Immediate replacement complete dentures: pitfalls of ignoring traditional teaching and established practice

A thirty-year-old female had immediate replacement dentures made by a general practitioner and her teeth extracted and the dentures fitted under general anaesthetic by her local oral surgeon three months previously. Anterior and posterior teeth had been extracted and no attempt had been made to smooth or shape the ridges. Both dentures were constructed with gum fitted anterior teeth without labial flanges. This treatment differs from traditional immediate replacement complete denture teaching. Traditionally, when possible the posterior teeth would have been extracted first and then once there had been a period of healing the immediate replacement complete dentures would have been made replacing the remaining anterior teeth. A trans-septal alveolotomy would have been performed, which would reduce the labial undercut on the edentulous ridge so that the denture could have a labial flange which would enable a border seal to be established to enhance retention but would not displace the lip. Care would have been taken to ensure that the fit surface of the denture would reflect the change in ridge shape that would follow healing. The divergence of this treatment management from a traditional approach raises important questions. In the past oral surgeons were well versed in pre-prosthetic surgery. As demand for this type of treatment has declined, so has the opportunity for oral surgery trainees, who themselves may have limited experience in prosthetic dentistry, to learn the techniques involved. Teaching of this form of removable prosthetic dentistry has been reduced reflecting the reduced frequency of this presenting condition.