Diagnostic Waxing and Provisional Restorations Flashcards

1
Q

Diagnostic Waxing
Elements used as part of a Diagnostic Wax up:
(5)

A

-A full health history
-Intra-oral examination of patient
-Diagnostic Casts (mounted)
-Occlusal Evaluation
-Esthetic evaluation – Primarily for anterior
FPD work. However, should also be
considered for posterior work as well.

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2
Q

Diagnostic Waxing
steps (5)

A

Diagnostic Waxing
Interim Restoration
Patient Feedback
Soft tissue Management
Cast of Interim
Clinical Photographs
Predictable Definitive Restoration

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3
Q

Diagnostic Waxing – Systemic Approach
8 (long) steps

A

STEP 1 –
Initial diagnostic casts are made along with discussion about patient
restorative and esthetic goals
STEP 2 –
Diagnostic wax up of these goals is made and includes:
-Pontic shape, size, contour, and relation to the ridge
-Incorporate any changes to the current esthetics and function
STEP 3 –
This wax up then can be used with a putty matrix to make a temporary
which incorporates these desired changes
STEP 4 –
Tooth preparation and temporization
STEP 5 –
Patient returns with temporaries in place and provides feedback on the
shape, length, and overall esthetics and function. Any changes to
the temporary desired by you or the patient can then be made at
this time.
Diagnostic Waxing-Systemic Approach
STEP 5 –
Patient returns with temporaries in place and provides feedback on the
shape, length, and overall esthetics and function. Any changes to
the temporary desired by you or the patient can then be made at
this time.
STEP 6 –
Once temporaries are representing desired results, a new impression is
made of the temporaries to provide to the lab. Photographs of the
temporaries with measurements are provided for the lab.
STEP 7 –
FPD created from a final impression, and using the models of your
temporaries. Definitive prosthesis is tried in and seated.
STEP 8 –
Evaulation of final product after patient has had prosthesis for a period of time

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4
Q

Using wax to create intended restorative contours on casts for the
purpose of

A

evaluation and planning the restorations. A wax replica of
proposed treatment.

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5
Q

Using a Temporary Crown Former
(2)

A

Fit to space and waxed in and
secured
Once shaped, putty or vacuum
matrix made.

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6
Q

Provisional Restorations
Definition:

A

A prosthesis designed to enhance esthetics, stabilization and/or function for a limited
period of time after which it is to be replaced by a definitive prosthesis.

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7
Q

Provisional Restorations
Used to assist in

A

determination of the effectiveness of a specific treatment plans form and
function.

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8
Q

Provisional Restorations – Diagnostic Potential
Provisional restorations are used in a variety of ways to
accomplish your

A

treatment planning as you progress

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9
Q

Your — can be used to verify reduction both visually,
or with small holes in the matrix to use a perio probe.

A

vacuum matrix

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10
Q

In addition to vacuum matrix viewing to assess reduction, – can be used as well with properly placed cuts and
removal to see visually or measure with a probe what your
reduction is based on your diagnostic wax up

A

Putty
matrixes

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11
Q

When significant change is occurring, — are of little use
to you. Therefore, these alternate methods of checking
reduction are helpful.

A

depth cuts

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12
Q

Diagnostic casts were taken and mounted using a —.

A

facebow

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13
Q

Custom incisal guide table records gathered (2)
requirements

A

incisal length and guidance

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14
Q

Mounted Diagnostic wax up used with same mandibular to measure the
length of the — and — movements while also
improving (2)

A

incisal edges
protrusive
canine guidance and tooth contour.

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15
Q

An — is made of the diagnostic wax up.
A — matrix is made on stone cast of wax up
Preparations are started.
Reduction is checked with — matrix
Provisional is made as two —
In patient mouth, we can see that the incisal edges need to be reduced in
provisional due to the interferences seen in protrusive

A

alginate
vacuum
vacuum
3 unit temporaries

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16
Q

Patient is now sent home with provisionals to “test” them out.
Patient will check (3)
Changes can be made in the temporary for any areas patient is not
satisfied with.
If provisionals are modified, a new impression of temps should be
taken to mount for the case when sent to the lab.
Definitive crowns will incorporate the adjustments made and the input of family and friends.

A

smile, speech, and occlusion.

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17
Q

Using a bite registration, the study models for this case can be mounted to assess:
(2)

A

Incisal guidance, length, and angulation
Establish the occlusal plane

18
Q

Mounted case with wax up to assess (2) for fixed
prosthesis.

In this case, we need atypical contours for the FPD.
Case is mounted with Facebow and in Maximum Intercuspation

A

contours and parameters

19
Q

Here we see restorations that are:
Creating gingival inflammation either
by (2)
Also, if restorations are —,
they will also have a similar impact.

A

lack of patient ability to clean
Or with ill fitting restorations with poor
marginal adaptation that allow more
bacteria to impact the tissue.

over contoured

20
Q

Using a provisional,
we can see if the
tissues respond well
to the new contour
and fit.
Reinforcing (2), we
observe in this
case, the patient
tissues responded
very well to the
provisional based
on a wax up.
A final impression
can now be taken
as tissue
inflammation has
resolved.

A

OH and
patient care

21
Q

Based on a wax up, provisional FPD’s placed with — pontic to develop
extraction site into excellent esthetic case during healing.
Once tissue heals and contours established, a final impression can be made.

A

ovate

22
Q

We want our provisional
to allow for optimum
gingival health prior to

A

cementation.

23
Q

— pontic site development
can take weeks to months to
properly develop.

A

Ovate

24
Q

Provisional Restorations – Allowing healing
Temporary bridge placed here after crown
lengthening surgery.
These provisionals allow for (2)
Once healed, new provisionals will be made
and used as a more definitive guide to final
restorations.

A

healing, patient
cleaning.

25
Q

Digital Software now can help design the changes in tooth (2)

A

shape and contour.

26
Q

Provisional Restorations – Diagnostics - Summary
To…
-To verify adequate —
-To determine if planned restoration will satisfy the (3)
requirements of the patient.
-To determine the response of the — to the planned restoration.
-To facilitate transition during therapy
-(3)

A

preparations
functional, esthetic, and phonetic
gingival tissues
Orthodontic, restorative, periodontal

27
Q

Provisional Restorations – Challenges
(3)

A

Time is needed to make an adequate temporary
Time the material is in the mouth is limited
Provisional materials have limitations

28
Q

Provisional Restorations – Materials
Poly Methyl Methacrylate (Jet Acrylic) –

A

NOT USED IN THIS LAB

29
Q

Poly Methyl Methacrylate (Jet Acrylic) –
Disadvantages
(4)

A

High Exothermia
Toxic Monomer
High Volumetric Shrinkage (8%)
Low Abrasion Resistance

30
Q

Poly Methyl Methacrylate (Jet Acrylic) –
Advantages
(5)

A

Good marginal fit
Not brittle
Polishes well
Durable
Inexpensive

31
Q

Provisional Restorations – Materials
Bis-Acryl Resin –

A

USED IN THIS LAB

32
Q

Bis-Acryl Resin –
Disadvantages
(5)

A

Difficult to polish
Loses polish over time
More brittle
Challenging to repair or reline
More expensive

33
Q

Bis-Acryl Resin –
Advantages
(7)

A

Less Shrinkage
Low Exothermia
No toxic odor
Automix delivery
Easy to trim and shape
Radio-opaque
More biocompatible

34
Q

Provisional Restorations – Materials
Lab Processed Materials
(3)

A

-Heat Cured PMMA
-Lab processed PMMA
-CAD-CAM

35
Q

-Heat Cured PMMA

A

Method creates stronger temp material

36
Q

-Lab processed PMMA

A

Bio Temps from Glidewell Lab

37
Q

After Wax up completed, and
vacuum matrix made from wax
up on duplicate cast, —
preparations done on duplicate
cast.
No preps started on patient yet!

A

minimal

38
Q

Based on Wax up, you or
the — fabricates
temporary to fit the minimal
preps done.
No preps started on patient
yet!

A

Lab

39
Q

Provisional Restorations – Materials – Eggshell Technique

A

Patient arrives and you prepare the teeth to the
ideal preparations needed based on intra-oral
conditions.
This Eggshell fits over your preparations because
the preparations are more reduced than the
minimal preps done on the cast.
The Eggshell must fit loosely and completely
over your prepared teeth to allow for room to
“reline” the temporary with resin.
Eggshell is relined with material, trimmed, polished, and
cemented in the patient.
Reduced chairside time making a temporary to do it this
way.

40
Q

Eggshell Technique
Benefit and Downside

A

Better esthetics, fit, and polish if done well.
Down side?? Cost! These can be expensive for a lab to
make and very time consuming for you to make.

41
Q

Provisional Restorations – Materials – CAD-CAM

A

Diagnostic wax up or digital plan made for ideal outcome.
Teeth are prepared and impression or scan sent to lab with the wax up.
Scan is made of wax up and tooth preps.
Temporary is milled and polished.
Down side?? Cost of large enough block to create eggshell. In addition, time to fire or
glaze and stain the temporary.

42
Q

Provisional Restorations – Lab Communication
To Lab:
(6)

A

-Shade of desired restorations
-Stump Shade
-Final Impression
-Cast of Provisional restorations that simulate what you
want to achieve
-Articulated casts
-Incisal guide table for anterior cases.
P