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Diagnostic Wax-Up:


We cannot emphasize enough the value of a diagnostic wax-up on study models, especially if you are changing the incisal edge position.  As in any large project, a schematic mock-up allows you to more accurately predict the final outcome.

There are several advantages to preparing a diagnostic wax-up:

1) It allows the patient to see on a mock-up of what you anticipate the final look of his/her teeth to be in shape and form. It improves communication with your patient and incorporates his/her commitment to the process.

 

2) It acts as a matrix to fabricating provisional restorations which will more closely resemble the final result. It can save a significant amount of chair side time. It enables you to simply take an impression of the diagnostic wax-up, fill this impression with autopolymerizing resin, and place over the prepared teeth. The impression is removed and the resin is carefully finished and polished. If the preparations are veneers which extend through contact areas, the provisional can be quite retentive. It may be necessary to spot etch and bond the teeth before seating the provisionals.

3) It allows for a trial run period for both you and your patient. By having your patient wear provisionals identical to the diagnostic wax-up, you can monitor the functional occlusion directly in the mouth instead of on an articulator. Modifications for anterior protrusive and lateral excursive can be accomplished and a duplicate model made as a guide for the definitive restorations.

You can also evaluate incisal edge position directly in the patient's mouth. Not only does anterior guidance determine its length, but also phonetics and esthetics play a significant role. Check the incisal edge position against the lower lip when the patient counts from 40 to 45. Evaluate the smile line of the maxillary anterior teeth. The upward curve of the incisal edges should mimic the curve of the lower lip when smiling. The patient, too, benefits from this test period with provisionals. Make sure the patient is satisfied with the esthetics. Now is the time to make any necessary changes, not after the final restorations are bonded.

The effort taken with a diagnostic wax-up and trial period with provisionals will reap great dividends for achieving success in the final outcome.


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