Setting and waxing up the lower complete denture

Setting the mandibular posterior teeth : First of all , we draw a line from behind the retromolar pad until the canine line ,running through the crest of the ridge . Our objective is to get the central fossa of the lower posterior teeth to be centered on the ridge . Palatal cups of the upper posterior teeth would be directly on the fossa of the lower teeth which are directly centered over the lower residual ridge . What is the sequence of setting the lower posterior teeth ? Usually , we start from the lower first molar because of its importance in occlusion . so we cut away a piece of the wax ( 2/3 of it ) in the first molar area . There are two ways : either we set the tooth in the wax and then we close down or we attach the lower first molar to the upper first molar with wax and then we close down . Where does lower first molar exactly has to fit ? The mesiobuccal cusp is setting between upper 5 & 6 (in the proximal area ) and the distobuccal cusp is in the central fossa of the upper 6 .

Next , we set teeth number 4 ,5 and 7 according to the upper occlusion . Now we might face some problems in this step ( after setting the lower first molar ) : Depending on how much overjet and overbite we have , for example if we made an overjet of 3 mm while setting , that means the lower posterior teeth will be too far back , that means the space for lower 4 & 5 will be limited , we will set the second premolar and when we come to set the first premolar we wont find enough space for it . so what to do at this point is rather than reset all the lower anterior teeth , we trim the mesial and distal of teeth 4 &5 so that they can fit in the space . The opposite might happen as well , an extra space may be present for the lower 4 & 5 , we can make spaces between the teeth ( mm for each) to accommodate this issue . Remember that there must be always a symmetry between right and left , and that starts from and depends on the upper anterior teeth . If we set the upper posterior teeth incorrectly , the lower posterior teeth will be either too buccal or too lingual . There has to be inter digitation between the lingual cusps of the lower posterior and the palatal cusps of the upper posterior , no space should be seen from the lingual view .

festooning
everything that is wax will turn into the final denture , so if there are irregularities of wax or extra wax scattered on the denture while setting it will appear again in the final denture . both the wax rim and the baseplate will turn to one piece . so if theres a space between the wax rim and the baseplate that will turn to a groove in the final denture , for example . The steps are : 1. Check the occlusion of teeth and make sure teeth are set in their right positions . 2. Fill in the wax where its negative ( in the areas where it is deficient ). Remove excess wax on the teeth if theres any . Make sure there is enough wax in the palatal & facial surfaces of the upper denture , and the facial & lingual surface of the lower denture . 3. Now we start festooning , and it is very important because it shows the anatomy and defines the shape of the tooth . A tooth is like a picture , and every picture has a frame The wax covering the teeth will turn to a gingiva in the final denture . So if the wax covering the tooth is too far from the edge of tooth , this makes the patient looks old and as if he has a gingival recession , if the wax is too thick over the tooth this would make the patient looks like he is having an inflamed gingiva .

So the way we shape the wax affects everything in the denture ; outer appearance , possibility of food accumulation , oral hygiene , phonetics and esthetic of the denture . Notes : There should be no concavities under the teeth in both upper and lower dentures . In lower denture , when the patient swallows the posterior part of the tongue will rise , so if there are concavities under lower teeth , it will get locked there while rising and this causes and up and down movement for the denture . So , Avoid undercuts in the lingual and palatal area when looking vertically . it should be nice and smooth .

There are two main things about festooning : First: shape of the wax from one contact area to the other . In each acrylic tooth , extending from the cervical margin , theres a ridge lap. Between the crown of the acrylic tooth and this lap theres a groove ,if we follow this groove when carving away the wax , well have the right shape ( right length for the crown ) .

Removing too much wax tooth will look too long. Removing too little wax tooth will look too short . In general , anterior teeth are longer than posterior teeth , the central gingival margin is almost the height of the canine gingival margin , while the lateral gingival margin is shorter . the lateral tooth is more occlusal from the gingival side and is more gingival from the incisal side shorter than central from its both sides gingival and incisal . From the canine all the way back, teeth become shorter from the gingiva . The thickness of the wax is relatively thin , when looking at an acrylic tooth from a lateral view , the wax covering it shouldnt be too bulky , in order to simulate the normal healthy gingiva . To remove excess wax from the facial surface of the tooth , we use a lacron carver and we hold it at a 45 degrees angle to the long axis of the tooth ( angle between the gingiva and the tooth becmose acute ) .

Second thing we do in festooning is shaping the roots , but we should be careful not to show too much of the anatomy of the roots , not to extend it all the way to the baseplate , it wouldnt look natural . normally the roots of our teeth do not show much from the bone .

So the anatomy of the roots should extend 4 -5 mm from the cervical margin . after that the bone is naturally too thick that we cant see the roots . Its done by removing wax between the teeth and do roundation . normally theres a small depression ( 3-5 mm ) between the roots .

Canine eminence : Canine is the most prominent one , its root is also prominent . Usually we expect to see the wax over the canine to be more prominent than that over the lateral , central and the premolar . this is called canine eminence .

Stippling : The gingiva is attached to the tooth by Crestal fibers . this fibers will show as small depressions in that area , near the free gingival margin . it can be

created by using a tooth brush to make a rough surface at the edge of the margin. ( its optional for us as students to do it in the lab ) They indicate healthy gingiva , if they disappear then the gingiva is inflamed .

The End Aya Alali