Creating colored diagnostic wax-ups

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1 Page 1 of 6 Creating colored diagnostic wax-ups By Lee Culp, CDT To fulfill the role of partner in the successful dentist-technician restorative team, the technician needs to have a complete understanding of the masticatory system and all possible restorative options. This includes fixed, removable, and implant. The technician who desires to create a nice diagnostic communication tool for the dentist and patient also should have a working knowledge of orthodontics, periodontics, endodontics, and oral surgery. This column describes the philosophy, procedures, and techniques used to create a functional, esthetic, colored diagnostic wax-up that will be used for co-diagnosis and treatment planning of a simple-to-complex restorative case. The prescription To ensure success, an accurately filled out diagnostic RX form from the dentist is imperative. Information should include teeth to be restored, type of restorations to be used (partial or full coverage), vertical dimension changes, maxillary tooth length (centrals), and change to the periodontal aspects. Orthodontic movement of teeth also should be specified at this time. In addition to the RX, we request an excellent impression of the mandibular and maxillary arches along with correct inter-occlusal records and facebow (Fig. 1). The reason we request impressions instead of models is that we can repour the impressions several times. For diagnostic purposes, it also ensures a high-quality model poured by the laboratory with die stone that has correct water/powder ratios. Fig. 1 Excellent impressions received from the dentist of the mandibular and maxillary arches. The models To communicate with the dentist, we supply three diagnostic models. The first model reflects the preoperative conditions; the second reflects the changes that we deem necessary. The second model is the most important, since the dentist can visibly see all areas that have been taken away or reduced and all areas that have been added to create the correct esthetics and function. The third model is a finished wax-up in tooth-colored waxes that will be shown to the

2 Page 2 of 6 patient (Fig. 2). Fig. 2 Pour three models to reflect existing conditions, planned restorative changes, and final presentation. The same care should be given to a diagnostic case as the final restorative treatment. Models should be of high quality and mounted with a facebow on an anatomical articulator (Fig. 3). After models are mounted, a complete evaluation should take place comparing current conditions with the restorative request of the dentist (Fig. 4). Fig. 3 Mount the models on an anatomical articulator. Fig. 4 Evaluate the occlusion, arch form, and esthetics. The diagnostic wax-up

3 Page 3 of 6 Since a complete set of technique instructions on diagnostic waxing would fill a book, I will explain the basics so that you can get started on this service for your dentist clients. First, decide what areas of existing teeth within the dental arch both facially and occlusally need to be removed to create optimal esthetics and function. If teeth have to be reduced too much, the orthodontic movement needs to be considered. Next, based on the esthetic-function needs of the patient, add a colored wax to complete the contours of the teeth that need to be lengthened, repaired, or moved facially or lingually (Fig. 5). Periodontal esthetics also should be analyzed at this point, after consultation with the restorative dentist to decide appropriate reduction of the bone and tissue. If the dentist and patient agree, then periodontal recontouring is done on the model to reflect the final outcome (Fig. 6). The model reflecting the changes is now duplicated with a firm laboratory putty (Fig. 7). Once the molds are removed, the models with changes are put away and later returned to the dentist so that the changes can be seen. Fig. 5 Add colored wax to complete the contours of the teeth that need to be lengthened, repaired, or moved. Fig. 6 Make changes on the model to reflect periodontal changes.

4 Page 4 of 6 Fig. 7 Duplicate the model using a firm lab putty. We use the third set of models to create the final patient presentation wax-up. The teeth are prepared with prep design to mimic final clinical preparations (veneer, inlay-onlay, full crowns). The design will be the same, but the stone should be "over-prepped" (2.0 mm) to allow wax to flow during the injection process (Fig. 8). Pay particularly close attention to exactly following existing tissue contours. Fig. 8 Prepare the third model for wax injection. To create the wax-up fast and efficiently, we developed a wax injection process. Place a hole at a facial anterior margin, or if it is full arch, inject the wax from the distal of the most posterior tooth. Prior to injection, internal colorants are added directly to the model to add depth and realism (Fig. 9).

5 Page 5 of 6 Fig. 9 Add colored wax to the model to create realism. Heat the "white" wax and inject it into the mold using a glass eye dropper (Fig. 10). After cooling for a few minutes, remove the mold and clean up the wax-up. Fig. 10 Heat the "white" wax and inject it into the mold. Next, make an incisal cutback for a translucent enamel wax (Fig. 11). Use the same mold, but cut back the mold so that only the incisal edge is left. Place the enamel wax into the mold and allow it to cool. Fig. 11 Make an incisal cutback for a translucent enamel wax. Evaluate the wax-up for function and esthetics and create anatomical details and texture (Fig. 12).

6 Page 6 of 6 Fig. 12 Carve in the anatomy and texture. Replicate a porcelain look by glazing the wax using Johnson's Future floor wax painted on with a brush (Fig. 13). The wax dries in approximately five minutes. This technique allows ultimate communication between dentist and technician, and also creates an impressive presentation to the patient (Fig. 14). Fig. 13 Glaze the wax with Johnson's Future floor wax. Fig. 14 The completed colored diagnostic wax-up. Originally published in the February 2005 Dental Lab Products. Copyright Advanstar Dental Communications.

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