Immediate dentures are a good treatment choice for many people. Immediate full or partial dentures are made before teeth are extracted. Then on the same day that the teeth are removed the finished dentures are inserted. Immediate dentures are different from regular dentures in that the final impressions are made before some or all of the teeth that are to be removed are extracted. Each patient's healing time and ability to accommodate to an immediate denture varies. This requires using your tongue, lips and cheek muscles to learn to control them. Traditionally, fabricated dentures are constructed to replace an already existing full denture. There is no healing time necessary and the initial fit will be much better because the impressions will exactly reflect the soft tissues on which the denture base rests.
With immediate denture construction, there is an approximation of the fit of the denture base. Because the teeth are still in place when the denture is being constructed and tried in, the fit will not be as exact initially. It is more difficult to try in the set up of teeth of an immediate denture due to circumstances that teeth are still present. The check for fit and appearance when the teeth are still in place is done around other teeth still present to a "best fit". This is especially true when the natural teeth that will be removed have drifted far out of their original position. Immediate dentures are made so that the patient will not be forced to be without teeth while the gum tissues heal and the remaining tissue ridges reach their final shape. This final healing can take 3 to 6 months after the teeth are removed, which will also depend on how many teeth are removed.
The immediate denture will be placed the same day the teeth are removed. The patient will be numb and somewhat swollen from the local anesthetic, and not really able to tell much about the comfort of the denture base and the fit of the denture teeth against the opposing jaw and teeth. Expect several appointments with us during the healing period as the swelling goes down and the denture base settles. Your bite will change and need to be readjusted. The more teeth removed at the time the immediate denture is delivered, the longer it will take to heal and the more sore spots you will have. Once all the teeth are extracted, the bone begins healing, but also starts to change (remodel) and will begin to "dissolve" (resorb) over time. This occurs because the teeth are no longer present to help protect the bone from pressure. Then over the next few months and through the next year or so the jaws will resorb from 10-20% or more until the bone/gum tissue stabilizes. Since the bone/gum shrinks back as healing occurs, the current immediate denture(s) will loosen up and may not be as retentive as it was at the time of original placement. So, immediate dentures are relined up to four times with a soft reliner material, called tissue conditioner, to help cushion the hard denture base against the healing extraction sites. This reline material/tissue conditioner is like a stiff bubble gum that will mould to the surrounding tissues as the healing progresses. Then after about two weeks it begins to harden and absorb odors and bacteria, which then needs to be replaced with a new tissue conditioner.
Sometimes we will advise removing some teeth as the denture is being made, leaving only a few front teeth in place. This will help make a more accurate fit of the immediate denture. Of course, every case is unique. You can expect sore spots and places where the tissue is rubbed against by the denture. When this happens, take out the denture and see us immediately. If you continue to wear the denture without adjustment, the gum tissue will be badly damaged and it will take longer to heal. Although the general process of making an immediate denture is close to that of a traditional full denture, the immediate denture construction poses different and more significant problems.
Later, a hard reline of the denture is then done for you to accommodate to the new shape of the bone/gum after the tissue completely heals at the extraction site. This is called a hard reline. The extra plastic will fill in the space between the denture base and the new position of the soft tissue. Originally, this space was estimated in the sites where the teeth had not yet been removed. Tissue shrinkage will continue for some time, but after about 6 months, it slows down enough that it is practical to do the definitive hard reline. With either immediate dentures, or after some years of wearing dentures, the tissue may change enough that relines are again necessary. As you age and have no teeth, the bone in the jaws gets smaller. The plastic base of the denture does not change along with the jaw changes, so a periodic reline is necessary. Bone responds to pressure by resorbing (dissolving) away, and this unfortunately is a continual process. Implants can help stop this process and stabilize a denture.
An upper denture has more surface area with a full palate (roof of the mouth) to create a "suction" seal, whereas a lower denture has no real seal and uses gravity to sit on the lower bone. Control of the lower denture is basically by gravity, the lips and the tongue. Over the next months to years the bone in the jaws will resorb due to continued force of the denture pressing on the bone/gum.
It is possible that after many years of missing teeth, the bone on which the denture sits becomes so small that it is difficult, if not impossible, for a denture to remain properly in place. Dental implants can help retain a denture and act like tooth roots to help preserve the bone and prevent it from resorbing away. This is more important for lower dentures which have much less retention as compared to the upper denture. The standard of care for a mandibular denture to place at least 2 dental implants in the lower front part of the jaw (mandible) to secure the denture to the implants with attachments. The attachments and implants connect the bone/gum and denture and keep it securely in place. An added benefit is to help protect the bone/gum from the constant force and pressure of a loose lower denture which will help prevent future loss of the bone.
If you decide to place implants after having dentures instead of planning on them before, this can be done. Once the healing has occurred and the dentures have been adjusted, the dentures can be used as a template to help place the implants in their correct positions. So the timing for implants is ideal once the patient has adjusted to the dentures. However, immediate placement of implants with the original surgical appointment of the extractions and denture placement can also be done.
Talk with Dr. Hummert regarding your treatment options.
If you have any questions about immediate dentures, please feel free to ask us.
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