Im m ediate com plete dentures— a starting point
Richard A. Smith, D D S , Y o r k , P a
A n im m e d ia te d e n t u re s h o u ld b e u se d in p ra c ti­
c a lly all in s ta n c e s in w h ic h th e lo s s of te e th in an
a rc h is u n a v o id a b le . D iffe re n t t e c h n iq u e s a re
a v a ila b le to th e d e n tis t f o r fa b ric a tio n of im m e ­
d ia te c o m p le t e d e n tu re s . E a c h m e th o d h a s ce rta in
a d v a n ta g e s and lim ita tio n s . A second d e n tu re
s h o u ld b e in c lu d e d to fa cilita te a c o n t in u in g tre a t­
m e n t p la n . T h e te rm “ e d e n tic s ” is s u g g e s te d to
f o c u s a tte n tio n o n th e n e e d f o r tre a tm e n t of th e
e d e n tu lo u s p a tie n t a fte r th e initial in s e rtio n a n d
a d ju s tm e n t of th e d e n tu re . C o m p le te d e n tu re s
m u s t b e th e sta rt of a la s tin g tre a tm e n t p ro c e s s .
Dentists see many patients in daily practice who
must have multiple tooth extractions because
o f advanced periodontal disease or uncontrolled
caries. Ideally, the patient should be motivated
to carry on a program of meticulous oral hygiene
and plaque removal. After hopelessly diseased
teeth are removed, carious teeth restored, and
diseased periodontal tissues treated, partial
dentures— fixed or removable—may be made.
H owever, this cannot be done in all instances
because the pathological condition may be too
advanced for a reasonable prognosis.
One approach to the treatment o f a hopeless­
ly diseased dentition is the removal o f all teeth
in an arch and, after an appropriate period for
healing o f the ridge, construction o f a complete
denture. A preferable alternative is an imme­
diate denture. If the decision has been made
that all teeth in an arch must be removed, the
dentist should plan Construction o f an imme­
diate complete denture. This type o f restoration
should be considered as the starting point o f a
continuing professional service.
Four questions are pertinent to the planning
and construction o f an immediate complete den­
ture. Why should an immediate denture be made?
When should this be done? H ow may the den­
tist do it? What should be done for continuing
care?
W hy an im m e d ia te d e n tu r e
sh o u ld b e m a d e
The advantages of the immediate denture are
many and obvious. The patient is saved the em­
barrassment o f being edentulous for an extend­
ed period. The denture has a more pleasing ap­
pearance because tooth size, form, shade, and
position can be readily duplicated. The pres­
ence of some natural teeth serves as an inval­
uable guide to the vertical dimension o f occlu­
sion and the centric relation. Speech patterns
are not changed because there is not a prolonged
period of edentulousness. The overall ability o f
the patient to adapt to wearing a complete den­
ture is better because he is more likely to have
a positive emotional response to this type o f res­
toration.
W h en to m a k e an
im m e d ia te d e n tu r e
An immediate denture should be made in almost
all instances. Gehl and D resen ,1 in discussing
immediate dentures, said “ . . . that with some
exceptions they are indicated for practically all
patients in whose mouths a complete and thor­
ough examination has revealed a condition o f the
teeth that would warrant their removal in order
that the best interests o f the patients might thus
be served. . . . ” A n immediate denture o f som e
type and configuration can and should be made
for almost all patients who must lose their teeth.
On the other hand, is there an instance in
which an immediate denture should not be made?
The answer is “ almost never. ’’ One may not wish
to construct and insert an immediate denture if
the patient has a serious medical problem such
as rheumatic fever, poorly controlled diabetes,
acute allergic responses, or severe cardiovascu­
lar problems. In the planning o f treatment for
such a patient it is imperative to consult with
the physician and oral surgeon. Their counsel,
advice, and assistance are invaluable.
JADA, Vol. 87, September 1973 ■ 641
 Many oral surgeons prefer to treat patients by Craddock,2 the short-flange type advocated
who require extractions but who have severe by Pound,3 and the “ classical” full-flange type.
systemic diseases, in a hospital operating room
on an inpatient basis; optimal supportive ser­ ■ Flangeless im mediate denture: This is one
vices to the life and well-being of the individual of the easiest to construct and insert. However,
are immediately available. This is not a favor­ it poses a major problem of retention, and an
able time for the insertion and adjustment of an early remake is necessary. It is most useful if
immediate denture, especially if general anes­ a distinct undercut or prominence of the ante­
thesia is used. rior alveolar ridge area exists and if alveoplasty
Two alternatives are available in this situa­ is not planned. After posterior teeth are removed
tion. One is the making of full-arch diagnostic and the ridge has healed satisfactorily, the im­
casts, facial measurements, and tooth shade pression is made o f the remaining anterior teeth
records to be used as a guide in subsequent con­ and ridges with an irreversible hydrocolloid (al­
struction o f a conventional complete denture ginate) impression material in a stock tray. Af­
after the teeth have been extracted and the oral ter the cast is poured with a mechanically spat-
tissues have healed.
A better choice is to complete an immediate
denture before the teeth are extracted and to in­
sert it on a delayed basis several days after the
oral surgical aspect of treatment. The denture is
fitted and kept comfortable by application of an
appropriate tissue-conditioning material. This
is changed as required during healing, usually
once a week or every ten days. When the ridge
has stabilized—usually in two to three months
— the denture is then rebased or remade.
Another factor to consider carefully in the
determination of when an immediate denture
should be made— or any denture treatment
should be undertaken— is the emotional readi­
ness of the patient for the treatment. This all-
important aspect is often ignored by dentists.
It is too easy to become wrapped up in the de­
mands of technique and to slight the aspects of
the dentist-patient relationship. The finest tech­
nical expertise may come to naught if the pa­
tient’s emotional acceptance of treatment is
lacking.
An oversimplification might be to say— if the
patient likes the dentist, he will probably like the
denture. If he does not relate to the dentist, a
formidable barrier exists in the path of success­
ful treatment.

H ow to c o n s tr u c t
an im m e d ia te d e n tu r e

A wide choice o f impression materials, impres­

sion techniques, and methods o f treatment is
available. An immediate denture may be made
with various numbers of teeth in different pat­
terns remaining in the arch. Three general cate­
gories o f immediate dentures that may be made
are the flangeless or “ socketed” type described
642 ■ JADA, V o l. 87, S e p te m b e r 1973
Fig 1 ■ Top, flangeless maxillary immediate complete denture
ready for insertion. No alveoloplasty or surgical template is re­
quired. Center, second denture must be planned. Bottom, flange­
less denture is later rebased. Patient now has two serviceable
restorations.
ulated stone, the extent of the posterior flange
areas is delineated arbitrarily on the cast at the
point at which the tissues begin to flare away
horizontally from the ridge. The posterior palatal
seal is scribed into the cast in the same manner
as that used for a conventional complete den­
ture. Extension in the anterior area is not a prob­
lem because there is no flange.
A record base may be constructed with cold-
curing acrylic resin, a thermoplastic resin formed
in a vacuum press, or from a shellac baseplate
with the tissue surface corrected. Any o f these
methods is satisfactory if handled with due care.
The centric jaw relations may be registered in
zinc oxide-eugenol paste, accelerated dental
stone, or wax. If a combination of shellac base­
plate wax or waxes is used, the casts should be
mounted on the articulator immediately after
the registration to minimize distortions of the
material.
The teeth are set up so that they are “ socket­
ed” approximately 3 mm beneath the labial gin­
gival margin. They are contoured to be flush
with the palatal gingival surface with no exten­
sion therein. Processing and finishing of the den­
ture is relatively simple (Fig 1, top). N o sur­
gical template is needed. Insertion is no prob­
lem because the procedure involves removal of Fig 2 ■ Top, dental surveyor is used to determine labial exten­
the remaining teeth and no alveoloplasty is per­ sion of short-flange immediate denture. Bottom, short-flange
formed. Postoperative discomfort is minimal. denture, like flangeless type, will not require alveoloplasty or
The biggest problem is retention, and usually surgical template.
a denture adhesive powder is required. About
eight weeks after the extractions are performed, template is not needed. When ridge resorption
a second denture with conventional flanges and tissue changes begin, it is relatively simple
should be made (Fig 1, center). After several to add a tissue-conditioning or a cold-curing
months when the residual ridge has changed acrylic resin material, or both, to the denture
enough to make the second denture loose, the to readapt it. In this manner the underextended
first denture should be rebased. The patient flange is gradually built up. One has the option
then has two dentures, one for wear and one for of rebasing this denture later or of constructing
a spare (Fig 1, bottom). If a mishap such as a a new one. I recommend making the second
fractured tooth or denture base should occur, denture; then, any rebasing procedure may be
immediate, preemptive attention is not demand­ done without haste.
ed. Boucher4 said, “ Most exacting patients should
have two sets of dentures, regardless of the type
■ Short-flange immediate denture: Immediate of procedure used in their construction, in order
dentures with a short-flange are made in a man­ not to be without dentures in case of an emer­
ner similar to that of the flangeless dentures. gency, such as breakage, rebasing, or loss. This
The impression may be made with irreversible becomes doubly important when immediate den­
hydrocolloid (alginate) in a stock tray. The ante­ tures are constructed, as one of the advantages
rior flange area may be determined arbitrarily, given for this type of construction was that the
but use of a dental surveyor is preferred. With patient would not be without teeth at any tim e.”
the table tipped to the planned path of insertion, It is a beneficial service to the patient to provide
the area marked by the carbon rod shows the him with two workable dentures.
limit of a short denture flange; no alveoloplasty
need be performed (Fig 2, top). If this type of ■ Full-flange im m ediate dentures: One may
denture (Fig 2, bottom) is inserted, a surgical wish to construct a classical full-flange type of

S m ith : IM M E D IA T E C O M P L E T E D ENTUR ES ■ 643


Fig 3 ■ Top, rubber impression for full-flange immediate den­
ture is made in acrylic resin tray that does not touch anterior
teeth. Bottom, after rubber impression is positioned in mouth,
a “ pick-up” impression is made with irreversible hydrocolloid
(alginate). Excess alginate is carefully trimmed from rubber peri­
phery.
Fig 4 ■ Left, clear surgical template facilitates insertion of full-flange immediate denture. Right, full-flange
denture inserted. There is more lip distension than with flangeless or short-flange dentures. Gold restora­
tion was placed in distal aspect of maxillary right incisor to simulate one present in natural tooth.
644 ■ JAD A, V o l. 87, S e p te m b e r 1973
immediate denture if an anterior alveoloplasty
is planned for improvement o f appearance. A
useful impression technique has been described
by Campagna.5 An impression tray o f cold-cur­
ing acrylic resin is made on a diagnostic cast,
with a large opening left around the remaining
teeth. The peripheral borders are molded on the
tray in the mouth with stick modeling compound.
A rubber-base impression is made inside this
tray, but the tray does not touch the remaining
teeth (Fig 3, top). Any flash onto the tooth area
is trimmed away. This impression is replaced
in the mouth and a secondary “ pick-up” impres­
sion is made over it with irreversible hydrocol­
loid (alginate) in a stock tray. E xcess alginate
is carefully trimmed from the periphery (Fig 3,
bottom). This combination impression is then
poured in dental stone to form the working cast.
A clear surgical template should be made of
the trimmed cast to aid insertion, particularly
if alveoloplasty is planned (Fig 4). Although the
need for relining or rebasing may not occur as
soon as it might with the other types of imme­
diate dentures, it will occur sometime. A s with
the other immediate dentures, a desirable ser­
vice to the patient is construction of the second
denture. When the second ultimately loosens
because o f tissue changes, rebasing may be per­
formed on the first denture.
Many methods of relining or rebasing den­
tures are available. It is not the purpose of this
article to discuss them. Whatever method the
dentist may prefer he can perform the proce­
dure without haste or pressure if a second den­
ture has been made.

C o n tin u in g c a r e for th e p a tien t
Techniques of denture construction and rebas-
ing are only one part of the treatment. It has
been said that, “ Prosthetic appliances, such as
complete dentures, are merely part of, rather
than the whole treatment for edentulous pa­
tients.” 6 A paramount need is for ongoing pro­
fessional concern and assistance.
The “ what” o f continuing care for the patient
with dentures should include regular recall for
examination. A t this time the oral and adjacent
tissues should be carefully observed for evidence
o f inflammation or neoplasm. Radiographs of
the edentulous ridges should be made period­
ically. The denture bases or denture occlusion
should be adjusted as needed, and dentures
should be rebased or new dentures constructed,
when indicated. The patient should be coun­
seled if deficiencies are observed in mainten­
ance o f cleanliness o f the denture or the oral tis­
sues. The denture should be cleaned with use of
techniques available in the dental office. Condi­
tions of the oral tissues should be recorded for
future comparative evaluation. Finally, the pa­
tient must be given psychological support.
A term that has been suggested for the den­
tal vocabulary to separate the concept o f con­
tinuing care o f the edentulous individual from
the initial preparation o f dentures is “ edentics.”
This word is defined as, “ . . . the art, science,
and techniques used in the regular care o f the
edentulous.” 7 The word focuses attention on
the specific need o f the edentulous patient for
care; his need is just as great as that of the pa­
tient with natural teeth.
A s part o f the psychological preparation of
the patient for the transition to being edentu­
lous, it is of the utmost importance to educate
him to the fact that he should have this continu­
ing care. The responsibility of the dentist is not
completed when the denture is inserted, adjust­
ed, and rebased. Professional surveillance should
be maintained through the lifetime o f the pa­
tient.
S u m m a ry
Treatment planning must be flexible. An imme­
diate denture may be made for an arch with one
natural tooth or for a complete arch of teeth pres­
ent. A variety o f workable techniques is avail­
able, but the one that best fits the unique require­
ments o f the patient should be selected.
The alveolar bone must be conserved. It is
best to perform little or no alveoloplasty on re­
moval o f the anterior teeth. There are som e ex­
ceptions such as instances of gross anterior tooth
displacement, but these, fortunately, are not
common.
Two dentures should be planned. This ser­
vice provides the patient with an extra restora­
tion that can be invaluable if one denture is dam­
aged. This also simplifies the dentist’s problems
in making needed repairs or when rebasing one
denture.
The dentist must be aware of the emotional
needs of his patient. Psychological factors are
extremely important. N eglect in this area can
result in failure in terms of overall patient satis­
faction, in spite o f the finest treatment planning
and technical expertise.
The immediate denture must be considered
as one part of overall treatment. There is no
such thing as a permanent denture. The imme­
diate denture is one part o f what must be a con­
tinuing, ongoing professional service. The pa­
tient must be educated accordingly. Periodic
recall, examination, rebasing, and adjustments
are imperative for optimal health care.
C o n c lu s io n
The dentist must give thoughtful consideration
to the various options available in immediate
denture treatment and select the one that best
fits the needs of his patient. N o one method will
fit all situations. An integral, vital portion o f the
patient’s treatment is ongoing, conscientious
professional surveillance. If complete dentures
are made, they should be considered as the be­
ginning of a treatment process— not the end.
Dr. Smith is director of professional research at Dentspiy Inter­
national, Inc. His address is 500 W College Ave, York, Pa 17404.
1. Gehl, D.H., and Dresen, O.M. Complete denture prosthe­
sis, ed 4. Philadelphia, W. B. Saunders Co., 1958, p 424.
2. Craddock, F.W. Prosthetic dentistry; a clinical outline, ed 2.
St. Louis, C. V. Mosby Co., 1951, p 292.
3. Pound, E. Controlled immediate dentures. J Prosthet Dent
24:243 Sept 1970.
4. Boucher, C.O., ed. Sw en son 's complete dentures, ed 5. St.
Louis, C. V. Mosby Co., 1964, p 494.
5. Campagna, S.J. An impression technique for immediate
dentures. J Prosthet Dent 20:196 Sept 1968.
6. The Academy of Denture Prosthetics. Principles, concepts,
and practices in prosthodontics—1967. J Prosthet Dent 19:180
Feb 1968.
7. Edentics—continuing care for the edentulous patient
(pamphlet). York, Pa, Dentists’ Supply Co. of New York, 1968.
Smith: IMMEDIATE COMPLETE DENTURES ■ 645