The Wax Try-inThe Wax Try-in

Wax Try-inWax Try-in

Verify & Verify & ChangeChange::- AppearanceAppearance

- PhoneticsPhonetics

- Occlusal relationshipsOcclusal relationships

- Patient comfort Patient comfort

Two try-in appointmentsTwo try-in appointments

• Initial wax try-inInitial wax try-in- Confirm esthetics, phoneticsConfirm esthetics, phonetics- Verify centric, protrusiveVerify centric, protrusive

• Final wax try-inFinal wax try-in- Ensure balanced (if applicable), Ensure balanced (if applicable),

wax-up completewax-up complete

Don’t Overlook Problems Don’t Overlook Problems

• Difficult/impossible to change after Difficult/impossible to change after processing processing

• May require removal, resetting & May require removal, resetting & re-processingre-processing

• Procedures more costly & time consumingProcedures more costly & time consuming

Incisors too longIncisors too long

Initial Wax Try-inInitial Wax Try-in

• Verify: Verify: - Appearance of the anterior teeth Appearance of the anterior teeth - Accuracy of the maxillomandibular recordsAccuracy of the maxillomandibular records

• Changes will almost always need to be made Changes will almost always need to be made • Technician has not finalized balance at this stageTechnician has not finalized balance at this stage

Make Changes Technician Can’t Assess Make Changes Technician Can’t Assess

Esthetic ProblemsEsthetic Problems Other changes can be prescribed Other changes can be prescribed

for the technician to completefor the technician to complete

Verify Occlusal Vertical Dimension Verify Occlusal Vertical Dimension & Interocclusal Distance& Interocclusal Distance

• Same techniques used previouslySame techniques used previously

• Critical to measure & feel 2-4 mm of Critical to measure & feel 2-4 mm of interocclusal distance interocclusal distance

• No tooth contacts during closest speaking No tooth contacts during closest speaking spacespace

Changing OVD Changing OVD

• Effects:Effects:

- Occlusion Occlusion

- Facial estheticsFacial esthetics

a

As the mandible opens (ie. byincreasing the occlusal verticaldimension) the incisal edge movesdownward and backward. Byincreasing the vertical dimension,more overjet is obtained and there isa tendency toward moving to askeletal Class II situation.

• As mandible moves downward As mandible moves downward (opening or increasing OVD) (opening or increasing OVD)

• Incisal edge moves backIncisal edge moves back

• Increases overjetIncreases overjet

• Helpful Angles Class IIIHelpful Angles Class III

• Problem Angles Class IIProblem Angles Class II

• As mandible moves downward As mandible moves downward (opening or increasing OVD) (opening or increasing OVD)

• Incisal edge moves backIncisal edge moves back

• Increases overjetIncreases overjet

• Helpful Angles Class IIIHelpful Angles Class III

• Problem Angles Class IIProblem Angles Class II

Vertical Dimension AlterationsVertical Dimension Alterations

• One or both arches may require One or both arches may require changechange

• Made by the laboratoryMade by the laboratory

• May require resetting of all teeth in May require resetting of all teeth in at least one archat least one arch

• Height of both anterior & posterior Height of both anterior & posterior teeth must be in harmonyteeth must be in harmony

Vertical Dimension AlterationsVertical Dimension Alterations

• If only posterior teeth are changedIf only posterior teeth are changed- Undesired effect on: Undesired effect on:

- Overbite relationshipsOverbite relationships- EstheticsEsthetics- Balancing contacts Balancing contacts

• Assess how changes will affect overall Assess how changes will affect overall appearance appearance

Centric Position ContactsCentric Position Contacts

• Check with articulating paper Check with articulating paper

• Stabilize the mandibular denture Stabilize the mandibular denture

• New centric relation record New centric relation record

• Minimal amount of recording Minimal amount of recording mediummedium

Minimal Registration Material Minimal Registration Material

• Improves record Improves record accuracy accuracy - Less resistance Less resistance

during closureduring closure- Reduces chance of Reduces chance of

deflection when deflection when checking record checking record

✔✔ ✘✘

✔✔✘✘

Small Amount of Registration Material Small Amount of Registration Material

• Opposing cusps should not penetrateOpposing cusps should not penetrate

• Cuspal indentations improve accuracy Cuspal indentations improve accuracy compared to flat wax rimcompared to flat wax rim

Confirm Accuracy of Mounting Confirm Accuracy of Mounting

• Ensure record is fully setEnsure record is fully set• Loosen articulator centric lockLoosen articulator centric lock• Seat both record bases & Seat both record bases &

interdigitate teeth into recordinterdigitate teeth into record

Accurate MountingAccurate Mounting• Teeth interdigitate perfectly Teeth interdigitate perfectly

- No space around the cuspsNo space around the cusps

• Condylar ball should contact fossae wallCondylar ball should contact fossae wall

• If either criteria not met, remake recordIf either criteria not met, remake record

Second Record Used to Confirm Second Record Used to Confirm Inaccurate MountingInaccurate Mounting

• Mandibular cast removed from Mandibular cast removed from mounting ringmounting ring

• Mounting plaster ground thinnerMounting plaster ground thinner

• Cast remounted, using the new recordCast remounted, using the new record

Tooth PositionTooth Position

• Canine Relationship Canine Relationship - Most critical tooth Most critical tooth

relationshiprelationship

- If half tooth offset not If half tooth offset not present, diastema required present, diastema required between anterior & between anterior & posterior teethposterior teeth

Canine RelationshipCanine Relationship

• Problems encountered when:Problems encountered when:- Jaw size discrepanciesJaw size discrepancies- MalocclusionsMalocclusions- Improper contouring of occlusal rimsImproper contouring of occlusal rims

Eliminating a Canine Eliminating a Canine DiscrepancyDiscrepancy

• Reducing or increasing overjetReducing or increasing overjet• Reducing or increasing arch Reducing or increasing arch

circumference of one or both circumference of one or both occlusion rimsocclusion rims

• Altering vertical dimensionAltering vertical dimension

Eliminating a Canine Eliminating a Canine DiscrepancyDiscrepancy

• Bodily moving teeth more facially or Bodily moving teeth more facially or more lingually more lingually

• Changing axial inclination (tilting) of Changing axial inclination (tilting) of teethteeth

Prior to resetting teeth, the Prior to resetting teeth, the dentistdentist should determine how to eliminate a should determine how to eliminate a

canine discrepancycanine discrepancy

Excursive Contacts Excursive Contacts

• If the canine relationship is not If the canine relationship is not acceptable, and will be changed, acceptable, and will be changed, excursive contacts will change as wellexcursive contacts will change as well

Excursive ContactsExcursive Contacts

• Evaluate visually and with articulating paper Evaluate visually and with articulating paper

• Intraoral/articulator discrepancies:Intraoral/articulator discrepancies:

- Remake protrusive record Remake protrusive record

- Check/reset condylar inclinationCheck/reset condylar inclination

Verify Comfort: Tongue Space Verify Comfort: Tongue Space

Ask patient to comment on: Ask patient to comment on:

- Comfort Comfort

- Ability to speak with the denturesAbility to speak with the dentures

EstheticsEstheticsCheck:Check:

- Amount of incisal displayAmount of incisal display

- Harmony of the maxillary teeth Harmony of the maxillary teeth with the smile linewith the smile line

- Accuracy of the midlineAccuracy of the midline

- Angle of the occlusal planeAngle of the occlusal plane

EstheticsEsthetics

Check Check - Proper soft tissue profile, Proper soft tissue profile,

contourscontours- Lip supportLip support- Display of the vermilion Display of the vermilion

border,border,- Correct nasolabial angleCorrect nasolabial angle

EstheticsEsthetics

• Ask patients for their opinion prior to Ask patients for their opinion prior to voicing your opinionvoicing your opinion

• Avoids biasing the patientAvoids biasing the patient

• May be helpful to have family or friend May be helpful to have family or friend attend the wax try-inattend the wax try-in

EstheticsEsthetics

If you or the patient have reservations about If you or the patient have reservations about appearanceappearance

- Resolve prior to final processingResolve prior to final processing

- Never attempt to persuade a patient out Never attempt to persuade a patient out of a concern of a concern

- Problems will be yours later, if the Problems will be yours later, if the patient does not like the appearancepatient does not like the appearance

PhoneticsPhonetics

• Easier to assess Easier to assess - Teeth have replaced bulky rims Teeth have replaced bulky rims

• Crowded tongue space can Crowded tongue space can adversely affect phoneticsadversely affect phonetics

LispingLisping

• Non-uniform overjet of Non-uniform overjet of the anterior teeththe anterior teeth

• Diastemas between teethDiastemas between teeth• Palatal contoursPalatal contours• Diamond-shaped Diamond-shaped

openings between incisorsopenings between incisors

PhoneticsPhonetics• If have not worn dentures for extended If have not worn dentures for extended

period period oror

• Dramatic changes Dramatic changes (Contour, Tooth Position, (Contour, Tooth Position, Vertical Dimension):Vertical Dimension):

Allow the patient to read a Allow the patient to read a out loudout loud for for 5-10 5-10 minutesminutes to assess phonetics and comfort to assess phonetics and comfort

Sibilant SoundsSibilant Sounds• ‘‘S’, ‘Z’‘T’ ‘CH’ ‘SH’: S’, ‘Z’‘T’ ‘CH’ ‘SH’:

‘‘Sixty-sixSixty-six’, ‘’, ‘MississippiMississippi’) ’)

• Incisors should approach end to end Incisors should approach end to end relationshiprelationship

a

Normalrelationship ofincisors in CRRelationship of the incisorsduring pronunciation of thesibilants. If the lower incisal edgeis anterior or posterior themaxillary incisal edge, thisindicates an error in the overjet.

Fricative SoundsFricative Sounds

• F, V, ‘F, V, ‘Fifty-Five’Fifty-Five’

• Ask patient to count Ask patient to count from from ‘50 to 60’‘50 to 60’

• Maxillary incisal edges Maxillary incisal edges should just touch the should just touch the posterior one third of posterior one third of the lower lip the lower lip

Denture base contours Denture base contours

• Affect Affect phonetics, phonetics, comfort and comfort and retentionretention

• Should not be Should not be slightly convex slightly convex in shape in shape

ConvexConvex ConcaveConcave

Denture Base Contours Denture Base Contours

Ensure that the denture base is not unduly thick or Ensure that the denture base is not unduly thick or thinthin- Excess bulk will impair comfortExcess bulk will impair comfort

- Feel between index finger & thumbFeel between index finger & thumb

- Base that is too thin will be weakenedBase that is too thin will be weakened- Should not be able to see throughShould not be able to see through

Patient InputPatient Input

Use open ended questionsUse open ended questions

““How do you like the appearance?How do you like the appearance?”, ”,

rather thanrather than

““Don’t the new dentures look great?Don’t the new dentures look great?””

Patient InputPatient Input

• If the patient sounds unconvinced If the patient sounds unconvinced

- ask more questionsask more questions

• Do notDo not rush this step to save time! rush this step to save time!

Final Wax Try-inFinal Wax Try-in

• Confirm that prescribed changes are Confirm that prescribed changes are acceptable acceptable

• Making further alterations if requiredMaking further alterations if required

• Diastemas should be closedDiastemas should be closed

• Phonetics should be acceptablePhonetics should be acceptable

Laboratory Prescription Laboratory Prescription

Request: Request:

- Processing, finishing & polishing Processing, finishing & polishing

- Laboratory remount of the dentures Laboratory remount of the dentures

- Adjustment of occlusion to compensate for Adjustment of occlusion to compensate for processing changesprocessing changes

Laboratory Prescription Laboratory Prescription • Request: Request:

- Fabrication of remount index and casts, Fabrication of remount index and casts, (used at the delivery appointment) (used at the delivery appointment)

- Refinement of wax-up Refinement of wax-up

- Special requestsSpecial requests

• Send Send remount jigremount jig to laboratory to laboratory

Importance of Wax Try-inImportance of Wax Try-in

• Chance to change setupChance to change setup• If not willing to change If not willing to change

aspects of setup, aspects of setup, appointment is a waste appointment is a waste of timeof time

• An opportunity to An opportunity to improve the final resultimprove the final result

LaboratoryLaboratory

• Check Centric contactsCheck Centric contacts

- Ensure even on all posterior teethEnsure even on all posterior teeth

- Check visually from facial and tongue spaceCheck visually from facial and tongue space- Move in wax if far from contactMove in wax if far from contact- Adjust with bur if minor prematuritiesAdjust with bur if minor prematurities

- Ensure sufficient overjetEnsure sufficient overjet

- Begin checking lateral & protrusive contactsBegin checking lateral & protrusive contacts

ChecklistChecklist

• Centric record verified with recording mediumCentric record verified with recording medium• Vertical dimension verified:Vertical dimension verified:

a. 2-3 mm between lip closure and teeth touchinga. 2-3 mm between lip closure and teeth touchingb. Phonetics tests ("50`s-60`s" or "Mississippi") - b. Phonetics tests ("50`s-60`s" or "Mississippi") -

space between rimsspace between rimsc. Lips appear and feel unstrainedc. Lips appear and feel unstrained

• Tooth form, arrangement & shade verifiedTooth form, arrangement & shade verified• Phonetics verified ("S","F" and "M" sounds)Phonetics verified ("S","F" and "M" sounds)• Balanced occlusion, anterior teeth only grazing in protrusionBalanced occlusion, anterior teeth only grazing in protrusion