The decision may be _lWde to insert dentures at the time of tooth removal and bony recontouring. Hartwelll-‘ cites several advantages of an immediate denture technique. The insertion of a denture after extraction offers immedi-ate psychologic and esthetic benefits to patients, whereas alternatively they may De edentulous for some time. The immedia-te insertion of a denture after surgery also functions to splint the surgical site, which results in the reduction of postoperative ‘bleedirrg and edema and improved tissue adaptation to the alveolar rige. Another advantage
is that the vertical dimension can be most -easily reproduced with an immediate denture technique. Disadvantages include the need for frequent alteration of the denture postoperatively and the construction of a new
denture after initial healing has taken place. . Surgical- treatment for immediate denture insertion can be accomplished in stages, with extraction of the posterior dentition in the maxilla and the mandible done before anterior extraction. This allows for initial healing of the posterior areas and facilitates the denture con- struction. After the initial healing period of the posterior segments, new records are taken and models are mount- r
ed on a serniadjustable articulator. After replacement of the model teeth with prosthetic teeth, the cast of the alveolar ridge area is then carefully recontoured (Fig. 13-29). Immediate denture surgery generally involves the most conservative technique possible in removal of the remaining teeth. An intraseptal alveoloplasty, preserving as much vertical height and cortical bone as possible, is generally indicated. (Fig. 13-30). After the- bony recontouring and elimination of gross irregularities is completed,
the tissue is approximated with digital pressure, and the clear acrylic surgical guide constructed on the presurgical casts is inserted. Any areas of tissue blanching or gross irregularities are then reduced until the clear surgical guide is ‘adapted to the alveolar ridge in all areas. Incisions are closed with continuous or interrupted sutures. The immediate denture with a soft liner is inserted. Care should be taken not to extrude any reline material into the fresh wound. The occlusal relationships are .checked and adjusted as necessary. The patient is instructed to wear the denture continuously for 24 hours and to return the next day for a postoperative check. Bupivacaine or another similar long-acting local anesthetic injected at the conclusion of the surgical procedure greatly improves comfort in the first 24-hour postoperative period. At that time the denture is gently
removed, and the underlying mucosa and alveolar ridge areas are inspected for any areas of excessive pressure. The denture is cleaned and reinserted, and the patient is instructed to wear the denture for 5 to 7 days and to remove it only for oral saline rinses. Sutures are generally taken out 7 days postoperatively.