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Same Day Dentures v Conventional Dentures
What are same-day dentures?
Dentures are widely used in dentistry as a replacement for missing and lost teeth. They come in a variety of shapes and sizes and are made from a diversity of materials. They can be used virtually anywhere, and very few people are not candidates to receive dentures, either complete ones replacing all the teeth, or partial ones replacing only a few missing teeth. The concept of same-day (immediate dentures) is a relatively modern one, considering that dentures have been around for almost 100 years. The process is simple – extract the teeth and fit the denture in the same visit. This type of denture can be beneficial for patients who have missing front teeth, where looks are all that matters, or when extraction would cause a massive deficit in eating or speech.
How are same-day dentures different from regular dentures?
Firstly, they differ in the material. Although same day dentures are made from acrylic resin (or plastic) like complete dentures, the resin in is specially treated to minimize trauma and sensitivity, and often soft and flexible acrylic (which has no monomer, or the acid that causes all the irritation) is used.
Secondly, same-day dentures are manufactured and fitted differently. While standard dentures require multiple fittings and impressions that involve advanced techniques to record the relationship between upper and lower jaws, same-day dentures are much easier. Only one impression is done before the teeth are extracted. The denture is made according to that impression. The second visit involves extracting the teeth and then inserting the denture all on the same day.
Finally, as you would expect, they differ a lot in fitness and comfort, but we’ll get to that later on. As you can probably imagine, there are some disadvantages to this type of denture. Since they are made before the teeth are extracted, and before complete healing of the bones and the gums, they don’t fit as well as traditional dentures, and therefore a bit of food being trapped under the denture is expected, and consequently the hygiene and possible inflammation and infection of the wound could occur. Also, quite a bit of adjustment would be needed to improve the fit and comfort so you would need to visit the dentist almost every month for minor readjustments. This type of denture also lacks longevity, where it usually works for one year and would need to be replaced afterward once all the healing and bone remodeling is done. The cost is also an issue, not because they are more pricey than standard dentures (except when soft, flexible dentures are used since these are quite expensive), but because they only last a year, while other types could last up to 5 years.
Advantages Of immediate dentures
Although same-day (immediate dentures) are by no means the perfect all-around solution for missing teeth, they can be the best option in many circumstances.
When front teeth are missing or need to be removed, an immediate denture fitted on the same day is the quickest and most convenient way to restore a person’s smile. Most people will suffer from embarrassment and a lack of confidence if they have to face the day with missing front teeth while waiting for a conventional denture to be made.
Allows proper chewing patterns.
Every single tooth plays a vital role in the eating process so living for any period with missing teeth can affect the diet and quality of life. Immediate dentures allow people the option of having a full complement of teeth after having teeth removed.
Helps maintain clear speech.
The teeth play an essential role in the production of clear speech. Missing teeth, especially front teeth can cause slurred speech and the inability to produce certain sounds. For people who are missing vital teeth, immediate dentures offer the quickest solution for returning the speech to normal.
Helps support facial features.
Many people fail to realize just how important teeth are in preserving the shape and fullness of the face. Missing teeth can affect the position of the jaw bones, cheeks and lips and cause the face to look sunken and compressed. Immediate dentures help to instantly restore support to the face and prevent a look of premature aging.
Disadvantages Of same-day dentures
Although immediate dentures are a convenient solution for people who want to have a denture fitted the same day as they have teeth extracted, they do also have some disadvantages.
A same-day denture will work out to be more expensive because it will have a lifespan of only a year compared to about five years for a conventional denture. Also, fitting, adjusting and relining immediate dentures can require more visits and therefore add to to the total cost of the procedure.
Immediate dentures are short-lived and are best viewed as a temporary solution. A conventional denture will last about five years while an immediate denture will have a lifespan of only a year.
Same-day dentures will be manufactured before the dentist removes the patient’s teeth, so it is likely that the denture might not fit as snuggly as a conventional denture. Additionally, after teeth are extracted the bone in the jaw that used to secure the teeth will begin to shrink away resulting in loosening of the denture.
Requires more adjustments.
After the dentist has extracted the teeth, he will wait until the mouth has healed, and the initial bone shrinkage has occurred before fitting a conventional denture. This allows him to ensure a more secure and long lasting fit. However, immediate dentures are fitted before the healing process has begun so the patient will likely have to schedule more visits for adjusting and re-fitting as the mouth heals.
Immediate denture replacement procedure
An impression of the jaw where the tooth to be extracted is taken, and another one for the opposing jaw to control the size, and sent to the lab.
The lab breaks the tooth to be removed from the poured mold and places an artificial tooth in its place (of course not very accurate as can be expected).
The lab returns the denture to the dentist, who during the next visit of the patient extracts the tooth, places stitches in its place, and checks the denture for fitting. Minor adjustments could be made then to ensure proper fit and comfort.
Wear the denture for 24 hours straight after extraction, even during sleeping, so that the gums adjust to their presence.
Come back for a check-up visit the following day, to ensure that nothing harmful is going on in the wound area.
Come back one month later to check the fit, and if there are any changes in the occlusion and closure.
3 months later is the time for relining, which is adding another layer to the inside of the denture to improve fit.
One year later, this denture is discarded, and a new permanent one is fabricated.
Aftercare advice for same-day dentures.
First 24 hours after surgery.
The dentist will fit the immediate denture in place as soon as the teeth have been extracted and it is essential that the denture is not removed for 24 hours. The pressure of the denture in place will help to stop bleeding. After the immediate denture is fitted in place, it is likely that the patient will feel some degree of pain and discomfort. The dentist will advise on appropriate pain control medication. Refrain from smoking and drinking alcohol for at least 48 hours after having teeth extracted and the denture fitted. Smoking and drinking can interfere with the blood clotting process and irritate the wound. Drink plenty of fluids. Limit diet to soft foods while the wound is still tender. Avoid very hot foods and drinks to avoid irritation. Avoid drinking fluids through a straw as this can disrupt the blood clotting process in the wound. While the denture is still in place, it is beneficial to rinse the mouth with warm salty water (1 teaspoon salt in 1 cup water) twice a day.
It is likely that the dentist will ask the patient to schedule a visit the following day so he can remove the denture, check the wound and make sure it can be re-fitted comfortably.
48 hours after surgery.
Remove denture and clean it with a denture brush and denture cleaner. After cleaning the denture, carefully fit it back into the mouth.
The first week after surgery.
Unless otherwise advised by your dentist, keep the denture in for 24 hours a day for the first week. Only remove the denture to clean it with denture brush and cleanser. Continue to diet on soft, easily chewed foods. Avoid drinking through a straw and if possible, avoid smoking and drinking alcohol.
Two weeks after surgery.
The second week after surgery the denture should be removed during sleep and soaked in water overnight.
Two weeks onward.
As the healing process takes place, the contouring of the mouth will change, and the denture might become slack and ill-fitting. The dentist will be able to make additional adjustments to make the denture comfortable.
Care and cleaning same-day dentures.
The final point concerning same-day (immediate dentures), and possibly the most critical point, is their cleaning and hygiene. Immediate dentures need an incredible amount of care, even more so than regular dentures.
There are two aspects of post-operative care of immediate dentures; the first is care of the wound. Since it is an open wound, great measures should be taken to avoid inflammation and infection. The dentist would advise refraining from rinsing and spitting for the first day or two and then prescribe a saline mouthwash to prevent bacterial contamination and infection. In severe cases, the dentist may even prescribe anti-inflammatory medication and sometimes antibiotics to ensure no harm would come to the wound. The stitches should be removed one week later at most since they are a common area for bacterial colonization and if left for long, could be the source of infection.
The dentist would also advise you to refrain from smoking for the first week, or at the very least for two days after the procedure, and would limit you to a soft and cold diet for the first day or two, all to minimize the trauma to the open wound.
The second aspect is the hygiene of the denture itself. After the first 24 hours where the denture should not be removed at all, the dentist would advise you to clean the denture using the BSB technique, which stands for “Brush – Soak – Brush again.” The denture should be brushed using the normal toothbrush and toothpaste as your natural teeth, and then soaked in a denture cleaning solution before being brushed once again and inserted back in the mouth. The denture should be worn during the day and removed at night and should not be worn continuously, as this puts pressure on the wound are and underlying gums and bone, and could cause inflammation and irritation.
Dr. Mohamed Tarek Galal Abdel Hamid is a practicing dentist, the founder and owner of Confidental clinic in Cairo.