An Immediate Denture is a treatment used for patient’s with a completely failing dentition. It is separated into three parts. 1) planning fabrication and delivery, 2) healing and adjustments and 3) Final reline
My definition of a failing dentition is one that cannot be restored thought conventional dentistry or one that the cost of such dentistry out ways the long term out come. In other words you pay a lot for very little.
The immediate denture is a way to restore the patientesthetically and functionally immediately after removal of all his/her teeth. It begins with first analyzing the patient’s mouth. Measurements are taken as to where the incisal edge, the edge of the two central incisors, needs to be placed. Also where we can make esthetic improvements by placing the teeth in the appropriate place. Next we look at the space between the teeth. We want to placed the teeth so that they are pleasing to look at and function well. The patient should be able to chew and speak, after delivery. We then look at the the occlusion or patient’s bite. We want to know is it nice and even and do not cause the denture to rock or dislodge. After the first three steps we look at the bone around each tooth and determine where we have to removed bone to level the ridge. We don’t want an irregular ridge because it will make the denture uncomfortable for the patient. Once we have made all our measurements we can move forward with final impressions, Jaw Relation Record(JRR) or bite registration and facebow record. The face bow allows us to mount the case on an artificial jaw and simulate the patient’s jaw movements. The surgery is first performed on the casts and a guide is made of the edentulous ridge to aid the surgeon during surgery. The teeth are then set up according to the information we gathered from the patients mouth and then processed into dentures. When the dentures are ready we can now have the surgeon remove all the remaining teeth level the ridges and the dentures are delivered.
After the surgery the patient wears the dentures for 24hrs without removing them. This is the only time the dentures should be worn without taking them out of the mouth. After the 24hrs the dentures are removed by the restoring dentist and cleaned and minor adjustments made. The patient is seen every 1-2 weeks after delivery for adjustments until they are comfortable. This can take anywhere from 3weeks to 2 months. The adjustments include reducing areas of pressure, adjusting the bite and temporary relines of the dentures. Once the edentulous ridges have healed. The temporary reline will fill any voids between the denture and the ridge, creating a stable and comfortable base. The temporary material is not designed to last forever. A final laboratory reline is required.
It takes about 6months before the ridges are completely healed and the bony changes have stopped. At this time the dentures will be relined with a permanent acrylic. The immediate dentures are used as impression trays and the impressions are made under function. The patient will be required to be without their dentures for a period of 2 days while the dentures are relined. Once the dentures are relined. Adjustments are made on delivery and 1 week after. The reline allows the dentures to fit very tight and further adjustments may be require until the dentures are completely comfortable.