Vertical dimension of occlusion

About: Vertical dimension of occlusion is a research topic. Over the lifetime, 732 publications have been published within this topic receiving 8152 citations.

Tooth wear treated with direct composite restorations at an increased vertical dimension: results at 30 months.

Abstract: Statement of problem. Severe tooth wear localized to the anterior maxillary or mandibular teeth with loss of interocclusal space is difficult to manage. Purpose. This study evaluated the outcome of composite restorations placed at an increased vertical dimension of occlusion in such patients. Methods and material. Sixteen patients were restored with 104 restorations in 2 groups. In group A, Durafill composite and Scotchbond Multipurpose dentine adhesive system were used to place direct anterior restorations (N = 52). In group B, Herculite XRV composite and Optibond dentine bonding agent was used (N = 52). The restorations were placed at an increased vertical dimension of occlusion creating a posterior disclusion of 1 to 4 mm. Results. Clinical follow-up showed that the posterior occlusion remained satisfactorily restored after a mean duration of 4.6 months (range 1 to 11 months). Mean follow-up of 30 months has shown a combined success rate of 89.4% for both groups with 93 of the restorations remaining in service. Maintenance in group A was high with 33 failures, but low in group B with 6 failures. Patient satisfaction was reported as good. Conclusion. Direct composite restorations may be a treatment option for localized anterior tooth wear. (J Prosthet Dent 2000;83:287-93.)

Effect of increasing vertical dimension on the masticatory system in subjects with natural teeth.

Abstract: M any studies show that the postural (rest) position of the mandible changes subsequent to dental attrition, loss of teeth, and prosthetic treatment.’ ’ Immediate changes of the mandibular posture may also be achieved in many ways, e.g., by changing the occlusal vertical dimension both in subjects with natural teeth and in those with complete dentures, by placing or removing dentures in edentulous subjects, by muscular fatigue,“-” or simply by changing the position of the head. In spite of these findings, which demonstrate an adaptability of the mandibular posture to changes in occlusal vertical dimension, the concept of constancy of the rest position has not been abandoned by all authors. Increasing the vertical dimension of occlusion is therefore often held to be a hazardous procedure in prosthetic treatment.“-” Results of experiments that increased vertical dimension both in subjects with natural teeth and with complete dentures have been interpreted as deranging the function of muscles and joints of the masticatory system.’ Clinical experience, however, supports the opinion that the masticatory system adapts well to moderate changes in the occlusal vertical dimension, “’ The present study was designed to test the effect of increasing the vertical dimension of occlusion by a modification of the method used by Christensen.’ Electromyography was added to the methods of

Vertical dimension: a study of clinical rest position and jaw muscle activity.

Abstract: A n understanding of factors which determine the position of the mandible with respect to the maxillae is critical for clinical dentistry. One of the more controversial aspects of jaw relation involves vertical rest position. Establishment of a correct vertical dimension of occlusion is of concern in several dental specialties. In the prosthodontic treatment of the edentulous patient, establishment of a correct vertical rest position is considered essential.” ’ Boucher et al.’ noted that if the vertical dimension is too great the patient may complain of soreness of the residual ridges, tightness of facial muscles, and clicking of the dentures during speech. If the vertical dimension is too small, the patient will look older as the lower half of the face is compressed, the cheeks and lips are slack, and the chin protrudes.’ For dentulous patients, Ramfjord and Ash’ have claimed that altering the vertical dimension of occlusion may result in traumatic occlusion. They also warn that altering the vertical dimension of occlusion can be a contributing factor in the progress of periodontal disease.’ Intruding upon the freeway space (interocclusal distance) is also believed to result in continuous hyperactivity of the masticatory muscles..’ Much of the controversy over the significance of clinical rest position stems from imprecise and inadequate definitions. Rest position, defined according to the Glossary of Prosthodontic Terms, 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 the glenoid fossae.“” One can easily see that this definition is inadequate. How is “postural position”

A cephalometric study of the clinical rest position of the mandible

Abstract: 1. Balance between antagonistic muscles can occur at an infinite variety of muscle lengths and tones within certain physiologic limits because of the complex, dynamic character of the neuromuscular system. 2. Certain pathologic states of muscle are recognized clinically: stretch-weakness, shortness, contracture, spasm, hyper-tenseness, fatigue. 3. The ability of a patient to regain the lost vertical dimension with dentures will depend to a large degree on: (a) the amount of lengthening and stretch-weakness of the opening muscles, (b) the amount of shortness and tightness of the closing muscles, (c) the duration and permanence of these changes, (d) the amount of superimposed hyper-tenseness, (e) the degree of coordination and the ability to learn. 4. Of 32 patients studied cephalometrically after the insertion of dentures, 28 showed measurable bone resorption over intervals varying from 5 to 46 months, each patient varying to a different degree. 5. If these 32 patients are divided arbitrarily into those given an adequate interocclusal clearance and those not given an adequate interocclusal clearance, some with rapid rates of resorption and some with little or no resorption will be found in each group. The rate of bone loss appears to be more characteristic of the individual than of the group. 6. Analysis of the data suggests that there are many factors influencing the rate of resorption of edentulous ridge, including anatomic, functional, metabolic, and prosthetic factors, and that dependence on a single factor in the establishment of the occlusal vertical dimension is unsafe.

Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts.

Abstract: Today the clinician is faced with widely varying concepts regarding the number, location, distribution and inclination of implants required to support the functional and parafunctional demands of occlusal loading. Primary clinical dilemmas of planning for maximal or minimal numbers of implants, their axial inclination, lengths and required volume and quality of supporting bone remain largely unanswered by adequate clinical outcome research. Planning and executing optimal occlusion schemes is an integral part of implant supported restorations. In its wider sense this includes considerations of multiple inter-relating factors of ensuring adequate bone support, implant location number, length, distribution and inclination, splinting, vertical dimension aesthetics, static and dynamic occlusal schemes and more. Current concepts and research on occlusal loading and overloading are reviewed together with clinical outcome and biomechanical studies and their clinical relevance discussed. A comparison between teeth and implants regarding their proprioceptive properties and mechanisms of supporting functional and parafunctional loading is made and clinical applications made regarding current concepts in restoring the partially edentulous dentition. The relevance of occlusal traumatism and fatigue microdamage alone or in combination with periodontal or peri-implant inflammation is reviewed and applied to clinical considerations regarding splinting of adjacent implants and teeth, posterior support and eccentric guidance schemes. Occlusal restoration of the natural dentition has classically been divided into considerations of planning for sufficient posterior support, occlusal vertical dimension and eccentric guidance to provide comfort and aesthetics. Mutual protection and anterior disclusion have come to be considered as acceptable therapeutic modalities. These concepts have been transferred to the restoration of implant-supported restoration largely by default. However, in light of differences in the supporting mechanisms of implants and teeth many questions remain unanswered regarding the suitability of these modalities for implant supported restorations. These will be discussed and an attempt made to provide some current clinical axioms based where possible on the best available evidence.