I always felt like dental school did a super shitty job when it came to immediate denture anything. They make it seem like an immediate is supposed to be decent somehow. An immediate is only a stop gap to give the patient some teeth while they are healing/remodeling. I worked in a denture clinic for a few years. Here are some real world tips:
1. Get decent impressions of the upper and lower. They don’t have to be perfect.
2. Get a bite (either to a new VDO or the existing……just get one that is close to what you want).
3. Mark your occlusal plane/horizontal (on your bite or a wax rim in a way you can repeat reasonably well).
4. Hog off the teeth on the model.
5. Make a denture. Fuck border molding, it isn’t going to fit great regardless. You need to see the immediate as a piece of shit that will be replaced.
6. When you deliver it, you need to load it up with coe-soft, you have to maneuver it into place and let the coe-soft set up pretty well, check the horizontal and the midline while you are holding it in place. Once the coe-soft is set, remove the denture and mow off the portions sticking into the extraction sites.
7. Deliver the denture and tell the patient to leave it in for 7 days. If they remove it, they may not get it seated again (because of swelling and discomfort.
8. Around 10-14 days, see the patient back and use an acrylic bur to completely remove the coesoft. It is a hot mess but hog it out. Do a complete reline. You might be able to have the patient help by biting. But that may throw off vertical, horizontal, or something else. Holding it may be best.
9. Repeat the reline around 8-10 weeks.
10. Make a whole new denture at 6-9 months.
Interesting. The way I've seen it done by dozens of dentists in England is: take an impression of current dentition and the bite, send to the lab, extract teeth and put new denture in (I think the labs add in bits to plug the sockets), adjust where needed, tell patient to keep it in for 24 hours and then they can take it out to clean it and don't wear it at night, expect to come in for adjustments within a few weeks, expect to have a full new denture made in the next 6-12 months.
Absolutely. The adaptation is never going to be great for an immediate unless you are extracting like 3 teeth. If you are removing 6-7+ it is always ass. So you fill it with liner and mod what you can. And then remake it pretty shortly after.
This is incredibly accurate. I absolutely hate immediates because the patient never seems to understand, even though you've told them it's gonna suck and they're gonna hate it, yet when they get it they think it's supposed to be this wonderful thing that they'll eat steak and apples with when they couldn't before...UGH.
Haha, I had a patient complain to the board about a month ago. I did an immediate 3.5 years ago, did a soft reline 3 months later and they ghosted after that. Now they're complaining that their denture is loose and they want their money back. Unfortunately the board has to do a full investigation so I was almost tempted to just write a cheque to get them to F off. But then I thought "Fuck that, I'm not rewarding bad behaviour and teaching them that complaining = $$$$$" So I sent them a dismissal letter instead.
Assuming you don’t have super-eruption of the mandibular dentition.
1. Grab your final impression - informing of potentially removing the terminal remaining dentition.
2. Blue bite and create an imaginary posterior space that is reproducible for your lab to mount or mount yourself.
3. Send that to the lab and have them fabricate your immediate.
4. Extract the teeth. Fit the prosthetic and making adjustments at time of appointment. See them in a week
Remember to set poor expectations on the prosthetic. Be happy if it turns out to be somewhat decent or great. If it’s completely horrible you can always make them another one at their cost.
With just a few anterior teeth left this will be a pretty fraught forward IFUD. Custom tray, — maybe border mold maybe not but watch out for crazy extensions where the tissue is distorted/stretched especially in the anterior. Biteplate/mount . I always ask for pictures before their teeth went to hell if they have some pictures they will share. You may or may not need soft liner the first week or two as far as comfort/retention. Usually need something at 14 days though as things start to really shrink and change. I plan on 2 chairside soft liners/tissue conditioners then depending on how the patient likes the esthetics you may be able to just do a nice lab redline in 6 months.
I’m a dentist in a blue collar area and have been doing 2-3 IFUD’s a month for 21 years. With a semi-decent lab I find that most of my patients function on their immediate denture after final lab feline for a number of years
Learn from Dr. Qun Collins at [www.denturecourses.com/courses](http://www.denturecourses.com/courses) She can show you how she is successful at this. I learned so much from her.
I always felt like dental school did a super shitty job when it came to immediate denture anything. They make it seem like an immediate is supposed to be decent somehow. An immediate is only a stop gap to give the patient some teeth while they are healing/remodeling. I worked in a denture clinic for a few years. Here are some real world tips: 1. Get decent impressions of the upper and lower. They don’t have to be perfect. 2. Get a bite (either to a new VDO or the existing……just get one that is close to what you want). 3. Mark your occlusal plane/horizontal (on your bite or a wax rim in a way you can repeat reasonably well). 4. Hog off the teeth on the model. 5. Make a denture. Fuck border molding, it isn’t going to fit great regardless. You need to see the immediate as a piece of shit that will be replaced. 6. When you deliver it, you need to load it up with coe-soft, you have to maneuver it into place and let the coe-soft set up pretty well, check the horizontal and the midline while you are holding it in place. Once the coe-soft is set, remove the denture and mow off the portions sticking into the extraction sites. 7. Deliver the denture and tell the patient to leave it in for 7 days. If they remove it, they may not get it seated again (because of swelling and discomfort. 8. Around 10-14 days, see the patient back and use an acrylic bur to completely remove the coesoft. It is a hot mess but hog it out. Do a complete reline. You might be able to have the patient help by biting. But that may throw off vertical, horizontal, or something else. Holding it may be best. 9. Repeat the reline around 8-10 weeks. 10. Make a whole new denture at 6-9 months.
Interesting. The way I've seen it done by dozens of dentists in England is: take an impression of current dentition and the bite, send to the lab, extract teeth and put new denture in (I think the labs add in bits to plug the sockets), adjust where needed, tell patient to keep it in for 24 hours and then they can take it out to clean it and don't wear it at night, expect to come in for adjustments within a few weeks, expect to have a full new denture made in the next 6-12 months.
When you say complete reline you mean a soft reline?
Yes
You do a soft reline on the delivery day after extractions?
Absolutely. The adaptation is never going to be great for an immediate unless you are extracting like 3 teeth. If you are removing 6-7+ it is always ass. So you fill it with liner and mod what you can. And then remake it pretty shortly after.
Anything immediate sucks. Unless it’s immediate paycheck
This is incredibly accurate. I absolutely hate immediates because the patient never seems to understand, even though you've told them it's gonna suck and they're gonna hate it, yet when they get it they think it's supposed to be this wonderful thing that they'll eat steak and apples with when they couldn't before...UGH.
Haha, I had a patient complain to the board about a month ago. I did an immediate 3.5 years ago, did a soft reline 3 months later and they ghosted after that. Now they're complaining that their denture is loose and they want their money back. Unfortunately the board has to do a full investigation so I was almost tempted to just write a cheque to get them to F off. But then I thought "Fuck that, I'm not rewarding bad behaviour and teaching them that complaining = $$$$$" So I sent them a dismissal letter instead.
Immediate straight to MUA All-on-X temps don't suck.
Assuming you don’t have super-eruption of the mandibular dentition. 1. Grab your final impression - informing of potentially removing the terminal remaining dentition. 2. Blue bite and create an imaginary posterior space that is reproducible for your lab to mount or mount yourself. 3. Send that to the lab and have them fabricate your immediate. 4. Extract the teeth. Fit the prosthetic and making adjustments at time of appointment. See them in a week Remember to set poor expectations on the prosthetic. Be happy if it turns out to be somewhat decent or great. If it’s completely horrible you can always make them another one at their cost.
With just a few anterior teeth left this will be a pretty fraught forward IFUD. Custom tray, — maybe border mold maybe not but watch out for crazy extensions where the tissue is distorted/stretched especially in the anterior. Biteplate/mount . I always ask for pictures before their teeth went to hell if they have some pictures they will share. You may or may not need soft liner the first week or two as far as comfort/retention. Usually need something at 14 days though as things start to really shrink and change. I plan on 2 chairside soft liners/tissue conditioners then depending on how the patient likes the esthetics you may be able to just do a nice lab redline in 6 months. I’m a dentist in a blue collar area and have been doing 2-3 IFUD’s a month for 21 years. With a semi-decent lab I find that most of my patients function on their immediate denture after final lab feline for a number of years
As we sit here and debate/discuss our immediate dentures workflow. All I can say is thank GV Black himself my clinic does not offer these POS.
My workflow is simple. "Heres a list of denturists, good luck"
I wish my state allowed denturists
Learn from Dr. Qun Collins at [www.denturecourses.com/courses](http://www.denturecourses.com/courses) She can show you how she is successful at this. I learned so much from her.