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