An atypical chairside immediate denture: A clinical report

Anton S. Gotlieb, DDS,a and Samuel W. Askinas, DDSb

College of Dental Medicine, Nova Southeastern University, Ft. Lauderdale, Fla.
This clinical report describes the fabrication of an immediate complete denture for a patient with an
extensive fixed prosthesis that was no longer serviceable because of major loss of integrity of the
supporting abutment teeth. The procedure, which was performed chairside, replicated the existing
fixed prosthesis as part of an immediate complete denture. (J Prosthet Dent 2001;86:241-3.)

here are many advantages to immediate, as

opposed to conventional, complete dentures.1 From
the patients point of view, chief among these advantages is the preservation of the persons natural
appearance and social mobility (loss of such mobility
often results from the absence of anterior teeth). When
a conventional complete denture is fabricated, there is
normally a period of several weeks to months of edentulism for healing after extraction.2 This clinical report
describes the chairside fabrication of an immediate
maxillary complete denture.

attached fixed prosthesis during the removal of the

impression. Wax strips (Utility wax strips, Hygienic,
Akron, Ohio) then were placed on the occlusal surface
of the maxillary impression tray to maintain the mobile
fixed prosthesis in position during the impression procedure. Maxillary and mandibular irreversible
hydrocolloid impressions (Integra, Kerr, Orange,
Calif.) were made with the use of stock trays (TRA
Tens, Teledyne Water Pik, Ft. Collins, Colo.) (Fig. 3).
The mandibular cast was poured in dental stone
(Microstone, Whip Mix, Louisville, Ky.).

CLINICAL REPORT
The patient was a 78-year-old woman with no significant medical history. She was first seen on referral
with a multiunit ceramometal fixed partial denture
extending from the maxillary right first molar to the
maxillary left first molar (Fig. 1). The latter tooth was
an attenuated pontic cantilevered distal to the maxillary left second premolar abutment tooth. The
prosthesis had been placed several years previously.
The crowns of all abutment teeth, except the maxillary
right first molar, had completely decayed to the gingivae, and the prosthesis was extremely mobile because
it was attached to only a single intact abutment tooth.
The patient was adamant that she could not be edentulous for any length of time, however brief, as her
employment required meeting the public every day.
After radiographic and clinical examinations were
completed, the patient was appointed for the chairside
fabrication of a maxillary immediate complete denture
(Fig. 2). Consideration was given to incorporating the
patients 12-unit fixed partial denture in the immediate
prosthesis.3 Because of the dentures weight and the
associated problems of ensuring its attachment to the
denture base, the decision was made to duplicate the
denture with acrylic resin.
The maxillary right first molar was anesthetized
(Citanest Plain 4%, ASTRA, Westborough, Mass.) in
anticipation of its possible odontectomy with its
aAssociate
bProfessor

Professor, Department of Restorative Dentistry.

and Chairperson, Department of Restorative Dentistry.

SEPTEMBER 2001

Fig. 1. Patient at initial examination.

Fig. 2. Panoramic radiograph.

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Fig. 3. Maxillary impression with occlusal wax stops and

vibrating line.

GOTLIEB AND ASKINAS

Fig. 5. Maxillary cast with acrylic resin dental arch and posterior palatal seal area outlined.

Fig. 4. Maxillary impression with tooth-colored acrylic resin

in dental arch.

Fig. 6. Maxillary and mandibular casts hand articulated in

maximum intercuspal position.

A slurry of PMMA (Alike, GC America, Alsip, Ill.)

was prepared in a shade that matched the patients dentition and poured into the dental arch of the maxillary
impression (Fig. 4).4 After polymerization, the acrylic
resin was removed from the dental portion of the
impression and trimmed to the gingival borders. Several
retentive diatorics were prepared in the ridge laps of the
acrylic resin dental arch to ensure accurate locking of
the fixed prosthesis duplicate to the subsequent cast.5
The acrylic resin arch was reseated in the impression, and the maxillary cast was poured in dental stone.
This maxillary cast was retrieved from the impression
with the acrylic resin dental arch in place (Fig. 5).
Both casts were hand articulated in maximum inter-

cuspal position to verify the integrity of the occlusal

relationship (Fig. 6).
The posterior border and posterior palatal seal were
scored on the maxillary cast. Pink autopolymerizing
PMMA resin (Acraweld, Schein, Philadelphia, Pa.) then
was applied to the entire maxillary cast; PMMA polymer was alternately added and saturated with monomer
to form the entire denture base. The maxillary cast and
denture were placed in a pressure pot (Aquapress,
Lang, Wheeling, Ill.) with warm water, and 20 psi of air
pressure was applied during polymerization.
The maxillary denture was separated from the cast,
finished, and polished (Fig. 7). The patient was reanesthetized, and the maxillary right first molar with its

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Fig. 7. Maxillary denture separated from cast.

Fig. 8. Patient at 1 week after insertion.

attached fixed prosthesis was removed. The roots of 2

additional teeth were removed in the maxillary right
quadrant, and 2 sutures were placed.
Pressure-indicating paste (Mizzy, Cherry Hill, N.J.)
was applied to the intaglio surface of the denture,
which then was inserted and adjusted for impingements. This procedure was repeated until the denture
was fully seated and the occlusion duplicated the
patients original maxillomandibular relationship. The
denture was relined with tissue conditioner (Coe Soft,
GC America, Alsip, Ill.) to enhance retention, patient
comfort, and patient confidence. The patient was dismissed after she made an appointment for the removal
of the remaining maxillary retained roots. She was seen
after 24 hours and again after 1 week (Fig. 8) and was
comfortable at all times. The definitive prosthesis was
delivered 1 month after the placement of the immediate denture.

was delivered 1 month after the chairside immediate

denture was placed.

DISCUSSION
Conventional immediate denture treatment
requires a series of appointments. Replacement of
the patients remaining teeth is accomplished by
placing denture teeth on the cast to duplicate or
refine the patients natural esthetics and establish
an ideal maxillomandibular relationship. This conventional procedure may be difficult or impossible
to accomplish when the remaining dentition in
the arch includes extensive fixed prostheses linking anterior and posterior teeth.
For the patient previously described, the esthetics
and articulation of the immediate denture duplicated
those of the preexisting maxillary fixed prosthesis. The
patient was comfortable with both prostheses,
although it was obvious that the occlusal relationship
was less than ideal. This situation was ultimately
resolved, as planned, when a new maxillary complete
denture was fabricated after the maxilla had healed. It

SEPTEMBER 2001

SUMMARY
The chairside fabrication of an immediate denture
has been described. Conventional immediate denture
procedures were not possible with this patient
because the entire maxillary arch consisted of a fixed
prosthesis attached to only 1 intact, but mobile,
abutment tooth with a strong likelihood of spontaneously exfoliating. The patient, due to the
requirements of her lifestyle and employment,
emphasized the necessity for the most timely and efficacious restoration of the maxillary arch.

REFERENCES
1. Arbree NA. Immediate dentures. In: Zarb GA, Bolender CL, Carlsson GE,
editors. Bouchers prosthodontic treatment for edentulous patients. 11th
ed. St. Louis (MO): Mosby; 1997. p. 415-42.
2. Livaditis GJ. Indexing procedures for converting removable partial dentures after extractions while the patient retains the prosthesis. J Prosthet
Dent 1999;81:485-91.
3. Zalkind M, Hochman N. Converting a fixed partial denture to an interim
complete denture: esthetic and functional considerations. Quintessence Int
1997;28:121-5.
4. Khan Z, Heaberle CB. One-appointment construction of an immediate
transitional complete denture using visible light-cured resin. J Prosthet
Dent 1992;68:500-2.
5. Mou SH, Chai T. The pontic-splinted procedure for tooth and denture
base additions in denture repair. J Prosthet Dent 2001;85:126-8.
Reprint requests to:
DR ANTON S. GOTLIEB
DEPARTMENT OF RESTORATIVE DENTISTRY
NOVA SOUTHEASTERN UNIVERSITY COLLEGE
3200 S UNIVERSITY DR
FT. LAUDERDALE, FL 33328
FAX: (954)262-1782
E-MAIL: agotlieb@nova.edu

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DENTAL MEDICINE

Copyright 2001 by The Editorial Council of The Journal of Prosthetic

Dentistry.
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