Single Denture Solutions and Immediate Denture Techniques

Overcome Problems: Single Denture

Problems and Solutions for a single denture:

1. Maximum base extension
2. Reduction of forces — achieve proper occlusion
3. Esthetics & phonetics due to anterior deep bite
   1. Selective enamel grinding
   2. Crown extension into dentin
   3. Increase overjet within the limits of esthetics & phonetics
4. Techniques and templates
   1. Yurkastas: U-shaped metal occlusal template, 20-degree — detects minor deviations in the occlusal scheme
   2. Swenson: casts mounted on an articulator — denture teeth set on a pencil-marked diagnostic cast as a guide (time-consuming)
   3. Bruce: clear acrylic resin template with pressure-indicating paste placed over the natural teeth
   4. Boucher et al. (et.al): interferences removed, prematurities removed, balanced occlusion established

Types of Immediate Denture

Types:

1. Interim: complete temporary denture for esthetics, mastication, and occlusal support; typically worn 4–6 months
2. Transitional: temporary partial denture (PD); artificial teeth are added as natural teeth are lost and it may become an interim denture
3. Immediate: interim acrylic resin partial denture placed at the appointment of extraction to restore esthetics and function
4. Conventional: complete denture fabricated to be inserted immediately; maxillary anterior teeth may be left while posterior teeth are removed 1–3 months before fabrication — predictable, stable ridge contour

Indications, Advantages, Disadvantages, Contraindications

Indications (example): Maxilla with remaining anterior teeth present; cooperative patient.

Advantages (ADV):

• Avoids change in appearance
• Better healing
• Improved ridge form
• Preserves vertical dimension and guides VDO
• Reduces bleeding and protects tissues
• Maintains speech & mastication
• Prevents embarrassment; immediate esthetics

Disadvantages (DISADV):

• No anterior tooth try-in
• Increased complexity
• Reline or rebase and maintenance often required
• Increased discomfort, time, and cost
• Less initial retention

Contraindications (Contraindic):

• Patient unavailable for follow-up
• Uncontrolled systemic condition
• Acute infection
• Emotionally disturbed patients
• Recent or planned radiation therapy
• Severe gag reflex
• Extensive bone loss

Steps for Immediate Denture Construction

Steps:

1. Diagnosis
2. Extraction of posterior teeth as indicated
3. Primary impression
4. Secondary impression
5. Jaw relation records
6. Mounting and setting teeth
7. ICD try-in

Construction: Without Surgery

Types

1. Socketed type

   Indications: upper arch, limited periodontal disease, little change in tooth position.

   Contraindications: low arch, mentalis muscle may dislodge denture.

   Advantages:

   • Anterior tooth position duplicated
   • Anterior seal improves retention
   • Resistance to movement during mastication

   Disadvantages:

   • Absence of a labial flange
   • Not maintained long term
   • Possible gingival and bone recession
   • Reduced healing due to socket coverage
   • Denture strength may be compromised
   • Cannot be used if trimming bone is necessary
2. Flanged type

   Indications: sufficient space labially; suitable for lower immediate denture.

   Advantages:

   • Provides lip support
   • Resistance to anteroposterior movement
   • Protects healing sockets

   Disadvantages:

   • Insufficient space for labial flange
   • Deep labial undercut
   • Difficulty in insertion and removal

Construction: Surgical Options

1. Labial plate alveoloplasty

   Remove labial cortical plate (very aggressive). Used in severe bone resorption cases. Indications: prominent premaxilla, deep overbite; usually requires flap elevation.

2. Interseptal alveoloplasty

   More conservative technique: removes interseptal bone, preserves blood supply, and helps prevent excessive bone resorption.