Diagnostic-Wax-upWhen fabricating a diagnostic wax-up, the steps taken by the laboratory technician directly relate to the principles taught in the Spear FGTP workshop. Establishing the position of the teeth requires careful consideration of all the components necessary for creating an esthetically pleasing outcome, but also incorporating all of the elements required for establishing proper function. Why do you need to think through the process when determining what needs to be sent to your laboratory? Without all the pieces of the puzzle, it is not possible to produce the final picture.

The following are the steps taken by the technician in producing a diagnostic wax-up.

1. The maxillary cast is mounted with a horizontal transfer device (facebow, Kois transfer device, etc.), and the mandibular cast with a centric relation record, assuming a full mouth wax-up will be completed and the patient is treated in CR.

a. Receiving accurate information from the clinician is important so that the occlusal plane is not skewed, the midline is not canted and functional problems are not incorporated into the diagnostic wax-up or definitive restorations.

2. Maxillary and mandibular anterior teeth are waxed. The maxillary anterior teeth are waxed first, followed by the mandibular anterior teeth. This is done to establish:

a. labial aspect: anterior-posterior position

b. labial inclination

c. incisal edge position (incisal tooth length)

d. midline (location and inclination)

e. incisal plane

f. After the mandibular anterior label surface and incisal edge is established in wax, the lingual morphology is created.

3. The palatal morphology of the maxillary anterior teeth is waxed to establish:

a. the contact to mandibular incisal edges which includes the minimal space required to maintain adequate strength of the restorative material

b. the vertical dimension

c. the pathway of function between the centric occlusal contact and the edge-to-edge position

4. The maxillary posterior teeth buccal cusps only are waxed establishing:

a. cusp length

b. the occlusal plane

c. buccal width (buccal corridor)

5. The mandibular posterior teeth are waxed establishing:

a. buccal cusp height

b. the occlusal plane

c. curve of Spee (A-P curve)

d. curve of Wilson (lingual cusp height)

e. occlusal morphology

6. Completion of the maxillary posterior teeth are waxed establishing centric occlusion contact with occlusal morphology and lingual cusp length

7. Refinement of established occlusion and function in both arches It is important for the clinician to understand each set of steps undertaken by the technician when producing a diagnostic wax-up, if they are going to attain the desired esthetic and functional outcomes. The implications of these steps should be taken into consideration by the clinician during diagnosis and treatment planning, and when gathering information to send to the dental laboratory.

Bob Winter, D.D.S., Spear Faculty and Contributing Author


Comments

Carlos Mas Bermejo
April 23rd, 2014
Very clear and very concise. Congratulation for the scheme
Rob Minch
April 23rd, 2014
Hey Bob- great article; I would love to learn more- in a hands on course. Do you think Spear might offer a dx wax up course any time soon?? If so, sign me up!!!!
Dr Farhan Durrani
April 26th, 2014
EXCELLENT DESCRIPTION OF DIAGNOSTIC WAX UP IN SHORT BUT PHOTOGRAPHS WITH INCISAL EDGE SHOW IN RELAX IS ALSO ESSENTIAL
Uwe Mohr MDT
May 28th, 2014
One of the most important steps of this procedure happens before it comes to the Lab> Impressions. Impressions need to be detailed, including alveolar, lingual and palatal aspects. When the technician has finished the waxup, he will make several matrices for the dentist to either transfer the waxup as a mockup or use it as a matrix to generate temps. These matrices sit on the palate or alveolar ridges, bucal and lingual structures in a final seat position. If these contours are not on the model, you will not get an accurate seat of the matrix and an inaccurate transfer of the waxup and the end result is a wasted waxup, unnecessary redo of the procedure. Help yourself and your Lab, give them the best possible impressions with full contours ....And, most importantly, tell your Lab not to make the models all smooth to look pretty, don't sand thenm down to make them shiny, leave all the anatomy in place, it is needed for an accurate seat of the matrix.
Dr.ANIL MOHAN
June 25th, 2014
What is the first step in creating an ideal occlusion? a) Find Centric relation b) Incisal Edge Position c) Wax Up Pls answer dis anyone?
Thomas
February 13th, 2015
Hey everyone, could anyone answer me this? I dont understand one single step in digital smile designing. How do laboratory are able to transfer information from patients photo to stone model and make a identic wax up like in patients photo? Maybe there is some technology that im not aware of it... Thank you !
James P.
November 5th, 2015
Two suggestions - first, can you do a video showing how the teeth are prepared with the burs prior to adding the wax. Some areas may not need reduction, but others may need significant reduction. What burs, technique, etc. Secondly, a hands-on course of 1 to 1 1/2 days of how to do a DWU in our own office. Like this article a lot. Good topic.