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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2024 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided 

the original author and source are credited  

 

 

The keys to succeed an immediate maxillary complete denture : a 
case report 

Emna Abid, Amel Labidi, Sana Bekri *, Sameh Rzigui, Hiba Triki, Lamia Mansour 

Department of Removable Prosthodontics, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia  ABCD F Laboratory of Biological, Clinical and 
Dento-Facial Approach, University of Monastir, Monastir, Tunisia 

Article Info: 
_____________________________________________ 
Article History: 

Received   05 December 2023     
Reviewed  28 February 2024 
Accepted   16 April 2024 
Published 15 May 2024 

_____________________________________________ 
Cite this article as:  

Abid E, Labidi A, Bekri S, Rzigui S, Triki H, Mansour 
L, The keys to succeed an immediate maxillary 
complete denture: a case report, Asian Journal of 
Dental and Health Sciences. 2024; 4(1):60-64 

DOI: http://dx.doi.org/10.22270/ajdhs.v4i1.73  

Abstract 
_________________________________________________________________________________________________________________ 

The transition from partial to total edentulism is a delicate situation for certain patients that 

involves the practitioner in the management process. The immediate complete prosthesis is 

therefore an effective solution capable of removing the constraint of appearing totally 

edentulous by delivering a prosthesis on the day of extraction of the remaining teeth. A 

partially edentulous patient consulted us with the typical indication for this immediate 

prosthesis with four remaining maxillary incisors and a major aesthetic concern. The prosthetic 

production chain is particular concerning firstly the presence of a bilateral terminal edentulism, 

the confection of the individual impression tray, the orientation of the anterior occlusion plane 

while anterior teeth remaining on the arch, the fitting of the prosthetic anterior teeth following 

the working model rectification as well as the surgical phase on the day of denture insertion. 

Surgical guide would be very useful when bone regularization is imperative. The post-

prosthetic follow-up phase is important in order to optimize tissue integration of the prosthesis, 

while taking into consideration the rebasing that is often unavoidable after a few months.  

Blood problems, a protracted healing process, significant bone loss, mental illness, or 

emotional problems contraindicate this type of prosthesis. The dentist and the laboratory 

technician are invited to master the clinical and laboratory stages of this prosthesis in order to 

appropriate the result aesthetically and functionally. 

Keywords: Edentulism; Aesthetics, Immediate prosthesis, Anterior teeth, Occlusion plane, 

Surgical guide, Individual impression tray 

 

*Address for Correspondence:   

Sana Bekri, Department of Removable Prosthodontics, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia. ABCD F Laboratory of Biological, Clinical and 
Dento-Facial Approach, University of Monastir, Monastir, Tunisia 

   

Introduction 

An immediate complete denture is a dental prosthesis 
constructed to replace the lost dentition and associated 
structures of the maxillae and/or mandible and inserted 
immediately following removal of the remaining natural teeth 
1. Thanks to clinical practice and the number of cases treated, 
we can conclude that this method is a reliable therapy that 
enables the transition from partial to full edentulism 2. 

Dentists are frequently expected to create immediate dentures, 
and patients are requesting them more often for psychological 
and aesthetic purposes. The appropriate indication and careful 
execution of clinical and laboratory fabrication are essential to 
the success of immediate dentures. While some patients may 
experience significant challenges during the first year of 
wearing dentures immediately, most patients report general 
satisfaction 3,4. The aim of this article is to expose, through a 
clinical case, the particularities of the technical and clinical 

realization in order to obtain an immediate prosthesis that is 
well adapted and satisfying for both the patient and the 
practitioner. 

Observation 

A 52-year-old patient with arhythmia consulted us for aesthetic 
and functional prosthetic rehabilitation. The dento periodontal 
examination showed moderate mobility of the four remaining 
upper incisors on the maxillary arch, while the lower teeth were 
well implanted. Examination of the osteomucosal surfaces 
revealed a moderately deep palate, Class I tuberosities and 
well-formed ridges. Given the patient's aesthetic concerns, the 
prosthetic decision was to perform an immediate complete 
denture in the maxilla and a partial removable denture in the 
mandible. Primary impressions were taken using an 
irreversible hydrocolloid (Algin major Alginate, Major, Italy) to 
make two individual impression trays for the secondary 
impressions (Fig.1)

                     Open Access                                                                                                                                                                                                               Case Report                                                                           

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Emna Abid et al                                                                                                                          Asian Journal of Dental and Health Sciences. 2024; 4(1):60-64 

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Figure 1: Maxillary and mandibular primary impressions 

 

The limit of the maxillary individual impression tray was 
located 2mm from the vestibule floor, even with regard to the 
remaining teeth. The maxillary peripheral seal was made with 
Kerr® thermoplastic paste in the posterior and lateral regions, 
while the anterior region was realized with an elastomer that is 
polyether (Fig.2). 

Impressions of both arches were then taken using medium-
viscosity polysulfide in the maxilla (Fig.3). 

Two occlusion recording base were prepared in the laboratory, 
then a recording of the intermaxillary relation was made in 
centric relation and at the correct occlusal vertical dimension 
(OVD) (Fig.4). 

 
 

Figure 2: maxillary individual impression tray with anterior 
joint made of polyether 

     

Figure 3 : Maxillary and mandibular working impressions 

 

Figure 4: recording of the intermaxillary relation  

 

The orientation of the anterior occlusal plane was made 
according to the level of the remaining teeth, given that their 
positions were correct respecting aesthetic and phonetic 
imperatives. The posterior occlusal plane was positioned 

parallel to the camper plane using the Fox plane (Fig.5). a wax 
try-in was performed allowing to confirm the OVD and molar 
occlusion (Fig.6).



Emna Abid et al                                                                                                                          Asian Journal of Dental and Health Sciences. 2024; 4(1):60-64 

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   Figure 5: orientation of the anterior occlusal plane           Figure 6: The wax-up try-in 

 

The anterior maxillary prosthetic teeth were fitted in the 
position of the remaining plaster teeth, using a silicone key and 
choosing a prosthetic tooth dimension and shape close to that 
of the natural teeth as well as waxing of the stabilizing polished 
surfaces (Fig.7). 

The prosthesis was then polymerized with heat-cured acrylic 
resin in the laboratory and properly polished. Tooth extraction 
was then initiated (Fig.8) then the prosthesis was tried in and 
the static occlusion was adjusted using an articulating paper.

 

        

Figure 7: fitting the anterior maxillary prosthetic teeth using a silicone key 

 

 

Figure 8: teeth extraction 

 

A tissue conditioner was applied to the prosthesis to optimize 
healing (Fig.9). After delivery of the immediate complete 
prosthesis (Fig.10), the patient was instructed not to remove 
the prosthesis for 24 hours and asked to return for a follow-up 
appointment the following day. 

Signs of soft tissue trauma due to the prosthesis were checked 
and dynamic balancing according to the balanced occlusion 
concept was performed. Instructions for insertion and removal 
of the prosthesis, as well as instructions for hygiene of the 
prosthesis, were given.



Emna Abid et al                                                                                                                          Asian Journal of Dental and Health Sciences. 2024; 4(1):60-64 

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   Figure 9: relining with tissue conditioner    Figure 10: final denture 

 

Control and follow-up appointments were scheduled at 5 days, 
10 days and 20 days from the day of prosthesis delivery. These 
close monitoring sessions allow the patient to feel secure and 
well cared for, ensuring better psychosomatic integration of 
this new prosthesis and strengthening the trusting relationship 
between patient and practitioner. these sessions consist of 
listening to the patient's complaints to relieve them, replacing 
the tissue conditioner every week, and motivating the patient 
in terms of hygiene and maintenance. then monthly 
appointments will be sufficient until 6 months when the 
prosthesis may become unstable following final bone healing 
thus requiring relining. 

Discussion: 

The indication for an immediate prosthesis depends essentially 
on the patient's social and psychological conditions. This type 
of prosthesis is particularly recommended for patients who are 
embarrassed by appearing edentulous, for patients who work 
in a profession that requires contact with the public, or in an 
emergency before a trip or vacation. However, there are always 
contraindications, such as patients suffering from blood 
disorders, prolonged healing, severe bone loss, emotional 
disorders or mental incapacity not allowing them to 
understand the purpose of the treatment 5,1. 

The design of an immediate complete denture involves a chain 
of clinical and laboratory steps that is unique and often delicate. 
Examination of the remaining teeth in both arches is important 
for planning the prosthetic sequence. Only the anterior 
maxillary teeth will be preserved, so the posterior ridges must 
be edentulous and healed to ensure stable osteomucosal 
support for the occlusion recording bases in the working phase. 
The maxillary arch should therefore be prepared in Kennedey 
Applegate Class I 6. Premolars are preferentially retained if they 
have an antagonist to serve as a reference for the OVD if this is 
conserved 4. Significant vestibuloversion of the maxillary 
incisors indicates the need for a fenestrated individual 
impression tray to facilitate insertion, as its boundary facing the 
remaining teeth must cross the convexity of the alveolar 
process to be located 2 mm from the vestibular floor. In 
addition, fenestration minimizes the risk of plaster teeth 
fracture during demolding of the impression 6,7. Advanced 
mobility of the remaining teeth must be taken into account to 
prevent their accidental extraction when the impression is 
disinserted, so filling the interdental spaces with soft wax or 
high viscosity silicone or even composite resin helps to avoid 
this problem 5. For the lower arch, we need to detect the 
presence of egressions in order to correct them and re-establish 
a correct occlusal plane. 

Thanks to its elasticity and rigidity after setting, the use of 
polyether for the anterior joint, prevents damage to this region 
and easy removal of the working impression, while ensuring 
good registration of the joint, unlike Kerr thermoplastic paste, 
which can break when crossing the convexity of the alveolar 

process 2 ,6. 

Aesthetic and phonetic imperatives dictate the orientation of 
the anterior occlusal plane: the edge of the maxillary incisors 
should be 2 mm below the rest lip position, parallel to the bi- 
pupillary plane touching the wet line of the lower lip for the “F” 
and “V” sounds. If the teeth are extruded, the correct level can 
be marked on the working model. If the teeth are short, we can 
make an anterior supra-dental wax margin to orientate the 
occlusal plane correctly. 

Interincisal point must coincide with the median sagittal plane 
(MSP) 2. If it is shifted, transfer the correct position of the MSP 
to the working model. 

Wax-up of posterior prosthetic teeth validates intermaxillary 
relationship and OVD. The anterior maxillary teeth can be fitted 
according to the references indicated by the practitioner during 
the bite registration phase, choosing a suitable shape, color and 
dimensions. 

Regularization of the extraction sites can be combined with 
teeth extraction, previously simulated by rectifying the working 
cast. A transparent resin surgical template derived from the 
polymerized prosthesis is used to guide the surgical phase by 
visualizing compression zones. “Occlusal” guides improve 
surgical corrections, as they confirm perfect prosthesis 
placement thanks to the prosthetic occlusion obtained by 
posterior tooth sectors 6,2. A comparative study by Michael et 
al. showed that simple extraction of the tooth is to be preferred 
to any other surgical technique for immediate prostheses 
guaranteeing better stability of bone resoption, and that when 
alveoloplasty is required for aesthetic reasons, intraseptal 
alveoloplasty is preferable to alveoloplasty of the vestibular 
cortical bone 8. 

Wearing the prosthesis immediately after extraction ensures 
rigorous haemostasis and improved postoperative follow-up. 
The denture serves as a bandage to help assist bleeding, to 
prevent damage from the tongue, food, or teeth. This prosthesis 
guides and accelerates healing by protecting the blood clot, and 
provides immediate esthetics, enabling the patient to carry out 
social and professional activities without discomfort, as well as 
restoring masticatory and phonetic function 5,4. 

Patients should be instructed after healing that the dentures 
should be removed at least eight of every twenty-four hours to 
allow the tissues to rest 1. Check-ups should be made weekly for 
the first month, followed by visits at 3 months, 6 months and 
one year 6. 

The inevitable resorption of the alveolar ridge may influence 
prosthetic retention and stability, so relining after six months 
of prosthesis wear is recommended 8. 

 

 



Emna Abid et al                                                                                                                          Asian Journal of Dental and Health Sciences. 2024; 4(1):60-64 

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Conclusion: 

The immediate total prosthesis is the treatment of choice for the 
transition from partial to total edentulism especially when the 
anterior teeth are remaining. This type of rehabilitation, 
although challenging for the practitioner, will always remain in 
force and occupy a crucial position in our field. Thus, it is 
essential to master all the stages of its clinical and laboratory 
execution. 

References 

1. Heartwell CM Jr, Salisbury FW. Immediate complete dentures: An 
evaluation. J Prosthet Dent. 1965 ;15:615-24. 
https://doi.org/10.1016/0022-3913(65)90031-4 PMid:14313308 

2. Benoit H, Michel PO, Prothèse complète immédiate d'usage Les 
cahiers de prothèse n°111. 

3. Jonkman, R. E. G., Waas, M. A. J., Kalk, W. Satisfaction with complete 
immediate dentures and complete immediate overdentures. A 1-
year survey. Journal of Oral Rehabilitation,1995; 22(11): 791-796. 

https://doi.org/10.1111/j.1365-2842.1995.tb00224.x 
PMid:8558350 

4. Sonja K, Josip P, Tomislav B, Robert C. Immediate complete denture, 
Acta Stomatol Croat.2001; 35:281-5. 

5. Yeung C, Leung KCM, Yu OY, Lam WYH, Wong AWY, Chu CH. 
Prosthodontic Rehabilitation and Follow-Up Using Maxillary 
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PMCid:PMC7591000 

6. Bagui M., Fajri L., Belhaj K, El Mohtarime B., Merzouk N. The 
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7. Ayako I, Corinne T, Pierre M, Olivier E. Le porte-empreinte individuel 
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8. Michael CG, Barsoum WM. Comparing ridge resorption with various 
surgical techniques in immediate dentures.J Prosthet 
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https://doi.org/10.1016/0022-3913(65)90031-4
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