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One of the goals of an occlusal appliance can be to release the Lateral Pterygoid muscles, seat the
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condyles
o in Centric relation and establish intercuspal position at this point. Over the years I have
varied my technique for reaching this goal. One approach is to use bimanual guidance ( bilateral
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manipulation)
U each time you mark the posterior occlusion until you have achieved multiple stable
sstops. At this point most patients can close on their own repeatedly into this position to allow
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completion
n of the adjustment. Another approach is to adjust the appliance overtime, getting stable
gstops and allowing the appliance itself to release the muscles. This method requires seeing the
patient at short intervals so that each time they develop a new posterior interference you readjust
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giving them multiple stable stops.
LRecently I started using a leaf gauge to adjust the posterior stops at the appliance delivery
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appointment,
a and I find it efficient and effective. Once the appliance has been fit adjusted so it seats
fcomfortably and is retentive I begin establishing the posterior stops. I choose a random amount of

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leaves in the device, place it between the patients front teeth and ask them
to “slide forward, back and lightly squeeze”. Then I ask them if they feel anything touching in the
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back.
o I keep removing leaves until they feel the first posterior tooth contact, each time with the same
instructions. At this point my assistant holds the miller forceps with articulating ribbon in place and
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we
d begin to adjust. Each time we mark I place the leaf gauge between the appliance and their
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centrals and ask them “slide forward, back and lightly squeeze”. I adjust the marks until there are
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none, then remove a leaf and follow the same process. Once I am down to only one leaf I remove it
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and now have the patient close on their own to refine the occlusion before beginning the excursions.
My experience with this procedure is that it is easier on me, the patient and my assistant then trying
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to
n guide the patient every time we mark the occlusion. I have also found that I am getting far more
predictability. As I see my patients back for adjustments I have very minor if any changes to make to
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the
c intercuspal contacts. This allows the process to move forward and the patient and I can work
cmore closely on fine adjustments. I have also found that I am seeing faster resolution of muscle and
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joint symptoms since I implemented this technique.
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 Adjusting the intercuspal contacts with this method works on both Tanner style and flat plane
appliances. There are some patients where it is more appropriate clinically to slowly adjust the
appliance back into centric relation. Other than this exception I have followed this protocol and loving
both the technique and the results.

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Posted by Lee Ann Brady on June 23, 2011 Tagged with: Occlusal Appliances
4 Responses to “Using a Leaf Gauge to Adjust an Occlusal Appliance”

1.

Chul Oh says:
June 23, 2011 at 8:01 AM

It’s very nice. Seems easier than before. Thank you Lee.

Lee Ann Brady says:

June 23, 2011 at 10:00 AM

Chul, I find it is soooo much simpler then any of the other techniques, and it really works well.

2.

Andrea Beerman says: