Immediate dentures are needed when the natural teeth are loose, broken or beyond repair. In this procedure all natural teeth of the upper and/or lower jaw are extracted; the immediate dentures are put in soon after the last tooth is extracted.
Loose teeth are usually the result of Periodontal disease, also known as gum disease or pyorrhea. Periodontal disease is an infection of the gums and supporting structures of the teeth that can cause the teeth to be become loose. Advanced periodontal disease, the last stage of gum disease, will cause the teeth to become so loose that chewing is difficult or impossible. It usually takes many decades for periodontal disease to reach this final stage.
Teeth may be broken because of trauma or tooth decay. Certain individuals may be especially prone to advanced and widespread tooth decay. These people have "soft teeth" not becuase their teeth are actually soft but because conditions in their mouth make them especially at risk for rampant tooth decay. Among these conditions are poor oral hygiene, dry mouth, consumption of high-sugar food and drink, gastric acid reflux, and drug abuse.
Immediate dentures are dentures which are made from an impression of the mouth while the natural teeth are still present. A model is made from the impression. The dental laboratory removes the teeth from the model and fabricates dentures based on an approximation of how the edentulous ridge will look after the teeth have been extracted. The dental term "immediate denture" refers to this procedure wherein dentures are made to be inserted at the time of extraction of the natural teeth. An alternate method of making dentures for someone who has many broken and unrestorable would be to extract all the teeth and wait for complete healing before making the dentures. This leaves you with no teeth during the year-long healing period and is impractical for most people.
The first step once you decide to begin treatment will be to make impressions of the natural teeth. At this first treatment visit the following procedures are also done: A full set set of x-rays is made. A bite realtion that shows how the upper and lower jaw meet is done. The doctor and the patient will choose the shade of teeth to be used. Vital signs are taken. Prescriptions will be gien to you and the the extraction visit appointment will be made.
The Extraction Appointment:
At the extraction appointment you will be in the office for two to three hours. You will usually need to have someone bring and take you from this appointment. Anti-anxiety drugs can be prescribed which will allow anxious patients to tolerate the procedure. Alternately nitrous oxide (laughing gas) can be administered for anxious patients.
Lidocaine and similar injectable local anesthetics are administered for anesthesia. All of the teeth are removed at this one appointment. Bony prominences that might interfere with the seating of the dentures may be removed during or after the extractions.
The immediate dentures are inserted immediately after the teeth are extracted. There is usually a great deal of swelling that prevents the dentures from seating properly at first but the patient can practice wearing the dentures from the beginning. The patient will be need to place pressure on the extraction sites by either biting on the dentures or biting on gauze. Pressure must be applied until bleeding stops; this can take up to 6 hours or more.
The Postoperative Appointments:
Patients are told to expect moderate to severe swelling that may make it difficult to wear the dentures during the first week. You must understand that during the first week healing must take precedence over wearing the dentures.
After one week the patient returns for the first post-operative appointment. At this visit a temporary soft liner may be placed that will permit the dentures to fit comfortable and will compensate for any shrinkage that may have occurred. The dentures are also adjusted if necessary to permit a more comfortable fit. In some cases, patients may not be able to wear one or both of their dentures in the first post-operative weeks because of pain and swelling
The healing during the post-operative period can be divided into two stages. In the first stage the soft tissue heals and the swelling subsides. The first 48 hours of this first stage of healing are especially critical for a uneventful post-operative course. It is very important to allow the gums to heal undisturbed. You must not smoke and avoid coughing, sneezing, spitting, blowing the nose, or sucking through a straw. Even talking should be avoided. The first stage of healing takes at least a week but can last a month.
The second stage of healing is osseous remodeling or reshaping of the jawbone. The tooth sockets of the jawbones are absorbed by the body in a slow process that results in the replacement of the socket-shaped bone with round smooth edentulous ridge. This second stage of healing can take a full year or more. During the second stage of healing the patient will be seen every two months or so for adjustments to the dentures and changes to the soft liner. Changes in the gums and edentulous ridges occur much slower during this period and may be almost imperceptible from one post-op visit to another.
After the gums have healed and shrunk completely the dentures are relined and treatment is complete. The reline procedure is done by making an impression of the gums inside the dentures after complete healing. The dentures are sent to the dental lab, the tissue surface of the denture is ground away and replaced with new pink hard denture base material adapted to the gums as they are after healing. The reline appointment is scheduled as the first thing in the morning. Reline impressions are made inside the dentures. The dentures are sent to the dental lab and returned late in the afternoon of the same day. You will be without the dentures during that day. In some cases the dentures are remade instead of relining the original immediate dentures. This reline is usually done one year or more after the extractions.
Patients with serious pre-existing medical conditions will need to have medical clearance from their medical doctor. Certain blood thinning drugs will need to be temporarily stopped prior to the day the extractions are done. Certain medical conditions require that the patient take antibiotics prior to the extractions.