Phased Planning of Full Arch Reconstruction — Sequence from Wax-up to Final Restoration

Full arch reconstruction is not 'make all my teeth at once'. It's systematic planning, a sequence of work, and testing at every stage. Errors without a diagnostic phase are costly — remaking an entire arch can cost tens of thousands of zlotys.

Why phased approach is crucial

In reconstructions involving many teeth (8–28 units), every error is multiplied. Poorly planned occlusion on one tooth is a problem. On twenty — it's a catastrophe requiring a complete redo.

Phased planning allows to:

• Test each change before it's finalized
• Verify occlusion, esthetics, and phonetics in the temporary phase
• Make corrections at the PMMA stage instead of on finished ceramic
• Control the budget — decisions made step-by-step, not blindly

Six phases of full arch reconstruction

Phase 1: Diagnostics — analysis of the current state: X-rays (CBCT if implants), diagnostic models, occlusal analysis on an articulator, photodocumentation. Goal: a map of problems and a treatment plan.

Phase 2: Diagnostic wax-up — physical or digital design of the final tooth position. The patient sees the treatment goal before any procedures begin. At deltalabs., we design wax-ups in CAD and print 3D models.

Phase 3: Mock-up / esthetic trial — temporary placement of the design onto the patient's teeth (directly or from a silicone template). The patient evaluates esthetics, phonetics, and shape in their mouth, not on a model.

Phase 4: Preparation and PMMA temporary crowns — after mock-up acceptance, tooth preparation occurs. Temporary crowns milled from PMMA recreate the accepted design. The patient wears them for 4–8 weeks.

Phase 5: Verification and corrections — during the temporary phase, we check: occlusion in CR and during eccentric movements, esthetics under various lighting, phonetics (sibilants, labiodentals), patient comfort. Any corrections are made on the PMMA — inexpensive and fast.

Phase 6: Final restoration — only after full acceptance of the PMMA do we fabricate the ceramic restorations (zirconia, e.max). Occlusal parameters from the temporary phase are precisely transferred to the CAD design.

Role of articulator and bite registration

For full arch reconstruction, an articulator is mandatory — not optional. Bite registration in CR (centric relation) is the starting point for all subsequent occlusal decisions.

At deltalabs., we work with semi-adjustable articulators (KaVo Protar, Artex). For complex cases, we use digital occlusal analysis to compare the articulator bite with the situation in the mouth.

Common errors in reconstruction planning

• Omitting the wax-up — the dentist and patient do not see the treatment goal, so the final evaluation is subjective
• Too short a temporary phase — 1 week is insufficient to evaluate occlusion when changing VDO
• Lack of CR registration — work designed in an arbitrary mandibular position
• Working on multiple arches without phasing — simultaneous change of maxilla and mandible without a reference point

How deltalabs. supports phased planning

At each stage, we provide diagnostic tools and prototypes:

• Digital CAD wax-up with iteration capability
• 3D printed models for patient presentation
• PMMA temporary crowns milled from CAD (not handmade)
• 1:1 transfer of parameters from PMMA to ceramic design

Communication at each stage — photos, notes, corrections — is part of the process, not an extra cost.

1. How long does a full arch reconstruction take from diagnosis to final restoration?

Typically 3–6 months, depending on the number of teeth, need for implantation, and PMMA wear time. The temporary phase should last a minimum of 4 weeks.

2. Is a wax-up necessary for every reconstruction?

For restorations involving a change in VDO or more than 6 units — yes. For smaller restorations, the decision depends on the extent of occlusal change.

3. Can I skip the PMMA phase and go straight to ceramic?

Technically yes, but the risk of remake increases exponentially. PMMA is insurance — correcting a temporary costs a fraction of correcting ceramic.