He Would Not Leave the House Without Teeth

Quick answer: An immediate denture is made in advance and fitted at the same appointment as the extractions, so you never appear in public without teeth. It requires more adjustments and a reline a few months later, because the gums shrink as they heal — but for most people that trade-off is worth it.

The call

Yehoshua, 74, from RBS Alef, had six upper teeth left, all with advanced gum disease and all mobile. He had known for a year that they needed to come out and had been putting it off for one reason, which he stated in the first two minutes: he was not prepared to be seen without teeth, not at shul, not by his grandchildren, not for a single day.

That is not vanity. It is the most common reason people delay treatment they know they need, and the practical answer is to plan around it rather than argue with it.

What we found

Six remaining upper teeth, all grade II to III mobile, advanced bone loss on every one, and generalised infection. None was savable, and each was contributing to the deterioration of the ridge.

The lower arch was in better shape, with eight teeth of reasonable prognosis, so we planned a full upper denture opposing his own lower teeth and a lower partial denture.

What we did

The sequence for an immediate denture starts weeks before the extractions.

Four weeks before: impressions of the mouth with the teeth still present, a bite registration, and shade and mould selection. Choosing the tooth shape and colour while his own teeth were still there meant the denture could be made to resemble them, which matters more to most people than they admit.

Two weeks before: the technician set the teeth up in wax on the model, then trimmed the model where the teeth would be extracted, shaping it to approximate how the ridge would look after healing. This is skilled guesswork, and it is why immediate dentures fit less precisely than conventional ones.

Extraction day: all six teeth out under local anaesthetic, the ridge smoothed where necessary, the sockets sutured, and the denture inserted immediately. It acts as a pressure dressing over the sockets as well as replacing the teeth, which helps with bleeding and comfort.

He went home with teeth. He was told not to remove the denture for the first 24 hours — take it out too early and swelling can make it impossible to get back in.

Adjustments: at 24 hours, one week, three weeks, and then as needed. Sore spots are expected, not a sign of failure.

Reline at four months. This is the part people are not always warned about and then resent. As the sockets heal, the bone remodels and the ridge shrinks noticeably over the first six months. The denture that fitted on day one will be loose by month three. A reline — adding new material to the fitting surface — restores the fit. Budget for it from the start.

The outcome

He was never seen without teeth. The reline at four months restored a snug fit, and a second reline at two years kept it that way.

He now eats a normal diet apart from very hard foods, which is a realistic outcome for a full upper denture opposing natural lower teeth.

What to do if this happens to you

1. Say if being without teeth is unacceptable to you. It changes the plan entirely, and it is a reasonable thing to insist on.
2. Start the process weeks before the extractions. An immediate denture cannot be made on the day.
3. Bring an old photograph if you want the denture teeth to resemble your own.
4. Do not remove the denture for the first 24 hours.
5. Budget for a reline at three to six months. It is part of the treatment, not a failure of it.
6. Expect several adjustment visits. Sore spots are normal in the first month.

Facing extractions and worried about appearance? Ask Ramat Beit Shemesh Urgent Dental Care about immediate dentures. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.