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
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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