Immediate Complete Denture Impressions - DentalCEToday

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Immediate CompleteDenture ImpressionsCase Report and ModernClinical TechniqueLEARNING OBJECTIVES:After reading this article, the individual will learn:• historic techniques for taking impressions forimmediate complete dentures, and• a new technique for taking accurate impressions forimmediate complete dentures.ABOUT THE AUTHORDr. Massad is director of removableprosthodontics at the The ScottsdaleCenter for Dentistry in Scottsdale, Ariz.He is an associate faculty member ofTufts University School of DentalMedicine in Boston, and is an adjunctassociate faculty member of the Department ofProsthodontics at the University of Texas Health ScienceCenter Dental School in San Antonio, Tex. He can bereached at (918) 749-5600 or joe@joemassad.com.Disclosure: Dr. Massad is the developer and holds thepatent for the Strong-Massad Dentate & Implant Trays.Dr. Cagna is a professor and directorof the Department of RestorativeDentistry, Advanced ProsthodonticProgram, at the University ofTennessee Health Science CenterCollege of Dentistry in Memphis, Tenn.He may be contacted via e-mail at the addressdcagna@ utmem.edu.Disclosure: Dr. Cagna is a stockholder in Global DentalImpression Trays, which is the company that manufacturesthe impression trays used in this article.INTRODUCTIONContinuing EducationRecommendations for Fluoride Varnish Use in Caries ManagementFor patients confronted with the extraction of theirremaining natural teeth and the need for complete prosthodonticrehabilitation, the transition is generallypsychologically challenging for the pa-tient and demandingof the clinician. This dramatic treatment is oftennecessitated by generalized caries, extensive periodontaldisease, or a malocclusion that is not amenable totreatment. Of considerable significance to many patientsfacing this course of treatment is their desire to specificallyimprove the appearance of their anterior teeth, contributingto an attractive smile. In order to optimize immediatedenture therapy, thoughtful consideration must be given tothe treatment planning, definitive impression making, anddenture tooth set-up phases of therapy.The primary advantage of an immediate denture is theabsence of an edentulous period where prosthetic toothreplacement is not available. Specifically, advantages ofimmediate complete dentures include the maintenance orimprovement of: 1. dental aesthetics, 2. perioral and facialtissue support, 3. masticatory function, and 4. phonetic ability.If the patient’s natural anterior teeth remain but are scheduledfor extraction, the selection and arrangement of anteriordenture teeth, from an aesthetic perspective, may be easier.From the patient’s viewpoint, immediate completedentures provide the psycho-social advantage of continuoustooth display to allow personal and public interactions.Though abrupt, the transition from the dentulous state toedentulism may be made less difficult by incorporatingimmediate complete dentures in the treatment plan.Major disadvantages of immediate denture therapyrelate to the technical difficulties associated with denturefabrication. Because immediate complete dentures areconstructed prior to extraction of the remaining teeth, 4significant challenges arise: 1. the making of anatomicallyand physiologically accurate definitive impressions in thepresence of remaining teeth and associated soft and hardtissue undercuts is often difficult and occasionallyimpossible, 2. if the residual teeth are mobile, recordingaccurate interocclusal jaw registrations may be difficult, 3.creating edentulous contours on dentate master castsutilizing clinically valid and reliable estimation techniques isoften associated with unavoidable errors, and 4. the1
Continuing EducationImmediate Complete Denture Impressions: Case Report and Modern Clinical Techniqueinability to accomplish a full wax try-in of the proposeddenture tooth arrangement makes the aesthetic outcomeunpredictable. It is due to these technical difficulties thatimmediate complete dentures are often considered“interim” prostheses requiring replacement upon healing ofthe edentulous ridges.Optimal retention, support, and stability for removableprosthodontic restorations are important factors intreatment success and patient comfort. When consideringim-mediate complete dentures, certain clinical conditionsoften prohibit achieving ideal retention, support, andstability in the planned prostheses. As mentioned, thepresence of residual natural teeth and associatedunfavorable osseous and soft tissue contours require thatthe clinician: 1. modify existing techniques to generatephysiologically and anatomically accurate impressions andmaster casts, 2. evaluate existing den-tate or partiallyedentulous clinical conditions and predict expected edentulousridge contours following tooth extractions, 3. developthese edentulous contours on the master casts, and finally4. construct the immediate complete dentures.Although techniques have been developed to fabricateimmediate complete dentures, significant obstacles arefrequently encountered. The development of diastematasecondary to advanced periodontal disease maycomplicate impression procedures. Varying degrees ofperiodontal involvement of the residual dentition will resultin an irregular contour of the edentulous alveolar ridges.Irregular osseous contours that protrude into the vestibularsulcus interfere with an accurate impression in this area,ultimately affecting the development of a peripheral seal inthe final prostheses.The accurate, physiologic replication of vestibularanatomy (including frenum attachments, the postpalatalzone, and the retromylohyoid space) is important to thedevelopment of peripheral denture seal and dentureretention. When physiologic vestibular anatomy isrepresented accurately in the immediate denture flangecontours, the denture may function effectively as suction isachieved. Under such conditions and in the presence ofappropriate volume of saliva, optimal consistency of thesaliva, accurate fit, and a favorable occlusal scheme,satisfactory denture retention is possible.It is not uncommon to encounter problems with dentureretention on the day of immediate denture insertion. Asmentioned, this problem can often be traced back toinaccurate adaptation of the denture flanges to thephysiologic limits of the vestibular sulci. Horizontal and/orvertical overextension of vestibular anatomy duringimpression making, as is common when usinginappropriately contoured stock impression trays andirreversible hydrocolloid im-pression materials, does notallow physiologically accurate impressions. The result willbe overextension of the immediate denture flange.Ultimately, extensive adjustments are necessary on the dayof denture placement and during the post-operativeadjustment period.Although challenging in many ways, anatomic andfunctionally accurate impressions are critical to successfulimmediate denture therapy. A predictable immediate dentureimpression technique adaptable to a wide variety of dentateand partially edentulous conditions is available. The followingcase report discusses historical immediate denture impressiontechniques, and concerns in regard to the utility of theresultant casts. Also presented are step-by-step proceduresfor making immediate denture impressions using a newimpression tray design and modern impression materials.CASE REPORTA 44-year-old white female presented on referral from hergeneral dentist for evaluation and treatment of a severelycompromised dentition. The patient was a professionalmakeup artist and expressed concern regarding theaesthetics of her smile and the appearance of her teeth duringclose, personal, daily interactions with her clients. Thepatient also reported that she smokes cigarettes (one halfpack per day). This habit began 15 years ago.Intraoral examination revealed multiple missing teeth,substantial accumulation of dental plaque and calculus,many teeth with 6 to 9 mm probing depths, generalizedbleeding on probing, generalized moderate to severemobility, and severe fremitus involving most teeth (Figures 1and 2). Following scaling and root planing, many of theteeth previously demonstrating moderate mobility nowdisplayed severe mobility.2
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Immediate Complete Denture Impressions - DentalCEToday

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