introduction, classification of jaw relation,definition, physiologic rest position,vertical dimension at rest ,methods for determining vertical dimension at rest,vertical dimension at occlusion,methods for determining vertical dimension at occlusion,evaluation of vertical dimension,effects of increased vertical dimension, effects of decreased vertical dimension, review of literature.

1. VERTICAL JAW RELATION
PRESENTED BY: DR.SHARI.S.R
2NDYR MDSSTUDENT
GDC ,TRIVANDRUM65

2. INTRODUCTION
• Recording of jaw relations in the treatment of edentulous patients
aims at facilitating the adaptation of the complete denture to the
masticatory system to give them an optimal and comfortable
function.
• Toachieve this goal, the recording must include an approximate
vertical dimension of occlusion, stable occlusal contacts in harmony
with the existingTMJ and masticatory musclefunctions.
.

3. Definition
Maxillomandibular relationship - GPTVIII
• Any spatial relationship of the maxillae to the mandible;
• Any one of the infinite relationships of the mandible to themaxillae

4. Classification of Jawrelations
• Orientation jaw relation.
• Vertical jaw relation.
• Horizontal jaw relation.

5. Classification
• The vertical jaw relation can be classified as follows:
1)Vertical dimension at rest-VDR
2)Vertical relation at occlusion-VDO

6. Definition
Vertical dimension, GPTVIII
The distance between two selected anatomic or marked points
(usually one on the tip of the nose and the other upon the chin),
one on a fixed and one on a movablemember

7. Principle
The most important factor in deciding the vertical
dimension is:
The mandibular musculature and occlusion rims
or occlusal stops from the teeth .

8. Physiologic rest position
GPT-VIII
• 1:The mandibular position assumed when the head is inan
upright position and the involved muscles, particularly the
elevator and depressor groups, are in equilibrium in tonic
contraction, and the condyles are in a neutral, unstrained
position
• 2:The position isusually noted when the head is held upright
(role of gravity)

9. Significance of Physiological Rest
position
• Bone to bone relation
• Fairly constant throughout the life
in absence of any pathosis.
• Can be recorded and measured
within acceptable limits.
Textbook of complete dentures : Charles M. HeartwellJr.,Arthur O Rahn, 5thEdition

10. Vertical dimension of occlusion, GPTVIII
Occlusal vertical dimension
The distance measured between two points when the occluding
members are in contact.

11. Vertical Dimension at Rest
• Definition: -
• The distance between two selected points (one of which is on the middle of the face or
nose and the other of which is on the lower face or chin) measured when the mandible is in
the physiologic rest position-GPT-8
• It is essential to record the vertical dimension at rest as it acts as a reference point during
recording the vertical dimension at occlusion.
• TheVD at rest should be recorded at the physiological rest position of themandible.

12. Inter-relationship
VDR-VDO=Freeway space or the
interocclusal rest space
Interocclusal rest space- GPTVIII
The difference between the
vertical dimension of rest and
the vertical dimension while
in occlusion.
It ranges from 2-4 mm in
vertical direction at the
position of the 1st premolar

13. Syllabus of complete dentures : Charles M. HeartwellJr.,Arthur O Rahn, 4th Edition
Factors
considered
for rest
position
Gravity
Neuromuscular
disturbances
calm, cool and
relaxed
make
measurements
without delay
No one method for determining rest position can be accepted as being valid for all patients.
Several methods are available to confirm this record

14. VERTICAL JAW RELATION AT REST
METHODS FOR DETERMINING VDR
 Facial measurement after swallowing and relaxing.(Reference points)
 Speech (em)
 Tactile sense(Opening------- closing)
 Measurement of anatomical landmarks (Wills guide)
 Facial expression (skin tone)

15. Facial measurements after swallowing and relaxing
• Sit upright and eyes looking straight ahead.
• Insert maxillary occlusal rim.
• Two reference points are marked .
• Instruct the patient to wipe his lips with tongue-swallow-drop shoulders in rest position.
• Mandible come to physiological rest position.
• Distance between two reference points is measured.

16. Tactile sense
• Stand erect.
• Open the jaws wide till he feels discomfort in his muscles of mastication.
• Ask to close slowly.
• Instruct to stop closing when he feels that muscles are totally relaxed.
• Distance between two reference points are recorded.
• This method relies on patient ‘s perception of relaxation and will vary for each patient.

17. Speech
1st method:
• Ask patient to repeatedly pronounce the letter ‘M’.
2ND method:
• Keep talking to patient.
• Measure the distance b/w reference points immediately after patient stops talking.

18. Anatomic landmarks
• Distance b/w anterior nasal spine and lower border of mandible =A
• Distance b/w the pupil of the eye and rima oris.=B,is measured using wills guide.
• If both the distances (A=B ) are equal ,then jaws at rest

19. Facial expression
• Skin around the eyes and chin should be relaxed.
• Nostrils are relaxed and breathing should be unobstructed.
• Upper and lower lip should have a slight contact in one plane.

20. METHODS FOR DETERMINING VDO

21. Classification of the methods
• Mechanical :
• 1. Ridge relation
A.Incisive papilla to mandibular incisors
B. Parallelism of the ridges
• 2. Measurement of the former
dentures
• 3. Preextraction records
A. Profile radiographs
B. Casts of teeth in occlusion
C. Facial mesurements
Physiological
1. Physiological Rest Position
2. Phonetic and Esthetics as guides
3.Swallowing threshold
4.TactileSense
5.Wax occlusal rims.
6.Power point.

22. • 1.Incisive papilla to mandibular incisors
• Incisive papilla – stable landmark
• Distance :
Papilla -Incisal edges of mandibular anterior teeth : 4 mm
Papilla -Incisal edges of maxillary central incisors : 6 mm
Mean vertical overlap : 2 mm
• Individual variations
• Not relevant in patients with severe resorption
RIDGE RELATIONS
MECHANICAL METHODS

23. • Mandible is parallel to maxilla only at occlusion
• Paralleling and a 5 degree opening in the
posteriors is acceptable as suggested by Sears.
Marked resorption of the ridges makes this rule
void.
• It is applicable only no abnormal change in the
alveolar process such as a previous advanced
periodontal disease or gross supra-eruptions.
• Most people – ridges are notparallel
Teeth lost at different times
Resorption pattern
PARALLELISM OF THERIDGES

24. MEASUREMENT OF THE FORMERDENTURES
• Measurements are made from the borders of with a Boley
gauge.
• Correlated with the observations of the patient’s face
• Distance is too short or long – Corresponding change can be
made.
• Problems:
• Loss of the ridges under the dentures results in an increase in
interocclusal distance.
• Patients can shift the mandible, or the denture can be shifted
on its support to accommodate for errors in occlusion.
• Inaccurate adaptation of the denture base to the support
results in displacement of the denture

25. These data reveal the progressive changes which occur when the natural
teeth are extracted.
They provide information about –
• Occlusal vertical dimension
• Anteroposterior angle of occlusal plane
• Position and inclination of maxillary central incisors
• Horizontal and vertical overlap of each tooth.
• Length and width of teeth.
(A pre-extraction profile record. -J. Prosth. Dent. 45: 479, 1981)
PREEXTRACTION RECORDS

26. 1. PROFILE RADIOGRAPHS
• Much used in research of vertical dimension of
occlusion
• Lateral skull radiographs before and after
extraction are compared.
Disadvantages:
• Radiation risks – So cannot be consideredfor
routine clinical use.
• Considerable time
• Unreliable-
-Inaccuracies that exist in the technique
-Inaccuracies in the enlargement of
image.

27. Review of literature
Cone- beam computed tomography –synthesised cephalograms for evaluating the vertical
dimension of occlusion. West china journal of stomatology Vol.37 no.1 feb 2019
Objective: The accuracy of the vertical dimension of occlusion was compared and analysed on the basis
of CBCT synthesized cephalograms,closest speaking space method,and interocclusal distance.
Results:The closest speaking space method was used as the standard control group,the difference
between the seven methods and closest speaking space method were analysed.The seven methods
include freeway space method and six CBCT synthesized cephalograms methods(N-ANS/ANS-Me,S-
Go/N-Me,ANS-Gn/N-ANS,ANS-FH/Me-FH,ANS-Xi-Pm and CA/LA).
CBCT synthesised cephalograms with the exception of ANS-FH/Me-FH, can provide references for the
clinical evaluation of occlusal vertical dimensions of patients with edentulous jaws

28. 2.PROFILE PHOTOGRAPHS
• Made with the teeth in maximum occlusion
• Enlarged to life size
• Measurements of anatomic landmarks on the
photograph are compared with measurements using
the same anatomic landmarks on the face.
• These measurements can be compared when the
records are made and again when the artificial
teeth are tried in.
Disadvantages :
• Angulation of the photos might differ.
• Photo enlargements cause inaccuracies.

29. 3.PROFILE
SILHOUETTES
• Lead wire adaptation along the
midline helps preparing a cardboard
cutout, which is preserved after
extraction.
• Repositioned to the face after the
vertical dimension has been
established at the initial recording
and/or when the artificial teeth are
tried in.
(A pre-extraction profile record. -J.
Prosth. Dent. 45: 479, 1981)

30. 4. CASTS OFTEETH IN OCCLUSION
• Practical method
• Measurements:
• - Incisive papilla and crest of the lower ridge
-Extended height of upper and lower buccal frena
-Hamular notch and retromolar pad
• Indicate the amount of space required between
the ridges for teeth of this size.
• Valuable in patients whose ridges are not
sacrificed during the removal of teeth or
resorbed during a long waiting period for denture
construction.

31. 5. RESIN FACE MASKS:SWENSON
(1959)-
• Acrylic resin face masks are made before
the extractions and later, when the patient
is edentulous, fitted on the face to see
whether the vertical dimension has been
restored properly.
Disadvantages:
• Requires a great deal of time
• Extensive experience with the use of facial
impressions and casts.
• Different topography of face in erect and
recumbent posture. 26
Swenson’s Complete Dentures, Boucher, Editor, Fifth edition

32. 6. FACIAL MEASUREMENTS
• Distance between two tattoo points (chin and nose) at occlusion measured using
dividers before extraction
• This measurement is used after extraction

33. PHYSIOLOGICAL METHODS
1.PHYSIOLOGICAL REST POSITION(Niswongers method)
• Indication of the appropriate vertical dimension at rest
• Rest vertical dimension – Occlusal vertical dimension= Interocclusal
distance
• Interocclusal distance : 2-4mm when observed at the position of first
premolars.
• May no65t be an exact guide

34. • METHOD :
-Patient relaxed, with trunk upright and
the head unsupported.(Ala-tragus
line is parallel to the floor).
-After insertion of the occlusal rims the
patient should be asked to swallow and
let the jaw relax.
-The lips are parted to reveal how much
space is present between the occlusal
rims.
-The interocclusal distance should be 2-
4mm at the premolar region.

35. ->4mm- occlusal vertical
dimension is too small.
-< 2mm- occlusal vertical
dimension is too great.
- Occlusion rims are adjusted
until adequate interarch space
is obtained and patient
comfort and phonetic and
esthetic considerations are
satisfactory.

36. 2.PHONETICS
• Listening to speech sound production and observing the relationships of teeth during
speech.

37. Phonetics
Silverman’s closest speaking space
(production of ch,s,j)
‘F ‘or’ v’ and’ s’ speaking anterior tooth relation

38. A.) CH, S, ANDJ
• Bring the anterior teeth close together.
• Lower incisors should move forward to a position nearly
directly under and almost touching the upper incisors.
• If anterior teeth touch when these sounds are made or if the
teeth click together during speech, the vertical dimension is
too great.

39. A).CLOSEST SPEAKING SPACE:SILVERMAN
• Measures the vertical dimension when the mandible
and muscles involved are in physiologic function of
speech.
• The occlusion rims are placed in the mouth and the
height is adjusted until a minimum of 2 mm space exists
when the patient pronounces the letter “S”.
• Closest speaking space – 1-2mm
• Disadvantage: Patient who has an 8-10mm closest
speaking space will require other means for
determination of the vertical dimension.

40. B).THE ‘F’OR ‘V’ AND ‘S’ SPEAKING ANTERIOR TOOTH RELATION:
POUND AND MURRELL
• Incisal guidance is established by
arranging anterior teeth before
recordingVDO
• ‘f’ and ‘v’ sounds -The incisal edges of
the maxillary anterior teeth create a
seal on the moist area of the vermilion
border of the lower lip.
• ‘s’ - The position of the mandibular
anterior teeth is determined when the
patient says words beginning with ‘s’. When
the ‘s’ sounds are articulated, the mandible
moves forward. The incisal edges of the
anterior teeth do not make contact.

41. PROCEDURE
• After anterior teeth arrangement .
• Impression paste is added on the posterior part of mandibular occlusal rims.
• Upper and lower rims inserted .
• Ask the patient to close mouth till anterior teeth occlude to their proper
position.

42. 3.ESTHETICS
• Labial surfaces of the occlusion rims
should be contoured to replace or
restore the tissue support provided
by the natural structures.
• If lips are not properly supported
anteriorly- tendency to increase the
vertical dimension is great- leads to
increased lower face height.
• Recent evidence – this method is
unrelia65ble

43. 4.SWALLOWINGTHRESHOLD
• Powell and Zander(1965), Boucher(1955)
and Shanahan(1955)
• Teeth come together with a very light
contact at the beginning of the swallowing
cycle.
• Highest point of jaw during deglutition =
VDO
Technique:
• Build cones of wax on the lower denture
base in such a way that they contact the
upper occlusion rim when the jaws are
opened too wide.

44. • The flow of the saliva is stimulated by
food, such as a piece of candy.
• Repeated action of swallowing the saliva
will gradually reduce the height of the
wax cones to allow the mandible to reach
the level of occlusal vertical dimension.
• Length of the time to complete this
action and the relative softness of the wax
cones will affect the results. (The consistency of the the swallowing
technique in determining occlusalvertical
relation in edentulous patients - J Prosth.
Dent., 36: 159, 1976)

45. 5)TACTILE SENSE
Lytle’s Neuromuscular perception - Lytle RB in 1964
43
• It relies on patient’s perception of different vertical height.
• A central bearing device is attached to accurately adapted
record base
• Bearing pin is adjusted beyond the rest position, pin is
then lowered by half turn. Patient has to signify over-
closure.
• Pin is raised again till excess opening is seen.
• Appropriate vertical relation is judged by the patient.
• Disadvantage :
• It cannot be used in patients with poor neuromuscular
coordination.
• Presence of foreign objects in the palate and the tongue
space.
Lytle RB,Vertical relation of occlusion by the patient's neuromuscular
perception,Volume 14, Issue 1,January–February 1964, Pages12–21

46. 6. POWER POINT ( BOOS BIMETER , 1940):
• Attach the bimeter to an accurately adapted mandibular
record base.
• Attach a metal plate in the vault of an accuratelyadapted
maxillary record base to provide a central bearing point.
• Adjust the vertical distance by turning the cap.
• According to him max biting force occurs atVDO
• The gauge indicates the pounds of pressure generated
during closure at different degrees of jaw separation.
• When the maximum power point is determined, lock the
set nut.
• Make plaster registrations and transfer the cast to an
articulator.
• Disadvantage: Such a device offers no more accuracythan
Niswonger’s or Silverman’smethod.

47. 7.WAX OCCLUSIONRIMS
• Establish the vertical dimension at rest
• Thinly coat the maxillary occlusion rim with petrolatum.

48. • 5.Soften a roll of baseplate wax in a
waterbath at 130o F and contour it in a
triangular shape with the base on the
occlusion rim and attach it to the
occlusal surface of the mandibular
occlusion rim.
• 6.Seat the mandibular record base in
the mouth and place the tips of the
index fingers bilaterally on the buccal
flanges in the area of the second
bicuspids to assure that the record base
is stable when the jaw is moved.

49. • 7.Request the patient to retrude the
mandible and close on the back
teeth but to stop closing the jaw
when he feels that the closure is
sufficient.
• 8. Allow the wax to harden before
removing the tentative record from
the mouth.

50. • 9.Reinsert the record and have
the patient close to maximum
occlusion. Measure the distance
between the points of reference
and compare with the
measurements made with the
mandible at rest.
- If the measurement is less than the
measurement at rest and the
baseplate wax is not penetrated
through to make occlusion rim
contact, the record is acceptable.

51. Evaluating vertical dimension
Patient’s tactile sense:
• Place the trial dentures in the patient’s mouth.
• Instruct the patient to open and close until the teeth contact.
• Ask the patient if the teeth appear to touch too soon, if the jaws
seem to close too far before they touch, or if the teeth feel just
right.
• This method is not very effective with senile patients or with those
who have impaired neuromuscular coordination.
65

52. Swallowing followed by relaxing
1.With the dentures in place instruct the patient to wipe the lips with the tip
of the tongue, swallow and let the shoulders drop in a relaxed position.
• If the teeth are together it can indicate that no interocclusal distance
exists.
2.Two small cones of a soft wax are placed, one in each central sulcus of the
mandibular first molars.
• Encourage the patient to swallow several times.
• If6t5he vertical dimension of occlusion is correct, the wax will be penetrated
and reduced to tooth contact.

53. Phonetics
• Three, thirty-three :There should be enough space for the tip ofthe
tongue to protrude between the anterior teeth.
• Fifty-five : Incisal edges of the maxillary central incisors should
contact the vermilion border of the lower lip at the junction of the
moist and dry mucosa.
• Emma65 and Mississippi :Teeth should not contact.

54. Effects of increased vertical dimension
• Discomfort to the patient.
• Trauma and pain under the basal seat areas of dentures:The jarring
effect of the teeth coming into contact sooner than expected may not
only cause discomfort but in most cases it will also cause pain owing to
the bruising of the mucosa
• Loss of free way space : Muscular fatigue of any one or group of muscles
of mastication. In turn results in annoyance from the inability to find
comfortable resting position.
• Clicking sound :When occlusal vertical dimensions is increased,opposing
cusp will frequently meet each other producing an embarrassing clicking
sound. 65

55. • Appearance : Elongated appearance and at rest the lips are parted;
Patient tries to close them together producing an expression of strain.
• Bone resorption : Due to continuous pressure on the residual alveolar
ridge it undergoes rapid resorption.
• Loss of retention and stability : Leverages are caused due to premature
contacts, further loss of ridge leads to loss of retention and stability.
• Generalized Hyperemia : Space between the teeth is essential when
mandible is at rest. If no space is present between the teeth in denture, it
may result in generalized hyperemia.

56. Effects of decreased vertical relation
Inefficiency : Pressure which is possible to exert with teeth in
contact decreases considerably with over closure because the muscles of
mastication acting from attachments have been brought closer together.
Cheek, Tongue and lip biting : Loss of muscular tone, as well as
reduced vertical height, the flabby cheek tend to become trapped
between the teeth during mastication.
Appearance (Denture look) : The general effect of over closure on
facial appearance is of increased age because of closure approximation of
nose to chin, soft tissue sag and fall in and the lines on the face are
deepened.

57. Angular cheilitis (perleche):
A reduced vertical dimension results in a crease at the
corners of the mouth beyond the vermilion border and the
deep fold thus formed becomes bathed in saliva thus
leading to infection and soreness.
Pain in temporomandibular joint :
Over closure may cause pain in temporomandibular joint
probably due to strain of the joint and associated
ligaments.
58

58. REVIEW OF LITERATURE

59. Reestablishment of Occlusal Vertical Dimension in Complete DentureWearing
in TwoStages
61
Case Reports in Dentistry. 2015;2015:1-5.
A 65-year-old woman came to a Dental School, Brazil,
The complete dentures were fabricated 23 years ago and her principal complaint was poor esthetics and ear pain.

60. • The present clinical report describes a method of gradual reestablishment of ovdusing diagnostic
acrylic splint on artificial teeth in old complete dentures before the manufacture of new complete
dentures.
• The use of diagnostic occlusal acrylic splints on old complete dentures with an altered ovd is an
effective and reversible treatment,gradually allowing reestablishment in the OVD ,verifying the
patients ability to tolerate the proposed increase before manufacturing a new complete denture set.

61. The Study of the Effect of Altering the Vertical Dimensionof
Occlusion on the Magnitude of Biting Force
• Aim:Todevelop a device capable of measuring the biting force generated during maximum
biting, during a change inVD and to determine, the relationship between theVDO and the
biting force.
• Materials and Methods: Indigenously fabricated electronic gnathodynamometer was used
to record biting force of 10 individuals at alteredVD.The range of alteration was chosen from
increased 7.5 mm to decreased 4.5 mm and establishedVDO as baseline.
• Results: Bite force was maximum at theVDO in edentulous subjects. Maximumbiting
force recorded atVDO was reduced with subsequent increase or decrease inVD.
• Clinically highest biting force could act as an aid in determining and verifyingVDOfor
edentulous patients
Journal of InternationalOral Health 2015; 7(11):1-5

62. Reliability of determining vertical dimension of occlusion in
complete dentures: A clinical study.
• Objectives :1.Toassess the reliability of the conventional
methods in obtaining vertical dimension. 2.Toanalyse
changes in morphologic face height after extraction. 3.To
assess the reliability of measuring base of nose to chin
distance in obtaining vertical dimensions.
• Results: Nose-chin measurement has a significant corelation
with cephalometric measurements, hence it is found to be a
very effective pre extraction aid in determining vertical
dimension. However, reliability of pre extraction records in
long period of edentulousness is limited.The conventional
methods used to determine the vertical dimension are not
reliable
The Journal of Indian ProsthodonticSociety. 2006;6(1):38.

63. Conclusion
• Many methods of assessing and recording vertical jaw
relations in edentulous patients have been presented and
evaluated.
• Since there is no precise scientific method of determining
the correct vertical relations, the registration of vertical
relations depends upon the clinical experience and
judgment of the dental surgeon himself.
• Several methods should be used to verify the vertical
dimension and there is no one single best method todo
so.

64. REFERENCES
1. Prosthodontic treatment for edentulous patients : Boucher 9th Edition
2. Textbook of complete dentures : Charles M. HeartwellJr.,ArthurO Rahn, 4th and 5thEdition
3. Marin D, LeiteA, deOliveira Junior N,Compagnoni M, PeroA,Arioli Filho J. Reestablishment ofOcclusal
Vertical Dimension inComplete DentureWearing inTwo Stages.Case Reports in Dentistry. 2015;2015:1-5.
4. Gosavi SS, Ghanchi M, Patil S, Sghaireen MG,AliAH,AberAM.The Study of the Effect of Altering the
Vertical Dimension of Occlusion on the Magnitude of Biting Force. Journal of InternationalOral Health.
2015 Nov 1;7(11):110.

65. REFERENCES
5. Bhat VGopinathan M. Reliability of determining vertical dimension of occlusion in complete
dentures: A clinical study. The Journal of Indian Prosthodontic Society.2006;6(1):38.
6. Irving M. Sheppard, Stephen M. Sheppard, “Vertical dimension measurements”, JPD 1975, 34(3):
269 – 277
7. A.J. Turell; “Clinical assessment of vertical dimension”, JPD 1972, 28(3) : 238 –246
8. Silvermann MM; “The speaking method in measuring vertical dimension”, JPD 1953, 3(2) : 193 –
199
9. Swerdlow H; Vertical Dimension literature review, J Prosthet Dent March April 1965,Vol 15, no. 2.
241-247.

66. 65 67