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Transcript

  • 1. The Wax Try-in
  • 2. Wax Try-in
    • Verify & Change :
      • Appearance
      • Phonetics
      • Occlusal relationships
      • Patient comfort
  • 3. Two try-in appointments
    • Initial wax try-in
      • Confirm esthetics, phonetics
      • Verify centric, protrusive
    • Final wax try-in
      • Ensure balanced (if applicable), wax-up complete
  • 4. Don’t Overlook Problems
    • Difficult/impossible to change after processing
    • May require removal, resetting & re-processing
    • Procedures more costly & time consuming
  • 5. Incisors too long
  • 6. Initial Wax Try-in
    • Verify:
      • Appearance of the anterior teeth
      • Accuracy of the maxillomandibular records
    • Changes will almost always need to be made
    • Technician has not finalized balance at this stage
  • 7. Make Changes Technician Can’t Assess Esthetic Problems Other changes can be prescribed for the technician to complete
  • 8. Verify Occlusal Vertical Dimension & Interocclusal Distance
    • Same techniques used previously
    • Critical to measure & feel 2-4 mm of interocclusal distance
    • No tooth contacts during closest speaking space
  • 9. Changing OVD
    • Effects:
      • Occlusion
      • Facial esthetics
  • 10.
    • As mandible moves downward (opening or increasing OVD)
      • Incisal edge moves back
      • Increases overjet
      • Helpful Angles Class III
      • Problem Angles Class II
  • 11. Vertical Dimension Alterations
    • One or both arches may require change
    • Made by the laboratory
    • May require resetting of all teeth in at least one arch
    • Height of both anterior & posterior teeth must be in harmony
  • 12. Vertical Dimension Alterations
    • If only posterior teeth are changed
      • Undesired effect on:
        • Overbite relationships
        • Esthetics
        • Balancing contacts
    • Assess how changes will affect overall appearance
  • 13. Centric Position Contacts
    • Check with articulating paper
    • Stabilize the mandibular denture
    • New centric relation record
    • Minimal amount of recording medium
  • 14. Minimal Registration Material
    • Improves record accuracy
      • Less resistance during closure
      • Reduces chance of deflection when checking record
    ✔ ✘ ✔ ✘
  • 15. Small Amount of Registration Material
    • Opposing cusps should not penetrate
    • Cuspal indentations improve accuracy compared to flat wax rim
  • 16. Alternate Technique Alluwax with a Wax Spatula
  • 17. Placement of Alluwax
  • 18. Alluwax Should Be Placed Over Contacts
    • First contacts are on these areas
    • Prevents penetration and contact on prematurities
  • 19. Confirm Accuracy of Mounting
    • Ensure record is fully set
    • Loosen articulator centric lock
    • Seat both record bases & interdigitate teeth into record
  • 20. Accurate Mounting
    • Teeth interdigitate perfectly
      • No space around the cusps
    • Condylar ball should contact fossae wall
    • If either criteria not met, remake record
  • 21. Second Record Used to Confirm Inaccurate Mounting
    • Mandibular cast removed from mounting ring
    • Mounting plaster ground thinner
    • Cast remounted, using the new record
  • 22. Tooth Position
    • Canine Relationship
      • Most critical tooth relationship
      • If half tooth offset not present, diastema required between anterior & posterior teeth
  • 23. Canine Relationship
    • Problems encountered when:
        • Jaw size discrepancies
        • Malocclusions
        • Improper contouring of occlusal rims
  • 24. Eliminating a Canine Discrepancy
    • Reducing or increasing overjet
    • Reducing or increasing arch circumference of one or both occlusion rims
    • Altering vertical dimension
  • 25. Eliminating a Canine Discrepancy
    • Bodily moving teeth more facially or more lingually
    • Changing axial inclination (tilting) of teeth
  • 26. Prior to resetting teeth, the dentist should determine how to eliminate a canine discrepancy
  • 27. Excursive Contacts
    • If the canine relationship is not acceptable, and will be changed, excursive contacts will change as well
  • 28. Excursive Contacts
    • Evaluate visually and with articulating paper
    • Intraoral/articulator discrepancies:
      • Remake protrusive record
      • Check/reset condylar inclination
  • 29. Verify Comfort: Tongue Space
    • Ask patient to comment on:
      • Comfort
      • Ability to speak with the dentures
  • 30. Esthetics
    • Check:
      • Amount of incisal display
      • Harmony of the maxillary teeth with the smile line
      • Accuracy of the midline
      • Angle of the occlusal plane
  • 31. Esthetics
    • Check
      • Proper soft tissue profile, contours
      • Lip support
      • Display of the vermilion border,
      • Correct nasolabial angle
  • 32. Esthetics
    • Ask patients for their opinion prior to voicing your opinion
    • Avoids biasing the patient
    • May be helpful to have family or friend attend the wax try-in
  • 33. Esthetics
    • If you or the patient have reservations about appearance
      • Resolve prior to final processing
      • Never attempt to persuade a patient out of a concern
      • Problems will be yours later, if the patient does not like the appearance
  • 34. Phonetics
    • Easier to assess
      • Teeth have replaced bulky rims
    • Crowded tongue space can adversely affect phonetics
  • 35. Lisping
    • Non-uniform overjet of the anterior teeth
    • Diastemas between teeth
    • Palatal contours
    • Diamond-shaped openings between incisors
  • 36. Phonetics
    • If have not worn dentures for extended period
    • or
    • Dramatic changes (Contour, Tooth Position, Vertical Dimension):
      • Allow the patient to read a out loud for 5-10 minutes to assess phonetics and comfort
  • 37. Sibilant Sounds
    • ‘S’, ‘Z’‘T’ ‘CH’ ‘SH’:
    • ‘ Sixty-six ’, ‘ Mississippi ’)
    • Incisors should approach end to end relationship
  • 38. Fricative Sounds
    • F, V, ‘ Fifty-Five’
    • Ask patient to count from ‘50 to 60’
    • Maxillary incisal edges should just touch the posterior one third of the lower lip
  • 39. Denture base contours
    • Affect phonetics, comfort and retention
    • Should not be slightly convex in shape
    Convex Concave
  • 40. Denture Base Contours
    • Ensure that the denture base is not unduly thick or thin
      • Excess bulk will impair comfort
        • Feel between index finger & thumb
      • Base that is too thin will be weakened
        • Should not be able to see through
  • 41. Patient Input
    • Use open ended questions
    • “ How do you like the appearance? ”,
    • rather than
    • “ Don’t the new dentures look great? ”
  • 42. Patient Input
    • If the patient sounds unconvinced
      • ask more questions
    • Do not rush this step to save time!
  • 43. Final Wax Try-in
    • Confirm that prescribed changes are acceptable
    • Making further alterations if required
    • Diastemas should be closed
    • Phonetics should be acceptable
  • 44. Laboratory Prescription
    • Request:
      • Processing, finishing & polishing
      • Laboratory remount of the dentures
      • Adjustment of occlusion to compensate for processing changes
  • 45. Laboratory Prescription
    • Request:
      • Fabrication of remount index and casts, (used at the delivery appointment)
      • Refinement of wax-up
      • Special requests
    • Send remount jig to laboratory
  • 46. Importance of Wax Try-in
    • Chance to change setup
    • If not willing to change aspects of setup, appointment is a waste of time
    • An opportunity to improve the final result
  • 47. Laboratory
    • Check Centric contacts
      • Ensure even on all posterior teeth
      • Check visually from facial and tongue space
        • Move in wax if far from contact
        • Adjust with bur if minor prematurities
      • Ensure sufficient overjet
      • Begin checking lateral & protrusive contacts
  • 48. Checklist
    • Centric record verified with recording medium
    • Vertical dimension verified:
    • a. 2-3 mm between lip closure and teeth touching
    • b. Phonetics tests ("50`s-60`s" or "Mississippi") - space between rims
    • c. Lips appear and feel unstrained
    • Tooth form, arrangement & shade verified
    • Phonetics verified ("S","F" and "M" sounds)
    • Balanced occlusion, anterior teeth only grazing in protrusion

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