Interim/immediate Denture Fabrication

[Ramen_Noodles]

I have a patient who wants a upper and lower interim complete denture. I have taken the alginate impressions and have the casts made but I was wondering if I need another appointment (make custom trays with wax) to do a jaw relations record and face-bow to mount the casts before I send them to lab to be fabricated? Thanks!

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[Vicviper]

Unless they can hand articulate it really well, you need to do some sort of jaw relation, otherwise how will they know how to place the VDO / height of the teeth? The more info you give the lab, the better it will be. Immediate dentures are already terrible, so help the lab out! How many teeth are they missing? If it's not many, or just anterior I'll do the extractions and just wait 3 weeks or so for healing to start the process.

I hate doing immediate dentures because you never get a good result - if you're just doing it as an interim, that's ok. I don't even offer it as an option to my patients anymore, I just let them know they're going to be without teeth while things heal. I do a lot of dentures, and it's really never a problem, it just depends on how you present it to the patient.

 

[lemoncurry]

If the patient has enough teeth to balance the upper and lower casts in occlusion, just make a bite reg. If there aren't enough posterior teeth, ask the lab for wax bite rims.

 

[Ramen_Noodles]

Thanks. How long do you usually wait after the extractions to start fabricating the permanent dentures?

 

[lemoncurry]

I usually tell the patient 6 months for healing. during that time, I provide adjustments and soft relines for the interim dentures.

 

[charlestweed]

I’d try to make the interim dentures fit as close to the permanent ones as possible. Patient feels depressed about losing all his/her teeth. Why create more stress by giving the patient ill-fitting dentures?

I’d use the preliminary alginate casts to make upper/lower custom trays. Use wax to do functional border-molding around the custom trays. Take the polyether impression. Use the indelible pencil to mark the posterior palatal seal. Use patient’s existing teeth and bite registration material for accurate mounting of the casts.

You can do several soft relines after extractions for better fit and patient’s comfort. A couple of months later, when the ridge resorption and remodeling reach a stable level, you can do the same day hard reline by using the interim dentures as custom trays to take a new polyether impression. Determine the new posterior palatal seal. Patient comes in in the morning for impressions...the lab picks up the case, performs reline, and delivers them back to your office the same day in the afternoon. These interim dentures should then function like permanent dentures.

 

[TanMan]

Is this for dental school or private practice? If it's for dental school, you have to see what the policies/procedures require. If it's in your practice, then you want to see if you have some kind of stable occlusion. If you are not able to achieve any kind of stable occlusion or if you're going to set the patient into CR, then you'll most likely need wax rims to get a bite record. I've heard of CAD/CAM dentures before, but I've removed all removables from my office and have not had a chance to review that technology.

One of the best moments of my dental life is when I stopped doing all dentures and removables. I have very little headaches now.

 

[FanOfCostco]

[QUOTE="TanMan, post: 19399053, member: 48348]

One of the best moments of my dental life is when I stopped doing all dentures and removables. I have very little headaches now.[/QUOTE]

GET THIS MAN A BEER ASAP! You da real MVP

 

[DrJeff]

Is this for dental school or private practice? If it's for dental school, you have to see what the policies/procedures require. If it's in your practice, then you want to see if you have some kind of stable occlusion. If you are not able to achieve any kind of stable occlusion or if you're going to set the patient into CR, then you'll most likely need wax rims to get a bite record. I've heard of CAD/CAM dentures before, but I've removed all removables from my office and have not had a chance to review that technology.

One of the best moments of my dental life is when I stopped doing all dentures and removables. I have very little headaches now.

CAD/CAM denture fabrication, both immediate and "traditional" has been quite a pleasant game changer for me. Granted my sample size so far has only been about a dozen arches (I also try to do as little removable work as possible for my own sanity!!), but of those arches, which have been everything from 2 full/full immediate cases to single arch replacement RPD's, I have been quite pleased with the results.

My assistant will use my Trios scanner and scan the arches, and then I go right to delivery once the lab has fabricated the unit(s) - if it's not an arch of immediate, I've had to do very minimal, if any, adjusting upon insertion and then less follow up adjustments over the following week or 2 compared to traditional impression based, wax rim denture fabrication. For immediate arches, definitely not having to do any more post insertion adjustments than the traditional way. And I am using the same small lab for my digital arches as for my traditional arches, lab differences isn't in play here.

I won't say that digital denture fabrication has completely made we want to openly seek out denture patients, but I will say that in my limited experiences so far with it, I am finding it far less stressful and more time efficient that denture fabrication the traditional way...

 

[TanMan]

CAD/CAM denture fabrication, both immediate and "traditional" has been quite a pleasant game changer for me. Granted my sample size so far has only been about a dozen arches (I also try to do as little removable work as possible for my own sanity!!), but of those arches, which have been everything from 2 full/full immediate cases to single arch replacement RPD's, I have been quite pleased with the results.

My assistant will use my Trios scanner and scan the arches, and then I go right to delivery once the lab has fabricated the unit(s) - if it's not an arch of immediate, I've had to do very minimal, if any, adjusting upon insertion and then less follow up adjustments over the following week or 2 compared to traditional impression based, wax rim denture fabrication. For immediate arches, definitely not having to do any more post insertion adjustments than the traditional way. And I am using the same small lab for my digital arches as for my traditional arches, lab differences isn't in play here.

I won't say that digital denture fabrication has completely made we want to openly seek out denture patients, but I will say that in my limited experiences so far with it, I am finding it far less stressful and more time efficient that denture fabrication the traditional way...

Your testimony almost makes me want to try it.... almost. From a time/financial perspective, I lose money with dentures and production/hour drops significantly with every case that I had on the schedule. Maybe I'll try it on my grandmother; I don't have a Trios, but I do have an omnicam. I'll definitely look more into it from an enthusiast's point of view, rather than someone who will make dentures for patients