Vol. 10 No.

1 Februari 2016 ISSN : 1907-5987

CASE REPORT

Immediate Removable Partial Denture For Aesthetic

Anterior Maxillary Tooth Rehabilitation
Benita Aryani Hendrata*, Paulus Budi Teguh**
*Clinical Student Faculty of Dentistry Hang Tuah University
**Department of Prosthodontic Faculty of Dentistry Hang Tuah University

ABSTRACT

Background: An anterior tooth extraction can cause aesthetic and psychological problems.
An Immediate Removable Partial Denture could be the choice of aesthetic rehabilitation
because is inserted immediately following the natural tooh extraction. Purpose: This paper
reported the case of Immediate Removable Partial Denture for aesthetic anterior maxillary
tooth rehabilitation in a 41-years old woman teacher. Case Report: A 41-years-old woman
teacher wasn’t confident with her #22 tooth microdontia and malpositioned. In order to
rehabilitated her aesthetic problem could be done by immediate #22 tooth extraction. Case
Management: Removable Partial Denture preparation was done by removing the #22 tooth.
The denture was inserted immediately after the extraction. After the denture was inserted, at
the 24-hours, 3 days, 1 week, and 1 month should be evaluated to know the bone resorption
process and whether the Immediate Removable Partial Denture should be relined or not.
Conclusion(s): The Immediate Removable Partial Denture provides an aesthetic
rehabilitation and increases the patient’s self-confidence because the patient has no
edentulous period.

Key Words: Immediate Removable Partial Denture, Aesthetic, Anterior Tooth Extraction

Correspondence: Paulus Budi Teguh, Department of Prosthodontic Faculty of Dentistry

Hang Tuah University, Jl. Arif Rahman Hakim 150 Surabaya 60111 Indonesia, Telp. 031-
5945894, 031-5912191, E-mail: paulusteguh@yahoo.co.id

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BACKGROUND day of extraction. After the healing

process is completed, a new denture is
Modern dentistry offers many fabricated as the long-term
options for the restoration of partially prothesis.12,13
edentulous patient, like Removable This paper reported the case of
Partial Dentures (RPDs). Many RPDs with CID for aesthetic anterior
patients choose RPDs due to factors maxillary tooth rehabilitation.
ranging from cost to physiology.1
RPDs are utilized to improve the
aesthetic and masticatory functions.2,3 CASE REPORT
According to Gunadi, et al. (2013),
there are two types of RPDs depend on A 41-years old woman teacher
the fabrication and the timing of visited the Department of
insertion, Conventional RPDs and Prosthodontic Faculty of Dentistry
Immediate RPDs (Immediate Hang Tuah University, needed for
4
Denture). Immediate denture could be RPDs to rehabilitate her aesthetic and
inserted immediately following the masticatory functions. The patient was
natural teeth extraction, mainly willing to have her 22 tooth being
anterior teeth so that minimize the extracted and reshaped without being
aesthetic problem. edentulous because the patient was a
Immediate denture (ID) is a teacher and asked for immediate
removable partial denture or a replacement of the extracted tooth in
complete denture that was constructed order to continued her professional
for placement immediately after the duties. Beside that, the patient also had
natural teeth extraction.5,6 ID is a lost some of her posterior teeth. The
necessity to prevent anxiety and patient was informed about Immediate
embarrassement because patient has no Removable Partial Denture to maintain
edentulous period and can do the daily her aesthetic and masticatory
activities without worried.7,8 ID can problems.
restore the phonetic and mastication Extra-oral examination revealed
functions, also preserve the remaining that temporomandibular joint was
oral tissues.9,10 normal, face shaped was tapering,
Currently, there are two popular eyes, nose, and lip were normal. Intra-
types of ID, Conventional (or Classic) oral examination revealed that 22 tooth
Immediate Denture (CID) and Interim was microdontia and malpositioned,
(or Transitional or Nontraditional) 14, 15, 16, 22, 23, 24, 25, 26, 36, 37,
Immediate Denture (IID).11 In CID, 44, 45, 46 teeth had been extracted
the patient has lost the posterior teeth because of dental caries, calculus on
and the anterior teeth are removed at the anterior and posterior region both
the day of immediate denture maxillary and mandibular, caries on
placement. After the placement of the cervical mesial side 43 tooth, 27, 33,
CID and after the healing process is 34 teeth were supraposition, and also
completed, the denture is refitted or there were diastema and gingival
relined to serve as the long-term recession on the anterior region
prothesis. While in IID, the anterior mandibular teeth (Fig 1).
and the posterior teeth remain until the

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Fig 1. Pre Treatment Intra-Oral Condition Of The Maxillary And Mandibular Teeth.

Fig 2. Panoramic radiographic examination revealed that the remaining teeth had lost a
few bone resorption.

According to Kennedy periodontal treatment planning,

classification, maxillary: Class III scalling and root planing on the
Kennedy modification 1 with 22 tooth anterior and the posterior region both
microdontia and malpositioned, maxillary and mandibular to reduce
mandibular: Class II Kennedy oedema possibility and prevent the
modification 1. complications after extraction.
Restorative procedure, caries on
cervical mesial side 43 tooth was filled
CASE MANAGEMENT with Glass Ionomer Cement (GIC).
After that, occlusal adjustment 27, 33,
In initial appointment, the patient 34 teeth that were supraposition on the
was interviewed for the dental and incisal and occlusal side in accordance
medical history related to the chief to the Curve of Spee, so that the
complaints which accompanied the maxillo-mandibular relationship would
diagnostic examination. Panoramic be harmony and also prevented the
radiographic examination was also traumatic occlusion. Then occlusal rest
taken. The patient was informed about seat preparation on 17, 27, 47 teeth.
the limitations of the Immediate The dentinal tubules should be covered
Denture. Primary impressions for the by varnish to prevent the sensitive
diagnostic casts were made with teeth.
irreversible hydrocolloid impression The mandibular individual tray
material (alginate) in perforated stock was made with ostron blue and was
trays and were poured using gypsum border moulded with green stick
type III (dental stone). The diagnostic compounds and then the spacer was
casts served several purposes as an aid removed, the perforations were made
to diagnosis and treatment planning. in the tray to enhance the flow of the
Mouth preparation followed the impression material. The mandibular
prelimenary diagnosis and the functional impression was made with
development of a tentative treatment silicone impression material and the
plan. Mouth preparation included maxillary functional impression was

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made with irreversible hydrocolloid Artificial teeth shade selection

impression material (alginate) to based the patient’s natural teeth were
produce the working casts (Fig 4). The selected by a shade guide. While
working casts were poured using artificial teeth shape and size selection
gypsum type III (dental stone). based on the patient remaining teeth as
a guide. After making the clasps, the
artificial teeth arrangement on the
posterior region both maxillary and
mandibular (Fig 7). The occlusion of
the artificial teeth arrangement were
evaluated in the patient if the occlusion
was harmony or not (Fig 8).

Fig 4. Maxillary And Mandibular

Functional Impressions.

The working casts were

surveyed and blocked out. Afterwards,
maxillary and mandibular relations
were recorded with the occlusion rims
in the patient (Fig 5), then the working Fig 7. The Artificial Teeth Arrangement On
casts with the occlusion rims were The Articulator.
mounted on the articulator (Fig 6).

Fig 8. The Evaluation Of Artificial Teeth

Arrangement In The Patient.
Fig 5. Maxillary and Mandibular Record
With Occlusion Rims In The Patient. After the evaluation was done,
22 tooth was trimmed on the working
cast with a carbide bur. The trimming
used the pocket depths as a guide and
should be concave. The labial tissue
could be trimmed deeper about 1mm
than the pocket depths. The aim was to
preserve as much bony tissue as
possible.

Fig 6. The Mounted Working Casts On The

Articulator.

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A A B

Fig 11A. Maxillary RPD With An

B Immediate Denture.
Fig 11B. Mandibular RPD.

At the day of the denture

placement, the patient was prepared
for the extraction. Asepsis on the
Fig 9A. #22 Tooth Before Trimmed. extraction site with povidon iodine
Fig 9B. #22 Tooth After Trimmed. 2%, then 22 tooth was extracted under
local anesthetic, nasopalatine nerve
After that, 22 artificial tooth block and anterior superior alveolar
arrangement on the trimming site nerve block with pehacain (lidocain
followed by contouring (Fig 10). After 2% + adrenaline 1:80.000). A
contouring was done, the dentures hemostat was placed in the extraction
were then fabricated with heat cured socket to reduce the bleeding and the
polymethylmethacrylate resin. patient was instructed to bite the sterile
gauzed firmly for about 20 minutes.

Fig 10. #22 Artificial Tooth Arrangement

On The Trimming Site.
Fig 12. Extraction Procedures.
The dentures that had been
constructed, were prepared and Before the denture’s placement,
polished, should be considered about the dentures were cleaned with
the borders of the denture bases, the antiseptic liquid soap. After the
facial surfaces, teeth and adjacent bleeding had stopped, the maxillary
areas. All of the sharped margins were and mandibular RPDs were inserted
rounded off. and should be considered about if there
were sharped clasps, occlusion, and
articulation, mainly if there was a
premature contact with an articulating
paper.

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to kept the extraction site clean. After

cleaning, the dentures should be worn
immediately.

Fig 13. Insertion Of The RPDs With An

Immediate Denture.

The patient was given post- Fig 14. Condition Of The Maxillary And
extraction home care instructions, Mandibular Teeth At The 24 Hours Visit.
which include not to removed the
immediate denture and used it all day On the 3 days visit after the
during the first 24 hours due to post- insertion, the extraction socket began
extraction oedema that could make its to healing. There were not any sore
reinsertion impossible for 3 to 4 days spots or traumatic ulcerations. The
until reduction of oedema. The patient patient felt more comfortable with the
should avoid rinsing, avoid drinking dentures and could eat well. There
hot liquids, and diet should be liquid or were no problems with the occlusion
soft. Ice packs could be wrapped in a and articulation, also the retention and
cloth and applied in 20 minutes the stabilitation of the dentures were in
intervals immediately after the a good condition.
extraction and throughout the first 24 On the first week visit after the
hours could reduce bleeding and insertion, the extraction socket healing
swelling. Antibiotic and analgesic was almost completed. The patient’s
medications were prescribed as adaptation with the dentures were
required and the patient was recalled better and felt really comfortable with
for the 24 hours visit for necessary the dentures. The retention and the
adjustments and checked up. stabilitation of the dentures still in the
At the 24 hours visit, the patient good conditition.
complained if she felt a little pain on
the gingival around the extraction site
because of the labial flanged. The A
labial flanged was reduced on the
inside using a fraser bur. Intra-Oral
examination revealed that there were
not any pain or irritations. There were
not any swelling or bleeding in the B
patient. The patient was instructed to
continue the antibiotic and analgesic
medications. After the 24 hours visit,
the patient should be shown how to Fig 16A. Condition Of The Maxilary And
Mandibular Teeth Without The Dentures On
removed the denture after eating to The 1 Week Visit.
clean it with soft toothbrush and Fig 16B. Condition Of The Maxilary And
antiseptic liquid soap, also to rinse the Mandibular Teeth Without The Dentures On
mouth at least three to four times daily The 1 Week Visit.

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On the first month visit after the patient has no edentulous period after
insertion, the extraction socket was the anterior teeth extraction.17 22 tooth
completely healing. The patient’s that was malpositioned, became
adaptation with the dentures were looking better. The patient who is a
better and felt really comfortable with teacher could do her professional
the dentures. The retention and the duties without worried. Immediate
stabilitation of the dentures still were denture also has therapeutic and
in the good conditition so that the prophylaxis functions, because
relining wasn’t needed. immediate denture acts as a bandage to
help control bleeding, to protect
against trauma and oral environment
A
aggressions, such as food, debris, and
saliva coming in contact with the
wound, to protect the blood clot, and
promote rapid healing.18,19 The patient
is likely to adapt more easily to the
B dentures because speech and
mastication are rarely
compromised.8,12
Less postoperative pain is likely
to be encountered because the
extraction sites are protected by the
Fig 17A. Condition Of The Maxilary And immediate denture.13,19 Immediate
Mandibular Teeth Without The Dentures On denture also may result in reduced
The 1 Month Visit. residual ridge resorption and also
Fig 17B. Condition Of The Maxilary And promotes better ridge form.20,21 Less
Mandibular Teeth With The Dentures On bone resorbtion by using immediate
The 1 Month Visit.
denture than waiting for the healing
process, because there is functional
DISCUSSION stimulation from the used denture.
Moreover, by using immediate denture
On this case, the maxillary RPD face height and circumoral support can
with the conventional immediate be maintained.
denture was constructed with partial Immediate denture also has
flanged. Partial flanged gives more many disadvantages, there is no try-in
natural appearance so that the aesthetic possible so the final result couldn’t be
factor could be better achieved.4 predicted. Increased treatment cost
Healing process is faster because the because more chair time and
less contact between the oral tissues immediate denture might be relined
and the partial flanged so could after few months.12,13
minimize the irritation and helps When trimmed 22 tooth, the
accelerating the healing period.4,14 labial tissue could be trimmed deeper
Partial flanged also gives better than the pocket depths. This is because
retention and stabilitation.15,16 the anterior maxillary ridge resorbs
Immediate denture gives many upward and backward with progressive
advantages, especially increases the bone loss.22-24
patient’s self-confidence because the

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The success or failure treatment 6. Gadge HR, Gandhewar MA, Kori S,

Nagral S, Lotwani V. Immediate
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