Dr.R.Muthukeerthana MDS.
Prosthodontist and Implantologist,
Raga Dental Center for Implant and Laser,Thanjavur.



ABSTRACT :

Back ground:
The Transitional / Immediate Complete denture is mainly fabricated to replace the lost teeth with the associated structures of maxillae and mandible and inserted immediately following the removal of remaining hopeless teeth.This Immediate Denture can be used for both partially edentulous or completely edentulous patients immediately after extraction of the teeth.
Aim: Here, we present a case of 57 year old female patient who underwent immediate extraction of her all periodontally compromised teeth and replacement of her missing posterior tooth immediately with Immediate Complete denture. Relevance for patients: This mainly helps in restoring the vertical dimension, esthetics and phonetics of the patient.



Keywords :

Vertical Dimension, Immediate Denture, Esthetics, Phonetics.

CITATIONS :

R.Muthukeerthana, Transitional complete denture – A Case report, The journal of prosthodontics and dental materials. 2022; 3(2):84-91.



INTRODUCTION :

Under normal circumstances providing a patient with a transitional /immediate denture is the most effective way of making the transition from natural dentition to artificial dentition1. GPT-9 defines immediate denture as ‘any fixed or removable dental prosthesis fabricated for placement immediately following the removal of the natural tooth /teeth’2. It mainly helps in restoring the masticatory efficiency, phonetics, esthetics by not violating the harmony of oral environment3. An immediate denture is a complete or partial denture inserted immediately after the extraction of the teeth. According to Boucher, there are two types of immediate denture
1. Conventional Classic Immediate denture{CID}
2. Interim/ Transitional / Non traditional Immediate denture {IID}
In CID , Prosthesis is fabricated immediately following the extraction of the teeth which can also be used as definitive or long term prosthesis in later periods whereas IID , short term prosthesis , a new denture or relining has to be done after the healing. The advantages of interim immediate denture are preservation of facial appearance and height, reduction in post extraction pain , muscular tone and phonetics4.
Several procedures has been described in the literatures to construct an immediate denture which reduces the time and provide an economically comfortable one. Khan et al7 did an immediate transitional denture in one appointment using self polymerizing , tooth coloured acrylic and visible light cured resins followed by multiple extractions on same appointment which has complicated the acceptance of new denture by the patient8. A Less traumatic immediate complete denture9 was constructed where the remaining teeth were cut off till the gingival margins instead of extracting those teeth where the roots were extracted at a later time. Goova et al8 described the use of patient’s fixed prosthesis for fabricating in one appointment , an interim immediate partial denture , where the remaining three teeth were maintained to preserve the vertical dimension at occlusion where they were able to maintain the facial support , vertical dimension during the healing period.
The purpose of this case report was to describe a technique for fabrication of an interim immediate denture by restoring the vertical dimension in the missing posterior teeth eventually proceeded with extraction of the remaining teeth with alveoloplasty using a surgical stent after extraction which aids in restoring the patient existing facial height, esthetic, phonetics and vertical dimension. The outcome of this treatment is always unpredictable pertaining to assessment of the vertical dimension at occlusion and centric relation5,10.



CASE REPORT:

A patient named Mrs. Rajeshwari , 57 years old reported with the chief complaint of missing posterior teeth in upper and lower back tooth region for past 6 months and needs to replace the mobile teeth immediately with a denture. The patient presented with no significant medical history. Clinical examination revealed an unrestored mouth with generalized periodontitis of the existing teeth. We decided for the treatment of immediate complete denture along with patient’s concern and demand.

Image Image

The Casts were duplicated with dental stone. As there are missing posterior teeth in both the arches we did a tentative jaw relation by keeping the remaining teeth as a vertical stop and articulated in a mean value articulator{fig 1c}.

Image

The wax try in was completed in order to record the vertical dimension at occlusion{VDO}.This mainly helped us to maintain the vertical dimension and facial height.

Image

In the laboratory side, the existing teeth were marked as ‘X’ and ‘O’ , initially all the X marked teeth were knocked out till the gingival level and replaced with artificial teeth, simultaneously we proceeded with O marked teeth {fig 1d and fig 1e}}.

Image

Then teeth arrangement was completed and occlusion was established.
Image

After dewaxing, the casts were evaluated for undercuts and blockouts using surveyor. By maintaing an unilateral undercut , the ridge shape has been modified in the cast for alveoloplasty where we fabricated a surgical stent using clear autopolymerizing resin. This surgical stent has been used as a guide for alveoloplasty, after the removal of the remaining teeth{fig 1g }.
Image

This surgical stent has been used as a guide for alveoloplasty, after the removal of the remaining teeth{fig h}.
Image
Simultaneously, the immediate denture was fabricated{fig 1i}. The patient was delivered with immediate complete denture on the same day of extraction and alveoloplasty by maintaining the vertical dimension and facial height similarly with esthetics.

Image

The patient visited after 24 hours to evaluate denture support, retention and stbalility.The patient has been advised to take proper medications and follow the instructions given such as not rinsing and consuming hot foods/ drinks.
After 24 hour , we observed for sore spots in the regions of canine eminences, lateral to tuberosities and in undercuts. If there, pressure spots has to be removed. The denture should be kept out of the mouth for a very short time.
After 7th day , the ridges was evaluated{fig 1j} . The dentures can be removed at night. The patient was happy that we satisfied her demands and needs.

Image

One month, two month and three month check up for evaluation of the denture . A new denture was fabricated after a proper healing period.
Image

DISCUSSION

The conventional immediate denture requires a series of appointments to perform standard procedures after the extraction of the remaining teeth along with adjunct surgery, denture has to be evaluated for areas of pressure and adjusted11. In Conventional complete denture, it requires a healing period from several weeks to months of edentulism12. Interim Immediate denture is used to preserve the esthetic, phonetics, occlusion & most important provide psychological support to the patient. The procedure performed in this clinical report preserved the patient’s oral environment. This technique followed the steps of traditional technique with slight modification by fabricating a surgical guide which has acted as a template or guide for alveoloplasty that mainly helped us to modify the ridges along with the extraction. This surgical correction of the alveolar ridges eventually helped us in the healing period by maintaining the ridge shapes.
The functional advantages are possibility to do denture adjustments, use of pressure indicating materials in a blood free field and the preservation of the vertical dimension at occlusion{VDO}. The fundamental for the success of removable prosthesis is maintain the existing vertical dimension at occlusion and centric relation8



CONCLUSION

By considering the introduction and successful outcome of the treatment, further clinical studies could be needed to evaluate the use of present technique. A fixed or removable or implant supported denture should be favored as the final treatment of edentulous patients



REFERENCES

1. Jonkman R E, Van waas M A,Van’t Hof MA & Kalk W. An analysis of satisfaction with complete immediate dentures. Journal of dentistry.1997;25(2):107-11.
2. Glossary of Prosthodontics terms-9:e47.
3. Charles Heartwell & Arthur O Rahn –Syllabus Of Complete Dentures 4th Edition.
4. Zarb GA, Bolender CL. Prosthodontic treatment for edentulous patients .13th edition.St.Louis.C.V.Mosby Co.2004.
5. Wyatt CCL.Immediate Dentures .In MacEntee MI,ed.The Complete denture: a clinical pathway . Chicago,IL:Quintessence Publishing 1999;99-107.
6. Winkler S. Essentials of complete denture .Immediate denture; 3rd edition :487-492.
7. Khan X, Haeberle CB. One appointment construction of an immediate transitional complete denture using visible light-cured resin. J Prosthet Dent. 1992;68:500–2.
8. Gooya A, Ejlali M, Adli AR. Fabricating an interim immediate partial denture in one appointment (modified jiffy denture). A clinical report. J Prosthodont. 2013;22:330–3.
9. Woloch MM. Non traumatic immediate complete denture placement: a clinical report. J Prosthet Dent. 1998;80:391–3.
10. Wyatt CCL. Immediate dentures. In: MacEntee MI, editor. The complete denture: a clinical pathway. Chicago, IL: Quintessence Publishing; 1999. pp. 99–107.
11. Gilboa I, Cardash HS. An alternative approach to the immediate overdenture. J Prosthodont. 2009;18:71–5.
12. Bouma LO, Mansueto MA, Koeppen RG. A nontraditional technique for obtaining optimal esthetics for an immediate denture: a clinical report. J Prosthodont. 2001;10:97–101