Vertical Occlusal Dimension Research Articles

Correlation between Anthropological Measurements in Hand and Occlusal Vertical Dimension: A Study in a Tertiary Hospital of Kathmandu

INTRODUCTION: Determination of the proper vertical dimension during prosthesis construction is of paramount importance in treating patients with missing teeth. This study was conducted to correlate the measurement of finger length with occlusal vertical dimension. MATERIALS AND METHODS: An analytical cross-sectional study was conducted in the Department of Prosthodontics, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal among 145 MBBS and BDS students. Length of four fingers and vertical occlusal dimension were measured by two anatomical methods with the use of vernier calipers. Data were analysed in SPSS version 20. Mean, standard deviation, frequency and percentage were calculated depending upon the nature of data. Pearson’s correlation was used to determine the relation between finger length with vertical occlusal dimension. RESULTS: Moderate positive correlation was found between occlusal vertical dimension (OVD) measuring tip of nose to gnathion and base of nose to menton with all four fingers (p<0.001 each). When compared for males and females, significant moderate correlation was found between OVD by both methods and anthropological measurements in all the four fingers in males (p<0.001 each) but only with index finger when OVD was measured from tip of nose to gnathion in females (p<0.001). CONCLUSIONS: The findings of this study concluded that all four fingers may be used for determination of OVD in males but only index finger may be used in females.

Vertical Occlusal Dimension Changes of Complete Dentures between Autoclave and Traditional Processing Techniques

The aim of the present in vitro study was to investigate the effect of using an autoclave with three different programs and the traditional water bath method (short cycle) on the changes in the vertical occlusal dimension of the complete acrylic dentures. Forty complete acrylic dentures were divided into four groups: G1, dentures were polymerized by water bath method (short cycle for 90 min at 74 °C and then 30 min at 100 °C); G2, dentures were polymerized with an autoclave (134 °C/2.1 bar/10 min); G3, dentures were polymerized with an autoclave (121 °C/1.1 bar/20 min); and G4, dentures were polymerized with an autoclave (121 °C/1.1 bar/5 min). The vertical occlusal dimension of the dentures was measured before and after the polymerization process. The difference between the initial and final measurements expressed the change in the vertical occlusal dimension. Data were statistically analyzed by t-test and one-way ANOVA test. Statistically significant lower vertical dimension changes were detected in G1 (0.703 ± 0.078 mm) compared to the other groups (p < 0.05), whilst statistically greater changes were detected in G4 (1.263 ± 0.063 mm) compared to the other groups. No statistically significant differences were found between G2 (0.844 ± 0.061 mm) and G3 (0.88 ± 0.059 mm) (p > 0.05). Within the limitations of the present in vitro study, it can be concluded that all polymerization methods increase the vertical occlusal dimension of complete acrylic dentures. The increase in the vertical occlusal dimension in Groups 1, 2 and 3 was less than 1 mm which is clinically acceptable and can be overcome by selective abrasion. Therefore, the traditional curing technique using a water bath and the autoclave methods using two settings (134 °C/2.1 bar/10 min or 121 °C/1.1 bar/20 min) could be used for the complete acrylic denture with acceptable augmentation in the vertical occlusal dimension. In contrast, the method used in G4 increases the vertical occlusal dimension by more than 1 mm, which is not clinically acceptable.

Full mouth rehabilitation with fixed prostheses by increased vertical occlusal dimension using 3D printed splint in a patient with excessive tooth wear

Full mouth rehabilitation with fixed prostheses by increased vertical occlusal dimension using 3D printed splint in a patient with excessive tooth wear

Chimeric LSMAP Double-barrel Fibula Free Flap: Goal-oriented Surgical Technique and Tips for One-stage Mandibular Reconstruction.

Summary:Composite oromandibular defects involving jaw bones, intraoral and skin/soft tissues, or dynamic structures such as the tongue, soft palate, and pharynx are real reconstructive challenges even today. Despite improvements in oral dental rehabilitation, another complex task to deal with in young patients with dentate or nonatrophic mandible is correcting a too large vertical occlusal dimension, which makes the prosthodontic rehabilitation very challenging. Instead of using more complex and time-consuming methods such as simultaneous free flaps and to avoid further bone graft and second-stage revision procedures, an innovative double-barrel shaped chimeric fibula free flap with lateral supramalleolar artery perforator flap is used to fulfill all of the reconstructive requisites in one-stage. This new operative technique has never been described before. To deal with a complex head and neck reconstruction, the step-by-step harvesting technique, flap design, and inset of flap are described, giving tips and tricks to avoid jeopardizing its vascularity. A proper match between the bone transplant and native mandible, together with a sufficient amount of tissue for proper oropharyngeal reconstruction was achieved in one stage. Both the functional and aesthetic results were excellent, requiring no further revisions in a second stage. The chimeric fibula free flap with lateral supramalleolar artery perforator flap is a novel, versatile, and useful technique that provides a good opportunity for clinicians and patients to achieve adequate prosthetic rehabilitation and improved aesthetics in reconstruction of postablative extensive oromandibular defects in one stage.

A comparative study of conventional and Hall techniques of crown placement using finite element stress analysis

Hall technique of crown placement causes the changes in vertical occlusal dimension; the mode of settlement of which needs to be explored. To assess and compare the changing patterns of stress distribution following placement of stainless steel crowns on primary teeth by Hall and conventional techniques using a finite element model analysis. The clinical crown heights of primary molars restored with Hall and conventional techniques and opposing teeth in contact, vertical dimension changes in the primary canine area were measured using intraoral digital scan. T-scan was used to measure the changes in bite force while the finite element analysis was used to assess deformative changes on the 2nd, 5th, 10th, and 15th days. The Hall technique of crown placement caused more stress distribution in the tooth supporting tissues that settled in 2 weeks as compared with conventional technique of crown placement in which settlement occurred in 2 days. The settling of vertical occlusal dimension as well as stress distribution in Hall technique probably takes place by intrusion of crowned tooth and opposing teeth in contact.

Fixed and removable combination prosthodontic management with reconstruction of vertical occlusal dimension for a patient with extensive tooth wear

Fixed and removable combination prosthodontic management with reconstruction of vertical occlusal dimension for a patient with extensive tooth wear

An anterior reconstruction: increase the occlusal vertical dimension or reduce periodontal support?

Aim The aim was to document a clinical situation which was managed at minimal biological cost and with straightforward implementation. Summary Challenges of space management may arise in prosthetic dentistry as a minimum height is needed for the supporting tissues and the restorative material. While increasing the vertical occlusal dimension allows an increase in the height of the prostheses, the option may be complex and has disadvantages, including the need to modify the entire occlusion. Crown lengthening is an alternative therapeutic option, but it results in a decrease in periodontal support. Nevertheless, it allows less extensive prostheses to be provided without impacting the rest of the arch. Managing complex clinical situations with moderate biological cost and straightforward implementation is possible, as illustrated in this clinical report. Key learning points 1. Crown lengthening is a solution to increasing the tooth surfaces necessary at prosthetic rehabilitation. 2. Increasing occlusal vertical dimension (OVD) is a solution to providing the occlusal space necessary for the restorative material without reducing the supporting tissues. 3. Crown lengthening reduces periodontal support but can be considered when the root length of the affected teeth is sufficient. 4. Increasing the OVD requires modification of the entire occlusion. 5. Crown lengthening offers the advantage of not modifying OVD or intercuspal position (ICP).

Oral manifestations and rehabilitation of a patient with osteogenesis imperfecta

Introduction. Osteogenesis imperfecta is a rare heritable connective tissue disorder characterized by increased fragility of the bony tissue. The incidence of orofacial alterations associated with osteogenesis imperfecta is variable and includes dentinogenesis imperfecta, malocclusions, hypoplasia of the jaws, delayed dental development and structural abnormalities of the teeth. Case outline. A 22-year-old female was referred to the Clinic for Pediatric and Preventive Dentistry for dental treatment. Enlarged head, triangular-shaped face, mandibular prognathism with excessive maxillary hypoplasia, lowered vertical occlusal dimension were present features. The intraoral findings included dentinogenesis imperfecta with Kennedy?s class IV in the upper jaw and class II in the lower jaw. Panoramic radiograph revealed abnormalities in the crown and root shape, obliteration of the pulp chamber and severe deficiency of alveolar bone mass. Overall treatment involved five phases: I ? preventive and prophylactic treatment, II ? direct restauration of five teeth with glass ionomer cement, III ? extraction of severely damaged teeth, IV ? prosthodontic rehabilitation with removable partial dentures, V ? maintenance and follow-up phase. Conclusion. Low prevalence and wide variety of signs and symptoms make dental treatment of osteogenesis imperfecta overly complex and challenging. Nevertheless, it is essential to improve craniofacial and dental function along with facial aesthetic.

Considerations in occlusal vertical dimension rehabilitation

The vertical dimension is one of the important aspects that affect facial appearance, because it is related in facial height ratio. The vertical occlusal dimension is the height of the lower face measured from two points (infra-nasal and gnation points) when the maxillary and mandibular teeth were occlusion in the maximum intercuspal position. In complex cases, tooth wear can result in a decrease in facial height because the predominant wear on the anterior teeth encourages downward movement of the condyles when the intercuspal is maximum so that the vertical di-mension decreases. In addition, factors that cause a decrease in the vertical dimension are loss of posterior teeth accompanied by skeletal disharmony or accompanied by tooth abrasion and migration. The purpose of this paper is to explain how to restore the decreased occlusal vertical dimensions. Things that need to be considered are di-vided into two, extraorally and intraorally. Extraoral considerations are in the form of a large reduction in OVD, fa-cial esthetics and conditions of the temporomandibular joint. The parameters considered intraoral were the remain-ing tooth structure and occlusion. It was concluded that tooth wear due to functional and parafunctional activities can result in dimensional changes in facial morphology as well as a decrease in the occlusal vertical dimension. Correct OVD rehabilitation is an important factor in the success of rehabilitation treatment.

Evaluación del conocimiento del cáncer oral en dentistas en la Región de Los Ríos, Chile, en 2017

The alteration of the vertical dimension can deteriorate the facial harmony, and it can be measured through objective and subjective methods, although many of which are not reliable. Objective: Relate the anthropometric fingers length with the measurement of the vertical occlusal dimension (VOD). Material and Methods: Cross-sectional, observational study that included 114 students from the School of Dentistry with class I malocclusion and complete dentition. The VOD was evaluated as the measurement between the subnasal points and the mental point; anthropometric measures included the length of the fingers (from the most mesial fold to the most distal edge) and the distance projected between the thumb and the index finger. Results: The average VOD was 64.03±5.15mm. A correlation was found between the VOD and the index finger length (p<0.01, r=0.29), between the VOD and middle finger length (p<0.01, r=0.31) and correlation between the VOD and the length of the little finger (p<0.05, r=0.23). No correlation was found between the VOD and the ring finger lengths (p= 0.051) or thumb (p=0.12). Conclusions: The anthropometric measurements of the index finger, middle finger, little finger and the projection of the thumb on the index finger correlated with the length of the vertical occlusal dimension.

Restorative Rehabilitation of a Patient with Generalized Non-Carious Cervical Lesions: Case Report

Non-Carious Cervical Lesions (NCCL) are a current problem of multifactorial origin that is associated with the loss of vertical occlusal dimension, hypersensitivity, loss of teeth, fractures, and many other pathologies that affect the masticatory function of the oral cavity. Identification of the etiological factors of NCCL comprises a key piece for the solution of the problem. Based on clinical scientific evidence related with the diagnosis, a restorative treatment must be planned according to the loss of dental structure in order to return function and aesthetics. The purpose of this case report was to describe a 54-year-old male patient who was diagnosed with generalized NCCL combined with occlusal vertical dimension loss. The protocol of the treatment process is described.

Manifestations of pain symptoms in reduced occlusion

This article presents the analysis of the relevant literature highlighting the mechanisms of the development of malocclusion and pain symptom at the reduced occlusal vertical dimension. In this case, the key complaint presented by patients is permanent steady pain described as dull, stabbing, or compressing by its character. Most often, the pain is localized within the paratoid-masticatory area as well as buccal, temporal and frontal areas, and irradiates to the upper and lower jaw or the teeth that often leads to performing unnecessary dental manipulations; to the region of the temporomandibular joint (TMJ); to the ear that sometimes is accompanied with fullness and tingling in the ears. In some cases this pain can irradiate to the hard palate and tongue. Many patients note the growing intensity of pain when chewing. Some patients experience episodic increase in pain when there are pain attacks described as compressing or stabing in the background of steady dull pain. The pain gets more intense even at the slightest movements of the head, lower jaw, or when speaking. The duration of the pain attack is approximately 20–30 minutes. A few minutes before the onset of the attack, all patients notice the emergence of somes forerunning symptoms, e.g. hyperlsalivation, paresthesia, toothache. The attacks can be provoked by conversation, overcooling, and emotional tension. It has been experimentally proven that a prolonged muscle contraction, which is often observed during emotional stress, can cause pain in the regions mentioned above. But whether will it arise or not and to what extent, it depends on the state of adaptive capacity of the body and dentofacial system. When the adaptive capacity of the body and the dentofacial system as its part are weakened, the local background for the occurrence of pain symptoms in the maxillofacial area may be: affective states (depression, anxiety), prolonged chewing load, and prolonged neck muscle tension during dental manipulations.
 Among the local factors that can cause pain, malocclusions rank the leading place. For example, a hyperbalancing contact is a sign of impaired muscle activity and coordination during the maximal closure of teeth in the lateral position of the mandible, and occlusal contacts on the balancing side affect the distribution of muscle activity during parafunctional closure, and this redistribution can impact on the temporomandibular joint (Andres K. H. et al.).
 Occlusion abnormalities may result from reduced occlusal vertical dimension, deformation of the dentitions caused by periodontal disease, partial loss of teeth, pathological tooth wearing, as well as due to improperly inserted fillings, unfit inlays, onlays, crowns.
 Reduced occlusal vertical dimension can also cause otalgia and some other otorhinolaryngological problems, pathogenesis of which is quite debatable and controversial in current literature. J. S. Costen considered hearing loss, tingling and other ear symptoms are associated with pressure produced by the head of the mandible joint onto the auditory tube. Reducing the vertical occlusal dimension results in increasing pressure of the head of the mandible joint onto the subtle bone arch of the articular fossa, which separates the cavity of the joint from the dura mater; this can trigger dull pain in the spine.
 It is important to remember that pain is a symptom that most often makes patients to search for a dental care. Pain is one of the first clinical manifestations of the body decompensation. Patients with TMJ dysfunction who experience the pain symptom is to a greater or lesser extent make up a group of patients who require a special integrated approach in their treatment.

Conservative oral rehabilitation of the bruxism patient with tooth wear

Tooth wear, a progressive but gradual loss of convexity on the cusp of the tooth, does not cause premature deterioration of the dentition. However, it may evolve into pathological wear if this normal wear becomes accelerated due to abnormal endogenous or exogenous factors. The pathological wear can lead to pathological changes of pulp, impaired function, occlusal disharmony and aesthetic problems. When treating patients with pathological wear, the cause of the wear must be analyzed, and each tooth should be diagnosed individually. Additionally, the loss of the vertical occlusal dimension, as well as the appropriateness of the space for restoration, should be evaluated. These procedures can prevent the progression of the wear, limit the range of any possible restoration, and finally, allow a clinician to establish a conservative treatment plan. This case report presents a patient with pathological wear caused by bruxism, and treated with monolithic zirconia fixed dental prostheses, so as to restore the lost guidance and the collapsed tooth shape; treatment was made with an occlusal adjustment of specific teeth, which showed interference during lateral excursive movement. As the result of the treatment, the functional movement of the mandible was freed, and the recurrence of tooth wear was prevented. The pathological wear displayed by this patient was successfully treated by this conservative method, as well as a limited range of restoration, all the while ensuring functionality and aesthetically satisfying results.

Implant Treatment for the Patients with Severe Deep Bite Using Screwed Denture: Technical Note

The purpose of this article is to report an innovative technique for an increase vertical dimension with screwed denture fixation and intravenous sedation for the patients with severe deep bite. Bite raising is essential to maintain a long term stability of occlusion in the case of implant treatment associated with severe deep bite. Generally, a removable denture is used to increase occlusal vertical dimension for the first step of oral rehabilitation in the case of severe deep bite. However, these patients sometimes fail wearing removable denture for increasing vertical dimension, because of severe discomfort. On the other hand, an intravenous sedation is advantage that the patients fall asleep and is completely unaware of the procedure being performed. Therefore combination screwed denture fixation and intravenous sedation allowed to raise occlusal vertical dimension in implant treatment. In conclusion, this combined method using screwed denture and intravenous sedation are the most promising technique for implant treatment to raise the vertical occlusal dimension for the patients with severe deep bite. Keywords: Severe deep bite, Screwed denture, Bite raising, Implant fracture

Evaluation of functional parameters in the occlusion of complete denture wearers before and after prosthetic treatment

PurposeThe aim of the study was to evaluate functional parameters of the occlusion in complete denture wearers before and after prosthetic treatment. MethodsThe sample used as the basis for the present study consisted of 50 healthy Caucasian patients (35 women and 15 men), aged from 44 to 86 years (mean=69.18±10), with a total deficiency of teeth. All patients received new complete dentures. Each patient underwent lateral radiograph with the presence of complete dentures, both before (initially existing dentures) and after the prosthetic treatment (new restorations). Cephalometric analysis was based on the Ricketts and McNamara criteria. In order to assess the functional parameters of the occlusion T-scan III analysis was conducted. The following parameters were measured: occlusion – and disclusion time. ResultsStatistically significant differences of functional parameters obtained before and 3 months after the treatment were noted in the whole study group. Both before and after therapy occlusion time was longer in women than in men. No statistically significant link was noted between functional parameters in occlusion and age of the patients, denture wearing time, and edentulous period. Some relationships were noted between occlusion time and cephalometric parameters associated with anterior facial height. ConclusionReconstruction of the surface of artificial teeth and vertical occlusal dimension affects the sustainability of parameters of occlusion and balance of forces in centric occlusion. The progressive shortening of occlusion time during the period of monitoring may be considered as a sign of progressive adaptation.

Effect of home reliner on occlusal relationships and oral mucosa: viscoelastic analyses by smoothed particle hydrodynamics simulation

BackgroundFor decades, many reports have expressed negative opinions about home reliner (HR), because it may result in residual ridge resorption. Recently, some clinical studies evaluated HR. However, the effect of HR on occlusal relationships and the oral mucosa remains unclear. Here, we dynamically analyzed the situation in which a patient applies HR to an upper complete denture. MethodsWe numerically simulated the effect of HR on occlusal relationships and the oral mucosa. In the simulation, the thickness of HR was set to 2mm as a proper amount and 4mm as an excessive amount. The loading points were set at the center of the right and left occlusal surfaces of the denture. ResultsCompared with the case without using HR, at proper amounts (2mm on the right and left sides), HR suppressed the depression of the ill-fitting denture, and stress on the oral mucosa was decreased. In the excessive HR model (4mm on the right and left sides), the vertical occlusal dimension was increased, and stress on the oral mucosa originally fitted with the denture base was increased. When the denture was modeled in an inclined position (2mm on the left side and 4mm on the right side), stress on the oral mucosa on the left buccal side was markedly increased. ConclusionIt was found that when an improper amount of HR was applied, the occlusal vertical dimension increased and the oral mucosa was pressured more than that under non-HR conditions.

Effect of occlusal vertical dimension changes on postsurgical skeletal changes in a surgery-first approach for skeletal Class III deformities

The purposes of this study were to investigate the relationship between occlusal vertical dimension (VD) changes and postsurgical skeletal changes in the surgery-first approach and to derive regression models for the final mandibular setback at B-point. This retrospective study included 40 patients (16 men, 24 women; ages, 22.6±4.0years) who had undergone a bimaxillary surgery-first approach. Using cephalograms generated from cone-beam computed tomography representing the presurgical, postsurgical, and posttreatment stages, skeletal landmarks in the maxilla and mandible were investigated to derive multivariate linear regression-based prediction models. Additionally, a patient classification based on the VD was established and verified to generate regression models for the classified groups. For the nonincreased VD group, the surgical setback of B-point was its predictor for the final mandibular setback (R(2) at 92%). Meanwhile, the final mandibular setback of the increased VD group was predicted according to the surgical upward movement of pogonion, the postsurgical horizontal position of A-point, and the postsurgical vertical position of the coronoid process (R(2) at 94%). The results of this study support the clinical observation that the more increased the vertical occlusal dimension after surgery, the less predictable the position of B-point at the posttreatment stage.

The association between dental wear and reduced vertical dimension of the face: A morphologic study on human skulls

ObjectiveThe aim of this study was to explore the relationship between dental wear and facial morphology, with particular reference to the occlusal vertical dimension, in modern human skulls. DesignOne hundred and three skulls (52 men and 51 women) between the ages of 20 and 50+ years old were studied. The selected skulls were from a modern period (the 17th and the 18th centuries) and included at least one entire condyle and had at least 3 posterior teeth (premolar or molar) in each quadrant to allow for dental articulation. Occlusal wear was evaluated using ordinal scale (0–4) and vertical occlusal dimension was evaluated by measuring upper facial height (UFH), lower facial height (LFH), LFH-to-UFH ratio (L-U-R) and dental wear. Based on the occlusal wear score, two groups were defined: with and without significant wear. ResultsSignificant relation was observed between age and dental wear (P<0.01). No significant differences were found in the LFH (P=0.847) or UFH (P=0.108) between the two wear groups. In addition, no significant difference (P=0.132) was demonstrated in the LFH-to-UFH ratio between the groups. No difference was observed in the dental wear score between genders (P=0.321). ConclusionWithin its limitations, this study demonstrated that dental wear does not influence the vertical dimension of occlusion. Our assumption is that the dento-facial complex fully compensates for the dental effects of wear throughout life.

The relationship between facial morphology and the structure of the alveolar part of the mandible in edentulous complete denture wearers. A preliminary study

Objective. Although the effect of involutional processes that occurs in the maxilla and mandible of edentulous subjects is obvious, the problem of factors definitely determining the direction of changes still remains unsolved. This study was aimed at determining the relationship between facial morphology and the structure of the alveolar part and the body of the mandible in edentulous complete denture wearers. Materials and methods. Twenty-five healthy edentulous Caucasian patients in the 70.5 ± 9 years of age group were examined. All patients underwent tele-X-ray examination with the presence of currently used dentures in the oral cavity. To assess morphological parameters of the facial skeleton, cephalograms were analyzed according to Ricketts and Mc Namara method. To assess the mandible morphology, the films were measured using the method of Tallgren. Results. The period of edentulism was found to be negatively correlated with the anterior segment of the body of the mandible within its symphysis. The parameter corresponding to the location of the first lower molar showed a directly proportional correlation with G’-Sn’, G’-Me’, Sn’-Me’, N-Ans, N-Me, Ans-Me, Co-Gn and Co-Go. Positive correlations were found between the parameters describing contour of the alveolar part of the body of the mandible and mandibular symphysis and G’-Me’, Sn’-Me’, N-Me, Ans-Me describing the height of the occlusal vertical dimension. Conclusion. The study showed a directly proportional correlation between the vertical occlusal dimension of the lower face conditioned by prosthetic rehabilitation and the height of the alveolar part in the lateral regions of the mandible.

Rehabilitación con coronas completas de metal-cerámica y prótesis parciales removibles convencionales

El tratamiento se realizó en un paciente de sexo femenino de 67 años, con buen estado de salud general, portadora de prótesis removible superior incómoda para sus funciones fisiológica y estética. Al examen presenta PPR (prótesis parcial removible) superior de marcado desgaste incisal y oclusal, soporte y retención deficiente, disminución de la DVO (dimensión vertical oclusal), pérdida de contorno facial, edentulismo superior clase II modificación 2 de Kennedy, rebordes conservados, presencia de piezas 1.7, 1.3 y 2.3; edentulismo parcial inferior clase III modificación 1, sin aditamento protésico, rebordes muy reabsorbidos, presencia de piezas 3.8, 3.4, 3.3, 3.2, 3.1, 4.1, 4.2, 4.3, 4.4, 4.5 y 4.8. Se restauró la DVO confeccionando coronas metal cerámica con islas de metal para los apoyos oclusales y brazos recíprocos en los pilares de las piezas 1.7, 3.8 y 4.5. ; y de placas linguales sobre los cíngulos de la piezas 1.3 y 2.3., de la PPR superior e inferior respectivamente. Se construye la morfología oclusal dándole over jet y over bite, desoclusión canina y protección mutua, con cúspides de 30º. Estéticamente se procedió a restablecer el contorno vestibular superior perdido, con la línea de la sonrisa específica.