Guide to Immediate Dentures

IMMEDIATE DENTURE
Guided By:-
Dr. Dilip Dhamankar (HOD)
Dr. Ravi Kumar C.M. (Prof.)
Dr. Meenaksi (Prof.)
Dr. DRV Kumar (Reader)
Dr. Arun (Reader)
Dr. Manish Chadha (Senior Lect.)
Dr. Devendra (Senior Lect.)
Dr. Mayank (Senior Lect.)
Dr. Soham Prajapati
2nd Year PG,
Dept. of Prosthodontics
& Maxillofacial Prosthesis
Including Oral Implantology
29-09-2014
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• Introduction
• Classification of Immediate Dentures
• Definition
• Review of Literature
• Advantages & Disadvantages
• Indications & Contraindications
• Diagnostic Procedures
Contents
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• Treatment Plan
• Cast Modificiation
• Surgical Templates
• Wax contouring, Flasking and Boil Out.
• Processing and Finishing
• Surgery & Immediate Denture Insertion
• Postoperative Care
• Conclusion
• References
Contents

Introduction
• For the patients facing the loss of all his or her
remaining natural teeth, there are four
treatment options.
• Option 1
– One is for the patient to have all remaining teeth
extracted and wait for 6 to 8 months for the
extraction sites to heal. The complete denture is
made following healing.
4IMMEDIATE DENTURE
Essentials of Complete Denture Prosthodontics, Sheldon Winkler, 2nd edition
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Introduction
• Option 2
– It is to covert an existing RPD into an interim
complete denture.
• Option 3
– It is to make a conventional immediate complete
denture.
• Option 4
– To place implants and fabricate dentures or if some
teeth are healthy can be used as to make
overdenture.
5IMMEDIATE DENTURE
Essentials of Complete Denture Prosthodontics, Sheldon Winkler, 2nd edition
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• Immediate dentures are more challenging to make than
routine dentures for both the dentist and the patient.
• Immediate dentures may be single immediate dentures or
maxillary and mandibular immediate dentures in the same
patient.
• The later should be made together to ensure optimal
esthetics and occlusal relationships.
Introduction
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Classification of Immediate Dentures
Prosthetic treatment for edentulous patients, Zarb, Bolender, 12th edition.
TWO TYPES
Conventional
(Classic) Immediate
dentures
(CID)
Interim (transitional or
nontraditional)
Immediate dentures
(IID)

Classification of Immediate Dentures
• In 1973 Arthur M. Lavera and Arthur J. Krol
described the classification of immediate
dentures as
• Conventional and Transitional ,
• Labial flange vs No Labial flange
– No Labial Flange
• Flangeless immediate dentures
• Partial flange
Immediate denture service ; Arthur M Lavere and Arthur J . Krol ;( JPD Jan 1973
vol 29 no 1)

Definitions of Immediate Denture
According to GPT –8 :-
“Any removable dental prosthesis fabricated for placement
immediately following the removal of natural tooth/ teeth. “
According to Heartwell :-
“An immediate complete denture is a dental prosthesis
constructed to replace the lost structure and associated
structure of the maxillae and/or mandible and inserted
immediately following removal of remaining teeth.”

• An immediate complete denture may replace one tooth or all
sixteen teeth in either the maxillary or the mandibular arch
or in both arches.
INTERIM PROSTHESIS
“ a prosthesis designed to enhance esthetics, stabilization
and/or function for a limited period of time, after which it is
replaced by a definitive prosthesis”
- GPT 8

INTERIM IMMEDIATE DENTURE
• A removable dental prosthesis designed to enhance
aesthetics, stabilization and/or function for a limited
period of time, after which it is to be replaced by a
definitive prosthesis.
Textbook Of Prosthodontics, V Rangarajan

Classical flange type
• Anterior alveoloplasty is planned for improvement
of appeareance.
• Use of surgical template
• Need for relining or rebasing may not occur as soon
as it might with other types of immediate dentures,
it will occur sometime.
• Useful impression technique has been described by
CAMPAGNA for construction
IMMEDIATE DENTURE
Immediate denture service ; Arthur M Lavere and Arthur J . Krol ;( JPD Jan 1973 vol
29 no 1)
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Labial Flange
• DISADVANTAGES
– poor esthetic value
– source of irritation to the tissue
IMMEDIATE DENTURE
29 no 1)
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Labial Flange
• ADVANTAGES
– Aid stability of the
denture
– Healing of the tissues
– The labial flange is
made very thin to avoid
fullness of the lip and
present the desired
esthetic effect.
IMMEDIATE DENTURE
29 no 1)
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Labial Flange Type Immediate Denture
• Indications
1. Bony undercuts not present.
2. The lip line and lip activity are normal.
3. The teeth are periodontally involved and supporting bone is lost.
• Contraindications
1. Pronounced undercuts are present.
2. Fullness of lip would produce an unaesthetic result.
IMMEDIATE DENTURE
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Partial Flange
• As resorption takes place, the
flange is extended with cold-
curing acrylic resin placed
directly in the mouth for
maintaining proper esthetics
and healing
• Alveolectomies are not needed
• Very little irritation is expected
IMMEDIATE DENTURE
29 no 1)
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Partial Flange Type Immediate Denture
• Indications
1. Undercuts are present on the labial and
buccal section of residual ridge.
2. It is desirable that flange serve as a surgical
splint
• Contraindications
1. Economic condition of the patient renders
multiple corrective procedures impractical.
2. Unusual active lip line.
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Flangeless Immediate Dentures / Socketed
Dentures
• Easy to construct and insert.
• Major problems of retention ,adhesive is required.
 No surgical template is needed.
IMMEDIATE DENTURE
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Dentures
• Insertion is no problem because procedure involves removal
of remaining teeth
• No alveoloplasty is performed so less Postoperative
discomfort
IMMEDIATE DENTURE
29 no 1)
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Dentures
• About 8 weeks after extraction, a second denture with
conventional flanges should be made.
• After months when residual ridge has changed enough to
make the first denture loose, the first denture should be
rebased. The patient has two dentures one for wear and one
for spare.
IMMEDIATE DENTURE
29 no 1)
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Flangeless Immediate Dentures
• Indications: -
1. When deep undercuts on the anterior and buccal residual ridge.
2. A high lip line and an active lip, that would expose an unesthetic flange.
3. Minimal amount of surgery is desirable
• Contraindications :-
1. Substantial amount of bone loss.
2. Uneven contour of anterior residual ridge
IMMEDIATE DENTURE
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Major Difference between Conventional and
Interim Immediate Denture (Practically
Speaking)
• The CID is usually selected when only anterior
teeth remain or if the patient is willing to have
the posterior teeth extracted before immediate
denture procedure begins.
IMMEDIATE DENTURE
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Major Difference between Conventional and
Interim Immediate Denture (Practically
Speaking)
• The IID is indicated when both anterior and
posterior teeth are to be extracted at the same
time and immediate dentures are provided.
New complete dentures are again fabricated
after the healing period.
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CID IID
• Long term prosthesis.
• Can be reline.
• Only anterior teeth
remaining.
• Good stability & retention
at placement to maintain
during healing.
• Cost is less.
• Longer time taking
• Transitional /short term
prosthesis.
• New denture after healing
• Both anterior & posterior
teeth present.
• Fair stability & retention
which must be improved by
reline(tissue
conditioning)during healing.
• Cost effective.
• Less time consuming

CID IID
• Indications
– Only anterior teeth
remain or few
posterior that do not
support existing R.P.D.
– Two extraction visits
are feasible.
• Indications
– When multiple anterior &
posterior teeth are
present or existing r.p.d
that patient wish to
retain until insertion due
to esthetics or functional
concern
– Only one surgical visit is
preferable.

CID IID
• Disadvantages
– Esthetics cannot be
changed.
– End of treatment pt. has
one denture.
– If all posterior teeth
remove V.D. is not
maintained. So opposing
premolar maintained.
– Can not convert from r.p.d.
• Disadvantages
– Second denture allow an
alteration of esthetics.
– Pt. has spare denture to use
in extentuating
circumstances.
– Posterior teeth are present
V.D of occlusion is
preserved.
– Can be converted from r.p.d

Review of Literature
 In 1860, Richardson was the first one to refer about
immediate Dentures (Seals, 1999).
- Prosthetic treatment for edentulous patients, Zarb, Bolender,
12th edition.
 In 1966 Robert W Bruce presented a technique for
construction of immediate dentures in which no bone or
soft tissue was removed at the time of extraction thus
preserving maximum of supporting tissues
- Trimming the cast in the construction of immediate dentures(
JPD 1966 vol 16 no 6)

 Author has made certain observations after a 2 year
follow up of patients done with this technique:
 Ridge loss was less as compared to convention
dentures.
 Loss of vertical dimension was less
 Highly polished labial flange aids in healing
 Soft liner maintain physiologic denture and helps
in retention
 physiologic stimulation needed for the ridge
preservation is maintained.

• In 1972 Walter J. Demer The presence of bony
undercuts in a relatively high percentage of patients is
the cause of problem in placement of immediate
dentures.
• The lack of a try in of the trial denture base in its
completed form is the complicating element.
• These causes considerable difficulty in placing the
dentures and can be the source of severe
postoperative discomfort for the patient.
29IMMEDIATE DENTURE
Minimizing problems in placement of immediate dentures ; Walter J.Demer (JPD March 1972
vol 27 no 3)
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• In 1977 Ali Bolouri explained the procedure for the
fabrication of the double custom tray for immediate
denture.
• This technique is useful for the patients with labially
inclined and highly mobile anterior teeth and also the
chance of distortion in removal of the impression
from the mouth is greatly reduced.
30IMMEDIATE DENTURE
Double custom tray procedure for immediate dentures ; Ali Bolouri (JPD March
1977 vol 37 no 3).
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• An abbreviated type of IID has been called the “JIFFY
DENTURE” (Raczka & Esposito, 1995). It is similar to
the IID because it is replaced by a second complete
denture after healing
31IMMEDIATE DENTURE
Double custom tray procedure for immediate dentures ; Ali Bolouri (JPD March
1977 vol 37 no 3).
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Advantages of any Immediate
Dentures
• Maintenance of patient’s appearance as they
are not without teeth even for one day.
- Prosthetic treatment for edentulous patients, Zarb, Bolender, 12th edition.

Dentures
• Bandage or dressing effect that the prosthesis offer to the
wounds of extraction and alveolectomy.
• This bandage effect tends to control hemorrhage, to prevent
a large measure of outside contamination of the wounds and
and to maintain drugs or other therapeutic agents at the site
of the wounds.
33
- Complete Denture Prosthodontics, John J. Sharry, 3rd edition

Dentures
• Less post-operative pain as extraction site is protected. Some
authors have discussed about reduced RRR. ( Heartwell 1965,
Johnson 1966, Kelly 1958, Campbell 1960, Carlson 1966)
• Vertical dimension, jaw relationship, muscle tone, face height
and tongue position is maintained. The tongue will not spread
out as a result of tooth loss.
34
12th edition.

Dentures
• It is easier to duplicate (if desired), the natural tooth shape
and position, plus arch form and width. If desired the
horizontal and vertical positions of the anterior teeth can be
more accurately replicated.
• The patient is likely to adapt more easily to dentures at the
same time that recovery from surgery is progressing. Speech
and mastication are rarely compromised and nutrition is
maintained.
35IMMEDIATE DENTURE
12th edition.
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Dentures
• The availability of tissue conditioning material allows for
considerable versatility in the correction and refinement of
the denture fitting surface, both at the insertion stage and at
subsequent appointments.
• Overall, the patients psychological and social well being is
preserved. The most compelling reasons for the ID
prescription are that a patient does not have to go without
teeth and there is no interruption of a normal lifestyle of
smiling, talking, eating and socializing.
36IMMEDIATE DENTURE
12th edition.
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Disadvantages of any Immediate
Dentures
• The anterior ridge undercut (often severe) that is caused by
the presence of remaining posterior teeth may interfere with
the impression procedures and therefore preclude also
capturing a posteriorly located undercut, which is important
for retention.
37IMMEDIATE DENTURE
12th edition.
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Dentures
• The presence of different number of remaining teeth in
various locations (anterior, posterior or both) frequently leads
to recording incorrectly the centric relation position or
planning improperly the appropriate VDO. An occlusal
adjustment or even selective pretreatment extractions any be
needed to make accurate record at the proper VDO.
38IMMEDIATE DENTURE
12th edition.
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Dentures
• The inability to accomplish a denture tooth try-in in advance
on extraction precludes knowing what the dentures will
actually look like on the day of insertion. Careful planning
operators experience, attention to details of the technique
and explanation to the patients best address this inherent
problem.
• Because this is more difficult and demanding procedure, more
chair time, additional appointments and therefore increased
costs are unavoidable.
39IMMEDIATE DENTURE
12th edition.
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Dentures
• Functional activities (e.g. speech AND mastication) are likely
to be impaired. HOWEVER, this is a temporary inconvenience.
40IMMEDIATE DENTURE
12th edition.
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Indications
- Patient is socially active
- Good health
- Available time and can afford multiple visits
- Periodontally compromised teeth.
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12th edition.
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Contraindications
 Emotionally disturbed individuals with pyschological
disorders.
 Poor surgical risks because of -
 Cardiac disturbances,
 Endocrine disturbances,
 Systemic condition that effects blood clotting ,
 Post irradiation of the head and neck regions.
-
42IMMEDIATE DENTURE
12th edition.
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Contraindications
• Uncooperative patients
• Patients with acute periapical or periodontal pathogenesis.
• Patients who have extensive bone loss adjacent to
remaining teeth.
• Patient with poor general health or deliberating diseases.
43IMMEDIATE DENTURE
12th edition.
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DIAGNOSIS AND TREATMENT
PLANNING
44IMMEDIATE DENTURE
12th edition.
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PLANNING
45IMMEDIATE DENTURE
Whenever possible, it is preferable to construct an
immediate denture for one arch at a time - BY
WINKLER
Upper and lower immediate denture in the same
patient should be made together to ensure
optimal esthetics and occlusal relationships - BY
ZARB BOLENDER.
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PLANNING
46IMMEDIATE DENTURE
Diagnostic Procedure
The diagnostic procedures are divided into two
phases:
(A) Patient examination
(B) Consultation interview.
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PLANNING
47IMMEDIATE DENTURE
(A) Patient examination
The examination of the patient should include:
a) Findings of local and systemic status.
b) Accurately articulated cast.
c) Appraisal of any existing prosthesis.
(B) Consultation interview.
• Past dental history,
• Existing systemic conditions.
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PLANNING
48IMMEDIATE DENTURE
Past dental history:-
• Hemorrhagic tendencies.
• Excessive swelling.
• Excessive post operative pain.
• Allergic reaction to local anesthetics.
Tooth Modification : -
The occlusal plane
Eliminate prematurities in centric relation.

PLANNING
49IMMEDIATE DENTURE
• What type of Immediate denture should be
prescribed?
• Explanation to the patient
• Informed Consent
• Examination
12th edition.
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50IMMEDIATE DENTURE
Explanation to the patient
12th edition.
• They do not fit as well as Complete Dentures. They
may require temporary relining or use of adhesives.
• They will cause discomfort. The pain of the
extractions, in addition sore spots of the immediate
denture will make the first week or two after insertion
difficult.
• It will be difficult to eat and speak initially, almost like
learning to speak and eat all over again.
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51IMMEDIATE DENTURE
12th edition.
• Esthetics may be unpredictable as anterior try in is not
possible. The appearance may be unpredictable from what you
and dentist has expected.
• Many other dental factors are unpredictable such as gagging
tendency, increased salivation, different chewing sounds and
facial contour.
51/135

52IMMEDIATE DENTURE
12th edition.
• It may be difficult to insert the immediate denture on first day.
Every effort may be done to do so. If it is not possible it will be
inserted or remade as soon as possible.
• Immediate denture should be worn for first 24 hours without
being removed by the patient. The dentist will remove it after
24 hours.
• Because supporting changes are unpredictable, immediate
dentures may loosen up during 1 to 2 years. The patient is
responsible for all involved in refitting or relining the denture.
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Examination

Number and Type of Radiographs
Needed.
• 1 OPG
• If no periapical lesions are present,
– 4 Bitewings Radiographs [2 with each quadrant
(one for premolars and one for molars)]
– 4 IOPA Radiographs (1 for each quadrant covering
incisors and canine)
• If periapical lesions are present,
– 12 IOPA Radiographs
– 2 Occlusal Radiographs

Procedures
First extraction/surgical visit
1. Primary impression and preparation of
custom tray.
2. Final impression.
3. Recording of maxillomandibular impressions.
4. Try-in of posterior teeth.
5. Preparation of surgical template.
6. Surgery and insertion.
7. Post operative instructions and care.
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First extraction/surgical visit
• Clinical decision for extraction for
conventional immediate denture , then
posterior teeth should be first identified for
extraction.
• Opposing premolars may be retained to
preserve the vertical dimension of occlusion .
• Hard and soft tissue operation.
• Heal for a short time, usually only 3 to 4
weeks.
• If over denture abutments, endodontic
treatment to be done before preliminary
impressions made.

Primary Impression & Diagnostic
Casts
• Elastomeric or alginate – impression materials
• The impression should be free of voids and should record the
full extensions planned for the denture prosthesis.
• These impressions are poured in stone and used to make
custom trays for the final impressions.
• If an IID is planned, preliminary impressions and casts will
contain all of remaining teeth and if a CID is planned, those
will contain only anterior teeth.

59IMMEDIATE DENTURE
• An ‘IID’ preliminary impressions and casts
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60IMMEDIATE DENTURE
• A ‘ CID’ , preliminary impressions and casts
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Protection of loose teeth from
extraction during preliminary or
final impression procedures for
immediate dentures
 Blocking out by wax
 Lubricating medium to the teeth
 Placing a vaccum formed plastic over
the teeth
 By placing loose fitting copper bands
over the extremely mobile teeth

Border-Molded Custom Impression
Tray and Elastomeric Impression
Material
• An elastomeric impression made in a border molded custom
impression tray.

Custom trays
• Many successful tray type and impression technique for
immediate denture are described in the dental
literature.
• There are two basic ways to fabricate the final
impression tray, depending on the location of
remaining teeth and operator’s preference –
Type (1)
Type (2)
63IMMEDIATE DENTURE
- Prosthetic treatment for edentulous patients, Zarb, Bolender, 12th
edition
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Type (1) :- Single arch custom
impression tray
• The type 1 method more closely resembles a routine
custom impression tray for removable partial dentures.
• It can also be used in CID technique.
• This type of tray is effective when only anterior teeth
are remaining or both anterior and posterior teeth are
remaining.
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edition
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Type (2) :- Two tray or sectional
custom impression tray
• The type 2 method is used only when the posterior
teeth have been removed (CID).
• It can not be used in IID technique because usually
there are posterior teeth present.
• 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.
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THE CAMPAGNA COMBINATION
IMPRESSION
• Anterior teeth remain.
• A custom tray is constructed to
cover the edentulous posterior
regions with a continuous strut
that extends through the
anterior/labial vestibular space.
• In essence, the residual anterior
teeth project through a hole in
the tray.
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IMPRESSION
• This unique primary custom tray is
border molded and used to make an
elastomeric impression of the
edentulous regions and all peripheral
and vestibular areas.
• A secondary impression is then
made over the primary impression
using a stock impression tray and
irreversible hydrocolloid to capture
the remaining teeth only.
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IMPRESSION
DRAWBACK
Vestibular anatomy associated with the dentate regions is
recorded using irreversible hydrocolloid
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Maxillomandibular Relation Record
72
• Identical to those for
complete dentures.
• The remaining teeth and
anatomic landmarks such as
retromolar pad, can serve as
a guide to the height of the
rim.

Maxillomandibular Relation Record
73
•An evaluation of patient existing vertical dimension in
accomplished.
•A facebow transfer & record of centric relation are made.
•The cast are mounted on the articulators.

• Set the posterior teeth in centric occlusion
• The trial denture bases are tried in the mouth and used to
verify vertical dimension of occlusion and centric relation
record as with complete dentures.
• Followed by arrangement of anterior teeth.

• Now it is important to take time
with the patient to record various
landmarks and to input the
patients esthetics desires, as
follows:
• 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 cast.
• High lip line should be determined.

• A decision of placement of
diastema, rotated teeth, notches,
and other natural arrangement
should occur.
• The existing anterior vertical and
horizontal overlap should be noted
• A discussion can then occur with
patient as to the display of tooth /
gingiva that will be attempted, or
the need for a localized anterior
alveoletctomy if too much tooth /
gingival display is anticipated

 The casts and land area are marked
with all the information gathered
above, which should include
pocket depths, free gingival
margins, a line marking the
interproximal of each tooth.
 The tooth selection is confirmed
with the patient.

- When tooth is extracted these teeth supported gingival
tissues collapse into region of alveolus.
- Therefore it is necessary to trim the cast for every
immediate denture if the denture base is to be in close
adaptation to the ridge at the time of insertion.

Cast Modification
• Most well known methods are:
– Standard (1958)
– Jerbi (1961)
– Spatial Modelling (2008)
- Cast modification for immediate complete dentures: Traditional and
contemporary considerations with an spatial modeling (J Prosthet Dent
2008;100:399-405) 79/135IMMEDIATE DENTURE

Standard’s Cast Modification
Technique
80
A, Cross-sectional view of cast in posterior region. B, Coronal
segment is removed using saw or laboratory engine. C,
Subsequent cut joins lingual gingival margin to intermediate line
on facial surface of cast. Intermediate line is parallel and 2 mm
apical to facial gingival margin.

Standard’s Cast Modification
Technique
D, Stone contours are gently rounded at facial and lingual
surfaces. On facial surface, rounding extends to soft tissue
height of contour. E, Resultant reduction is shown. Dotted line
indicates premodification contours. F, Cross Sectional View of
tooth placement and denture base contours proposed by
Standard. - Cast modification for immediate complete dentures: Traditional and
2008;100:399-405)

Jerbi’s Cast Modification Technique
A, Cross-sectional view of cast in posterior region. B, Coronal
segment is removed using saw or laboratory engine. C, One-
mm-deep recess is created in area occupied by root.- Cast modification for immediate complete dentures: Traditional and
2008;100:399-405)

D, Vertical cut extending from facial extent of prepared socket
to line denoting junction of cervical and middle thirds of facial
surface. E, Cut extending from faciolingual center of socket to
midway point of cut described in Figure 2, D. F, Floor of
prepared socket is extended lingually.

G, Stone contours are gently rounded at facial and lingual
surfaces. H, Resultant reduction is shown. Dotted line indicates
premodification contours. I, Cross-sectional view of tooth
placement and denture base contours proposed by Jerbi.
2008;100:399-405)

Cast Modification Technique
• Both Standard and Jerbi based their respective
Cast Modification procedures upon clinical
observations and each technique yielded
reasonable success.

DRAWBACK
 Overzealous reduction at the facial, lingual, and
interproximal .
 Denture bases would “bind” in these areas during
placement preventing complete seating of denture bases,
and necessitated adjustment of the denture bases, the
supporting hard and soft tissues, or both.
]IMMEDIATE DENTURE
2008;100:399-405) 86/135

DRAWBACK
 Binding at time of prosthesis insertion occurs most
commonly at facial and interproximal surfaces. Binding at
lingual aspect occurs less often.

Surgical template
• Accurate adaptation of an immediate
denture to the underlying tissue is desirable
for the comfort of the patient and health of
the tissues.
• One essential consideration for accurate
adaptation in the surgical site is the
realistic trimming of the stone cast.
• To ensure that adaptation of the
immediate denture to the edentulous ridge
is nearly identical to the adaptation of the
denture to the trimmed cast, a surgical
template is recommended

Surgical template
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.
Surgical template should be:
- Transparent
- Two millimeters thick to provide rigidity and uniform
transparency,
- Able to securely seated in the mouth.

Surgical template
Template is fabricated by following procedure:
o Make on irreversible hydrocolloid (aliginate) impression of the
edentulous ridge after the cast has been trimmed at boil out.
o Pour the impression in stone

Surgical template
• Four methods -
• Vacuum form method
• Sprinkle on technique (a clear acrylic resin is used)
• Light-cured clear material.
• Process template in clear acrylic resin , created by waxing
up flasking and heat processing

Surgical template
• Advantages
– Areas of binding were clearly identified by
blanching of the underlying soft tissues. Clinicians
used this information to guide osseous
recontouring at the time of tooth removal.
– This allowed improved seating of the associated
immediate denture and minimized damage to the
soft tissues.

Surgical Template
• Disadvantages
– Modifications were performed at the expense of
valuable osseous tissues.

Cast Modification Based On Spatial
Modeling

Modeling
• The resultant technique is intended to
minimize prosthesis induced soft tissue injury,
decrease the need of osseous contouring, and
promote clinical efficiency.

Modeling
A, Bone levels superimposed upon cross-section of a representative posterior
segment. B, Coronal segment is removed using saw or laboratory engine. C,
Two lines are placed on surface of cast. One line arcs from mesiofacial line
angle to distofacial line angle, and is located 2 mm lingual to midfacial
surface. Second line is parallel to and 4 mm from gingival margin. D, Sharp
blade or laboratory engine is used to connect lines drawn in Figure 5, C.

Modeling
E, Two lines also guide lingual reduction. One line arcs
from mesiolingual line angle to distolingual line angle, and
is located 2 mm facial to midlingual surface. Second line is
parallel to and 2 mm from gingival margin. F, Sharp blade is
used to connect lines drawn in Figure 5, E.

Modeling
G, Sharp angles and lines are eliminated, thereby creating
gently rounded faciolingual contour. H, Foregoing cast
modifications permit natural collapse of soft tissues into
extraction site to minimize likelihood of binding or tissue
compression during placement of prosthesis.- Cast modification for immediate complete dentures: Traditional and

Modeling
I, Resultant reduction shown. Broken line indicates
premodification contours. J, Cross-sectional view of tooth
placement and denture base contours as determined by
spatial modeling

Modeling
K, Mesiodistal cross-section of cast with osseous contours
superimposed. Papillae are shortened and rounded to
simulate collapse that occurs following extraction
of adjacent teeth. Broken line indicates premodification
contours- Cast modification for immediate complete dentures: Traditional and

Modeling
L, Papillae may collapse due to their relationships
with underlying interradicular bone. Papillae also
may “roll” as depicted in Figure 5, H.

Discussion
• A comparison of the Standard, Jerbi, and
proposed cast modifications is presented

Discussion
• Examination indicates the 3 methods of cast
modification are similar at the lingual surface,
but different as they project facially.
• Aggressive trimming of the cast’s facial surface
may result in binding or soft tissue
compression upon initial placement of the
resultant prosthesis.

Discussion
• As previously noted, this may necessitate
osseous recontouring, relief of the denture
intaglio, or both. Insufficient adjustment
commonly results in incomplete seating of the
denture base and an uncontrolled change in
the occlusion.

Discussion
• Subsequent masticatory loading drives the
prosthesis toward its fully seated position,
trapping the soft tissues between the denture
base and the supporting bone. This may result
in “stabbing” or “crushing” discomfort,
depending upon the surface characteristics of
the underlying bone.

Discussion
• Because it calls for the most aggressive
reduction at the facial surface of the dental
cast, the method described by Jerbi is most
likely to result in binding or soft tissue
compression during insertion of an immediate
denture.
107
2008;100:399-405) IMMEDIATE DENTURE

Discussion
• The method described by Standard requires
intermediate reduction, and therefore is less
likely to produce facial binding or soft tissue
compression. The method introduced in this
article yields the least facial reduction, and is
least likely to hinder the clinical placement
process.

Discussion
• While transparent surgical guides are an
indispensable component of immediate denture
therapy, they should not mandate unnecessary
reduction of the supporting bone. Instead, cast
modification should be performed with a thorough
appreciation for the spatial arrangement and physical
characteristics of the supporting hard and soft
tissues

Arranging of Anterior teeth
o Setting anterior teeth for immediate dentures differs
from that of complete dentures.
o Some authors have suggested the removed of all the
teeth at this stage and a setting of denture teeth with
desired tooth arrangement irrespective of where the
natural teeth were.
o However, this method eliminates much valuable
information provided by the remaining teeth.
IMMEDIATE DENTURE
edition.
110/135

Wax contouring, flasking, and
boil out
The wax contour is similar to that for complete dentures.
Extra wax should be added to provide a thickness of material
for strength during future deflasking.
Thickness of acrylic resin is also needed to provide room to
trim from the inside to relieve the sore spot or to seat the
denture.

Processing and Finishing
• The immediate denture are processed and finished in the
usual manner at complete dentures.
• Both the immediate denture and the surgical template should
be placed in chemical sterilizing solution in a bag for delivery.

Surgery and Immediate Denture
Insertion
o During extraction of the remaining teeth, should take care to
preserve the labial plate of bone.
o Usually no bone trimming is done.
o The surgical template is used as a guide to ensure that the
prescribed bone trimming is done adequately.
o The template should fit and be in contact with all tissue
surfaces.

Insertion
o Inadequately trimmed areas planed for bone reduction will
blanch from the pressure and be seen through the clear
template.
o The template is removed and the bone or soft tissue trimmed
until the template seats uniformly and completely.
o This indicates that the denture will seat as it was originally
intended to ensure proper occlusions and minimally induced
discomfort.

Insertion
• Suture are placed where necessary.
o If the over denture abutment must
be reduced after the extractions,
the extraction sockets can be
protected during preparation by
covering them with ‘burlew foil’.

Insertion
o Immediate dentures should be disinfected prior to the
placement.
o Pressure areas inside the denture (indicated by rocking) can be
located with pressure indicating paste and trimmed.

Insertion
o If occlusion is not correct, the denture should be rechecked for
seating particularly distally so called ‘heel areas’ .
o when occlusal prematurities are verified a quick occlusal
correction is done to allow simultaneous bilateral contacts.

Insertion
• If immediate denture will be found inadequate retentive, a
tissue conditioning liner can be placed at this stage but the
material should not be allowed to get into the extraction
sites. ‘Berlew foil' can be used to cover the extraction sites
for this procedure.

Post operative care and
Patient Instructions
Instructions for the patient are discussed throughout the
treatment and reviewed carefully at the placemat
appointment
 The first 24 hours: -
• The patient is instructed, not to remove the denture from the
mouth during first 24 hours.
• Patients should avoid rinsing, avoid drinking hot liquids or
alcohol.
• Diet for the first 24 hrs. should be liquid or soft.

The following should occur at the 24 hrs visit
• Ask the patients where they feel sore.
• Remove the denture and wash it.

• Quickly check the tissue for sore spots relate to the
denture . This will appear as strawberry red spots.
usually these area includes canine eminence, lateral to
tuberosities and retromylohyoid undercuts.
• Adjust any gross occlusal discrepancy in centric relation or
excursions.
• Reevaluate the denture for retention, place a tissue
conditioner if retention in unsatisfactory.

First postoperative week
• Counsel the patient to continue to wear the immediate
denture at night for 7 days after extraction or until swelling
reduction. This ensures that a recurrence of nocturnal swelling
will not preclude reinserting in the morning.
• Starting immediately after the 24 hrs. visit, the patient should
be shown how to remove the denture after eating to clean it,
and to rinse the mouth at least three to four times daily to
keep the extraction sites clean, the denture should be
reinserted and worn continuously.
• After one week suture can be removed and the patient can
begin removing the denture at night.

Further follow up care
• After 2 weeks remount casts are poured, the maxillary denture
is related to its semi- adjustable articulator using the remount
matrix made before flasking, a centric relation record is used to
remount the mandibular denture, and refinement of occlusion
is performed.

Denture reline
- The changes that occur in ridge contour as the result of initial
healing of the soft tissues, and also bone have definite effect on
fit of the denture.
- Several relines may be required during the first 8-12 month,
following the removal of the natural teeth
- Soft reliners should be used as it promotes healing due to
cushioning effect.

CONVERTING R.P.D INTO
IMMEDIATE DENTURE
126/135

CONCLUSION
 ID are an important treatment modality as they provide
instant esthetics and function to the patient after extraction
of all the natural teeth. More importantly they provide a
psychological support to the patient at the time of this
debilitating loss. It is time consuming and expensive and
patient should also understand the limitation of this service.

References
• Essentials of Complete Denture Prosthodontics, Sheldon
Winkler, 2nd edition (361- 384)
• Complete Denture Prosthodontics, John J. Sharry, 3rd edition
(295-310)
• Prosthetic treatment for edentulous patients, Zarb, Bolender,
12th edition.(123-160)
• Syllabus of Complete denture, Charles M. Heartwell, 4th
edition.(223-259)
• Glossary of Prosthodontic terms, 8th edition
• Textbook Of Prosthodontics, V Rangarajan(248-259)

References
• Immediate denture service ; Arthur M Lavere and Arthur J .
Krol ( JPD Jan 1973 vol 29 no 1,10-15)
• Trimming the cast in the construction of immediate dentures (
JPD 1966 vol 16 no 6, 1047-1053)
• Minimizing problems in placement of immediate dentures ;
Walter J.Demer (JPD March 1972 vol 27 no 3,275-284)
• Double custom tray procedure for immediate dentures ; Ali
Bolouri (JPD March 1977 vol 37 no 3, 284-289).
• Cast modification for immediate complete dentures:
Traditional and contemporary considerations with an spatial
modeling(J Prosthet Dent 2008;100:399-405)

Guide to Immediate Dentures

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