Benefits and Reasons to Do a Diagnostic Wax-up

With the growing popularity of digital dentistry and advanced dental treatments, slowly but surely a diagnostic wax-up became the foundation of every treatment plan. It effectively establishes the proposed outcome of both function and esthetics, as such bettering the performance of restorative and surgical procedures.

However, there are some who are still uncertain of its benefits and uses, and the following article outlines everything you need to know about the diagnostic wax-up – how to complete it, which techniques to opt for, and what its benefits are.

Definition

According to the glossary of Prosthodontic Terms, a dental diagnostic procedure in which planned restorations are developed in wax on a diagnostic cast to determine optimal clinical and laboratory procedures necessary to achieve the desired esthetics and function. It is intended to be a replica of a proposed dental treatment plan.

A diagnostic wax-up is an outcome-based tool that is expected to accurately present the desired result of the proposed treatment. The dental professional’s job is to provide detailed instructions informing the dental lab of the patient’s needs and expectations. Only then will the laboratory technicians be able to establish accurate tooth alignment, position, morphology, inclination, and occlusal relations.

Types of diagnostic wax-up

Generally speaking, depending on the severity of the issue, a dental professional may request one of the four types of diagnostic wax-up to be performed:

• Basic – Used for developing an overall treatment plan for restorative procedures. Waxing is minimal and used only in critical areas which require restoration.
• Full contour – Used when the treatment plan includes contours and esthetics. More wax is used in comparison to the basic wax-up and is a preferable procedure when the patient is looking to replace the missing teeth.
• Case presentation – Most commonly used to display an end result and present it to the patient.
• Orthodontic – Provides dental practitioners with a visual model of the patient’s dental situation and aids in the better preparation of the treatment plan. It is a detailed representation of the given case and is used as a communication tool between the dental and lab professional.

The procedure

The following steps need to be taken during the diagnostic wax-up:

• Create impressions and occlusal records.
• Create two sets of study models, one for the original dental state and the other to be used for the wax-up.
• Conduct diagnostic wax-up.
• Patient, clinician, and technician discuss the restoration plan based on the three-dimensional representation.
• Make adjustments to the initially proposed treatment plan (if necessary).

Treatment tools

During the diagnostic wax-up process, three types of treatment tools are created:

• Two preparation silicone guides

The guides are used to determine whether there is enough space to place the restorative material properly and deliver a strong, durable, and aesthetically pleasing result. A palatal guide represents the incisal edge of the teeth, while a window guide identifies the surfaces of the malpositioned teeth.  

• A copyplast stent

The stent is intended to create the intraoral mockup used for pre-treatment evaluation or final tooth preparation. Furthermore, it creates provisional restorations used in trial therapy to analyse the proposed functional and aesthetic changes.

• A provisional shell

The shell is created before the teeth are prepared and is relined intraorally.

Diagnostic wax-up benefits

Improved diagnosis and treatment plan

A diagnostic wax-up may reveal that the initially proposed restoration plan cannot be achieved. It can show issues invisible to the bare eye and indicate that the treatment is not possible from a functional perspective and that a new one needs to be proposed. Fortunately, after the diagnostic wax-up is completed, the dental professional has a clear picture of the patient’s potential and can define an accurate treatment plan.

Minimal corrections

Taking this into consideration, it is evident that a diagnostic wax-up can help accelerate the treatment process by eliminating the number of adjustments and corrections. With an accurate representation of the restorative possibilities, crowns, bridges, and other dental solutions will surely be better designed the first time around.

Improved quality of temporary solutions

When impressions are taken with quality materials, the fit of the temporaries is superior, with far less flash in comparison to temporaries created with alginate. A diagnostic wax-up can temporise an entire arch in a short amount of time – the stent is filled with restoration material and placed over the prepared teeth. Upon peeling it off, the temporaries are revealed and require minimal polishing.

A better understanding of the result

Some patients may feel sceptic about the proposed plan of treatment. They express feeling uncertain about the final result and would prefer to see the example of the mock-up before they start the treatment. A diagnostic wax-up can deliver just that – a representation of the outcome, i.e. what their teeth will look like once the treatment is finished. However, note that this is only possible in the case of some minor changes.

Here’s what happens: the stent made from the diagnostic wax-up and filled with provisional material is placed onto the patient’s teeth. Once removed, it will closely show the proposed result. However, when more radical changes are being made, the stent has to be placed over unprepared teeth and will, as a result, appear distorted.

Improved communication

Unfortunately, misinterpretations are possible when information is exchanged between a patient, dental technician, and clinician. But with a diagnostic wax-up, you get a visual representation of a particular patient’s case, their needs, and proposed treatment methods. As such, it is an effective mean of communication between the three people involved in the dental restoration process.

How we do it

At Oceanic Dental Laboratory, we utilise only first-grade materials to conduct a diagnostic wax-up and in that way ensure the dental professional is presented with the most accurate representation of the patient’s dental situation. And for the patient, they are given a clear insight into the final result and can be provided with quality temporaries.