October 1998 • Volume 80 • Number 4

Nontraumatic immediate complete denture placement:
A clinical report

Michael M. Woloch, DDS^a
Forest Hills, N.Y.

The immediate complete denture is an accepted method of restoration for the patient whose last remaining teeth are to be removed.^1-6 The prosthesis is fabricated before removal of the teeth and is inserted immediately after the extractions. The appointment at which the immediate denture is placed is an important and challenging one for both patient and dentist. An approach that can make this procedure more predictable for the dentist and comfortable for the patient is presented.

In the conventional immediate denture technique, standard procedures are performed. The remaining teeth are extracted and any necessary adjunct surgery is performed,^4,7 which includes removal of retained roots and correction of unfavorable tissue contours such as severe undercuts. The denture is placed, tested for areas of excessive pressure, and adjusted.^6,7 Some practitioners take a centric relation record, remount the denture, and refine the occlusion by selective grinding⁷; others accomplish this at a subsequent appointment.⁶ The patient is given postoperative home care instructions, which include not removing the denture for 24 hours, the use of analgesics and ice packs, and appointed for a 24-hour postoperative examination and any needed adjustments.^4,7,8

There are several difficulties with the standard procedure. There is diminished predictability in a combined surgical and prosthodontic visit. Surgery is performed, and difficulties with extractions, bleeding, and/or pain control may be encountered. An immediate denture is delivered that requires an indeterminate amount of adjustment.^2,9 This type of appointment can therefore become prolonged and stressful for both dentist and patient. Another disadvantage is that the bloody field makes adjusting the denture and remount procedures inconvenient.¹⁰ For those practitioners who refer the patient for extractions and surgery, the denture placement is performed by an oral surgeon, which shifts the responsibility to the surgeon to accomplish several important prosthodontic procedures associated with denture delivery.^7,11 The patient’s initial experience with their new denture is accompanied by the pain and swelling that often follow surgery; thus, acceptance of the prosthesis can be compromised.^2,12 In postoperativeadjustment visits, distinction between pain from surgical wounds or those caused by denture impingement may not be readily apparent.

This clinical report describes a procedure for the placement of an immediate denture in which the surgical and prosthodontic aspects of immediate denture delivery are reversed and performed in separate visits, providing greater control for the prosthodontist and comfort for the patient. Instead of extracting the remaining teeth at the time of denture placement, the teeth are decoronated (sectioned at the gingival margin) and the immediate prosthesis placed as a conventional complete denture.

CLINICAL REPORT

TOP

A 61-year-old man with 4 remaining maxillary teeth (Fig. 1) who requested improved esthetics and function was evaluated for treatment.

A treatment plan of an immediate maxillary complete denture was accepted by the patient.

A maxillary impression was made and a stone cast prepared (Fig. 2).

After verification of interocclusal records, the remaining teeth were removed from the stone cast (Fig. 3), leaving 1 mm of each tooth above the gingival margin.

Because the teeth will be decoronated intraorally at the gingival margin, this minimized the adjustments required to the tissue surface of the denture at the time of placement. The prosthesis was then fabricated in the usual manner. At the time of insertion, vital teeth were anesthetized and all remaining teeth severed at the gingival margin¹³ (Fig. 4).

In teeth with vital pulps, a few millimeters of pulp tissue were removed and a stopping material (Cavit, Premier, Norristown, Pa.) placed in the canal orifice.¹⁴ This procedure removes the pulp chamber and its contents and constitutes a pulpotomy.

The denture was inserted and a pressure-indicatingmaterial was used to detect and adjust pressure areas (Figs. 5 and 6).

Any contact of the teeth with the tissue surface of the denture was relieved. The denture was then remounted and the occlusion refined as with conventional denture placement. Instructions given to the patient were the same as for complete denture delivery. Analgesics were provided, and the patient was instructed to remove the denture at bedtime. Follow-up appointments, starting with a 24-hour postinsertion visit, were conducted as with conventional denture placement.

The roots were removed after 3 weeks by using appropriate elevators and forceps. However, at the discretion of the clinician, extractions can be performed from several days to 2 to 3 weeks after denture placement. As an alternative, extractions can be performed the same day, after denture placement, by the attending dentist or an oral surgeon. Should any tooth become symptomatic, early removal is indicated.

There are advantages to this treatment procedure. The patient receives their new denture without the additional trauma of extractions or surgery. In the initial period that the denture is worn, it will not rest on extraction sites or surgical wounds. These factors will tend to make the transition to a complete denture prosthesis both physically and psychologically more acceptable to the patient. For the dentist, denture placement is simplified, because the visit is devoted exclusively to the prosthodontic, rather than the surgical, aspects of immediate denture placement. The amount of local anesthetic and pain control medications required are reduced, because no anesthetic is needed for soft tissues or nonvital teeth. The possibility of a protracted appointment because of surgical complications, bleeding, or pain control difficulties are greatly reduced or eliminated.

With this technique, denture adjustments and the use of pressure-indicating materials are performed in a blood-free field. Areas of pressure are more likely to be detected by the patient at the time of placement because of the substantially reduced use of soft tissue anesthetic. The restorative dentist retains control over all prosthodontic aspects of denture placement because, with this technique, the placement of the denture is not delegated to the oral surgeon. However, extractions and other surgical treatment, including management of medically compromised patients, can be accomplished by an oral surgeon after prosthodontic treatment.

There are some contraindications to this treatment procedure: (1) severe bilateral undercuts for which relieving the denture cannot compensate; and (2) patients with teeth that are symptomatic or that have acute infections.

This technique can also be applied to situations where the teeth are to be removed and replaced by a provisional fixed partial denture in the same visit. If potentially difficult extractions are anticipated, these teeth can be severed at the gingival margin. Abutments can then be prepared and the provisional fixed partial denture fabricated, contoured, relined, and inserted. The extractions can be performed at a subsequent visit by the attending restorative dentist, or the patient can be referred to an oral surgeon. As an alternative, the extractions can be performed at the end of the preparation visit, because the clinician is now assured that the time-consuming prosthodontic aspects of this visit have been completed.

This clinical report presents a treatment procedure that makes immediate denture placement a more predictable and less stressful procedure. It provides greater control over the prosthodontic aspects of denture delivery by the restorative dentist, and the convenience of performing the placement procedures in a clean, blood-freeenvironment. The delivery of the prosthesis is less traumatic because extractions and/or surgery are deferred. In addition, by the time the remaining roots are extracted, all denture adjustments will have been made and the patient will have accommodated to the prosthesis.

I wish to thank Drs. Donald Kitsis and Alan Broner for their assistance in developing the concept in this article, and Dr. Gary Goldstein for his guidance.

1.  Lavere AM, Krol AJ. Immediate denture service. J Prosthet Dent 1973;29:10-5.

2.  Waltz ME. Considerate postoperative care for immediate denture patients. J Prosthet Dent 1966;16:822-7.

3.  Bothwell J. Immediate denture insertion. J Canadian Dent Assoc 1935;1:61-5.

4.  Hickey JC, Zarb GA, Bolender CL. Boucher’s Prosthodontic treatment for edentulous patients. 10th ed. St Louis: Mosby; 1990. p. 534-62.

5.  Heartwell CM, Salisbury FW. Immediate complete dentures: an evaluation. J Prosthet Dent 1965;15:615-24.

6.  Bruce RW. Immediate denture service designed to preserve oral structures. J Prosthet Dent 1966;16:811-21.

7.  Rahn AO, Heartwell CH. Textbook of complete dentures. 5th ed. Philadelphia: Lea & Febiger; 1993. p. 437-78.

8.  Herman GL. Esthetic and emotional factors in immediate denture construction. Compend Contin Educ Dent 1989;10:486-8.

9.  Lambrecht JR. Immediate denture construction: the impression phase. J Prosthet Dent 1968;19:237-45.

10.  Holt RA, Stratton RL, Donoghue T Prevention of cross contamination during immediate denture delivery. Quintessence Int 1985;11:787-9.

11.  Jordan LG. Cooperation of oral surgeon and prosthodontist in rendering artificial denture service. J Prosthet Dent 1952;2:55-9.

12.  Pound E. An all-inclusive immediate denture technic. J Am Dent Assoc 1963;67:16-22.

13.  Feldstein S, Teitel M. The immediate overdenture. J Am Dent Assoc 1976;93:775-8.

14.  Cohen S, Burns RC, editors. Pathways of the pulp. 4th ed. St Louis: Mosby; 1987. p. 470.

• Poster presentation before the Academy of Prosthodontics, Newport Beach, Calif., May 1996.
• ^aInstructor, Graduate Prosthodontic Program, School of Dental and Oral Surgery, Columbia University, New York.
• Reprint requests to:
  DR MICHAEL WOLOCH
  25 BURNS ST
  FOREST HILLS, NY 11375

·         Copyright © 1998 by The Editorial Council of The Journal of Prosthetic Dentistry.

• 0022-3913/98/$5.00 + 0. 10/1/90586
• J Prosthet Dent 1998;80:391-3.

This article is referenced by these articles:

Trial anterior artificial tooth arrangement for an immediate denture patient: A clinical report
Journal of Prosthetic Dentistry
September 2000 • Volume 84 • Number 3
Ashok Soni, DDS, MDS^a
New York University, College of Dentistry, New York, N.Y.