Diagnostic Design: Materials Explained

Video Transcript:

Hi, this is Brent at Frontier Dental Laboratory. Today I’m going to go over diagnostic designs and really emphasize some key points that are very, very important as we develop the smile, because this will be a template to go to the finals. And so everything is really set up at the very beginning with the diagnostics.

Now with the diagnostics, they start off with the really, really good impressions because this design’s going to be transferred to the mouth. Accuracy is the most important thing. Now we can either get regular PVS impressions, alginate impressions of the models we poured up, or we can go to a digital.

Digital is a fantastic way to be able to do that, to send it to us. And keep in mind at the laboratory, as we get more and more into digital, we are transitioning to more of a digital type of workflow. You may get either a diagnostic wax up there or you’ll actually get a digital printout as well too, and we could talk about more of that.

But basically we want to get some good models. So what we’ll do is we have the impressions here, we’ll mount them up. And we also duplicate a baseline impression, so you have a baseline and a diagnostic design. So when you get your diagnostic back, you’re going to get pretty much all of these models here.

And we’ll start off with a tissue alteration form. And what we’ll have is a tissue alteration form and what we will do is we will actually adjust the tissue heights as we see fit, up to about one millimeter. Because we don’t want to do more than about one millimeter, we don’t want to get into biological width violations. If you want to do more or if you don’t want to do any at all, just let us know. But basically you’ll find in your case a tissue alteration form. In this case, we didn’t do any tissue alteration form.

So we did the diagnostics and we do all of our diagnostics based off of golden proportions. I’m a big believer in golden proportions. To me, that’s the best looking smile. It’s just time and time again, some of the best smiles I’ve ever seen. I put it on a golden proportion matrix there and it looks absolutely perfect. And so I really believe that.

So we’ll usually go off of that. And so we’ll do the design and then when you’re done, when you get this, we will provide you with a couple tools. One of them is obviously the temporary matrix here. The temporary matrix is based off the diagnostic wax up, and you’ll use this to transfer the diagnostic wax up to the mouth. And this is usually the best, “aha”, moment of the whole appointment. It’s the first time the patient will be able to see what it looks like. And so this is our temporary matrix here. We relined it with a light wash and we have a heavy putty here, which makes it very, very rigid there, so it doesn’t distort it as you’re putting it in.

Now, these two devices here, these two tools here, these are not quite understood how to use this. We’ve got the temporary matrix, excuse me, the prep matrix here, and this is more for your facial reduction. So what you’ll do is as you’re doing your depth cuts and you’re doing your reduction, again, this is based off the diagnostic design. So in order to transfer this to the mouth, we have to make sure that you reduce enough of the tooth structure to be able to achieve what this design is. And so what you’ll do is you’ll do your depth cuts away from this, most likely slice through the interproximal. You could be doing full crowns or veneers for whatever you need there, and then you’ll be putting this in and out of the mouth so you can see how much reduction. You want to make sure that each tooth is in their zone. There’s a good maybe eight tenths to one millimeter of reduction all the way across, including the interproximal.

So you press in that, and so then you’ll be able to see that you have the proper reduction on that.

This one is the lingual matrix here. The lingual matrix is for the incisal reduction and also the interproximal reduction. Again, this is built off the diagnostic design and it is meant to make sure that all of the preps are kind of in their zone so that the teeth that are built to golden proportion will fit in there. So after you do your reduction, you could put this on and you make sure that all the preps, because you might have some rotated teeth and teeth that are kind of out of position and everything. You want to make sure they’re in this. So as you’re prepping, you’re going to be looking at the lingual aspects of this lingual matrix and making sure the preps are in there. Plus you want to make sure that you have enough of the incisal reduction.

Again, this is based off the incisal length of the diagnostic design, and you want to make sure that you have enough reduction in order to achieve the diagnostic design plus the amount of incisal translucency that we want to have. Usually we need to have a good millimeter of reduction off the incisal edge to get half a millimeter of incisal translucency. If you want a millimeter of incisal translucency, we need a millimeter and a half reduction and so on and so forth.

These two tools are probably the most important tools that you’ll have of all the diagnostic, and you’ll be using these all the time here. And of course, your temporary matrix.

Now, in the case where we have a bite opening, let’s say for instance that on this particular case we were doing a bite opening for this case here, we’re not on this case, but let’s just say for the matter of purposes that we are. What you’ll receive, we’ll make you a bite matrix there. Now, if you provide us with an open bite, vertical bite, or some sort of jig or something like that, that you’ve used, maybe a Kois Deprogrammer, maybe a CR bite that you’ve given us, we’ll mount that to the CR bite, or we can actually even sometimes open the bite on the articulator. What we’ll do is we’ll mount it, set the pen, and we’ll make you a putty bite that’s a full arch bite there.

Now how you use this here is quite simple, basically, this will be the bite that you’re building to create a tripod bite. Basically what you’ll be doing is start with prepping with the right side first. And once you get pretty close to be finishing the right side, you can put this back in the mouth there and then use some bite material, Blu-Mousse Bite, Vanilla Bite, or what have you. It will stick to this because this is a poly vinyl, and you’ll put this in and you’ll reline that and you’ll build a bite on the right side. Then you can prep the left side and again, do the same thing, put it back in, and then flow bite material on the left side and then prep the anterior and then again, put this back in.

And so you’ve built yourself a tripod bite that when we get the case, a prepped case, we will have it at the right vertical, at the same vertical that we did on the bite opening of the case there. And it’s actually quite simple to do and it’s very, very predictable and a good way so you don’t lose a vertical if you’re going to be prepping all the teeth at one time.

So we call it the horseshoe putty bite and we will give this to you on every case when there’s going to be a bite opening for you.

With that, any questions at all, you can ask the smile designers, who you’re assigned to, and we want to make those processes as simple and pleasant as possible. This is obviously the hardest appointment, but this is a very, very gratifying appointment for when the patient sees their new smile.

So any questions, please let us know.

Thank you.