leaf gauge
An example of a leaf gauge.

If you like using the leaf gauge as much as I do, you undoubtedly have occasions when you wonder why there is a discrepancy between what you see clinically and what you get when the case is mounted. While there can be many reasons for this, one of the reasons that I can control is how I help the patient show me the reference I’ve chosen for my inter-arch relationship. I’ve discovered over the years that the way I direct the patient to close into the gauge can impact what they actually do.

If you put something between someone’s teeth and tell them to “squeeze,” they will. They squeeze into whatever you’ve placed between their teeth. If that something is a leaf gauge between their front teeth, the squeeze that occurs may be forward of the fully seated condylar position, not the reference we are usually looking for.

I’ve refined my patient interaction when using the leaf gauge to always direct them to their posterior teeth by telling them to bite there (in the back) rather than just asking them to squeeze.

Here is the “script” I use whenever I use the leaf gauge:

Close onto the gauge

Slide all the way out on the gauge

Slide all the way back

Close gently on your back teeth

Anything touching?

If yes, add leaves and start over

If no, squeeze gently (or “half hard”) on your back teeth

Anything touching?

If yes, add leaves and start over

If no, squeeze hard on your back teeth

Anything touching?

If yes, add leaves and start over

If no, hold that squeeze on your back teeth for 20-30 seconds

3.27 Leaf Gauge 1
Tell the patient to "squeeze."
3.27 Leaf Gauge 2
Make sure you tell the patient to squeeze on their back teeth.

(Click this link for more dentistry articles by Dr. Gary DeWood.)

Gary DeWood, D.D.S., M.S., Spear Faculty and Contributing Author


Comments

Cree
March 30th, 2015
Gary, I'm confused. If they squeeze and you ask "Anything touching?" and they say "No" why do you add leaves?
Gary DeWood
March 30th, 2015
That is either the worst senior moment EVER .. or the transcription error in printing. Every NO should be a yes and every YES should be a no. Thanks for alerting me!
Micheal
March 31st, 2015
I agree...I'm confused. Can you maybe explain that for us Gary...why you add leaves if they say NO.
Gary DeWood
March 31st, 2015
You do NOT - add leaves only if the answer is YES. Should be corrected now. Sorry for the confusion everybody!
Richard Healy
March 31st, 2015
Thanks for the correction................Makes allot more sense....
Faiz Tanveer
April 4th, 2015
hi there.... If it's YES touching ( first point of contact ) then you continue with equilibrating but if it's NO not touching ......is it correct to assume the jaw is in centric and to make a bite record ?
Gary DeWood
April 4th, 2015
Hey Faiz! the script I showed above goes all the way to 'Squeeze Hard on your back teeth" - that is used ONLY for the load test. To take a bite record using the leaf gauge I go to "Squeeze Gently on your back teeth", that bite is always taken at an open vertical because we want to capture the first point of contact and the shift from that contact to MIP on the models. This would always be done prior to equilibration. If using the leaf gauge to equilibrate, then the point of contact found with the leaf gauge would be adjusted since you are trying to get simultaneous contacts on all posterior teeth. When you get to 1 leaf and the patient doesn't feel a point you are very close.
Yu Cheng Chu
April 6th, 2015
hi Gary, long time no see, should we take the leaf gauge bites with patient sitting or laying supine? thanks a lot for your course! warmest regards, John
Gary DeWood
April 8th, 2015
Hey John! GREAT to hear from you! Theoretically it should not matter. I usually have the patient leaning back in the chair when I take the bite.
Roxanna Jean Esguerra
April 8th, 2015
Hi Gary! I too am a leaf gauge fanatic. I even use the leaf gauge when making records for verifying correct transfer of the kinematic hinge onto a fully adjustable articulator. This is done exactly as you described, except with increasing the number of leaves for each subsequent record. I did have one patient that I got burned with, perhaps due to the language I used when making the records. I will be sure to adopt the "script" you've listed above and see If I can get more predictable results.
Gary DeWood
April 8th, 2015
Thanks Roxanna! See you this summer in San Antonio!