Patient Visit 4

 Laboratory Procedures

Finalize Wax up

1. Equipment and Materials:
a. Mounted maxillary and mandibular master casts and trial dentures
b. Bunsen burner and matches
c. Hanau torch
d.  No 7 Wax spatula
e. Carver, Roach
f. Scraper, Kingsley
g. Wax, hard pink baseplate
h. Toothbrush

2. Procedure:
Attach the maxillary and mandibular trial dentures to the master casts with a small amount of wax to stabilize them.  Keep the maxillary and mandibular teeth together during this procedure to prevent errors.

Maxillary
1. Remove the maxillary cast and mounting ring from the articulator.
2. Start at the second molar on the right side.  Using a  wax spatula, trace around the denture teeth to create a gingival crevice.  This will also create a ledge of wax around the collars of the teeth.  The entire buccal and labial surface of each tooth must be exposed.  No wax must remain on the exposed crowns of the teeth.
3. Starting at the right second molar, carve the wax ledge created using the large Kingsley scraper.  Carve until it is uniformly 1 mm wide around all teeth.  This will produce the correct amount of festooning of the wax.
4. Now, start at the right second molar and carve the root prominences in the wax of the denture flanges.  The buccal flanges should be about 3 mm thick and the labial flange should be about 2 mm thick.
5. Alternate flaming with the torch and carving until an esthetic result is achieved.
6. Lingual festooning should imitate the normal lingual contours of each tooth.
7. Use a toothbrush or Robinson bristle brush to stipple the portions of the denture base that are visible when the denture is worn.  Usually, this involves the labial and buccal flanges to the first molar region. 
8. Replace the mounting ring, the cast and the upper trial denture on the articulator.  Check for possible errors in occlusion created inadvertently during waxing as hot molten wax shrinks upon cooling and can change occlusal relationships.
9. Remove all green compound from the tissue surface of the record base.  Seal the record base to the master cast with wax.

Mandibular
1. Remove the lower mounting ring, cast and wax trial denture from the articulator.
2. Add wax to the labial and buccal surface of the flanges.  Add wax to the lingual surface sufficient to make the lingual flange a minimum of 3 mm thick.  Extend the wax distally to the limits of the impression.  Lingually, smooth the wax.  Do not do any other carving or festooning other than to follow the contour of the lingual surface of the teeth.
3. Carve the labial and the buccal surfaces of the wax denture in the same manner as the maxillary denture.  The labial flange should be 2 mm thick and the buccal flange should be a minimum of 3 mm think.  The buccal flange should fill the buccal vestibules.
4. Replace the mounting ring, cast and wax denture on the articulator to recheck the occlusion for change which may have occurred during this process.
5. Seal the record base to the master cast with baseplate wax.

Grading before processing

- Grade A - Teeth arranged for proper esthetics, phonetics, and mechanical function.  Wax-up neat, clean, and anatomically natural.  Base 2-2.5 mm in thickness.  No wax on occlusal surfaces.  If monoplane occlusion is being used, then all buccal and lingual cusps are on same plane. 
- Grade B - Minor discrepancies from above which do not compromise the quality of the clinical treatment.  Base slightly thinker or thinner than ideal.  Wax slightly over or under carved.
- Grade C - Tooth arrangement is adequate to make a clinically acceptable complete denture, but marginally so.  Some wax in contacts between teeth or on areas which should not have wax.  Wax festooning is excessively think or thin.
- Grade E - Tooth arrangement prevents clinically acceptable complete denture treatment.  Most anterior teeth have wax in contact areas.  Record base over-extended.  Posterior teeth significantly out of occlusion.  Tooth position forces upper member of articulator out of its terminal hinge position (ball element not against vertical wall of articulator).  Monoplane teeth not set flat.  Compensating curve not in harmony with condylar or incisal guidance.  Posterior teeth not set in correct relation to the ridges for stability and natural esthetics.  Denture adhesive inside record base or on master cast.  Maxillary teeth do not fit into occlusal index.  Index rocks on remount jig.  Incisal guide pin does not contact incisal guide table by 5 mm or more.  Index is missing.