1. The Wax Try-in

2. Wax Try-in Verify & Change: Occlusal relationships Appearance
Phonetics
Patient comfort

3. Two Try-in Appointments
Initial wax try-in
Verify centric, protrusive
Confirm esthetics, phonetics
Final wax try-in
Ensure balanced (if applicable), wax-up complete

4. Initial Wax Try-in Verify: Accuracy of maxillomandibular records
Appearance of anterior teeth
Changes will almost always need to be made
Technician has not finalized balance at this stage
Canted Occlusal Plane
Midlines Off

5. Centric Position Contacts
Check first – Affects everything else
Check with articulating paper
Stabilize mandibular denture
New centric relation record
Minimal amount recording medium

6. Minimal Registration Material
Improves record accuracy
Less resistance during closure
Reduces chance of deflection when checking record ✔ ✘ ✘ ✔

7. Small Amount of Registration Material
Opposing cusps should not penetrate
Cuspal indentations improve accuracy compared to flat wax rim

8. Confirm Accuracy of Mounting
Ensure record is fully set
Loosen articulator centric lock
Seat both record bases & interdigitate teeth into record

9. Accurate Mounting Teeth interdigitate perfectly
No space around the cusps
Condylar ball should contact fossae wall
If either criteria not met, remake record
Doesn’t fit
Fits well

10. Second Record Used to Confirm Inaccurate Mounting
Mandibular cast removed from mounting ring
Mounting plaster ground thinner
Cast remounted, using the new record

11. Don’t Overlook Problems
Difficult/impossible to change after processing
May require removal, resetting & re-processing
Procedures more costly & time consuming

12. Verify Occlusal Vertical Dimension & Interocclusal Distance
Same techniques used previously
Critical to measure & feel 2-4 mm of interocclusal distance
No tooth contacts during closest speaking space

13. Changing OVD
Effects:
Occlusion
Facial esthetics

14. As mandible moves downward (opening or increasing OVD)
Incisal edge moves back
Increases overjet
Helpful in Angles Class III
Problem in Angles Class II

15. Vertical Dimension Alterations
May require resetting of all teeth in at least one arch
Extensive changes made by lab
Height of anterior & posterior teeth must be in harmony

16. Vertical Dimension Alterations
If only posterior teeth are changed
Undesired effect on:
Overbite relationships
Esthetics
Balancing contacts
Assess how changes will affect overall appearance

17. Tooth Position Canine Relationship Most critical tooth relationship
If half tooth offset not present, diastema required between anterior & posterior teeth
Insufficient Offset

18. Canine Relationship Problems encountered when: Jaw size discrepancies
Malocclusions
Improper contouring of occlusal rims

19. Eliminating a Canine Discrepancy
Reducing or increasing overjet
Reducing or increasing arch circumference of one or both occlusion rims
Altering vertical dimension
Reducing overjet in of 1st/4th quadrants to improve canine relationship & reduce lisping

20. Eliminating a Canine Discrepancy
Bodily moving teeth facially/lingually
Changing axial inclination (tilting)

21. Prior to resetting teeth, the dentist should determine how to eliminate a canine discrepancy

22. Excursive Contacts Evaluate visually and with articulating paper
Intraoral/articulator discrepancies:
Remake protrusive record
Check/reset condylar inclination

23. Verify Comfort: Tongue Space
Ask patient to comment on:
Comfort
Ability to speak

24. Esthetics Check: Amount of incisal display
Harmony of the maxillary teeth with the smile line
Accuracy of the midline
Angle of the occlusal plane
Initial setup - teeth too long.
2nd quadrant set higher to assess position for reset

25. Esthetics Check Proper soft tissue profile, contours Lip support
Display of the vermilion border
Correct nasolabial angle

26. Esthetics Ask patients for their opinion prior to voicing yours
Avoids biasing the patient
Family or friend may be helpful

27. Make Changes Technician Can’t Assess. Esthetic Problems
Make Changes Technician Can’t Assess Esthetic Problems Other changes can be prescribed for technician
Move and assess quadrant 2,
technician matches reset with remaining teeth

28. Esthetics If you or the patient have reservations about appearance
Resolve prior to final processing
Never attempt to persuade a patient out of a concern
Problems will be yours later, if patient does not like appearance

29. Incisors too long

30. Phonetics Easier to assess Teeth have replaced bulky rims
Crowded tongue space can adversely affect phonetics

31. Lisping Non-uniform overjet of anterior teeth Diastemas between teeth
Palatal contours
Diamond-shaped openings between incisors

32. If have not worn dentures for extended period
Phonetics
If have not worn dentures for extended period or
Dramatic changes (Contour, Tooth Position, OVD)
Allow the patient to read a OUT LOUD for 5-10 minutes to assess phonetics and comfort

33. Sibilant Sounds ‘S’, ‘Z’‘T’ ‘CH’ ‘SH’: ‘Sixty-six’, ‘Mississippi’)
Incisors should approach end to end relationship

34. Fricative Sounds F, V, ‘Fifty-Five’
Ask patient to count from ‘50 to 60’
Maxillary incisal edges should just touch wet line of the lower lip

35. Denture base contours Affect phonetics, comfort and retention
Should be slightly concave, NOT convex in shape
Convex
Concave

36. Denture Base Contours
Ensure that denture base is not unduly thick or thin
Excess bulk will impair comfort
Feel between index finger & thumb
Base that is too thin will be weakened
Should not be able to see through

37. Patient Input Use open ended questions
“How do you like the appearance?”,
rather than
“Don’t the new dentures look great?”

38. Patient Input If the patient sounds unconvinced
Ask more questions
Do not rush this step to save time!

39. Final Wax Try-in Confirm that prescribed changes are acceptable
Making further alterations if required
Diastemas should be closed
Phonetics should be acceptable

40. Laboratory Prescription
Request:
Processing, finishing & polishing
Laboratory remount of the dentures
Adjustment of occlusion to compensate for processing changes

41. Laboratory Prescription
Request:
Fabrication of remount index & casts, (used at delivery)
Refinement of wax-up
Special requests
Send remount jig to laboratory

42. Importance of Wax Try-in
Chance to change setup
If not willing to change aspects of setup, appointment is a waste of time
An opportunity to improve the final result

43. Checklist Centric record verified with recording medium
Vertical dimension verified:
a. 2-3 mm between lip closure and teeth touching
b. Phonetics tests ("50`s-60`s" or "Mississippi") - space between rims
c. Lips appear and feel unstrained
Tooth form, arrangement & shade verified
Phonetics verified ("S","F" and "M" sounds)
Balanced occlusion, anterior teeth only grazing in protrusion

44. Videos Analyzing & Adjusting Centric Contacts Adjust Lateral Contacts
Adjust Protrusive Contacts

45. Denture Tooth Setup Project
Set Posterior Teeth
Check Centric contacts
Ensure even on all posterior teeth
Check visually from facial and tongue space
Move in wax if far from contact
Adjust with bur if minor prematurities
Ensure sufficient overjet
Begin checking lateral & protrusive contacts