Immediate Dentures
Introduction:
Advances in therapy have helped people to look young and beautiful for a longer period in life. When an individual loses a tooth or some teeth or is anticipating the loss of teeth in the near future, the main concern is the changes it brings about in the appearance and problems associated with it.
In the modern world of business, stress and social obligations many dental patients who must become partially or completely edentulous can no longer submit to the custom of waiting up to 3 months without restoration while their gums heal.
The use of immediate partial or complete denture meets the challenges and promotes the preservation of ridge as well as that of self-confidence.
What is immediate denture?
A removable complete or partial denture fabricated for placement immediately after the removal of natural teeth.
Who all can be candidates for immediate denture?
Any person who is anticipating loss of teeth or has lost a portion of tooth which cannot be restored can go in for an immediate denture. The systemic health of the patient is of concern depending on the number of teeth to be extracted and replaced with immediate dentures.
Usually people into public speaking, politicians, teaching and people who have to interact with the general public are good candidates for the same.
What are the reasons for immediate replacement?
Probably the most important reason why an individual opts for immediate replacement is the psychological factor of being humiliated on losing tooth. We are aware of the role that the teeth play in phonetics. By immediate replacement of the teeth we help the individual to communicate with confidence and clarity.
Chewing and swallowing is another major work load of the oral cavity of which teeth in an important component. The presence of teeth natural or artificial prevents the developing abnormal chewing patterns.
Further it prevents disuse of alveolar bone and any damage to the ligaments surrounding tempromandibular joint.
What are the advantages?
The biggest advantage of all is that the patient need not have to leave the clinic with no teeth remaining in the mouth, especially the front teeth. Hence the appearance of the person is maintained. The denture also supports the muscle of the lip and cheek, which helps to maintain the tonicity. The edentulous look due to the chin getting closer to the nose because of the loss of teeth is avoided.
There is little interference with the speech or chewing, which help in preserving the psychological and social wellbeing.
Other advantage is that it acts as a bandage for the extraction wound. Healing is enhanced as food debris etcare kept away from the extraction wound. Resorption of alveolar bone is lessened due to maintenance of function.
What are the disadvantages?
As the tooth to be replaced is extracted only at the time of denture delivery a complete try in for the same is not possible. Invariably it is the front tooth which requires immediate replacement and hence the patient and the doctor will not be able to visualize the outcome beforehand.
It is difficult and demanding procedure for both patient and the doctor. The chair time and cost for the treatment is going to be more compared to the conventional prosthesis.
Case report:
A female patient aged 25yr old reported to the oral surgery department with protruding upper front tooth needing correction of the same. She was diagnosed with fibrous dysplasia and was posted for surgery. Since its involving the upper anterior teeth, it was decided to go in for an immediate denture. Impression was made and cast was modified for the construction of the denture in consultation with operating the oral surgeon.
Surgical template was madeand given to the surgeon as a guide to prepare the ridge and tissue to receive the final prosthesis .Priority was given to the removal of the lesion, keeping in mind the need for the prosthodontics replacement of the lost structures. After the surgery the denture was inserted immediately into place and the patient was very happy to recover and see herself in the new looks. 
Conclusion :
Management of this particular case shows us that it is possible to fabricate an immediate denture even in a case with a pathological lession where the level of surgical extened is less predictable compared to the situation where its just removal of teeth for replacement.
Hence when ever we are forced to extract teeth especially in the esthetic zone, it is our duty to let the patient know that he/she has an option of getting the teeth replaced immediately. I am quite sure that none of us will be willing to walk with teeth missing even for few hours. So let us help those people who are forced to face this situation in life.
Dr. Shaju Philip
Specialist and Senior Lecturer
GMC MDSC Sharjah
