Introduction:

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.
A second option is to convert an existing removable partial denture
into an interim complete denture. A third option is to make a conventional
immediate complete denture.
GPT .7 defines an immediate denture as
A complete or removable partial denture constructed for insertion
immediately following the removal of natural teeth.
Interim denture
A fixed or removable 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 prosthesis.

Requirements of immediate complete dentures

According to Heartwell and

Salisbury 1965, to attain maximum

degree of success the following requirements should be satisfied.

1) compatibility with surrounding oral environment.
2) Restoration of masticatory efficiency with limits.
1

3) Function in harmony with the activity necessary in speech, respiration

and deglutition.
4) Esthetic acceptability.
5) Preservation of tissues that remain.

Indications for immediate denture service

Dentulous

or

partially

edentulous

patient

whose

remaining teeth are periodontally compromised and must

be extracted.
Contraindications for immediate denture service
According to HEARTWELL and SALISBURY, immediate dentures
are contraindicated for
a) Patients with diseases of a debilitating nature.
b) Patients for whom multiple extractions might be unwise because of
systemic conditions.
Eg :
cardiacdisturbances,
Endocrine gland disorders
Blood dyscrasias
Those with a slow healing potential
c) Emotionally disturbed individuals. This is a large group of
patients which includes people in the menopausal and climateric period of
life.

c) Patients whose mental capacities do not allow them to comprehend

their

responsibility

in

this

service. This includes the aged

individuals who are incapable of remembering instructions.

e) Indifferent unappreciative patients. Many young patients can be
classified in this group as they are indifferent to the consequences of
not following advice in the use and care of dentures.
f) Patients with acute periapical or periodontal pathosis.
g) Patients who have extensive bone loss adjacent to remaining
teeth. Patients with extensive loss of a chronic nature will have a rapid, ever
changing support for the dentures. These changes are reflected in the
occlusal relations of teeth,and unless these relations are kept in harmony,
extensive bone loss will result.
h) Patients who have to undergo surgery in anterior region for the
removal of deeply embedded teeth. In such cases it will be impossible
to predetermine accurately the amount of bone removal; also post
operative oedema may prevent wearing of an immediate denture.

ADVANTAGES
1) Decreased period of edentulousness. (no time)
2) Patients can continue their social and business activities without
embarrassment.
3) General appearance of the patient is less affected as there is only a
minimal change in muscle tone and occlusal vertical dimension can be
maintained.
4) General appearance of the patient is less affected as there is only a
minimal change in muscle tone and occlusal vertical dimension can be
maintained.
3

5) Ridges are subjected to early functions, so less resorption will take

place and the resultant ridges are better preserved and adapted to
support a complete denture.
6) Patients become adjusted to changes more quickly than with
conventional dentures.
7) Healing period is faster and less painful. Immediate denture can be
considered as a matrix or bandage with negative pressure over the surgery
site.
8) Esthetics can be improved. Unwanted diastemas and rotations can be
eliminated.
9) Locations of the anterior incisal plane and vertical dimension of
occlusion are easily ascertained when there are natural teeth than when they
are missing. The centric relation may be more accurately recorded for
dentulous patients than for edentulous patients.
10) Patient does not develop undesirable masticatory habits and the normal
size of the tongue is maintained.
11) The co-operation and emotional attitude of the patient are improved in
comparision with those attitudes present when all teeth are extracted without
immediate placement.

DISADVANTAGES
1) As residual ridge resorption occurs, the fit of denture is lost.

2) Requires relining after 6 months.

3) It is costly, due to increased treatment time, postoperative adjustments,
and the need to reline or remake the denture following healing.
4) No anterior tryin, so esthetics of the immediate denture cannot be
evaluated until the insertion appointment.
4

CLASSIFICATION

OF

IMMEDIATE

COMPLETE

DENTURES
Lavere. A and Krol. A 1973, (JPD. 1973. 29. 10/15) classified
immediate complete dentures as.
1) Conventional Immediate Dentures.
2) Transitional dentures or Diagnostic dentures.
Each classification is further divided into groups of immediate
dentures having a
1) Labial flange.
2) Partial labial flange.
3) No labial flange.
In conventional type, posterior teeth are first extracted leaving the
first premolars. After 3-6 weeks, anterior teeth are extracted.
In transitional type, no teeth are extracted prior to the construction.
The denture is constructed prior to and is placed immediately following the
extraction of all remaining natural teeth.
It is indicated for apprehensive patients who will not readily accept
two or more surgical procedures.
Labial flange Vs No labial flange:
Three schools of thought exist in regard to the construction of a labial
flange for immediate dentures.
I) Labial flange has poor esthetic value and may be a source of irritation to
the tissue; thus, the maxillary denture is made without a labial flange.
5

II) Labial flange is desirable in order to aid stability of the denture and
healing of the tissues. The labial flange is made very thin so as to avoid
fullness of the lip and present the desired esthetic effect.
III) Advocates use of short or partial flange which extends only partially
along the labial surface of maxillary residual ridge. As resorption takes
place, the flange is extended with cold-curing acrylic resin placed in the
mouth. In this way, proper esthetics and healing are maintained.
Alveolectomies are not needed, and very little irritation is expected due to
the limited contact of short labial flange with the tissues.
Flangeless immediate dentures.
Indications :
1) when deep undercuts are present on the anterior labial and buccal
residual ridge.
2) A high lip line and an active lip would expose an unesthetic flange.
3) Minimal account of surgery is considered desirable.
Contraindicated :
1) when periodontal disease exists with a substantial amount of bone
loss which makes an acceptable cosmetic effect difficult.
2) When an anterior fixed partial denture has been worn resulting in an
uneven contour of anterior residual ridge.
Partial flange type :
This is indicated for immediate dentures when
1) undercuts are present on the labial and buccal sections of the residual
ridge.
2) It is desirable that flange serves as a surgical splint.

Contraindicated when
1) economic condition of the patient renders multiple corrective
procedures impractical.
2) The patient has an unusual active lip line which would cause the
denture flange to be unesthetic due to exposure of its labial border.
Labial flange :
Is indicated when
a) no large anterior bony undercuts are present.
b) The lip line and lip activity are normal.
c) The teeth are periodontally involved and supporting bone is
lost.
Contraindicated when
1) Pronounced undercuts are present in the anterior labial region of the
alveolar residual ridge.
2) Fullness of the lip would produce an unaesthetic result.
Bates and Stafford in 1971,

( BDJ 1971,131, 408-410)

Classified complete immediate dentures in to

a) Flanged

Alveolotomy with interseptal Alveolectomy

Alveolectomy
Extractions only

d) Socket fit
FLANGED IMMEDIATE DENTUTES.
The use of flange without an surgery depends up on
a) amount of labial undercut present.
b) Extent to which repositioning the anterior teeth is necessary.
7

c) Length, tonus and activity of upper lip.

Alveolotomy is defined as fracturing and moulding of the labial plate
of alveolar process following interseptal alveolectomy.
Alveolectomy may be defined as surgical excision of part of the
alveolar process.
SOCKTE FIT
Socket fit or open faced dentures have the anterior teeth fitting into the
sockets of the extracted teeth, which produces an excellent esthetic result.
These are indicated where a flange is difficult to place and where the
periodontal condition is such that minimal pockets exist.
The drawback of this type is that the retention of the denture is not as good
as a flanged one.

Immediate denture conventional

Transitional
1) Usually made when only six
1) Does not require the teeth
anterior teeth remain

extraction

2) Healing and shrinkage period

2) Not

necessary

of posterior part of residual

dentures

alveolar ridge is necessary.

inserted after extraction of all

3) Centric relationship is to be

are

because

immediately

teeth.

recorded.

3) No need since morphology of

teeth

and

the

existing

occlusion is preserved in
transitional dentures.
4) No special functions.

4) Serve as protective splints.

DIAGNOSIS AND TREATMENT PLANNING

Scrupulous treatment planning and patient education plus meticulous
clinical performance aided by the careful use of tissue conditioners, will
virtually ensure a predictable treatment outcome for most immediate
dentures. With well planned monitoring and modifications, these dentures
will become the definitive prostheses for long term wear.
In some patients, the sequelae of advanced periodontal disease,
including aberrant occlusal relationships, plus the status of treatment
requirements for the opposing arch, might require a staged approach to
the final objective of a definitive prosthesis.
Explanation to the patient about immediate denture treatment
A careful explanation to the patient, the limitations of immediate
denture service should be done. The list includes.
1) They do not fit well as complete dentures. They may need temporary
linings with tissue conditioners and may require the use of dental
adhesives.
2) They will cause discomfort. The pain of the extractions, in addition to
the sore spots caused by the immediate denture, will make the first week
or two after insertion difficult.
3) It will be difficult to eat and speak initially.
4) The esthetics may be unpredictable. Without an anterior try in, the
appearance of the immediate denture may be different from what the
patient or the dentist expected.
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5) Many other denture factors are unpredictable such as the gagging

tendency, increased salivation, different chewing sounds and facial
contour.
6) It may be difficult or impossible to insert the immediate denture on the
first day.
7) Immediate dentures must be worn for the first 24hrs without removal by
the patient.
8) Because supporting tissue changes are unpredictable, immediate
dentures may loosen up during the first 1 to 2yrs. The patient is
responsible for all fees involved in refitting or relining the dentures.

Diagnostic procedures
The diagnostic findings are determined by investigating the local oral
conditions, the patients mental attitude, systemic status and past dental
history.
The diagnostic procedures are divided into two phases.
1) patient examination
2) consultation interview
The examination of the patient should include findings of
1) Local and systemic origin.
2) Roentgenographic study.
3) Accurately articulated casts.
4) Visual and digital examination.
5) Appraisal of any existing prosthesis.
In consultation interview the following are determined.
a) Mental attitudes.
b) Expectations and wants.
c) Past dental history.
d) Existing systemic conditions.
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The local factors of particular significance in complete immediate denture

treatment are
a) Condition of the teeth to be extracted -endodontically treated
teeth, multi roots, ankylosis, hypercementosis, curved roots.
b) Position of teeth.
c) Presence of foreign bodies.
d) The presence of bony or tissue undercuts that must be reduced
or eliminated.
e) Exostosis
f) Bone loss adjacent to remaining teeth.
g) Muscle co-ordinations.
Past dental history
The following should be evaluated
1) Heamorrhagic tendencies
2) Excessive swelling
3) Excessive postoperative pain.
4) Allergic reaction to local anesthetics.
The insertion procedures are influenced by the anesthetic used.
Sensitivity to local anesthetics may necessitate the use of a general
anesthetics.But it is difficult to check occlusion by remount procedures if
general anesthetics are used.
Heamorrhagic tendencies may indicate the use of a surgical splint as a
bandage. Patients prone to excessive swelling after extractions may present
problems in occlusal correction during post-operative phase.

11

Systemic status :
Systemic conditions affecting the basal seat include the following
1) Necrosis, Osteoporosis and Xerostomia in patients with poorly
controlled diabetes.
2) Poor

clotting

mechanism,

patients

with

cardiovascular

and

cerebrovascular disease. A good blood clot influences good bone

healing.
3) Mucosal disorders, psycogenic symptoms.
4) Keratotic lesions, dyskerotosis resulting from Vit A and B deficiency.
5) Osteoporosis occurring as a result of bone matter defects, as in
malnutrition resulting from diabetes.
6) Poor synthesis of lobe matrix in sensitivity.
TREATMENT
The procedures in the treatment plan are :
a) primary impression and preparation of custom tray.
b) Final impression.
c) Recording of maxillo-mandibular relations.
d) Try in of posterior teeth.
e) Preparation of surgical template.
f) Surgery and insertion.
g) Post-operative instructions.
Diagnostic mounting of pre extraction casts- patients esthetic and
functional evaluation mounted.
Diagnostic casts serve to guide the
12

1) initial discussion of esthetics (tooth mold and shade selection)

2) plane of occlusion.
3) Patients existing midline and modification of its position.
4) Patients existing vertical dimension of occlusion and amount of
interocclusal distance.
5) To evaluate whether patients existing maximum occlusal position
coincides with the planned centric relation position for the immediate
dentures.
6) To estimate the angles classification of occlusion for the patient and a
note of the display of posterior tooth in buccal corridor.

Impressions for Immediate Dentures :

The philosophy of the operator should be that of making or building
the impression rather than taking it. Careful consideration must be given to
recording the extent and width of border of impression.
A single snap impression in a stock tray is unlikely to give the precise
definition of the extent of sulcus which is necessary to produce a denture
that will have satisfactory border seal.
John. Andesson, Roy storer adviced a two stage impression.
Type of tray for the preliminary Impression :
A tray should be chosen that conforms reasonably well to the future
denture bearing area.
Tray may be of metal or plastic.
Any tray is modified to obtain better adaptation.
Where only anterior teeth are present. A partially edentulous type
of tray should be used,
-to ensure reasonable adaptation of the tray to both anterior and
posterior regions.
13

- to help in the seating of the tray.

- to ensure a fairly uniform thickness of impression material.
A box tray may also be used in this situation provided it is modified
in the posterior regions by the addition of impression compound.
The border of the tray should be checked in relation to the functional
sulcus. There are three main areas where stock trays are usually under
extended.
upper jaw :
Lateral to tuberosities. Here complete coverage is essential , as the
impression material tends to flow backwards out of the tray rather than
sideways into sulcus by tuberosities. Commonly, airblows appear in this
region of the impression.
lower jaw :
Distolingually in the lower jaw. Because of the considerable
variation in sulcus depth and distolingual extent, stock trays are invariably
incorrectly extended in these areas.
both jaws
The anterior segments. If anterior teeth are

all proclined the flange

of the stock tray is unlikely to lie near the sloping alveolar ridge and will not
enter the labial sulcus.
Materials for the preliminary impression
The presence of natural teeth and the need for accurate reproduction
of their contours necessitates use of an elastomeric impression material and
the alginate.
When a stock tray is under extended, a brand of alginate should be
chosen which when mixed gives a mix which is fairly viscous. The high
viscosity will result in extension of the material into those parts of denture
bearing area not covered by the tray.
14

When lower posterior teeth have been missing for many years, the
adjacent cheek and lingual tissues may have folded over the alveolar
ridge. In order to expose the potential denture bearing areas it is necessary
to push aside encroaching tissues.
Alginate is not sufficiently viscous to achieve this and all too often a
fold of mucosa from cheek or floor of mouth is trapped between the
impression material and the alveolar ridge.
Impression compound suitably softened has sufficient body to push
aside the overlapping tissue and to expose the extent of the alveolar ridge.
To make use of both the alginate in respective areas where each is needed, a
combined ALGINATE-COMPUND technique is used.
Type of tray and materials for final impression :
Type of tray depends on the material to be used.
ALGINATE :
Tray is made of Shellac Or Acrylic
Spacer used is 3mm thick.
The operator should confirm that good adhesion can be obtained with
alginate and adhesive or perforations can also be used.
Stock tray takes more time for adjusting it to its contours.
ELASTOMER
Special tray is made.
Elastomers are used in thinner section.
Spacer used is 1.5mm thick.

Tray adhesive can be used.

Areas prone to under extension in a special tray.

a) lateral to the tuberosities.
b) Distolingually in the lower jaw
c) The anterior segments in both jaws.
15

Preparation of the mouth and casts for immediate dentures

William .G. Maison 1953 classified the common anatomic abnormal
difficulties of the mouth relative to immediate denture insertion as follows :
1) Hard tissues
2) Soft tissues
3) Ridge relation
HARD TISSUES
1. Bony protuberances (exostoses)
a)

Torus palatinus
In most cases it requires no preparation of the mouth but, if
extremely large or severely pedenculated, surgical reduction is
required.
Treatment of cast :
1)

any area (Torus or hard rugae ) under the denture base that may act
as a fulcrum which in turn will cause the denture to have lever
action, to fracture should be given adequate relief. Relief should
not involve post dam area.

2)

The procedure of avoiding the coverage of this bony elevation can

be done by giving
Horse shoe type denture (roofless)
Construction of a cast metal palatal base or a swaged metal
base relieving the torus slightly with air chamber metal.

b)

Torus mandibularis or lingualis.

If extensive, requires surgical intervention and is simple to perform.
Treatment on the cast :
If it is to be removed, the cast is scraped to conform with the
surgery. If small and no surgical reduction is needed, relief is given with
16

lead foil, but do not extend the relief so as to break the peripheral seal of
denture at the lingual flange.
c)

Sharp spines
These are greatest cause of denture pain, for every bite is
dynamite. These should in all cases, be surgically removed,
preferably at the occasion of necessary extractions.
Treatment on the cast no aid is accomplished

d) knife-edge ridges
Treatment on the cast : use of shallow modified cusps and a
small mold of posterior teeth, thus forming a narrow occlusal table.
The teeth should be set toward the lingual side of the ridges to direct.
the occlusal loads with in the arches, and toward the center of the
denture foundation, but the possibility of displacement by the tongue
should be avoided.
e) Maxillary Tuberosities
These may be divided into three classes
1) the bulbous type.
2) Low hanging tuberosities
3) The tuberosity that is a monstrosity (seldom seen)
Bulbous type : creates undesirable undercuts, endangering adequate
peripheral seal at the soft areolar tissue.
Treatment on cast : the cast is scraped as to relieve any undesirable
undercuts.
Low-hanging tuberosities : cause an abnormal ridge relation due to the
lack of space between the tuberosities of the maxilla and the retromolar
pads.
This can be corrected by surgical excision. Any attempt to gain
clearance by intervention of the retromolar area of the mandible is to be
17

condemned, for the retention of the full lower denture is most dependent up
on the retromolar pad.
Treatment an cast :
The distal ends of cast are scraped to allow for the denture base
clearance.
f)

Alveolar contour
At the same time when the posterior teeth are removed, all
necessary alveolar contouring should be performed. This should be
confined to a slight smoothing of all rough, sharp or jagged margins,
and the trimming of the alveolar septums of the processes, and the
removal of all excessive gingival tissues.
The anterior region of maxilla may present an unfavorable
undercut so the denture cannot be inserted. The area may have to be
trimmed in cases of extreme vertical or horizontal overlap to correct
minor faulty ridge relations.

Treatment an cast :
Labial surface is trimmed but slightly in ordinary cases. Most of
trimming is done at gingival crest. To protect the peripheral seat at the labial
flange of the denture, the cast may be scrapped lightly (approx mm)
according to flexibility of the tissue. This aids in preventing the denture seal
from breaking at labial frenum.
SOFT TISSUES
a)

Abnormal frenula and ligament and muscle attachments.

Superior attachment of the pterygomandibular raphe may be so
abnormal as to obliterate the maxillary tuberosity. This ridge of tissue
then hinders denture retention by causing a break in the continuity of
the peripheral seal.
18

Treatment on cast-by giving relief.

b)

Soft flabby tissue : spongy mucosa hypertrophied tissue

Frequently the anterior region of the upper arch becomes
swollen and spongy because of trauma. This is due to heavy occlusal
stress brought about by resorption and loss of vertical dimension.
The elasticity of this creeping sponge like tissue , which is
constantly yielding and changing its shape under chewing pressure,
seriously interfaces with the stabilization and efficiency of dentures.
Therefore these tissues must be
1) removed surgically
2) controlled .
3) prevented.

Treatment on the cast

use of a small mold of low cusp teeth (non-inter locking )
plastic teeth, will lessen stress of occlusion over these areas.
Ample free-way space in denture setup will also aid in the
prevention of flabby ridges by allowing non contact of the
occlusion when the jaws are in rest position , repose or during
speech.
Impression technique should be such that there will be
minimum dislodgement of hyperplastic tissue by pressure
which would cause the denture to rebound and pinch or draw
the tissue under its base.
When recording jaw relations in flabby ridge cases, beware or
producing harmful effects of occlusal pressure open flabby
tissues. The use of very soft equalizing wax under the

19

occlusion rims and over occlusal rims will help to relieve

excessive pressure.

Ridge relation
Faulty ridge relation ship- immediate dentures are contraindicated for
patients with extreme malrelation of the ridges.
Vertical opening and centric relation records are made by using
old fashioned MUSH-BITE technique. Very soft wax which
can be molded in to the form of oblong cakes at ordinary room
temperature, is placed over the posterior areas of upper ridges.
The size of wax cakes depends upon that of the inter maxillary
space. They may be placed unilaterally or bilatetally.
Care must be taken to avoid placing any wax on remaining
anterior teeth so as to cause an increase in the vertical
dimension.
The patient is instructed to occlude slowly the anterior teeth to
their normal occlusion
3-5 minutes are followed for wax to flow.
The wax record is checked to be sure of its correctness by
comparison with previous observations and markings on the
remaining anterior teeth when they were in proper contact.
The wax must be thoroughly chilled before it is removed.
Advantage
Anterior teeth are apart when casts are mounted on articulator.
Wax will not allow patient to exert any objectionable pressure, and
tissues are displaced to minimum.

20

Walter.J. Demer 1972 stated that some unaltered immediate dentures

are incompatible with any method of placement on the residual ridge.
Adequate provision for solving these problems is an essential part of
immediate denture routine.
In includes
1) horizontal modification
2) vertical shortening of denture flange.
3) Surgical removal of bony undercuts.
Treatment of specific undercuts in maxillary arch
1)

distobuccal aspect of tuberosities the undercuts in the denture

flange are reduced horizontally. Vertical shortening of the flange
might endanger air seal and jeopardize retention surgery is seldom
indicated.

2)

Buccal aspect of tuberosities :

If undercuts are unilateral and shallow, no treatment is needed.
If they are bilateral and shallow, undercuts on the flange on one
side of denture are reduced horizontally.
If severe, either surgical correction or vertical shortening of the
flange of denture to crest of contour on one or both sides may
be used.

3) Canine eminences:
If depth of undercut is minimal, horizontal space made in the flange is
enough.
4) Incisive fossae.

21

An anterior path of insertion for the denture with or without some

horizontal space provided in flange will usually suffice for shallow anterior
undercuts if there are no posterior undercuts.
When both anterior and posterior undercuts are present, most of
necessary space is provided in the posterior flanges.

In mandibular arch
Distolingual undercuts
An anterior path of placement of lower denture will suffice if the
undercut is not too severe and if it is uncomplicated by other undercuts.
Buccal and lingual and undercuts in bicospid region
Space is made in the denture flanges horizontally from the inside.
Sublingual undercuts : Denture flange is thinned to make horizontal space
on its inner surface.
Incisive fossae and canine eminences : shallow undercuts may be treated by
making horizontal space inside the denture flanges. If severe, vertical
shortening of the labial flange to crest of contour is required.

CUSTOM TRAYS
According to Boucher,
There are two ways to fabricate the final impression tray, depending on the
location of the remaining teeth and operator preference.
22

Type. A : A Single full arch custom impression tray.

It can be used both when only anterior teeth are remaining and when
anterior and posterior teeth are remaining.
1) Tooth areas are blocked out with two sheet wax thickness; the
edentulous areas are blocked out if required.
2) A Stop effect is established by providing holes through the wax
anteriorly on one or two teeth and posteriorly in the tuberosity or
posterior palatal seal areas.
3) The tray is outlined to be 2-3 mm short of vestibular roll and to
extend and include the posterior limit.
4) Resin of choice is adapted over the cast, into the stops, and to the
planned outline. A handle is added to the anterior or to the mid
palate. The latter is regarded as advantageous when anterior teeth are
present, because if the anterior handle is too long, it may interfere
with proper border molding.
Type. B : Two-tray Or Sectional custom impression tray.
This method is used only when the posterior teeth have been
removed. It involves fabricating two trays on the same cast-one in the
posterior, which is made like an edentulous tray, and one in the anterior.
1) Outline the borders of the tray again 2-3 mm short of the vestibule
but covering the posterior limit and/or retro molar pads.
2) Use melted wax to block out tissue undercuts, interdental spaces and
undercuts around teeth.
3) Adapt resin of choice on to edentulous areas extending anteriorly up
to the incisal edges of teeth to include a handle.
4) For the anterior section, some operators prefer variations:
One is to adapt a custom tray.
Another is to use a stock tray.
23

The anterior section must cover the labial surfaces of teeth and the
vestibule.
5) The posterior sectional tray is tried in, relieved as with a complete
denture tray, border molded, adhesive applied, and then the posterior
impression made in any material desired, [zinc Oxide-eugenol paste,
polysulfide rubber base, polyvinyl silicones, polyether]
6) The posterior impression is removed and inspected. Excess material
is removed and it is replaced in the mouth; the anterior section of the
impression is made to it by one of the variations.
7) The most important consideration in sectional tray technique is
careful and proper reassembly of the two separate impressions.
Spilt- Tray impression technique
This is proposed by Nikzad Javid, H. Tanaka in 1974.
It is same as Bouchers method but differs in one way. They made
notches in the posterior tray in the area of incisal edges. These act as
mechanical interlocks to hold the anterior tray. Holes are drilled in anterior
tray to aid in alginate retention.
Advantages :
An accurate impression of edentulous, with better control of labial
peripheral tissues can be made.
Borders are more easily controlled with alginate.
K. Gardner, Gregory Technique :
This technique uses a posterior custom posterior impression tray that
once border molded and impressed, is removed, trimmed of any flash and
placed back in mouth for making the anterior segment of the impression.
24

Anterior segment impression is made by placing a thoroughly mixed

putty (Vinyl Poly siloxane) in the labial vestibular space in the region of
anterior teeth and molded in contact with surface of tray, labial surface of
teeth, and labial vestibule.
The impression is removed as one piece or as 2 piece.

Advantages:
1) Labial vestibule can be recorded in a relaxed physiologic state.
2) The two-part impression usually can be removed in one piece.
3) Vinyl polysiloxane index accurately records the labial vestibular
space.
4) Impression can be made by one person without any assistance.
5) Procedure is not messy.

JAW RELATIONS
The procedures for jaw relation records are identical to those for
complete dentures.
Undercut areas around teeth are blocked out with wax, and auto
polymerizing acrylic resin or light cured resin is adapted to the
edentulous areas of cast. Wax occlusion rims are added to proper
height and width. The remaining teeth and anatomic landmarks such
as retro molar pad, can serve as a guide to the height of the rim.
The record bases and occlusion rims are tried in for patient comfort.
An evaluation of patients existing vertical dimension is accomplished,
determining if one wishes to retain it.
25

 The occlusion rims are trimmed to the desired vertical dimension of

occlusion.
A face bow transfer and a record of centric relation are made.
The casts are mounted on the articulator.

Setting the denture teeth / verifying Jaw relations and Patient Try-in
appointment.
The articulated casts are used for setting any anterior / posterior teeth
that are missing so that a try-in can be accomplished on the patient.
Set the posterior teeth in tight centric occlusion. The trial denture
bases are tried in the mouth and used to verify vertical dimension of
occlusion and centric relation as with complete dentures. The lower cast is
remounted with a new centric relation record until the articulator mounting
and the patients centric relation coincide. Teeth are reset to any new
mounting and tried in again.
Until this point, the procedures have been similar to complete
dentures. Now it is important to take time with the patient to record various
landmarks and to input the patients esthetic desires, as follows.
a) Midline or newly selected midline is recorded on the land area of the
master casts.
b) The anterior plane of occlusion (Using interpupillary line as a guide)
is determined and marked on the cast.
c) High lip line should be determined. A discussion can then occur with
patient as to the display of tooth that will be attempted, or the need
for a localized anterior alveolectomy if too much tooth display is
anticipated [ in class II Division 2 malocclusions]
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d) A discussion of placement of diastema, rotated teeth, notches and

other contouring should occur.
e) The existing anterior vertical and horizontal overlap should be noted.
The casts and land area are marked with all the information gathered
above, which should include pocked depths, free gingival margins, a line
marking the inter proximal of each tooth and a drawing of where the new
tooth position should be.
Trimming the cast
The technique of trimming the cast for an immediate denture should
be based on realism.
The alveolar bone supporting the teeth does not encompass the entire
root surface. Between the crest of alveolar bone and the cementoenamel
junction there is a part of the root of the tooth that is not surrounded by
bone. This portion of root which is not surrounded by bone supports the
surrounding gingival tissues. When the tooth is extracted these tooth
supported gingival tissues collapse in to region of alveolus (tooth
socket). Immediately following the extraction of the teeth, and with no
surgical reduction of the bony process, there is a change in the shape and
size of resulting edentulous ridge. 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.
Frank. C Jerbi 1966, proposed the following method:
It is a modification of Kellys rule of thirds technique where labial
aspect of tooth was divided into three equal bands of space between
gingival line and depth of vestibular space the gingival, middle,
vestibular.

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Trimming the labial portion begins at the labio-to lingual center of the
ridge and is confined to gingival and middle thirds, most of trimming is
done on gingival thirds.
1) First step is to cut away those parts of the crowns of the teeth that are
visible i,e at free marginal gingiva. It must be remembered that a
portion of crown still lies beneath gingiva.
2) Step two is to trim the cast so that the sites of previously removed
crowns are recessed approximately 1mm. With this step, the trimming
equals the removal of entire crown of each tooth.
3) Third step is a flat cut across the facial surface of the ridge. Starting
the cut at labial depth of recess made in the cast during step two.
Stone is removed in a continually diminishing amount from this point
to the junction of the gingival and middle third areas of facial surface
of ridge. The removal of this amount represents the collapse of labial
gingival tissues towards the alveolus.
4) Step four is another flat cut across facial portion of the ridge. This cut
begins at crest of ridge and extends to the mid width point of cut
made in step three. This begins the contouring of labial surface of the
ridge.
5) The fifth step is to trim that part of the cast which is lingual to the
teeth. Most casts present a reproduction of continuous roll of gingival
tissue that normally lies against the lingual aspects of teeth and it is a
landmark for trimming the cast in this area. This roll is completely
trimmed away, but care is taken to preserve a part of the cast to
represent the incisive papilla in its collapsed position.
The last step is to shape and smooth the surfaces of the cast that
have been trimmed in the previous steps. The vestibular third
of ridge is not trimmed.
Boucher technique:
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Remove with a saw or cutting disk every other anterior tooth from
the cast, leaving at least one cuspid, central incisor and lateral incisor. Trim
the extraction site on the cast with a carbide bur as if tooth had been
removed and a small clot had formed in the site. In other words, the
resulting area should be concave not convex.
Set every other tooth in maxilla first and then the mandible, referring
to the notes and marks made at the try-in-visit. Remove the remaining teeth
and complete the set up. A boley gauge can be used to compare the preexisting distance between cuspids on the pre extraction diagnostic cast and
the new tooth arrangement.
Wax contouring, Flasking and boil out
The wax contour is similar to that for complete dentures, although
immediate denture may be thinner at this point, especially in the anterior.
Make sure wax is added to provide a thickness of material. Thickness of
acrylic resin is needed to provide room to trim from the inside to relieve the
sore spot or to seat the denture.
The casts are flasked in the usual manner for complete dentures. At
boil out the cast should be smoothed with a knife to a harmonious rounded
contour.
Surgical Templates
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.

It is a prescription for the surgical

procedure and is essential when any amount of bone trimming is

necessary.
This template is fabricated by the following way
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1) Make on alginate impression of edentulous ridge after the cast has

been trimmed and boil out.
2) Pour the impression in stone.
3) Make a clear resin template on this duplicate cast by either of these
three methods.
a) Vacuum from method: a hole is placed in the center of the cast and
a clear sheet is vacuumed on the cast.
b)

Sprinkle on technique using clear acrylic resin.

c) Process a template in clear acrylic resin-done by waxing up,

flasking and heat processing.
Processing and finishing:
The immediate dentures are processed and finished in the usual
manner of complete dentures.
Keep the undercut areas of the denture slightly thick at this point to
allow for insertion over undercuts. Using on upward / backward path of
insertion of immediate denture may allow insertion without trimming;

Surgery and immediate denture insertion:

The dentist extracts the remaining teeth, taking care to preserve the
labial plate of bone. Usually no bone trimming is done.
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. Inadequately trimmed areas planned for bone
reduction well blanch from the pressure and be seen through the clear
template.
The template is removed and bone or soft tissue trimmed until the
template seats uniformily and completely. This indicates that the denture
30

will seat as it was originally intended to ensure proper occlusion and

minimally induced discomfort. Sutures are placed where necessary.
The denture is placed so that it seats well with good firm bilateral
occlusion and no gross deflective contacts. Pressure areas the denture can
be located with pressure indicating paste and trimmed. If the occlusion is
not correct, the denture should be rechecked for seating, particularily
distally.

Post- operative care:

First 24 hours:
The patient should avoid rinsing and not remove the immediate
dentures during the first 24hrs. Because inflammation, swelling and
discolouration are likely to occur, their partial control can be helped with
ice packs on the first day.
Because of swelling, 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.
The patient is alerted to expect minimal blood on their pillow during
the first night, but trouble some hemorrhaging is rare as denture acts as a
bandage.
At the 24 hour visit:
1) Ask the patient where they feel sore. Warn them that you are going to
remove the denture and that this will cause some discomfort.
2) Quickly check the tissues for sore spots related to denture; these will
appear as strawberry red spots. Commonly these areas include cuspid
eminences, lateral to tuberosities, posterior limit areas, and
retromylohyoid under cuts as well as any other under cut ridge areas.
31

3) These areas may be related to the denture bases visually or with the
adjunctive use of pressure indicator paste. The corresponding areas
are relieved in the acrylic resin.
4) Adjust any gross occlusal discrepancy in centric relation or
excursions
5) Reevaluate the denture for retention .Place a tissue conditioner if
denture retention is unsatisfactory.

First postoperative 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.
Further Follow-up care:
After 4-6 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 the occlusion is done.
A non traditional technique for obtaining optimal esthetics:

32

Lars. O. Bouma, Michael. A. Mansueto 2001, proposed this technique

where anterior teeth are extracted first.
This technique had the following advantages.
a) The phased extraction of teeth enables maturation of a portion of
residual ridge before immediate complete denture placement.
b) Anterior esthetics are managed throughout the complete denture
prosthesis.
When anterior teeth are extracted first, other benefits in immediate complete
denture therapy can also be realized.
1) Anterior tooth position, size, shape and color can be idealized
via a wax try-in.
2) The use of an interim removable partial denture acclimatizes
the patient to complete dentures.
3) Patient specific trials allow analysis of lip competence,
esthetics and the need for alveoplasty.
Conclusion
Immediate dentures are one option for the patient facing the edentulous
state. An immediate denture provides restoration of esthetics, phonetics and
masticatory function facilitating the transition to the edentulous state.
Proper follow-up care is essential to the success of an immediate
dentures.

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IMMEDIATE DENTURE
Introduction
Requirements
Indications Contraindications.
Advantages Disadvantages.
Classification.
Diagnosis and treatment planning.
Steps in treatment
Impressions type of trays
- materials.
Preperation of mouth casts.
Custom trays.
Jaw relations.
Posterior teeth arrangement / Try in.
Trimming the cast.
Fabrication of denture.
Surgery and immediate insertion.
Post-operative care.
Non-traditional techniques.
Conclusion.
References.

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References :
1. Bouchers Prosthodontic Treatment for edentulous patients. 11th ed.
2. Syllabus of complete dentures 4th ed. Hertwell.
3. Immediate and Replacement Dentures. John. Andrson. 3rd ed.
4. Essentials of complete Denture prosthodontics. Winkler 2nd ed.
5. J.P.D. 1966. Vol. 16. No. 6. 1047/1053.
6. J.P.D. 1973. Vol. 29. 1. 10-15.
7. J.P.D. 1990. Vol. 64. 2. 182-185.
8. J.P.D. 1972. Vol. 27. 3. 275-283.
9. J.P.D. 1965. Vol. 15. 4. 615-621.
10.A.D.J. 1986; 31:3.
11. J.P. 2001; 10: 97/101.
12.B.D.J. 1971. 131; 408.
13.J.P.D. 1953. 3: 67-81.
14.J.P.D. 1974; 32: 349-351.

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