How long do immediate prostheses last

With an immediate prosthesis (Synonym: immediate prosthesis) it is a definitive (final) removable partial or full denture to replace missing teeth. Used immediately after a surgical procedure, it needs to be adapted to the changed jaw structure after the wound has healed.

In the wound healing phase after a Tooth extraction (Tooth removal) not only regenerate the soft tissues covering the jawbone. Rather, the alveolus (the bony tooth socket) of the extracted tooth is restructured so that the alveolar ridge undergoes a change in shape.

It only makes sense in exceptional cases to incorporate a definitive denture that should remain in function for a number of years without waiting for the restructuring process of wound healing. On the other hand, chewing function and aesthetics must be ensured, and extensive wound areas must be protected from mechanical stimuli, if necessary.

If a definitive (final) denture is used immediately after a surgical procedure, it must be adapted to the shape of the jaw, which changes in the course of wound healing, after a few weeks. The time required for wound healing is about two months.

As a rule, it is partial immediate dentures (partial dentures) low-cost plastic prostheses based on PMMA (polymethyl methacrylate), which are attached to the remaining dentition with hand-bent wire clips and thus largely restore the chewing function and aesthetics.

This simple form of partial denture is a purely mucosal or gingival (on the mucous membrane or gums) restoration, without being supported by the remaining teeth, which transfers the chewing pressure to the alveolar ridge. This reacts to this long term atrophy (Regression of the bone). In addition, the curved brackets are not very gentle on the neck area of ​​the bracket tooth in the long term. For the reasons mentioned, this type of care is a cost-effective compromise that is only conditionally beneficial for oral health and should be the exception.

On the other hand, the situation is different with an immediately (immediately) deployed Full denturewhich is used to supply a completely toothless jaw. This follows the design principles for every full denture that is not manufactured in the context of a surgical procedure. A Lining with functional edge design After the wound has healed, it can be turned into a full-fledged permanent denture.

Definitions: interim prosthesis - immediate prosthesis

According to health insurance guidelines, you must choose between an interim prosthesis and a Immediate prosthesis (from Latin: immediately) can be distinguished. While the latter is a right away inserted after surgery final restoration the interim prosthesis is only used to bridge the gap until a definitive (final) denture is made.

Indications (areas of application)

  • Restoration of the chewing function, phonetics (language function) and aesthetics after tooth extractions
  • Preservation of the vertical jaw relation (distance from upper to lower jaw base)
  • Stabilization of the occlusion (the chewing closure and the chewing movements)
  • Prevention of elongation (a tooth outgrowing from the jawbone in the absence of opposing teeth)
  • Preventing tooth migration and tilting
  • Protection of the surgical wound

Contraindications (contraindications)

  • Proven allergy to PMMA (polymethyl methacrylate; a plastic) or other ingredients

The procedure

I. Dental office - preoperative impressions

At an appointment that is so far before the surgical procedure that the immediate denture can be manufactured in the dental laboratory in the meantime Impressions of the jaw to be restored and the opposing jaw made of alginate (impression material).

Is the planned prosthesis a Full denture, one will already try now to shape the future edges of the prosthesis in the sense of a functional edge design to be influenced by functional movements that the patient performs under supervision before the impression material sets (hardens). If necessary, an individual impression tray is made on the basis of the first impression in the dental laboratory Functional impression is taken. The aim of the edge design is to ensure that the future edges of the prosthesis are embedded in the surrounding soft tissue in a way that is free from interference, yet easily displaced and thus sealed.

With the help of a Bite taking (made of wax or silicone) the positional relationship between the upper and lower jaw is brought into relation to one another.

II. Laboratory

II.1. Fabrication of a partial immediate prosthesis

  • The impressions are used in the dental laboratory Plaster models created.
  • The models are based on the bite registration articulated (Articulator: device for imitating the position of the jaws in relation to one another and the movements of the temporomandibular joint).
  • etching - The crowns of the teeth intended for extraction are erased (removed) on the plaster model.
  • The clasp teeth are measured in order to determine the tooth equator (greatest curvature of the tooth crown). Bent by hand Brackets are adjusted and fixed on the model. The brackets will later rest against the neck of the tooth below the tooth equator with a slight tension.
  • The Prosthetic base, in which the brackets are anchored and the denture teeth are set up, is first modeled from wax. With regard to the finished plastic base, restrictions in wearing comfort must be accepted in favor of the material thickness, since the plastic is not stabilized by a metal frame.
  • The wax model is implemented in acrylic.
  • The hardened denture acrylic is finished and polished.

II.2. Manufacture of a total immediate prosthesis

Making a Full denture inserted immediately is largely based on the design principles for every full denture that is not manufactured in the context of a surgical procedure. However, the usual intermediate steps such as the wax try-in (try-on of the teeth that were initially set up in wax, still offers the possibility of correcting the position) cannot be carried out.

  • In the dental laboratory, the impressions Plaster models created.
  • The models are articulated on the basis of the bite registration (articulator: device for imitating the position of the jaws in relation to one another and the movements of the temporomandibular joint).
  • etching - The crowns of the teeth intended for extraction are erased (removed) from the plaster model.
  • The Prosthetic base, in which the denture teeth are set up, is first modeled from wax.
  • The wax model is implemented in acrylic.
  • The hardened denture acrylic is finished and polished.

III. Dental practice - integration of the immediate denture

Immediately after the surgical procedure, the patient is provided with the interim replacement. Small corrections to brackets, margins and occlusion (final bite and chewing movements) can be made. The base of the prosthesis is checked for pressure points, with the restriction that at this point in time the patient cannot perceive pressure points due to the ongoing local anesthesia (local anesthetic).

After the procedure

  • After the surgical procedure, an appointment for a wound and pressure sore check is scheduled for the next few days.
  • Regular checks should also be carried out in the course of further wound healing in order to be able to make repeated corrections to the prosthesis seat.
  • After the wound has healed, the dentures are adapted to the changed jaw situation by relining.

L.iterature

  1. Pospiech P: The prophylactically oriented supply with partial dentures. Georg Thieme Verlag, Stuttgart 2001: 160f
  2. Lehmann KM, Hellwig E, Wenz HJ: Dental Propaedeutics: Introduction to Dentistry. Deutscher Zahnärzte-Verlag 2008: 282
  3. Caesar HH, Lehmann KM: The partial denture: Basics. Construction and dental engineering. New Merkur Verlag 2007: 142

     
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