Dental Tribune Nordic Edition No.4, 2016

13 Dental Tribune Nordic Edition | 4/2016 TRENDS & APPLICATIONS The mock-up: A clinician’s everyday tool for aesthetic dentistry By Dr Yassine Harichane, France For a wax-up, also known as a diag- nostic wax model, laboratory wax is used to create an aesthetic con- cept model based on the patient’s plaster model. However, its aes- thetic and functional use is limited. From an aesthetic perspective, even though the wax does not re- produce the tooth shade perfectly, it facilitates visualisation of the shape and position of the teeth in the concept model. As far as function is concerned, even when a high-performance articulator is used, it is still difficult to replicate the full range of masticatory move- ments. The mock-up, essentially a pre- view produced from composite, is a technique all too rarely em- ployed by dentists, but that proves exceptionally practical in a wide variety of situations in routine clinical practice. It offers a pre- view of the intended aesthetic result and as such plays a decisive role in treatment planning.1–3 The mock-up phase follows validation of the wax-up. In this phase, the concept model is adapted directly in the mouth after validation on the plaster model.4, 5 This facili- tates transfer of the wax-up data from the patient model directly to the mouth.6, 7 The trial fitting in the mouth offers the opportunity to verify the concept model from an aesthetic, functional and psy- chological perspective. This last aspect is of particular signifi- cance, considering that it imparts an important principle of patient acceptance, namely being able to first try out a solution and then make an educated final decision. In this way, the patient plays an active role in the decision-making process, which considerably im- proves communication.8 It is important to note that communication with the dental technician too is optimised in the process, which promotes smooth cooperation between the practice and the laboratory. It is only possible to implement minimal corrections directly on a wax-up, whereas the dentist is free to make aesthetic changes to the mock-up by adding or removing materials generally available in the dental practice.9 In addition, the mock-up can be used to check the occlusion in the mouth in order to validate the accuracy of the wax-up. After any corrections, a duplicate of the mock-up is sent to the laboratory. The dental technician now has at his or her disposal additional information, with which he or she can achieve a predictable aes- thetic result. Treatment plan Mock-ups are suitable for treatment in the anterior region requiring corrections to the shape of teeth through the addition of material and, to a lesser extent, adaptation of the position of the teeth. The main indications are thus loss of substance on vital teeth, missing individual teeth, diastema or other congenital aesthetic defects that permit a bio-aesthetic approach.10 Once a diagnosis has been established and the type of treat- ment selected, the dentist orders a wax-up based on the patient’s tooth model. Of course, he or she needs to inform the dental techni- cian in the laboratory of what he or she expects in terms of shape and position, but not yet the shade. The first step is for the den- tist to validate the wax-up on the model; this allows him or her to make any necessary corrections directly in the practice using suit- able materials. In such cases, it is always worth asking the dental technician to send additional wax with which any corrections re- quiring addition of material can be performed. The wax-up is then shown to the briefed patient (it is a 3-D simulation of the concept design)—and the limitations (the tooth shade cannot be replicated in a wax-up) mentioned—and it is compared with the plaster model without wax-up in order to demonstrate the improvements objectively. Once the patient has accepted the wax-up and any nec- essary corrections have been made, the wax model is trans- ferred from the plaster model to the patient’s mouth in order to simulate the treatment intra- orally. These steps are described in the “Step by step” section. The mock-up is shown to the patient in order to determine the optimal tooth length and the general proportions of the new smile. It is still possible to make corrections at this stage. After any corrections, the dentist and patient approve the mock-up and an impression is taken, which is then sent to the laboratory, where it serves as a reference for the final production of the concept model. Materials Mock-ups are easy to produce in routine clinical practice as long as there is sufficient material avail- able and the user masters the necessary skills in advance. In this article, I describe a technique in which a self-curing composite (Structur 3, VOCO; Fig. 1), which is usually employed in the produc- tion of temporary crowns, bridges, inlays and onlays, is deployed in thescopeofanoff-labeluse.Incon- trast to laboratory wax, which is used for wax-ups, the visual prop- erties of this material allow repro- duction of the natural tooth shade 3 2 1 6 5 4 “The mock-up, essentially a preview produced from composite, is a technique all too rarely employed by dentists” Fig. 1: Cartridge with self-curing composite (Structur 3).—Fig. 2: Pre-op situation, portrait.—Fig. 3: Pre-op situation, smile. Fig. 4: Pre-op situation, intra-oral in occlusion.—Fig. 5: Pre-op situation, intra-oral in non-occlusion.—Fig. 6: Wax-up without preparation of the teeth.

Dental Tribune Nordic Edition No.4, 2016

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