The immediate complete denture:

one clinical entity, but different approaches

the very name of the immediate complete denture is subject to discussion. Indeed, the so-called immediate prosthesis filled teeth is defined as a prosthesis designed to replace the last teeth to be extracted and inserted immediately after the avulsion. However, it should not be confused either with an artificial transition (in which teeth can be added as and when the avulsion of the remaining teeth) or with one temporary prosthesis, also inserted after tooth extraction, but design different, both simple and designed to respond to an emergency aesthetic, functional and allow one gradual adaptation to wearing a denture. In these situations, one conventional full denture is considered more or less short term [1].

The immediate complete denture is in fact one final prosthesis that meets stages of implementation techniques, rigorous and well defined. This type of prosthesis has all the success factors of a final prosthesis with:

fingerprinting techniques adapted to the clinical

a restoration of stable occlusal relationships in a pattern of bilaterally balanced type;

mounting of the front teeth, taking into account the aesthetics of the remaining natural teeth [2-4].

Its benefits are numerous and justify the value of this technique.

After the last tooth extractions, immediate placement of this prosthesis is a real dressing that allows the organization of blood clot contains edema postoperatively, but also ensures the protection of the extraction of any trauma related to language , the opposing teeth or the bolus. Thus, the blood clot protected, faster healing will occur. With this prosthesis, the patient found not only one satisfactory chewing and swallowing, but also one optimal phonation. Similarly, the immediate insertion of the prosthesis provides immediate support paraprothétiques organs, particularly the cheeks and lips. Their position and tone are preserved and upper pathetic, because of their shapes and volumes simply take over the dental units.

Psychologically, this stage of the total tooth loss is difficult for patients to cross. She signed an attack on physical integrity, physical disability [5]. The loss is also the last teeth to patients, a trademark of aging and decay. The immediate insertion of the prosthesis provides for many patients, relief and comfort significant [6]. At any moment they appear in the eyes of the outside deprived of their teeth, the development of a prosthesis immediately hide from this state. The integration is facilitated and prosthetic attachment to his patient's denture later revealed the essential psychological impact of such treatment.

Technically, the benefits of immediate complete dentures are also numerous. It allows the preservation and reproduction of a number of information acquired préextractionnel stage, called préextractionnels documents after analyzing their respective value. The concept of clinical value of these documents is very important, especially in terms of two parameters, the centric relation and occlusal vertical dimension Ia. According to the type of tooth loss, the remaining teeth can maintain the vertical dimension in complete disharmony with corn ¡'centric relation due to different malpositions generally affecting the teeth "occlusal analysis on articulator stage allows the diagnosis, initially, to assess these two factors and, second, to establish a therapeutic approach involving occlusal grinding or extraction of posterior teeth in high malpositions.

Moreover, the selection and installation of the front teeth are designed to replicate the organization and appearance of natural teeth in accordance with these documents préextractionnels. For this, the change in shape of the teeth, makeup techniques, finishing collars and makeup of the soft tissue allows us to restore one similar status. However, we must always reproduce the existing state [3] (Fig. 1)? The decision rests with the patient after explanation by the practitioner of the benefits and limitations of each approach.

Finally, the biological impact of the insertion of a prosthesis on immediate behavior and the phenomena of bone remodeling resulting remain a key issue, even if this approach is appreciated differently. Many local factors, but also regional and systemic are involved in the evolution of bony structures, supports the prosthesis immediately. They ensure the sustainability of prosthetic treatment. Age and sex are two particularly important factors. They have major impacts on the nature of the bony structures as well as the setting and the level of calcium metabolism concerned, especially in the presence of osteoporosis. The establishment of the treatment plan and the therapeutic approach adopted will always have as their primary concern the preservation of tissue integrity and in the foreground, the maintenance of the alveolar ridge.

Faced with these various controversies, the therapeutic response is threefold: the immediate supraradiculaire denture, the prosthesis immediately associated to simple extractions, the prosthesis immediately associated with bone surgery. Each will be described and the respective indications presented. A critical analysis of techniques in relation to their impact on the bone allows the practitioner to identify the best therapeutic indications.