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The influence of immediate dentures on tissue healing and alveolar ridge form
THE INFLUENCE OF IMMEDIATE DENTURES ON TISSUE HEALING AND ALVEOLAR RIDGE FORM ELLSWORTH K. KELLY, COLONEL, DC, USA,” AND RAYMOND F. SIEVERS, D.D.S.” Washington, D. C., and Bellevue, Wmh.
as a splint for the tissues and promotes healing. The bone resorbs less rapidly and tissue softness is preserved when stimulation is supplied by a denture base.‘*” No exper’m I ental substantiating evidence of these statements exists, but most dentists agree with these observations from the clinical appearanceof the alveolar ridges after immediate dentures are inserted.
T
HE IMMEDIATE
DENTURE ACTS
TEMPLATE TESTS
We formulated a clinical investigation to determine if immediate dentures did exert a beneficial influence on the resulting alveolar ridge. Subjects were available for whom the social advantages of an immediate denture meant very little. We used a clear acrylic resin template and inserted it after the anterior teeth were extracted. After using the template as a guide for the surgery, half of the anterior portion of the template was cut away, and the patient wore it just as he would have had it been an immediate denture (Figs. 1 and 2). This procedure was followed for a number of patients, and 7 of them cooperated sufficiently so that we could use them as a representative group. Observations were made on the second, third, fifth, and seventh postoperative days. RESULTS
Uniform results were obtained in that on the second and third days the anterior tissue which was confined in the template appeared more rounded and smoother. However, this advantage was lost by the fifth day and thereafter it was impossible to differentiate which side of the ridge had been covered and which side was uncovered (Figs. 3 and 4). The last patient became very fond of the acyrlic resin template and not only wore it faithfully but used it during mastication to some extent. Her ridge continued to show a difference in the uncovered and covered sides after the fifth postoperative day. The opinions or assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the Army Department or the United States Army at large. Received for publication Nov. 12, 1958. *Chief, Dental Service, Walter Reed Army Hospital. **Formerly Captain, DC, USA. 738
Volume 9 Number 5
IMMEDI,ATE
DENTURES
;30
We concluded that the key to good ridge formation under the influence of immediate dentures was the early functional stimulation that the bases put on the tissue and not the splinting action of the base. In fact, our results showed that there was a benefit from the splinting action but that this benefit decreased after the first postoperative day and was nonexistent after three or four days. Fia. 1.
Fig. 2.
Fiz. 3.
Fig. 4.
Fig. 1 .-The transparent templates were cut away in the anterior region. These were placed in the mouth at the time of extraction and worn to simulate the effect of an immediate denture. Fig. 2 .-This template had been in place 5 days after bhe teeth were extracted. Note that part of tbe tissue is exposed. Fig. 3 .-A template had been worn for 24 hours. The covered side (right) appears smoothel where the edematous tissue has been confined. Fig. 4.-The template has been worn for 5 days. There is little difference in the character of the ridge on either side, and this difference became less apparent within a day or two. IMMEDIATE
DENTURE
TESTS
Sometime later we followed this study with the insertion of immediate dentures made on a base such as we had used for the first study. These dentures were made in the usual way, but half of the anterior section was cut away so that half of the anterior ridge was not in contact with the denture base (Figs. 5, 6, and 7). Five patients have been tested in this manner over the past 5 years. RESULTS
The first few postoperative days showed results such as we obtained when the patients wore the cut-out templates. However, the results of function soon became
KELLY
740
AND
SIEVERS
J. Pros. Den. Sept..Oct., 1959
apparent. The covered side continued to look more rounded and smoother than the uncovered side, and this difference was apparent until the fifth or sixth week postoperatively. The mucosa appeared more resilient and thicker under the covered
Fig. 5.
Fig. 6.
Fig. 7.
Fig. cut-away teeth on Fig. Fig.
&-The extent of contact of the denture base of a test immediate denture with the portion is outlined in pencil. The thin band of acrylic resin supporting the anterior the uncovered side was not ln contact with the tissue. 6.-A test immediate denture is in place in the mouth. ‘I.-The tissue on the uncovered side is not in contact with the denture base material.
side than it did on the side not covered by the denture base (Figs. 8 and 9). The results for all patients were fairly uniform, but it appeared that the difference in ridge formation occurred in direct proportion to the amount of stimulation the
IMMEDIATE
74’1
DENTURES
patients gave to the tissues. The patients who adapted quickly to the denture and reported that they were eating everything very early had a greater difference in the covered and uncovered portions than did the patients who adapted poorIy and did not do much vigorous chewing during the experimental period. The tests were terminated 5 to 6 weeks after extraction so that comfortable dentures could bc constructed for the patients.
rig. a.
pig. 9.
Fig. S.--The covered (left) side looks slightly more rounded and smoother 48 hours post. operatively. The templates produce this same effect at this stage of healing. Fig. B.-The difference in form between the uncovered and covered sides is quite apparent 30 days postoperatively. The character of the mucosal covering is thick and resilient on the side under function (left) and taut and thin over the bony prominences on the uncovered (right) side. SUMMARY
Clinical tests with transparent templates and immediate dentures indicate that : 1. With only the template, the tissue covered appeared smoother and fuller for the first 2 to 3 postoperative days. Thereafter, the difference between the two sides disappeared, although the patients continued to wear the template.
742
KELLY
AND
SIEVERS
J. Pros. Den. Sept..Oct., 1959
2. With the immediate denture, the good effects of the coverage were prolonged, and after 30 days, distinctly different types of ridges were formed. The results varied among the patients in direct proportion to the function they exerted on the tissue with the denture. CONCLUSIONS
1. Immediate dentures exert a beneficial splinting action on the tissues by containing the edema and molding the tissues for the first 48 hours postoperatively. After this period, the mere covering of the tissues does no appreciable good. 2. The functional stimulation to the tissues from an immediate denture creates a smoothly-rounded, bony ridge formation and a thick, resilient mucosal covering which would not occur without the stimulation. REFERENCES
1. Swenson, M. G: Improving Immediate Dentures in General Practice, J.A.D.A. 47:550, 1953. 2. Hughes, F. C.: Immediate Denture Service : Advantages, Disadvantages and Technical Procedures, J.A.D.A. 34:20, 1947. Box 307 WALTER REEDHOSPITAL WASHINGTON 12, D.C.
as a splint for the tissues and promotes healing. The bone resorbs less rapidly and tissue softness is preserved when stimulation is supplied by a denture base.‘*” No exper’m I ental substantiating evidence of these statements exists, but most dentists agree with these observations from the clinical appearanceof the alveolar ridges after immediate dentures are inserted.
T
HE IMMEDIATE
DENTURE ACTS
TEMPLATE TESTS
We formulated a clinical investigation to determine if immediate dentures did exert a beneficial influence on the resulting alveolar ridge. Subjects were available for whom the social advantages of an immediate denture meant very little. We used a clear acrylic resin template and inserted it after the anterior teeth were extracted. After using the template as a guide for the surgery, half of the anterior portion of the template was cut away, and the patient wore it just as he would have had it been an immediate denture (Figs. 1 and 2). This procedure was followed for a number of patients, and 7 of them cooperated sufficiently so that we could use them as a representative group. Observations were made on the second, third, fifth, and seventh postoperative days. RESULTS
Uniform results were obtained in that on the second and third days the anterior tissue which was confined in the template appeared more rounded and smoother. However, this advantage was lost by the fifth day and thereafter it was impossible to differentiate which side of the ridge had been covered and which side was uncovered (Figs. 3 and 4). The last patient became very fond of the acyrlic resin template and not only wore it faithfully but used it during mastication to some extent. Her ridge continued to show a difference in the uncovered and covered sides after the fifth postoperative day. The opinions or assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the Army Department or the United States Army at large. Received for publication Nov. 12, 1958. *Chief, Dental Service, Walter Reed Army Hospital. **Formerly Captain, DC, USA. 738
Volume 9 Number 5
IMMEDI,ATE
DENTURES
;30
We concluded that the key to good ridge formation under the influence of immediate dentures was the early functional stimulation that the bases put on the tissue and not the splinting action of the base. In fact, our results showed that there was a benefit from the splinting action but that this benefit decreased after the first postoperative day and was nonexistent after three or four days. Fia. 1.
Fig. 2.
Fiz. 3.
Fig. 4.
Fig. 1 .-The transparent templates were cut away in the anterior region. These were placed in the mouth at the time of extraction and worn to simulate the effect of an immediate denture. Fig. 2 .-This template had been in place 5 days after bhe teeth were extracted. Note that part of tbe tissue is exposed. Fig. 3 .-A template had been worn for 24 hours. The covered side (right) appears smoothel where the edematous tissue has been confined. Fig. 4.-The template has been worn for 5 days. There is little difference in the character of the ridge on either side, and this difference became less apparent within a day or two. IMMEDIATE
DENTURE
TESTS
Sometime later we followed this study with the insertion of immediate dentures made on a base such as we had used for the first study. These dentures were made in the usual way, but half of the anterior section was cut away so that half of the anterior ridge was not in contact with the denture base (Figs. 5, 6, and 7). Five patients have been tested in this manner over the past 5 years. RESULTS
The first few postoperative days showed results such as we obtained when the patients wore the cut-out templates. However, the results of function soon became
KELLY
740
AND
SIEVERS
J. Pros. Den. Sept..Oct., 1959
apparent. The covered side continued to look more rounded and smoother than the uncovered side, and this difference was apparent until the fifth or sixth week postoperatively. The mucosa appeared more resilient and thicker under the covered
Fig. 5.
Fig. 6.
Fig. 7.
Fig. cut-away teeth on Fig. Fig.
&-The extent of contact of the denture base of a test immediate denture with the portion is outlined in pencil. The thin band of acrylic resin supporting the anterior the uncovered side was not ln contact with the tissue. 6.-A test immediate denture is in place in the mouth. ‘I.-The tissue on the uncovered side is not in contact with the denture base material.
side than it did on the side not covered by the denture base (Figs. 8 and 9). The results for all patients were fairly uniform, but it appeared that the difference in ridge formation occurred in direct proportion to the amount of stimulation the
IMMEDIATE
74’1
DENTURES
patients gave to the tissues. The patients who adapted quickly to the denture and reported that they were eating everything very early had a greater difference in the covered and uncovered portions than did the patients who adapted poorIy and did not do much vigorous chewing during the experimental period. The tests were terminated 5 to 6 weeks after extraction so that comfortable dentures could bc constructed for the patients.
rig. a.
pig. 9.
Fig. S.--The covered (left) side looks slightly more rounded and smoother 48 hours post. operatively. The templates produce this same effect at this stage of healing. Fig. B.-The difference in form between the uncovered and covered sides is quite apparent 30 days postoperatively. The character of the mucosal covering is thick and resilient on the side under function (left) and taut and thin over the bony prominences on the uncovered (right) side. SUMMARY
Clinical tests with transparent templates and immediate dentures indicate that : 1. With only the template, the tissue covered appeared smoother and fuller for the first 2 to 3 postoperative days. Thereafter, the difference between the two sides disappeared, although the patients continued to wear the template.
742
KELLY
AND
SIEVERS
J. Pros. Den. Sept..Oct., 1959
2. With the immediate denture, the good effects of the coverage were prolonged, and after 30 days, distinctly different types of ridges were formed. The results varied among the patients in direct proportion to the function they exerted on the tissue with the denture. CONCLUSIONS
1. Immediate dentures exert a beneficial splinting action on the tissues by containing the edema and molding the tissues for the first 48 hours postoperatively. After this period, the mere covering of the tissues does no appreciable good. 2. The functional stimulation to the tissues from an immediate denture creates a smoothly-rounded, bony ridge formation and a thick, resilient mucosal covering which would not occur without the stimulation. REFERENCES
1. Swenson, M. G: Improving Immediate Dentures in General Practice, J.A.D.A. 47:550, 1953. 2. Hughes, F. C.: Immediate Denture Service : Advantages, Disadvantages and Technical Procedures, J.A.D.A. 34:20, 1947. Box 307 WALTER REEDHOSPITAL WASHINGTON 12, D.C.