Immediate Dentures – Workflow from Extraction to Wear

Why an immediate denture and not wait?

The patient says: 'I can't go without teeth for 3 months.' – and they're right. An immediate denture is a denture that the patient receives on the day of tooth extraction (or the day after).

Advantages:

• Patient doesn't wait, isn't toothless publicly
• Psychologically easier
• The denture quickly adapts to the patient's new anatomy (teeth continuously change after extraction for the first 2–3 months)

Disadvantages:

• The lab must work quickly (CAD design, printing/production in 3–5 days)
• The denture will change over time (bony socket resorbs) – the patient will need relines

Anatomy of the immediate denture workflow

Phase 1: Planning and preparation (1–2 weeks before)

What the dentist does:

1. Chooses the extraction date
2. Sends to the lab: mandibular/maxillary model with teeth to be extracted + model or information on occlusal height, tooth color
3. Plans which teeth will be extracted, which will remain

What the lab does:

1. Creates a "post-extraction" model (prints a model without teeth to be extracted)
2. Designs the denture on the edentulous model (CAD)
3. Prints / manufactures – work takes a minimum of 2–3 days

Phase 2: Extraction day – denture insertion

In the clinic (dentist):

1. Extracts teeth
2. Waits 10–15 minutes for bleeding to subside
3. Patient comes to the office (if the lab is nearby) or denture arrives by shipment
4. Dentist inserts denture, checks occlusion, removes sharp edges

At home (patient):

• Wears the immediate denture
• Rapid physiological changes occur (wound heals, bone changes)

Phase 3: Follow-up, relines (1st month)

Check-up schedule:

• Day 1 after extraction: check-up, follow-up visit, adjustment if discomfort is present
• Week 1: first reline (usually some areas need to be relieved where the patient feels discomfort)
• Week 2–4: additional relines depending on how quickly the socket changes

What changes:

• The tooth socket changes shape (bone resorbption)
• Rests may become less retentive (because the bone changes)
• Denture may move more

Phase 4: Reline and finalization (2–3 months)

After 2–3 months, when the socket stabilizes → the denture is sent for reline to the lab:

1. The lab removes old material from the intaglio surface
2. Creates a new impression (patient comes in, an impression is taken with the denture in place)
3. New material is added – the intaglio surface changes again
4. The denture returns to the patient – the final version

Dimensions and design of the immediate denture

The design must be accurate even though the patient does not yet have the "post-extraction" appearance:

1. Occlusal height – measured on the natural teeth (those remaining) + extraction taken into account
2. Tooth position – the lab designs the teeth to align with the natural teeth (if some remain)
3. "Edentulous" model – the lab must have an accurate model without the teeth to be extracted (or notes stating "extract teeth 16, 17, 18")

Common errors in immediate dentures

1. Occlusion too high – patient says "I can't close my teeth"
2. Rests not engaging – denture dislodges immediately (needs relining)
3. Denture prepared too low – patient says "I can't chew, it hurts"
4. Lab did not receive enough information – denture is "to be redone"
5. Patient expects "perfection" – doesn't understand that relines will be needed (needs to be explained beforehand)
6. Too long between extraction and insertion – if waiting >2 hours, the socket is already changing, the denture may not fit well