Diagnostic Waxing and Provisional Restorations Flashcards
What are the elements used as part of a diganostic wax up?
-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
What are the steps following diagnostic waxing?
- diagnostic waxing
- interim restoration
- patient feedback/soft tissue management
- cast of interim/clincal photographs
- predictable definitive restoration
What are the steps of diagnostic waxing through final product?
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.
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 – **
Evaluation of final product after patient has had prosthesis for a period of time.
When do you make changes to the temporary if you or the patient desires it?
Step 5 - Patient returns with temporaries in place and provides feedback on the shape, length, and overall esthetics and function.
What is diagnostic waxing?
Using wax to create intended restorative contours on casts for the purpose of evaluation and planning the restorations. A wax replica of proposed treatment.
What are the different methods of doing a diagnostic wax up?
- literally create a wax tooth
- use a denture tooth
- use a polycarbonate shell
What is a provisional?
- 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
- Used to assist in determination of the effectiveness of a specific treatment plans form and function
How do you know if you have reduced enough on this preparation?
- use a putty
- use a vacuum matrix
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
Putty matrixes
Steps to make a provisional restoration?
- mounted diagnostic casts (with facebow)
- diagnostic wax up
- alginate of wax up and cast made
- vacuum matrix or puttys made
- crown preps done
- provisional made
- check occlusion and protrusive
- patient tests them out at home
- changes can be made it needed
- definitive crowns will be made included any adjustments
What can cause gingival inflammation with crowns/provisionals?
- lack of patient ability to clean
- ill fitting restorations with poor marginal adaptation that allow more bacteria to impact the tissue.
- Also, if restorations are over contoured
Based on a wax up, provisional FPD’s placed with _________ pontic to develop extraction site into excellent esthetic case during healing.
ovate
Ovate pontic site development can take _____________ to properly develop.
weeks to months
What are the challeneges of provisional restorations?
- Time is needed to make an adequate temporary
- Time the material is in the mouth is limited
- Provisional materials have limitations
What are the disadvantages of jet acrylic (poly methyl methacrylate)?
High Exothermia
Toxic Monomer
High Volumetric Shrinkage (8%)
Low Abrasion Resistance
What are the disadvantages of bis-acryl resin?
Difficult to polish
Loses polish over time
More brittle
Challenging to repair or reline
More expensive
Compare the disadvantages of jet acrylic vs bis-acryl resin?
Jet Acrylic
- High Exothermia
- Toxic Monomer
- High Volumetric Shrinkage (8%)
- Low Abrasion Resistance
Bis-acryl resin
- Difficult to polish
- Loses polish over time
- More brittle
- Challenging to repair or reline
- More expensive
Compare the advantages of jet acrylic vs bis-acryl resin?
Jet Acrylic
- Good marginal fit
- Not brittle
- Polishes well
- Durable
- Inexpensive
Bis-acryl Resin
- Less Shrinkage
- Low Exothermia
- No toxic odor
- Automix delivery
- Easy to trim and shape
- Radio-opaque
- More biocompatible
What are the advantages of jet acrylic?
Good marginal fit
Not brittle
Polishes well
Durable
Inexpensive
What are the advantages of bis-acryl resin?
Less Shrinkage
Low Exothermia
No toxic odor
Automix delivery
Easy to trim and shape
Radio-opaque
More biocompatible
What are the different lab processed materials for provisional restorations?
-Heat Cured PMMA (Method creates stronger temp material)
-Lab processed PMMA (Bio Temps from Glidewell Lab)
-CAD-CAM
What is the eggshell technique?
- 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.
What do you need to send to the lab for the crown restorations?
-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
