Diagnostic Waxing Research Articles

Evaluation of objective and subjective treatment outcomes in orthodontic cases treated with extraction of a mandibular incisor.

To analyze changes in occlusal characteristics following mandibular incisor extractions (MIE), to determine the usefulness of wax setups in treatment planning MIE cases and to compare the pre- and posttreatment dental attractiveness between MIE cases and nonextraction (NE) controls. The Peer Assessment Rating (PAR) Index was used to score pre- and posttreatment dental casts of MIE cases (n = 14) and matched NE controls (n = 14). Occlusal characteristics were evaluated on diagnostic wax setups and posttreatment casts. Attractiveness of pre- and posttreatment cases judged on intraoral photographs of cases (n = 6) and controls (n = 6) were rated by 76 dental students and 10 laypeople using visual analogue scales (VAS). The difference in PAR score reduction (%) between the MIE and NE groups was not significant. Between the wax setup and posttreatment casts, there were moderate correlations in overjet, overbite, and right canine classification. There was no significant difference in pre- and posttreatment change in VAS scores (%) for attractiveness between the MIE (49.8 ± 4.3 [S.E.]) and control groups (40.8 ± 4.3 [S.E.]). However, there was a significant difference (P = .000) between the observer groups. There were no significant differences in the treatment outcomes of orthodontic cases treated with MIE or NE, indicating that MIE is a valid treatment option. A wax setup is moderately correlated with posttreatment results. Both laypeople and dental students rated posttreatment dental attractiveness higher than pretreatment in MIE and NE groups. Dental students tended to be more critical than laypeople in their ratings.

Comprehensive digital approach with the Digital Smile System: A clinical report

This clinical report describes a comprehensive digital approach with the Digital Smile System (DSS) and its clinical use in the prosthetic treatment of a patient for whom 6 anterior maxillary porcelain veneers were fabricated. Following this digital protocol, extraoral facial images and a diagnostic intraoral digital scan were obtained. Digital smile analysis, virtual diagnostic waxing, and milled trial restorations were made in the diagnostic phase. After tooth preparation, data from digital scans were used in the computer-aided design and computer-aided manufacturing (CAD-CAM) of the definitive restorations.

Minimally invasive aesthetic rehabilitation in composite resin: report of two clinical cases

Patient demand looking for the perfect smile has been steadily growing in the last few years. Thus, these two case reports discuss some ultra-conservatives approach to achieve good esthetic results. In the first case the clinical protocol of a restorative approach is described, the cosmetic remodeling of the teeth and in the second case, the replacement of extensive unsatisfactory composite restorations. The treatment planning was based on diagnostic waxing and the making of mock-up in both cases. Teeth bleaching were also performed before restoration. To conclude, these conservative relative therapies with composite resin restorations provide an ultra-minimally invasive protocol with excellent esthetic appearances and fuction, especially for young people. KeywordsDental esthetics; Composite resins; Smiling; Restoration.

A novel approach for a prosthetically driven treatment planning of a class III skeletal malocclusion: A case report

IntroductionClass III malocclusion is primarily a skeletal condition characterized by the protrusion of the mandible, or the retrusion of the maxilla, or both. Orthodontic treatment alone, or in combination with orthognathic surgery, usually resolves most cases of class III malocclusion after growth completion. Conversely, oral rehabilitation of partially edentulous patients is challenging and sometimes requires surgical, orthodontic and prosthetic treatments.The aim of this case report is to compare the end results of treatment of a partially edentulous patient with class III skeletal malocclusion prosthetically planned before or after the orthognathic surgery. Case reportA 30 years old twin sisters were referred to prosthodontic clinics for full mouth rehabilitation in National Guard Dental Center. They reported that they were unhappy with their masticatory function and the esthetic appearance of their smile. Medical evaluation revealed that the patients presented satisfactory general health. They underwent orthodontic treatment, the first twin will undergo a comprehensive prosthodontic planning and treatment prior to the orthognathic surgery to correct the anteroposterior discrepancy between the arches by having her diagnostic wax up on the mock surgery casts, while the second twin underwent the surgery without any prosthetic consultation nor planning.Intraoral examination revealed that the first twin had an anteroposterior discrepancy between the dental arches and multiple missing teeth, second twin had almost edge to edge teeth relationship with tendency to class III and multiple missing teeth. ResultsThrough this approach an improvement in the maxillo-mandibular relationship is expected, giving proper occlusal function, canine guidance will be achieved by means of prosthetic treatment, improvement of the smile and periodontal health are also expected to be better in the first twin than the second. ConclusionSkeletal class III malocclusions, are cases prognosis, due to the complexity of situations. Suggesting a multidisciplinary treatment is of great importance for achieving the objectives of therapeutic plan, as the orthodontics alone would not be capable of restoring dentofacial harmony and thus avoiding success and stability in the treatments.

The CAD/CAM Compound Prosthesis: Digital Workflow for Fabricating Cement-Retained Zirconia Prosthesis Over Screw-Retained Milled Titanium Bars

The computer-assisted design/computer-assisted manufactured compound prosthesis involves designing and milling a cement-retained prosthesis over milled titanium bars. In the presented clinical case report, a diagnostic wax pattern was made to assess esthetics, contours, and occlusion. A total of eight maxillary root-form implants were restored by following the combined prosthesis design concept. The mandibular arch was restored with a screw-retained implant-supported zirconia fixed prosthesis. A milled polymethyl methacrylate (PMMA) maxillary interim prosthesis was fabricated to intraorally confirm the diagnostic wax pattern. The interim PMMA prosthesis was then scanned, and three screw-retained titanium milled bars were designed that provided the substructure of the definitive restoration. A cement-retained milled zirconia prosthesis was then designed and fabricated. The zirconia prosthesis provided the superstructure of the definitive complete-arch restoration. After confirming esthetics, phonetics, occlusion, and accessibility for oral hygiene, the superstructure was cemented with temporary cement to enable retrievability.

Laminate veneers: mimetizing nature through anatomical remodeling – case report

OBJECTIVE: Dental aesthetics is one of the areas of dentistry that has most advanced in terms of procedures, techniques and materials. Changes in color, shape, and texture are commonly cited as grounds for complaint, which are sometimes characterized by details, making the work challenging. The objective of this work is to report the planning and execution of a clinical case of smile harmonization with ceramic laminates for remodeling smile.CASE DESCRITION: A male patient consulted a specialist to refine the appearance of his smile that already had a satisfactory pattern of color and texture. The planning was started using digital smile planning, followed by diagnostic waxing of the elements involved. The planning approval took place through the Mock up. The dental grinding performed was minimal and followed a silicone wear guide. The pieces were made in lithium disilicate and installed under absolute isolation according to the cementing protocol of the material. The finishing and polishing completed the installation of the pieces, removing excesses and guaranteeing periodontal compatibility.CONCLUSION: We conclude that indirect aesthetic treatments currently have a minimally invasive character and are highly accepted due to their ability to remodel the smile with perfection and naturalness.

Laboratory workflow to obtain long-term injected resin composite interim restorations from an additive manufactured esthetic diagnostic template.

An analogue and digital workflow for the fabrication of a diagnostic 3D printed polymer template and its duplication for long-term injected composite resin interim restorations is described, because of the lack of scientific evidence in 3-dimensional (3D) printing applied to dentistry in terms of printer technology, printer parameters, postpolymerization processes, and material characteristics. In addition, in the case of 3D printed temporary resins, they cannot be relined successfully and its mechanical properties in the mouth have not been tested yet. The main benefits of this approach relate to the improvement of clinical and laboratory procedures, as conventional waxing is eliminated, conventional master casts are not needed and the process is entirely automatized, improving the workflow, with minimal intervention of the laboratory technician. The additive manufactured diagnostic template represents the materialization of the digital diagnostic waxing and provides a powerful tool to visualize the digital diagnostic waxing in the patient's mouth and face. Furthermore, the diagnostic 3D printed template can be used for multiple applications including interim restorations, radiographical, or surgical guide fabrication. The duplication technique described provides a predictable workflow to obtain long-term injected resin composite restorations from an additive manufactured esthetic diagnostic template, improving the laboratory and chairside procedures.

Diagnostic Wax and Mock-up Technic Use and Property as a Diagnostic Method for the Performing Sector Anterior Composite Resins

En la actualidad las consultas dentales por alteraciones estéticas han ido en aumento, considerándose que los dientes anteriores son los que principalmente se ven cuando una persona habla o sonríe, se deja de manifiesto que éstos son actores esenciales dentro de la estética de un paciente. Sin embargo también debemos preocuparnos de la conservación y/o devolución de guías de desoclusión para así lograr una oclusión mutuamente protegida. Con los avances tecnológicos que ha habido en adhesión esto perfectamente se puede lograr mediante resinas compuestas con una técnica mínimamente invasiva y a un menor costo. Se presenta a consultar una paciente que acaba de terminar su tratamiento de ortodoncia, y a la cual el especialista le indicó que debía tratarse múltiples caries en los molares, pero al realizar la revisión inicial nos encontramos con un grave problema estético en los dientes anterosuperiores, se le ofreció a la paciente tratar dicho problema mediante una técnica de encerado diagnóstico, Mock-up y posteriormente la realización de restauraciones mediante resinas directas. El propósito de presentar este caso clínico es mos- trar una técnica de Mock-up modificado que resulta útil tanto como herramienta diagnóstica como para distintos pasos dentro del mismo tratamiento restaurador.

An Evaluation of knowledge and preference of prosthodontic, orthodontic or integrated treatment options for peg shaped maxillary lateral incisors among general practitioners in Kingdom of Saudi Arabia-A Survey

Background and objective: The requirement for dental specialties and the number of specialists in each country depends mainly on the complex oral health care needs of the society. Missing lateral incisor or Peg shaped lateral incisor is such a condition. The aim of this study was to assess the awareness of general practitioners regarding needs of prosthodontic, orthodontic, or integrated treatment approach for management of peg shaped lateral incisor through a self-represented survey.Methodology: A Cross-sectional study was planned to conduct a survey using questionnaire containing 16 questions which were mailed and distributed to random sample of 292 general dental surgeons who voluntarily took part in the study.Results: Results were self-descriptive due to simple form of questionnaire. Most important goal for the treatment according to 80.7% responders was improvement in esthetics. According to responders, malocclusion was the most important factor (41.6%) which influences the treatment plan. 73.9 % responders told that the prefer to refer the patient to specialist when patients are reported with malocclusion and highly esthetic demand. Almost 40% responders do the diagnostic wax up in such cases. 43.2% responders decided to plan prosthetic treatment after completion of orthodontic treatment and for that full coverage crown was the most preferred choice for rehabilitation. 90.1% of responders believed that combination of both orthodontic and prosthodontic approach was best to achieve the perfect treatment outcome.Conclusion: Pre restorative orthodontic treatment is best for management of peg lateral incisor. Multidisciplinary approach towards the complex dental treatment is always better for the best treatment outcome. Referral system is also developed by such means.

Digital workflow to rehabilitate worn dentition on a non-hinge simulated patient

This report describes the complete mouth rehabilitation of worn dentition by using a digital workflow on a non-hinge simulated patient. A dentiform was used to simulate a patient with loss of occlusal vertical dimension. Physical diagnostic waxing along with a digital workflow was then used to re-establish the occlusal vertical dimension at the interim and definitive restoration stages.

OSC12: Dual Stent to Stabilize Implant Hand Piece.

Introduction: The limited access and visibility, along with proximity of the mandibular canal or maxillary sinus in the posterior region of alveolar ridge makes it difficult to place the implant in ideal angulation. This may lead to imprecise prosthetic rehabilitation due to the extreme angulations and misalignments incurred in the arch of placement. Using a surgical stent designed based on the diagnostic wax up could eliminate most of the clinical and laboratory complications. Discussion: In this article we are describing a novel technique for fabrication of a stent with dual assembly which helps the implantologist to place implant in predetermined position and angulation in posterior inaccessible areas. This stent guides the head of the hand piece by which the determined path of osteotomy is maintained. Since it is a dual assembly it could be easily inserted in the patient’s with reduced oral orifices. Conclusion: This article provides a description about a technique which helps the implantologist to precisely position the implant effortlessly even in less accessible areas. The implant osteotomy in the posterior maxillary region becomes effortless and more precise using the dual assembly stent. The technique allows the hand piece to be stabilized throughout the osteotomy and hence positioning of the implant in the predetermined angulation without any error.

Reestablishing aesthetic and function of patient with severe worn dentition: a conservative approach with provisional fixed tooth/implant supported prosthesis

Patients with severe parafunctional habits can have a reduction of their occlusal vertical dimension (OVD) and may create complex cases of oral rehabilitation, in which the patient may develop occlusal, masticatory and psychological problems. Objective:To report a clinical case of restoration of masticatory function and aesthetics from the production of tooth/implant-supported prostheses with conservative preparations, reestablishing the OVD and occlusal stability. Case report: Patient MVN, 55 years old, wheelchair user, presenting bruxism with a history of gastric reflux due to hiatal hernia, attended the clinic at the University complaining of dental sensitivity, difficulty in chewing and aesthetic smile commitment.At clinical examination it was found widespread wear of teeth. Radiographic examination showed good periodontal health and dental implants in good condition of osseointegration. The OVD was established from the VDR and confirmed by the metric method. The initial casts were positioned on the articulator for diagnostic waxing. From the waxing it was possible to make provisional fixed tooth/implant-supported prostheses. In the lower arch, the prosthesis was screwed on the implants #35, #37, #46, and #47, with the remaining teeth working as an auxiliary support, while in the upper arch two interim prosthesis were made, one for the elements #16 and #17 (tooth-supported) and one for the elements #13, #12, #11, #21, #22, #23, #24 (tooth/implant-supported). Thus, the OVD and the aesthetics lost by bruxism abrasion were restored. Conclusion:This case demonstrates the importance of the provisional prostheses for aesthetic and functional rehabilitation of patients with severe worn dentition.

Consequences of experience and specialist training on the fabrication of implant-supported prostheses: A survey

Statement of problemFabricating fixed restorations on implants requires that dentists stay up-to-date with the scientific publications. Material and methodsA questionnaire containing 29 questions was sent to dentists, members of the Israeli Society of Prosthodontics, and university faculty members. Differences were evaluated using the chi-square and Fisher exact tests and Mann-Whitney U and Wilcoxon tests for questions enquiring into the frequency of use of certain methods (α=.05). ResultsA total of 155 questionnaires were completed by 84 general dental practitioners and 71 specialists and residents. Statistical differences (P<.05) were found in the course of the fabrication of the implant-supported prostheses in the diagnostic waxing, trial restoration, and impression-making processes. Trial restorations were often used by residents and specialists before starting an esthetic restoration. Diagnostic waxing was used when treating patients with complex esthetic needs, mainly by prosthodontists (P=.019). A custom tray for impression making was used more by residents and specialists than by general dental practitioners (P<.001). The open tray technique for impression making of single or up to 3 implants was performed mainly by residents, specialists, and general dental practitioners with professional experience of fewer than 15 years. General dental practitioners used primarily plastic or metal trays for impression making. ConclusionsSignificantly, impression techniques and the use of custom open trays, diagnostic waxing, and trial restorations were performed by residents, specialists, and dentists with fewer than 15 years of experience.

Changes in Lip Profile of Edentulous Patients After Placement of Maxillary Implant-Supported Fixed Prosthesis: Is a Wax Try-in a Reliable Diagnostic Tool?

A diagnostic wax try-in has been recommended to correctly design the future prosthesis for edentulous maxillae and to predict its effect on the supporting oral tissues. The objectives of this study were to analyze (1) the reliability of this diagnostic tool in planning fixed implant-supported prostheses and (2) the amount of prosthetic compensation required. Nine female patients participated in this prospective study (mean age, 53.6 years). After anamnesis, clinical examination, and preoperative analysis, the patients underwent preoperative prosthetic preparation, and the wax try-in was fabricated. To evaluate the efficiency of the diagnostic wax try-in, three profile cephalograms were taken of each patient: (1) with the initial conventional prosthesis, (2) with the wax try-in, and (3) with the implant-supported prosthesis. Two analyses were carried out for the assessment of lip support: the nasolabial angle and Steiner's S-line. To analyze the amount of prosthetic compensation, two measurements-vertical and horizontal distances- were obtained for each wax try-in and final prosthesis. For the Steiner's S-line, the results of the statistical tests indicated no significant difference between the initial and final prosthesis for the upper (P = .237) and lower lips (P = .237), and between the wax try-in and final prosthesis for the upper (P = .463) and lower lips (P = .463). Regarding the nasolabial angle, the results of the statistical tests indicated no significant difference between the initial and final prosthesis (P = .594), and between the wax try-in and final prosthesis (P = .800). Regarding prosthetic compensation, the results of the statistical test indicated no significant difference between the vertical (P = .753) and horizontal evaluations (P = .855) carried out for the wax try-in and those for the final prosthesis. On the basis of the data collected, it was concluded that the methods of replacing muco-supported prostheses with implant-supported fixed prostheses were efficient at maintaining the original lip design. The wax try-in was capable of predicting the future lip design and the prosthetic compensation of the final prosthesis. More studies are required to consolidate these data.

MANEJO CLÍNICO MULTIDISCIPLINAR DA REABILITAÇÃO ESTÉTICA UTILIZANDO CERÂMICAS PURAS: REVISÃO DE LITERATURA

O anseio por um sorriso estético e harmônico eleva o nível de exigência e de expectativa do paciente devido o indivíduo estar inserido numa sociedade onde a aparência tem grande relevância na sua aceitação e autoestima. Dentro desse contexto, uma abordagem multidisciplinar para a reabilitação estética e funcional do sorriso foi inserida na Odontologia contemporânea, destacando-se tratamentos mais conservadores como o clareamento dentário, o aumento de coroa clínica, coroas e facetas cerâmicas por meio de materiais que mimetizem as estruturas dentais. O objetivo deste trabalho é apresentar uma revisão de literatura a respeito de reabilitações do sorriso em cerâmica pura, que se baseia em enceramento diagnóstico e planejamento reverso, uso de mock-up e fotografias, aumento de coroa clínica, clareamento, cimentação adesiva, com foco no resultado estético final. Um bom planejamento integrado, com a indicação correta, possibilita uma abordagem mais conservadora da estrutura dental, apresentando-se como excelente solução para alterações estéticas e funcionais do sorriso. Portanto, é indiscutível a importância do conhecimento por parte do profissional, sobre o material e sua técnica, para obtenção de um resultado satisfatório. Conclui-se que a reabilitação estética do sorriso ocorre a partir de uma multidisciplinaridade entre várias especialidades, que posteriormente a um planejamento integrado, permitem restabelecer o sorriso.

MANEJO CLÍNICO MULTIDISCIPLINAR DA REABILITAÇÃO ESTÉTICA UTILIZANDO CERÂMICAS PURAS: REVISÃO DE LITERATURA

The desire for an aesthetic and harmonious smile raises the level of demand and expectation of the patients, due to the individual being inserted in a society where the appearance is very important to their acceptance and self-esteem. Within this context, a multidisciplinary approach to the aesthetic and functional rehabilitation of the smile was added to the contemporary odontology, highlighting more conservative treatments like teeth whitening, the increase of clinical crown, crowns and ceramic veneers, using materials that mimic the dental structures. The objective of this paper is to present a literature review on the smile rehabilitation techniques using pure ceramics, which is based on diagnostic waxing and reverse planning, the use of mock-up and photographs, an increase of clinical crown, whitening, and adhesive cementation, focusing on the final aesthetic result. A good integrated planning, with the correct indication, enables a more conservative approach to the tooth structure, presenting itself as an excellent solution for aesthetic and functional modifications in the smile. Thus, it is unquestionable the importance of knowledge by the professional, about the material and the technique, to obtain a satisfactory result. It is concluded that the aesthetic rehabilitation of the smile occurs from multidisciplinary approaches within some specialties, which subsequently to an integrated planning may allow to restore the smile.

Digital approach to planning computer-guided surgery and immediate provisionalization in a partially edentulous patient

This report describes a digital approach for computer-guided surgery and immediate provisionalization in a partially edentulous patient. With diagnostic data obtained from cone-beam computed tomography and intraoral digital diagnostic scans, a digital pathway of virtual diagnostic waxing, a virtual prosthetically driven surgical plan, a computer-aided design and computer-aided manufacturing (CAD/CAM) surgical template, and implant-supported screw-retained interim restorations were realized with various open-architecture CAD/CAM systems. The optional CAD/CAM diagnostic casts with planned implant placement were also additively manufactured to facilitate preoperative inspection of the surgical template and customization of the CAD/CAM-fabricated interim restorations.

Integrating conventional and CAD/CAM digital techniques for establishing canine protected articulation: A clinical report

Canine protected articulation is widely accepted for patients requiring extensive oral rehabilitation. Computer-aided design and computer-aided manufacturing (CAD/CAM) restorations have been primarily designed in occlusion at the maximum intercuspal position. Designing a virtual articulator that is capable of accepting excursive occlusal records and duplicating the mandibular movements is a challenge for CAD/CAM technology. Modifying tooth shape using composite resin trial restorations to produce esthetic results and later scanning the modified teeth to create milled crowns is becoming a popular use of the CAD/CAM technology. This report describes a technique that combines conventional and CAD/CAM prosthodontic techniques for milling crowns for canine teeth that are designed to establish or improve canine protected articulation. This technique involves designing and fabricating interim restorations based on diagnostic waxing, scanning the designs intraorally, and storing them in software as pretreatment digital records. The scanned designs are then applied to the digital representation of the prepared teeth to fabricate the definitive restorations.

Occlusal rehabilitation of a geriatric patient with multiple failed fixed prostheses: A clinical report

Commonly observed complications or clinical failures related to fixed dental prostheses (FDPs) include inferior esthetics, loss of retention, loss of tooth vitality due to secondary caries, periodontal disease, tooth fracture, and prosthesis fracture. While treatment of such complications is usually more demanding for the operator, psychological reassurance to the patient is an integral and often the foremost part of the retreatment procedure. This clinical report describes occlusal rehabilitation of a geriatric patient presented with multiple failed FDPs. Endodontic retreatment of abutments and meticulously designed ceramometal FDPs resulted in alleviation of dental pain, improvement in esthetics, gingival health, and enhanced masticatory efficiency while no complaints were reported during 1-year follow-up period. Clinical Relevance to Interdisciplinary Dentistry Complete mouth rehabilitation of a patient with previously failed prostheses often requires an interdisciplinary approach. In this patient, functional, esthetic, biological and restorative goals were defined before starting the treatment. Careful intraoral examination and radiographic analysis, occlusal analysis by mounting diagnostic casts on semi adjustable articulator, patient counselling to understand their expectations from treatment, and diagnostic wax up procedures, to determine approximate protocol of the treatment were performed. Satisfactory gingival health, esthetics, and function were reported at end of treatment and subsequent recall visits.

Impact of digital prosthodontic planning on dental esthetics: Biometric analysis of esthetic parameters

Statement of problemImproving dental esthetics is a main objective of prosthodontic treatment. Recently, digital diagnostic waxing has been proposed as an alternative to conventional diagnostic waxing; however, the impact on esthetics has not been evaluated. PurposeThe purpose of this study was to evaluate the impact of diagnostic waxing on biometric esthetic variables and to compare the esthetic outcome achieved by digital waxing with conventional waxing. Material and methodsThree biometric variables were evaluated: perceived frontal proportion (PFP), width/height (W:H) ratio, and symmetry. Maxillary casts of 13 patients were collected. All of them had maxillary anterior teeth that required prosthodontic treatment. Two forms of diagnostic waxing were executed: conventional and digital waxing. Measurements of the esthetic variables were conducted digitally. For the PFP, a frontal image was made and the width of each tooth was measured. Subsequently, the PFP values of the lateral incisor to central incisor and of the canine to central incisor were calculated. In addition, the height and width of each tooth was measured to calculate the W:H ratio. Using the previous measurements, the symmetry between the right and left sides was determined. ResultsNo consistent or recurrent PFP was detected for any cast. The diagnostic waxing did not alter the PFP of the pretreatment casts. The diagnostic waxing had restored the W:H ratio to what is assumed to be a natural ratio. An improvement in symmetry was detected after the diagnostic waxing and was more prominent after the digital waxing. However, no significant difference was found between the 2 diagnostic waxing methods. ConclusionsThe 2 diagnostic waxing methods influenced the esthetic variables of the anterior maxillary teeth and yielded similar outcomes. Digital waxing appears to be a reasonable alternative, but further investigations are needed to ensure its practicality.