Immediate dentures are a specialized type of dental prosthetic designed to be placed in the mouth immediately following the removal of natural teeth. This offers an immediate restoration of appearance and function. The process is a carefully coordinated sequence of clinical and laboratory steps that anticipates the changes the mouth will undergo post-surgery. These prosthetics act as a transitional appliance, helping patients maintain their smile and the ability to speak while their gums and underlying bone structure begin the healing process.
Pre-Extraction Clinical Planning
The initial step in creating an immediate denture is a comprehensive clinical assessment, including detailed medical and dental histories. The dentist takes preliminary impressions of the existing teeth and surrounding gum tissue. These molds are sent to a dental laboratory to create accurate plaster models, which serve as a blueprint of the mouth before extractions.
Following the molding, the dentist records the relationship between the upper and lower jaws, known as bite registration, to ensure the new dentures align correctly. The patient also selects the appropriate shade and size of the artificial teeth, guided by aesthetic preferences. These details are transferred to the lab for fabrication.
The laboratory technician uses the plaster model to “surgerize the cast.” This involves physically grinding away the plaster teeth to simulate the gum line after extraction. The technician then replaces these removed plaster teeth with the selected artificial denture teeth, setting them into the denture base material. This process creates a prosthetic designed to fit the mouth immediately after surgery. The finished denture is then returned to the dental office, ready for the procedure.
Insertion and Post-Surgical Care
The procedure begins with the removal of the natural teeth. Immediately following the extractions, the custom-fabricated denture is inserted. The denture serves a dual purpose: replacing missing teeth and acting as a surgical bandage by applying continuous pressure to the extraction sites. This sustained pressure controls post-operative bleeding and limits swelling.
For the first 24 hours, the patient must not remove the denture, even while sleeping, as swelling could make reinsertion impossible. Patients are advised to apply ice packs to the face to manage swelling. They must also avoid actions that could dislodge blood clots, such as forceful rinsing, spitting, or drinking through a straw. Pain management involves prescribed or over-the-counter medication. A liquid or soft diet is necessary for the first day, and the patient must return for a check-up and adjustment approximately 24 hours after insertion.
Managing Initial Tissue Changes
The period following placement is characterized by rapid changes in oral anatomy. As the gums heal, the underlying bone structure, known as the alveolar ridge, remodels. This bone resorption is a natural response to the loss of the tooth root, causing supporting tissues to shrink and the denture’s fit to loosen.
This predictable shrinkage makes the immediate denture progressively unstable, leading to sore spots and reduced comfort. To counteract this, the dentist applies a temporary soft liner, or tissue conditioner, to the inner surface of the denture. This pliable material conforms to the changing contours of the healing gum tissue, improving retention and cushioning the extraction sites.
The temporary soft liner is not a permanent solution and may need replacement every few weeks during the active healing phase, which lasts three to six months. Patients must follow specific cleaning instructions, avoiding abrasive toothpaste on the soft liner. Gentle cleaning with a soft brush and mild soap is recommended. Adjustments for comfort and bite alignment are frequent during this phase to accommodate ongoing tissue changes.
Permanent Relining and Maintenance
Major tissue remodeling generally stabilizes between six and twelve months after extractions. Once the jawbone and gum tissue reach a stable form, the immediate denture is ready for the final, permanent adjustment, known as a hard reline. This procedure is necessary because temporary soft liners are not durable for long-term wear, and the denture base no longer accurately matches the healed tissue contours.
A permanent reline involves taking a final impression using the immediate denture as a custom tray. The denture is sent to the laboratory, where the temporary lining is removed and replaced with new, hard acrylic material. This process creates a stable, long-lasting fit designed to maximize comfort and function. Since the denture is processed in a lab, the patient may be without their appliance for several hours or a full day.
After the hard reline, the immediate denture transitions into a long-term appliance requiring regular maintenance. Patients should remove the denture nightly to allow gum tissues to rest. They must clean the prosthetic using appropriate cleansers and a soft-bristled brush. Annual check-ups are recommended to inspect the fit and screen for tissue changes that may necessitate future adjustments.