Anterior Analysis and Restorative System (AARS)

We are often presented with difficult spacing problems in the anterior region.The assessment, planning and restoration of these spacing problems has always been a complex process. Patients are becoming more demanding and discerning about their treatment options, and the finished result. It is becoming increasingly important to ensure that the restoration is in correct proportion and is esthetically pleasing.

Cases such as the one presented below, do not work out satisfactorily without careful measurement, planning and execution.

CASE STUDY - Patient: Tony D. 38yo Male - Presents with multiple and variable diastemas and wants all gaps completely closed without crowns.

Up to now it's been difficult to accurately measure teeth in contact, which has made the assessment process difficult. Once we have measured up, it has been hard to decide what to do - for example, how do we decide how wide to make teeth so that they are-

1. Wide enough to fill any adjacent gaps.
2. Look natural in height versus width ratio.
3. Look to be an appropriate overall size relative to the human species.
4. Are symmetrical with the same teeth on the other side of the mouth.
5. Look in natural width proportion to the other teeth.

We also need to consider how we can achieve the above objectives without orthodontics, if possible, so as to minimize patient expense and inconvenience. If this is not possible we need to determine exactly where we need to move the teeth to and by how much in order to get the best result.

Current methods of measuring include Boley gauges that were somewhat awkward to use and read. They usually didn't have digital readouts, and sometimes used Vernier scales that weren't very intuitive (or even understandable to some). Other clinicians used dividers and then transferred the width to a rule, and attempted to read off the rule as accurately as they could. Conventional engineering calipers have bulky tips that only measure from the inside surface - They are designed to get around an object, not in between teeth.

Since the tooth cannot be extracted to measure around, we need a system specifically made for dentistry where teeth are in contact, and direct access to the contact points is denied. Dentagauge 1 is a new instrument that has symmetrical arrowhead tips, which measure not from the face, but from the end of the tip. This tip fits snugly into the embrasure, and because it is symmetrical it self centres in the embrasure to give an extrapolated measurement of the contact point.

Normally these arrowheads would bump into each other when attempting to close the gauge, thus stopping the ability to fully close the caliper. Therefore it would not be able to be zeroed in its fully closed position and it would be unable to read distances below 2.5mm approx. However, Dentagauge 1's arrowhead tips overlap, which allows the instrument to be fully closed and zeroed. This design allows the gauge to be used for a variety of other purposes, such as measuring pins, posts, wire diameters, denture teeth, implant accessories etc. It also measures gaps down to 0.8mm.

Each Dentagauge has an upper and lower jaw - a total of four jaws for different applications. All measurements can be made in inches or millimeters, or converted from one to the other at the push of a button. The uses of each of the four different jaw ends are as follows:

• Dentagauge 1- upper jaw is used for gaps 0.8mm to 106mm. The lower jaw is used for teeth in contact and in a relatively straight line.
• Dentagauge 2- upper jaw is used for crown, veneer or wax bite thickness and measures from 0mm to 152mm. The lower jaw is used for the external measurement of twisted teeth, where direct access to the external contact points is possible, or for teeth that are malposed buccally or lingually and for teeth in contact where they are positioned around the perimeter of a circle, as in the anterior smile region. NB: When teeth are crowded one needs to use one's judgment as to which gauge to use in which situation- this is obtained with clinical experience.

Fig 1: Dentagauge 1 - upper jaw measuring gap
Fig 2: Dentagauge 1 - lower jaw measuring UL2 tooth width
Fig 3: Dentagauge 2- lower jaw, measuring UR1 tooth width where direct access to contact points is possible

If all these accuracies seem to be obsessive, please hold your judgment. Even with special tips designed for dentistry, and two devices for teeth in different configurations, plus a scale that reads to 100th of a millimeter in accuracy, measuring teeth in contact in dentistry is still an art, not a precise science, due to the variable configurations teeth present to us. There is still an error, albeit a much smaller one when using the Dentagauge Duo.

Why Are Tooth Measuring Errors Important?

Errors in assessment and construction can lead to big problems. Errors often accumulate as you work across the smile, resulting in the last tooth to be restored being undersized or oversized, with substantial problems if the patient notices the error. These days, patients are becoming more and more aware of good and bad cosmetic dentistry, and they expect a good result for what they perceive to be an expensive fee. Seemingly small errors in tooth sizes, or noticeable asymmetries can be the cause of significant heartache for the patient and dentist alike.

Using a mannequin, let us trace the steps required to assess and treat a challenging asymmetrical case. Initial presentation is as below:

STEP ONE - Measure the teeth widths and any spaces.

Measure all the tooth widths and gaps, from the mesial of one canine across to the mesial of the other canine, to get the total distance measured on the curve through the buccal side of the contact area. Write the measurements down as below.

Do not measure in a straight line as this is a much lesser number. Do not measure the length of the arc at the perimeter, only through the contact area - because you will be using this area later to check your reconstruction.

Using the Dentagauges the following spaces and tooth widths were calculated:

1. UL3-UL2 = 1.40mm
2. UL2 tooth width = 6.36mm
3. UL1 tooth width = 8.72mm
4. UL1-UR1 = 2.40mm
5. UR1-UR2 = 2.34mm
6. UR1 tooth width = 8.75mm
7. UR2 Tooth width = 6.55mm

Continue with Case Study ...

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