Immediate dentures part 2: denture construction

In the first part, the advantages and disadvantages of immediate dentures were discussed, followed by a discussion around assessment and treatment planning for immediate dentures. This section will focus on the various stages of immediate denture construction. Immediate removable prostheses are usually fitted on the day that teeth are extracted, unlike conventional dentures which replace teeth historically lost to dental disease. For this reason, some stages of denture fabrication may not be undertaken. Each case is different and has to be assessed individually as certain factors may alleviate the need for every single denture construction stage. Sufficient information must be provided to the technician in order to fabricate an optimal and predictable prosthesis for the patient. As always, good communication between the clinician and technician is necessary in order to ensure a predictable result.

Several factors can impact on an immediate denture construction, such as multiple teeth requiring extractions. This increases the challenge and unpredictability of the final prosthesis, particularly where teeth in the opposing arch are being extracted, leading to a change in the occlusal vertical dimension (OVD). Clinicians need to be aware of this limitation, as do patients. Additionally, certain denture stages, such as jaw registration and wax try-in, may not be required or even possible if patients have retained their natural teeth and are having extractions for the first time. In situations where there are spaces due to missing teeth, these can be utilized to carry out the stages as normal (Figure 1). Where occlusal re-organization has been planned, one can anticipate greater difficulty in fitting the final prosthesis, especially in situations where it has not been possible to carry out the jaw registration stage. For example, when multiple teeth are extracted from opposing arches causing loss of stable occlusal contacts. Periodontally involved teeth which are mobile can cause problems, particularly when taking impressions. These may require additional care in order to prevent iatrogenic removal, for example, by splinting to adjacent teeth.