If you plan on getting complete dentures in just one visit, without the need for a dental lab, your dentist may need to rely on the Larell One Step Denture technique for fabrication, using easily adjustable templates made of a special thermoplastic material. Alternatively, you can opt for same-day dentures or all-on-4/6/8 mini implant supported dentures.
Immediate dentures are used to provide patients with denture replacements without leaving them without teeth for an extended period. The traditional technique for immediate dentures involves removing the posterior teeth first, allowing for healing, and then constructing the denture to be delivered when the anterior teeth are extracted. However, this approach has its drawbacks.
The traditional technique introduces delays and complications during the healing and long denture fabrication process. And even if you opt for immediate dentures using other techniques, they are likely to have fitting issues upon placement, since they are typically based on estimations of the post-extraction ridge, which can lead to dentures that are either too small or too large.
With the Larell One Step technique for immediate dentures, patients can benefit from instant fabrication with a guaranteed fit. This results in shorter treatment times, improved denture fit, and fewer post-placement problems or adjustments.
While all immediate dentures will still require a relining procedure to account for alveolar bone shrinkage that occurs over time, this technique shows reduced shrinkage during the first six months due to its more accurate fit. Ultimately providing greater comfort for the patient.
Procedure for getting immediate dentures
Before the day of the procedure, you may need to visit the dentist for diagnostic tests, such as dental impressions, X-rays, and 3D scans, to aid in treatment planning and the fabrication of the immediate denture.
Once the dentist has diagnosed the patient’s condition and planned the treatment, they can proceed to create the dentures in just one visit. However, before starting the procedure, there are a few factors that the dentist needs to consider. These include the patient’s overall health, the dentist’s ability to remove teeth and perform alveoloplasty (reshaping the jawbone to create smooth ridges), and the complexity of the surgery.
Here is the step by step process:
Step 1: Tooth extraction and performing alveoloplasty
When teeth are removed and alveoplasty (smoothing of the bone ridges) is performed, local anesthesia is commonly used, or conscious sedation. It is administered to numb the area and ensure that the patient does not experience pain or discomfort throughout the tooth extraction and surgical process. At this point, any bony outgrowths, such as tori or exostoses, and any deep indentations, called undercuts, are also addressed.
Step 2: Take impressions
Once the extraction and bone reshaping are completed, the dentist takes an impression of the jaw’s ridge using a substance called alginate. This impression captures the shape of the edentulous (toothless) ridge and is quickly filled with a stone-like material that sets rapidly.
Step 3: Denture fabrication
Next, the dentist fits the Larell denture template onto the model created from the impression. This template helps determine the placement of the teeth on the denture and ensure a proper fit in areas such as the palate (roof of the mouth), tuberosity (bumpy areas on the upper jaw), and flanges (extensions of the denture that rest against the gums).
The flanges are trimmed to leave a small gap, around 2 to 3 millimeters, between their height and the vestibular fold, allowing space for future adjustments.
Alternative Technique for designing immediate dentures
Your dentist may also choose to design your immediate dentures using a different approach:
- The impression and model are made using the patient’s existing teeth and the pre-extraction ridge.
- The dentist can then perform alveoloplasty on the model before proceeding with the denture fabrication.
This method is particularly useful when the same dentist who will extract the teeth and shape the jawbone is also responsible for making the denture. It allows the dentist to determine in advance the amount of reshaping needed and ensures a closer fit of the preformed template.
Step 4: Immediate denture fitting
Once the chosen technique is completed, and all natural teeth to be removed have been extracted, and alveoloplasty is finished, the denture is ready to be fitted and completed. The dentist places the template in the patient’s mouth to check its fit, the extension of the flanges, the display of the teeth, and the support provided to the lips.
Step 5: Denture relining
To enhance the denture’s fit and comfort, a material called reline material, such as Flexacryl, is added to the denture. The reline process ensures a better adaptation of the denture to the reshaped jawbone.
Step 6: Finishing
Finally, the denture undergoes finishing and polishing using the same procedures as any other denture.
Step 7: Follow-up appointments
After the initial placement, you will need to schedule several follow-up visits in the weeks and months following the procedure. These appointments allow the dentist to monitor your healing progress, make any needed adjustments to the denture, and provide instructions for proper care and maintenance.
Aftercare Tips for Immediate Dentures
Common After-Surgery Conditions:
- Swelling around the operated area is normal and will reach its maximum in two days. Applying a warm towel can help reduce discoloration.
- Stretching of the corners of the mouth may cause dryness and cracking. Keep your lips moist with an ointment like Vaseline.
- A slight elevation in temperature for 24-48 hours is normal. If it persists, notify your dentist.
- If immediate dentures are inserted, sore spots may develop. Your dentist will see you within 24-48 hours to make necessary adjustments and improve the bite relationship.
Keep the Denture in Place:
- Ideally, leave your new denture in place for 24-48 hours to allow the tissues to heal and improve stability.
- If it becomes uncomfortable or bleeding persists, the denture can be removed briefly but should be reinserted as soon as possible.
- After 2-3 days, wear the denture during the daytime only and leave it out at night.
Bleeding:
- Biting with the denture in place should control bleeding. If bleeding persists, remove the denture and bite on a gauze pad placed over the extraction sites for 20-30 minutes.
- If bleeding continues, repeat the process. If bleeding is excessive, contact your dentist.
Rinsing:
- Rinse gently with cold water when the denture is in place during the first 24 hours.
- After that, rinse with warm water several times a day with or without the denture in place.
- During the first 24-48 hours, you may want to remove the denture briefly and rinse gently with a mouthwash solution for a fresher taste.
Retention:
- The denture may not fit tightly initially, as healing takes time. Adjustments may be needed during subsequent visits to your dentist.
- If retention becomes a significant problem, a soft lining material may be placed to improve stability.
Bite Relationship:
- Adjustments to the bite of the denture may be necessary and should be done by your regular dentist who knows your proper jaw and tooth relationships.
Sore Spots:
- It’s normal to develop sore spots in your gums in the first two weeks. Your dentist can adjust the denture to alleviate these spots.
- If a bone spicule or sharp area of tissue is causing the problem, it can be easily treated by your dentist.
Diet:
- You can start with liquids or soft foods right after getting the denture.
- Gradually progress to a regular diet, which may take 10 days to several weeks depending on your comfort level and chewing ability.
Stitches:
- Stitches, if used, will generally dissolve on their own. If they are black or purple, your dentist will remove them after 7-10 days.
Post-Operative Appointments:
- Visit your regular dentist within the first few days after denture insertion for evaluation and necessary adjustments.
- Close follow-up in the first couple of weeks is important for optimal healing. You will also have an appointment with the oral surgeon’s office about 7-10 days after surgery.
FAQs
Is sedation necessary for fitting immediate dentures?
Immediate dentures involve the extraction of teeth and the immediate placement of a denture. This can be a somewhat invasive procedure, and some patients may find it uncomfortable or stressful. As such, the procedure is typically done under local anesthesia, but additional sedation options may be available to help patients feel more at ease and reduce any potential pain or anxiety associated with the procedure.
How long does it take to get immediate dentures?
Here’s a general timeline for the procedure of same-day immediate dentures:
- Initial consultation and treatment planning – usually takes about 30 minutes to an hour
- Impressions and preliminary measurements – The dentist will take impressions of your mouth and make measurements to create a customized denture that fits your remaining teeth and gums. This step typically takes around 30 minutes.
- Tooth extractions and alveoloplasty – The time required for this step can vary depending on the number of extractions and the complexity of the procedure. It can range from 30 minutes to a couple of hours.
- Immediate denture fabrication – Once the teeth are extracted and bleeding controlled, impressions of the post-extraction ridge are taken, and the dentist may modify the denture template to ensure proper fit and occlusion. The denture fabrication process, including applying the reline material, checking the inner surface to ensure even pressure distribution, confirming the occlusion using articulating paper, and polishing the denture takes about 35 minutes.
- Follow-up appointments: After the initial placement, you will need to schedule several follow-up visits in the weeks and months following the procedure for denture adjustments due to changes in the shape of the jawbone.
What are the benefits of the Larell One Step Denture?
This type of denture is well-suited for immediate dentures because your false teeth can be placed right after the teeth are removed, without the need for a lengthy laboratory process or implants. The Larell technique allows for a good fit by using easily adjustable templates made of a special thermoplastic material.
Here are other benefits of Larell one-step immediate dentures:
- Whether the immediate denture is made to fit against another denture or the patient’s natural teeth, the occlusion (how the upper and lower teeth fit together) can be easily adjusted.
- The close fit of the template before the final adjustment allows for a precise fit to the shape of the jaw ridge after the teeth are extracted. This functional border molding technique also helps in providing comfort to the patient by properly relieving muscle attachments near the ridge.
- This technique allows for quicker and more comfortable functioning with the denture, and it minimizes the shrinkage of the jaw ridge over time due to the good fit and occlusion of the denture.
- The positioning of the teeth over the ridge also allows for better chewing while still providing the necessary support and retention.
- The Larell dentures have a monoplane occlusion, meaning that the upper and lower teeth have a flat biting surface, which allows for a balanced occlusion. This balanced occlusion helps in maintaining the best possible retention and support for the denture.
- In cases where the postsurgical ridge is not smooth or even, and there are areas that require softer material, a combination of soft and hard reline materials can be used together in the same template. These materials provide the necessary support, retention, and comfort desired by the patient.
- Occlusal surfaces (the biting surfaces) of the denture can be easily modified. For example, if there is an open bite (a gap when the teeth come together), the denture template can be immersed in boiling water for a short time and the teeth can be manually moved to close the bite. If larger adjustments are needed, notches can be made in the template to allow for movement of entire segments and create the desired occlusion. The base of the template can also be adjusted to fit the unique shape of the patient’s jaw ridge. It’s important to make these modifications before the reline process, as once the template is relined, no further adjustments can be made.
Final Thoughts
As with any immediate denture, the jaw ridge will undergo changes after the surgery, and a reline (adjustment) of the denture may be necessary around 6 months after the initial placement. The same Larell template can be used for this reline process by removing a small amount of material and repeating the procedure. The occlusion will have already been set, so it becomes easier to reline the denture.
Reference
https://www.dentistrytoday.com/one-step-in-office-immediate-dentures/
