On

 How to implement ? 

 

Benefits of an Esthetic Wax-Up : 

 Aids in developing an overall personalized treatment plan for the restorative procedures.
 Guides the dentist to determine the best result for the patient.
 Visualizes the final esthetic and functional outcome to the dentist and the patient.
 Facilitates communication with the patient and with the laboratory technician.
 Motivates the patient when they see what the treatment will accomplish.
 Provides a template for indirect mock-ups . 

An esthetic wax-up may be considered the greatest working tool in dentistry. Wax, unlike other materials, allows easy changes through addition and/or carving. The final tooth form can be shown to patients and modified to suit their needs and expectations, and patients become more motivated when they can visualize their custom-made complete treatment plan. The wax-up can be impressed with a silicone impression material to fabricate composite/acrylic mock-ups that further enhance visualization of the expected outcome and allow for the fabrication of excellent provisional restorations.

There are several types of anterior restorations: composite, glass-ionomer, ceramic, and porcelain-fused to metal crowns, as well as composite and ceramic veneers. Veneers are a very popular, conservative, and successful treatment for improving an unpleasant smile; tooth preparation for veneers involves facial surface reduction and may involve incisal edge reduction as well. Teeth from canine to canine the mounted casts were prepared to receive ceramic veneers.
This post will guide you to fabricate an esthetic wax-up on these teeth, restoring the missing tooth surfaces to an ideal, pleasant, and functional form.


Waxing Armamentarium : 

  • Mounted casts with prepped teeth from canine to canine.
  • Geo classic snow white wax, Renfert ; its white color serves as a visual aid for the dentist and when presenting the case to the patient.
  • Electric wax knives.
  • Boley gauge caliper used to measure lengths and widths of teeth.
  • Carving instruments.
  • Large double end pattern painter.
  • Shimstock occlusal strips.
  • Sticky wax.
  • Nylon stockings.
  • Sharp pencil.
  • Ultrafine-point black marker.
     
     


Waxing Steps for an Esthetic Wax-Up :

1️⃣ Identify the margins of the preparation : 

Use a pencil to mark the margins on the prepared tooth surfaces; wax should be placed within the confines of the pencil markings. 


 
2️⃣ Wax the central incisors 

Determine the length of the central incisors. The central incisors are the first teeth to be waxed in an esthetic wax-up as they guide the dimensions of the rest of the anterior teeth. The Panadent waxing guide can be used to determine the width of the teeth. The length of the central incisors range between 10 and 11 mm with 2 to 4 mm of display when the lips are at rest and should allow for anterior guidance to be established. Measure the length of prepared teeth on the cast using the Boley gauge to determine the thickness of wax that should be added at the incisal edge. The central incisor length of the cast used in this exercise was found to be 8 mm. 


Wax the labial surface. Apply a thin layer of sticky wax to all the prepared tooth surfaces, then start adding the white wax near the cervical part of the central incisors, making sure to cover all the margins of the preparation. Proceed to wax the entire labial surface; the wax should be added carefully to avoid going beyond the margins. 
Add more wax at the cervical third where the height of contour is located and at the line angles; further enhancement of these contours is done at the final carving and contouring step. 

 
 
 
 

Establish the incisal edge by adding wax over the incisal edges of the prepared central incisors. Because the premeasured length of these teeth was 8 mm, add approximately 2 to 3 mm to reach a reasonable final length. When the last layer of wax added to the incisal edges of both central incisors is still warm and soft, press the upper cast against the bench top to level the two central incisors and achieve an even length. This is necessary for beautiful esthetics. The central incisors may be the same length as the first premolars on your cast; therefore, with the upper cast pressed against a flat bench top, both central incisors and first premolars should contact the bench. 

 
 

You can also verify the length by measuring with the Boley gauge. Return the cast to the articulator and verify that there is enough overjet and overbite in the intercuspal position (about 2 mm). Verify the adequacy of anterior guidance by moving the upper cast to simulate protrusive movement; the central incisors should separate the rest of the teeth in protrusion. If the length was not adequate as determined by the Boley gauge/lack of overbite/lack of adequate anterior guidance, more wax should be added to the incisal edges. 






3️⃣ Wax the lateral incisors : 

Start by adding wax to the labial surface, making sure to cover all the margins. Apply more wax at the height of contour in the cervical third and at the line angles, then add wax to form the incisal edges, which should be shorter than those of the central incisors by 1 to 1.5 mm. 

 
 


4️⃣ Wax the canines : 

Establish the initial layer of wax. Add wax to the labial surface starting at the cervical part, making sure that all the margins are covered. 

 

 

Wax the canine contours. Add more wax at the cervical third to establish the height of contour, which is more pronounced in the canines compared to the incisors, then wax the labial ridge by adding a vertical layer of wax connecting the cusp tip of the prepared tooth to the cervical height of contour. These contours should be added to give the canine its marked convexity in the mesiodistal and cervicoincisal directions. 
Wax the line angles by adding wax to join the proximal ends of the height of contour to the incisal aspect of the tooth. The contours and line angles of both canines should be a mirror image with regard to location and thickness. Further adjustments are done at the final carving and contouring step. 

 
 
 
 

Wax the canine cusp. Start by forming the cusp tips by adding wax beads to the cusp tip of the prepared tooth structure then pressing the cast against the bench top when the last wax bead added to both canines is still warm to level the canines with the central incisors. 

 
 
 
 

 
 


For a beautiful smile, the canines and the central incisors lie on the same plane, and the lateral incisors are 1 to 1.5 mm short of that plane. The cusp ridges are then added by joining the incisal aspect of the line angles to the cusp tip, keeping the mesial cusp ridge shorter than the distal cusp ridge and the corresponding cusp ridges of the contralateral canines at the same level and contour.

After the wax solidifies, the cast can be returned to the articulator to check for canine guidance; the canines should separate all teeth in lateral excursions.
Wax the remaining missing tooth structure by filling in wax between the contour lines to complete the canines.



5️⃣ Final carving and contouring : 

Reseal the margins. Heat the thin end of the instrument and gently retouch the margins of the teeth to close any open areas. 

Adjust the size of the teeth. The apparent width of the teeth is the width as perceived from the facial view of the smile, not the facial view of each individual tooth. The size of the face of the teeth can be adjusted by drawing the face of the teeth with the ultrafine-point black marker to guide the carving and achieve mirror images of the contralateral teeth and a harmonious smile. The Hollenback carver is used to carve the wax between the lines and away from the lines, keeping the line angles at their proper location.

 
 
 
 

Carve the embrasures. The incisal embrasures are carved with the carver by proper carving and rounding of the point angles. The first embrasure carved is the one between the central incisors, which should be the smallest. The embrasure between the central and the lateral incisors is larger, and the embrasure between the lateral incisor and the canine is the largest. Contralateral embrasures should be mirror image. 

 
 

Carve the lingual surface. The excess wax at the lingual finish line should be smooth with the tooth structure, and excess wax flakes on the cast are removed with the brush or airway syringe. Evaluate your work. 

 
 

The final wax-up should be evaluated from facial, proximal, and incisal views with the goal of achieving a symmetric harmonious smile with matching contralateral point angles, line angles, embrasures, and contours.


The cervical contour of tooth no. 6 is deficient compared to tooth no. 11, and the distolabial line angle of tooth no. 8 is more convex compared to that of tooth no. 9. The line angles of the lateral incisors do not match well, and the incisal embrasure between the central incisors is too small compared to the remaining embrasures. 

Final adjustments and polishing. After making the needed adjustments, the wax-up can be gently polished with nylon stockings, and wax flecks on the cast should be cleaned. 





 Characterization : 

To give the smile more character, you may carve the developmental depressions, which exist mesial and distal to the midline of the teeth. Start by shading the areas to be carved with the ultrafine-point black marker. The developmental depressions of the central incisors and canines are carved with the discoid end of the large discoid-cleoid carver, and those of the lateral incisors are carved with the small end of the discoid-cleoid carver; carving should be done very gently to achieve a smooth wax-up. The resultant developmental depressions should be nearly symmetric in width and depth and can be viewed from both the labial and incisal views. 






Same Cast , Different Smiles :

How to create a narrower smile ?
To create narrower-looking teeth, the line angles and heights of contours should be repositioned closer to the midline of the tooth, the labial ridge of the canine should be positioned more mesially, and the incisal embrasures should be carved wider to decrease the mesiodistal width of the incisal edges. 

Add a layer of wax to the previously created smile with more wax at the prospective position of the line angles and cervical height of contour, then mark the line angles, heights of contour, and canine labial ridge positions with the ultrafine-point black marker to guide you during carving.
Using the Hollenback carver, increase the size of the incisal embrasures by rounding the point angles of the teeth. Narrow developmental depressions and vertical characterization lines may be carved to enhance the narrow appearance of the smile. 


 
 
 
 



How to create a wider smile ?

To create wider-looking teeth, the line angles and heights of contour should be repositioned to be farther from the midline of the tooth, the labial ridge of the canine should be positioned more distally, and the incisal embrasures should be carved smaller to increase the mesiodistal width of the incisal edges. 

Add a layer of wax to the previously established smile with more wax at the prospective position of the line angles and cervical height of contour, and close all embrasures with the wax to be able to recarve them to a smaller size. Mark the line angles, heights of contour, and canine labial ridge positions with the ultrafine-point black marker to guide you during carving. Using your Hollenback carver, start carving away from the lines and between the lines, keeping the line angles at their marked locations. 

Carve small incisal embrasures by creating minimal rounding of the point angles. Horizontal grooves may be lightly carved with the thin end of the instrument, which enhances the wide appearance of the teeth. 

 
 



Which one will your patient choose ? 







Waiting for your comments , Best regards ..