Three-Dimensional Mock-up. Direct-indirect-direct mock-up supporting the dental technician, Modified mock-up technique

OBJECTIVE: The Three-dimensional mock-up or direct-indirect-direct mock-up represents a significant evolution of the conventional diagnostic waxup and traditional mock-up techniques. Its goal is to restore centrality to the clinician in the aesthetic- functional process, reducing dental technician subjectivity and ensuring a predictable, controlled, and patient-shared outcome. Through the direct application of body and flow composites onto natural teeth, the clinician sculpts a three-dimensional preview of the new smile, which is validated both aesthetically and functionally in real time, then digitally transferred to the laboratory for finalization using a CAD/CAM workflow. This method enables bidirectional clinical-technical communication, perfect consistency between design and outcome, and individualized aesthetics with full respect for function.

MATERIALS AND METHODS: The three-dimensional direct-indirect- direct mock-up technique consists of three phases:
1.aesthetic-functional analysis and collection of key clinical reference points;
2. direct intraoral phase, where the composite (body/flow A1) is modeled to create a three-dimensional prototype that can be immediately tested (test drive);
3. digital transfer to the laboratory, CAD/CAM optimization for model prototyping, and fabrication of a silicone index for final intraoral reproduction using bis-acrylic resin.
This protocol ensures coherence between the clinical project, digital workflow, and final restoration, while reducing errors and operative times.

RESULTS: The technique demonstrated highly predictable outcomes, with perfect correspondence between the mock-up and the final restoration. Improvements were observed in clinical-technical communication, morphological accuracy, and patient satisfaction, with optimal functional and phonetic stability.

CONCLUSIONS: The Three-dimensional mock-up or direct-indirect-direct mock-up represents a methodological evolution that combines clinical artistry with the precision of digital workflows, enabling complete three-dimensional management of the aesthetic project. The technique allows faithful transfer of all spatial and morphological smile parameters to the laboratory, eliminating arbitrary interpretations and enhancing both clinician-technician synergy and patient centrality.

CLINICAL SIGNIFICANCE: The introduction of the modified three-dimensional mock-up technique brings substantial advances to daily dental practice: 1. complete three-dimensional control of the aesthetic-functional project, verifiable and adjustable directly in the mouth; 2. optimized clinical-technical communication through digital transfer of aesthetic and functional 3D data; 3. reduced technician subjectivity and increased predictability of aesthetic outcomes; 4. reliable guidance for minimally invasive preparations, minimizing overcontouring and prosthetic discrepancies; 5. superior dimensional stability through the use of addition silicones and next-generation bis-acrylic materials; 6. a patient-centered approach with direct validation of aesthetics, phonetics, and function prior to finalization.

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