Esthetic colored wax-ups

There are several different color choices for creating a treatment plan wax-up. Most lab technicians use white solid, clear or gray wax, finding this to be acceptable. It’s a standard operating procedure because the results are predictable, the material easy to work with.

My concern with clear wax is that I am unable to see any detailed contouring because of the material’s innate translucency. To clearly distinguish a three-dimensional appearance, I usually prefer to use one single color of wax. I have found many technicians often won’t select one solid color because the overall appearance is too opaque. However, it‘s opacity that gives my wax-ups the three-dimensional quality I am seeking. The esthetics, however, are frustrating because of the time spent on the project, and time equals money.

Wax-ups are, of course, meant to define height of contour, tissue design, long axis angulation and symmetry between the line angle and surface texture as well as which areas are either convex or concave. Also, the technician can check occlusion contact via the wax-up-especially if the patient’s diastema is unappealing and improvement is one of the treatment goals. In short, wax-ups are best described as a diagnostic tool to help discover how to improve a person’s smile.

But if the technician isn’t sure how to correct the patient’s situation he may have no immediate answer for the clinician. He only will be able to provide a blueprint with which the clinician can work. From there, the provisional restorations always can be fabricated using the wax-up as a guide, which gives the patient a preview of what to expect. However, sometimes he or she may request changes based on the way the temporaries fit. This is even expected in some cases.

The intention with this article is to illustrate another way to generate better patient case acceptance while still using a wax-up communication tool.

Case Study

The clinician in this case sent a nice impression, which when poured up showed that Nos. 7-10 were peg laterals-tiny enough to require full crowns. Tooth No. 9 was protruding and No. 8 was pushed inward (Figs. A, B). My treatment plan wax-up was designed to close the gap between 6 and 7-as well as 7 and 8-and correct the misalignment between 8 and 9, and the diastema between 9 and 10, and 10 and 11.

01 In Figs. C and D, I completed the prep design with orange-colored areas needing to be prepped more and the yellow areas needing less prep. For the body area I prepped 1 mm and for the incisal, 2 mm. The more protrusive the teeth, the more I prepped the model. Figure E offers a side view of the model showing the misalignment of the teeth and how I would make repairs to the patient’s smile.

02 Before preparation, I made a stent (Fig. F) suitable for fabrication of the final restorations for tooth Nos. 8 and 9. The Renfert Waxlectric™ II waxing unit and GEO™ Wax Finish liquid varnish were two of the tools I used for this particular project (Fig. G).

03 In proceeding with the plan, I used Beige-Opaque Avantgarde Renfert GEO wax for the internal color in the first layer (Fig. H) and then applied GEO Natural all the way to the gingival area. I then layered Snow–White L Opaque GEO wax over those two colors. The two centrals were nearly completed in this image (Fig. I) but 6, 7, 10 and 11 were still processing.

04 The final wax-up design closed the gap between all the teeth mentioned earlier and demonstrated in Figs. A and B. The teeth were not larger in size because I created the lobe in a way that made them look smaller, using the waxing technique and tooth angulation. Before creating the lobe, I photographed the models repeatedly until I understood the proper angle from which to approach that step.

05 By measuring the incisal edge of the teeth, I determined their existing length and whether they needed to be increased or decreased in size, according to the tissue level (Fig. J). In duplicating the teeth length, I measured the width between the lateral and canine teeth (Fig. K) and applied that size to the wax-up (Fig. L). The long axis and tooth design were taken into account in the measurement as well (Figs. M, N).

06 On top of the finalized wax-up, I applied a thin coat of GEO™ Wax Finish liquid varnish for a shiny, glazed appearance (Fig. O). Final front view (Fig. P) wax-up appearance is very similar to ceramic teeth. Final incisal edge to gingival area view (Fig. Q).

Conclusion

Treatment plan wax-ups are very good blueprint tools for dentists and technicians to use when attempting to increase patient case acceptance. They also can be an excellent showcase for a technician’s artistic skills to be put to use. The effort a technician puts into this body of work will also, in the long run, translate into better porcelain skills, especially when it comes to wax and design.

Everything about the cosmetic case can be taken into account with the wax-up blueprint: tooth shape, teeth length, closing the diastema, misalignment correction, vertical dimension and teeth angulation. An authentic looking wax-up only makes everybody’s job easier in the long run-and provides the patient with a view of what is to come!

*Case courtesy of Dr. Joseph L. Caruso, DDS, MS, Prosthodontist, Chicago, IL

About the author

Luke S. Kahng, CDT, is an accomplished dental technician with more than 20 years of experience in the field of cosmetic restorations. He is the founder and owner of LSK121 Oral Prosthetics, a dental laboratory in Naperville, Ill. Mr. Kahng has published more than 60 articles in many prestigious dental journals, nationally and internationally. His lecture circuit has taken him across the United States and internationally to teach fellow professionals, using a hands-on, demonstrative approach. He has created morphological models to mimic natural teeth and assist in teaching predictable results. In 2009, he created the Chair Side Shade Selection Guide to facilitate effective communication regarding color between doctors, patients and technicians. In 2010, version two of the product was released, to wide acclaim. In addition, he has created 3D Technical Manuals for technicians interested in learning his porcelain techniques.