Whether your making a complete denture as a provisional or as a final prosthesis, a patient who still has some teeth (but not for long) needs to be properly prepared for your plan. The transition from dentulous to edentulous is never easy as there are a few different kinds of major changes in store for your patient. The better you explain them beforehand, the happier the patient will be.
Our explanation will have to take these major changes into consideration. My goal is to paint a picture of the immediate denture process that is slightly worse than what I expect it to be. I don’t want to make it sound so horrible that the patient runs away screaming, but I also don’t want to make it sound like it’s a piece of cake.
“When we take out those remaining teeth, your body will take several months to fully heal. Your bone and gums will slowly shift to fill the sockets and settle. It’s impossible to make you a prosthetis that fits you perfectly while your healing because the bones and gums keep shifting. It’s like building a house on sand. So during that time I’ll need to make frequent adjustments to remove sore spots and make the denture fit you better.
Now we must keep in mind that an immediate denture is a guess. It’s a highly educated guess, but it’s still a guess. You still have teeth in the way and your bone and gums will shift, so we make an educated guess about how it should all turn out. The alternative is to take out the teeth and have you walk around with nothing until you’re fully healed months from now, and then I could make you a great denture. Of course we’re not going to do that!”
Side note: if the patient is going to have a full implant supported restoration, then you’ve completed your immediate denture discussion. But if the final restoration is the denture or the denture retained by some implants, you must continue:
“Since the immediate denture is a guess, it typically has a shorter life span than a regular denture. The immediate denture can fail for cosmetic reasons or for functional reasons. We may struggle to get it to fit you comfortably or decide that the teeth should be in a slightly different position. That is why we may need to make a brand new denture from scratch once you’ve fully healed and that’s okay. The immediate denture did its job and got us through the healing period.”
It’s a lot to say, so feel free to change the words around to be comfortable for you. Notice how I was able to give an accurate, if not slightly pessimistic, account of the immediate denture process. But I’ve given the patient full disclosure about the complications ahead, from expected (adjusmtents) to less common (new denture fabrication). I’ve also hepled the patient understand the body’s healing process as the force behind their eventual complaints, i.e. sore spots and temporary loose fit.
I give this speech at the consultation visit, then I refer back to it every time I see them during fabrication, from initial impression to insert. That way there are no unpleasant surprises, only pleasant ones.