The best thing we can do for our patients is paint a realistic picture of what they can expect from our efforts and proposed treatment. One of the easiest ways you can do this for them is mock-up up their teeth to let them visualize the changes you're proposing. This is an important step before you perform irreversible treatment. While this can be achieved several ways, the following is my quick and effective preferred method.

Have a wax-up of the proposed changes completed. It's critical that you have a clear understanding of your patient's goals, and if your lab is doing the wax-up make sure to communicate these goals with them. Also, if your lab is preparing the wax-up it's vital they know your limitations in preparing your patient's teeth; if not, they may provide a wax-up that will be unachievable.

Once the wax-up is complete you need a matrix of it in order to transfer it to the patient's mouth. One of the easiest ways to fabricate this matrix is to use a material like Copyplast from Great Lakes Orthodontics; it's a flexible thermoplastic material. You could also use Platinum 85 from Zhermack, which is a PVS putty that you form over your model. It's critical that you make a stone duplicate of your wax-up if you're using one of these materials. I find it less stressful to use a stone duplicate from my lab for either method so I don't have to worry about damaging the wax-up.

Once your matrix is made, simply load it with a bis-acryl of your choice and place it over the teeth. Assuming you made an accurate matrix, you'll have a close representation of the wax-up on your patient's teeth with very little flash to remove.

While this method will not work for all cases, it works nicely for many, and it's a great way for you and your patient to preview the proposed changes. The mock-up can be removed by simply pulling at the margins with hand instruments. I hope you'll find this technique helpful in your practice.

John R. Carson, DDS, PC, Spear Visiting Faculty. [ ]


Commenter's Profile Image Doug McMaster
February 22nd, 2013
This is a GREAT concept, particularly with additive situations such as erosion, etc. I like to photograph it in place as well. Wonderful if spouse/other is present too.
Commenter's Profile Image John Carson
February 22nd, 2013
Thanks Doug, I am glad you liked it.
Commenter's Profile Image John Sweeney
February 22nd, 2013
Great Post John, I really like this technique too. I especially like to use this when adding extra length to teeth. I do my incisal depth cuts right into the acrylic, which keeps me from removing unnecessary tooth structure. Also, if the wax up and lab preparation of the teeth were correct, it's useful in doing buccal depth cuts as well. Always enjoy your insight and posts.
Commenter's Profile Image Gerald Benjamin
February 23rd, 2013
The best way to mockup a patient (which I do for all of my cosmetic consultation patients) is to do a direct resin (DRM) mockup in the mouth. This is a technique where the dentist placed a B1 or lighter resin on the teeth and over the soft tissue if needed to immediately give the patient an approximation of what the final treatment will look like. Laboratories frequently miss the perfect incisal edge position by 1 mm...either too long or too short. As in dentures where I set the length in the mouth, the DRM gives me the precise incisal edge position. The other advantages: 1. The patient knows that you have the skill and that you understand cosmetic principles 2. I know whether I have to lengthen the tooth, incisally, gingival or both 3. The patient knows that they need to see my periodontist and why 4. The patient gets to see whether their cosmetic problem can be resolved in 4,8 or 10 teeth because they will ALWAYS select the correct number of teeth to be treated and then I do not appear to be selling them anything. We learn all of this within 10 MINUTES of meeting the patient The DMR is a much more efficient way to mockup the patient AND if you can not do a DMR which improves the smile, the dentist and patient learn that restorative dentistry will not be the modality of treatment and that ortho, surgery and restorative may all be needed.
Commenter's Profile Image John R. Carson
February 24th, 2013
John, Thanks for the nice words and I too enjoy what I have seen from you! Gerald, Thanks for the comments and input!
Commenter's Profile Image Gerald Benjamin
February 24th, 2013
Thanks so much for your kind words. When your mentors are Frank Spear, Newton Fahl and Fred McIntre, it would be difficult to be a mediocre clinician.