Lecture 7 - Wax up Provisional and Lab Communication Flashcards
what are the elements used as part of a diagnostic wax up
- a full health history
- intra oral exam
- diagnostic casts mounted
- occlusal evaluation
- esthetic evaluation
what is the sequence in the diagnostic wax up
- diagnostic waxing
- interim restoration
- patient feedback: soft tissue management
- cast of interim- clinical photographs
- predictable definitive restoration
what are the steps in the diagnostic waxing
1- initial diagnostic casts are made. discussion with patient about restorative and esthetic goals
2- diagnostic wax up includes: pontic shape, size, contour and relation to the ridge. incorporate any changes to the current esthetics and function
3- the wax up can be used with a putty matrix to make a temporary which incorporates these desired changes
4- tooth preparation and temporization
5- patient returns with temporaries in place and provides feedback on the shape, length and esthetics and function. any changes to the temporary desired made at this time
6- a new impression is made of the temporaries to provide to the lab. photographs of the temporaries with measurements are provided for the lab
7- FPD created from a final impression and using the models of temporaries. definitive prosthesis is tried in and seated
8- final evaluation after patient has had prosthesis for a period of time
wax is used to:
create intended restorative contours on casts for the purpose of evaluation and planning the restorations
what is the definition of 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
a provisional is used to assist in:
determination of the effectiveness of a specific treatment plans from and function
what can be used to assess reduction
- vacuum matrix
- putty matrices
when significant change is occurring are depth cuts beneficial
no
what can be evaluated on the diagnostic casts
- can mount using facebow
- custon incisal guide table records gathered incisal length and guidance requireemnts
- mounted diagnostic wax up used with same mandibular to measure the length of the incisal edges and protrusive movements while also improving canine guidance and tooth contour
what is used for the impression of the diagnostic wax up
alginate
a vacuum matrix is made on______ of wax up
stone cast
patient will check ______ in the temporaries
smile, speech and occlusion
if provisionals are modified what happens?
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
bite registration can be used to assess:
- incisal guidance, length and angulation
- establish the occlusal plane
cases are mounted in:
MI
what can cause gingival inflammation from the provisionals
- lack of patient ability to clean
- ill fitting restorations with poor marginal adaptation that allow more bacteria to impact the tissue
- if restorations are over contoured
when is a final impression taken when there is gingival inflammation
after the inflammation has resolved
what is an ovate pontic used for
the develop extraction site into excellent esthetic case during healing
how long does ovate pontic site development take
weeks to months
when are temporary bridges places in relation to crown lengthening surgery and why
right after crown lengthening surgery to allow for healing and patient cleaning
what is the purpose of the provisional restoration
- to verify adequate preparations
- to determine if planned restoration will satisfy the functional, esthetic and phonetic requirements of the patient
- to determine the response of the gingival tissues to the planned restoration
- to facilitate transition during therapy: ortho, restorative and periodontal
what are the challenges to 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 and advantages of PMMA
- D: high exothermia, toxic monomer, high volumetric shrinkage (8%), low abrasion resistance
- A: good marginal fit, not brittle, polishes well, durable, inexpensive
what are the advantages and disadvantages of bis acryl
-D: difficult to polish, loses polish over time, more brittle, challenging to repair or reline, more expensive
-A: less shrinkage, low exothermia, no toxic odor, automix delivery, easy to trim and shape, radio opaque
- more biocompatible
what are the lab processed materials used to make provisional restorations
- heat cured PMMA: creates stronger temp material
- lab processed PMMA: bio temps from glidewell lab
- CAD-CAM
how are eggshells made
- vacuum matrix is made from wax up on duplicate case, minimal preparations done on duplicate cast, no preps started on patient yet
- based on wax up lab fabricates temporary to fit the minimal preps done, no preps started on patient yet
- prepare patients teeth to the ideal preps based on intra oral conditions
- eggshell is relined with material, trimmed, polished and cemented in the patient
what makes the eggshell fit over the patients prepped teeth
-because the preps are more reduced than the minimal preps done on the cast
the eggshell must fit _____ and _____ over prepared teeth to allow for:
loosely and completely; room to reline the temporary with resin
what is the advantage of eggshells
- reduced chairside time
- better esthetics, fit and polish
what is the disadvantage of eggshells
cost
how is CAD/CAM used to make provisionals
- 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
what is the downside of CAD/CAM provisional
cost of large enough block to create eggshell
- time to fire or glaze and stain and polish
what needs to be sent to the lab to create a provisional
- shade of desired restorations
- stump shade
- final impression
- cast of provisional restorations that stimulate what you want to achieve
- articulated casts
- incisal guide table for anterior cases
when is the stump shade really important
in anterior cases so they lab can blend emax or veneer better
