Techniques to transfer full arch wax/ups

[paulg100]

Was wondering if anyone has come up with a better technique for an issue were having at the minute.

Which is how to transfer full arch wax ups to temps accurately in the mouth.

The less reference points there are, the harder it gets to locate the putty index. Not quite so bad on the upper as you have the palate, but on a full arch lower there's nothing left to locate.

Haven't come across anything in articles or lectures yet.

The only way we've come up with so far is to wax either the anteriors or posteriors first. Then duplicate the model/partial wax up and then wax the remaining teeth.

That way the doc can do the temps in two parts and have half the remaining dentition for location, if this makes sense.

Has anyone come across a better technique for this issue?

 

[thewhitelab]

interesting question, what about using an articulator and then using the upper as a reg?

 

[paulg100]

well, its not so much a problem from the lab end. Cross mounting and locating the duplicated models is not a issue.

Its more to do with the clinical end and how the doc transfers the putty index to the mouth to make his temps.

Or maybe i misunderstood?

 

[rkm rdt]

You should be making the temps.

 

[paulg100]

"You should be making the temps."

Sais Who ?

would be nice from a commercial factor for me, but from the docs perspective, its hard to make the justification if there competent at doing it themselves .

IF i was making them myself, id just be transferring acrylic from the temps with a putty index, same as the doc does in the mouth, and id have the same problem of no reference points from wax up model to prep model.

whats that i hear..? "do it with CAD/CAM ", still the same problem. no reference points from wax-up model to prep model.

 

[rkm rdt]

"You should be making the temps."

Sais Who ?

would be nice from a commercial factor for me, but from the docs perspective, its hard to make the justification if there competent at doing it themselves .

If theres not an effective way of transferring index's for these full arch cases to the mouth, then maybe that is the justification.

I would say so. I assume the temps are req'd for a longer term than a single crown temp, so it makes sense for you to fab a stronger version.Besides, the last thing you want is a call asking if the case is ready early because the drs temps have fractured.
The dr will save valuable time to focus on any modifications req'd as well.

Are you prepping the teeth prior to waxing the diagnostic ?

This is where cad design has it's advantages beause you can easily fab temps from the scan of the waxup.

 

[paulg100]

"Are you prepping the teeth prior to waxing the diagnostic ?"

depends, i use an additive reductive technique for most wax up work.

Yeah there "long term" temps, maybe 2-3 months, maybe a bit more, but TBH weve never had any issues with the docs temps breaking in luxatemp.

" This is where cad design has it's advantages beause you can easily fab temps from the scan of the waxup."

Surely the doc still has to send a prep model for you to make the temps on? prepping a model your self and then making temps to fit that model is never going to fit in the mouth?? let alone accurately , ie centric stops etc transferring accros.

 

[Rick Sonntag]

Paul:
Has the doctor tried making the temps from a model of the actual preps? He could simply take an alginate once the teeth are prepped, pour it in snap-stone, add separator, then use a putty matrix made from your wax-up over top of the his prep model. That way he as all of the same landmarks as your wax-up model and a very accurate transfer. This also allows to doctor to measure the thickness of his temps to ensure the proper material is chosen for the situation.

Rick

 

[Scotts studio]

Why not use a clear matrix material called tempspan, my only concern would be the vertical stop, you would need some reference points.

 

[corona]

Was wondering if anyone has come up with a better technique for an issue were having at the minute.

Which is how to transfer full arch wax ups to temps accurately in the mouth.

The less reference points there are, the harder it gets to locate the putty index. Not quite so bad on the upper as you have the palate, but on a full arch lower there's nothing left to locate.

Haven't come across anything in articles or lectures yet.

The only way we've come up with so far is to wax either the anteriors or posteriors first. Then duplicate the model/partial wax up and then wax the remaining teeth.

That way the doc can do the temps in two parts and have half the remaining dentition for location, if this makes sense.

Has anyone come across a better technique for this issue?

thats the technique i think that works the best for solutions where you are removing most of the landmarks or have no teeth or landmarks to speak of , However , if you are doing a full lower diagnostic with all teeth in place , have you tried just cutting back the facials and incisal cusps , and leaving 3/4 of the occlusal and all of the lingual contours in tact (if the diagnostic will allow ) and utilizing those landmarks as a key-index for the temps ? ive done that in a couple of cases and the docs seem to like it. but i think your technique is the more universal . I would also like to hear of any cool new tips on this technique , good post !

 

[paulg100]

Rick:

I think we would still have trouble with transfers with little to no land marks there.

Corona:

Yep i went with the original suggestion of splitting the wax up across two models in the end (original and dupe with posteriors waxed)
pain having to dupe and re-artic but if it gets an accurate transfer after ive spent alot of time incorporating function and stops in the wax up
then its worth it.

i tried the idea of leaving some buccal and lingual areas on the posteriors but didnt really work out.

Thanks for the suggestions so far.

 

[rkm rdt]

glad to help an aging waxosaurus

 

[disturbed]

Umm..i just use the gums as a reference
..siltech matrix gets a little bulky but works fine for full arch cases. The flash around the margins cleans up easily and the docs i and my mentor work for have had no complaints in ten plus years, light occlusal adjustments but we never got a temp model back that looked like it had been ground on excessively.

Just cover the tissue, we also put our matrix in a dry pressure pot to insure accuracy

 

[patmo141]

Could you leave 3 stops on the occlusals of the preps....when the temps came out it would look almost like implant screw holes on a few of the teeth. Then the doc can just fill those in with a quick reline. Maybe leave a buco-lingual slot on a couple of the anteriors. Something that will be really easy to contour using the surrounding acrylic.

Edit:
rethinking that statement....you are making these on the un-prepped model...sooo, scratch that.

 

[martintay]

Good question , could the dentist prep 2 posterior and 2 anterior teeth on either side of the arch.... then these crowns could be fabricated inside your matrix for accurate location , if that makes sence . May not be ideal but i think you need hard tissue to locate matrix on .

 

[Hary]

Rick:

I think we would still have trouble with transfers with little to no land marks there.

Corona:

Yep i went with the original suggestion of splitting the wax up across two models in the end (original and dupe with posteriors waxed)
pain having to dupe and re-artic but if it gets an accurate transfer after ive spent alot of time incorporating function and stops in the wax up
then its worth it.

i tried the idea of leaving some buccal and lingual areas on the posteriors but didnt really work out.

Thanks for the suggestions so far.

Hi, you can take impression of your wax up with putty (siltex) the putty has to go all the way back to the hamular notch . than take the puty with a blade take out all the interproximel and then do a wash inside of the putty with a light body.

 

[AJEL]

I'm just a removable guy, if the patient has opposing dentition. I have made snap-on in acetal with a bite registration to to opposing arch. the DDS fills the acetal shell and has the bite registration and closes the arch and light cures the long term temp in place. At least one arch will occlude with theoposing if the original bite was correct. This might be a little bulky but has a nice polished surface. I have some LVI DDS who like this for long term diagnostics prior to the C&B construction of full mouth cases, it is easier to adjust until the new verticle is dialed in that adjusting bridge work.

 

[paulg100]

Umm..i just use the gums as a reference
..siltech matrix gets a little bulky but works fine for full arch cases. The flash around the margins cleans up easily and the docs i and my mentor work for have had no complaints in ten plus years, light occlusal adjustments but we never got a temp model back that looked like it had been ground on excessively.

Just cover the tissue, we also put our matrix in a dry pressure pot to insure accuracy

Like i say that works fine for the upper as you have the palate for reference. When you prep most or all the lower teeth it dosent work really.

Ajel: liked that idea, sounds like that might have some mileage, will have to play with that some.

At the moment im still waxing posts first. Then duplicating then waxing ants on new model. That way there is always enough virgin landmarks to locate.