A denture is a gadget which can be inserted into your upper or lower jaw that can replace missing teeth. An immediate denture can be inserted immediately after existing teeth in the arch are extracted, and provide you an immediate replacement for your teeth. However, it probably will not fit or function as well as a regular denture.
Teeth normally sit on u-shaped hills (referred to as ridges) located in the upper and lower arches of the mouth. A denture can be made using a model that duplicates the ridge. A moldable (pudding-like) impression material can be placed in a u-shaped container and inserted into your mouth. It then can flow on and around your upper or lower ridge and slowly harden into a pudding-like consistency. The impression can then be removed from your mouth and filled with a wet cement-like stone. After the stone hardens it can be removed from the impression and become a solid model that duplicates the size and shape of the ridge. A denture is a cover that can fit over the ridge and hold teeth.
Once a tooth is extracted the neighboring bone flows into the area where the tooth had been located causing the ridge to become smaller. To understand how and why the ridge responds imagine a hill that contains a row of trees. If the trees were removed large holes would remain. The dirt surrounding them would gradually flow into these holes causing the hill to become thinner and shorter and the shrinkage would continue while the holes filled in with dirt.
Why is the insertion of a denture immediately after teeth extractions a potential problem? Imagine a woman in her ninth month of pregnancy asking a dressmaker to design for her a dress that she can to wear to a party one week after her due date. The dressmaker would have to guess how much she would shrink after the baby’s delivery. If the dress were made too tight she would not be able to wear it to the party. Thus he would have to make it slightly a larger than her anticipated post-delivery size. However, each week after the baby’s birth her body would continue to shrink, causing the dress to become looser and looser. Eventually it might feel too baggy and she might decide to have the dress size reduced or buy a new one.
A similar dilemma exists when constructing a denture. If teeth are extracted it is ideal to allow the ridge 2-6 months of shrinkage prior to making an impression. A denture made from an impression made sooner will probably become looser and looser as the ridge continues its shrinkage. Eventually the denture may need to be re-made or re-sized. Re-sizing is called relining and entails the addition of new material to the underside of the denture to fill in the gap created by ridge shrinkage.
It is possible to lessen the degree to which the ridge shrinks after an extraction. Assume a landscaper plans to remove from a hill a row of trees and then re-plant new trees on the same hill in the future. Once the old trees are removed he could immediately fill the holes with soil and also add fertilizer to the new soil to help feed the new tree. In a few months he could then plant new trees on a hill that is similar in size to the old one. A dentist can reduce the ridge shrinkage after extractions and stimulate the growth of new bone in the holes by placing materials that occupy space and stimulate the growth of new bone. These materials are called bone grafts.
The soil or bone graft needs to be placed as soon the trees or teeth are removed. Once the holes fill in there will not be enough surrounding side walls to prevent soil or bone grafts from washing away before they can integrate with their surroundings.
It is also possible to enhance the tightness of a complete denture by connecting it to dental implants that have previously been inserted into the jaw bone. A dental implant is a man-made tooth root that can bond and attach to the jaw bone and anchor a crown, bridge or denture. A denture can connect with a dental implant using a snap or screw so that it does not loosen.
A successful denture also needs to have the following features:
Natural appearance, which is determined by the following:
Shade of the artificial teeth and gums
Angulations and position of the upper and lower front teeth
Length of the upper front teeth, which should be visible when talking and smiling
Plane of Occlusion (the imaginary plane created by connecting the biting edges of the upper front teeth), which should be approximately parallel to the eyes and lips.
It is only possible to view and evaluate the appearance if the denture teeth are positioned in a wax trial denture and placed in the mouth. The teeth can be re-positioned during a wax try-in. A trial denture cannot be inserted until the natural teeth to be replaced are taken out of the mouth. Thus a denture try-in cannot be performed when making an immediate denture.
Allow one to chew, swallow, and talk, which will depend upon:
The size, shape and position of the new teeth and gums
The ability of the denture wearer to adjust to a new oral gadget
The tendency for food to lodge under the denture and the ability of the mouth to either remove or tolerate it
It is only possible to predict the function of a new denture if a try-in is performed. An Immediate Denture can be inserted immediately after teeth are extracted. It will allow you to have an immediate replacement for your natural teeth. However, it may not be cosmetically acceptable.
Adequate retention and stability, which are determined by the tightness of the Denture and affected by jaw bone shrinkage.
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