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Prosthodontics Lab # 5
Thursday Section 27-10-2011

{ WAX RIM }
Last week you fabricated upper and lower baseplate , this week you will be completing upper and lower WAX RIM ,the case the upper and lower master cast with their record blocks are ready to be mounted in the articulator . for teeth setting Last week we talked about type of material that can be used for base plate and we talked about a requirement of baseplate and the differences between special tray .construction and base plate construction Now today before talking about the ways to construct wax ..rim we will talk about the advantages of wax rim Last week we said that the edentulous patient has lost his vertical and horizontal jaw relationship, so we need to regain what was lost from the patient mouth and to be able to rehabilitate the patient and make a new vertical and horizontal relationship which is close to what the patient had, in term of providing the patient with good appearance and speech ability we need to have rims in the baseplate or in the record block that help us for easily .removal or easy addition of the material

The wax rim for terms of this criteria or this requirement, we use wax for RIM (not acrylic) because its easy to remove or add, so you can adjust the vertical dimension and the horizontal relationship easily with wax.

?What is the advantage of wax rim? Why we use it

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In other words when I want to do a jaw relation registration in patient mouth, I will insert the upper record block and then the lower record block and register vertical and horizontal relationship Now edentulous patient has collapsed lips especially in : case of significant reabsorbing so
1)

establish a labial and cheek support.

In patient mouth you support the lip to have a good support, we have to look at the mesio-labial angel, if its too supported remove wax, collapse add wax, until you get a good position of the lips, not to be too stressed or too relaxed, in a position that stimulates lips before .teeth extraction

2)

reestablish the level and orientation of occlusal plane.

In anatomy there is something we call it Occlusal Plane (plane that passes between the incisor and occlusal .(surface But in the patient who has lost his teeth where is the occlusal plane ? LOST How can I know where is the level position of occlusal plane ? By using wax rim So it will help the clinician in reestablishing the occlusal plane, which is usually 0-2mm below the lip border or .below upper lip when its relaxed Also I need to know the correct orientation of the jaw, the wax rim will help me to reestablish the orientation of .occlusal plane by using fox plane device So you will end with functional and aesthetic occlusal plane ?? Level who much is it up or down ?? Orientation tilt of occlusal plan
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3)

establishing vertical dimension of occlusion and free way space.

I n

(VDO: vertical dimension of occlusion. ( or OVD .VDR: vertical dimension at rest

e d FWS: free way space : the distance between the teeth e .at rest ntulous patient the vertical dimension is loss, so the upper and lower wax rim when we place them in patient mouth it .(will determine the vertical dimension of occlusion (VDO Now in the normal condition we dont bit our teeth instead they are in a relaxed position or what we call it vertical dimension at rest. And in patient mouth when we ask the patient to bit and then ask him to relax the . space between them we called free way space

FWS = VDR - VDO

So if the FWS is low in other words if the VDO is high thats mean you have increase in VDO so you have to remove wax from the lower. But if FWS is high you have to add wax to the lower jaw not upper (because you have already established the position of the upper according to .esthetic!!) so dont adjust the level from the upper We dont establish VDR because its present regardless) (the presence of teeth or not

4) Determine the horizontal relationship.

Horizontal (anterior posterior) or what we call the Centric Relation (RCP tooth contact position), normally the patient can move his mandible in many way, but I need a position at which I can do setting of the teeth on articulator which is similar to the position and maximum inter cuspation or
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very closed to maximum inter cuspation which the patient .had before So I have to go back to the relationship of something fixed and related to Centric Relation. Then we fix it and start .sealing for the wax together In this way I register the vertical relationship in patient mouth and the horizontal (anterior posterior) relationship .((Centric Relation

5) Help in detecting teeth size and shape.

By now the technician have the horizontal relationship, ?but how will he know the size of the teeth So the dentist has to determine the size of the teeth on the wax rim in patient mouth. First I will define the mid line of the face for esthetic reasons then the canine line; by these three lines I can determine the width and teeth .size from the charts of the company of acrylic teeth I also ask the patient to smile and mark the high smile .line which will define 3/2 of the height of the teeth From these lines I can determine the size of the teeth in terms of length or width, now shade of teeth I write it .down to the technician

In patient mouth when we do jaw relation registration first we do it in the upper jaw .we determine labial and cheek support the level of occlusion plane and orientation of occlusal .plan determine the midline, the canine line and the smile .line Then we put upper and lower together

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determine vertical dimensional: free way space , .anterior posterior relations

Now we want to place the wax rim on the base plate and because every patient is different from the other, we make a standard in numbers to construct wax rim in the patient mouth, we need to add or remove wax either .facially or occlusally to make it suitable for this patient

? Where do I need to place the wax rim To stimulate what was lost from the patient in terms of cheek support, lip support, in terms of esthetic and phonetics, the artificial teeth must be set in a position which is close to the pre-extraction position of teeth that's mean the teeth must be positioned in a zone area where forces inward from the cheeks and lips counter act the forces outward from the tongue, other than this the denture will be movable, so we want to place the teeth in a position close to the pre-extracted position and this . what we call it in the prosthodontic Neutral Zone Neutral zone: is that the wax rim positioned according to the pre-extraction position. How we know the pre extraction position ? we know it from the pattern of .resorbtion

Maxilla
In maxilla the resorbtion happens: Backward - inward upward .So the end result smaller maxilla

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In the anterior area the resorption occur posterior so .that the crest of ridge goes more posterior In the posterior area the resorbtion occur inward, the crest of ridge go more medially, and the ridge becomes .smaller in height so it go upward So when I want to make a wax rim the center of the wax rim a little bit buccal to the center of the ridge because the pre-extracted position buccal or facial to the ridge, and that in the cast that you have in the upper if you look laterally the wax rim is diverged interiorly because upper incisors in the occlusal plan to make good labial support they have to be proclined and tip of the wax rim almost at the beginning of land area of the cast (rim is a little bit labial to the crest of the ridge) & posteriorly from the wax rim to the cast (betnazil esqa6) almost at the beginning of land area ( center of wax rim a little bit .(facial to the center of the ridge

In the patient mouth the more edentulous being the patient is the more resorbtion is, the older the patient being edentulous the more resorbtion is and the .more facial the wax rim is

In a recent extraction almost the centers coincides because there is no resorbtion yet, we usually make a denture after three months of extraction because most of resorbtion happens in the first three months and it continuous in rapid rate relatively until one year and then .it slows down but it never stop This resorbtion is a physiologic resorbtion occur because the alveolar bone is present to retained teeth, if teeth are lost then no need for this bone so it resorbed

So the resorbtion is a physiologic continuous process .with a decreasing rate over time but it never stops

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And wearing denture may increase the rate of resorbtion .especially if it's not good The longer being edentulous the more facial the wax rim need to be, because more bone lost ,on the other hand the more recent extraction is the wax rim will be on the crest ridge because minimumal .resorbtion happened

:Now the dimension we need in the upper :Length From frenum area to occlusal plane 17- 19 mm Labial sulcus area 22-24 mm Buccal sulcus 18-20 mm

Note if you take the lower margin of the range In one area you must take the lower margin in the other area, So if you take 17 in frenum don't take 24 in labial, take 22. If you chose the minimum keep the minimum all around, if you take the max, keep the max all around, and if you .take the average keep the average all around

Now the width represents the width of incisors usually :upper incisors wider buccoligually than lower incisors

: Width Incisor area 6-8 mm Premolar area 8-10 mm Molar area 10-12 mm

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The change in width should be transient not in the form of steps, and again always remember if you take the minimal of the range continue with the minimal of the range and .vice versa The last point is where do we want to end the wax, well we end it at tuberosity area (no teeth) but not vertically .we make oblique cut

Mandible
:Mandibular occlusal rim It differs from the maxilla in the position of the rim, it follows the pattern of resorbtion which is of course different from the maxillary resorbtion, in mandible it :depends on the areas

.Anterior area: backward, downward

Premolar area: buccaly inward, lingually outward (smaller in width & height). Molar area : the teeth are normally lingually tilted, so most of the resorbtion in lingual area (buccal area is more resistant due to the presence of good corticated bone), so resorbtion lingually occur outward & the crest of the ridge become more buccal so end result wider mandible posteriorly. With time as resorbtion continue the mandible will become more and more downward giving class 3 relationship (long period edentulous patients) but the end result is bigger mandible. Center of wax rim of the anterior area labial to the crest of the ridge, premolar area in the same range, molar area lingual to the crest of the ridge. Dimensions ..
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Length: Anteriorly from the frenum area 16-18 mm The labial sulcus 18-20mm

Remember not to measure from buccal sulcus because I want the end of wax rim to flush with 2/3 of retro molar pad area.

Width: Incisor area 4-6mm Premolar area 6-8mm Molar area 8-10mm

Then the technician started the practical DEMO =)

Good Luck Dentists

Done by : Ruba Ghanem and Sanaa Qasem

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