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1. IMMEDIATE COMPLETE DENTURES Immediate Complete Dentures are those dentures inserted immediately after the teeth are extracted and should be considered temporary prostheses. Patients often ask for immediate dentures because they are reluctant to be seen in public without teeth. Usually their expectations are higher than is realistically possible. For this reason, any patient contemplating an immediate denture must be thoroughly informed of the consequences of their decision to have immediate complete dentures made. First, the dentist should emphasize that immediate dentures are more expensive than conventional complete dentures. Emphasis should also be made that the denture will need several relines with tissue conditioner, which will drive up the cost. As the ridges resorb and recontour, immediate complete dentures will loosen and feel over-contoured, and cannot be considerably thinned in the labial flange area. The patient must be informed that after six months a new denture will need to be made and that dental insurance will not cover the cost of two dentures. After six months, the dentist may offer relines as an alternative to new dentures, but only after the patient has been examined and the prognosis has been made, by the dentist, that relining is an acceptable alternative. Patients often desire their dentures to resemble their natural teeth. They must be informed that due to the requirements that dentures must have a balanced occlusion for proper retention and stability, this may not be possible. Usually a patient will be more receptive of this idea when the dentist explains that usually their natural teeth were lost due to periodontal disease, and that some of the factors that led to their loss were premature contacts of their natural teeth. When patients realize that their dentures would not be satisfactory when they are made to look like their natural teeth, they generally will accept the dentist’s professional advice in having their dentures made according to his guidelines. As a default, if a patient will not make a reasonable concession, it is better to refuse the treatment than to deal with the aftermath if the dentist compromises and has dentures fabricated that he knows are not in the patient’s best interest. When immediate complete dentures are chosen, the patient must understand that he must leave them in for three days without removing them. Explain that the dentures are simply a compression bandage with teeth on them for this period of time. Also explain that the patient will experience swelling and some discoloration of their skin. This is normal after surgery and should be expected. Although it may seem ridiculous to the point of being impossible, some patients have been known to schedule a large dinner after their surgery to celebrate and show off their new dentures or to even schedule a photography session to capture their new look. I am aware of one patient who had her extractions scheduled the day before her wedding and honeymoon. Such irresponsibility on the part of a patient is usually reflected in a patient’s history of failing to accept responsibility for their actions. The end result may be that they will blame the dentist and be reluctant to pay their bill.
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