The Wax Tryin

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The Wax Try-in
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Wax Try-in

• Verify Change
• Appearance
• Phonetics
• Occlusal relationships
• Patient comfort

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Two try-in appointments

• Initial wax try-in
• Confirm esthetics, phonetics
• Verify centric, protrusive
• Final wax try-in
• Ensure balanced (if applicable), wax-up complete

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Dont Overlook Problems

• Difficult/impossible to change after processing
• May require removal, resetting re-processing
• Procedures more costly time consuming

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Incisors too long
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Initial Wax Try-in

• Verify
• Appearance of the anterior teeth
• Accuracy of the maxillomandibular records
• Changes will almost always need to be made
• Technician has not finalized balance at this stage

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Make Changes Technician Cant Assess Esthetic
Problems Other changes can be prescribed for
the technician to complete
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Verify Occlusal Vertical Dimension
Interocclusal Distance

• Same techniques used previously
• Critical to measure feel 2-4 mm of
  interocclusal distance
• No tooth contacts during closest speaking space

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Changing OVD

• Effects
• Occlusion
• Facial esthetics

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• As mandible moves downward (opening or
  increasing OVD)
• Incisal edge moves back
• Increases overjet
• Helpful Angles Class III
• Problem Angles Class II

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Vertical Dimension Alterations

• One or both arches may require change
• Made by the laboratory
• May require resetting of all teeth in at least
  one arch
• Height of both anterior posterior teeth must be
  in harmony

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Vertical Dimension Alterations

• If only posterior teeth are changed
• Undesired effect on
• Overbite relationships
• Esthetics
• Balancing contacts
• Assess how changes will affect overall appearance

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Centric Position Contacts

• Check with articulating paper
• Stabilize the mandibular denture
• New centric relation record
• Minimal amount of recording medium

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Minimal Registration Material

• Improves record accuracy
• Less resistance during closure
• Reduces chance of deflection when checking record

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Small Amount of Registration Material

• Opposing cusps should not penetrate
• Cuspal indentations improve accuracy compared to
  flat wax rim

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Alternate Technique Alluwax with a Wax Spatula
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Placement of Alluwax
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Alluwax Should Be Placed Over Contacts

• First contacts are on these areas
• Prevents penetration and contact on prematurities

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Confirm Accuracy of Mounting

• Ensure record is fully set
• Loosen articulator centric lock
• Seat both record bases interdigitate teeth
  into record

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Accurate Mounting

• Teeth interdigitate perfectly
• No space around the cusps
• Condylar ball should contact fossae wall
• If either criteria not met, remake record

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Second Record Used to Confirm Inaccurate Mounting

• Mandibular cast removed from mounting ring
• Mounting plaster ground thinner
• Cast remounted, using the new record

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Tooth Position

• Canine Relationship
• Most critical tooth relationship
• If half tooth offset not present, diastema
  required between anterior posterior teeth

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Canine Relationship

• Problems encountered when
• Jaw size discrepancies
• Malocclusions
• Improper contouring of occlusal rims

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Eliminating a Canine Discrepancy

• Reducing or increasing overjet
• Reducing or increasing arch circumference of one
  or both occlusion rims
• Altering vertical dimension

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Eliminating a Canine Discrepancy

• Bodily moving teeth more facially or more
  lingually
• Changing axial inclination (tilting) of teeth

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Prior to resetting teeth, the dentist should
determine how to eliminate a canine discrepancy
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Excursive Contacts

• If the canine relationship is not acceptable, and
  will be changed, excursive contacts will change
  as well

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Excursive Contacts

• Evaluate visually and with articulating paper
• Intraoral/articulator discrepancies
• Remake protrusive record
• Check/reset condylar inclination

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Verify Comfort Tongue Space

• Ask patient to comment on
• Comfort
• Ability to speak with the dentures

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Esthetics

• Check
• Amount of incisal display
• Harmony of the maxillary teeth with the smile
  line
• Accuracy of the midline
• Angle of the occlusal plane

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Esthetics

• Check
• Proper soft tissue profile, contours
• Lip support
• Display of the vermilion border,
• Correct nasolabial angle

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Esthetics

• Ask patients for their opinion prior to voicing
  your opinion
• Avoids biasing the patient
• May be helpful to have family or friend attend
  the wax try-in

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Esthetics

• If you or the patient have reservations about
  appearance
• Resolve prior to final processing
• Never attempt to persuade a patient out of a
  concern
• Problems will be yours later, if the patient does
  not like the appearance

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Phonetics

• Easier to assess
• Teeth have replaced bulky rims
• Crowded tongue space can adversely affect
  phonetics

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Lisping

• Non-uniform overjet of the anterior teeth
• Diastemas between teeth
• Palatal contours
• Diamond-shaped openings between incisors

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Phonetics

• If have not worn dentures for extended period
• or
• Dramatic changes (Contour, Tooth Position,
  Vertical Dimension)
• Allow the patient to read a out loud for 5-10
  minutes to assess phonetics and comfort

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Sibilant Sounds

• S, ZT CH SH
• Sixty-six, Mississippi)
• Incisors should approach end to end relationship

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Fricative Sounds

• F, V, Fifty-Five
• Ask patient to count from 50 to 60
• Maxillary incisal edges should just touch the
  posterior one third of the lower lip

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Denture base contours

• Affect phonetics, comfort and retention
• Should not be slightly convex in shape

Convex
Concave
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Denture Base Contours

• Ensure that the denture base is not unduly thick
  or thin
• Excess bulk will impair comfort
• Feel between index finger thumb
• Base that is too thin will be weakened
• Should not be able to see through

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Patient Input

• Use open ended questions
• How do you like the appearance?,
• rather than
• Dont the new dentures look great?

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Patient Input

• If the patient sounds unconvinced
• ask more questions
• Do not rush this step to save time!

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Final Wax Try-in

• Confirm that prescribed changes are acceptable
• Making further alterations if required
• Diastemas should be closed
• Phonetics should be acceptable

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Laboratory Prescription

• Request
• Processing, finishing polishing
• Laboratory remount of the dentures
• Adjustment of occlusion to compensate for
  processing changes

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Laboratory Prescription

• Request
• Fabrication of remount index and casts, (used at
  the delivery appointment)
• Refinement of wax-up
• Special requests
• Send remount jig to laboratory

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Importance of Wax Try-in

• Chance to change setup
• If not willing to change aspects of setup,
  appointment is a waste of time
• An opportunity to improve the final result

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Laboratory

• Check Centric contacts
• Ensure even on all posterior teeth
• Check visually from facial and tongue space
• Move in wax if far from contact
• Adjust with bur if minor prematurities
• Ensure sufficient overjet
• Begin checking lateral protrusive contacts

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Checklist

• Centric record verified with recording medium
• Vertical dimension verified
• a. 2-3 mm between lip closure and teeth
  touching
• b. Phonetics tests ("50s-60s" or
  "Mississippi") - space between rims
• c. Lips appear and feel unstrained
• Tooth form, arrangement shade verified
• Phonetics verified ("S","F" and "M" sounds)
• Balanced occlusion, anterior teeth only grazing
  in protrusion