PHASE 1: LAB PHASE
STAGE 1
1) Pour a cast
2) Teeth wax up. 16 teeth to be made replicated to contralateral counterpart tooth.
3) Accurate Emergence profile and axial walls.
4) Teeth need to be in arch facially, lingually and occlusally.
5) Occlusal anatomy with correct dimensions.
Instruments: impression trays (set; L size), Plaster, Alginate, Thomas set,Divider,Burner,Blue wax, 0.5 mm mechanical pencil, elfy,explorer, spirit
STAGE 2
1) Anatomical wax Build ups of Teeth (those missed in stage 1) with proper Morphology; on articulated cast.
2) Gingival emergence profile.
3) Correct axial contours; with further emphasis on emergence profile.
4) Refined occlusal topography.
5) Additional identification of Occlusal high spots and their adjustment in CO
Instruments same as stage 1, addition of Plane line articulator / hinge articulator
STAGE 3
PART 1
1) Setting up articulator (consular guidance bennet shift, incisal pin)
2) mounting of cast according to yaw pitch roll
PART 2
3) pulp horns in red wax
4) Wax up : functional in green wax ; non functional in blue wax
5) Adjustments of occlusal high spots in CO, lateral and protrusive movements
Instruments: semi adjustable Hanau articulator, rest same as stage 1.
STAGE 4
3D Manual moulding of playdough to form all teeth Morphology with specific outline forms of teeth in view of facial, lingual, mesial, distal and Incisal/occlusal surfaces, with appropriate crown and Root ratios, root anatomy and features
STAGE 5
An extensive stage of stomatology; prosthetic teeth, and anatomical features.
1) Set the articulator ( condylar guidance, bennet shift )
2) Occlusal rims
3) Establish occlusal plane
4) Tooth setup (with yaw pitch roll, and curve of Spee + Wilson and inter arch distances at canine premolars and molars)
5) Carving of roots ( with correct crown: root ratio, and total tooth length)
6) Roots angulation
7) Inter radicular trabecular bone with 5 mm biological width
8) Cortical bone
9) Buttress, anterior nasal spine, nasal septum, maxillary sinus, nerves, foramina.
10) Buccal shelf, mental foramen, chin bone
11) Soft tissue with buccal, labial frenum
12) Festooning (gingival roll and stippling)
13) Palatal rugae
Instruments: Hanau articulator, Plaster, Pink wax, Acrylic teeth, Wax knife, Protactor, Divider, Scale (ruler), Burner, spirit
PHASE 2: PRECLINICAL STAGES
STAGE 1
RCT, post and core
1) Presentation on access cavity, number of canals in each tooth, errors in RCT, obturation techniques, and post and core, objectives of RCT.
2) Access cavity prep and manual filing on extracted teeth.
3) 10 Warm vertical condensation.(at least 5 multirooted)
4) Instrument retrieval.
5) Reciprocating hand piece filling.
6) 10 Post preparation and post insertion.
7) Build-ups.
8) MTA repair
STAGE 2
Basic crown prep stage
• Even margin and even contour of margin
• No ski jumps, No ripples, No unsupported rods
• Angle of axial wall and margin is obtuse
• 10 margins on roots, at 1mm difference each
Presentation on:
1) PFM crowns: 0.75mm margin.
2) Crown margins from 2mm till CEJ and on roots.
3) Crown margins and axial surfaces.
4) 10 final complete crown preparation.
5) 10 wax crowns on prepared crowns.
6) 10 composite crowns on prepared crowns.
7) 10 acrylic crowns on prepared margins.
8) 3 crowns with CEJ dips and mesial and distal differentiation.
9) 3 crowns in occlusion in articulator.
Instruments: 0.3mm mechanical pencil; 0.3mm sharpie pens (not blue or black, use bright colors)
STAGE 3
Restorative stage
1) Inlays / Onlays (optional).
2) Luminares (optional).
STAGE 4
1) Composite build-ups on articulated cast
2) Occlusion adjustment in CR.
STAGE 5
1) Orthodontics
2) Bracket placement on 3 casts