What are Immediate Dentures?
Immediate dentures are dentures that are put in ‘immediately’ after having a tooth extraction.
This could be to replace any number of teeth.
It may be that the prognosis is very poor for all your remaining teeth (as commonly happens with severe gum disease), in which case an ‘immediate complete denture‘ or dentures (top and bottom) may be made.On the other hand, an ‘immediate partial denture’ could also be made as a temporary solution to allow the gums to heal up before you consider other treatment, if you require a single front tooth extracted. Or any combination in-between these two extremes.(See You have just had a tooth removed and want your gap filled, what should you do?
After a tooth extraction your gums will heal and shrink as the bone in that area is no longer needed to support your tooth. Most changes occur during the first three months when one or more denture relines will often be needed and by 6 months your bone level should be pretty stable.
At this point the temporary relines can be replaced with a more permanent acrylic reline, a new denture or a fixed option such as a dental bridge or implant – whichever is the most appropriate for your situation.
This healing generally isn’t a problem at the back of your mouth and so immediate dentures tend only to be used where aesthetics would otherwise be a problem to allow you to continue to smile and socialise.
The amount of shrinkage and healing time will vary slightly from one person to another.
What are the Advantages of Immediate Dentures?
Immediate Dentures have a number of advantages:
- No gap- You don’t have to walk around without teeth or with a gap in your smile
- Better healing– It promotes better healing by stabilising the clot underneath
- Less resorption– It loads your ridges straight away saying to your brain- “Hey, we need this bone for support” thus reducing the overall amount of resorption
- Improved chewing- It allows you to continue to chew and function normally
- Improved speech- It stops your speech being affected from having a space (if it is at the front of the mouth)
- Easily adjusted– They can be easily relined when the gum shrinks up to cover any unsightly gap or improve the fit. A temporary bridge on the other hand may need to be re-made.
- Better alternative– With immediate full dentures it allows the exisiting position of the natural teeth to be copied and the correct height of the dentures (OVD) to be somewhat gauged- instead of it being a total guess.There is however, another side to the coin discussed below.
What are the Disadvantages of Immediate Dentures?
Since it is a denture, all the disadvantages of standard dentures could apply here, such as it will need to be taken in and out to be cleaned, biting and speech may be affected to begin with etc. Bear in mind, immediate dentures are a working progress/ temporary solution whilst healing occurs and further adjustments are part of the game- there is no way of avoiding them with the changes that occur to your jawbone.
If you are having an immediate denture, i.e. your teeth are removed and the denture put straight in, you do not have the luxury of a try-in stage (See-partial denture procedure) There is quite a lot of guesswork involved here, due to the ‘straight-in’ procedure. With a single tooth this generally isn’t too much of a problem, but with a full denture where the extension of the base is so crucial to your grip, a poor fit may result. Frequent adjustments and the use of denture fixative may be needed in-between the relines.
Are there any Alternatives to an Immediate Denture?
If it is a single tooth:
- Do nothing
Just leave the space…
- Temporary bridge
A temporary bridge can sometimes be made but this cannot be added to and so can become unsightly and need replacing when the gum shrinks. Temporaries, no matter how well they are made are not easy to clean and tend not to be the best for gum health; collecting a lot of plaque around them. Dentures can be removed which makes cleaning much easier and more efficient.
If it is an immediate full denture:
(i) Extract the teeth, wait for the gums to heal and then make a set of dentures- seriously not a good idea! You would be hard pressed to find a dentist who would agree to doing this.
(ii) Provide a partial denture for the back teeth- to help the patient start getting used to wearing a plate, if they haven’t worn one before.. Then do an immediate, just for the front teeth, at an appropriate time.
(iii) Make a creeping denture- where by teeth are added one at a time when they cause pain and need extracting- this can be useful for patients who may have difficulty adapting, though this can be inconvienient and expensive as additions and relines are needed.
If you already have a partial denture, you can have an immediate tooth addition- this is like a tooth addition, but the ‘immediate’ bit means that you are never without a space. This really only needs to be done for front teeth which affect your smile, otherwise it makes more sense to take the tooth out, let it heal a bit, then add a tooth to the denture- removing the guesswork.
Your denture will need to be sent away to the lab for an immediate addition, so you will be without it for a period of time. It is important to bear this in mind when organising work and social commitments. That said, most dentists will complete the treatment in a single day by having you come in early in the morning and then again later that same afternoon. On the second appointment, it is literally out with the tooth, in with the denture.
What is the Procedure for an Immediate Denture?
The exact process and number of appointments depends on how many teeth the denture will be replacing.
The basic procedure is:
- An impression is taken of your teeth and the bite recorded
- The dentist tells the technician which tooth (or teeth) are going to be extracted
- The technician grinds these off the model of your teeth to simulate the extraction and makes the denture in the normal way
- The dentist confirms the right tooth has been added before the tooth extraction, then the tooth is made numb, removed and the denture is put straight in
- A review appointment is needed to make adjustments- see immediate denture aftercare below.
What should I do After an Immediate Denture?
Special instructions for the aftercare of immediate dentures are needed.
Your dentist will give you instructions for the care and follow up of your immediate dentures. Since you have had an extraction, you should follow the extraction aftercare instructions regarding diet, painkillers, numbness etc.
We don’t want you to take your dentures out for 24 hours because you are likely to cause bleeding and the socket and gums may swell slightly meaning the denture might not fit back in.
Leaving them in will help to stabilise the clot, prevent bleeding and control this swelling and inflammation.
Once the denture is inserted, it is not ideal to keep taking them in and out to make adjustments, thus disturbing the clot that is trying to form. Because of this, the first night is generally not the most comfortable, the fit and bite may be slightly off and make chewing a little difficult. Hopefully though, it’s just a phase.
The dentist will take them out at the next appointment (usually the following day) and assess the socket and make any necessary adjustments to the fit of the denture. They will also show you how to put your dentures in and take them out and give you instructions on looking after your dentures.
Some pain and soreness is to be expected and as with any denture, further adjustments are likely to be needed. A temporary reline will be needed- as we have said, to compensate for the bone resorbing over the next few months, before a permanent reline replacement denture or other solution is made- around the 6 month mark.