1 The Wax Try-in
2 Wax Try-in Verify & Change: Occlusal relationships AppearancePhonetics Patient comfort
3 Two Try-in AppointmentsInitial wax try-in Verify centric, protrusive Confirm esthetics, phonetics Final wax try-in Ensure balanced (if applicable), wax-up complete
5 Centric Position ContactsCheck first – Affects everything else Check with articulating paper Stabilize mandibular denture New centric relation record Minimal amount recording medium
6 Minimal Registration MaterialImproves record accuracy Less resistance during closure Reduces chance of deflection when checking record ✔ ✘ ✘ ✔
7 Small Amount of Registration MaterialOpposing cusps should not penetrate Cuspal indentations improve accuracy compared to flat wax rim
8 Confirm Accuracy of MountingEnsure record is fully set Loosen articulator centric lock Seat both record bases & interdigitate teeth into record
9 Accurate Mounting Teeth interdigitate perfectlyNo space around the cusps Condylar ball should contact fossae wall If either criteria not met, remake record Doesn’t fit Fits well
10 Second Record Used to Confirm Inaccurate MountingMandibular cast removed from mounting ring Mounting plaster ground thinner Cast remounted, using the new record
11 Don’t Overlook ProblemsDifficult/impossible to change after processing May require removal, resetting & re-processing Procedures more costly & time consuming
12 Verify Occlusal Vertical Dimension & Interocclusal DistanceSame techniques used previously Critical to measure & feel 2-4 mm of interocclusal distance No tooth contacts during closest speaking space
13 Changing OVD Effects: Occlusion Facial esthetics
14 As mandible moves downward (opening or increasing OVD)Incisal edge moves back Increases overjet Helpful in Angles Class III Problem in Angles Class II
16 Vertical Dimension AlterationsIf only posterior teeth are changed Undesired effect on: Overbite relationships Esthetics Balancing contacts Assess how changes will affect overall appearance
17 Tooth Position Canine Relationship Most critical tooth relationshipIf half tooth offset not present, diastema required between anterior & posterior teeth Insufficient Offset
18 Canine Relationship Problems encountered when: Jaw size discrepanciesMalocclusions Improper contouring of occlusal rims
19 Eliminating a Canine DiscrepancyReducing or increasing overjet Reducing or increasing arch circumference of one or both occlusion rims Altering vertical dimension Reducing overjet in of 1st/4th quadrants to improve canine relationship & reduce lisping
20 Eliminating a Canine DiscrepancyBodily moving teeth facially/lingually Changing axial inclination (tilting)
21 Prior to resetting teeth, the dentist should determine how to eliminate a canine discrepancy
22 Excursive Contacts Evaluate visually and with articulating paperIntraoral/articulator discrepancies: Remake protrusive record Check/reset condylar inclination
23 Verify Comfort: Tongue SpaceAsk patient to comment on: Comfort Ability to speak
25 Esthetics Check Proper soft tissue profile, contours Lip supportDisplay of the vermilion border Correct nasolabial angle
26 Esthetics Ask patients for their opinion prior to voicing yoursAvoids biasing the patient Family or friend may be helpful
28 Esthetics If you or the patient have reservations about appearanceResolve prior to final processing Never attempt to persuade a patient out of a concern Problems will be yours later, if patient does not like appearance
30 Phonetics Easier to assess Teeth have replaced bulky rimsCrowded tongue space can adversely affect phonetics
31 Lisping Non-uniform overjet of anterior teeth Diastemas between teethPalatal contours Diamond-shaped openings between incisors
32 If have not worn dentures for extended periodPhonetics If have not worn dentures for extended period or Dramatic changes (Contour, Tooth Position, OVD) Allow the patient to read a OUT LOUD for 5-10 minutes to assess phonetics and comfort
33 Sibilant Sounds ‘S’, ‘Z’‘T’ ‘CH’ ‘SH’: ‘Sixty-six’, ‘Mississippi’)Incisors should approach end to end relationship
34 Fricative Sounds F, V, ‘Fifty-Five’Ask patient to count from ‘50 to 60’ Maxillary incisal edges should just touch wet line of the lower lip
35 Denture base contours Affect phonetics, comfort and retentionShould be slightly concave, NOT convex in shape Convex Concave
36 Denture Base Contours Ensure that 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
37 Patient Input Use open ended questions“How do you like the appearance?”, rather than “Don’t the new dentures look great?”
38 Patient Input If the patient sounds unconvincedAsk more questions Do not rush this step to save time!
39 Final Wax Try-in Confirm that prescribed changes are acceptableMaking further alterations if required Diastemas should be closed Phonetics should be acceptable
40 Laboratory PrescriptionRequest: Processing, finishing & polishing Laboratory remount of the dentures Adjustment of occlusion to compensate for processing changes
41 Laboratory PrescriptionRequest: Fabrication of remount index & casts, (used at delivery) Refinement of wax-up Special requests Send remount jig to laboratory
42 Importance of Wax Try-inChance to change setup If not willing to change aspects of setup, appointment is a waste of time An opportunity to improve the final result
43 Checklist Centric record verified with recording mediumVertical dimension verified: a. 2-3 mm between lip closure and teeth touching b. Phonetics tests ("50`s-60`s" 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
44 Videos Analyzing & Adjusting Centric Contacts Adjust Lateral ContactsAdjust Protrusive Contacts
45 Denture Tooth Setup ProjectSet Posterior Teeth 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