Upon completion of your first anatomical tooth set up, after the hours of pain and strife, and the multitudes of faculty checks, you end up with an acceptable set up. It is not until you build up the courage to practice again, and are dumbfounded at the idea (and proof) that a person can become worse at a task they supposedly mastered.
Well, you are not alone. Here are some tricks of the trade I have learned from my colleagues here at Boston University that certainly helped me during our anatomical tooth set up summative.
1. This ruler is king.
At BU, we are provided with the materials we’ll be using that day in lab. Enclosed in one of the goody bags was this Trubyte millimeter ruler (Fig 1). Naturally, we use it to verify VDO umpteen times; but there are a few other important overlooked uses.
While setting upper anteriors, the protractor-like portion (Fig 2) can be used to replicate the ‘natural’ curvature of the maxilla. I recommend checking to see if you are following the curve of the maxilla after each pair of anteriors are placed.
In addition, the ‘median’ line bisecting the protractor-like portion (Fig 1A), can help you verify your midline when placed in between your central incisors (given your centrals are placed on your denture midline).
Further, as shown in Fig 1B, the start of the ruler slopes up and makes a subtle turn before meeting up with the protractor-like portion. Upon closer inspection, this ‘corner’ happens to be the exact 5-6 degree taper the upper molars are supposed to be placed in, in relation to the premolars (Fig 3). Coincidence? I think not.
2. Make sure your upper set up is perfect (easier said than done).
Our faculty has ingrained into us: “The most important step in making dentures is the step you are on”. In order to achieve a perfect set up, your occlusal rims have to be perfect. For your occlusal rims to be perfect, your record bases must be perfect. Perfect record bases come with perfect impressions, etcetera.
Remember, the ruler is just a guide. You have to make sure the centrals are the proper distance in front of the incisive papilla, your crest of ridge lines are in the right place, and the subsequent, correct placing of the actual denture teeth. If all this is done right, the lowers basically set themselves.
3. Electronic Waxer.
The Kerr Ultra-waxer 2 (Fig 4) was given to us to be used in our dental anatomy wax up lab. At least half of us continued to use this throughout remo for setting teeth (versus the old fashioned Bunsen burner technique). Along with the interchangeable spatula heads, you can manually adjust the temperature to the degree you like, without worrying about melting the wax too fast and dripping everywhere. If you aren’t into scorched hair or third degree burns, then I would certainly consider switching over to this safer technique.
4. Practice makes perfect.
This timeless adage is the epitome of our future careers. Know the materials you are working with. Learn from them and learn with them. Make mistakes, fix them and try again. Yes, the long hours spent in lab are tiring, but these logged hours will be worth it in the end. Remember, we are all in this together!
~Alyssa Mazzoli, Boston University ’16