Vertical jaw relation

Vertical jaw relation-COMPLETE DENTURE

1. BASIL JOSE PART 1 VERTICAL JAW RELATION

2. CONTENTs INTRODUCTION DEFENITION VD AT REST VD AT OCCLUSION FREE-WAY SPACE METHODS OF RECORDING IMPORTANCE OF VD COSTEN’S SYNDROME CONCLUSION

3. INTRODUCTION Vertical dimension is the amount of separation between maxilla and mandible in a frontal plane which depends on the TMJ and the tone of muscles of mastication. Even if this relation is easy to record its very critical as any error in VD are the first to produce a discomfort and strain.

4. DEFINITION The length of face as determined by the amount of separation of the jaws –GPT 9 FACTORS AFFECTING: Teeth : act as occlusal vertical occlusal stop Musculature : opening and closing muscles tend to be in a state of minimal tonic contraction

5. Vd at rest “Length of the face when the mandible is in rest position”- GPT Reference point during recording VD at occlusion VD at rest= VD at occlusion+ freeway space Records at physiological rest position of mandible-achieved by functional movements

6. METHODS OF MEASUREMENT : Facial measurement after swallowing and relaxing Tactile sense Measurement of anatomic landmarks Speech Facial expression

7. 1.FACIAL MEASUERMENTS AFTER SWALLOWING AND RELAXING Patient is asked to upright and relax Two reference points are marked on nose and tip of chin Patient is asked to make functional movements Patient asked to relax his shoulders Mandible comes to physiologic rest position Distance between two points measured

8. 2.ANATOMIC LANDMARKS (A)The distance between the pupil of the eye and rima oris (B) distance between anterior nasal spine and the lower border of mandible Measured using Willis guide If both are equal, jaws are considered at rest

9. 3.TACTILE SENSATION Paient asked to stand erect and open his mouth wide till he feels discomfort in his muscles of mastication Next patient asked to close mouth slowly. Stop closing when muscle's feels relaxed Distance between two reference patient point recorded

10. 4.SPEECH Two methods : 1 st METHOD Patient asked to repeatedly pronounce the letter ‘m’. Distance between two reference points is measured immediately after patient stops 2 nd METHOD dentist keep talking to patient and measure the distance between reference point immediately after patient stops

11. 5.FACIAL EXPRESSION Features that indicate jaw at rest position: Skin around the eyes and chin should be relaxed Nostrils relaxed Upper and lower lips should have slight contact in single plane

12. VD AT OCCLUSION ‘The length of the face when the teeth/ occlusal rim or any other stops are in contact and the mandible is in centric relation or the teeth are in centric relation’ – GPT Constant position

13. METHODS FOR DETEREMINING VD AT OCCLUSION MECHANICAL METHODS : do not require any functional movement PHYSIOLOGICAL METHODS

14. MECHANICAL METHODS a) RIDGE RELATION -Distance from incisive papilla to mandibular incisor -Parallelism of ridges b) PRE-EXTRACTION RECORDS -Profile photographs -Profile silhouttes -radiography -Articulated casts -Facial measurements c) MEASUREMENT FROM FORMER DENTURE

15. PHYSIOLOGICAL METHODS -Power point -Using wax occlusal rims -Physiological rest position -Phonetics -Aesthetics -Swallowing threshold -Tactile sense neuromuscular perception -Patient’s perception of comfort

16. Ridge relations The positional relationship of the mandibular ridge to the maxillary ridge - GPT Measure by two methods: Distance from the incisive papilla to mandibular incisors Parallelism of ridge

17. Incisive Papilla to Mandibular Incisors: The incisive papilla is a stable landmark that changes comparatively little with resorption of the alveolar ridge. The distance between papilla to maxillary incisal edge is 6 mm .vertical overlap is 2mm usually. hence distance between incisive papilla and lowe r incisor is approx. 4mm Based on this VD at occlusion calculated

18. Ridge parallelism Parallelism of the maxillary and mandibular ridges, plus a 5-degree opening in the posterior region, often gives a clue as to the appropriate amount of jaw separation.

19. Because the clinical crowns of the anterior and posterior teeth have nearly the same length, their removal tends to leave the residual alveolar ridges nearly parallel to each other. This parallelism is natural, provided there has been no abnormal change in the alveolar process such as previous advanced periodontal disease or gross overeruptions

20. Pre-extraction records Gives an idea about the VD at occlusion of the patient when the teeth were present PROFILE PHOTOGRAPHS: Made before extraction Taken at maximum occlusion Enlarged to actual size of the patient anatomical landmarks are measured and compared Used to determine VD at occlusion

21. PROFILE SILHOUTTE Silhouette means an outline An accurate silhouette is made using cardboard or wire using patients photograph Serves as template..gives VD at rest Positioned on pt’s face while recording VD at oclusion Chin should be at least 2mm above lower border of silhouette

22. RADIOGRAPHY Cephalometric radiographs and radiographic condylar fossa are evaluated ARTICULATED CASTS Maxillary and mandibular cast mounted are used as pre extraction records After extraction the cast are articulated in a separate articulator and inter occlusal distance compared

23. FACIAL MEASUREMENT Two tattoo points are marked on upper and lower halves of face before extraction VD at occlusion is measured Measured using divider or caliper MEASUREMENT FROM FORMER DENTURE Boley’s gauge used to measure distance between border of maxillary and mandibular denture when in occlusion

24. Physiological methods POWER POINT (by B oos ) Maxillary record base with central bearing plate Mandibular record base with bimeter Record bases are inserted in patient’s mouth asked to bite in different degrees of jaw separation Biting force transferred from central bearing plate to bimeter Highest reading point from bimeter is called power point

25. USING WAX OCCLUSAL RIMS Tentative VD are measured and cast are articulated in tentative centric relation Tracing devices attached to rims is used for graphic tracing

26. PHYSIOLOGIC REST POSITION ( Niswonger’s method) Patient is made to sit in upright Occlusal rims are inserted Patient is asked to swallow and relax Lips are carefully parted to measure free way space(2-4mm)

27. PHONETICS SILVERMAN’S CLOSEST SPEAKING SPACE Closest speaking space measures VD in function Upper and lower teeth are in closest relation without contact when c,h , s , j are pronounced Ideally lower incisor should touch palatal surface of upper incisor

28. THE F OR V AND S SPEAKING ANTERIOR TOOTH RELATION : Position of anterior teeth is determined by position of maxilla when F or V is pronounced Position of lower anterior teeth is determined by position of mandible while pronouncing S

29. AESTHETICS Depends on tooth selection SKIN If VD high – skin stretched , nasolabial fold obliterated nasolabial angle increased LIPS Affected by thickness of labial flange Occlusal rim should aid in lip support

30. TACTILE SENSE OR NEURO MUSCULAR PERCEPTION Maxillary record base with central bearing plate Mandibular record base with central bearing screw Both are inserted Central bearing screw is tightened until patient experiences discomfort. This point is recorded. This is repeated Central bearing point is reduced until a comfortable jaw relationship is attained

31. PATIENT PERCEPTION OF COMFORT Record base with extensively tall occlusal rims are inserted in mouth Excessive wax is removed stepwise till comfortable occlusal height is attained Depends on patient cooperation

32. FREE-WAY SPACE Inter occlusal distance The space between teeth at rest Exist only at rest It is the difference between VD at rest and VD at occlusion 1-8mm in natural dentition 2-4mm in CD patients

33. Effects of increased vd Unattractive appearance Discomfort Soreness and ulceration Accelerated ridge resorption Impaired function Clicking of teeth Loss of freeway space

34. Effects of decreased vd Unattractive appearance TMJ problems Angular cheilitis Masticatory inefficiency Loss of tongue space Costen's Syndrome

35. Costen’s syndrome decreased vertical dimension producing a number of symptoms of the TMJ region collectively called Costen's Syndrome SIGNS & SYMPTOMS Mild catarrhal deafness and dizzy spells which are caused by the inflation of the eustachian tube

36. Tinnitus or a snapping voice in the joint, which are experienced during chewing. The patient has painful limited joint movement and tenderness on palpation and certain neuralgic sensation like burning, pricking sensation of the tongue, throat and side of nose and various forms of atypical headache Dryness of mouth due to disturbed salivary function

37. 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 to do so

38. References Prosthodontic treatment for edentulous patients : Boucher 9th Edition  ESSENTIAL OF COMPLETE DENTURE PROSTHODONTICS-WINKER

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