Is bone grafting indicated when delivering an immediate denture?

I routinely graft these since the buccal plate is intact, usually in the key spots for future implants, first molar and canine. The minis can be planned to keep pressure off the grafts also. If you are placing traditional implants at the same time the denture needs a great fit with frequent relines to prevent bone resorption. The implants need to be covered and not loaded to integrate. The minis can be a temporary implant while the other implants heal. What is the treatment plan?

Thanks CRS! I always appreciate your comments. I've done only a few dentures (10-15) since I've been in private practice. As you can imagine, I did very few cases during my 4 year stint in the Air Force. My question wasn't regarding a specific patient, just guidance regarding a hypothetical situation where the patient doesn't have the finances for implants at the time of extractions. So what I can take from this is to graft key sites and maybe a soft reline at delivery of an immediate denture? Thanks again! Justin

I do a lot of dentures And immediates . your question is too broad to cover i will address only what i see mostly Most of the time these cases are loosing their last teeth on the lower, anterior to the mental foramen. I am only addressing a lower case here. These will be cases that will be hybrids or bars if you want or plan for implant support. If this is The case there is no need to graft in most cases. Your best bet is to remove the teeth, place collaplug s and then the denture. Don't do osteoplasty and don't suture to close. Your goal here is to create as wide a band of attached gingiva as possible for the future. Have patient wear denture and not remove for 1-2days if it will stay. Have back and remove any pressure on the buccal tissue. If you have no retention do this at delivery. Pressure on the buccal tissue will create the bone loss you don't want These cases you want horizontal bone loss due to the amount of space needed for the prosthesis. Grafting doesn't make sense here most of the time unless your are placing the implants Placing implants at the time of extraction of these teeth has got to be planned and not arbitrary. You essentially have no guides for you to follow. You will usually place the implant at the level of the apex of the anterior teeth coinciding with the change of the trajectory of the bone . This keeps the implant emergence to the lingual of your prosthesis and hidden. Your denture can be relined as needed during healing. Implants at my office after 3 months after the lab reline. Now I have worked out my tooth position occlusion and space needs for implant and prosth planning. Much of the cost with this procedures is the prosthesis If you can get implants in at 3-9 months (and that second number is arbitrary) you can use locators on 2 and let the patient regroup for the prosthesis part . You are maintaining bone and aiding with the movement. With the Go Indirect you can use the healing caps as your locators to save more money and it is a great hybrid denture implant