Vertical jaw relation

1. VERTICAL JAW
RELATION
ASWATI SOMAN
PG RESIDENT

2. CONTENTS
• Introduction
• Definition of jaw relation
• Vertical jaw relation
• Factors affecting VD
• VDR
• VDO
• Freeway space
• Effects of incorrect vertical dimension
• Methods of recording vertical dimension-
• Conclusion
• References

3. • Complete dentures must be used in most functions once
served by natural dentition.
• Mastication, speech and appearance all depend on specific
vertical and horizontal relations of mandible to the maxilla.
• Any horizontal jaw relation is valid only at a specific vertical
dimension…..hence the importance of vertical jaw relation.

4. JAW RELATION
• Any spatial relationship of maxillae to mandible, any one of
the infinite relations of mandible to maxilla[GPT -8]
• Orientation relation-maxilla to cranium
• Vertical relation-jaw separation or vertical height of face
• Horizontal relation

5. • Vertical dimension is defined as: - “The length of the face as
determined by the amount of separation of the jaw under
specified condition.” .
• The vertical jaw relations are those established by the amount
of separation of the two jaws in a vertical direction under
specified conditions… Boucher.

6. • May be recorded as:
vertical jaw relation at rest
vertical jaw relation at occlusion
Correct vertical dimension should be established before
recording horizontal relation as increasing or decreasing the
vertical dimension can have deleterious effect

7. Determinantsof Vertical Relations of Mandibleto
Maxilla
• The masticatory musculature
• The occlusal stops (teeth or occlusion rims)

8. VERTICAL DIMENSION AT REST
• The length of the face when the mandible is at rest position-
GPT
VERTICAL DIMENSION AT OCCLUSION
• The length of the face when the teeth are in maximum
intercuspal position

9. Physiologic rest position” is
• The postural relation 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 glenoid fossa.
• Physiologic rest position of the mandible is not
determined by teeth it is established by muscles and
gravity.
• Position of head is important; it must be held in an
upright position by the patient and not supported by a
headrest

10. • Teeth should not contact at rest position and a space exist
• This is because the rest position is comfortable and the hard
and soft tissue return to this position most often
• Contact of teeth during this position is like premature contact
and lead to soreness of supporting tissues and bone
resorption.
• The vertical distance between the teeth at rest position is
termed as freeway space

11. FREEWAY SPACE
• Interocclusal distance
• 2-3mm between occlusal surface of teeth when mandible is in
rest position
• VDR = VDO +IOD
• Dentulous – 1-10mm
• Avg 2-4 mm
• Edentulous – 2-4mm

12. METHODS OF DETERMING VDR
FACTORS AFFECTING REST POSITION
• Posture of the patient
• A relaxed patient
• Neuromuscular disturbances
• Duration
• Use of several methods

13. METHODS
FACIAL MEASUREMENT
• VDR Is calculated by making facial measurement
• Two marks are placed one on the tip of the nose and the other
on the chin directly below the nose
• The vertical distance between the two points is measured
using a divider or scale
• Measurement can also be made using dakometer or willis
guage

15. METHODS USED TO MAKE THE PATIENT ASSUME THE REST
POSITION
• SWALLOWING: Instructed to drop the shoulders, wipe his/her
lip with tongue, swallow and close the mouth
• TACTILE SENSE: The patient is instructed to open the mouth
wide until a strain occur. Then asked to close the mouth slowly
until feel comfortable and relaxed
• PHONETICS: Patient is instructed to say words contain “m”.
Lips meet when this is pronounced. Measurement is made in
this position

16. MEASUREMENT OF ANATOMIC LANDMARK
• The willis guide states that the distance between the pupil of
the eye to the rima oris should be equal to the distance
between the anterior nasal spine to the lower border of the
mandible, when the mandible is in its physiologic rest position

17. METHODSOF DETERMININGVERTICAL
DIMENSIONOF OCCLUSION
• Physiologic method
• Mechanical method
• Pre extraction methods
• Measurements of old denture

18. Physiologic method
NISWONGER’S METHOD
• Niswonger in 1934 suggested a method for determining the
vertical dimension that is commonly used today.
• The patient is seated so that the Ala- Tragal line is parallel with
the floor.
• Two markings are made, one on the upper lip below the nasal
septum other in the most prominent part of the chin.
• It uses the physiologic rest position to determine the VDO

19. • Contoured maxillary rim is placed in the patient,s
mouth and vertical dimension at resy isdetermined
• Then contoured mandibular rim is placed in patients
mouth and it is trimmed and countoured until it meets
the maxillary rim evenly
• The lower rim is then adjusted till the facial
measurement in occlusion is 2-4mm less than the rest
position

20. SWALLOWING THRESHOLD
• The position of the mandible at the beginning of the
swallowing act has been used as a guide to the vertical
relation.
• when a person swallows, the teeth come together with
very light contact at the beginning of the swallowing
cycle
• The technique involves building a cone of soft wax on
the lower denture base so that it contacts the upper
occlusion rim with the jaws too wide open

21. • The flow of saliva is stimulated and the repeated action
of swallowing will gradually reduce the height of wax
cone to allow the mandible to reach the level of occlusal
vertical relation.
• The length of time this action is carried out and
relative softness of the wax cone will affect the results.
• The length of time this action is carried out and the
relative softness of the wax cone will affect the results
• It is difficult to find consistency in the final vertical
positioning of the mandible by this method.

22. • The swallowing technique produced an increase of 0 to
5 mm (mean2.8 mm) in the vertical dimension of
occlusion in the edentulous group. He found that the
increase was
• directly proportional to the number of missing
posterior teeth prior to extraction of the teeth.
Naveen Raj T, Ashish Meshram, Shantanu Mulay, Honey Jethlia,REVIEW ON
METHODS OF RECORDING VERTICAL RELATION, Journal of Clinical and Diagnostic
Research, 2013 March

23. PHONETIC METHOD
• Silverman’s closest speaking space
• It is the minimal amount of interocclusal space between
the upper and lower teeth when sounds like ch, s, and j
are pronounced. There is 1-2 mm clearance between
teeth
• Seated upright with the plane of occlusion parallel to the
floor
• Using upper incisal edge as a guide - pencil line is drawn
on a lower incisor when the teeth are in centric
occlusion.
• Then, a second line is drawn above the other after the
patient has said ‘S’, ‘yes’ or ‘SISS’ repeatedly
Naveen Raj T, Ashish Meshram, Shantanu Mulay, Honey Jethlia,REVIEW ON METHODS OF
RECORDING VERTICAL RELATION, Journal of Clinical and Diagnostic Research, 2013 March

24. • The closest speaking space is the distance between these
lines.
• This space should be same at the try-in when it is again
checked phonetically and the vertical dimension of
occlusion adjusted
• If the distance is too large, it means that too small a
vertical dimension of occlusion may have been
established.
• If the anterior teeth touch when these
sounds are made, the vertical dimension
is probably too great.

25. NEUROMUSCULAR PERCEPTION
• Central bearing device
• Powerpoint

26. MECHANICAL METHOD
RIDGE RELATION
• Incisive papillae to mandibular incisor
• Ridge parallelism

27. INCISIVE PAPILLAE TO MANDIBULAR INCISOR
• The incisive papilla is used to measure the patients
vertical relation since it is a stable land mark and is
changed little by resorption of the residual alveolar
ridge.
• The distance of the incisive papilla from the incisal edge
of the mandibular incisors is about 4 mm in the natural
dentition.
• The incisal edge of the maxillary central incisor is an
average of 6mm below the incisive papilla
• So the average vertical overlap of the opposing
central incisor is about 2 mm

29. RIDGE PARALLELISM
• Paralleling of the ridges, plus a 5 degree opening in the
posterior region as suggested by Sears, often gives a clue
to the correct amount of jaw separation.

30. PRE EXTRACTION RECORDS
• Profile photograph
• Profile silhouettes
• Radiograph
• Articulated cast
• Facial measurements

31. OPEN-RESTMETHODINESTABLISHINGVERTICALDIMENSION
• Douglas and Maritato described the open-rest method of
establishing the vertical dimension of occlusion.
• Open-rest position is an unstrained mouth-breathing position.
• The lips are slightly parted to permit observation of the mesial
marginal ridges of the upper and lower first bicuspids.
• The position which represents the upper and the lower
posterior occlusal plane related to the corner of the mouth.
• open-rest position indicated that the upper occlusion rim
should be 3 mm above the corner of the mouth in the
premolar region and the lower rim should be 2 mm below the
corners of the mouth.
Naveen Raj T, Ashish Meshram, Shantanu Mulay, Honey Jethlia,REVIEW ON METHODS OF
RECORDING VERTICAL RELATION, Journal of Clinical and Diagnostic Research, 2013 March

32. Profile Silhouettes:
• An accurate reproduction of the profile in silhouette can
be cut out in cardboard or contoured in wire.
• The silhouette can be repositioned to the face after the
Vertical Dimension has the established at the initial
recording and / or when the artificial teeth are tried in

33. Lead wire adaptation:
• Lead wires may be adapted carefully to pre extraction
profiles, and this contour is transferred to a cardboard.
• The resultant cutout is stored until after extraction.
• When the dentist estimates the vertical relation using
the trial plates, the cardboard cutout is placed against
the profile in order to see whether the facial contour
has been maintained or re-established.
• It is not in common use today.

35. Swenson’s method(1959):
• Swenson suggested that acrylic resin face masks made
before the extraction and later when the patient is
rendered edentulous, it is fitted on the fact to see
whether the vertical relation has been restored
properly.
• This method is rather impractical because it requires a
great deal of time and is little more accurate than the
lead–wire technique.

37. Drawbacks of this method
• It is time consuming
• Requires lot of skill and experience with the use of facial
impressions and casts for the fabrication of artificial
facial parts
• Lastly the face assumes a different topography in the
erect posture from that in the recumbent or semi-
recumbent position

38. MEASUREMENT OF FORMER DENTURES
• Measurements are made between the borders of the
maxillary and mandibular dentures by means of a boley
gauge and corresponding alterations can be made in the
new denture to compensate the occlusal wear.
• Ifthe teeth click or if the closest speaking space is
obliterated during speech, the vertical dimension should be
reduced and the amount of reduction is determined
arbitrarily.

39. Measurement offormerdentures usingBoley’s
gauge

40. Anthropometric measurements
• In the past, VDO has been correlated with various
anthropometric measurements like the distance from the
outer canthus of one eye to the inner canthus of the other
eye, vertical height of the ear, twice the length of one eye, and
vertical length of nose at the midline.
• This study find correlation between VDO and IPD so as to
explore the possibility of a method for determination of VDO.

41. • IPD increases till mid 20’s.
• Remains fairly constant thereafter
• Hence, interpupillary distance can be used as a guide in
establishing VDO when patient is totally edentulous
• IPD parameter is fairly constant in males after early
middle age, but in contrast females continue to record an
increase in this facial parameter into later middle age
• VDO = 30.843 + 0.500 x Interpupillary distance
Ruchi Ladda,1 Vikrant O. Kasat, A new technique to determine vertical dimension of occlusion
from anthropometric measurement of interpupillary distance J Clin Exp Dent. 2014 Oct; 6(4

42. II) The best parameter to predict the VDO in case of males was
found to be the index finger and in case of females it was little
finger.
• the variations between VDO and finger lengths are within the
range of 2-4 mm
• VDO = 31.123 + 0.423 × length of index finger
• VDO = 35.167 + 0.382 × length of little finger
• digital vernier caliper is used to measure the length
Ruchi Ladda,A new technique to determine vertical dimension of occlusion from
anthropometric measurements of fingers IJDR 2013.

43. EFFECTOF INCREASEIN VD
• Discomfort
• Trauma
• TMJ problem
• Bone resorption
• Muscular fatigue
• Clicking of the teeth
• Facial distortion
• Difficulty in swallowing and speech

44. EFFECTOF DECREASEIN VD
• Inefficiency
• Cheek biting
• TMJ problem
• Facial distortion
• Angular chelitis

45. 1) Discomfort to the patient
2) Trauma: by the jamming effect of the teeth coming into
contact sooner than expected may cause not only
discomfort, but also pain owing to the brusing of the
mucous membrane by these sudden and frequent blows.
EFFECTS OF INCREASED VERTICAL
RELATION

46. CLICKING TEETH
• The tongue which has become accustomed to the
presence of teeth in certain fixed positions and during
speech helps to produce sounds without the teeth
coming into contact. When there is increase in vertical
height opposing cusps frequently meet each other,
producing an embarrassing clicking or clattering sound.
This effect is also produced during eating.

47. • APPEARANCE- The face has an elongated appearance since, at
rest the lips are parted and closing them together will
produce an expression of strain.
• BONE - Residual alveolar bone undergoes rapid
resorption
•

48. EFFECTS OF DECREASED VERTICAL
RELATION:
• Inefficiency – which is due to the fact that the pressure
with which it is possible to exert; with the teeth in
contact decreases considerably with over closure
because the muscles of mastication act from
attachments, which have been brought close together.

49. • Cheek biting – In come cases where there is a loss of
muscular tone, as well as reduced vertical height, the
flabby cheek tends to become trapped between the
teeth and bitten during mastication.
• Apperance – the general effect of overclosure on facial
expression is of increased age. There is close
approximation of nose to chin, the soft tissues sag and
fall in and the lines on the face are deepened. The lips
loose their fullness and the vermillion borders are
reduced to approximate a line.

50. • Angular cheilitis : A reduced vertical relation results in a
crease at the corners of the mouth beyond the
vermillion border and the deep fold thus formed
becomes bathed in saliva, thus leading to infection and
soreness.
• TMJ problem: the patient has to often protudethe
mandible to occlude the teeth and this cause pain and
clicking in TMJ

51. CONCLUSION
• There is no universally accepted or completely accurate
method of determining vertical dimension of occlusion in
edentulous patients.
• Regardless of technique , determine it carefully for a
successful prosthesis…

52. References
• Textbook of Complete Dentures.Arthur Rahn and Charles
Heartwell.5th edition
• Prosthodontic Treatment for Edentulous Patients Zarb –Bolender
12th edition.
• Clinical dental prosthesis, H.R.B.Fenn, K.Pliddelow, A.P.Gimson,
second edition
• Textbook of prosthodontics, Rangarajan.
• Textbook of prosthodontics ,Deepak Nallaswamy
• Naveen Raj T, Ashish Meshram, Shantanu Mulay, Honey Jethlia,REVIEW
ON METHODS OF RECORDING VERTICAL RELATION, Journal of Clinical
and Diagnostic Research, 2013 March
• Ruchi Ladda,1 Vikrant O. Kasat, A new technique to determine vertical
dimension of occlusion from anthropometric measurement of
interpupillary distance J Clin Exp Dent. 2014 Oct; 6(4)
• Ruchi Ladda,A new technique to determine vertical dimension of
occlusion from anthropometric measurements of fingers
• IJDR 2013