UWO School of Dentistry Immediate Dentures zTransitional Complete zConventional Complete zPartial الملتقى المصرى لأطباء الأسنان

UWO School of Dentistry

Immediate Dentures

Transitional CompleteConventional CompletePartial

الملتقى المصرى ألطباء األسنانwww.egydental.com

http://www.egydental.com/


Objectives Immediate Dentures

Know: Describe and prescribe appropriate types of

ID Clinical protocols associated with each type Laboratory protocols Post-insertion care


Immediate Transitional Dentures

Complete clearanceIndications

Multiple extractions Patient needs/demands


ImmediateTransitional Denture

A denture made without prior extraction of teeth

Synonyms: Interim Temporary Provisional



Indications Multiple extractions Esthetics Function Conventional ICD

contraindicated



Technique: Alginate impressions Lab or office pour

Gypsum modelHybrid model

Mounted models Arbitrary estimation of contour





AfterBefore


ImmediateTransitional Denture



Problems Intensive post insertion care Short-term solution More expensive


Conventional Immediate Dentures

Maxillary six anteriors Posterior teeth extracted 8-

12 weeks previouslyPredictable, stable ridge

contour


“Conventional” Immediate Complete Dentures

Concept Remove all posterior teeth about 3 months before making immediate denture



Rationale Allows for posterior segment to heal and stabilize

Maintains anterior teeth for appearance, some function



Indications Maxilla anterior teeth present Cooperative patient

Not Recommended Both jaws

simultaneously Mandibular arch


Immediate Dentures Impression Techniques

Single custom traySplit impression technique

Posterior segment Anterior segment

Stock trayPutty index


Split Impression Tray - Alginate

Retention lugs

Handle



Stock Tray Technique

Short-comings Small oral opening Proclined maxillary

anterior teeth Anatomic accuracy of

vestibule


Split Impression Tray-Putty-Index Technique

Tray extends to and contacts incisal edge of anterior teeth


Putty-Index Technique









Cast trimming guidelines “Normal” periodontal condition

“Rule” of Thirds Advanced periodontal deterioration X-ray & probing measurements



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


Round over lingual aspect of socket


Round off labial to middle third, sand smooth


ICD Master Cast Trim

Trimmed areas sanded smooth

Avoid removing incisive papilla


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


Immediate Partial Dentures

Framework incorporates wrought wire retentive loops for tooth attachment

Loops bent into place at processing stage, after cast trim


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.”



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


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


Post Insertion Management

Recall next dayRemove dentureApply topical anesthetic to

traumatized mucosaLocate over extensions and pressure

areas and adjustReappoint 1 week



Healing, shrinkage, resorptionPatient remountRelines

Interim – within first 12 months Definitive – 12 months +



Remount when:Healing edema resolvedTraumatized mucosal lesions healed

Usually within 14-21 days



Reline Short term – tissue conditioners Mid-term – intermediate direct liners

E.g. Kool liner™

Long-term – standard reline protocol


Immediate Denture Appendix

Review clinic & lab protocols Try in cast trimming



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.”


ICD Try-In

Sectional wax-up Anterior segment for

patient viewing Posterior segment for

check record


ICD Try-In

Posterior “removable” section used for: Confirmation of

horizontal and vertical relationships

Tooth shade



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


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


ICD Master Cast Trim

Trimmed areas sanded smooth

Avoid removing incisive papilla


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

Documents

UWO School of Dentistry Immediate Dentures zTransitional Complete zConventional Complete zPartial الملتقى المصرى لأطباء الأسنان