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What are the challenging factors of immediate denture treatment?
- limited evaluation of trial
- increased complexity, cost, discomfort, maintenence, visits,
What are the benefits of immediate denture treatment?
- better healing, ridge form
- prevents facial musclulature collapse, pathologic invasion, bone loss, embarassment
- facilitates pt adaptation, health
- guide for individual esthetics and perspective occlusion
Basic understanding of immediate denture treatment sequence
- 1 clinic: Exam & preliminary impressions
- 1 lab: custom trays
- 2 clinic: master
- 2 lab: record base & occlusion rim
- 3 clinic: max-mand relation, tooth selection
- 3 lab: wax trial (if indicated)
- 4 clinic: wax trial tryin, confirm mounting/esthetics
- 4 lab: complete setup festooning, turn in for processing
- * schedule extractions
- 5 clinic: extractions/insertion, adjust tissue surface, flanges, occlusion, give care instructions
- 6 clinic: 24 hr
- 7 clinic: 72 HR
- 8 clinic: one week, clinical remount
Recognize the situations that require pre-prosthetic surgery so the properly-planned surgical procedure will be performed during extraction appt
Preprosthetic surgery (alveoloplasty, tuberosity reduction, tori removal etc.) should be planned together with extraction for a case like this
Oral exam checklist for potential immediate denture patients
- 1. soft tissues
- 2. ridge and alveolar contours (gross undercut or not)
- 3. teeth:
- - look for potential RPD
- - abutments or overdenture
- - support roots
- 4. jaw relation, occlusal plane, and VDO (acceptable or overclosed)
- 5. interarch space ( sufficient for prosthesis or not)
Possible Diagnosis leading toward to immediate denture treatment option
- Severe periodontitis
- Partial edentulism
- Rampant caries
Describe two-stage surgical approach for immediate dentures. What is the indication and what are the advantages for this approach?
- One-stage surgical approach: extract all teeth at the same time
- Two-stage surgical approach: extract posterior teeth/and or problematic teeth first
- 1. Ensure an optimal final impression that conform accurately to the contour of buccal, labial, and lingual vestibules.
- 2. Shorter and simpler surgery at the time of ID delivery.
- 3. After initial extraction some edentulous spaces become available for esthetic try-in and confirmation of jaw record
- 4. Extraction of teeth that require immediate attention (e.g., infected and/or painful teeth)
What are the four key questions that should be addressed to better manage our denture patient’s expectation?
- 1. What are the benefits of having a denture vs. other options?
- 2. How long will the denture last?
- 3. What are the limitations of the denture?
- 4. How much will the denture cost? (ID fee + permanent reline fee/or remake CD fee)
What can immediate denture offer in terms of esthetics, function, and comfort? Should the dental implant option be included for the ID patient and why?
- esthetics: excellent
- function: restore some masticatory not all, pt adaptation
- comfort: hard 1st week, improves after
- Always inform the patients about implant option for the ultimate solution for function and comfort IF their expectation can not be met by the immediate denture phase.
- Immediate denture is a transitional phase in order to remove
- the hopeless teeth and regain the healthy oral environment.
- Definitive replacement options (lab reline of ID, or new CD, or implant option)
- will be revisited based on patient’s adaptation and response to their ID phase
How to prepare our patient prior to the master impression appt
- Place soft liner in the old partial denture, if indicated. Consult with instructor.
- Instruct your patient to remove existing removable partial dentures for 24 hours prior to the final impression appointment.
- Prophylaxis:remove all calculus from the remaining teeth so that the tissues will be in optimum condition during treatment planning, impressions, extraction and denture placement.