Caring for a Dental Leaf Gauge 

Lee Ann Brady, DMD 

In the Pankey Essentials courses, we use dental leaf gauges to train dentists in how to feel for the first point of occlusal contact, as a method for occlusal deprogramming, and as a tool for articulating models on an articulator in centric relation. Dental leaf gauges not only assist us in diagnosis and treatment planning but also in enabling our patients to discover the nature of their occlusion as we help them understand how malocclusion can manifest in TMD symptoms, parafunction, tooth damage, and more. 

In our Essentials 1 course, I am sometimes asked how to take care of leaf gauges, so I thought I would share my answer.  

Although they don’t last forever, dental leaf gauges do last a long time and you can autoclave them between uses. When you sterilize them, the leaves become sticky, so I separate them like a hand of cards before putting the gauge in the autoclave bag and separate them again when I take them out of the bag just before going to the mouth. 

Over time, with use, a leaf gauge will start to look a little beat up. I’m looking at one now. The Teflon screw that holds it together has turned color from going through the autoclave. I can see some ink stains from Madame Butterfly silk. It’s at the point where I think it looks too grungy to keep using. Although it might continue functioning for quite some time, I’m going to toss it and use a new one. After all, they are relatively low cost with a high return on investment.  

I’ve never seen a dental leaf gauge break after many trips through the autoclave. I tested cold sterilizing one and discovered the chemistry in the ultrasonic cleaner started to make the leaves brittle and they came out stickier than when autoclaved. So, my preference (and the protocol in my practice) is to bag them and put them through the autoclave. 

Improving the quality of alginate impressions for diagnostic models requires a fine-tuned technique based on specific materials. These materials are used in conjunction with clever steps that lead to a minimization of voids and bubbles.

Dr. Baggett explains his exact procedure for achieving drastically improved alginate impressions. With these recommendations, you’ll find your confidence and efficiency soaring. Impressions are one part of the treatment puzzle that must be as precise as possible to avoid problems down the road.

How to Improve Alginate Impressions for Diagnostic Models

At my practice, we still use alginate impressions as our main impression material for diagnostic models. I generally take them. A very helpful tip to improve the quality of your impressions is to use a 35 ml monoject plastic syringe (from your local dental supplier) and Ivoclar Accudent XD Pre-Sure Tip applicators (Ivoclar Reorder number 67891 Soft Flex Tips).  

By placing the flexible tips on the end of the 35 ml plastic syringes, you are able to squirt excess alginate loaded into the syringe onto the teeth at a 90 degree angle starting at the distals of the second molars. You can do this instead of wiping alginate on the teeth with your fingers before you seat the alginate loaded tray.

This technique results in a lot less bubbles and minimizes the chance for voids distal to the most posterior teeth. The flexible tips are autoclavable, the monoject syringes can be cold sterilized, and petroleum jelly can be applied to the rubber plungers so they can be used again.   

This tip – combined with the use of 1-inch medical tape along the posteriors of our maxillary trays as a post-dam seal – has improved the impressions taken at my practice tremendously.

What aspect of impressions do you find the most challenging and why? We’d love to hear from you in the comments!

One Easy Method That Will Increase Restoration Accuracy by Customizing An Articulator to the Actual Angle of the Eminence

When we rely too heavily on ‘assumptions’ to determine the angle of the eminence during a restoration, we risk creating a faulty end result for a significant amount of patients.

About 80-85% of patients will not present an issue. You can set the angle of the condylar path on the articulator, basing your efforts on a design assumption that most patients have an eminence with a steeper angle. The lab creates posterior disclusion on the articulator and there is equal or greater disclusion.

Problems arise when you end up with a patient who falls into one of two eminence categories.

Two Types of Patients Who Need Customization to the Angle of the Eminence

For 15-20% of the patients you treat, customization is necessary. These patients often fall into two categories:

1. Eminence is flatter than the assumption.

The restorations did not touch on the articulator, yet you’ll have to remove posterior differences chairside in these patients.

1. Eminence is steeper than the assumption.

These patients tend to experience less chewing efficiency. They complain that bits of snack food pack onto their restorations. This packing occurs on the occlusal table.

In both cases, a solution is needed. Creating posterior excursive disclusion or interferences relies on how well the angle of the eminence works with the angle of the anterior guidance. To achieve great results for patients outside the norm, there are two options.

How a Photograph Can Enable Restoration Customization

Accuracy is the ultimate goal for final restorations. Many dentists who find themselves dealing with a patient in the less common eminence percentile decide to take a protrusive bite record. My advice is to choose an alternative option that requires less effort.

The easier way also uses a semi-adjustable articulator. You still customize the articulator to match the patient’s actual angle of eminence. But instead of the protrusive bite record, send the lab an end-to-end retracted photograph.

For this image:

• The incisors should rest on the incisal edges.
• The second molars should be visible and in focus.

The lab can use this image to create posterior disclusion. They simply dial the condylar setting to match the photograph and use a sharpie to record it on the model.

What method do you prefer for customizing the articulator? We’d love to hear from you in the comments!