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The Diagnostic Wax-up :

The Key to Success


Diagnostic Wax-up

Def : A dental diagnostic procedure in which planned


restorations are developed in wax on diagnostic cast
to determine optimal clinical and laboratory
procedures necessary to achieve the desired
esthetics and function
• Tool/method/process through which practitioners
can fully visualize the true restorative needs of the
patient
• Diagnostic wax-up  blue print of the treatment
plan.

The glossary of prosthodontic terms


Applications

Diagnostic wax-up :
• Tools for :
-Diagnosis
-Treatment on dentate patients, partial
edentulous, complete edentulous
 Using wax or denture teeth set in wax media
The importance of diagnostic wax-up

 Provide important diagnostic information


 Assit in the selection of proper restortion
 Determine the need for preprosthetic surgery,
periodontal, orthodontic, endodontic treatment
 Estimating the amount of restorative space
 Point out for treatment in the opposing arch to
obtain such space
 Evaluating the planned occlusal scheme 
modification ?
 Communication the clinican, technican and patient
 Three - dimensional
The importance of diagnostic wax-up

 In edentulous spaces :
-Form radiographic and surgical implant
placement guides
• In fixed prosthodontics :
-Make a tooth preparation guide creating a
vacuum – formed template or silicone matrix
from the wax up
* guide tooth reduction
•Provisional restoration
Prototype definitive restoration testing
Evaluate esthetic & function
To Doing A Case

4 times :
1.In your mind
2.In wax
3.In plastic
4.In the final restorative material

Dawson
“ If you don’t know where you’re going, any
road will take you there”
 Waxing phase  ensures “you know where
you’re going”.
Successfull Diagnostic Wax-up

1. Well-impressed models (two set : archival and working)


2. Face-bow 7. Periodontal probing chart
3. CR bite 8. Observation of TMJ
4. MI bite 9. Observation of muscle
5. Protrusive bite 10. Diagnostic photographs
6. X-rays
Well-impressed models

Reflect all anatomic information contained


within the oral cavity
Deciding treatment plan
•Bone graft
•Orthodontic  occlusion
Face bow record

 Establishes the relationship of the maxillary


arch and dentition to the horizontal reference
plane
CR Bite Record

Provide a true representation of where the


teeth are in relation to where the condyles
rotate when opening and closing without the
condyles moving down the emenence
Should be the starting point
MI Bite Record

 To verify the termination of the slide from CR


to MI
 To view the full dentition in MI  to
determine whether tooth wear is occlusally
generated or other factors have contributed
to the worm dentition
Types of Diagnostic Wax-up

1. Basic diagnostic wax-up


2. Full-contour wax-up
3. Case presentation wax-up
4. Orthodontic wax-up
Basic Diagnostic Wax-up

 Plan for restorative procedures


 Minimal waxing  in deficient areas only
-Cusp tips  centric stop areas
-Lingual contours  anterior guidance
functions
-Incisal length  desired length or position
 Tool of choice to communicate with
technician  the case will be developed
Basic Diagnostic Wax-up

The basic diagnostic wax-up aids in developing an


overall game plan for the restorative procedures.
2. Full – contour wax-up

 Treatment plan  Improved esthetics and


contours
 Same process basic diagnostic wax-up + more
wax
Used : - missing teeth
- Implant placement determinants
- Create functionally correct
provisionals
 Tools of choice for large rehabilitation cases
2. Full – contour wax-up

The full-contour wax-up is used when improved esthetics and


contours are included in the treatment plan.
3. Case Presentation Wax-up

 To show the patient the end result of


treatment plan
 Teeth are prepared on the model as in the
mouth
 Wax built-up to proper contour & function
 Pink base plate wax to the tissue areas
3. Case Presentation Wax-up

The case presentation wax-up is generally requested to show the


patient the end result of the personalized treatment plan.
4. Orthodontic Wax-up

 Communication tool between :


-Restorative dentist
-orthodontist
4. Orthodontic Wax-up

The orthodontic wax-up helps visualize the possibilities available when


repositioning is an integral part of obtaining optimal results on a given
case.
Case Presentation
Case Presentation
Diagnostic Mock-up

 The clinical equivalent of a laboratory made


diagnostic wax-up
- The teeth being modelled intraorally 
tooth-color material  desired esthetic result
Free Hand Method

 The desired positions of the teeth are


communicated in relation to the existing
dentition
 Technician  instructed to wax the teeth
while modifying the length, width or midline
of the existing teeth by a given amount in
relation to the existing condition
Types of Diagnostic Mock-up

1. Preliminary diagnostic Mock-up


2. Secondary diangnostic mock-up
3. Removable mock-up provisional restoration
4. Fixed mock-up provisional restoration
1. Preliminary Diagnostic Mock-up

 A tool to obtain clinical information in a simplified


way prior to the diagnostic wax-up
• Used free hand intra orally to contour one or more
tooth
• Evaluate the affect on the patient’s appearance :
-Lip position
-Phonetic test  to evaluate tentative incisal edge
position vertically and buccolingually in relation to
the vermilion borders or the lower lip
F & V sounds
 Without etching or bonding
 Guide for the wax up
1. Preliminary Diagnostic Mock-up
1. Preliminary Diagnostic Mock-up
1. Preliminary Diagnostic Mock-up
Secondary Diagnostic Mock-up

Overlay prosthesis  after the diagnostic


wax-up has been made.
• Formed using silicone matrix made from the
diagnostic wax-up
• Filled with auto polymerizing resin
• Placed over the unaltered natural teeth
• Removed upon final polymerization
• Remains on the teeth  mechanically
retained in undercuts
Secondary Diagnostic Mock-up
Secondary Diagnostic Mock-up
Secondary Diagnostic Mock-up
Secondary Diagnostic Mock-up
Secondary Diagnostic Mock-up
Secondary Diagnostic Mock-up
Removable Mock-up Provisional
Restoration
 Removable overlay prosthesis  used until
final approval of the teeth arrangement is
obtained
Fixed Mock-up Provisional
Restoration
 Unaltered teeth  etched  silicone matrix
made form the diagnostic wax-up is used to
bond the mock up to the teeth.
Is designed to test the mock-up long term for
esthetic and function
NOTE  not the case :
• Mock-up is based on a subtractive wax-up
(tooth reduction needed for wax-up)
• The entire surface of the teeth was etched
Advantages

 Desired changes can be visualized clinically


 Tested with the patient’s rest position smile
and phonetically
 Patient active involved in the diagnostic
process providing feed back
 Sharing the responsibility for the final result
 Clinical information to guide the diagnostic
wax-up
Harry Laksono