Digital wax up in dentistry

Introduction

Use of wax up and mock up in curent modern dentistry

When to perform a wax up?

What is a diagnostic wax up? How to perform a mock

up?

Digital vs conventional

Advantages of digital

Protocol –de adaugat subcapitol

Clinical cases

My own case*

Introduction

Diagnostics are essential for predictable restorative dentistry. Both patient and clinician must agree on a

treatment goal before the final restorations are delivered to avoid future disappointments. However, fully

understanding the patient’s desires is difficult. A useful tool to overcome this problem is the diagnostic wax-up and

mock-up. A potential treatment outcome is modeled in wax prior to treatment and transferred into the patient’s

mouth using silicon indexes and autopolymerizing resin to obtain the patient’s approval. Yet, this time-consuming

only produces a single version of the possible treatment outcome, which can be unsatisfactory for both the patient
and the restorative team. Contemporary digital technologies may provide advantageous features to aid in this

diagnostic treatment step

(Int J Esthet Dent 2015;10:XXX–XXX)

When the diagostic wax up is not additive( i.e. we are not adding volume and /or lenght to the teeth arch), we need

to employ different techniques, alone or in combination, to visualize and disscus the proposed changes.

Computer imaging software has been available since the late 1980s, and there are a number of highly sophisticated

programs available today. When using imaging software, it is advised that the dentist controls the simlulation-

versus an assistant or a third party service- as we must be careful not to show anything that may not be achievable.

Ideally, this 2d digital imaging should only reflect changes we have been able to build into the 3d diagnostic wax

up.

( Johnatan B. Levine, Sivan Finkle, Smile Design Integrating Esthetics and Function, 2016, Consideration for a

Reductive Mock up)

The ideal moment to perform a diagnostic wax up?

The first and ideal time point is before any invasive treatment is performed. Once the pacient enterd the dental

office in pursit of assistance, the dentist should go through medical and dental anamnesis and examination. It’s a

duty to gather all the information and take facial and smile photography and sometimes impressions of the initial

situation.

We run a diagnostic wax up that is a useful tool to achive the goal of an objective materialization. It also improves

the communication between patient, practicioner and technician.

The main role of the diagnostic wax-up is giving a three-dimensional representation of the tentative treatment

outcome. ( surse 1,3,8 din articolul Sancho)

 1. Magne P, Magne M, Belser

U. The diagnostic template:

a key element to the com-

prehensive esthetic treat-

ment concept. Int J Peri-

odontics Restorative Dent

1996;16:560–569.

3. Simon H, Magne P. Clinically

based diagnostic wax-up for

optimal esthetics: the diag-

nostic mock-up. J Calif Dent

Assoc 2008;36 355–362.

. Kahng LS. Patient-dentist-

technician communication

within the dental team: Using

a colored treatment plan

wax-up. J Esthet Restor Dent

2006;18:185 –193; discussion

194–195.

Usually the dental technician models a possible dental configuration in wax using as reference:

 Clinical photographs

 Anatomical landmarks on the diagnostic casts (oclusal plane and length, positions of the remaning teeth)
After getting this information ,the dental technician responded to us with a 3d project in wax. Thus, this will aid us

in preparing our Mock-up1. (The wax up is later tried in the pacient’s mouth using silicone matrices and

autopolymeriable resin) (articol Sancho, European Scientific Journal February 2016 edition vol.12, No.6 )

The mock-up has multiple advantages, such as:

1. The pacient has an idea of what he/she is expecting

2. Esthetic communication

3. We cand make a functional control

4. The effect of the restoration on the upper lip posture

5. The relationship of the smile line with the lower lip

6. Check the occlusion and the phonetic

7. According to authors (e.g G. Gurel (2003) and P. magne (2004) ) another interesting aid of the mock up is

the control minimal invasive preparation.

How do we perform a mock up?

There are many ways of preparing a diagnostic wax up and therefor a mock up. These ways include:

1. Free hand mock up direct in composite ( without wax up)

2. Mock up according to the wax up with the self curing resine

3. Modern digital design mock up

The conventional mock up made after the wax up it’s only effective when an additive reconstructive attempted is

intended.

In case of substractive procedures are necessary, the intraoral transfer of the wax up will be needed to be performed

in a later treatment stage.

1
Dental Mock-up is a preparation that shows the end result over the unprepared teeth. It serves as a guide in prosthodontics treatment,
and is very important in esthetics reabilitations. Depending on the steps , it has different names: Mock-up, BFEP (bonded functional
esthetic prototype)( McLaren-2013) and APT ( aesthetic pre-evaluate temporary) ( Gurel-2003)
(about conventional mock up) de completat

On the other hand, the modern digital design gives us the opportunity to transform the previous facts into easier,

faster, cheaper and more predictable mechanized methods.

The restorative team can profit from virtual libraries from where different tooth morphologies can be selected (

Exocad, 3Shape, dental Wings, Sirona). This software tools offer numerous different tooth shape categorized

according to paramtere such as size, pacient’s age or phenotype. Moreover real teeth can be used as a reference to

generate tooth morphology proposal.

Schenk O. Biogeneric

– another step closer to

nature. V3.8: largest update

since introduction of the 3D

software. Int J Comput Dent

2010;13:169–174.

Digital diagnostics vs Conventional diagnostics

A time progress bar is depicted under each treatment step.

1. First impression

2. In laboratory- model

3. Diagnostic wax up on the model

4. Impression of the model ( we place a tiny peace of

plastic foil before the impression)

5. We cut the impression’s margins

6. Flow composite in the impression !!!de detaliat

7. Put the impression with the material in the pacient’s

mouth and see the result

Why choose digital?

 Increase productivity : Make more units per day

Reduce labor-intense processes

Get fast digital workflows

 Create high quality prosthethics: Get proven digital accuracy

Advanced dental work becomes easier

 Drive profit and stay competitive

 Provide more indications and materials

Advantages of digital wax up

The digital world provides a series of advantages. Working time is substantial reduced by eliminating the

mechanical handwork needed for conventional waxing techniques. The software allows for the integration of

photorealistic three-dimensional (3D) reconstructions of the pacient’s face into the virtual design software.

Kurbad A, Kurbad S. Cerec

Smile Design – a software

tool for the enhancement of

restorations in the esthetic

zone. Int J Comput Dent

2013;16:255–269.

The face is integrated by means of 2D digital photographs projected onto a 3D virtual skull or by means of 3D

facial scanners. This fact allows for virtual smile design, taking in considerations important facial reference such as

midline, smile line or the horizontal plane.

Another advantage is the possibility of rapidly modifying an initial design version in order to effortlessly try in

other tooth arrangements. This fact grants the techinician freedom to generate multiple version of the future

restoration in an efficient manner.

Until now, substravtive CAM processes have dominated dental manufacturing routines.

Restorations are obtained by trimming a solid block of material into the desired 3D object by means of computer-

controlled milling machine.

. Miyazaki T, Hotta Y, Kunii

J, Kuriyama S, Tamaki Y. A
review of dental CAD/CAM:
current status and future

perspectives from 20 years

of experience. Dent Mater J
2009;28:44–56.
Clinical cases:

In order to explain this process we present a clinical case in which the digital work-flow procedure was applied for

a prosthetic rehabilitation in natural teeth and implants. (oral implantology articol mail)

The first step, we need to take an intraoral photo, then we can make a diagnostic wax-up build up from the

pacient’s photo for the aesthetic’s planning using the digital smile’s technology. Once validated the simulation of

the rehabilitation, then we procede with the preparations, the final manufacturing will be created with the CAD-

CAM technologies.

The initial step in a highly precise digital work-flow is an analogue impression (*sursa 1 articol mail) so the intra-

oral scanner is used to record the two arches. A conventional impression has disavantages such as dimensional

changes due to on-going chemical reaction.(3). The conventional impression requires many critical steps that can be

skiped when using digital impression, that means the time chair is reduced. The accuracy of the digital scanners has

been determined by several authors.(10) Mainly, it is increasing the comfort of the pacient and minimizing

Fig. 1 Intraoral patient’s photo.

 Fig 2. Virtual diagnostic wax-up.

Fig 3. Digital impression using intraoral implant scan

bodies.
Fig 4. Digital model.

Fig 5. CAD model.

 Fig 6. CAM prosthesis. (a si b)

Fig 7. Definitive rehabilitation: the abutments.

 Fig 8. Front and lateral view of the final aesthetic.(a

si b)