Vertical jaw relations/ dentistry course in india

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Vertical jaw relations/ dentistry course in india

  1. 1. VERTICAL JAWVERTICAL JAW RELATIONSRELATIONS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. ContentsContents  IntroductionIntroduction  Classification of jaw relationsClassification of jaw relations  Vertical jaw relationsVertical jaw relations  Physiologic rest positionPhysiologic rest position  hypothesishypothesis  factors to be consideredfactors to be considered  methods of recordingmethods of recording  significancesignificance www.indiandentalacademy.com
  3. 3.  Methods of recording vertical jaw relationsMethods of recording vertical jaw relations  mechanical methodsmechanical methods  physiologic methodsphysiologic methods  Tests to aid in confirming the correct verticalTests to aid in confirming the correct vertical dimension.dimension.  Altered vertical dimensions and their effectsAltered vertical dimensions and their effects  ConclusionConclusion  ReferencesReferences www.indiandentalacademy.com
  4. 4. www.indiandentalacademy.com
  5. 5. IntroductionIntroduction  Complete dentures are constructed toComplete dentures are constructed to function in the mouth as an integralfunction in the mouth as an integral part of the masticatory apparatus &part of the masticatory apparatus & there fore they should be designed tothere fore they should be designed to conform to the patient’s physiologic jawconform to the patient’s physiologic jaw relations.relations. www.indiandentalacademy.com
  6. 6.  To achieve this goal the recording mustTo achieve this goal the recording must include an appropriate vertical relationinclude an appropriate vertical relation of occlusion, stable occlusal contactsof occlusion, stable occlusal contacts in harmony with the existing T.M.J andin harmony with the existing T.M.J and masticatory muscle functions, and themasticatory muscle functions, and the relationship between the prostheses &relationship between the prostheses & oral & facial soft tissues andoral & facial soft tissues and musculature.musculature. www.indiandentalacademy.com
  7. 7. Mandibular MovementsMandibular Movements  The constant function of swallowingThe constant function of swallowing saliva is the basis for establishing thesaliva is the basis for establishing the mandibular position and occlusion.mandibular position and occlusion. www.indiandentalacademy.com
  8. 8.  In swallowing the saliva, mandibleIn swallowing the saliva, mandible raises to its habitual closing terminalraises to its habitual closing terminal and then as the saliva is forcedand then as the saliva is forced backward into the pharynx by thebackward into the pharynx by the tongue, the mandible is retruded to itstongue, the mandible is retruded to its physiologic centric relation.physiologic centric relation.  These are the mandibular movementsThese are the mandibular movements that are used in determining thethat are used in determining the vertical relation and the centric relationvertical relation and the centric relation for the complete dentures.for the complete dentures.www.indiandentalacademy.com
  9. 9. Classification of jaw relationsClassification of jaw relations  Jaw relations are classified into threeJaw relations are classified into three groups. They are:-groups. They are:- Orientation jaw relations.Orientation jaw relations. Vertical jaw relations.Vertical jaw relations. Horizontal jaw relations.Horizontal jaw relations. www.indiandentalacademy.com
  10. 10. Vertical dimensionVertical dimension  Distance between the two selectedDistance between the two selected anatomic or marked points ( usuallyanatomic or marked points ( usually one on the top of the nose & the otherone on the top of the nose & the other upon chin), one on a fixed & one on aupon chin), one on a fixed & one on a movable member. [Gpt]movable member. [Gpt] www.indiandentalacademy.com
  11. 11. Vertical jaw relationsVertical jaw relations  They are classified as :-They are classified as :- Vertical dimension of rest.Vertical dimension of rest. Vertical dimension of occlusion.Vertical dimension of occlusion. Vertical dimension of other portions.Vertical dimension of other portions. www.indiandentalacademy.com
  12. 12. Physiological rest positionPhysiological rest position  The Mandibular position assumedThe Mandibular position assumed when the head is in an uprightwhen the head is in an upright position and the involved musclesposition and the involved muscles particularly the elevator andparticularly the elevator and depressor groups are in equilibrium indepressor groups are in equilibrium in tonic contraction, & the condyles aretonic contraction, & the condyles are in a neutral , unstrained position.in a neutral , unstrained position. www.indiandentalacademy.com
  13. 13. Vertical dimension of occlusionVertical dimension of occlusion  The distance measured between twoThe distance measured between two points when the occluding memberspoints when the occluding members are in contact.are in contact. www.indiandentalacademy.com
  14. 14. Review of literatureReview of literature  Thompson and Brodie (1942) suggestedThompson and Brodie (1942) suggested that the position of the mandible in relationthat the position of the mandible in relation to the face and head is unchangeable as isto the face and head is unchangeable as is the form of the mandible, and “thethe form of the mandible, and “the proportions of any face as far as verticalproportions of any face as far as vertical height is concerned, are constant throughheight is concerned, are constant through out life.”out life.” www.indiandentalacademy.com
  15. 15.  Niswonger , Boos, and JaffeNiswonger , Boos, and Jaffe apparently agree with this view.apparently agree with this view.  Leof (1950) believes that this relationLeof (1950) believes that this relation is not constant but is readily affectedis not constant but is readily affected by age, disease, and emotion.by age, disease, and emotion.  It seems that the constancy of theIt seems that the constancy of the vertical maxillomandibular relationsvertical maxillomandibular relations through out the life represents thethrough out the life represents the unique phenomenon, not generallyunique phenomenon, not generally found in relations of the other bones.found in relations of the other bones. www.indiandentalacademy.com
  16. 16.  Garnick and Ram fjord (1962) statedGarnick and Ram fjord (1962) stated that rest position is a vertical rangethat rest position is a vertical range rather than a point.rather than a point. www.indiandentalacademy.com
  17. 17. Physiological rest positionPhysiological rest position  Vertical dimension of rest.Vertical dimension of rest.  Postural position of the mandible.Postural position of the mandible.  The postural position of the mandibleThe postural position of the mandible when an individual is restingwhen an individual is resting comfortably in an upright position andcomfortably in an upright position and the associated muscles are in a state ofthe associated muscles are in a state of minimal contractual activity.minimal contractual activity. www.indiandentalacademy.com
  18. 18.  This rest position is established by theThis rest position is established by the muscles and gravity.muscles and gravity.  Two main hypothesis explain about theTwo main hypothesis explain about the rest position of the mandible.rest position of the mandible.  One involves active mechanism.One involves active mechanism.  Second one involves the passiveSecond one involves the passive mechanism.mechanism. www.indiandentalacademy.com
  19. 19.  But according to the current conceptsBut according to the current concepts this position is actively determined.this position is actively determined.  The clinically recorded rest positionThe clinically recorded rest position is usually 2- 4mm below theis usually 2- 4mm below the maximum intercuspation position.maximum intercuspation position.  But according to the EMG activity aBut according to the EMG activity a range of reduced muscle tension uptorange of reduced muscle tension upto an interocclusal distance of about 10an interocclusal distance of about 10 mm is recorded. It is therefore moremm is recorded. It is therefore more accurate to refer to a range of postureaccurate to refer to a range of posture rather than to a single rest position.rather than to a single rest position. www.indiandentalacademy.com
  20. 20. Factors to be considered whileFactors to be considered while recording the rest positionrecording the rest position  Position of the mandible is influencedPosition of the mandible is influenced by the gravity.by the gravity.  It is a relaxed position of the mandible.It is a relaxed position of the mandible.  Neuromuscular disturbances.Neuromuscular disturbances. www.indiandentalacademy.com
  21. 21.  Rest position is a position in space.Rest position is a position in space.  No one method for determining the restNo one method for determining the rest position is a valid method.position is a valid method.  Space between the teeth is essentialSpace between the teeth is essential when the mandible is at rest.when the mandible is at rest. www.indiandentalacademy.com
  22. 22. Methods of recording the restMethods of recording the rest positionposition  Facial measurements.Facial measurements.  Tactile sense.Tactile sense.  Phonetics.Phonetics.  Facial expression.Facial expression.  Anatomical landmarks.Anatomical landmarks. www.indiandentalacademy.com
  23. 23. SignificanceSignificance  It is a bone to bone relation.It is a bone to bone relation.  In the absence of the pathosis theIn the absence of the pathosis the relation is fairly constant through outrelation is fairly constant through out the life.the life.  Position can be recorded andPosition can be recorded and measured with in the acceptable limits.measured with in the acceptable limits.  It is used in determining the verticalIt is used in determining the vertical dimension of occlusion.dimension of occlusion. www.indiandentalacademy.com
  24. 24. Vertical dimension of occlusionVertical dimension of occlusion  Mechanical methodsMechanical methods Ridge relation:-Ridge relation:- 1) Distance from the incisive papilla to1) Distance from the incisive papilla to the mandibular incisors.the mandibular incisors. 2) Parallelism of the ridges.2) Parallelism of the ridges. Measurement of the former dentures.Measurement of the former dentures. Preextraction records:-Preextraction records:- 1)Profile radiographs.1)Profile radiographs. 2)Casts of the teeth in occlusion.2)Casts of the teeth in occlusion. 3)Facial measurements.3)Facial measurements. www.indiandentalacademy.com
  25. 25. Physiological methodsPhysiological methods  Physiological rest position.Physiological rest position.  Phonetics and esthetics.Phonetics and esthetics.  Swallowing threshold.Swallowing threshold.  Tactile sense.Tactile sense.  Patient reported perception ofPatient reported perception of comfortcomfort www.indiandentalacademy.com
  26. 26. Relationship of ridge/ridgeRelationship of ridge/ridge relationsrelations www.indiandentalacademy.com
  27. 27.  The incisal edges ofThe incisal edges of the maxillary centralthe maxillary central incisors are an averageincisors are an average 6 mm below the6 mm below the incisive papilla. So theincisive papilla. So the average verticalaverage vertical overlap is about 2 mm.overlap is about 2 mm.  This relationship ofThis relationship of maxillary andmaxillary and mandibular anteriormandibular anterior teeth concerns not onlyteeth concerns not only the vertical ridgethe vertical ridge height but also estheticheight but also esthetic values.values. www.indiandentalacademy.com
  28. 28.  Disadvantage:Disadvantage:  In the absence of lower anterior teeth,In the absence of lower anterior teeth, this method cannot be used.this method cannot be used. www.indiandentalacademy.com
  29. 29. Parallelism of ridges:Parallelism of ridges:  Paralleling of maxillary and mandibularParalleling of maxillary and mandibular ridges plus 5 degree opening in theridges plus 5 degree opening in the posterior region as suggested by searsposterior region as suggested by sears often gives a clue to the amount of jawoften gives a clue to the amount of jaw separation.separation. www.indiandentalacademy.com
  30. 30. www.indiandentalacademy.com
  31. 31.  Disadvantages:Disadvantages: This theory cannot be used whenThis theory cannot be used when there is great amount of bone lossthere is great amount of bone loss which would change the ridge relation,which would change the ridge relation, also if the patient has lost the teeth atalso if the patient has lost the teeth at irregular intervals, the line of ridges isirregular intervals, the line of ridges is naturally thrown out of parallelnaturally thrown out of parallel.. www.indiandentalacademy.com
  32. 32.  Measurement of former dentures:Measurement of former dentures:  Measurement between the borders ofMeasurement between the borders of the maxillary and mandibular denturesthe maxillary and mandibular dentures can be made and can be correlatedcan be made and can be correlated with the observation of the patientswith the observation of the patients face to determine the amount offace to determine the amount of change required.change required. www.indiandentalacademy.com
  33. 33. Measurement of former denturesMeasurement of former dentures using Boley’s gaugeusing Boley’s gauge www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com
  35. 35. Pre extraction recordsPre extraction records  When natural teeth are in maximumWhen natural teeth are in maximum occlusion, the jaws are not necessarilyocclusion, the jaws are not necessarily in centric relation.in centric relation.  For this reason all the pre extractionFor this reason all the pre extraction records must be evaluated.records must be evaluated. www.indiandentalacademy.com
  36. 36. Profile radiographsProfile radiographs  Radiograph before extraction must beRadiograph before extraction must be taken and preserved.taken and preserved.  After extraction and after establishingAfter extraction and after establishing the tentative jaw relation, anotherthe tentative jaw relation, another radiograph should be taken.radiograph should be taken. www.indiandentalacademy.com
  37. 37.  The two radiographs must beThe two radiographs must be super imposed and compared.super imposed and compared.  The inaccuracies that exist in either theThe inaccuracies that exist in either the technique or the method of comparingtechnique or the method of comparing measurements make these methodsmeasurements make these methods unreliable.unreliable. www.indiandentalacademy.com
  38. 38. Radiographs:Radiographs: www.indiandentalacademy.com
  39. 39. Profile photographsProfile photographs  Profile photographs are made andProfile photographs are made and enlarged to life size. The photographenlarged to life size. The photograph should be made with teeth inshould be made with teeth in maximum occlusion.maximum occlusion.  Measurements of anatomical landMeasurements of anatomical land marks are compared with themarks are compared with the measurements of face using samemeasurements of face using same land marks .land marks . www.indiandentalacademy.com
  40. 40. Disadvantages:-Disadvantages:-  Angulations of photographs might differAngulations of photographs might differ with the patients posture.with the patients posture.  Enlargement can cause inaccuracies.Enlargement can cause inaccuracies. www.indiandentalacademy.com
  41. 41. Profile tracing:Profile tracing:  Lead wire adaptation .Lead wire adaptation .  This method is full of pitfalls as it isThis method is full of pitfalls as it is not possible to contour the wirenot possible to contour the wire accurately against the soft tissueaccurately against the soft tissue without producing distortion.without producing distortion. www.indiandentalacademy.com
  42. 42.  A piece of soft lead wire is molded toA piece of soft lead wire is molded to contour of the face starting from thecontour of the face starting from the eyebrow to just below the chin alongeyebrow to just below the chin along the midline. Then the contour isthe midline. Then the contour is transferred to the cardboard. Thetransferred to the cardboard. The resultant cutout is stored andresultant cutout is stored and compared to by placing against thecompared to by placing against the profile which is established after theprofile which is established after the extraction and estimation of theextraction and estimation of the vertical relation using the recordvertical relation using the record blocks.blocks. www.indiandentalacademy.com
  43. 43. Profile silhouettesProfile silhouettes  SimilarSimilar to profile tracing.to profile tracing.  An accurateAn accurate reproduction of the profilereproduction of the profile silhouettes can be cutout in asilhouettes can be cutout in a cardboard. Then the silhouettes can becardboard. Then the silhouettes can be positioned onto the face necessarypositioned onto the face necessary adjustments can be made.adjustments can be made. www.indiandentalacademy.com
  44. 44. Diagnostic castsDiagnostic casts  Various methods to determine verticalVarious methods to determine vertical relation of occlusion by using therelation of occlusion by using the diagnostic casts.diagnostic casts.  Heinz and Peters method.Heinz and Peters method.  Quinn et al method.Quinn et al method.  Bissasu method.Bissasu method. www.indiandentalacademy.com
  45. 45. Casts of teeth articulated in occlusionCasts of teeth articulated in occlusion Heinz and peters methodHeinz and peters method  Accurate casts of maxillary andAccurate casts of maxillary and mandibular arches made.mandibular arches made.  The maxillary cast is related to itsThe maxillary cast is related to its correct anatomic position on ancorrect anatomic position on an articulator with a face bow transfer.articulator with a face bow transfer.  An occlusal record with the jaws inAn occlusal record with the jaws in centric relation is used to mount thecentric relation is used to mount the mandibular cast.mandibular cast. www.indiandentalacademy.com
  46. 46.  After the teeth has been removed,After the teeth has been removed, edentulous casts are mounted on theedentulous casts are mounted on the articulator, the interarch measurementsarticulator, the interarch measurements are compared and necessaryare compared and necessary adjustments are made.adjustments are made.  They give information of the verticalThey give information of the vertical overlap and size and shape of teeth.overlap and size and shape of teeth. www.indiandentalacademy.com
  47. 47.  The casts also assist in theThe casts also assist in the selection of size, shape andselection of size, shape and position of the teeth.position of the teeth. www.indiandentalacademy.com
  48. 48. Disadvantage:Disadvantage:  It cannot used when there is a longIt cannot used when there is a long waiting period for fabrication ofwaiting period for fabrication of denture after extraction.denture after extraction.  It cannot be used when there isIt cannot be used when there is excessive bone loss during theexcessive bone loss during the extraction procedure.extraction procedure. www.indiandentalacademy.com
  49. 49. Quinn et al methodQuinn et al method  Quinn et al made maxillary & mandibularQuinn et al made maxillary & mandibular record bases and wax occlusion rims.record bases and wax occlusion rims.  Recorded the maxillo mandibularRecorded the maxillo mandibular relationship and made wax flanges for therelationship and made wax flanges for the dentate areas of diagnostic casts.dentate areas of diagnostic casts.  The maxillary and mandibular record bases,The maxillary and mandibular record bases, wax flanges, and the stone teeth werewax flanges, and the stone teeth were duplicated in a duplicating flask usingduplicated in a duplicating flask using reversible hydrocolloid impression material.reversible hydrocolloid impression material. www.indiandentalacademy.com
  50. 50.  The replica wax bases are used for makingThe replica wax bases are used for making the definitive impression, the resultant stonethe definitive impression, the resultant stone casts and the replica wax bases and the waxcasts and the replica wax bases and the wax teeth are mounted in an articulator inteeth are mounted in an articulator in maximal intercuspation, and the artificialmaximal intercuspation, and the artificial teeth are arranged with the impressionteeth are arranged with the impression material in place.material in place.  Disadvantages :- 1) This method requiredDisadvantages :- 1) This method required additional proceduresadditional procedures 2) Time consuming.2) Time consuming. www.indiandentalacademy.com
  51. 51. Use of lingual frenum BissasuUse of lingual frenum Bissasu  Bissasu proposed in determining theBissasu proposed in determining the original vertical relation by measuring theoriginal vertical relation by measuring the distance between the center of thedistance between the center of the Incisive papilla and the incisal edges of theIncisive papilla and the incisal edges of the maxillary central incisors and between themaxillary central incisors and between the anterior attachment of the lingual frenumanterior attachment of the lingual frenum and then adjusting the maxillary andand then adjusting the maxillary and mandibular wax occlusion rims, anteriorly,mandibular wax occlusion rims, anteriorly, to correspond with these measurements.to correspond with these measurements. www.indiandentalacademy.com
  52. 52. Advantages :-Advantages :-  Method is simpleMethod is simple  Does not require any additionalDoes not require any additional armamentariumarmamentarium www.indiandentalacademy.com
  53. 53. Facial measurements:Facial measurements:  These are also pre-extraction guides.These are also pre-extraction guides.  Various devices for making facialVarious devices for making facial measurements are used in differentmeasurements are used in different forms.forms.  DakometerDakometer  Willis gaugeWillis gauge  Orofacial deviceOrofacial device www.indiandentalacademy.com
  54. 54. DakometerDakometer  The instruments record both verticalThe instruments record both vertical dimension with the natural teeth indimension with the natural teeth in occlusion and the position of centralocclusion and the position of central incisors. In most cases recording canincisors. In most cases recording can be obtained with an error range of +be obtained with an error range of + or - 1mm.or - 1mm. www.indiandentalacademy.com
  55. 55.   i) The Dakometeri) The Dakometer www.indiandentalacademy.com
  56. 56. Willis gaugeWillis gauge  The instrument is used for recordingThe instrument is used for recording vertical height, before extraction.vertical height, before extraction.  The arm (A) is placed in contact withThe arm (A) is placed in contact with the base of the nose and arm (B) isthe base of the nose and arm (B) is moved along the slide (D) until it ismoved along the slide (D) until it is firmly and lightly touching the lowerfirmly and lightly touching the lower border of the chin, then it is locked inborder of the chin, then it is locked in position by the screw (C). The distanceposition by the screw (C). The distance on the scale (D) is recorded andon the scale (D) is recorded and preserved.preserved. www.indiandentalacademy.com
  57. 57.  Disadvantage:Disadvantage:  It is not accurate because theIt is not accurate because the degree of pressure applied every timedegree of pressure applied every time may not be the same.may not be the same. www.indiandentalacademy.com
  58. 58. www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com
  60. 60. Aabu-Ela and Razek methodAabu-Ela and Razek method  They have recorded the vertical relation ofThey have recorded the vertical relation of occlusion by the use of an orofacial device.occlusion by the use of an orofacial device.  The upper portion of the device extendedThe upper portion of the device extended between the orbital point and the externalbetween the orbital point and the external auditory meatus to form the Frankfort plane.auditory meatus to form the Frankfort plane. www.indiandentalacademy.com
  61. 61.  The lower part of the device is placedThe lower part of the device is placed against the inferior border of the mandibleagainst the inferior border of the mandible and pressed gently against the mandible.and pressed gently against the mandible.  This part of the device formed theThis part of the device formed the mandibular planemandibular plane..  The angle that was formed by the junction ofThe angle that was formed by the junction of Frankfort and the mandibular plane wasFrankfort and the mandibular plane was recorded.recorded. www.indiandentalacademy.com
  62. 62.  After the removal of the teeth duringAfter the removal of the teeth during recording of the vertical relation of occlusionrecording of the vertical relation of occlusion of the edentulous patient, the wax occlusionof the edentulous patient, the wax occlusion rims are reduced or increased until therims are reduced or increased until the previously recorded angle is duplicated thuspreviously recorded angle is duplicated thus restoring the VDO.restoring the VDO. www.indiandentalacademy.com
  63. 63. Facial measurements using tattooFacial measurements using tattoo  Permanent tattoo markings are placedPermanent tattoo markings are placed one on the upper half of face andone on the upper half of face and another on lower half of face.another on lower half of face.  The distance is measured andThe distance is measured and preserved. These measurements arepreserved. These measurements are compared when artificial teeth arecompared when artificial teeth are tried.tried. www.indiandentalacademy.com
  64. 64.  Silverman has also suggested theSilverman has also suggested the placement of tattoo marking on theplacement of tattoo marking on the patient’s upper and lower gingiva,patient’s upper and lower gingiva, slightly, left to the middle betweenslightly, left to the middle between attached gingiva in depth of vestibule.attached gingiva in depth of vestibule. www.indiandentalacademy.com
  65. 65.  Disadvantage:Disadvantage: Patient may not agree forPatient may not agree for placement of permanent tattoo marks.placement of permanent tattoo marks. www.indiandentalacademy.com
  66. 66. Swenson’s acrylic face mask:Swenson’s acrylic face mask:  Swenson’s described theSwenson’s described the construction of acrylic resin faceconstruction of acrylic resin face mask of the lower third of the face asmask of the lower third of the face as a record for future determination ofa record for future determination of vertical dimension.vertical dimension. www.indiandentalacademy.com
  67. 67. www.indiandentalacademy.com
  68. 68.  Disadvantages:Disadvantages:  Time consuming.Time consuming.  Requires lot of skill and experience toRequires lot of skill and experience to make impression of the face.make impression of the face.  Face assumes a different topography inFace assumes a different topography in the erect posture from that in thethe erect posture from that in the recumbent or semi-recumbent positionrecumbent or semi-recumbent position www.indiandentalacademy.com
  69. 69. The method suggested by Wright:The method suggested by Wright:  Wright marked the followingWright marked the following measurements from photographsmeasurements from photographs  The interpupillary distanceThe interpupillary distance  Brow chin distanceBrow chin distance www.indiandentalacademy.com
  70. 70. Interpupillary interpupillary brow chin brow chinInterpupillary interpupillary brow chin brow chin distance in : distance : : distance in : distancedistance in : distance : : distance in : distance Photograph of patient in photograph of patientPhotograph of patient in photograph of patient www.indiandentalacademy.com
  71. 71. Physiologic methodsPhysiologic methods www.indiandentalacademy.com
  72. 72. Niswonger methodNiswonger method  Niswonger suggested thisNiswonger suggested this method in 1934.method in 1934.  This method along with phoneticsThis method along with phonetics and esthetics is commonly usedand esthetics is commonly used today.today.  The patient is seated in suchThe patient is seated in such away that ala -tragus line isaway that ala -tragus line is parallel to the floor.parallel to the floor. www.indiandentalacademy.com
  73. 73.  There upon two marks , one at the baseThere upon two marks , one at the base of the nose and one on the chin areof the nose and one on the chin are made.made.  The patient is told to swallow and relax .The patient is told to swallow and relax . the distance between the two marks isthe distance between the two marks is measured and recorded .measured and recorded . www.indiandentalacademy.com
  74. 74.  Subsequently the occlusal rims areSubsequently the occlusal rims are constructed so that when they meet theconstructed so that when they meet the measured distance is 1/8 inch (2-4mm)measured distance is 1/8 inch (2-4mm) less than original distance. This 1/8less than original distance. This 1/8 inch is the average freeway space.inch is the average freeway space. www.indiandentalacademy.com
  75. 75.  DisadvantageDisadvantage:: As the marks are on the skin,As the marks are on the skin, they tend to move with the skin. So it isthey tend to move with the skin. So it is difficult to obtain two constantdifficult to obtain two constant measurements of the rest position.measurements of the rest position. www.indiandentalacademy.com
  76. 76. www.indiandentalacademy.com
  77. 77. Concept of equal thirds:Concept of equal thirds:  Willis suggested that the face can beWillis suggested that the face can be divided into equal thirds, the forehead,divided into equal thirds, the forehead, the nose, the lips and the chin.the nose, the lips and the chin.  However this concept is of littleHowever this concept is of little practical value as the points ofpractical value as the points of measurements are entirely vague.measurements are entirely vague. www.indiandentalacademy.com
  78. 78. Vertical dimension by means ofVertical dimension by means of power point or Boos methodpower point or Boos method  Boos in 1940 stated that there was aBoos in 1940 stated that there was a point of maximum biting power.point of maximum biting power.  He says that the patient registers theHe says that the patient registers the greatest amount of pressure on agreatest amount of pressure on a spring dynamometer at a point.spring dynamometer at a point.  So the Bimeter is used in this principle.So the Bimeter is used in this principle. www.indiandentalacademy.com
  79. 79.  The Bimeter is attached to an accuratelyThe Bimeter is attached to an accurately adapted mandibular record base.adapted mandibular record base.  A metal plate is attached to the vault ofA metal plate is attached to the vault of an accurately adapted maxillary recordan accurately adapted maxillary record base to provide a central bearing point.base to provide a central bearing point. www.indiandentalacademy.com
  80. 80.  Adjust the vertical distance by turningAdjust the vertical distance by turning the cap.the cap.  The gauge indicates the pounds ofThe gauge indicates the pounds of pressure generated during jaw closurepressure generated during jaw closure at different degrees of jaw separation.at different degrees of jaw separation.  When the maximum PowerPoint isWhen the maximum PowerPoint is reached, the lock nut is set, plasterreached, the lock nut is set, plaster registration is made.registration is made. www.indiandentalacademy.com
  81. 81. Phonetics as a guidePhonetics as a guide  Silverman’s closest speaking space methodSilverman’s closest speaking space method..  Proposed by Silverman in 1952.Proposed by Silverman in 1952.  Silverman identified that the production ofSilverman identified that the production of certain sounds like “S” “yes”,”J” , “ch” bringscertain sounds like “S” “yes”,”J” , “ch” brings the anterior teeth very close together.the anterior teeth very close together. www.indiandentalacademy.com
  82. 82.  Direct the patient into centricDirect the patient into centric occlusion and draw the line on a lowerocclusion and draw the line on a lower anterior teeth at the horizontal levelanterior teeth at the horizontal level of the incisal edges of the opposingof the incisal edges of the opposing upper anterior teeth. This is called theupper anterior teeth. This is called the centric occlusion line.centric occlusion line.  Ask the patient to sayAsk the patient to say yesyes and whileand while the phonetic soundthe phonetic sound ss is pronounced,is pronounced, draw the closest speaking line on thedraw the closest speaking line on the same lower anterior teeth at thesame lower anterior teeth at the horizontal level of the upper incisalhorizontal level of the upper incisal edge.edge. www.indiandentalacademy.com
  83. 83.  The distance between these two linesThe distance between these two lines is called the closest speaking space.is called the closest speaking space.  The measurements ranged fromThe measurements ranged from 0 to 10 mm.0 to 10 mm.  The closest speaking space asThe closest speaking space as measured in the natural dentition mustmeasured in the natural dentition must be reproduced in complete denturesbe reproduced in complete dentures after the loss of remaining naturalafter the loss of remaining natural teeth.teeth. www.indiandentalacademy.com
  84. 84.  This method aids the dentist toThis method aids the dentist to evaluate the vertical dimension ofevaluate the vertical dimension of occlusion.occlusion.  When correctly placed the lowerWhen correctly placed the lower incisors move forward to a positionincisors move forward to a position nearly directly under the upper centralnearly directly under the upper central incisors and come close to them but doincisors and come close to them but do not contact.not contact. www.indiandentalacademy.com
  85. 85.  The position of the tongue and itsThe position of the tongue and its relation to the teeth is also anrelation to the teeth is also an important factor, by asking the patientimportant factor, by asking the patient to pronounce repeatedly the numberto pronounce repeatedly the number “thirty three”.“thirty three”.  The dentist can evaluate if there isThe dentist can evaluate if there is enough space for the tip of the tongueenough space for the tip of the tongue to protrude between the anterior teeth.to protrude between the anterior teeth. www.indiandentalacademy.com
  86. 86. Swallowing threshold : ShanabanSwallowing threshold : Shanaban Thomas :Thomas :  Swallowing reflex is a primitive, innate reflex.Swallowing reflex is a primitive, innate reflex. The position of the mandible at theThe position of the mandible at the beginning of the swallowing act has beenbeginning of the swallowing act has been used as a guide to the vertical relation. Theused as a guide to the vertical relation. The theory behind this method is that when atheory behind this method is that when a person swallows, the teeth come togetherperson swallows, the teeth come together with a very light contact at the beginning ofwith a very light contact at the beginning of swallowing cycle.swallowing cycle. www.indiandentalacademy.com
  87. 87.  The technique involves building aThe technique involves building a cone of soft wax on the lower denturecone of soft wax on the lower denture base so that it contacts the upperbase so that it contacts the upper occlusion rim with the jaws too wideocclusion rim with the jaws too wide open.open. www.indiandentalacademy.com
  88. 88.  The flow of saliva is stimulated and theThe flow of saliva is stimulated and the repeated action of swallowing the saliva willrepeated action of swallowing the saliva will gradually reduce the height of the wax conesgradually reduce the height of the wax cones to allow the mandible to reach the level ofto allow the mandible to reach the level of occlusal vertical dimension.occlusal vertical dimension. www.indiandentalacademy.com
  89. 89. Facial expression and esthetics as aFacial expression and esthetics as a guide:guide:  The experienced dentist learns theThe experienced dentist learns the advantage of recognizing the relaxedadvantage of recognizing the relaxed facial expression when the jaws are atfacial expression when the jaws are at rest. In normally related jaws, the lipsrest. In normally related jaws, the lips will be even anteroposteriorly and inwill be even anteroposteriorly and in slight contact.slight contact. www.indiandentalacademy.com
  90. 90.  The lips of the patient in case ofThe lips of the patient in case of protruded mandible will not be evenlyprotruded mandible will not be evenly related , the lower lip will be anterior torelated , the lower lip will be anterior to the upper lip and not in contact. In casethe upper lip and not in contact. In case of retruded mandible the lower lip willof retruded mandible the lower lip will be distal to the upper lip and not inbe distal to the upper lip and not in contact.contact. www.indiandentalacademy.com
  91. 91.  When the vertical dimension isWhen the vertical dimension is increased both the, mentolabial andincreased both the, mentolabial and nasolabial grooves disappear when V.Dnasolabial grooves disappear when V.D is decreased the grooves areis decreased the grooves are exaggerated and the chin appears closeexaggerated and the chin appears close to the nose.to the nose. www.indiandentalacademy.com
  92. 92. Based on harmony of faceBased on harmony of face www.indiandentalacademy.com
  93. 93. Neuromuscular perception andNeuromuscular perception and tactile sense:tactile sense:  The stretch reflex and proprioceptiveThe stretch reflex and proprioceptive mechanisms of muscles and ligamentsmechanisms of muscles and ligaments of temporomandibular joints areof temporomandibular joints are retained in the fully edentulous patient.retained in the fully edentulous patient.  A number of studies have been done byA number of studies have been done by using this neuromuscular memory tousing this neuromuscular memory to determine the V.D of occlusion withdetermine the V.D of occlusion with mixed success (Lytle 1964, Tryde et al)mixed success (Lytle 1964, Tryde et al) www.indiandentalacademy.com
  94. 94. Tactile sense method:Tactile sense method:  The tactile sense of the patient is usedThe tactile sense of the patient is used as a guide in the determination of theas a guide in the determination of the occlusal vertical relation.occlusal vertical relation.  An adjustable central bearing screw isAn adjustable central bearing screw is attached in the palate of the maxillaryattached in the palate of the maxillary denture base or occlusal rim. Thedenture base or occlusal rim. The central bearing plate is attached to thecentral bearing plate is attached to the mandibular occlusal rim or trial basedmandibular occlusal rim or trial based denture base.denture base. www.indiandentalacademy.com
  95. 95.  The central bearing screw is firstThe central bearing screw is first adjusted so it is obviously too long i.eadjusted so it is obviously too long i.e the mouth is opened beyond thethe mouth is opened beyond the physiologic rest position. Then inphysiologic rest position. Then in progressive steps, the screw is adjustedprogressive steps, the screw is adjusted downwards until the patient indicatesdownwards until the patient indicates that the jaws are closing to far.that the jaws are closing to far. www.indiandentalacademy.com
  96. 96.  The procedure is repeated in theThe procedure is repeated in the opposite direction until the patient feelsopposite direction until the patient feels that the length is about right, thethat the length is about right, the adjustments are reversed alternativelyadjustments are reversed alternatively until the height of contact feels right.until the height of contact feels right.  Patient participation in the decision toPatient participation in the decision to establish a vertical dimension record isestablish a vertical dimension record is very important.very important. www.indiandentalacademy.com
  97. 97. Disadvantage:Disadvantage:  This method cannot be used in senileThis method cannot be used in senile patients and in those patients whopatients and in those patients who have impaired neuromuscularhave impaired neuromuscular perception.perception.  The problem with this method relates toThe problem with this method relates to the presence of foreign objects in thethe presence of foreign objects in the palate and tongue space.palate and tongue space.  The final determination must be madeThe final determination must be made at the try in after the teeth are inat the try in after the teeth are in position.position. www.indiandentalacademy.com
  98. 98. www.indiandentalacademy.com
  99. 99. Bio feed back using electromyography:Bio feed back using electromyography:  Rest position of mandible can beRest position of mandible can be determined by means ofdetermined by means of electromyography which would recordelectromyography which would record the minimal activity of the muscles.the minimal activity of the muscles.  Electrodes can be placed on one orElectrodes can be placed on one or more muscles of mastication tomore muscles of mastication to demonstrate their activation potentialdemonstrate their activation potential in the form of visual and audio signs,in the form of visual and audio signs, which are fed back to the patient, towhich are fed back to the patient, to attain a mandibular position showing nilattain a mandibular position showing nil or minimum EMG activity.or minimum EMG activity.www.indiandentalacademy.com
  100. 100.  Disadvantages:Disadvantages:  The equipment is too expensiveThe equipment is too expensive  The operate should have considerableThe operate should have considerable knowledge, skill and experienceknowledge, skill and experience  The patient should be capable ofThe patient should be capable of correlating the visual signs to thecorrelating the visual signs to the correct mandibular position.correct mandibular position. www.indiandentalacademy.com
  101. 101. Tests to aid in confirming the correctTests to aid in confirming the correct vertical relation:vertical relation:  Judgment of overall facial supportJudgment of overall facial support  Visual observation of space betweenVisual observation of space between the rims when the jaws are at restthe rims when the jaws are at rest  Measurement between the dots on theMeasurement between the dots on the face when the jaws are at rest andface when the jaws are at rest and when the occlusal rims are in contactwhen the occlusal rims are in contact www.indiandentalacademy.com
  102. 102.  Observation made when the sibilantObservation made when the sibilant containing words are pronounced, tocontaining words are pronounced, to ensure that the occlusal rims comeensure that the occlusal rims come close together but do not contact.close together but do not contact. Patient can be asked to pronouncePatient can be asked to pronounce words like Emma,Mississippi,forty fivewords like Emma,Mississippi,forty five and thirty three for evaluation.and thirty three for evaluation. www.indiandentalacademy.com
  103. 103. Effects of increased verticalEffects of increased vertical dimension:dimension:  It is very important to remember that asIt is very important to remember that as mentioned by Mehrson and Tench thementioned by Mehrson and Tench the tone of the muscles may be increasedtone of the muscles may be increased within physiologic limits but thewithin physiologic limits but the functional length cannot be increasedfunctional length cannot be increased www.indiandentalacademy.com
  104. 104. EffectsEffects  Discomfort to the patientDiscomfort to the patient  Trauma and pain to the basal seatTrauma and pain to the basal seat areasareas  The jarring effect of teeth coming intoThe jarring effect of teeth coming into contact sooner than expected may notcontact sooner than expected may not only cause discomfort but in mostonly cause discomfort but in most cases it will also cause pain owing tocases it will also cause pain owing to the bruising of the mucosa by thesethe bruising of the mucosa by these sudden and frequent blows.sudden and frequent blows. www.indiandentalacademy.com
  105. 105.  Loss of freeway space: This will result inLoss of freeway space: This will result in fatigue of any one or group of muscle offatigue of any one or group of muscle of mastication. In turn, it will result inmastication. In turn, it will result in annoyance from the inability to findannoyance from the inability to find comfortable resting position.comfortable resting position.  Clicking sound when the teeth contactClicking sound when the teeth contact  Appearance: The face has an elongatedAppearance: The face has an elongated appearance. The lips are apart at restappearance. The lips are apart at rest www.indiandentalacademy.com
  106. 106. Effects of reduced vertical heightEffects of reduced vertical height  InefficiencyInefficiency  Cheek bitingCheek biting  AppearanceAppearance  Angular chelitisAngular chelitis  Costons syndromeCostons syndrome www.indiandentalacademy.com
  107. 107. ConclusionConclusion  No one method of recording or determiningNo one method of recording or determining the jaw relations can be accepted as beingthe jaw relations can be accepted as being valid for all patients, there fore it is desirablevalid for all patients, there fore it is desirable to use several methods and confirm theto use several methods and confirm the results. More over the components of theresults. More over the components of the recording procedure include morphologicrecording procedure include morphologic and physiologic phenomena, the functionaland physiologic phenomena, the functional activity, psychological and social criteriaactivity, psychological and social criteria particularly in relation to esthetic decisions.particularly in relation to esthetic decisions. www.indiandentalacademy.com
  108. 108. ReferencesReferences  Boucher’s prosthodontic treatment for edentulousBoucher’s prosthodontic treatment for edentulous patients – 9patients – 9thth , 10, 10thth ,11,11thth edition.edition.  syllabus of complete dentures –Heartwell.syllabus of complete dentures –Heartwell.  Essentials of complete denture prosthodonticsEssentials of complete denture prosthodontics ––Sheldon Winkler.Sheldon Winkler.  Complete denture prosthodonticsComplete denture prosthodontics –– John J.Sharry.John J.Sharry.  Evaluation diagnosis, and treatment of occlusalEvaluation diagnosis, and treatment of occlusal problems Peter E Dawson.problems Peter E Dawson. www.indiandentalacademy.com
  109. 109.  Speaking method in measuring verticalSpeaking method in measuring vertical dimension. J.P.D 2001 vol 85 no 5 427-430.dimension. J.P.D 2001 vol 85 no 5 427-430.  Using the neutral zone to obtainUsing the neutral zone to obtain maxillomandibular relationships.J.P.D 2001 volmaxillomandibular relationships.J.P.D 2001 vol 85 621-3.85 621-3.  Pre extraction records for complete denturePre extraction records for complete denture fabrication. J.P.D 2004 vol 91 55-8.fabrication. J.P.D 2004 vol 91 55-8.  Physiological jaw relations and oclusion ofPhysiological jaw relations and oclusion of complete dentures. J.P.D 2004 vol 91 203-5.complete dentures. J.P.D 2004 vol 91 203-5. www.indiandentalacademy.com
  110. 110. www.indiandentalacademy.com

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