Simple extraction with no more surgery: It includes two types:

a- Socketed immediate denture:

- It is indicated only in upper arch and contraindicated in the lower arch as the presence of a labial flange in the lower denture is important to guard, against backward movement of the denture by the pressure of the lower lip.

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- The plaster teeth cut from the cast and replaced by the artificial teeth. This is best achieved by removing and replacing one tooth at a time so the form of the arch and the position of each individual tooth can be easily reproduced. - Root sockets are made in the plaster cast into which the necks

of artificial teeth are fitted taking into consideration the following:

- The socket depth should not exceed 5mm labially and 2mm palatally (Fig. 3- 28 b).

- The sockets should not be carried too far towards the palatal side i.e the socket should slope from the palatal margin upward toward the labial aspect.

- The direction of the socket should follow the long axis of the tooth.

The advantages of this technique are as follows:

- It provides anterior seal that assists in the retention of the denture.

- It provides resistance to movement during mastication.

- It provides a natural appearance as if the teeth are growing from the gums.

b- Flanged type immediate denture:

- This technique is indicated in cases having sufficient available space to accommodate a labial flange without giving the feeling of excessive lip fullness.

On replacing the plaster teeth by artificial ones, either one tooth is removed each time, or remove all teeth on one side of the arch, keeping the more acceptable side as a guide for the arrangement of artificial teeth.

Fig.3-29 a,b:Preserve the incisal edge position and tooth angulation information prior removal of stone teeth. Use a sharp pencil to mark the gingival outline buccally and lingually. Then mark the long axis of each tooth.

Fig.3-30:Esthetic convenience

groove

Fig.3-31: The Alternating Tooth

Setup Technique

Fig.3- 33:The Alternating Tooth Setup Technique

–Trim and set only one anterior tooth at a time.

–Alternate from side to side to keep natural neighboring tooth as angulation, length, and contour orientation.

Fig.3- 34: Objectives of the occlusion development (upper ID/lower RPD):

Centric: Bilateral even centric contacts.

Fig.3-:35 a, b: Eccentric: Fully balanced occlusion during lateral/protrusive movements.

Today’s goal: Complete the posterior teeth setup that obtains solid bilateral even centric contacts.

II- Immediate denture with alveoloplasty:

It includes two types:

a-Labial plate alveoloplasty:

This technique is only indicated in the following conditions:

1-Patients having a very prominent premaxilla with the teeth tilted outward and resting on the external surface of the lower lip and wash for an improvement in appearance.

2-Patients with poor posterior ridge, shallow sulci and narrow upper jaw with a wide lower jaw that necessitate the creation of a room for a labial flange to provide better retention and stability.

Patients exhibiting a very deep overbite with the incisal edge of the upper teeth touching the gingival margins of the lower teeth.

The technique is as follows:

- First, extraction of the six anterior teeth is carried out.

- A mucoperiosteal flap is reflected by making two inclined incisions distal to the canines.

- Using bone rongeur, the labial alveolar plate of bone is cut off.

- Then the bony septa are cut off using a side cutting rongeur. - A bone file is used to trim any remaining sharp edges.

- The flap is repositioned and excess soft tissue is trimmed. - Suturing of the flap is carried out using, 000 black silk

suture.

- The immediate denture is inserted in the patient's mouth after being lined with tissue conditioning material.

- The patient is instructed not to take of the denture till the next appointment 24 hours later.

- A suitable antibiotic is prescribed and the patient is instructed to make cold fermentation to minimize hematoma formation.

b- Interseptal alveoloplasty:

In this technique, no mucoperiosteal flap is reflected.

The technique is as follows:

- After extraction of the six anterior teeth, a bone rongeur is used to cut a V shaped wedge from the labial cortical plate distal to the canine or each side.

- The bony septa are then removed using bone rongeur.

- A chisel is inserted deep in the sockets and with the help of a mallet; slight knocks are applied with the chisel edge directed toward the labial cortical plate.

- Hand pressure is applied to the labial cortical plate to affect green stick fracture and moving the labial cortical plate towards the palatal cortical plate.

- Excess soft tissue is trimmed and the wound is sutured using 000 black silk suture.

- Immediate denture insertion and patient instructions are the same as the previous technique. .

The advantages of this technique are as follows:

1- Minimizing the possibility of bone resorption by keeping the labial cortical plate of bone and avoiding flap reflection.

2- Maintain the heamatoma between the two cortical plates and thus any pressure will not result in excessive bone resorption.

3- It affects the same purposes of the previous technique without flap reflection.

NB.: For both technique of immediate denture with alveoloplasty, the construction of a transparent acrylic template over a duplicate cast of the reduced one is helpful in detecting areas requiring further modifications before suturing (Fig. 36 a, b). - Following immediate denture insertion, the patient will be

recalled for changing the tissue conditioning material periodically and making any necessary adjustments.

- After three months, relining, rebasing or even making a new denture is indicated after complete healing of the tissues following extraction.

Note:

- It could be noted that the best approach for immediate denture construction is the simple extraction with no more surgery. However, in cases where surgical reduction of the alveolar process is considered necessary, the interseptal alveoloplasty is to be preferred as it will cause less damage and preserve as much of the residual ridge as possible

B

Fig. 3-36 A: Surgical Template:

Fabricated after cast trim. Used to locate pressure areas on mucosa at time of surgery. Denture trimmed according to blanched mucosa observed under template

B, :Trimmed areas sanded smooth

Avoid removing incisive papilla.

Try in:

Try-in of the set up posterior teeth is carried out to check the following:

- Reasonable occlusal vertical dimension. - Proper centric occluding relation.

- Even bearing on both sides.

- Then, the patient is dismissed and given appointment for extraction of the anterior teeth and complete denture insertion.

It the patient require the shape, colour and surface characteristic of his teeth to be copied exactly, an additional rubber base impression of the anterior teeth should be taken into which molten wax is poured to a level just above the gingival margins. The wax is chilled in cold water and removed from the impression and reproduced into tooth-coloured acrylic resin of the same shade.

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Post Extraction Instructions

- Do not remove denture

- Keep head elevated

- Small amounts of blood in saliva is normal

- Diet: soft and warm, not hot

- Avoid: – Spitting, rinsing – Strenuous activity – Alcohol, smoking a b

Fig. 3-37 a,b: Try-In of a socketed type denture of the Posterior segment for check record

Delivery andAftercare

The immediate denture is inserted when the surgical procedures have been completed. The patient should not remove the denture until the next day, when it is examined by the dentist. Subsequent to that appointment, the patient may remove it whenever he or she wishes.

Post Insertion Management

- Recall next day to remove the denture.

- Apply topical anesthetic to traumatized mucosa - Locate over extensions and pressure areas and adjust - Reappoint 1 week.

- The immediate-denture patient should be recalled every 3 months after the dentures have been properly fitted, to determine when they must be rebased or relined. (Some patients lose alveolar bone rapidly, and their dentures require rebasing within a few months. The majority should be rebased at 10 to 14 months).

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Fig.3- 38 : The immediate denture is inserted.

THE SINGLE COMPLETE DENTURE

The construction of a single denture may be presented in a variety of dental combinations. It could be constructed against:

1- Natural teeth.

2- Removable partial denture.

3- A previously constructed complete denture.

The single complete maxillary denture opposing all or some of the mandibular natural teeth is a very common clinical situation

Problems of single denture:

1- The firmness and rigidity in which the natural teeth are