[Downloaded free from http://www.j-ips.org on Thursday, December 14, 2017, IP: 78.111.189.

44]

Original Article

Lateral throat form re‑classified using a customized gauge:

A clinical study
N. Kalavathy, P. Roshan Kumar, Shefali Gupta, J. Sridevi, Mitha Shetty, Archana K. Sanketh
Department of Prosthodontics, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India

Abstract Background: A common problem faced by prosthodontists is achieving adequate retention and stability in the
mandibular dentures. Recording the lateral throat form (LTF) correctly can aid in the retention and stability.
Till date, Neil’s classification has been considered as the gold standard in measuring the depth of the LTF.
This is a subjective classification and varies among different operators. In this study, a customized tool was
used to measure the depth of the LTF, and a classification was proposed according to the measured depths.
Objectives: The objective of this study is to measure the exact depth of LTF using customized gauge and
to propose a classification based on the measured depth.
Materials and Methods: A customized gauge was made to measure the depth of the LTF. Two different
observers classified the LTFs according to Neil’s classification and according to the proposed classification in
a total group of 50 patients. The customized gauge was inserted into the alveolo‑lingual sulcus to measure
the depth. The Pearson’s correlation statistics was carried out to observe the inter‑observer relationships
of sulcus depth using this customized gauge. ANOVA test was used to compare the mean depth of the
sulcus as measured by observers 1 and 2.
Results: There was more inter‑observer variability when Neil’s classification was used as compared to the
one with the proposed classification using the gauge. The inter‑observer agreement for the proposed new
classification was assessed by Cohen’s kappa value, with P < 0.001. The mean depth of the sulcus as
calculated by observers 1 and 2 was compared with ANOVA test and found to be significant with P < 0.001.
Conclusion: The proposed new classification for LTF gave consistent results and was easier to use with less
variability when compared to the Neil’s classification.

Key Words: Alveolo‑lingual sulcus, lateral throat form, Neil’s classification, retention, stability

Address for correspondence:

Dr. N. Kalavathy, Department of Prosthodontics, D.A.P.M.R.V. Dental College, No. CA‑37, 24th Main, J.P. Nagar, 1st Phase, Bengaluru ‑ 560 078, Karnataka,
India. E‑mail: drkalavathy@gmail.com
Received: 23rd June, 2015, Accepted: 18th September, 2015

INTRODUCTION to know as much as possible about each patient’s intraoral

anatomy and function; expectations and experience; and likely
Successful denture therapy is a complex process demanding range of physical and psychological responses to treatment;
technical and interpersonal expertise. The prosthodontics needs
This is an open access article distributed under the terms of the Creative Commons
Access this article online Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak,
Quick Response Code: and build upon the work non‑commercially, as long as the author is credited and the new
Website: creations are licensed under the identical terms.
www.j‑ips.org For reprints contact: reprints@medknow.com

DOI: How to cite this article: Kalavathy N, Kumar PR, Gupta S, Sridevi J, Shetty
10.4103/0972-4052.167934 M, Sanketh AK. Lateral throat form re-classified using a customized gauge:
A clinical study. J Indian Prosthodont Soc 2016;16:20-5.

20 © 2016 The Journal of Indian Prosthodontic Society | Published by Wolters Kluwer - Medknow
[Downloaded free from http://www.j-ips.org on Thursday, December 14, 2017, IP: 78.111.189.44]

Kalavathy, et al.: Lateral throat form re-classified

and a new prosthesis. For this reason, thorough collection To overcome this problem, a customized gauge instrument was
of relevant information regarding intraoral anatomy needs to designed to measure the depth of the LTF and a study was
precede the initiation of fabrication of complete dentures.[1] conducted in the Department of Prosthodontics, Crown, and
These parameters require that patients perceive their dentures Bridge to evaluate the depth of LTF in completely edentulous
as stationary or well retained during function. In this regard patients. This instrument gives the exact depth of LTF, based
in the field of prosthodontics, retention and stability are the on which we can classify lateral form. This measurement was
two major concerns for complete denture therapy, especially in then used to modify the primary impression tray in the area of
lower denture because of less surface area available.[2] interest to record the LTF more accurately during subsequent
impression procedures. Keeping the above in mind, this study
Geriatric patients who present with resorbed ridges, challenge was conducted to measure the exact depth of the LTF using
the dentist in terms of achieving proper retention and a customized gauge and propose a new classification for LTF
stability. Retention is defined as that quality inherent in the based on the measurements obtained.
dental prosthesis, acting to resist the forces of dislodgement
along the path of placement.[3] Thomas described three MATERIALS AND METHODS
distinct spaces available on the lingual side of edentulous
ridge for the extension of the denture base to get adequate Study design
retention in resorbed lower ridges. These three spaces A total of 50 edentulous subjects were randomly selected from
were: (1) Sublingual crescent space (2) sublingual fossa the local population who fell under the inclusion criteria:
(3) retromylohyoid fossa.[4] • Patients with completely edentulous mandibular arches
• Patients with good neuromuscular coordination
The retromylohyoid fossa is a region below and behind the • Patients in whom retromolar pad can be easily distinguished.
retromolar pad and it provides an excellent area for extending
the denture for positive retention, especially when extensions The exclusion criteria were:
into the sublingual crescent and the sublingual fossa cannot • Patient who has undergone any surgical procedure of the
be made as in the case of resorption. Neil also mentioned jaws, e.g., hemimandibulectomy and glossectomy
that the distal end of the alveolingual sulcus (i.e. lateral • Patient who is not willing to sign the consent form
throat form [LTF]) [Figure 1] can be used to achieve more • Any congenital defect in the jaw
vertical height of dentures in this region. Lower dentures are • Any abnormality of oral structures.
shallow in the mylohyoid region and turn toward the tongue
This instrument was checked in patients, to measure the depth
and then curves back again toward ridges as we go more
of LTF on the left side, since left side has a better access for
posteriorly. Neil classified LTF as Class I, Class II, and Class
a right‑hand operator.
III depending on the displaceability of the instrument placed
in the alveolo‑lingual sulcus on protrusion of the tongue. The
Two different observers classified LTF in edentulous patients
perception of the displaceability of the instrument varies
using Neil’s classification [Table 1].
among different observers hence making this classification as
subjective and prone to error.[5,6] Instrument design (customized gauge design)
The Instrument was designed with a hollow “L” shaped
copper pipe with a flexible wire within it [Figure 2]. This
wire was freely movable inside the pipe and was extended
on both sides of the L‑shaped tube. Extension on one side
would help in the measurement, and on the other side, it
would move on a metal scale which is attached to the copper
pipe that would accurately give us the LTF depth. A stopper

Table 1: Neil’s classification

Classification Description
Class I No movement to the clinician’s finger or hand mirror
when patient is protruding
Class II About half as long and narrow as a Class I flange and
about twice the length of a Class III
Class III The entire finger/mirror is displaced. Minimum length
and thickness, usually ending the flange 2-3 mm below
of just at the mylohyoid ridge
Figure 1: Lateral throat form (left side)

The Journal of Indian Prosthodontic Society | Jan-Mar 2016 | Vol 16 | Issue 1 21

[Downloaded free from http://www.j-ips.org on Thursday, December 14, 2017, IP: 78.111.189.44]

Kalavathy, et al.: Lateral throat form re-classified

was attached to the vertical arm which was positioned on the Statistical analysis was carried out to verify the significance of
retromolar pad [Figure 3]. The stopper was made movable the proposed classification. Pearson correlation statistics to
horizontally so that the same instrument could be used on observe the relationship among the inter‑observer estimations
either side. A scale was attached on the horizontal arm so that of sulcus depth using customized gauge is shown in Table 5.
measurement can be made directly on the patients [Figure 4].
Mouth mirror is used to retract the tongue from the area Table 6 shows the comparison of mean depth of the sulcus as
of interest. measured by observer 1 using customized gauze for proposing
a newer classification using ANOVA test. Comparison of mean
Method to measure the lateral throat form depth of the sulcus as measured by observer 2 using customized
Patients were instructed to open their mouth and protrude their gauze for proposing a newer classification using ANOVA test
tongue so that it was ¼ inch ahead of the lower lip. Then the is depicted in Table 7.
instrument was placed inside the patient’s mouth so that the
stopper of the instrument rested on the middle third of the The results show that there is a significant inter‑observer
retromolar pad. Then the flexible wire was pushed from outside agreement in the proposed classification using a customized gauge.
till it touches the floor of the mouth [Figure 5].
DISCUSSION
The length of wire pushed in the vertical arm was indicated
on a scale attached to it and was equal to the length of wire Based on the Neil’s classification, percentage of Class I,
coming out from the vertical arm which in turn reflected the Class II, and Class III LTF according to the observers 1
LTF depth.

RESULTS

A total of 50 patients were observed by two different

observers. For each observation, depth was measured using
customized gauge [Table 2]. From these measurements, a
classification of the LTF was proposed according to the
depth measurement [Table 3]. Hence, the values obtained were
denoted with the proposed classification [Table 4].

Figure 3: Stopper attached to the vertical arm of the instrument

Figure 2: Customized instrument used to measure the depth of lateral

throat form

Figure 5: Instrument placed inside the oral cavity with the stopper
Figure 4: Metal scale attached to the horizontal arm of the instrument resting on retromolar pad and the metal ball attached to the flexible
below the flexible wire wire touching the floor of the mouth

22 The Journal of Indian Prosthodontic Society | Jan-Mar 2016 | Vol 16 | Issue 1

[Downloaded free from http://www.j-ips.org on Thursday, December 14, 2017, IP: 78.111.189.44]

Kalavathy, et al.: Lateral throat form re-classified

Table 2: Classification of lateral throat form using Neil’s LTF according to the observers 1 and 2 was tabulated in
classification and measurement using customized gauge Table 9.
Patients Observer 1 Observer 2
Neil’s Customized Neil’s Customized
classification gauge classification gauge
LTF, area situated at the distal end of the alveolo‑lingual sulcus,
1 Class I 3.0 Class I 3.0
has profound influence on the fabrication of complete dentures.
2 Class I 2.5 Class I 2.6 Yet its importance is not appreciated by most clinicians. The
3 Class I 3.0 Class I 3.1 length and thickness of the flange in the space are different
4 Class I 3.9 Class I 4.1
5 Class II 2.4 Class I 2.4
depending on the tonicity, activity, and anatomic attachments
6 Class I 3.5 Class I 3.4 of the adjacent structures. Neil described the difference of
7 Class I 3.0 Class I 3.2 this important area and divided it into three classifications.[5]
8 Class I 2.8 Class I 2.9
9 Class II 2.3 Class II 2.4
10 Class I 3.0 Class I 3.2 In the present cross‑sectional study, according to Neil’s
11 Class III 1.8 Class II 2.0 classification, observer 1 has classified 23 patients as Class I,
12 Class II 2.0 Class II 2.1 10 patients as Class II, and 17 patients as Class III. Observer 2
13 Class II 1.8 Class II 1.6
14 Class I 2.6 Class I 2.6 has classified 24 patients as Class I, 15 patients Class II, and
15 Class I 2.5 Class I 2.5 11 patients as Class III. This proves the variability among
16 Class III 2.2 Class II 2.4 two observers when using Neil’s classification to classify LTF.
17 Class III 2.0 Class II 2.0
18 Class III 2.1 Class II 2.2 Although Neil’s has been the gold standard for classifying the
19 Class III 2.4 Class II 2.4 LTF for many years, it is a subjective classification and varies
20 Class III 2.2 Class II 2.2 from operator to operator. It also varies between experienced
21 Class III 0.5 Class III 0.5
22 Class III 1.0 Class II 1.2 clinicians and beginners.
23 Class III 1.2 Class III 1.1
24 Class III 0.6 Class III 0.6 A study conducted by Huang et al. investigated the proportion
25 Class II 1.1 Class III 1.0
26 Class I 2.9 Class I 2.7
of three classes of LTF and reported that Class I was more
27 Class I 3.0 Class I 2.9 common than Class II or III.[7] Sadhvi et al. used a customized
28 Class I 2.5 Class I 2.6 instrument to measure LTF intraorally and compare its efficacy
29 Class III 1.1 Class II 1.2
30 Class III 0.3 Class III 0.5
with the conventional method.[8] Another study observed the
31 Class III 1.0 Class III 1.1 significant differences between the vertical dimension of LTF
32 Class I 2.8 Class I 2.7 measured in patients’ mouth and that of their diagnostic casts
33 Class II 2.3 Class II 2.4
34 Class I 3.1 Class I 3.2
using a customized instrument.[9] However, no attempt has been
35 Class I 2.6 Class I 2.8 made to classify the LTF based on such measurements. This
36 Class III 0.8 Class III 0.9 study aims to propose a classification based on the measured
37 Class I 2.6 Class I 2.8
38 Class I 3.5 Class I 3.5 depth.
39 Class II 0.9 Class III 0.8
40 Class I 2.5 Class I 2.6 In the present study, the customized tool described in this report
41 Class I 2.6 Class I 2.5
gives us the exact value of LTF depth which will be helpful
42 Class I 2.5 Class I 2.3
43 Class I 2.8 Class I 2.9 in classifying it and making good preliminary impressions by
44 Class III 0.6 Class II 0.8 selecting a proper stock tray. A good preliminary cast will ensure
45 Class II 1.5 Class III 1.4
46 Class II 1.9 Class III 1.7
that the custom tray is fabricated with proper extensions, which
47 Class III 1.0 Class II 1.2 will be reflected in the final denture. This will help us achieve
48 Class II 1.5 Class III 1.3 better retention and stability in mandibular dentures.
49 Class III 1.2 Class II 1.2
50 Class I 2.6 Class I 2.5
The statistical analysis with the Pearson’s correlation test
Table 3: Proposed classification for lateral throat form using demonstrated that there was a positive agreement between
customized gauge the two observers with respect to the measurement using the
Proposed Measurement customized gauge. The ANOVA test gave the mean values
classification range
for each class for both the observers and it was found to be
Class A 2.5-4.1 cm
Class B 1.5-2.4 cm
roughly the same.
Class C 0.5-1.4 cm
All these tests prove that the proposed classification is
and 2 was tabulated in Table 8. Based on the proposed consistent with the measurements and can be used as a reliable
classification, percentage of Class A, Class B, and Class C measure for checking the LTF.

The Journal of Indian Prosthodontic Society | Jan-Mar 2016 | Vol 16 | Issue 1 23

[Downloaded free from http://www.j-ips.org on Thursday, December 14, 2017, IP: 78.111.189.44]

Kalavathy, et al.: Lateral throat form re-classified

Table 4: Values obtained denoted with the proposed classification

Observer 1 Observer 2
Patients Neil’s Customized Proposed Neil’s Customized Proposed
classification gauge classification classification gauge classification
1 Class I 3.0 Class A Class I 3.0 Class A
2 Class I 2.5 Class A Class I 2.6 Class A
3 Class I 3.0 Class A Class I 3.1 Class A
4 Class I 3.9 Class A Class I 4.1 Class A
5 Class II 2.4 Class B Class I 2.4 Class B
6 Class I 3.5 Class A Class I 3.4 Class A
7 Class I 3.0 Class A Class I 3.2 Class A
8 Class I 2.8 Class A Class I 2.9 Class A
9 Class II 2.3 Class B Class II 2.4 Class B
10 Class I 3.0 Class A Class I 3.2 Class A
11 Class III 1.8 Class B Class II 2.0 Class B
12 Class II 2.0 Class B Class II 2.1 Class B
13 Class II 1.8 Class B Class II 1.6 Class B
14 Class I 2.6 Class A Class I 2.6 Class A
15 Class I 2.5 Class A Class I 2.5 Class A
16 Class III 2.2 Class B Class II 2.4 Class B
17 Class III 2.0 Class B Class II 2.0 Class B
18 Class III 2.1 Class B Class II 2.2 Class B
19 Class III 2.4 Class B Class II 2.4 Class B
20 Class III 2.2 Class B Class II 2.2 Class B
21 Class III 0.5 Class C Class III 0.5 Class C
22 Class III 1.0 Class C Class II 1.2 Class C
23 Class III 1.2 Class C Class III 1.1 Class C
24 Class III 0.6 Class C Class III 0.6 Class C
25 Class II 1.1 Class C Class III 1.0 Class C
26 Class I 2.9 Class A Class I 2.7 Class A
27 Class I 3.0 Class A Class I 2.9 Class A
28 Class I 2.5 Class A Class I 2.6 Class A
29 Class III 1.1 Class C Class II 1.2 Class C
30 Class III 0.3 Class C Class III 0.5 Class C
31 Class III 1.0 Class C Class III 1.1 Class C
32 Class I 2.8 Class A Class I 2.7 Class A
33 Class II 2.3 Class B Class II 2.4 Class B
34 Class I 3.1 Class A Class I 3.2 Class A
35 Class I 2.6 Class A Class I 2.8 Class A
36 Class III 0.8 Class C Class III 0.9 Class C
37 Class I 2.6 Class A Class I 2.8 Class A
38 Class I 3.5 Class A Class I 3.5 Class A
39 Class II 0.9 Class C Class III 0.8 Class C
40 Class I 2.5 Class A Class I 2.6 Class A
41 Class I 2.6 Class A Class I 2.5 Class A
42 Class I 2.5 Class A Class I 2.3 Class B
43 Class I 2.8 Class A Class I 2.9 Class A
44 Class III 0.6 Class C Class II 0.8 Class C
45 Class II 1.5 Class B Class III 1.4 Class C
46 Class II 1.9 Class B Class III 1.7 Class B
47 Class III 1.0 Class C Class II 1.2 Class C
48 Class II 1.5 Class B Class III 1.3 Class C
49 Class III 1.2 Class C Class II 1.2 Class C
50 Class I 2.6 Class A Class I 2.5 Class A

Table 5: Pearson correlation statistics to observe relationship There are a few limitations with using the instrument. Less
between the inter‑observer estimation of sulcus depth using experienced clinicians might not be able to correctly position
customized gauge
the instrument. The metal ball might not be visible in case of
Values Observer 1 Observer 2
an excessively large tongue. There are chances of over extending
Observer 1 r 1 0.989** the metal ball into the alveolo‑lingual sulcus.
P <0.001
n 50 50
CONCLUSION
Observer 2 r 0.989** 1
P <0.001
n 50 50 Instrument which was customized to measure LTF depth gave
**Correlation is significant at the 0.01 level consistent results when compared against the conventional method.
24 The Journal of Indian Prosthodontic Society | Jan-Mar 2016 | Vol 16 | Issue 1
[Downloaded free from http://www.j-ips.org on Thursday, December 14, 2017, IP: 78.111.189.44]

Kalavathy, et al.: Lateral throat form re-classified

Table 6: Comparative analysis (observer 1) using ANOVA test

Proposed n Mean SD SE 95% CI for mean Minimum Maximum P
classification Lower Upper
Class A 23 2.86 0.37 0.08 2.70 3.02 2.5 3.9 <0.001*
Class B 14 2.04 0.31 0.08 1.86 2.22 1.5 2.4
Class C 13 0.87 0.29 0.08 0.70 1.04 0.3 1.2
*Statistically significant. SE: Standard error, SD: Standard deviation, CI: Confidence interval

Table 7: Comparative analysis (observer 2) using ANOVA test

Proposed n Mean SD SE 95% CI for mean Minimum Maximum P
classification Lower Upper
Class A 22 2.92 0.40 0.08 2.75 3.10 2.5 4.1 <0.001*
Class B 13 2.16 0.27 0.08 2.00 2.33 1.6 2.4
Class C 15 0.99 0.29 0.07 0.83 1.15 0.5 1.4
*Statistically significant. SE: Standard error, SD: Standard deviation, CI: Confidence interval

Table 8: Percentage of each class of lateral throat form Conflicts of interest

according to Neil’s classification There are no conflicts of interest.
Observer 1 (%) Observer 2 (%)
Class I 46 48 REFERENCES
Class II 20 30
Class III 34 22 1. Shay K, Grasso JE, Barrack KS. The Complete Denture Prosthesis: Clinical
and Laboratory Application‑Baseline Data and Prognostic Indicators, Oral‑B,
at dentalcare.com continuing education course. Available from: http://www.
Table 9: Percentage of each class of lateral throat form
dentalcare.com/media/en-us/education/ce102/ce102.pdf. [Last revised on
according to proposed classification
2010 Aug 05].
Observer 1 (%) Observer 2 (%) 2. Kumar PR, Kalavathy N, Sridevi J, Deepak S, Mitha S, S harmila MR.
Class A 46 44 Lateral Throat Form measurement made easy using a customized gauge.
Class B 28 26 Ann Dent Res 2011;1:100‑4.
Class C 26 30 3. The glossary of prosthodontic terms. J Prosthet Dent 2005;
94:69.
4. Thomas EJ, Shanahan TEJ. Stabilizing lower dentures on unfavourable
Based on the above study, the proposed classification is Class A: ridges. Prosthet Dent 1962;12:420‑4.
2.5–4.1 cm, Class B: 1.5–2.4 cm, and Class C: 0.5–1.4 cm. 5. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for
complete‑denture therapy. Dent Clin North Am 1996;40:1‑18.
Our intention is that this particular classification will help 6. Barrett SG, Haines WR. Structure of the mouth in the mandibular
molar region and its relation to the denture. J Prosthet Dent
us to judge the expected retention property of the lower 1962;12:835‑47.
denture from the existing LTF and help in doing the treatment 7. Huang PS, Chou TM, Chang HP, Chen JH, Lee HE, Chen HS, et al.
planning in order to improve the retention of mandibular The proportion of 3 classes of lateral throat form. Int J Prosthodont
2007;20:640‑2.
denture.
8. Sadhvi KV, Nair CK, Shetty J. Lateral throat form‑design of a measuring
instrument. KDJ 2010;33:18‑9.
Financial support and sponsorship 9. Rastogi I. Evaluation of lateral throat form: An in‑vivo study. Int J Dent Res
Nil. 2014;2:40‑4.

The Journal of Indian Prosthodontic Society | Jan-Mar 2016 | Vol 16 | Issue 1 25