractions, hopefully Alveoloplasty, frenectomy in anterior, if needed

Question 26

Denture insertion (3)

Answer 26

PIP Relieve any pressure areas Bilateral occlusal contacts

Question 27

Immediate Overdenture ?

Answer 27

Reduce abutments and place amalgam prior to extractions

Question 28

Interim immediate denture steps (7)

Answer 28

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 casts 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 29

explanation to the pt concerning immediate dentures

Answer 29

ID must be worn the first 24 hrs without being removed by the pt, if they are removed, they may not be able to be reinserted for 3-4 days. the dentist will remove them at the 24 hour visit ID will loosen during healing, tissue conditioners will be required 6-9 mo after insertion at least a reline will need to be done, possibly a remake. the pt is responsible for fees

Question 30

Patient instructions (4)

Answer 30

Soft diet Some bleeding to be expected May have swelling for 3 – 4 days Return to clinic the next day; 24-hour post-op. do not remove until tomorrows appointment 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 31

Post-Insertion care at 24-hr appnt (3)

Answer 31

Remove and rinse denture Relieve any obvious pressure areas Evaluate retention and occlusion

Question 32

Post – Insertion Care at 72 hr appnt (2)

Answer 32

Evaluate extraction sites Evaluate tissue, denture retention, oral hygiene

Question 33

Retention

Answer 33

As tissue shrinks from denture contact, retention will usually decrease and require tissue conditioner

Question 34

Post-Insertion Occlusal correction – remount – done when patient is comfortable (---) Tissue conditioner changed as needed Decision to reline/rebase/remake is made after ---

Answer 34

2 – 3 weeks 4-6 months

Question 35

follow up (3)

Answer 35

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