Communication
Fig 3a
Fig 3b
Fig 3c
Figures 3 a-c: Diagnostic wax-ups for anterior all-ceramic crowns. Sizes and shapes can be easily adjusted and the patient can be involved in the decision making. Cases in:
aestheticlab.gr
Fig 4a
Fig 4b
Fig 4c
Fig 4d
Figures 4a-d: Diagnostic waxup (a) copied into an acrylic surgical template (b). The incorporated drill guide components (b,c) help in achieving a favorable implant placement (d). Case in: Cork Dental School and Hospital
Continued »
insertion angle, retention and space for the cast or CAD/ CAM framework. Furthermore, at the frame-
work modelling stage (Figure ıd), the key ensures the main- tenance of adequate space for the restorative material based on the original design. In many implant cases, clinicians favour screw- retained restorations due to their retrievability. Planning these cases can also benefit significantly from a good diagnostic setup (Figures 2a and 2b). In a hybrid case for example, an appropriate, strong framework design with adequate support and
REFERENCES
1. Lynch CD, McConnell RJ, Allen PF. Trends in Indirect Dentistry: 7. Communicating Design Features for Fixed and Removable Prostheses. Dental Update 2005;32(9):502-10. 2. Sadaqah NR, Tair JAA. Prosthetic reconstruction using gingiva-colored ceramic agent in fixed partial restoration in a 24-year old patient. Clinical, Cosmetic and Investigational Dentistry 2012;4:37-41. 3. Schlenoff M. Esthetic and func- tional provisional restorations Inside Dentistry 2010;April:100-01. 4. Wat PYP, Chow TW, Luk HWK,
Comfort MB. Precision Surgical Template for Implant Placement: A New Systematic Approach. Clinical Implant Dentistry and Related Research 2002;4(2):88-92. 5. Solow RA. Simplified radiographic- surgical template for placement of multiple, parallel implants. The Journal of Prosthetic Dentistry 2001;85(1):26-29.
mechanical retention features for acrylic teeth (Figure 2a) can be designed to avoid frequent occurrence of teeth- chipping and framework exposure while not compro- mising aesthetics (Figure 2b). When planning anterior aesthetics, a diagnostic wax-up can be invaluable for planning tooth shape and position. Using a semi-adjust- able articulator, the desired outcome can be trialled in lateral and protrusive excur- sive movements to ensure the correct relationship in dynamic occlusion. Copying this wax-up into an acrylic template enables try-in in the patient’s mouth. This can be used to include
the aesthetically demanding patient in real-time decision making. Such an approach can greatly simplify the process for everyone involved (tech- nician, patient and clinician) as the agreed template result can form the basis for the final restoration. In demanding cases where
the treatment planning involves accurate implant placement, transferring the information from a diagnostic wax-up (Figure 4a) to a surgical guide after appropriate radio- graphic imaging can prove very helpful5,6
. The positioning and angula-
tion of implants can be decided prior to the implant surgery based on the optimal tooth
positioning, bone quality and desired restoration type (e.g. screw or cement retained). The technician can then
incorporate appropriate drill guide components in an acrylic template copy of the original waxup that extends over the remaining teeth for reposi- tioning (Figure 4b). This will make the implant surgery much more simple and predict- able (Figures 4c-d). In conclusion, case treat-
ment planning can benefit from the dental technician’s contri- bution. The use of diagnostic wax ups/setups can play a vital role in planning final restora- tions, communicating with patients and guiding surgical cases.
ABOUT THE AUTHORS
Antonis Theocharopoulos received a BSc in dental tech- nology from the Technological Educational Institute of Athens, Greece in 2002. He has worked as a dental techni- cian in Aestheticlab in Athens (
www.aestheticlab.gr) for four years.
6. Zahran MH, Fenton A. A radiopaque implant template for partially eden- tulous patients. The Journal of Pros- thetic Dentistry 2010;103(6):390-92.
He received his MSc Dental Materials from Queen Mary University of London, UK in 2007 and his PhD from Barts and The London School of Medicine and Dentistry in 2011. He currently works as a lecturer in dental technology in Cork University Dental School and Hospital. Gerry McKenna is a lecturer in prosthodontics and oral rehabilitation in Cork University Dental School and Hospital. He has worked closely with Antonis on a number of clinical cases which have benefited greatly from close clinician– technician interaction.
Ireland’s Dental magazine 33
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