Immediate dentures.
An immediate denture is fitted at the extraction appointment, so the patient is never without teeth. Everything about it has to be planned before the extractions, and the patient has to understand what follows. Tick Immediate Denture on the Rx.
The advantage, and what it costs
The patient does not experience an edentulous period. For most people that is decisive — the social and functional impact of weeks without anterior teeth is substantial.
The denture also acts as a bandage over the extraction sites, supporting the clot and reducing post-operative discomfort and swelling.
The cost is that the anterior arrangement cannot be tried in, because the teeth being replaced are still present when the denture is made. The set-up is produced from the pre-extraction cast, and the patient sees the result at the fit appointment rather than before.
Records before extraction
Impressions, jaw relation and shade all have to be taken while the teeth are still in place — which means the existing dentition provides the reference for vertical dimension, midline, tooth position and shade.
That reference is valuable and should be used deliberately. Photograph the patient's existing teeth and smile before extraction. If they want something different from what they have, that conversation happens now rather than after the denture is made.
The laboratory trims the teeth from the cast to simulate the post-extraction ridge. How much to trim is a judgement, and any surgical reduction you plan should be described so the cast reflects it.
Setting expectations
Two things need saying clearly before treatment. First, the appearance cannot be approved in advance — the patient is accepting a result produced from a plan rather than one they have seen.
Second, the fit will change. Tissue heals and bone resorbs most rapidly in the first months after extraction, and the denture will loosen. A reline is not a remedy for a fault; it is a planned part of the treatment, and it should be in the fee discussion from the beginning.
A patient told this at the outset accepts it. One who discovers it at three months experiences it as a failure.
The interim period
Review soon after fitting and again as healing proceeds. Tissue conditioners or a temporary soft reline can maintain fit and comfort during the period when resorption is fastest.
A definitive reline or rebase follows once tissue changes have slowed — commonly some months after extraction, depending on the patient and the extent of surgery.
See denture relines and denture rebases.
Surgical coordination
The laboratory trims teeth from the cast to simulate the post-extraction ridge, and how much to remove is a judgement that should reflect what you actually plan to do surgically.
If alveoloplasty is planned, describe it — the cast should be reduced to match or the denture will not seat. If you intend to retain buccal plate, say so, because over-trimming produces a denture that is loose from the day it is fitted.
A surgical template made from the same cast can guide the reduction, which is worth considering where substantial contouring is planned.
What to put on the prescription
Tick Immediate Denture and mark clearly which teeth are being extracted and which are being retained, on the design chart.
Describe any alveoloplasty or surgical reduction planned, so the cast can be trimmed to match. Give the teeth shade and mould, and note whether the patient wants their existing appearance reproduced or changed.
Send photographs of the existing dentition. They are the best reference available and they cease to exist after the appointment.
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