Multiple Extractions and Immediate Dentures
When the decision has been made that the remaining teeth are non-salvageable and indicated for extraction in preparation for the transition to a full denture, there are two basic alternatives. The first alternative would be to extract the remaining teeth, and wait several weeks or months for the areas to heal before making the denture. Most people usually don't choose this option because it means that they will have to function without any teeth during this time. As you would expect, most patients would find this objectionable, and therefore in most cases, this is not the chosen alternative. The other alternative, which is the far more popular choice is that of an immediate denture.
An immediate denture is one that is placed immediately after having the remaining upper or lower teeth (or in some case both) removed. With this technique, the patient is able to have the esthetic benefit of having a denture placed at the time of extraction of the teeth, so that he or she can wear this prosthesis during the time that the extraction sites are healing. This way the patient will not have to go without teeth for any period of time.
In many cases, the immediate denture will indeed be the final denture, although in most cases it will require modification several months down the line to accommodate the changes that occur in the shape of the gums and bone during the healing process. In other cases, the dentist may decide that the best course of action would be to make the immediate denture a temporary denture, and then make the permanent denture later on after the gums and bone have fully healed.
Your dentist will take an impression of your upper and lower jaws, before any of the teeth are removed. A plaster mold is made from this impression, and this model is sent to the lab. The lab tries to simulate the surgery by grinding the teeth off the mold. The denture is then made on this modified mold. The lab does the best they can in trying to predict what the shape of the gums and bone will be like after the teeth have been removed, but despite their best efforts, it will most likely not match perfectly, and a reline (see below) may be required when the denture is placed at the time of surgery.
As you would expect, there is always a certain amount of discomfort involved whenever several teeth are removed. In most cases however, the denture actually acts much like a bandage over a wound, and may actually make the surgical sites more comfortable.
After the denture is placed, there is a normal settling process that takes place, usually beginning in the first few days after the surgery. This settling of the denture may cause small pressure sores to develop. Your dentist will see you for regular visits after placement of the denture, and the areas where the denture is rubbing excessively are trimmed and smoothed. These sores will heal, but the denture may continue to settle, and new sore spots may develop. This is normal, and adjustments may be required for up to the first month following placement of the denture.
This depends upon how many teeth need to be removed. Ordinarily, this can be done in one visit. There are times however, when there may still be many back teeth remaining, and your dentist may prefer to have the surgical phase of the procedure performed in two stages.
Sometimes it is desirable to have all the back teeth removed first, before having the front teeth removed and the denture placed. This two-stage procedure allows the back part of the jaws to heal and smooth out, so when your dentist takes the impression of your jaws, the back areas have already healed, allowing the lab to make a more accurate denture. This will result in a denture that will fit better, and be more comfortable when the remaining front teeth are removed and the immediate denture is placed.
When the teeth are removed, the bone that contained the teeth is often sharp and irregular. These sharp areas would result in increased pain, and prolonged healing. The surgeon may determine that these areas may need to be smoothed out at the time the teeth are removed. This allows the denture to glide in and out more easily without rubbing across sharp areas.
As mentioned above, it is normal for there to be pressure sores that develop due to the settling of the denture. These areas normally resolve quickly when the dentist makes adjustments to the locations on the denture that are causing the sores. It may take up to a month before the dentures are completely comfortable. This is a normal part of the experience of becoming accustomed to the new prosthesis, so don't be discouraged early in the process, when it seems that it is taking a long time for things to feel better.
It is not necessary to maintain a strictly liquid diet. You can advance to soft foods, and then regular foods when you feel comfortable enough to do so.
If it acceptable to your dentist, it is O.K. to use denture adhesive with the immediate denture. Right after the procedure though, it is important to be careful to avoid placing the adhesive in the areas where there may be stitches.
Because of the changes that will take place in the shape of the jaws after healing is complete, the denture, which may have fit well immediately following the procedure, may now not fit as well. The reline will allow for a better fit after the changes that have taken place in the jaws during the healing phase.
There are two types of relines. The first is called a soft reline. This is often done at the time of surgery or shortly thereafter, if the shape of the gums and the bone immediately after extraction of the teeth doesn't closely match the shape predicted by the lab, and the denture is loose when it is placed. This is a temporary lining material that gives a custom fit at the time of the procedure, so that the denture fits better. Remember though, as time goes on, the gums and bone will change shape, and the immediate denture will most likely become more loose as time passes and the gums and bone shrink during healing. This may require another temporary soft reline for stability of the denture before the healing is completed, but in most cases, the patient is able to use the denture after the initial soft reline until sufficient healing has taken place to either permanently reline the denture, or replace the temporary denture with the final prosthesis. The hard reline, or permanent reline is done several weeks to several months (depending upon how well the jaws have healed) after the surgery, when the gums and bone have finished healing.
This decision is made by the dentist, and may be from several weeks to several months after initial placement of the denture. It is done when it has been determined that there is unlikely to be any further significant change in the shape of the jaws due to further healing.
Dentures are still prosthetic devices, and it is unrealistic to expect that you will be able to eat everything that you once could with your natural teeth. Most patients however, are able to eat a wide variety of foods with minimal difficulty.
Your dentist will talk to you about dental implants, which are sometimes used to help stabilize dentures, when lack of good stability is a problem. Your dentist will determine if you may be a candidate for this type of treatment.