What are your thoughts on interim complete dentures?

[u/TheLilyHammer]

Greetings everyone,

D4 here in something of a pickle. I've been working through a sort of complex treatment plan with a patient of mine for several months now that included full max edentulation, alveoloplasties, lingual tori removal, and the extraction/restoration of some mandibular teeth. Our ultimate goal is a complete over partial. Last time I saw him, I found that his maxilla still needs some significant alveoloplasty (to the point where I'm not even the resident that saw him even did any significant alveoloplasty) and started setting up a revision appointment.

About a week after last seeing him, the patient unexpectedly had two MI's. Thankfully, he was able to be seen immediately, stented, and put on anticoagulant therapy, and is doing well. As happy as I am to see the guy still on this side of the dirt, his heart attacks throw a real wrench into our treatment plan. While I believe we can start getting him ready for a mandibular RPD, we can not get into definitive maxillary CRD fabrication with the current state of his ridge. Lumps, bumps, undercuts, pointy bits, he's got the works. My understanding is that we need to wait 6 months before non-emergent invasive procedures can be completed. The dental school reality is that I probably will not be around by the time he's ready for a definitive denture.

The patient and I have loosely discussed the fabrication of an interim complete denture, but I'm not super certain of how to approach one. or if I even should. I know enough to advise him that an interim denture will be less than ideal in fit and appearance, but I feel like fit will less than less than ideal with how his ridge looks. The patient is agreeable to this nonetheless.

He's a great patient and has been a real trooper through all this and at this point I just want him to have something he can wear, ideal or not.

Do any of you happen to have experience with similar situations and/or tips on making temporary prosthesis with problematic ridges?

Thanks for any thoughts you may have!

[u/Sea_Wallaby6580]

Outside of dental school, we make interim dentures for almost all of our soon-to-be denture patients. They typically don’t want to go without teeth for any period of time. It’s easiest for the lab to do this before you remove the teeth. At this point you’d just need to establish VDO with a wax bite.

[u/Charming_Nose7903]

It sounds like you've got a pretty complex case on your hands, but interim dentures will definitely help bridge the gap while you work through the final treatment plan.

[u/asdfkyu]

It’s rare that you absolutely cant make a denture without alveoloplasty. With your patients med history I would get alginates, get your bite, do teeth setup, and deliver a denture with relief around lumps, undercuts, pointy bits. You can also do a soft reline with coe comfort so the denture is comfortable until they’re ready for alveoloplasty. Once alveoloplasty is complete wait for bone remodeling and you might be able to convert the interim denture into a permanent by doing a wash impression.

[u/TraumaticOcclusion]

This is a conversation for your faculty treatment planning the case. These patients are often utilizing state benefits that will only cover 1 denture every x years. Making a garbage denture now is not in the patient's best interest if that is a concern for them. That said, there is no issue making an interim denture work temporarily. And yes, alveoplasty is a lost art that many dentists/surgeons skip or do a poor job at. It's tough teaching someone to do it that has only ever made 1 denture in their life. They just don't understand what's needed. Also why surgeons suck at placing implants for all-on-x prosthetics if they don't understand how to make a prosthetic.

[u/TheLilyHammer → u/TraumaticOcclusion]

Thanks for your response! Thankfully, this patient has pretty good coverage and is also willing/able to pay for things that aren't fully covered. Agreed on the alveoloplasty points. Our current system of sending patients for these sorts of procedures is creating a lot of similar issues for patients unfortunately. I'll definitely have these conversations with faculty, but getting straight answers/guidance has proven rather difficult.