1 / 46

The Wax Try-in

The Wax Try-in. Wax Try-in. Verify & Change : Appearance Phonetics Occlusal relationships Patient comfort. 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.

malik-hardin
Télécharger la présentation

The Wax Try-in

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation 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 ProblemsOther 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 • May require resetting of all teeth in at least one arch • Extensive changes made by lab • Height of 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. Confirm Accuracy of Mounting • Ensure record is fully set • Loosen articulator centric lock • Seat both record bases & interdigitate teeth into record

  17. Accurate Mounting • Teeth interdigitate perfectly • No space around the cusps • Condylar ball should contact fossae wall • If either criteria not met, remake record

  18. Second Record Used to Confirm Inaccurate Mounting • Mandibular cast removed from mounting ring • Mounting plaster ground thinner • Cast remounted, using the new record

  19. Tooth Position • Canine Relationship • Most critical tooth relationship • If half tooth offset not present, diastema required between anterior & posterior teeth

  20. Canine Relationship • Problems encountered when: • Jaw size discrepancies • Malocclusions • Improper contouring of occlusal rims

  21. Eliminating a Canine Discrepancy • Reducing or increasing overjet • Reducing or increasing arch circumference of one or both occlusion rims • Altering vertical dimension

  22. Eliminating a Canine Discrepancy • Bodily moving teeth more facially or more lingually • Changing axial inclination (tilting) of teeth

  23. Prior to resetting teeth, the dentist should determine how to eliminate a canine discrepancy

  24. Excursive Contacts • If the canine relationship is not acceptable, and will be changed, excursive contacts will change as well

  25. Excursive Contacts • Evaluate visually and with articulating paper • Intraoral/articulator discrepancies: • Remake protrusive record • Check/reset condylar inclination

  26. Verify Comfort: Tongue Space Ask patient to comment on: • Comfort • Ability to speak with the dentures

  27. Esthetics Check: • Amount of incisal display • Harmony of the maxillary teeth with the smile line • Accuracy of the midline • Angle of the occlusal plane

  28. Esthetics Check • Proper soft tissue profile, contours • Lip support • Display of the vermilion border, • Correct nasolabial angle

  29. 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

  30. 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

  31. Phonetics • Easier to assess • Teeth have replaced bulky rims • Crowded tongue space can adversely affect phonetics

  32. Lisping • Non-uniform overjet of the anterior teeth • Diastemas between teeth • Palatal contours • Diamond-shaped openings between incisors

  33. 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

  34. Sibilant Sounds • ‘S’, ‘Z’‘T’‘CH’‘SH’: ‘Sixty-six’, ‘Mississippi’) • Incisors should approach end to end relationship

  35. 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

  36. Denture base contours • Affect phonetics, comfort and retention • Should not be slightly convex in shape Convex Concave

  37. 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

  38. Patient Input Use open ended questions “How do you like the appearance?”, rather than “Don’t the new dentures look great?”

  39. Patient Input • If the patient sounds unconvinced • ask more questions • Do not rush this step to save time!

  40. Final Wax Try-in • Confirm that prescribed changes are acceptable • Making further alterations if required • Diastemas should be closed • Phonetics should be acceptable

  41. Laboratory Prescription Request: • Processing, finishing & polishing • Laboratory remount of the dentures • Adjustment of occlusion to compensate for processing changes

  42. 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

  43. 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

  44. 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

  45. Videos • Analyzing & Adjusting Centric Contacts • Adjust Lateral Contacts • Adjust Protrusive Contacts

  46. Denture Tooth Setup Project • 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

More Related