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Written by Andrew Sedler

Written by Andrew Sedler

Written by Andrew Sedler

Diagnostic Wax-Ups:

THE KEY TO SMILE DESIGN

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At Burbank Dental Lab, we pride ourselves on being leaders in the ever-changing area of restorative dentistry. Our case success and relationship with doctors has pushed us to become a dental lab that excels in creating restorative cases that leave the patient with a lasting smile.

In keeping with our core values to continually provide communication, we understand the significance of creating case management process flow and utilizing diagnostic wax-up and mock-up procedures to help create a dialogue between the patient, dentist, and lab.

Burbank Dental Lab

"Utilizing a diagnostic wax-up is perfect for a lab and dentist team in delivering a predictable "wow" for the patient's dental restorative treatment."

--- Andrew Sedler, COO

Why Are Dental Wax-Ups Important?

A dental wax-up holds significance in the result of a patient's restoration because it is an outcome-based tool for diagnostic purposes. It requires a three-way conversation between the patient, dentist, and dental lab to create the desired results. For this conversation to be productive, the clinician must effectively communicate and provide the necessary information to the laboratory to reach the desired outcome.

The prescription written should include both the needs of the patient and clinician to better understand what the patient wants and what the dentist believes is possible. It is our job at Burbank Dental to take that information and ensure that the physical condition of the mouth will prove that the process will be smooth and possible for that specific patient. We observe the following items to make this decision:

  • Position of the teeth in the mouth
  • Alignment of the teeth
  • Inclination
  • Morphology
  • Occlusal scheme based on the directions given by the clinician

If the diagnostic wax-up or esthetic wax-up is left to the lab's interpretation due to lack of information from the clinician and patient, then the preliminary observation will be all for naught. The more open a case is for interpretation, the less likely the patient's desired result will meet their expectations.

In addition, during the waxing process, it may be determined that due to functional issues, a case cannot be achieved as initially planned. For example, in cases where the vertical dimension is being opened if you are restoring the maxillary arch, after looking at the diagnostic wax-up one may find that there is no longer anterior contact with the lower front teeth. In a situation like this, the original plan to restore the anterior veneers will not work, and a new approach will need to be worked out. Perhaps, in this case, veneers will need to be changed to dental crowns or other procedures to establish proper contact.

Case Acceptance for Everyday Dentistry

Another use of the diagnostic wax-up is to use it as a visual aid to show the outcome of the proposed treatment to the patient. For some patients, dental treatment acceptance is higher when a dental plan is utilized because they can see the proposed changes beforehand. The completed diagnostic wax-up will serve as the template for making an intraoral dental mock-up and help to increase the case acceptance rate. Often when a patient can see the proposed final results, they are much more comfortable in deciding to move forward with treatment.

The diagnostic wax-up can also serve to create a prep guide. Once the length, incisal edge position, shapes, and contours are all worked out in the wax-up and approved, a matrix can then be created from the wax-up to serve as a preparation guide. This guide can be created as a clear guide or a putty matrix. These prep-guides provide a road map to accurately prep the case so that the final restorations can be fabricated to recreate the proposed wax-up.

Finally, provisionals can be fabricated based on the diagnostic wax-up. This step is critical in providing the patient with a visual of their tooth restorations before and after treatment. These provisionals can be created chairside using a matrix generated from the wax-up, or they can be fabricated in the lab (DuraTemps). The patient can then wear this version of their new smile for a while and make notes of any final corrections they may want to make before the dentist completes the final restorations.

The Steps of a Diagnostic Wax-Up

To complete a diagnostic wax-up in full mouth rehabilitation cases or cosmetic cases, begin with a complete workup of the pre-op dental records. Preliminary impressions and bite records of the patient's current situation are required to ensure proper mounting and articulation of the models.

This step should also include a record of the horizontal plane, often recorded with a stick-bite. A stick-bite can also verify any face-bow mountings that may have been provided. Taking this bite is easy, and it can help prevent inaccuracies in the wax-ups and final restorations.

To take this bite, simply:

Steps of a Diagnostic Wax-Up

1. Find a reference to the horizon.

2. Stand the patient in front of the horizontal reference.

3. Inject bite registration material on the lower anterior and have them close their mouth.

4. Add silicone material to the labial of both upper and lower incisors.

5. Place a stick into the silicone and cover with the material until stability is achieved.

6. Take a full face photo showing stick-bite.

7. Remove and send it to the lab.

Another great tool that provides invaluable information to the lab is the Kois Dento-Facial Analyzer. This tool is a simple way to record the facial midline and horizontal plane. There is no ear bow or movable joints. Once taken, the steepness and inclination of the occlusal plane are captured in the registration material on the index tray. This index tray is sent to the lab for use in the mounting process. The benefits of the Kois Dento-Facial Analyzer are the following:

  • Simple to use.
  • Reduces the chance for errors.
  • It is duplicatable if there is a need to retake a face-bow record.
  • It provides the information of a face-bow and stick-bite in one.
  • It establishes the midline.

The Kois-Dento Facial Analyzer makes the face-bow transfer process easy and ensures that the occlusal plane is evaluated correctly.

Adding Photos to a Diagnostic Wax-Up

Photos are a crucial component of the information that needs to be sent to the lab for accuracy in not only the wax-up process but in the overall success of the case. Photos are an essential part of conveying information to the lab. These images provide information that will help improve both functional and esthetic outcomes.

Photos help in diagnosis and treatment planning. They can show a starting point for the patient's tooth position, occlusion, and periodontal issues. They are a vital tool in educating patients on the current condition of their oral cavity and in helping them understand the proposed treatment.

At Burbank Dental Lab, we work hard to make sure each case that comes in is understood to be unique and must be handled with precision and care. Utilizing a diagnostic wax-up is perfect for a lab and dentist team in delivering a predictable  "wow" for the patient's dental restorative treatment. For this to work, the lab must understand the intricacies of the diagnostic wax-up and how it relates to patient expectations. Our Smiles by Design Team is highly trained to evaluate the dental diagnostic wax-up process and ensures your cosmetic cases will have predictable outcomes each time.

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Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
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Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

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