Communication Technical talk


Diagnostic wax-up/set-up contribution in treatment planning by Antonis Theocharopoulos and Gerry McKenna


T Fig 1a


o achieve optimal functional and aesthetic results for any patient, communication


between clinician and dental technician is of paramount importanceı


. To facilitate design clarity


before any final treatment plan is administered, visu- alisation of the ideal treatment outcome can be facilitated by a diagnostic wax-up/set-up. Decisions on treatment plan- ning where the patient is also involved can then be made2


. Provisional restorations can


be constructed based on the wax-up/set-up that allow for occlusion and aesthetics to be largely addressed prior to the definitive restoration thus increasing the degree of predictability3


. In implant


cases, optimised positioning of implants can be facilitated with surgical stents made based on an idealised wax-up/setup4 These steps are often over-


.


looked due to time constraints and the costs involved. These factors need to be reconsidered when compared to the signifi-


cant gain in reduced chair-side adjustment time and associated implications that contribute to the overall frustration within the clinician–patient–techni- cian triangleı


. One of the main benefits of


the diagnostic wax-up/set-up is that it aids the provision and maintenance of the required restorative space. Using sili- cone keys of the agreed design, ideally proven via a short or long-term provisional, the technician can then work very efficiently to accommodate all the required materials in the


given space to best serve func- tionality and aesthetics. In a patient that is to be


restored with a cemented implant-retained full-arch maxillary restoration (Figures ıa-d), a silicone key of an ideal tooth set-up is used to guide the technician through all restoration fabrication stages. At the abutment selection (Figure ıb) and design stage (Figure ıc), abutment shape, height, taper etc. can be fully customised to ensure adequate


Continued »


Fig 1b


Fig 1c


Figures 1 a-d: Maxillary cast with implant replicas and gum mask in place (a); Silicone key of diagnostic setup and chosen pre-fabricated abutments (b); Abutments finished to ensure adequate insertion angle, retention but also space for the cast framework (c); The wax modelling of the framework checked against the diagnostic setup key (d). Note the provision for the maintenance of adequate space for the restorative material based on the diagnostic setup design. Case in: aestheticlab.gr


Fig 2a


Fig 2b Fig 1d


Figures 2 a-b: Mandibular cast with silicone key of diagnostic setup and framework wax- up of a screw-retained hybrid denture. As acrylic teeth are to be incorporated, features that will account for mechanical support and retention have been incorporated into the framework (a) without compromising the aesthetics (b). The hybrid restoration with screw access holes are to be filled clinically with composite. Case in: aestheticlab.gr


Ireland’s Dental magazine 31


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48