Immediate Dentures by Westshore Denture Clinic
It cannot be overemphasized how important it is to understand all the ramifications of having all or some of your natural teeth removed and replaced with a denture. A denture is a prosthetic version of your teeth, not unlike a prosthetic version of your arm or leg with similar deficiencies and restrictions. As a result, it is important to understand that dentures are not an equal replacement of your natural teeth.
What research tells us is that a complete upper denture gives us about 50-60% chewing efficiency when compared to our natural teeth. A complete lower denture gives us only about 15%. Yes, 15% chewing efficiency when compared to our natural teeth! It is important to understand the limitations of dentures, especially immediate dentures, because if you don’t, you can end up with the perceived solution to your dental problem becoming just another aggravating dental problem.
Fixed dental restorations are always superior in function and chewing efficiency when compared to removable dental restorations. As a result, a denture, which is a removable restoration, is a lot less expensive for this very reason. In order to maximize the function and chewing efficiency of a lower denture it is advisable to keep as many teeth on your lower as you possibly can. If all of your lower teeth must be removed, and you are a candidate, I highly recommend surgically placing least two dental implants to secure your lower denture. Just two dental implants can increase lower denture chewing efficiency from 15% to 50-60% when compared to our natural teeth.
I am providing you with a lot of information regarding your planned transition from your natural teeth to a removable denture restoration. Please read it carefully. Please ask questions. The better informed you are about dentures the better the chances are that you will be satisfied with your dental experience.
What is an Immediate Denture?
An immediate denture is a denture that is fabricated before your teeth are surgically extracted. An impression is taken of your teeth and gums in their present condition and a model of your teeth and gums is made from this impression. That model is then contoured estimating what the shape and size of your gums will be after your teeth are removed. This is the model that your denture will be made on. Because this model is an estimate or “guess” of what your gums or remaining ridges will be like, your denture will not fit precisely. Even if it did fit precisely to begin with, as your gums heal they will rapidly begin to shrink, and your denture will not fit precisely. To compensate for the change in the shape of your gums a temporary lining will be placed inside your denture to adapt to the new shape of your gums. This procedure will be repeated throughout the heading period.
The amount of change that will occur depends on the condition of your teeth and gums before extractions, which teeth you are having extracted and the number of teeth that you’re having extracted. This change is not predictable as everyone’s oral situation is unique to them.
It is very important to understand that an immediate denture will not and cannot fit as well as a denture that is made on healed healthy gums.
Because of the guess work involved in the fabrication of your denture and the rapidly changing nature of your gums during healing it is expected that there will be periods when your dentures will fit poorly. This means your dentures can cause mouth sores, will feel loose, may affect your speech and reduce your ability to chew food properly.
Depending on which teeth you are having extracted, a wax try-in of your new denture may not be possible. A wax try-in is made by setting the denture teeth that will be used to replace your natural teeth in a wax base. This wax try-in can then be “tried in” your mouth so that you can see what your future smile will look like, and any necessary alterations to the appearance of your smile can be made prior to fabricating your denture. A try-in is also used as a check point during denture construction to confirm that the technical aspects of the denture are correct. This step is only possible when the denture is made after the gums have healed. In contrast, the appearance of the immediate denture is determined by referencing your present teeth. Changes to the shape, size, colour and position of the teeth can be made but it is not possible to see what the changes will look like. The end result of this limitation with immediate dentures, is that the finished denture may not meet your esthetic expectations.
Depending on the number of teeth to be extracted it may only be possible to determine your bite position using your present teeth. Typically when teeth are to be extracted their condition and position is compromised. This means that your jaw position may have developed a learned or acquired position based on poorly positioned or shaped teeth. This can affect the accuracy of the bite position of the immediate denture. This means the denture may be unbalanced when your back teeth meet causing tipping, displacement, mouth sores and reduced chewing efficiency. This also means that the amount of space between your jaws may be inaccurate. This may require resetting of the denture teeth on one or even both dentures if you have upper and lower dentures, to address and correct this issue.
Depending on the condition of your teeth and gums before extractions the exact healing time of your gums will vary. Extraction sites may heal in anywhere from 2 months to a year. Your exact healing time is not predictable and there is significant differences between individuals. Diet, tobacco products and general health also affect healing time.
Because immediate denture construction is based on estimates, and due to the rapidly changing oral environment, an immediate denture can be a very challenging denture to wear. A great deal of patience and perseverance may be required during the healing period and, as a result, not all individuals are candidates for immediate dentures.
Procedures that can address the deficiencies inherent in an immediate denture during healing are available. However not all of these procedures are included in the original cost of your denture. Proceeding with these procedures before healing is complete may mean repeating these procedures at an additional cost. This also depends on which immediate denture plan you choose.
Denture Options in Victoria, British Columbia
When the restoration of your natural teeth is no longer feasible and a denture is the recommended treatment plan, you have options.
Option 1: Extraction of teeth then waiting until gums have healed before placing the denture.
This option involves having your teeth extracted and waiting an appropriate amount of time for your gums to heal and then proceed with the fabrication of your denture. This is especially recommended when you are planning on having a partial denture with a metal framework involved. Ideally the framework is tried in prior to having the teeth attached to it to confirm fit accuracy. If the framework does not fit at this point it will be remade at no additional charge. If the denture is made without a try-in and the framework does not fit, the denture must be remade, at additional charge.
The advantage to waiting for your mouth to completely heal is that your denture will be certain to fit and function correctly. The disadvantage is you will have to go without teeth while your mouth heals.
Option 2: Extraction of teeth and immediate placement of a denture on unhealed gums.
The immediate denture is made with the intent that the denture will rebased to fit your gums when your gums have completely healed. It is important to know that rebasing only addresses the fit surface of the denture. It does not address deficiencies in the occlusion (bite) or appearance. This can only be achieved by resetting the teeth. Rebasing and resetting the teeth are done at additional charge. These procedures are not included in the original treatment cost of your immediate denture.
Depending on the amount of change that occurs during healing, a rebase may not be adequate to properly salvage the immediate denture and a new denture may be necessary. Temporary linings of this denture are included in the costs of an immediate denture for a 3 month period. After this period, temporary linings are charged at additional cost.
Option 3: Extraction of teeth, immediate placement of denture on unhealed gums, followed by the construction of another denture when gums have healed.
This option involves the construction of 2 dentures. The immediate denture would be made in the conventional manner. It would include in its original cost all the adjustments and temporary linings necessary to address fit and function, until your mouth is healed. At this time a new denture would be made on your healed healthy gums. This denture would be a precision equilibrated denture that would be guaranteed to fit and function properly. You would have the opportunity to see the denture in your mouth in a wax try-in before it is finished to critique the appearance of your smile and make changes before the dentures are finished.
This option is highly recommended if you are having numerous teeth extracted especially if they are your front teeth or the large molar teeth. A considerable fee reduction is available for this option. This treatment plan must be paid for in advance to receive this cost reduction. We do not offer any exceptions and the dentures must be paid for when you have an extraction date. Patients with dental insurance should note that the vast majority of dental insurance companies will not cover an immediate denture and a precision equilibrated denture in the same five year cycle. As a result, we typically bill your insurance company for the immediate denture which is the more expensive denture.
For all the above options, there are procedures that may be necessary to address immediate denture deficiencies that are not included in the cost of the original denture treatment plan:
ØChair-side direct hard liner
ØResetting denture teeth to address interocclusal distance (space between your upper and lower teeth) including the immediate denture/s and opposing denture if necessary.
ØResetting of the teeth to address appearance deficiencies, including tooth colour, size, shape and position.
ØEvery effort is made to construct your immediate dentures with as much accuracy as possible. Within the described limitations everything that can be done to maintain function and comfort will be done. However, it is important to understood that there are significant limitations brought about by the unpredictable nature and limitations of the oral environment after teeth have been extracted.
Benefits of Immediate Dentures
While all of the above can read like a cautionary tale, an immediate denture has its definite upside too. First of all, immediate dentures act like a bandage and protecti the extraction sites. The denture also maintains the distance between the upper and lower jaws so that the facial carriage doesn’t collapse during the healing period. Speech can be affected by an immediate denture but generally not to the degree that speech is affected when you must learn how to speak without teeth and then learn to speak again when you get your denture after healing. Of course the major benefit to the immediate denture, the biggest persuader of all, is that you will not have to be seen in public without your smile.
If you have an understanding of the immediate denture limitations and your expectations are reasonable, the likelihood of you having a positive experience in your transition from natural teeth to denture is very high. Without this understanding however, the transition can be quite difficult or even miserable, for some.
I _____________________________ have read and understand the above information. I have been allowed to ask questions and have had my questions regarding denture construction, cost and expectations satisfactorily answered. I am capable to proceed with treatment without third party involvement.
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