The document discusses immediate dentures, which are dentures fabricated and inserted immediately following tooth extraction. It defines immediate dentures and outlines their advantages in maintaining ridge form and function. Potential disadvantages include increased discomfort and cost. Indications and contraindications for immediate dentures are provided. The treatment sequence for fabrication is described in multiple clinical appointments. Methods for impression making, tooth arrangement, and denture construction are explained, including the use of flanges or open sockets. Post-insertion care and follow-up are important to ensure proper healing and denture adjustment.

1. IMMEDIATE DENTURE
Prepared by
Dr .Ibrahim Muneim Hussein
B.D.S

2. • Definition
• Advantages of immediate denture
• Disadvantage of immediate denture
• Indication of immediate denture
• Contraindication of immediate denture
• Types of immediate denture
• Treatment Sequence
• Methods of construction of immediate denture
• Alevoloplasty
• Digital immediate denture

3. WHAT IS AN IMMEDIATE
DENTURE?

4. According to Glossary of Prosthodontics
terms It is a partial or complete denture,
that’s fabricated to replace natural teeth
immediately after extraction
Definition

5. 1. Avoid any change in patient’s appearance
and Prevent changes of the facial and oral
musculature.
Advantages of Immediate Dentures

6. Advantages of Immediate Dentures
2. Promotes better healing and The
denture can prevents swelling.
3. Promotes better ridge form.
4. Prevents collapse of facial musculature.
5. Hastens patient adaptation to dentures.
6. A surgical stent and protective bandage
helps to reduce bleeding.
7. Protect the tissues at sensitive extracted
sites from irritation.

7. 8. Establish the speech patterns more
easily.
9. Prevents patient embarrassment.
10. Promotes patient health.
11. Provides a guide for optimal patient
esthetics.
12. Provides a guide for V.D.O.
Advantages of Immediate Dentures

8. Challenging Factors and disadvantages
of Immediate Dentures
4. Increased denture maintenance.
5. Increased treatment time and cost.
1. Increased complexity of clinical
procedures.
2. Limited evaluation of trial dentures.
3. Increased patient discomfort.

9. Indications for immediate denture
Physical reasons:
1. Disuse atrophy of the bony base
2. Unfavorable trabeculation of the repairing
bone
3. Damage of the temporomandibular joints

10. Indications for immediate denture
Physiologic reasons:
1.Abnormal functioning of the mouth and
mandible
2. Impaired enunciation
3.Abnormal deglutition

11. Indications for immediate denture
Psychologic reasons:
1. Humiliation
2. adverse subjective reactions
3. serving the indifferent patient

12.  Patient is unavailable for appointment.
 Patient is debilitated or with Systemic conditions
(poor surgical risk).
 Acute infections that require drainage.
 Emotionally disturbed or diminished mental
capacity and Indifferent patients.
 Patient who have undergone Radiation therapy.
 Patient with a severe Gagging reflex.
 Patients with extensive bone loss.
Contraindications of Immediate
Dentures

13. TYPES IMMEDIATE DENTURES
• Partial Immediate Denture
• Transitional Immediate Denture
• Conventional Complete Immediate
Denture

14. Differentiate
between
Immediate &
Interim
Dentures !

15. INTERIM IMMEDIATE DENTURE
• A dental prosthesis to be used for a short interval
of time for reasons of esthetics, mastication,
occlusal support, or convenience, until more
definitive prosthetic therapy can be provided.

16. INTERIM IMMEDIATE DENTURE MAY BE:
• A removable partial denture can serve as an
interim prosthesis to which artificial teeth will
be added as natural teeth are lost.
• A transitional denture may become an interim
complete denture when all of the natural teeth
have been removed from the dental arch.

17. IMMEDIATE PARTIAL
DENTURE

18. Immediate Treatment
Partial Denture:
A partial acrylic resin
denture that is placed
at the same
appointment of
extraction
to restore esthetic and
function immediately.

21. Immediate treatment partial
• support
• stability
• retention

22. IMMEDIATE TRANSITIONAL
DENTURE

23. IMMEDIATE TRANSITIONAL
DENTURES
• Indications
• Multiple extractions
• Esthetics
• Function
• If conventional ICD
contraindicated

24. IMMEDIATE TRANSITIONAL DENTURES
• Problems
• Intensive post insertion care
• Short-term solution
• More expensive
• After healing, a second denture is made

25. IMMEDIATE COMPLETE
DENTURE

26. CONVENTIONAL COMPLETE
IMMEDIATE DENTURES
• A complete removable denture or
over-denture fabricated for placement
immediately after the removal of
natural teeth

27. • Maxillary six anteriors are still.
• Remove all posterior teeth about 1-3
months before making immediate
denture.
• Predictable, a stable ridge contour.
CONVENTIONAL IMMEDIATE
COMPLETE DENTURES

28. CONVENTIONAL IMMEDIATE COMPLETE
DENTURES
Rationale
• Allows for posterior segment to heal and
stabilize.
• Maintains anterior teeth for appearance,
some function.
• After healing, it is relined with acrylic resin.

29. CONVENTIONAL IMMEDIATE COMPLETE
DENTURES
• Indications
•Maxilla
• anterior teeth present
•Cooperative patient
• Not Recommended
• Both jaws simultaneously
• Mandibular arch

30. It is not advisable to attempt to construct an
immediate denture to replace more than six or
eight teeth in an arch:
• First, there is considerable blood loss during the
removal of teeth and associated alveolectomy.
• Second, the denture will be subject to a greater
degree of procedural errors and will fit only for a
short time.
(The six anterior teeth and perhaps the premolars)

31. IMMEDIATE DENTURE TREATMENT
SEQUENCE

32. Oral examination and informed consent
The panoramic radiograph provides a useful
diagnostic aid. After reviewing the dental and
medical history of the patient, head and neck
examination is performed. During the normal
intraoral examination, the dentist should include
and record periodontal probing, a full charting of
all the teeth, need for frenum release, tori
reduction or any other hard and soft tissue surgery
if necessary .
When possible, teeth should be selected for
retention as overdenture abutments.

34. The normal and the common anatomic abnormal difficulties
of the mouth relative to immediate denture insertion is
classified as:
1-Hard tissues (exostoses, spiculae, mylohyoid ridges, knife-edge
ridges, maxillary tuberosity and alveolar contour)
2-Soft tissues (abnormal frenula and ligament and muscle
attachments)
3-Ridge relation (faulty ridge relationship). Also notation of following
factors help in later visits like
1.Existing midline and need for modification of its position
2. Patient's existing vertical dimension of occlusion and amount of
interocclusal distance and the need for conforming to or changing it
3. Horizontal and vertical overlap of anterior teeth
4. Type of angle's classification of occlusion for the patient
5. Display of posterior tooth in the buccal corridor

35. • 1st Clinical Appointment - clinical Examination &
preliminary impressions
Lab procedures - custom tray fabrication

36. •2nd Clinical Appointment - Master impressions
Lab procedures - master cast, record base &
occlusion rim fabrication if indicated

37. • 3rd Clinical Appointment - Maxillomandibular
relation records, and tooth selection
Lab procedures – Cast trimming, Setting of the
teeth & wax trial + denture fabrication

38. • 4th Clinical Appointment - Wax trial denture try- in
(confirm mounting & esthetics) if indicated
Lab procedures - process dentures

39. • 5th Clinical Appointment - Extractions & denture
insertion, adjust tissue surface & flanges, adjust
occlusion & care instructions

40. •6th Clinical Appointments - 24 hour post-insertion
checks, adjust dentures & reinforce care instructions

41. • 7th & 8th Clinical Appointments - 72 hour, and one
week post-insertion checks adjust dentures, clinical
remount & reinforce care instructions

42. Placement of the denture
-After completion of the surgical procedures, the patient is
instructed to close against sterile gauze until the cessation
of the bleeding. As soon as the patient has recovered from
the immediate effects of the operation, the denture is
inserted.
- Pressure-disclosing material will aid in locating pressure
points,
- check the occlusion, even gross occlusal disharmonies in
an immediate denture are corrected in the mouth.
Final occlusal adjustment will be delayed until all swelling
and edema have subsided and the patient is comfortable.

44. Impression Techniques

45. FUNDAMENTALS FOR IMPRESSION
MAKING:
• Area coverage
• Borders
• Valve seal without interference of function
• Accurate adaptation of the underlying tissues
without injurious displacement.
• Preserve the maximum ridge bulk.

46. Selecting & Arranging
artificial teeth:

47. SPECIAL LAB WORK FOR
IMMED. COMP. DENT.
• 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, and
• wax-up for try-in evaluation.

48. Set-up the anterior
teeth:
Immediate Denture Laboratory Project

49. Use a sharp pencil to mark the gingival outline
buccally and lingually
Preserve the incisal edge position and tooth
angulation information prior removal of stone
teeth.

51. DIFFERENT METHODS
FOR CAST TRIMMING
Immediate Denture Laboratory Project

52. The teeth are removed from the cast in a
manner that They are not cut below the gingival
crest
1-

53. The terminal 5 mm of gingiva should be trimmed in the
manner shown above so that the denture gingiva may
not appear too thick.
2mm

54. Remove stone tooth without obliterating the gingival
outline mark and shape into a gentle convex shape.
Place a subgingival esthetic convenience groove at the
labial gingival sulcus to aid in esthetic positioning of the
denture teeth.
Esthetic convenience groove
2-

55. Modify the undersurface of denture tooth
until the desired incisal edge position is
reproduced in the setup

56. 3-The Alternating Tooth Setup Technique
• Trim and set only one anterior tooth at a time.
• Alternate from side to side to keep natural
neighboring tooth as angulation, length, and
contour orientation.

57. 15 mm
Complete the anterior teeth setup

58. DURING THE SETTING-UP OF
ANTERIOR TEETH:
The study model can
be used to compare
the tooth
arrangement
incorporated in the
replacement teeth.

59. Set-up the posterior teeth:
Immediate Denture Laboratory Project

60. • Sectional wax-up
• Anterior segment
for patient viewing.
• Posterior segment
for check record.

61. Immediate Complete Denture
Try-In

62. Usually the Posterior
segment only tried as a
“removable” section
used for:
• Confirmation of
horizontal and vertical
relationships
• Tooth shade

63. Post Extraction
Instructions

64. INCLUDE THE FOLLOWING POINTS:
• Do not remove denture
• Keep head elevated
• Small amounts of blood in saliva is normal
• Diet: soft and warm, not hot
• Avoid:
• Spitting, rinsing
• Strenuous activity
• Alcohol, smoking

65. Post-placement Care
.Pressure-indicating paste is used to locate pressure areas
.overextensions of the denture borders are reduced.
.The occlusion is checked for interceptive occlusal contacts.
.patient should be seen every 24hours for the first three days, then every other day
for one week.
The first 24 hours
Patient should Not to remove the dentures from the mouth during the first 24
hours,
Patient should be reminded that the pain from extraction will not reduce by
removal the denture.
ice packs may be held on the face to combat swelling.
eat a soft diet
Analgesic, antibiotic, must be prescribed to patient depending on the case.
return for a scheduled appointment.
1st Adjustment must be seen after 24 hours:-
Remove denture 5 times per day
Rinse the mouth with warm saline
Avoid mouthwash containing alcohol

66. POST INSERTION MANAGEMENT
• Recall next day
• Remove denture
• Apply topical anesthetic to
traumatized mucosa
• Locate over extensions and pressure
areas and adjust
• Reappoint 1 week

67. The dentures should be worn at night for the first week only, after
this period, the dentures should be week only, after this period, the
dentures should be removed at night.
Proper nourishment is essential to the overall treatment of the
patient and must not be neglected.
• 1 st week after extraction and denture insertion:-
I-Instruct your patient to wear the denture day and night for first 7
days after extraction or until swelling reduction.
2-Remove the denture 4 or 5 times a day after the first day, and
rinse the mouth with warm salt water. Do this for the first week.
3- The denture must be cleaned and rinsed after meal as early as
possible and when removal and insertion of the denture is with
little or tolerable pain .

68. Further follow up care:-
1- 2nd week is the next call, this is depend on the case.
Then the patient should be seen one month later, 4-6
months intervals.
2-A denture adhesive will be necessary to help hold the
denture in place.
3- Relining may be necessary to achieve esthetic and
occlusion corrections.
4- Frequent or periodic recall mainly for changing
temporary liner, this is depend on the rate and amount
of bone resorption and ability of patient to keep the
liner clean

69. POST INSERTION MANAGEMENT
• Healing, shrinkage, resorption
• Patient remount
• Relines
• Interim – within first 12 months
• Definitive – 12 months +

70. POST INSERTION MANAGEMENT
Occlusal adjustment & Remount when:
• Healing edema resolved
• Traumatized mucosal lesions healed
• Usually within 14-21 days

71. POST INSERTION MANAGEMENT
• Reline
• Short term – tissue conditioners
• Mid-term – intermediate direct liners
• Long-term – standard reline protocol

72. THERE ARE 2MAIN METHODS
OF CONSTRUCTION
Immediate Complete
Denture

73. 1 Without surgery (Without Alveoloplasty).
A- Partially flanged type
B- Socket type
C- Completely flanged type
2 with surgery (Surgical Alveoloplasty)
Must be …Completely flanged type

74. 1-Anterior teeth socketed immediate denture
(open face design)
Advantages:
a-Very natural appearance
b-Easy to insert
c-Exact reproduction of tooth position
d-Easier to set teeth in laboratory
e-Not interference with lip musculature
Disadvantages:
a-Poor retention and inadequate support
b-Natural appearance is not long maintained
c-Denture has short life

76. 2-labial flange without alveolectomy
immediate denture.
Advantages:
a-Good retention and support
b-Rapid healing with smooth ridge
c-Easy in rebasing
d-Stronger denture
Disadvantages:
a-Poor appearance due to labial fullness
b-Difficult in case of undercuts
c-Lack of space around necks of teeth and so denture teeth are often
shortened after final waxing

78. 3-labial flange with alveolectomy
immediate denture
Indications:
a-Prominent premaxilla which prevent insertion of a
flanged denture
b-limited anterior inter-alveolar space and deep vertical
overlap
Contraindications:
a-Fairly severe surgical task
b-Increase in resorption following labial cortical bone
removal

79. 4-labial flange with alveolotomy
immediate denture.
Advantages:
a-No cortical bone is removed and post-surgical
resorption is reduced
b-Surgery is less traumatic than alveolectomy
c-Less interference with facial form
Disadvantages:
a-The undercut cannot always be completely
eliminated

80. • Unless it is necessary, one should avoid alveolectomy in
the anterior region.
• If it must be performed because of marked undercuts, a
transparent tray should be prepared for use during the
surgical procedures.
• It must be adapted to the cast after the necessary - cast
alveolectomy" has been performed.

81. Comparisons of flanged and open faced denture
1. Appearance of flanged denture does not altered after fitting where the
appearance of open – face denture (although good initially) can deteriorate rapidly
as resorption create a gap between the necks of the teeth and ridge
2. The flanged denture allows freedom in the positioning of teeth ,where, in open
face denture teeth have to be positioned in the sockets of the natural teeth
*so on case of malpositional teeth we can do good alignment in flanged denture
while we can not in open face type.
3. In upper denture:
a flange on an upper denture create a more effective borders seal , therefore ,
better retention than is achieved with an open face denture.
In lower denture: open face denture is not usually constructed because of poor
stability of lower denture during function , so flange denture is commonly used.
*so flange denture is better from the point of stability.
4.The presence of labial flange produces a stronger denture, labial flange will
make the denture stiffer so the midline fatigue fracture cause by repeated flexing
across the midline is reduced .so from the point of strength the flange denture is
better .

82. 5. As the bone resorbed fallowing extraction the denture become loose and a
reline is required , so the presence of labial flange make it easier to add either a
short term soft lining materials or a cold curing relining materials as a chair side
procedure, as the color of some reline materials is not always ideal they may be
visible when used with open face denture.
6. The flange denture cover the clot completely and protect them more
effectively, the flange denture exerts pressure on both lingual and labial gingiva
reducing post extraction hemorrhage.
7. The consequence wearing of ill fitting denture can lead to: If it is open face
,will produce a scalloped ridge in the region of the socketed teeth In flange
denture ,distribution the functional loads more favorably to the underlying ridge,
thus minimizing bone resorption.
8. When patient have got used to an open face immediate denture there is
difficulty to accept a denture with labial flange in future and patient will
complain from the fullness of the lip .
If flange denture had worn from the beginning this problem does not occur.
9. When the ridge morphology produce deeply undercut area it may not be
possible to fit a full labial flange unless there is surgical reduction, In this case the
using of partially flange denture or open face denture is preferable when surgical
procedure is contra indication.

83. ALVEOLOPLASTY
“The recontouring or reduction
of a portion of the alveolar
process”

84. GOALS OF ALVEOLOPLASTY
• Eliminate bony projections that result in undercuts.
• Improve the path of insertion of the prosthesis.
• Eliminate bony sources of irritation.
• Increase space between the residual ridges (inter arch
space I.R.S).
• Improve denture stability by removal of excess tissue.

85. DISADVANTAGES OF
ALEVEOLOPLASTY
ACCELERATES BONE LOSS
INCREASED POST-OPERATIVE PAIN

86. TYPES OF ALVEOLOPLASTY
• Simple alveoloplasty
• Buccal or labial cortical reduction
• Intraseptal alveolectomy and cortical
plate in-fracture
. Buccal or Labial Cortical Recontouring

87. SURGICAL TECHNIQUES INCLUDE
• Simple Excision
• Cryosurgery
• Electrosurgery

88. IMMEDIATE COMPLETE DENTURE
MASTER CAST TRIM
• Trimmed areas sanded
smooth
• Avoid removing incisive
papilla

89. IMMEDIATE COMPLETE DENTURE
SURGICAL TEMPLATE
• Fabricated after cast trim
• Used to locate the pressure areas on mucosa
at time of surgery
• Denture trimmed according to blanched
mucosa observed under template

90. Fabrication of Surgical Template
A clear surgical template duplicating the surface of the
immediate denture after modification of the stone cast is
used at the time denture placement as a guide for
surgically shaping the alveolar process. The clear template
allows the dentist to visualize the adaptation of the
denture base to the residual ridge.
Blanching of the soft tissue as seen through the template
indicates excessive pressure. .When the extractions and
alveolectomy are being done, the surgical template can be
inserted in the patient's mouth from time to time to assess
if sufficient bone has been removed.

92. THEN CONTINUE THE
CONSTRUCTION OF IMMEDIATE.
DENTURE. STEPS AS USUAL,
ACCORDING TO THE PLANNED
TRIMMED R.R. & NEW POSITION OF
THE ANTERIOR TEETH.

93. Digital Immediate Denture
the conventional methods for fabricating immediate
dentures and complete dentures have not changed for the
past 50 years and involve multiple clinical appointments
and lengthy laboratory schedules
Several commercial manufacturers currently fabricate
complete dentures using computer-aided design and
computer-aided manufacturing (CAD/CAM) technology.
The use of computer – aided engineering (CAE) and
computer – aided design/computer - aided manufacturing (
CAD/CAM ) technology to fabricate complete dentures
was in troduced in 2011.

94. Digital dentures fabricated using CAD/CAM technology
can reduce clinical appointments, provide high accuracy
in denture fit, allow less polymerization shrinkage of the
denture base, and facilitate easier duplication of dentures.
This technique not only reduced treatment time, clinical
visits, and dental expenses but also maintained the
patient’s appearance, mastication, occlusal vertical
dimension, and maxillomandibular relationship.
A full digital workflow can be used to produce immediate
denture

95. THANK
YOU

96. For more information follow my account
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https://www.slideshare.net/algbory