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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 3  |  Page : 168-171

Rehabilitation of failing dentition with interim immediate denture prosthesis


1 Department of Prosthodontics, Luxmi Bai Dental College, Patiala, Punjab, India
2 Department of Prosthodontics, Jaipur Hospital, Abohar, Punjab, India

Date of Web Publication7-Oct-2016

Correspondence Address:
Amit Sharma
LBDC, Patiala, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-4003.191724

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  Abstract 

Advances in therapy have helped patients with periodontal disease to retain part of their natural dentition for an extended period. 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 for 6–8 weeks for the extraction sites to heal. The conventional 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 conventional complete denture. A second option is to convert an existing removable partial denture into an interim immediate complete denture. A third option is to make a conventional immediate complete denture. The aim of this clinical report was to describe the fabrication of interim immediate denture in a patient with hopeless existing dentition.

Keywords: Dental prosthesis, interim immediate complete denture, vertical dimension


How to cite this article:
Sharma A, Chugh D, Sachdeva B, Kinra MS. Rehabilitation of failing dentition with interim immediate denture prosthesis. Indian J Dent Sci 2016;8:168-71

How to cite this URL:
Sharma A, Chugh D, Sachdeva B, Kinra MS. Rehabilitation of failing dentition with interim immediate denture prosthesis. Indian J Dent Sci [serial online] 2016 [cited 2018 Oct 17];8:168-71. Available from: http://www.ijds.in/text.asp?2016/8/3/168/191724


  Introduction Top


An immediate denture is defined as a complete or removable partial denture constructed for insertion immediately following the removal of natural teeth.[1]

Requirements

A prosthesis is not a living tissue, but at the same time, it must be physiologic and be tolerated to be an accepted part of a system composed of living tissues.[2] To attain the maximum degree of success, the following requirements should be satisfied: compatibility with surrounding oral environment, restoration of masticatory efficiency within limits, harmony with the following functions, i.e. speech, respiration, mastication, and deglutition, esthetics acceptability, and preservation of the remaining tissues.

Advantages of immediate denture treatment

Interim immediate denture acts as a bandage or splint, helps to control bleeding and stabilizes the clot, and prevents food collection and thus promote healing. The patient tends to regain adequate functions, e.g., speech, deglutition, and mastication as compared to conventional complete denture when the lips, cheeks, and tongue have gone unsupported without teeth for a long time.[2] Many patients are more willing to get diseased teeth removed if they can have them replaced immediately, as the edentulous state hampers their normal social and business activities. Placement of immediate denture preserves the health of joints and oral physiology. Placement of interim immediate dentures helps the basal tissues, muscles, and joints acquire a healthy condition. It also helps to preserve the residual ridge with minimum trauma and swelling.[3]

Disadvantages

Interim immediate dentures are more challenging than conventional complete dentures because of the presence of teeth, due to which impression making and jaw relations are difficult to record.[4] The interim immediate denture does not replace the stimulation that was supplied to the bone by natural teeth. Speech and mastication are likely to be impaired for a while. The procedures are challenging and demanding and require more chair side time. The changes in the hard and soft tissues during healing phase require frequent relining, rebasing, refinement of occlusion, etc., which are expensive as compared to conventional complete denture treatment modality. There is no opportunity to observe the anterior teeth at the try-in appointment; therefore, the esthetic results cannot be evaluated until the dentures are inserted.


  Case Report Top


A 63-year-old male patient came to the department of prosthodontics with a complaint of inability to chew food and poor appearance. The patient was evaluated for the treatment. The patient presented no significant medical history and no temporomandibular disease. Clinical examination and radiographic assessment [Figure 1] and [Figure 2] revealed an unrestored mouth with generalized severe chronic periodontitis of the remaining teeth that were considered hopeless. The patient was advised extraction of all the teeth due to his failing dentition and fabrication of interim immediate denture was planned. The patient, who signed the informed consent, accepted the treatment plan for an interim immediate denture.
Figure 1: Preoperative.

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Figure 2: Preoperative radiograph.

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Procedure

The primary impression was made with irreversible hydrocolloid impression material (Zhermack, Badia Polesine, Italy). The cast was poured in Type-III dental stone (DPI, Mumbai, Maharashtra, India). The wax spacer (Golden dental product, Hyderabad, Telangana, India) of 2 sheet thickness on an edentulous area and 1 sheet thickness on the dentulous area was adapted. The custom tray was fabricated with VLC tray material (M.P Sai Enterprises Pvt Ltd., India).

Border molding was done, the wax spacer was removed, relief holes were made, tray adhesive was applied, and final impression was made with medium-bodied and light-bodied addition silicone impression material (President, Coltene/Whaledent Private Ltd., Mumbai, Maharashtra, India).

Jaw relations were recorded [Figure 3]. Casts were mounted on Hanau Wide-Vue articulator (Hanau Wide-Vue Articulator, Whip Mix., Corp., and USA), and teeth arrangement was done.
Figure 3: Maxillomandibular relation.

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The trial was done [Figure 4].
Figure 4: Try-in.

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The remaining teeth arrangement was done for all dentition by knocking out the teeth from the cast alternatively. Modification of cast at the intended area is very critical in the fabrication of an immediate denture.[5] Three markings were scribed on the facial surface of the cast dividing it into cervical, middle, and apical thirds. The denture was fabricated before the extraction of all remaining teeth.

The surgical stent was prepared for both upper and lower arch on the primary cast after removing all the teeth from the same [Figure 5].
Figure 5: Surgical template.

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All the teeth were extracted under local anesthesia. Any bony spicule, if present, was removed with rongeur forceps and ridge form was checked with the surgical stent [Figure 6] and [Figure 7].
Figure 6: Maxillary template.

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Figure 7: Mandibular template.

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The denture was inserted on the same appointment [Figure 8] and [Figure 9].
Figure 8: Left lateral view.

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Figure 9: Right lateral view.

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Post insertion instructions were given and the patient was recalled after 24 h.

Follow-up was done on weekly basis.

After 3 months following healing of the residual ridge, conventional complete denture was fabricated.


  Discussion Top


Interim immediate dentures are very satisfying treatment modality for both patient and dentists. The patient gets the benefits of improved confidence, comfort, and continued dental esthetics. The dentist also finds satisfaction in providing a very acceptable treatment to the patients.[6],[7]

Interim immediate dentures are more challenging to make because a try in is not possible beforehand. The patient may not be completely satisfied with the final appearance and fit of the denture on the day of insertion. Thus, the patient's cooperation toward the treatment also plays a major role in success. Philosophical patients are the best candidates for this kind of treatment procedure.[8],[9]

Thus, it is important to explain the limitations of procedures before starting the treatment. The usual design of conventional complete denture was not suitable for this patient. The patient presented with dissatisfaction with dental esthetics and consequently his smile. His dental situation was further complicated by generalized chronic periodontitis. In this case, the patient was not convinced for multiple visits for the extraction and wanted all the teeth to be replaced immediately, so we formulated our treatment plan accordingly and decided to go for an interim immediate denture. The interim immediate denture was successful in fulfilling the requirement of the patient. The initial retention and stability were good and also the patient was able to maintain satisfactory oral hygiene and had no complaints regarding esthetic and function. However, this prosthesis was intended for use as an immediate interim denture. Follow-up was done regularly. After complete healing of ridge, conventional complete denture was fabricated for the patient.


  Conclusion Top


The success of interim immediate complete dentures greatly depends on a correct diagnosis, detailed treatment planning, and precise execution of fabrication procedures. A correct diagnosis and work plan can be made only after gaining insight into the patient's general health and detailed extraoral and intraoral examination.[10]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Academy of Prosthodontics Editorial Staff. The glossary of prosthodontic terms: Eighth edition. J Prosthet Dent 2005;94:10-92.  Back to cited text no. 1
    
2.
Heartwell CM Jr., Frederick WS. Immediate complete dentures: An evaluation. J Prosthet Dent 1965;15:615-24.  Back to cited text no. 2
    
3.
Sheldon W. Essentials of Complete Denture Prosthodontics. 2nd ed. Delhi: A.I.T.B.S. Publishers; 2009. p. 361.  Back to cited text no. 3
    
4.
Hickey JC, Zarb GA, Bolender CL. Boucher's Prosthodontic Treatment for Edentulous Patients. 9th ed. St. Louis: CV Mosby; 1985. p. 526.  Back to cited text no. 4
    
5.
Standard SG. Preparation of cast for immediate dentures. J Prosthet Dent 1958;8:26-30.  Back to cited text no. 5
    
6.
Richardson JA. Practical Treatise on Mechanical Dentistry. Philadelphia: Lindsay and Blakiston; 1860.  Back to cited text no. 6
    
7.
Nakamura SH, Martin JW, King GE, Kramer DC. The labial plate major connector in the partial mandibulectomy patient. J Prosthet Dent 1989;62:673-5.  Back to cited text no. 7
[PUBMED]    
8.
Demer WJ. Minimizing problems in placement of immediate dentures. J Prosthet Dent 1972;27:275-84.  Back to cited text no. 8
[PUBMED]    
9.
Kelly EK. Follow-up treatment for immediate denture patients. J Prosthet Dent 1967;17:16-20.  Back to cited text no. 9
[PUBMED]    
10.
Seals RR Jr, Kuebker WA, Stewart KL. Immediate complete dentures. Dent Clin North Am 1996;40:151-67.  Back to cited text no. 10
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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Abstract
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Case Report
Discussion
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