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Patient–Dentist–Technician Communication within the Dental Team: Using a Colored Treatment Plan Wax-Up LUKE S. KAHNG, CDT* ABSTRACT Communication among the restorative dental team must include the patient. The patient wants to know the details of the anticipated restorations; but because a patient is not aware of many dental innovations, care must be taken to provide them with a clear explanation of all antici- pated treatment parameters. Many patients have little understanding of today’s advancements in restorative procedures, and they may or may not understand all of the possibilities. Through effective communication, the patient gains confidence in the dental team and better understands the proposed restorative treatment. Patient satisfaction is significantly enhanced through effective communication. CLINICAL SIGNIFICANCE This article describes the use of a diagnostic wax-up to facilitate optimal communication between the dental team and the patient. ( J Esthet Restor Dent 18:185–195, 2006)INTRODUCTION cemented it in place. But, for what- ultimately finds that it is importantA patient looks to the dental pro- fessional to restore his or herteeth to ideal health, function, and ever reason, he or she is not happy with the result. The dentist may have tried many laboratories and to work with the dental technician at the treatment planning step, especially with regard to complexesthetics. Upon arrival at the dental have experienced similar results. He cases. Establishing optimal effectiveoffice, a team is created. The or she begins to question himself or communication and teamwork withrestorative team consists of the den- herself and wonders what is wrong. the dental laboratory techniciantist and the dental technician. In The preparation guidelines met the helps to build confidence for allorder to achieve all expectations, it materials specifications, so that was cases and helps ensure consistentis important that the team work not the problem. The directions on and successful results.together and establish optimal com- the prescription slip were followed,munication with the patient. so that was not the problem. Possi- Communication among the restora- bly the dental technician was not tive team is imperative and mustA situation may occur where the involved in the initial steps of treat- also include the patient. Often, thedentist may have made an impres- ment planning, and this lack of patient explains to the dentist whatsion, sent it to the dental labora- communication may have been he or she is expecting. The dentist intory, received the restoration, and partially to blame. The dentist turn will attempt to communicate *LSK 121 division of Capital Dental Technology Laboratory, Inc., Naperville, IL, USADOI 10.1111/j.1708-8240.2006.00017.x VOLUME 18, NUMBER 4, 2006 185
KAHNGFigure 1. Preoperative view. Provi- Figure 2. Full view of the treatment Figure 3. View showing the emergencesional postorthodontic treatment; the plan wax-up. profile. The different colors are used asprovisional was in the mouth for over a teaching tool to identify the travel2 years. paths of the opposing cusp. programmed articulator can mini- wax was added to replicate tissue. mize articulator-generated occlusal The pink wax gives a realistic errors. (Figure 4) and more natural appearance to the restorations, It is not only form-function ele- which helps promote case ments that develop the important acceptance by the patient. structural components of molar relief in the shaping of enamel PREPARATIONS AND IMPRESSIONSFigure 4. Protrusive view shows func- labial line angles, triangular beads, The provisional restorations thattional and nonfunctional areas. auxiliary line angles, and fissures. were worn during orthodontic Everything is brought together treatment were evaluated. Excessiveorthodontic treatment was com- under the essential mechanical prin- wear was seen and the provisionalpleted in just over 2 years and ciple of the mortar-pestle type restoration had worn quite thin onresulted in repositioning the canines adjustments. the maxillary right canine. Becausein a more optimal position. the provisional restoration was so The right posterior mandibular thin in this area, it was importantFollowing orthodontics study, casts quadrant (Figure 3) was fabricated to compensate with the toothwere made. Bite registrations (cen- using colors for teaching purposes. preparation.tric relation and protrusive func- Differences can be seen early intion) were made, as well as a cusps (buccal and lingual) as well as All the restorations must have ade-face-bow transfer record. A treat- in teeth. After evaluation, it was quate tooth structure reduction toment plan wax-up (Figure 2) was decided that unless minor adjust- allow for marginal placement to begenerated to help ensure a success- ments were needed, the mandibular positioned at or below the gingivalful outcome. anterior teeth would be untreated. margin. After removing the provi- The maxillary posterior, mandibu- sional restorations, the existingWhen fabricating a treatment plan lar posterior, and maxillary preparations were slightly modified.wax-up, variables that may influ- anterior teeth would be restored. In the preparation of the teethence the outcome of the occlusal Because the patient was worried (Figure 5), to ensure propermorphology must be addressed. A about the esthetic appearance, pink anatomic form, the preparation VOLUME 18, NUMBER 4, 2006 187
KAHNGLABORATORY PROCEDURES patient how the restorations resem- In the best interest of the doctorTreatment Plan Colored Wax-Up ble the wax-ups (Figure 16). The and the health of the patient, it isThe treatment plan colored wax-up colored wax-ups are valuable to the dental technician’s responsibilityis a full-contour wax-up of the the dental technician as well during to be educated in the latest materi-restorations. The colored wax is the porcelain build-up and contour- als, techniques, proper function ofhard enough to withstand try-in in ing stages of the restorations. occlusion, and the longevity proper-the mouth (Figure 10) for the indi- ties of the materials to be used. Thisvidual crowns and the fixed partial information should be shared anddenture. The wax try-in (Figures 11 Material Selection discussed among the entire team:and 12) allows the dentist to check Material selection is crucial in the doctor, patient, and technician.midline, size, shape (Figure 13), and success of any restoration.6 In After this team meeting, the finalpontic tissue adaptation (Figure choosing the right material, one decision as to which restorative14); it also allows the dentist to factor to consider is longevity. No materials are used rests with theshow the esthetic qualities of the matter how esthetically beautiful dentist.restorations to the patient. If the the restorations are, if they do notpatient requests changes, the dentist last, it is inconvenient for the The material chosen in this casecan change the wax-up immediately patient, the clinician, and the dental was Captek (Captek, Altamonteto achieve the desired contour laboratory. Springs, FL, USA). Captek is a thin(Figure 15). Upon completion of gold coping that is internally rein-the final restorations, the dentist Preparation design factors will forced. It is not a cast alloy, and itcan interchange them to show the determine the material you choose. is not a foil. The system is nonoxi-Figure 9. The provisional is completed. The patient is able Figure 10. The treatment plan colored individual wax-upto wear what she saw in the treatment plan wax-up. (individual crowns and FPD) is tried in the mouth. The wax try-in allows the midline, size, shape, pontic-to-tissue fit, and esthetic values to be checked. A patient’s request for changes can be made immediately to the wax-up. VOLUME 18, NUMBER 4, 2006 189
KAHNGdizing so there is no darkening that with opaque is thicker than for a ment copings with a laser welder.occurs as with traditional porcelain Captek framework with opaque. The tacking occurs in small areasfused-to-metal systems. Because it is This quality allows for additional on the facial and lingual surfaces innonoxidizing, there also is no dark porcelain thickness, because of the order to hold the pontic securely.background that can interfere with thinner Captek frame. Additionally, The Inconnect is then applied tothe optical qualities of the porce- its warm gold color enhances the the whole joint area. The Inconnectlain. Having a warm gold color and esthetics. is a pastelike material that willno oxides, the material needs less seal the joint area with a solderlikeopaque, which allows for addi- consistency to create a solid con-tional porcelain thickness. This Fabrication of the nector. This feature represents antranslates into better esthetic Captek Framework advantage over mere laservitality. The Captek copings and the sepa- welding, which often results in rate pontic are fabricated. The pon- inconsistencies. It is also anNo matter what material is used as tic needs to be attached to the advantage over a post-solderinga framework, the application of the abutment copings. Rather than approach, because no time isporcelain is the most important step using post-solder or complete laser needed for investing.to achieving the highest esthetics. welding (Figure 17), the new Incon-The skill and knowledge of the den- nect (Captek) material is used. The After framework completion, nor-tal technician and the thickness of Captek fixed partial denture with mal procedures are followed for thethe porcelain used greatly affect the the new Inconnect material allows application of UPC bonder, opaque,esthetic beauty of the restoration. the dentist to feel comfortable and porcelain. The UPC bonderMany ceramic restorations are very with the connectors to the pontic. (Captek) is a bonding materialesthetic but the metal framework The pontic is tacked to the abut- (Figure 18) for Captek. BecauseFigure 17. Captek framework is fabricated. The pontic is Figure 18. Finished Captek framework with the UPC bon-tacked into place with a laser welder and then attached to der applied and ready for opaque..the abutments using Inconnect. The Inconnect works like asolder to make a solid connector and will flow in to form asolid joint. VOLUME 18, NUMBER 4, 2006 191