Vertical DimensionAbstracts 001. Swerdlow, H. Vertical dimension - literature review. J Prosthet Dent 15:241, 1965. 002. Turrell, A. J. W. Clinical assessment of vertical dimension. J Prosthet Dent 28:238-246, 1972. 003. Thompson, J. R. The rest position of the mandible and its significance to dental science. JADA 33:151-180, 1946. 004. Atwood, D. A. A critique of research of rest position of the mandible. J Prosthet Dent 16:848854, 1966. 005. Hickey, J. C., Williams, B. H. and Woelfel, J. B. Stability of mandibular rest position. J Prosthet Dent 11:566-572, 1961. 006. Lyons, M.F. An electromyographic study of masticatory muscle activity at increased vertical dimension in complete denture wearers. J Prosthet Dent60:346-348, 1988. 007. Gattazi, J. G. Variations in mandibular rest positions with and without dentures in place. J Prosthet Dent 36:159, 1976. 008. Atwood, D. A. Cephalometric studies of the clinical rest position of the mandible. Part I. J Prosthet Dent 6:504-509, 1956. 009. Niswonger, M. E. Rest position of the mandible and centric relation. JADA 21:1572, 1934. 010. Tallgren, A. The continuing reduction of the residual alveolar ridges in complete denture wearers: A mixed longitudinal study covering 25 years. J Prosthet Dent 27:120-131, 1972. 011. Olsen, E. S. Vertical dimension of the face. DCNA 1964:611-622. 012. Weinberg, L. Vertical dimension: A research and clinical analysis. J Prosthet Dent 47:290-302, 1982. 013. Toolson, L. B. and Smith, D. E. Clinical measurement and evaluation of vertical dimension. J Prosthet Dent 47:236-241, 1982. 014. Silverman, S. I. Vertical dimension record: A three dimensional phenomenon. a. Part I: J Prosthet Dent 53:420-425, 1985. b. Part II: J Prosthet Dent 53:573-577, 1985. 015. Atwood, D. A. Cephalometric studies of the clinical rest position of the mandible. a. Part II: J Prosthet Dent 7:544, 1957. b. Part III: J Prosthet Dent 8:698, 1958. 016. Fayz, F., et al. Use of anterior teeth measurements in determining occlusal vertical dimension. J Prosthet Dent58:317-122, 1987. 1 Recording Vertical Dimension 001. Turrell, A. J. W. Clinical assessment of vertical dimension. J Prosthet Dent 28:238-246, 1972. 002. Lytle, R. B. Vertical dimension of occlusion by the patient's neuromusculature. J Prosthet Dent 14:12, 1976. 003. Silverman, M. M. Determination of vertical dimension by phonetics. J Prosthet Dent 6:465, 1956. 004. Boucher, L. J., et al. Can biting force be used as a criterion for registering vertical dimension? J Prosthet Dent 9:594, 1959. 005. Ismail, Y. and Arthur, G. The consistency of the swallowing technique in determining occlusal vertical dimension in edentulous patients. J Prosthet Dent 19:230, 1968. 006. Sheppard, I. M. and Sheppard, S. M. Vertical dimension measurements. J Prosthet Dent 34:269, 1975. 007. Wagner, A. Comparison of four methods to determine rest position of the mandible. J Prosthet Dent 25:506, 1971. 008. McGee, G. Use of facial measurements in determining vertical dimension. JADA 35:342, 1947. 009. Ekfeldt, A. and Jemt, T. Interocclusal distance measurement comparing chin and tooth reference points. J Prosthet Dent 47:560-563, 1983. 010. Silverman, S. I. Vertical dimension record: A three dimensional phenomenon. Part I. J Prosthet Dent 53:420-425, 1985. 011. Silverman, M. M. Pre-extraction record to avoid premature aging of the denture patient. J Prosthet Dent 5:465, 1955. 012. Smith, D. The reliability of pre-extraction records for complete dentures. J Prosthet Dent 25:592, 1971. 013. Boos, R. H. Intermaxillary relation established by biting power. JADA 27:1192, 1940. 014. Shanahan, T. E. Physiologic jaw relations and occlusion of complete dentures. J Prosthet Dent 5:319, 1955. 2 015. Pound, E. Controlling anomalies of vertical dimension and speech. J Prosthet Dent 36:124, 1976. Vertical Dimension 1. Definitions A. Definition of Vertical Dimension Rest: The vertical dimension with the jaws in rest relation. Rest relation is the habitual postural position of the mandible to the maxillae when the patient is resting comfortably in the upright position and the condyles are in a neutral unstrained position in the glenoid fossa, with minimum tonic contraction of the mandibular musculature to maintain posture. B. Vertical dimension of occlusion: The vertical dimension of the face when the teeth on occlusal rims are in contact in centric relation. GPT-6: The distance measured between two points when occluding members are in contact C. Interocclusal distance: The distance between the occluding surfaces of the maxillary and mandibular teeth when the mandible is in its physiologic rest position. This can be determined by calculating the difference between the rest vertical dimension and the occlusal vertical dimension. D. Speaking space: The interocclusal space which exists between the posterior teeth when the patient is enunciating "S" sounds. It is not related to the interocclusal space of rest position. It represents the difference between the vertical dimension of occlusion and the clearance between the teeth when S sounds are spoken. Other terms: Closest speaking space, Physiologic rest position, Interocclusal rest space. 2. Historical review a. Hunter – 1771: Stated that "In the lower jaw, as in all the joints in the body, when motion is carried to its greatest extent, in any direction, the muscles and ligaments are strained and the persons are made uneasy." Hunter also felt that the joints naturally fall when we sleep and the middle extremes of motion suggests that the muscles and ligaments are equally relaxed. Therefore the jaws are naturally and commonly not in contact nor are the condyles positioned as far back as they can go. b. Wallisch – 1906: First to define physiologic rest position of the mandible. " That the position of the mandible wherein all muscle action is eliminated and the mandible is passively suspended. " c. Anatomists – early 1900’s: Believed that at birth the gums were contact and with eruption and alveolar growth the jaws were forced apart increasing the vertical dimension. 3 3. Concepts: Constancy verses non-constancy a. Niswonger – early 1930’s: First investigator to study the rest position of the mandible by recording measurements on patients. What was his theory? b. Brodie – utilized the Broadbent-Boltan cephalometer introduced by broadbent in 1931 and utilizes bony landmarks of the head. Brodie stated what? c. Thompson – believed that a balance of tension in the musculature, which suspends the mandible determines the rest position. What were his conclusions? d. Swerdlow – "A major failure in denture construction is the establishment of incorrect VDO." What did he observe that lead to this statement? e. Turner – stated that the "temptation to restore a youthful appearance by increasing vertical dimension must be resisted." Why? Variability of Rest Position: non-constancy a. Harris and Hight – theory that the correct vertical opening in edentulous patients was debatable. Why was it debatable? b. Duncan and Williams – found a reduction in pre-extraction face height with the teeth in occlusion, as related to corresponding facial height after prosthetic treatment. What did they conclude from this? c. Coccaro and Lloyd- observed that the greatest reduction to be in the mid facial region in denture patients. What did they contribute this to? d. Atwood – one of the most extensive studies in the country. What was it? Why is vertical dimension important? 1. What is its significance in a dentate Patient? 2. What is the significance in an edentulous patient? 3. What does it determine overall? Is there really a "loss"of vertical dimension? 1. Yes/No What are the factors that may lead to the loss of vertical dimension? a. b. c. d. e. caries periodontal disease attrition traumatic iatrogenic 4 If there is a "loss" how do we evaluate it? (17 ways to evaluate Vertical dimension) a. Ceph – Brodie, Swerdlow, Thompson, Atwood, Tallgren, Silverman S., Coccaro b. Electromyography – Feldman, Leupold, Weinberg, c. Gnathodynamometer - Prombonas d. Sorenson profile scale – Sorenson, Toolson and Smith e. Occlusal rims – Shanahan, Gattozzi f. Wear – Turner, Tallgren Historical Methods a. b. c. d. Bimeter – Boos and Tueller (closing forces/power point) Tapping - Lytle and Timmer (proprioception-tactile sense) Jaw relator – Niswonger Standard of 3mm of IOD – Niswonger, Pleasure and Gillis More common a. b. c. d. Pre-extraction records Physiologic rest position Facial dimensions – Kois Open rest Most common a. Phonetics – (S sound) Silverman M., Pound, (M sound) Wagner, Turrel ("emma" Mississippi) b. Swallowing – Gillis, Shanahan, Ismail and George c. Esthetics – Facial expression: look for relaxation around eyes and nares. Lip profile will hint at jaw relationship: Normal – (Class I) Lips even and slightly touch Protruded – (Class II) protruded mandible. Lips not touching Retruded –(Class III) retruded mandible. Lips not touching Can we feel confident that we have recaptured Vertical Dimension a. Feedback from patients b. Your impression c. Cephalometrics – FMA 5 d. Denture – wax rim stage e. Postural Class I, II, III, differences in VDR: a. Variations in interocclusal rest space Class I 3-5 mm Class II > 5 mm Class III < 3 mm FMA normal 25 5 degrees a. FMA high – noncritical > 30 degrees b. FMA low – critical < 20 degrees Why is this so critical? How do you challenge Vertical dimension? a. b. c. d. stents provisionals duplicate dentures at altered VDO orthotics 6