Additive wax-ups, silicone guides and corresponding diagnostic templates are very helpful for the dentist to get a preview of the aesthetic and functional outcome of a case and also for the patient´s satisfaction. To get an instantly better preview of what the eventual outcome will be, the utilisation of a composite mock-up is wonderful as an aid (Galip G.)
Analysis of the patient´s face, the neighboring tissues and teeth provide three dimensional information which is necessary to give the restoration the correct volume and shape. A diagnostic “composite mock-up´´ which is the direct application of composite without surface preparation, is indicated when such elements are missing, or when an alteration of tooth form is necessary ( Galip G.)
The step by step procedure to get a clean and useful mock-up is described as follows:
1. A very clear chief complain of the patient
2. The pictures of the patient – extra-oral and intra-oral
3. Stone cast for both arches
4. Intermaxillary registration
5. The aesthetic analysis of the patient, the smile design construction – digital, manually, direct
6. The wax-up, based on the smile design analysis
7. Impression of the wax-up
8. The transfer of the wax-up inside the mouth
9. Validation of the mock-up together with the patient
Img. 1 – The power of a mock-up is given by its precision. A precise mock-up is the result of a precise wax-up transfer. In order to satisfy these two requirements we must take a good impression of the wax-up and a good transfer composite material. In this short article steps 7 and 8 will be described, namely the impression of the wax-up and the transfer of the wax-up inside the mouth using DMG products – Honigum silicone – heavy, putty and light, and Luxatemp composite. The chief complaint of the patient was – “I would like a brighter and more beautiful smile´´. The initial pictures of the patient: portrait, 6 images and intramural view, 10 images.
Img. 2 – Based on the dentist´s analysis of the smile and the chief complaint of the patient, the clinician will provide the dental technician with all the information needed for a personalized wax-up (length, volume, shape, position, etc). On the patient´s wax-up, the dentist will be able to check the quality of the result and do fine adjustments if necessary. Now the next level has to be very precise – the impression of the wax-up. The get a very accurate impression of the wax-up at least two things have to be accomplished: a very well finished wax-up and a very precise impression material.
Img. 3 – For the impression of the wax-up the HONIGUM PUTTY and HONIGUM LIGHT materials were used. For a very precise impression the wash technique was used. With a no. 15 blade, all the silicone material correspondent with the buccal gingiva needs to be removed. This stage is very important if we want to obtain a very clean mock-up. If the silicone is precisely cut, there will be no excess in the composite material, covering of the gingiva and the aspect of the mock-up will be very close to the final outcome of the restoration. The hardness of the set putty Honigum offers a real advantage to get a very accurate mock-up.
Img. 4 – As a technique to safely remove the buccal part of the silicone, I prefer to start cutting with the blade from the zenith point and then go interproximally to mesial and from the same point to distal.
Img. 5 – As a composite material I used Luxatemp because it is easy to work with, it has enough working time and the gel phase offers enough time to remove the gingival excess. Nice glossy surface after the setting time. Natural value of the material – A1 and Bleach
Img. 6 – This is the aspect of the mock-up immediately after the removal of the silicone key. For this case I used Bleach colour. No polishing procedures were done for this mock-up. The producer recommends that the silicone key be removed from the mouth during the elastic phase in the period of 2-3 minutes after start of mixing. From my clinical experience I find that the material should be left 5-7 minutes to get a better glossy surface and mock-up precision. The glossy surface of the mock-up is very important for the patient´s feeling during the “test drive´´ of our smile design. Also, as it can be seen in the images, the gingival limits of the mock-up are very good and no excess of the material is on the gingiva.
For a clean mock-up:
- precise wax-up
- precise silicone impression
- accurate preparation of the silicon key
- proper composite material