Immediate dentures in CD

1. 86
1
PRESENTED BY
DR KELLY NORTON

2. • Advances in therapy have helped patients with periodontal
disease retain part of their natural dentition for an extended
period of time. These patients can be well served by properly
designed removable partial dentures.
• For the patient facing the loss of all his/her remaining natural
teeth, there are three treatment options .
One is for the patient to have all remaining teeth extracted and
wait six to eight weeks for the extraction sites to heal.
The complete denture is made following healing, leaving the
patient without teeth not only during the healing phase , but
also during the time required for the fabrication of the
complete denture.
2
INTRODUCTION
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3. • A second option is to convert an existing removable partial denture
into an interim complete denture.
• A third option is to make a ‘ immediate complete denture’.
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4. Definitions
• IMMEDIATE DENTURE:
Any removable dental prosthesis fabricated for placement
immediately following the removal of a natural tooth/teeth.
GPT-8
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5. TRANSITIONAL DENTURE: GPT-8
A removable dental prosthesis serving as an interim prosthesis to
which artificial teeth will be added, as natural teeth are lost and that
will be replaced after post extraction tissue changes have occurred. A
transitional denture may become an interim complete dental
prosthesis when all of the natural teeth have been removed from the
dental arch.
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6. A fixed or removable dental prosthesis, or maxillofacial prosthesis,
designed to enhance esthetics, stabilization and/or function for a
limited period of time, after which it is to be replaced by a definitive
dental or maxillofacial prosthesis. Often such prostheses are used to
assist in determination of the therapeutic effectiveness of a specific
treatment plan or the form and function of the planned definitive
prosthesis.
Also called as PROVISIONAL PROSTHESIS
GPT-8.
6
INTERIM PROSTHESIS:
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7. TYPES OF IMMEDIATE DENTURES
(Prosthodontic treatment for edentulous patient-Zarb and Bolender)
1.CONVENTIONAL (CLASSIC) IMMEDIATE DENTURE (CID):
This is a type of immediate denture which, after it is made and
healing is completed, the same denture is refitted or relined to serve
as a long term prosthesis.
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8. 2. INTERIM OR TRANSITIONAL OR NON TRADITIONAL
IMMEDIATE DENTURE (IID):
This is a type of immediate denture in which after the healing is
completed, a second new complete denture is fabricated as the long
term prosthesis.
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9. JIFFY DENTURES (Raczka and Esposito 1995)
• It is similar to interim immediate denture because it is replaced by a
second denture after healing.
• It differs from interim immediate denture in that the denture “teeth”
are usually made with tooth coloured auto-polymerizing acrylic resin
or portions of the patient’s preexisting fixed or removable partial
denture.
• The disadvantage with this is that the denture teeth are not long
lasting (in wear and color stability).
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10. According to Heartwell, to attain maximum degree of success the
following requirements should be satisfied
• Compatibility with surrounding oral environment.
• Restoration of masticatory efficiency within limits.
• Harmony with the Function of speech, respiration and deglutition.
• Esthetic acceptability.
• Preservation of remaining tissues.
10
REQUIREMENTS
Textbook of Complete Dentures, Arthur O. Rahn, Charles M. Heartwell 5th edition
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11. ADVANTAGES AND DISADVANTAGES FOR
ALLTYPES OF IMMEDIATE DENTURES
ADVANTAGES
1. The maintenance of a patient’s appearance
because there is no edentulous period.
2. The denture acts as a bandage or splint to help
control bleeding, to protect against trauma and
contamination.
3. Circumoral support, muscle tone, VDO, jaw
relationship, and face height can be maintained.
4. The tongue will not spread out as a result of tooth
loss.
5. Less postoperative pain is likely to be
encountered because the extraction sites are
protected.
6. Reduced RRR due to early function
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12. 7. It is easier to duplicate (if desired) the natural tooth shape and
position, plus arch form and width.
8. Ease of adaptability to new dentures at the same time that recovery
from surgery is progressing. Speech and mastication are rarely
compromised, and nutrition can be maintained.
9. Overall, the patient’s psychological and social well-being is
preserved.
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13. 1. The presence of variable number of teeth makes impressions
and maxillo-mandibular positions more difficult to record.
2. Resorption of the ridges leading to reline or remake of denture
in six month or a year following insertion.
3. The anterior ridge undercut (often severe) that is caused by the
presence of the remaining teeth may interfere with the
impression procedures ; hinders in accurately capturing a
posteriorly located undercut, which is important for retention.
4. Inability to predict esthetics as anterior try in prior to insertion
is not carried out.
5. More chair side time, increased treatment cost
6. Temporary inconvenience of impairment of functional
activities
13
DISADVANTAGES
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14. (1) patients who are in poor general health or who are poor
surgical risks
• Post-irradiation of the head and neck regions
• Systemic conditions that affect healing or blood clotting
• cardiac or endocrine gland disturbances
• psychological disorders
(2) patients who are identified as uncooperative because they
cannot understand and appreciate the scope, demands, and
limitations to the course of immediate denture treatment.
14
CONTRAINDICATIONS
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15. 15
Conventional immediate
denture ( CID)
Interim Immediate denture
(IID)
Definitive or long term
prosthesis
Transitional or short term
Only anterior teeth are
remaining ( and premolars)
Usually both anterior and
posterior teeth are remaining
Good retention and stability Only fair retention and
stability; improved by
provisional relines during
healing
Overall cost is less than IID Includes cost of interim
denture and a second denture
Long treatment time due to
healing period of posterior
teeth extraction areas
Treatment time is shorter
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16. 16
Conventional immediate
denture ( CID)
Interim Immediate denture
(IID)
At placement of CID only
anterior teeth are extracted.
At placement of IID , both
anterior and posterior teeth
are extracted
Esthetics of the CID cannot be
changed
The second denture
procedure after the IID allows
an alteration of esthetics.
Contradicted for a patient
who has a complex treatment
plan or for changes in the
vertical dimension of
occlusion
Indicated in complex
treatment cases
Not useful for converting
existing prostheses
useful for converting existing
prostheses to an IID
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17. DIAGNOSIS and TREATMENT PLANNING
1. Explanation to the patient :
A careful explanation to the patient of the limitations of immediate
denture service should always be given.
The list includes:-
They do not fit as well as complete dentures. They may need
temporary lining with tissue conditioner and may require the
use of denture adhesive.
 They will cause discomfort.
 It will be difficult to eat & speak initially.
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18.  The esthetics may be unpredictable.
 Many other denture factors are unpredictable such as gagging
tendency, increased salivation, and facial contour.
 It may be difficult or impossible to insert the immediate denture on
the first day.
 Immediate denture must be worn for the first 24 hours without
removal by the patient.
 Because supporting tissue changes are unpredictable, immediate
denture may loosen up during the first 1 to 2 years.86 18

19. 2. Diagnostic procedure :
The diagnostic procedures are divided into two phases:
(A) Patient examination
(B) Consultation interview.
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20. (A) Patient examination: -
The examination of the patient
should include:
a) Findings of local and systemic
status.
b) Roentographic study.
c) Visual and digital examination.
d) Accurately articulated cast.
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22. 2286

23. a) Local & systemic status :-
 Condition of teeth to be extracted.
 Position of teeth.
 Presence of foreign bodies.
 The presence of bony or tissue undercuts that must be reduced or
eliminated.
 Exostoses.
 Bone loss adjacent to remaining teeth.
 Muscle co-ordinations.
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24. (b) Examination of existing prosthesis:-
Any existing prosthesis should be examined for shade,
mold, tooth position, lip support, and smile line.
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25. (B) Consultation interview:-
 Past dental history,
 Mental attitudes,
 Explanations and wants,
 Existing systemic conditions.
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26. (3) Tooth Modification : -
 As occlusal discrepancies can affect correct registration of centric
relation and can also interfere with the proper determination of
the occlusal vertical dimension.
 So these tooth modification should be made in advance to the final
impression.
 Many immediate dentures will
require modification of
opposing teeth to correct the
occlusal plane or to eliminate
prematurities in centric
relation.
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28. Diagnostic mounting of the cast:
• Initial discussion of esthetics (tooth mold & shade selection)
• Plane of occlusion.
• Patient existing midline and modification of its position.
• Patient existing vertical dimension of occlusion and amount
of inter occlusal distance.
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29. To evaluate whether patients existing maximum occlusal position
coincides with the planned centric relation position for immediate
dentures.
To estimate the angles classification of occlusion for the patient
and a note of the display of posterior tooth in buccal corridor.
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30. (4) Oral prophylaxis :-
 The patient should have a general scaling of the teeth to minimize
calculus deposits. This will reduce the post operative oedema and
chance of infection.
(5) Other treatment needs :-
 Often patients with single immediate dentures also require
restorations, crown or removable partial dentures; restorations are
usually performed coincident with the immediate denture
procedures.86 30

31. • WHAT TYPE OF IMMEDIATE DENTURE SHOULD BE
PRESCRIBED?
• Extracting the posterior teeth and performing other necessary
procedures first in patients can lead to predictable results for the
CID.
• However for other patients, the idea of a period without posterior
teeth is impossible to imagine hence, more and more patients are
opting for the convenience of the IID choice.
• If the dentist performs the technique meticulously and the patient is
cooperative, the resulting IID can be very successful and the second
denture procedures allow optimization of the end result.
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32. CLINICAL AND LABORATORY PROCEDURES
FIRST EXTRACTION / SURGICAL VISIT
• If a clinical decision is made to undertake preliminary extractions
(CID technique), then posterior teeth should be first identified for
extraction.
• Any other required hard and soft tissue operation.
• Short healing time, usually only 3 to 4 weeks, before the preliminary
impressions are made.
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33.  PRELIMINARY IMPRESSIONS AND DIAGNOSTIC
CASTS
33
• Impression material- irreversible hydrocolloid (alginate)
• Impressions should be free of voids and should record the full
extensions planned for the denture prosthesis.
• Impressions are poured in stone and are used to make custom trays
for the final impressions.
• If an IID is planned, these preliminary impressions and casts will
contain all of the remaining teeth and If a CID is planned, these will
contain only anterior teeth
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34. 34
IF AN IID IS PLANNED
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35. 35
IF A CID IS PLANNED
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36.  MANAGEMENT OF LOOSE / MOBILETEETH
1. Using periphery wax at the cervical areas
2. Applying a lubricating medium to the teeth
3. Placing copper bands over the loose teeth
(Soni, 1999)
4. Placing a vacuum-formed plastic over the
teeth (Vellis, Wright, Evans et al., 2001)
5. Placing holes in the tray and using an
amalgam condenser to release the tray
over loose teeth (Goldstein, 1992).
6. By using elastomeric impression materials
and irreversible hydrocolloid to make an
accurate preliminary impression of
extremely mobile and misaligned teeth
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37. CUSTOMTRAYS, FINAL IMPRESSIONS, AND FINAL CASTS
There are two basic ways to fabricate the final impression tray,
depending on the location of the remaining teeth and operator
preference.
TYPE ONE: SINGLE FULLARCH CUSTOM IMPRESSION
TRAY
• The type one method more closely resembles a routine custom
impression tray for removable partial dentures.
• It can be used in the CID technique. It is the only tray that can be
used for the IID technique
• This type of tray is effective when only anterior teeth are remaining
or when anterior and posterior teeth are remaining.
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 A Stop effect is established by
providing holes through the wax
anteriorly or posteriorly
 The tray is outlined to be 2 to 3 mm.
short of the vestibular roll and to
extend and include the posterior limit
i.e. posterior palatal seal and hamular
notch.

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40. TYPETWO:TWO-TRAY OR SECTIONAL CUSTOM
IMPRESSIONTRAY
The type two method is used only when the posterior teeth
have been removed (CID.
• It involves fabricating two trays on the same cast—one
in the posterior, which is made like a complete denture
tray, and one in the anterior (backless tray).
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41. 41
• Use melted wax to block out undercuts and interdental
spaces.
• Note: A double sheet of wax is not used because intimate
adaptation of the tray is desired.
• Adapt autopolymerizing acrylic resin or light-cured resin to
the posterior edentulous areas, covering the lingual surfaces
of the teeth (only) and extend up beyond the incisal edges of
the teeth to include a handle86

42. :
.
* CAMPAGNA TRAY-( CAMPAGNA 1968)
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A full arch tray with a hole cut out where the
remaining anterior teeth are (CID technique).
A stock tray is used over the full arch tray to
capture the anterior teeth in the impression.86
 For the anterior section or tray there
are varying techniques; one is to
adapt a custom tray, and another is to
cut and modify a plastic stock tray.
 Alternately, instead of the tray, adapt
plaster impression material or a
heavy mix of an elastomeric
impression material directly in the
patient mouth.
 The anterior section/impression
material must cover the labial
surfaces of the teeth and the
vestibule.

43. i
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45. 45
86
FINAL CASTS

46.  JAW RELATION RECORDS
46
• Identical to those for complete dentures.
• The remaining teeth and anatomical landmarks can serve as a
guide to the height of the rim.
• Record bases be stable and strong enough to record jaw
relations.
• An evaluation of the patient’s existing vertical dimension of
occlusion is accomplished.
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47. • A face-bow transfer and a recording of centric relation
are made.
• The casts are mounted on the articulator
47
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48.  SETTINGTHE DENTURETEETH/VERIFYING JAW
RELATIONS ANDTHE PATIENTTRY-IN APPOINTMENT
• Set the posterior teeth in centric relation.
• The trial denture bases are tried in the mouth and used to verify vertical
dimension of occlusion and centric relation
• Followed by arrangement of anterior teeth.
• Now it is important to take time with the patient to record landmarks on
the casts and to confirm the patient’s esthetic desires as follows:-
• The midline or newly selected midline is recorded.
• The anterior plane of occlusion using the interpupillary line as a guide is
determined and marked on the base of the cast.
48
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49. • The high lip line should be determined.
• A discussion of placement of diastemata, rotated teeth, notches,
and other natural arrangements should occur so that the patient
is actively involved in the esthetic decisions.
• The existing anterior vertical and horizontal overlap should be
noted
• The casts are marked with all the information gathered which
should include pocket depths, free gingival margins, a line
marking the interproximal of each tooth, and a drawing of
where the new tooth position should be.
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50. 50
CAST MODIFICATIONTECHNIQUE
Phoenix RFleigel J. Cast modification for immediate complete dentures: Traditional and contemporary
considerations with an introduction of spatial modeling. The Journal of Prosthetic Dentistry. 2008;100(5):399-405.
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Cast modification technique proposed by Standard
2mm
apical

51. 86 51
 Cast modification technique proposed by Jerbi

52. Cast modification based upon spatial modeling
52
Phoenix RFleigel J. Cast modification for immediate complete dentures: Traditional and contemporary
considerations with an introduction of spatial modeling. The Journal of Prosthetic Dentistry. 2008;100(5):399-405.86

53. 53
•Trimmed areas sand papered smooth
•Avoid removing incisive papilla
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54. ¤ Mark the every other anterior tooth with
an “X” and remove with a saw or cutting
disk from the cast, leaving at least one
canine, central incisor and lateral
incisor.
¤ Trim the extraction site on the cast with
a carbide bur, as if the tooth had been
removed and a small clot had formed in
the site.
¤In other words, the resulting area
should be concave and not convex.
Use pocket depth as a guide.
•ANTERIOR TEETH ARRANGEMENT:
 The following teeth arrangement technique is suggested:
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56.  WAX CONTOURING, FLASKING, AND BOIL-OUT
• Adequate wax is added to provide a thickness of material for strength
during future deflasking.
• Thickness of the acrylic resin is needed to provide room to trim from the
inside to relieve the sore spot or to seat the denture
• A remount cast to preserve the face bow, should be done for later patient
remounting, 2 to 4 week after delivery.
56
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57.  SURGICALTEMPLATES
• A surgical template is a thin, transparent form duplicating the
tissue surface of an immediate denture and is used as a guide for
surgically shaping the alveolar process (Farmer, 1983).
• It is a prescription for the surgical procedure and is essential
when any amount of bone trimming is necessary
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58. 1. Make an irreversible hydrocolloid (alginate)
impression of the edentulous ridge after the
cast has been trimmed at boil-out.
2. Pour the impression in stone.
3. Make a clear resin template on this duplicate
cast by any of these four methods:
a. Vacuum form method (a hole is placed in the
center of the cast and a clear sheet is vacuumed
onto the cast)
b. Sprinkle-on technique (a clear acrylic
[orthodontic] resin is used)
c. Process template in clear acrylic resin (created
by waxing up, flasking, and heat processing)
d. Fabricate the template in light-cured, clear
material
PROCEDURE
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59.  PROCESSING AND FINISHING
The immediate dentures are processed and finished in the usual
manner of complete dentures.
Both the immediate denture and the surgical template should be
placed in a chemical sterilizing solution in a bag for delivery.
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60.  SURGERY AND IMMEDIATE DENTURE INSERTION
• The dentist performing the operation then extracts the
remaining teeth, taking care to preserve the labial plate of bone.
• The surgical template is used as a guide to ensure that the
prescribed bone trimming is done adequately
• The template should fit and be in contact with all tissue
surfaces.
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61. • Inadequately trimmed
areas planned for bone
reduction will blanch from
the pressure and be seen
through the clear template,
indicated by rocking or
with pressure-indicating
paste.
• Sutures are placed where
necessary
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62. • The dentist or surgeon places the denture so that it seats well
with good firm bilateral occlusion and no gross deflective
contacts.
• If the occlusion is not correct, the denture should be rechecked
for seating, particularly distally, the so-called denture heel
areas, which are checked for interference.
• When occlusal prematurities are verified, a quick occlusal
correction is done to allow simultaneous bilateral contact
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63. • If the denture is found to be
poorly adapted or lacking in
retention & stability, a tissue
conditioner can be placed, but
the material should not be
allowed to project into the
extraction sites.
• Burlew foil can be used to
cover the extraction sites for
this procedure..
63
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64. First 24 hours
• The patient should avoid rinsing, drinking hot liquids or alcohol and
not remove the immediate dentures during the first 24hrs.
• Inflammation, swelling and discoloration are likely to occur, their
partial control can be helped with ice packs on the first day.
• Premature removal of immediate denture could make its reinsertion
impossible for 3-4 days or until swelling is reduced.
• The patient should be reminded that the pain from trauma of
extraction will not be eliminated by removal of dentures from the
mouth.
• Minimum blood on pillow can be expected
• Stick to a soft diet
64
POST OPERATIVE CARE AND PATIENT
INSTRUCTIONS
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65. ATTHE 24 HOURVISIT
• Ask the patient where they feel sore.
• Quickly check the tissues for sore spots related to denture;
appearing as strawberry red spots usually seen at cuspid
eminences, lateral to tuberosities, posterior limit areas,
and retromylohyoid under cuts as well as any other under
cut ridge areas
• These areas may be related to the denture bases visually or
with the adjunctive use of pressure indicator paste.
• Adjust any gross occlusal discrepancy in centric relation
or excursions
• Reevaluate the denture for retention .Place a tissue
conditioner if denture retention is unsatisfactory. 65
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66. FIRST POST-OPERATIVE WEEK
• Counsel the patient to continue to wear the immediate denture at
night for 7 days post extraction or until the swelling is reduced.
• This ensures that a recurrence of nocturnal swelling will not
preclude reinserting the denture in the morning.
• Starting immediately after the 24hr visit, the patient should be
shown how to remove the denture after eating to clean it, and to
rinse the mouth at least 3-4 times daily to keep the extraction
site clean.
The denture should then be quickly reinserted and worn
continuously.
• After 1 week, sutures can be removed, and the patient can begin
removing the denture at night.
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67. • During the first month after extraction, patient is asked to visit the
dental office weekly for sore spots adjustments.
• After 2 weeks, remount casts are poured, the maxillary denture is
adjusted to the articulator using remount matrix, made before
flasking.
• A centric relation record is used to remount the mandibular denture
and refinement of occlusion is done.
67
FOLLOW UP CARE
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68. SUBSEQUENT SERVICE FOR THE PATIENT WITH AN
IMMEDIATE DENTURE
• After the sore spots are eliminated & the tissues have healed, a
recall program for changing the tissue conditioner liner is
organized.
• Patients with Coonventional immediate denture’s frequently
prefer to have a definitive reline done within the first 3-6
months.
• Patients with IIDs can have their second denture started within 3
to 6 months.
• Advantage: IID can be worn as a spare if a laboratory reline is
selected for the second denture.
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69. CHANGE INTREATMENT PLAN
• New denture – conversion of CID to IID
• In case of unsatisfactory results- processing errors or unmet
expectations for the CID.
• A planned IID can turn out to be the final prosthesis
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70. A Nontraditional Technique for Obtaining Optimal Esthetics for an
Immediate Denture: A Clinical Report
J Prosthodont 2001;10:97-101.
Bimaxillary protrusion and severe labioversion of anterior teeth complicate
impression procedures and increase the difficulty in making esthetic
predictions for the immediate complete denture patient.
The presented technique, performed in reverse order of traditional methods, is
accomplished in stages in which the anterior and nonessential posterior teeth
are extracted and interim removable partial dentures placed.
An opportunity is thus created to evaluate esthetics, phonetics, and anterior
tooth function before extraction of the remaining dentition and delivery of
immediate complete dentures.
This technique facilitated the determination of the need for alveoplasty of the
anterior maxilla.
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CROSS REFERENCES

71. 71
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72. 72
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73. 73
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74. AN ALTERNATIVE APPROACHTOTHE IMMEDIATE
OVERDENTURE
Ilan Gilboa, DMD1 & Harold S. Cardash, BDS, LDS RCS
Journal of Prosthodontics 18 (2009) 71–75
A procedure is described for fabricating an immediate complete
overdenture where several teeth retain an interim fixed partial
denture (FPD) until the complete denture is finished.
This procedure allowed better control over the esthetic result and
the occlusion and was less traumatic for the patient.
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75. 75
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76. 76
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77. FULL MOUTH REHABILITATION BY IMMEDIATE DENTURE
PROSTHESIS- A CASE REPORT
Annals and essences of dentistryVol. IV Issue4 Oct- Dec 2012
77
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78. 78
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79. 79
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80. SINGLE-APPOINTMENT FABRICATION OF INTERIM IMMEDIATE
DENTURE: A CLINICAL REPORT
Yeganeh Memari .Ali Gooya Journal Dental School 2013; 31(1):52-57
80
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81. 81
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82. CONCLUSION
82
• Immediate dentures fulfil an important role
in today’s treatment modalities by
providing the patients with esthetics,
function, and psychological support after
extractions and during the healing phase.
• The success of immediate complete
dentures greatly depends on a correct
diagnosis, detailed treatment planning and
precise execution of fabrication procedures.
• If the patient is well prepared and the
appropriate type of immediate denture is
selected (conventional or interim), the
resulting prosthesis can be a success.
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83. REFERENCES
Prosthodontic Treatment For Edentulous Patients: Complete Dentures And
Implant-supported Prostheses – 12th edition
Syllabus of Complete Denture.Heartwell. 5th edition
Essential of Complete Denture Prosthodontics. Winkler 2nd Edition.
Academy of Prosthodontics Editorial Staff.The glossary of prosthodontic
terms: seventh edition, J Prosthet Dent 81:76, 78, 1999.
Campagna SJ: An impression technique for immediate dentures, J Prosthet Dent
20:198-202, 1968.
Campbell RL: A comparative study of the resorption of the alveolar ridges in
denture wearers and non-denture wearers,J Amer Dental Ass 60: 146-148, 1960.
Farmer JB: Surgical template fabrication for immediate dentures, J Prosthet
Dent 49:579-580, 1983.
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84. Heartwell CM and Salisbury FW: Immediate dentures: an evaluation, J
Prosthet Dent 15(4): 616-618, 1965.
Jerbi FC:Trimming the cast in the construction of immediate dentures, J
Prosthet Dent 16(6): 1048-1051, 1966.
Khan Z, Haeberle CB: One appointment construction of an immediate
transitional complete denture using visible lightcured resin, J Prosthet Dent
68:500-502, 1992.
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85. McGarryTJ, Nimmo A, Skiba, JF et al: Classification system
for partial edentulism, J Prosthodont 11:181-193, 2002.
RaczkaTC, Esposito SJ:The “jiffy” denture: a simple solution
to a sometimes difficult problem, Compendium of Continuing Education in
Dentistry 16: 914, 1995.
Seals RR Jr, KuebkerWA, Stewart KL: Immediate complete dentures, Dent Clin
North Am 40:151, 1996.
Soni A: Use of loose fitting copper bands over extremely mobile teeth while
making impressions for immediate dentures, J Prosthet Dent 81:638-639, 1999.
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86. •THANKYOU
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