Immediate Denture Technique
1. Establish Vertical Dimension Have patient stand with mouth in relaxed position. Place dot on tip of nose and prominence of chin. Measure this distance for future reference for vertical dimension. If teeth are present this will be easily determined.
2. Extract the Teeth. Extract the teeth and complete the preprosthetic surgery to ensure a smooth alveolar ridge. All undercuts and excessive alveolar processes should be reduced at this time. Sutures should be placed at this time if needed. Take alginate impression of arch after the extractions and preprosthetic preparation. Pour in Snap Stone or other quickset plaster.
3. Have patient rinse with mouthwash if possible. This conditions the tissue for better flow of material.
4. Choose Template Choose the template that fits closest on model as in the complete denture technique. The denture teeth will ideally be over the residual ridge.
5. Leave 1-2 mm space between the template and the depth of the vestibular fold. Check palate for proper contour. Check post dam area on model and reduce if necessary. Adjust the template by placing in the boiling pot, with the water boiling, for 45 seconds to a minute. Press the template to the model, forming it close to the model, within 2 mm. This step may be repeated if necessary. Fit should be close but does not need to be tight or exact.
Try in the template with the Occlusal Plane plate in place. If there are teeth in the opposing arch the occlusion will be determined by that articulation. If no teeth are present in the opposing arch the occlusal plane should be set to correct position in all planes. Visualize the tooth show and anterior/posterior position of the template for esthetics (no lip strain or pull). The template should not rock on the palate. Check the flanges and remove any extensions, leaving 2-3 mm of space between the flange and height of the fold. If needed, reheat the template and adjust palate to eliminate the rocking and flanges to close proximity to the ridge. Tip: If the occlusal plane is canted test stops made of the impression material can be used as a trial occlusion to determine proper occlusal plane. Once the occlusal plane is set, the entire template can be relined.
6. Coat inside of upper template with the primer/adhesive provided, extending slightly over the edge of the flanges.
7. Following reline material instructions, place reline material into upper template and place in mouth. Visually orient the template for tooth show and anterior posterior dimension. Place Occlusal Plane plate in mouth to determine ala/tragal plane and interpupillary occlusal lane. Check palate and then border mold. Wait 2-3 minutes for material to harden to the point it can be removed from the mouth. Apply Vaseline or mineral oil with cotton tip applicator to areas around the teeth. Tease up the reline material to increase the roll size of the flange and keep the material off the teeth.
8. Remove template when the reline material is hardened or starts to become warm. Check for voids, remove gross excesses from outside of template. Add additional material (for border molding or voids) if necessary and allow to harden, about 3 minutes. Finish flanges in normal fashion. Reseat the upper denture.
9. Place the post dam by mixing a small amount of reline material and add to posterior palatal border. Allow to fully harden prior to placing in mouth.
10. Use Pressure Indicating Paste to check intaglio surface for high spots. This may require more than one time to assure all high spots are removed.
11. Do a final occlusion check with articulating paper to balance the occlusion, checking for high spots and premature occlusion in lateral and protrusive movements.
12. Finish and polish and deliver the dentures. Discharge patient with standard instructions for usage including denture cleaning.
A full or immediate denture can then be completed for the opposing arch if no teeth are present or if another immediate denture is planned.