Overview: This guide describes the Appointment 2 clinical procedures for managing partial and complete denture combination cases during the wax rim continuation phase.
Recommended Materials
- Heat source
- Waxing instruments (spatula, carver, etc.)
- Baseplate wax
- PVS light body impression material
- PVS blue bite impression material
- Measurement tools (Willis gauge, metal ruler)
Maxillary Rim Aesthetics and Plane
The clinician must adjust the maxillary wax rim to establish proper lip support and occlusal alignment.
Adjust Lip Support: Add or remove wax from the labial surface of the maxillary rim until the nasolabial angle is approximately 90 degrees and the philtrum sits naturally.
Set Incisal Length: Modify the maxillary rim so 1–2 mm of wax is visible below the upper lip at rest. Use "F" and "V" sounds to verify the incisal edge of the wax rim touches the wet line of the lower lip.
Level the Occlusal Plane: Use a Fox Plane to ensure the maxillary rim is parallel to the interpupillary line from the frontal view and the ala-tragus line from the lateral view.
Mandibular Rim and Partial Preparation
The clinician must ensure the mandibular wax rim integrates correctly with natural dentition.
Check Clearance: Seat the lower partial wax rim and verify that the lower partial wax rim does not interfere with remaining natural teeth.
Set Height: Adjust the lower wax rim height so the rim is level with the corners of the mouth anteriorly and positioned halfway up the Retromolar Pad.
Vertical Dimension of Occlusion
Establish the correct Vertical Dimension of Occlusion (VDO) by measuring the patient's rest position.
Measure Rest Position (VDR): Place marks on the patient's nose and chin. Have the patient relax or say "Emma" to identify the Vertical Dimension at Rest (VDR).
Calculate VDO: Subtract 2–4 mm of freeway space from the measured VDR.
Adjust to VDO: Trim the mandibular wax rim until the marks on the patient measure the calculated VDO when the wax rims and natural teeth meet.
Centric Relation and Bite Registration
Capture the patient's Centric Relation (CR) to ensure a proper bite for the final denture.
Rehearse the Bite: Guide the patient into Centric Relation by instructing the patient to touch the roof of the mouth with the tongue and close gently.
Cut Notches: Carve "V" shaped notches in the posterior wax of both the maxillary and mandibular rims to retain registration material.
Inject Material: Apply bite registration material and guide the patient into the practiced Centric Relation until the wax rims meet.
Clinical Marks and Shade Selection
Define the aesthetic landmarks and select tooth properties for the final restoration.
Mark the Rim: Use a wax carver to scribe the Midline, Canine Lines (aligned with the corners of the nose), and the High Smile Line on the wax rim.
Select Teeth: Choose the shade and mold of the teeth with the patient. Match the selection to any remaining natural lower teeth.