Journal club presentation

1. CLINICAL MEASUREMENT AND EVALUATION OF
VERTICAL DIMENSION
JOURNAL CLUB
PRESENTED BY – DR. VAISHALI SHRIVASTAVA
IInd YEAR POST GRADUATE STUDENT
DEPT. OF PROSTHODONTICS, CROWN & BRIDGE
AND IMPLANTOLOGY 1

2. TITLE- CLINICAL MEASUREMENT AND
EVALUATION OF VERTICAL DIMENSION.
AUTHORS- L.BRIAN TOOLSON, DALE E. SMITH
SOURCE- Toolson LB, Smith DE. Clinical measurement
and evaluation of vertical dimension. Journal of
Prosthetic Dentistry. 2006 May 1;95(5):335-9.
2

3. • Determining the vertical dimension of occlusion is a critical procedure for a totally or partially
edentulous patient.
• Many edentulous patients have adapted to a vertical dimension which has decreased due to bone
resorption and posterior tooth wear.
• This report will discuss the accuracy and repeatability of two simple methods of determining vertical
dimension of occlusion.
1) the Sorenson
Profile Scale
(Dento-Profile
Scale Co, Fond du
Lac, Wis)
(2) measurement of
vertical dimension from
the base of the nasal
septum to the inferior
border of the chin as
shown by Smith
3

4. EVALUATION OF FACIAL MEASUREMENTS
• A freeway space or interocclusal distance of about 3 mm should be present between the maxillary and
mandibular occlusion rims.
• This interocclusal distance is determined by subtracting the measurement of vertical dimension of
occlusion from the vertical dimension of rest.
• Clinically, an accurate determination of the interocclusal distance is difficult when measurements are
taken from movable skin tissue.
4

5. 5
OBSERVATION
• The patient is instructed to relax the lower jaw,
lightly touch the lips together, and remain in this
position while the lips are separated and the
distance or lack of distance between the occlusion
rims or artificial teeth is observed.
• When the lips are separated, a space of
approximately 3 mm should be observed between
the occlusion rims or artificial teeth

6. 6
MOVEMENT OF THE MANDIBLE
• While the patient is standing, he should be instructed to relax the lower
jaw and lightly touch the lips together.
• With the mandible at the physiologic rest position, the patient should
then be instructed to lightly close together until the occlusion rims or
artificial teeth make contact.
• While the patient is closing, the lower border of the mandible is
observed to see if there is movement from the rest position to physical
contact .
• If no movement of the mandible is observed, there is insufficient
interocclusal distance, and the vertical dimension of occlusion should be
reevaluated

7. 7
The closest speaking space is defined as the distance
between the occlusion rims or artificial teeth when
the patient is saying words that contain the sounds /s/
or /ch/.
There should be a minimum of 1 to 2 mm of
clearance between the occlusion rims or artificial
teeth when the patient is making sounds which
contain the letters /s/ or /ch/

8. 8

9. 9
ACCURACY OF TWO METHODS USED TO DETERMINE VERTICAL DIMENSION OF
OCCLUSION
At each appointment, the
vertical dimension of
occlusion was measured by
having the patient bring the
posterior teeth lightly
together in centric relation
and checking with the
Sorenson Profile Scale and
the chin-nose method
13 patients
one arch of an
overdenture
observed over a
2-year period
Any changes in the
periodontal health of
overdenture
abutments,incidence and
control of caries, and changes
in the vertical dimension of
occlusion were observed.

10. 10
placing the nasion locator of the instrument firmly in
the depression at the bridge of the nose and raising
the chin seat until it lightly touched the most inferior
and anterior border of the chin.
The measurement was made to the nearest 0.5 mm

11. 11
The chin-nose distance was determined by placing a
plastic ruler under the base of the nasal septum and
placing a tongue blade at a right angle to the ruler and
bringing the tongue blade into light contact with the most
inferior part of the chin
The distance was recorded to the nearest 0.5 mm

12. 12
In addition, a cephalometric roentgenogram was completed at each recall examination using a
standardized cephalometer
The measurements from the
cephalometric films were
made between the nasion
(nasofrontal suture) and the
menton (most interior point
on the symphysis of the
mandible)

13. 13
shows the decrease in millimeters of the
vertical dimension of occlusion as measured by
each of the methods described previously.
The algebraic differences between the chin-
nose and cephalometric measurement and the
Sorenson Profile Scale and cephalometric
measurement are shown parenthetically in each
column.
RESULTS

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Table I also shows the arithmetic mean error between the chin-nose and cephalometric
measurement and the Sorenson Profile Scale and cephalometric measurement.
The mean errors of the chin-nose and Sorenson Profile Measurements were computed to determine
how close they were to the cephalometric measurements regardless of whether they were plus or
minus.

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• The chin-nose method of measuring vertical dimension of rest and occlusion is convenient, accurate,
and practical because it requires no sophisticated or expensive equipment and is easily mastered
• The measurement is difficult to record when a patient has a round facial profile or facial hair. In these
situations, it is difficult, if not impossible, to place the tongue blade and millimeter ruler with
consistent accuracy.
• The measurements are more consistent and accurate with patients who have a flat facial profile and
absence of facial hair
DISCUSSION

16. 16
Two methods of determining vertical dimension of rest and occlusion were compared with
measurements taken from cephalometric films to determine their reliability and accuracy.
Both methods using the chin-nose and Sorenson Profile Scale measurements were reliable in
recording preextraction vertical dimension of occlusion.
The chin-nose measurement is convenient and one of its primary advantages is that the measurement
is not taken from chin tissue, which is movable.
CONCLUSIONS AND SUMMARY

17. 17
2 methods were well
elaborated
Not mentioned about
consequences regarding
increased and decreased
vertical height.
Not included more methods to
record VDR and VDO

18. 18
COMPARATIVE EVALUATION OF VERTICAL
DIMENSION AT REST BEFORE EXTRACTION,
AFTER EXTRACTION AND AFTER
REHABILITATION WITH COMPLETE DENTURE-A
CEPHALOMETRIC STUDY
Source- Uppal S, Gupta NK, Tandan A, Dwivedi R,
Gupta S, Kumar S. Comparative evaluation of vertical
dimension at rest before extraction, after extraction
and after rehabilitation with complete denture–A
Cephalometric study. journal of oral biology and
craniofacial research. 2013 May 1;3(2):73-7.
CROSS REFERENCE

19. 19
study aims to determine cephalometrically, whether the vertical dimension at rest remains
stable during the various phases, that is dentulous, edentulous and after rehabilitation with
complete dentures

20. 20
This study was conducted in a total of ten randomly selected patients, who had some natural teeth present
with one or more opposing posterior teeth with vertical occlusal stops but were advised for extraction
because of poor prognosis.
Digital lateral cephalograms were done and measurements recorded at three stages: prior to extraction of
remaining natural teeth, post extraction and after complete denture rehabilitation
MATERIALS & METHOD:

21. 21
• On basis of the observations, statistical analysis and discussion, it can be concluded that the
vertical dimension at rest, shows a decrease following extraction of natural teeth (occlusal stops),
while there is an increase in vertical dimension at rest on insertion of complete denture prosthesis.
• Therefore, it can be stated that vertical dimension at rest is not stable position and varies following
extraction of natural teeth and rehabilitation.
CONCLUSION

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