Digital options are advancing in every area of dentistry. Determining how to integrate and apply these options into your practice can take some rethinking of how you do things. One easy way to take advantage of the world of digital dentistry is to use digital wax-ups. In this article, I will define what digital wax-ups are, and how you can take advantage of the benefits of digital wax-ups.
An essential step in the success of all cosmetic or restorative cases is the creation of a diagnostic wax-up. This is the foundation for all future restorative decisions. This process can require several appointments that include:
- The pre-consult appointment - Identification of conditions or patient desires, often at recall appointment.
- Impressions and pictures appointment
- Send out to the lab for diagnostic wax-up
- If smile imaging is desired, that usually requires a 3rd party to create the after images.
- Consultation appointment that may include imaging, presentation of diagnostic wax-up, possibly intraoral composite mock-up
- Send to the lab for provisional fabrication
Taking advantage of the digital workflow can save valuable chair time and create consistent results between imaging, wax-up, mock-up, and provisionals.
What is a digital wax-up?
The digital wax-up is much the same as a conventional wax-up on a stone model: the digital wax-up is overlaid onto the digital model. The process creates a 3D representation of the proposed result created over the 3D pre-op model. (Fig. 1 & 2)
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Full Process Sequence
1. IOS (Intra Oral Scanner) scan or conventional impression, and digital photos of smile.
2. The lab brings the scan file and digital photo in the 3D digital design software.
3. The lab merges the 2D smile photo and 3D scan file
4. A digital smile silhouette template is overlaid over the patient's smile image. (Figure 3)
- Automatically add and edit guidelines
- Select outline shapes on the 2D image
5. Patient's virtual teeth are digitally reshaped to conform to smile template.
6. 3D modeling allows evaluation from various angles.
7. 3D model and proposed "wax-up" can be tested on a virtual articulator. (Figure 4)
8. Digital wax-up and imaging can be presented to the patient.
9. Composite mock-up for actual application to patient's teeth can be printed, or a 3D model can be printed for use in making a putty matrix for mock-up application.
10. Provisionals can be milled or printed by the lab before preparation appointment.
Today within the digital workflow, digital photographs and an IOS scan can be captured at one simple appointment. Many clinicians do this as a standard portion of the recall appointment. If the patient's treatment process proceeds forward, the patient can be scheduled for a treatment plan consultation to present the diagnostic package. All of the elements needed for a consult can be generated without the need for inconvenient impression sessions.
Digitally-created elements include:
- Digital wax-ups can be created for planned full crowns or veneer restorations.
- Clinicians often apply an intraoral composite mock-up at the treatment consultation appointment. This is an immediate way to let patients “test-drive" their proposed new smile. One of the distinct advantages of using a digital workflow for “wax-up” is that it can be used to print thin mock-up shells.
- Another method to create an intraoral mock-up is to print models that can be used to make a putty impression of the mock-up, that can be used to place a composite mock-up in a direct method.
- Suggestion: Use pre-op mock-up for a photo session to send the patient home with photos of their new look
- Will be exact replicas of the imaging that the patient accepted. Provisionals can be fabricated from the 3D digital “wax-up”.
- Can be designed with specific reduction specifications built in.
Benefits of Going Digital for Diagnostic "Wax-Up"
- Using an IOS scan to generate a “wax-up” can reduce your appointments and give patients an impression-free diagnostic workup as well as the possibility of creating provisionals from the same Pre-Op IOS scan.
- Re-contouring gingival height can be designed to a precise position.
- Design in 2D and see the 3D result in real-time from various angles.
- 2D before and after imaging can be accurately replicated in digital “wax-up,” intraoral mock-up, and provisionals, and even to final restorations.
- Verification of restorative connection to actual tooth position (Can the wax-up and imaging indeed be restored, does it line up with teeth/root position?)
- View digital wax-ups on any device - Smile Designs can be viewed and approved via your computer, tablet, and even your smartphone. Figure 7
- Digital files can be used to overlay preparation model to create rapid turn-around of final restorations.
- Real-time savings
Beginning with an IOS is a natural flow to take advantage of these digitally-produced tools, but you can still benefit from the lab's digital capabilities. The lab can still digitize a conventional model and work digitally. As mentioned above there are several elements that can be produced digitally, that can be of benefit to you and your patients.
The Future of Digital Imaging and Provisionals
Upcoming Smile Design applications will provide an easy solution for aesthetic planning that leads to more predictable results.
Listed here are some applications that will be available to you in the near future through Burbank Dental Lab:
- 2D Digital imaging - Photo-realistic before and after digital imaging
- Clear orthodontic aligners able to be fabricated to facilitate more ideal tooth alignment, allowing for better cosmetic and restorative results.
- Printed reduction guides
- Tissue contouring guides
These exciting options and many more to come in the near future are all facilitated by our state of the art 3D printers, the Carbon M2 3D Digital Printer. These printers are the most sophisticated and versatile printers being used in the dental industry and will allow Burbank Dental Lab to take advantage of many materials that have not been available in dentistry prior to Carbons entry. Look for more new products and services to come soon. Figure 8
Digital applications are developing and changing long-held paradigms of how dentistry is done, both in the dental lab and in the clinical setting. It is our commitment at Burbank Dental Lab to stay on the leading edge and to facilitate your success in adopting digital solutions for the betterment of your practice.