Vertical-Jaw-relations-Dr.-K.-Krishna-Kishore.ppt

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1. SIBAR INSTITUTE OF DENTAL SCIENCES
Department of prosthodontics
JAW RELATIONS
Dr. K. Krishna Kishore
Professor & HOD

2. Definition of jaw relation: -
any spatial relationship of the maxilla to the
mandible - GPT.
Basically there are three different types of jaw
relations. (ACC to Boucher)
•Orientation jaw realtion.
•Vertical jaw realtion.
•Horizontal jaw realtion.

3. VERTICAL JAW RELATION

5. Definition

It may be defined as the vertical measurement of the face
between any two arbitrary selected points which are conveniently
located one above and one below the mouth usually in the
midline.

OR
Vertical jaw relation can be defined as those relations established
by the amount of jaw separation in a vertical direction under
some specified conditions (pre-determine conditions).

6. ACCORDING TO BOUCHER VERTICAL JAW RELATIONS ARE OF TWO
TYPES:
VERTICAL JAW RELATIONS OF REST POSITION
VERTICAL JAW RELATIONS OF OCCLUSION
VERICAL JAW RELATION OF REST POSITION IS ALWAYS GREATER
THAN VERTICAL JAW RELATION OF OCCLUSION

7. Vertical jaw relation of rest position or physiologic rest position of
mandible:
Definition:-
It is a postural position of mandible when the opening and
closing muscles of mandible are said to be in minimal tonic
contraction.
• Position where lips come in contact and teeth will not contact.
•Vertical dimension of rest is a measurable distance, a repeatable
reference with an acceptable range and a useful reference when
establishing a vertical dimension of occlusion.

8. Vertical jaw relation of rest position is a postural position
that is controlled by
 Opening and closing muscles
 Muscles responsible for the actions in mastication,
speaking, swallowing and breathing
 Position of head of the condyle

9. Factors affecting vertical jaw relation of rest:
•Mandibular position is influenced by gravity, position depends on
posture. Patient should sit upright with out head rest and look
straight.
•The rest position is relaxed position of the mandile. A
questionable variation in value may occur if the patient is tense,
under strain, nervous, tired, irritable.
•Patient suffering from neuromuscular disturbances require
special consideration.

10. •Dentist should make measurement of rest position without
delay since it cannot be maintained by a conscious patient
for a long period of time.
•No one method for determining rest position can be accepted
as being valid for all patients. It is advisable to use several
methods and compare the results.

11. SIGNIFICANCE OF PHYSIOLOGICAL REST POSITION:
•It is a border to border or bone to bone relation in vertical direction
•It is postural position of mandible
•It differs with defferent postures
•It can be re-recorded
•It helps in measuring vertical dimension
•It is of very short duration, hence dentist should be very quick in
recording it
•In absence of any pathology of t.M.J. This record is fairly constant
•In denture construction, it is used as a guide to re establish lost vertical
relation of occlusion

12. Vertical jaw
relation
at occlusion
Free way space

13. Free way space: - (synonyms)
 Inter occlusal distance
 Inter occlusal clearence
Definition: it is defined as the distance between the occluding surfaces of the
maxillary and mandibular teeth when the mandible is in its physiological rest
position.
Average free way space is 2-4 mm observed at the position of 1st premolar
In natural dentition average freeway space ranges from 1 – 8 mm
The free way space vary from patient to patient
Inter occlusal distance = defference between the vertical jaw relation of rest
and vertical jaw relation of occlusion
Importance of free way space is put forward by niswonger and thompson
Significance: adequate freeway space is necessary for comfort of the patient, to
maintain health of supporting tissues and proper functioning of dentures.
Inter occlusal gap
Inter occlusal rest space

14. METHODS OF DETERMINING VERTICAL JAW RELATION

1.Mechanical methods
2. Physiological methods
I). Mechanical methods:-
A). Ridge relation:-
i . distance of incissive papilla from mandibular incisors
Ii. Parallelism of ridges
B). Measurement of former dentures
C). Pre extraction records
 Profile radiographs & photographs
 Casts of the teeth in occlusion
 Facial measurements
 Profile silhouettes

15. 2. PHYSIOLOGICAL METHODS :
a. PHYSIOLOGIC REST POSITION
b. PHONETICS AND ESTHETICS
c. SWALLOWING THRESHOLD
d. TACTILE SENSE, AND PATIENT REPORTED
PERCEPTION OF COMFORT

16. MECHANICAL METHODS:
1.RIDGE RELATION:

A.Distance of incisive papilla from mandibular incisors:-

 Incisive papilla is a stable land mark and is changed
little by resorption of the residual alveolar ridge.
 The distance of incisive papilla from the incisal edge of the mandibular
anterior teeth averages approximately 4 mm in the natural normal
dentition.
 The distance of incisive papilla from the incisal edge of the maxillary
aterior teeth in 6 mm
 the vertical overlap between the upper and lower incisors is 2 mm based
on this value, the vertical dimension at occlusion can be calculated.

17. B. PARALLELISM OF RIDGES : -
 THE MANDIBLE IS PARALLEL TO THE MAXILLA ONLY AT
OCCLUSION. THIS FACTOR CAN BE USED TO DETERMINE THE
VERTICAL DIMENSION AT OCCLUSION.
 IN PATIENTS WHERE THE UPPER AND LOWER TOOTH ARE
EXTRACTED TOGETHER, THE UPPER AND LOWER RIDGES WILL BE
PARALLEL, THIS METHOD CAN NOT BE TAKEN INTO
CONSIDERATION WHEN THE PATIENT HAD LOST THERE TEETH AT
DIFFERENT PERIODS OF TIME AND SUFFERED A GREAT AMOUNT
OF BONE LOSS BECAUSE OF PERIODONTAL DIESEASE.

18. PARALLELISM OF RIDGES
DISTANCE OF INCISIVE PAPILLA
FROM MANDIBULAR INCISORS

19. 2. MEASUREMENT OF FORMER DENTURES :-
Dentures that the patient has been wearing can be measured
and these measurements are used to determine the vertical
dimension at occlusion

 Measurements are made between the borders of maxillary
and mandibular dentures by means of “boley’s guage”.

20. Boley’s gauge

21. 3. PRE EXTRACTION RECORDS:-
A. PROFILE PHOTOGRAPHS :
 Profile photographs are made with the teeth in maximum
occlusion before extraction and enlarged to the life size.
 Measurements of anatomic land marks on the photograph are
compared with measurements using the same anatomic land marks
on the face.
 When recording the jaw relations and during the wax trail the
measurments from the profile photographs are used to determine
the vertical dimension at occlusion

22. Profile radiographs
Profile Photographs

23. B. PROFILE RADIOGRAPHS:-

Types of radiographs are used
cephalometric profile
Condyles in the fossae
There use is limited due to the inaccuracy in the
technique

24. C. ARTICULATED CAST:
When the patient is dentulous the maxillary and mandibular casts are
mounted to articulator by using inter occlusal records
These mounted casts will give an idea about size shape and form of the
teeth and vertical overlap relation and interarch distance
After extraction the edentulous casts are
mounted in a separate articulator the inter arch
distance between the edentulous casts is
compared with that of mounted dentulous casts.

25. PROFILE SILHOUETTES :-
 The word silhouette means out line, an accurate out line is made with
the card board or contoured with lead wire using the patient
photograph this out line can be used as a template
 the out line is taken from pre extraction photograph shows the vertical
dimension at rest. It is positioned on the patient face while recording the
verticle dimension at occlusion. The chin should be at least 2 mm above
the level of lower border of the card board out line.
Outline placed on patient face while
recording the occlusal vertical dimension
2 mm space b/w lower border of chin & card board
Outline made from
preextraction photograph
at physiological rest position

26. Facial measurements:
two tatoo points are marked on the
–Upper half of the face (tip of the nose)
–Lower half of the face (base of the chin)
Patient is insructed to close the jaws in maximum occlusion and
vertical dimension is measured, these measurements are compared
after extraction when the artificial teeth are tried in
 A pair of calipers or dividers can be used to measure the distance
between the

27. Anatomical Landmarks:-
 In this the “Willis Guide” is used to measure the
distance from the outer canthus of the eye to the rima
oris(corner of the mouth) & the distance from the
anterior nasal spine to the lower border of the mandible.

 When both these measurements are equal, then the
jaws are considered at rest.

28. PHYSIOLOGICAL METHODS OF RECORDING

29. 1. Physiologic rest position:
It was introduced by niswonger and thomson in 1934
it is also called as niswongers method.
Procedure:
•Patient is asked to sit upright with his head unsupported &
the eyes looking straight.
•Two tattoo points are marked on the tip of the nose and base
of the chin
•upper and lower occlusal rims are modified according to the
clinical guidances, i.e.,
•Based on the appearance of these anatomical land marks,
nasolabial fold, philtrum, mentolabial fold and corners of the
mouth occlusal rims are adjusted to provide proper lip
support.

30. •Upper occlusal rim should be 1-2mm visible from lower
border of upper lip anteriorly.
•Posteriorly the height of the upper occlusal rim should be ¼th
inch below the stensen’s duct at 1
st
molar area.
•Lower occlusal rim should be approximately at the level of
lower lip anteriorly
•Posteriorly, height of the lower occlusal rim should be ½
height of the retromolar pad.

31. •Anteriorly, the occlusal plane of the upper occlusal rim should
be parallel to the interpupillary line
•Posteriorly, the occlusal plane of the upper occlusal rim should
be parallel to the ala tragus line.
•After adjusting, insert the occlusal rims into the patient mouth
and patient is asked to swallow and relax

32. •When the relaxation is obvious the lips are carefully parted
to see how much space is present between the occlusal rims.
This space is called “free way space”
•When the rest position is achieved measure the distance
between the two points with a divider
•Procedure is repeated until measurements are consistent
•The space between the occlusal rims should be 2-4 mm in
class i jaw relation
•More than 2-4 mm i.e. 4-6 mm in class ii jaw relation
•LESS THAN 2-4 mm i.E. 1-2 mm in class iii jaw relation
•It is measured in the first pre molar region

33. •PATIENT IS ASKED TO SIT UPRIGHT WITH HIS HEAD
UNSUPPORTED & THE EYES LOOKING STRAIGHT.
PROCEDURE:

34. •TWO TATTOO POINTS ARE MARKED ON THE TIP OF THE NOSE
AND BASE OF THE CHIN

35. Lip support is adjusted based on the appearance
of these anatomical landmarks
Philtrum
Mentolabial fold
Nasolabial fold
Corner of
the mouth

36. •Upper occlusal rim should be 1-2mm visible from lower border of
upper lip anteriorly.
•Posteriorly the height of the upper occlusal rim should be ¼th inch
below the stensen’s duct at 1
st
molar area.

37. •Lower occlusal rim should be approximately at
the level of lower lip anteriorly
•Posteriorly, height of the lower occlusal rim
should be ½ height of the retromolar pad.

38. •Anteriorly, the occlusal rim should be parallel to the interpupillary line
•Posteriorly, the rim should be parallel to the ala tragus line.

39. Freeway
space
Measuring distance between
two tatto points

40. PHONETICS AND ESTHETICS AS GUIDES:
•In phonetic method dentist will ask the patient to speak
certain words and observe the relationship of the occlusal
rims together.
•Methods for recording during phonetics :
1.Silvermans closest speaking space:
2.Repeat the name “emma”
3.Diverting the patient attention
4.Using ‘thirty three’
5.Pound and murrell’s technique

41. 1. Silverman’s closest speaking space

42. 1.Silvermans closest speaking space
•The patient is asked to pronounce sounds like ch, s & j this
brings the anterior teeth very close together when correctly
placed the lower central incisors come forward nearly
directly below the upper central incisors and almost touching
them.
•If the anterior teeth touch when these sounds are made, the
vertical dimension of occlusion is probably more.
•The minimal amount of space between the upper and lower
teeth which is present when these sounds are pronounced is
called the ‘ silverman’s speeking space’

43. •At correct occlusal vertical dimension there should be
minimum 1mm space between the occlusal rims when
these sounds are pronounced
•If occlusal rims contact, wax should be removed to
reduce the vertical height
•If space is more 1mm wax is added to increase the
vertical height.

44. •The closest speaking space which measures the vertical dimension in phonetic
method given by silverman should not be confused with the freeway space of
the physiological method which was given by niswonger and thompson
•Freeway space establishes the vertical dimension when the muscles are at
rest.
•The closest speaking space establishes the vertical dimension when the jaws
are in the function of speech
•Thus one is the static method (still) and the other is the dynamic method
(moving or functional)

45. 1.ENGAGE THE PT IN A CONVERSATION THAT WILL DIVERT HIS
ATTENTION FROM CONCIOUS PARTICIPATION IN THE PROCEDURE

46. 2.Have the pt to repeat the name “emma” until he is
aware of the contacting of the lips as a first syllabel
“em” is pronounced.
Then ask the pt to stop all jaw movements when the lips
touch. Measure between the two points of reference.
3.Engage the pt in a conversation that will divert his
attention from concious participation in the procedure.
A pause in the speech, will allow the mandible to drop
into relaxed position.
. 4. Using ‘thirty three’- when repeating this number there
should be enough space for the tip of the tongue to
protrude between the anterior teeth

47. •Dr. Earl Pound said the vertical dimension of speech
should be used as the primary guide for establishing
the vertical dimension of occlusion
5. POUND AND MURRELL’S TECHNIQUE:

48. 5. Pound and murrell’s technique:
•This technique is developed by the pound and murrell
•The position of artificial maxillary anterior teeth is determined
by position of the maxilla when the patient says words
beginning with ‘f’ or ‘v’.
•The position of artificial mandibular anterior teeth is
determined by position of mandible when the patient says
words beginning with ‘s’.

49. Procedure:
•Place the maxillary occlusal rim in the patient mouth and adjust
the occlusal rim to provide lip support. When the ‘f’ &’v’ sounds
are pronounced the incisal edges of maxillary anterior teeth create
a seal on the moist area of the vermilion border of the lower lip.
Ask the patient to reapt words “first” or “victor” , ‘five’ and ‘fifty
five’ and contour the wax to create the seal
•Record the midline on the wax-rim and arrange the two artificial
central incisors and check their position in the patient mouth
•Remove the occlusal rim and arrange the lateral incisors and
cuspids

50. •Return the maxillary record base to the mouth and make any
changes necessary for natural appearance
•Seat the mandibular record base with the attached “speaking
wax”, patient is asked to pronounce the numbers ‘six’ and ‘sixty
five’ and adjust to the ‘s’ position. When ‘s’ sounds are
pronounced, the mandible moves forward. The incisal edges of
the anterior teeth do not make contact
•The midline is marked and mandibular record base is removed
from the patient mouth, remove the speaking wax and arrange
artificial central and lateral incisors

51. •Return the mandibular base to the mouth and refine the four
artificial teeth to the ‘s’ position.
•Adjust the hard wax rim on the maxillary record base to
parllel camper’s line. Place notches in it to aid in repositioning
the vertical dimension and central occlusal records
•Place soft recording wax on posterior surface of the
mandibular rim
•Seat the mandibular rim and ask patient to retrude the
mandible from ‘s’ position to a comfortable retruded position
• Remove the record from the patient’s mouth and check for
alignment and sufficiency. Correct any discrepances and
remove excess wax.

52. The esthetic guide to the vertical maxillomandibular relation
is:
•The selection of teeth as the same size as natural teeth.
•The accurate estimation of the amount of tissue lost from
the alveolar ridges.
•The skin of the lips compared to the skin over other parts
of the face can be used as a guide. The tone of the skin
should be same through out.

53. SWALLOWING THRESHOLD :-
•The position of the mandible at the beginning of swallowing
act has been used as a guide to vertical relation. The theory
behind this method is that, when a person swallows, the teeth
come together with a very light contact at the beginning of
the swallowing cycle.
•If denture occlusion is continuously missing during
swallowing, the vertical dimension of occlusion may be
insufficient.

54. Technique:
•A soft cone of wax is build on the lower denture base in such a way
that it contacts the upper occlusal rim when the jaws are too wide
open. Then the flow of saliva is stimulated by a piece of candy. The
repeated action of swallowing the saliva will gradually reduce the
height of the wax cone, to allow the mandible to reach the level of
vertical dimension of occlusion.

56. 4. Tactile sense and pt perceived comfort:
A) lytle’s method:
•This is done by attaching central bearing screw in the palate of
maxillary denture or occlusal rim and central bearing plate is
attached to the mandibular occlusal rim or trail denture base.
•The central bearing screw is adjusted first so that it is obviously
too long. Then in progressive steps screw is adjusted down -wards
until the pt indicates that the jaws are closing too far.
•These adjustments are reversed alternatively until the height of
the contact feels right.

57. CENTRAL BEARING
SCREW
CENTRAL BEARING
PLATE

58. •B) another method is ask the pt to stand erect and open the jaws
wide until strain is felt in muscles. When this opening becomes
uncomfortable ask him to close slowly until the jaws reach a
comfortable relaxed position.
•Measure the distance between the two points of reference and
compare with the measurements made after swallowing.

59. C) boos bimeter (power point) boos (1940) stated that maximum biting
force occurs at ovd. A device that measures the biting force is
attached to the mandibular record base and a metal plate (central
bearing point) to the maxillary record base. A screw is turned to
adjust vertical relation. The maximum power point is determined on
the spring gauge.

61. IMPORTANCE OF VERTICAL DIMENSION
OR
DISCREPENCIES IN THE VERTICAL JAW RELATIONS AND
EFFECTS ON ORAL AND PARA ORAL STRUCTURES
VERTICAL DIMENSION RECORDING IS
IMPORTANT IN COMPLETE DENTURE FABRICATION
B’COZ THE INCREASE OR DECREASE IN VERTICAL
HEIGHT WILL HAVE ILL EFFECTS ON ORAL AND PARA
ORAL STRUCTURES.

62. DECREASE IN VERTICAL DIMENSION
1.CHEEK BITING
2.APPEARANCE
3.DIFFICULTY OR INEFFICIENCY OF MASTICATION
4.DIMINISHED BITING FORCE
5.ANGULAR CHELITIS (PERLECHE)
6.PAIN IN TMJ
7.COSTEN’S SYNDROME
8.RESORPTION OF ALVEOLAR RIDGE
9.DIMINISHED TONGUE SPACE
10.DIMINISHED FUNCTION OF EAR.
11.DIFFICULTY IN SPEECH.

63. 1.CHEEK BITING:-
A. DUE TO  V.D. AND  MUSCLE TONE, THE FLABBY CHEEK
TENDS TO BECOME TRAPPED BETWEEN THE TEETH
DURING MASTICATION.
B. WHEN OVERCLOSURE IS DELIBERATE, IT IS POSSIBLE TO
AVOID THIS CHEEK BITING BY
 SEATING THE UPPER POSTERIORS MORE BUCALLY THUS
PRODUCING A GREATER OVERJET.
 PUMPING THE BUCCAL FLANGES OF THE DENTURE TO GIVE
ADDED SUPPORT TO THE CHEEK.
2. APPEARANCE:-
APPEARANCE OF THE PATIENT FACE IS ALTERED
CLOSE PROXIMATION OF NOSE & CHIN
1.MUSCLES OF MASTICATION LOOSE THEIR TONICITY
2.LIPS LOOSE THEIR FULLNESS
3.COMMISURE OF LIPS DROPS DOWN WARDS
4.LINES ON THE FACE ARE DEEPENED

64. 3. DIFFCULTY OR INEFFICIENCY OF MASTICATION:-
THIS IS DUE TO FACT THAT THE PRESSURE WHICH
IS POSSIBLE TO EXERT WITH THE TEETH IN
CONTACT  CONSIDERABLY, WITH OVER CLOSURE
B’COZ THE MUSCLES OF MASTICATION ARE
ACTING FROM ATTACHMENTS, WHICH HAVE
BEEN BROUGHT CLOSER TOGETHER.
4. DIMINISHED BITING FORCE:-
THIS MAY BE ADVANTAGEOUS IN CASE OF KNIFE
EDGE RIDGES WHICH CANNOT BE MADE MORE
COMFORTABLE IN ANY OTHER MANNER THAN BY
DECREASING V.D WHERE BY THE TRAUMA IS
DECREASED DUE TO DECREASED BITING FORCE.

65. 5. ANGULAR CHELITIS: (SORENESS OF CORNERS OF MOUTH)
•OVER CLOSURE OF MOUTH OR  IN V.D RESULTS IN
FALLING OF THE CORNERS OF THE MOUTH BEYOND THE
VERMILLION BORDER AND THE DEEP FOLD THUS FORMED
IS BATHED IN SALIVA AND REMAINS MOIST AND THIS AREA
BECOMES INFECTED.
•OPENING THE V.D RESTORES THE CORNERS OF THE MOUTH
TO THEIR NOMAL POSITION.
•5-10 Mg OF RIBOFLAVIN (ORALLY)
6. PAIN IN TMJ:-
GROSS OVER CLOSURE OF THE JAW, MAY RESULT IN PAIN
IN THE TMJ DUE TO THE STRAIN OF THE JOINT AND
ASSOCIATED LIGAMENTS.

66. 7. COSTEN’S SYNDROME:-
•MILD DEAFNESS & DIZZY SPELLS RELIEVED BY
INFLATION OF EUSTACHIAN TUBES.
•TINNITUS
•TENDERNESS ON PALPATION OF TMJ
•VARIOUS NEURALOGIC SYMPTOMS SUCH AS
BURNING OR PRICKING SENSATION OF
TONGUE, THROAT AND SIDE OF NOSE
•DRYNESS OF THE MOUTH DUE TO DISTORTED
SALIVARY GLAND FUNCTOIN.
8. DIFFICULTY IN SPEECH:-
PATIENT IS NOT ABLE TO PRONUNCE
PROPERLY

67. 9. RESORPTION OF ALVEOLAR RIDGE:-
DECREASED BITING FORCE DUE TO DECREASED VERTICAL
DIMENSION CAUSE DECREASED STIMULATION OF BONE
RESULTING IN DENTURE LOOSING ITS ORIENTATION AT THEIR
FOUNDATION BY MOVING FORWARDS & BACKWARDS BY
ROTATION.
10. DIFFICULTY IN HEARING:-
THIS RESULTS BECAUSE OF THE LACK OF TONGUE SPACE
WHICH TENDS TO PUSH THE TONGUE TOWARDS THE THROAT
WHICH LEADS TO CLOSURE OF THE EUSTACHIAN TUBE. THIS
RESULTS IN IMPAIRMENT OF HEARING.

68. INCREASE IN VERTICAL DIMENSION
1.DISCOMFORT
2.PAIN & TRAUMA
3.LOSS OF FREE WAY SPACE
4.CLICKING TEETH (DISTURBANCE OF SPEECH)
5.APPEARANCE
6.RESORPTION OF SUPPORTING TISSUES.
7.CHANGE IN HORIZONTAL RELATION.
8.INSTABILITY OF DENTURES.
9.MUSCLE FATIGUE.
10.DIFFICULTY IN SWALLOWING.
11.ALTERATION OF NORMAL TONGUE MOVEMENT.
12.MID LINE FRACTURE OF MAXILLARY COMPLETE
DENTURE

69. 1. DISCOMFORT:-
INCREASED VERTICAL DIMENSION RESULTS IN
PREMATURE CONTACT OF TEETH

THERE WILL BE ALTERATION OF CERTAIN MUSCULAR
MOVEMENTS LIKE TONGUE AND MANDIBLE WHILE
EATING AND TALKING.

CONSIDERABLE DISCOMFORT UNTIL A NEW CORTICAL
PATTERN HAS BEEN ESTABLISHED.
2. PAIN AND TRAUMA:-
THE EFFECT OF TEETH COMING INTO CONTACT
SOONER THAN EXPECTED MAY CAUSE ONLY
DISCOMFORT, BUT IN MOST CASES IT WILL ALSO
CAUSE PAIN OWING TO THE BRUISING OF THE
MUCOUS MEMBRANE BY THESE SUDDEN AND
FREQUENT BLOWS. PARTICULARLY IT IS SEEN IN
LOWER DENTURE WHERE AREA TO RESIST PRESSURE
IS SO MUCH LESS THAN THE UPPER.

70. 3. LOSS OF FREEWAY SPACE:-
LOSS OF NORMAL FREE WAY SPACE WHEN THE
MANDIBLE IS IN REST POSITION MAY HAVE SEVERAL EFFECTS.
 IT IS DIFFICULT FOR THE PATIENT TO FIND A COMFORTABLE
REST POSITION.
 TRAUMA CAUSED BY CONSTANT PRESSURE ON THE MUCOUS
MEMBRANE.
 MUSCLE FATIGUE OF ANY GROUP OF MUSCLES OF
MASTICATION.

71. 4. CLICKING OF TEETH:-
THE TONGUE HAS BECOME ACCUSTOMED TO THE
PRESENCE OF TEETH IN CERTAIN FIXED POSITIONS, AND
DURING SPEECH IT HELPS TO PRODUCE SOUNDS WITH OUT
THE TEETH COMING IN CONTACT.
 VERTICAL HEIGHT

TEETH ARE RAISED

OPPOSING CUSPS FREQUENTLY TOUCH EACH OTHER

CLICKING SOUND

72. 5. APPEARANCE:-
INCREASED VERTICAL DIMENSION RESULTS IN
ELONGATION OF THE FACE PRODUCING AN
EXPRESSION OF STRAIN WHICH IS OBVIOUS AT REST
WHEN LIPS ARE PULLED.
6. RESORPTION OF SUPPORTING TISSUES:-
 VERTICAL HEIGHT

DOES NOT ALLOW THE MUSCLES TO ELEVATE THE

MANDIBLE TO COMPLETE THEIR CONTRACTION

CONTINUOUS FORCE TO OVER COME THIS
OBSTACLE

RESORPTION OF SUPPORTING TISSUES UNTIL
PROPER
DISTANCE IS ESTABLISHED

73. 7. CHANGE IN HORIZONTAL RELATION:-
INCREASED VERTICAL HEIGHT

CAUSES TRAUMA TO THE SUPPORTING TISSUES

RESORPTION OF SUPPORTING TISSUES WILL CHANGE THE
HORIZONTAL RELATIONS

74. 8.INSTABILITY OF DENTURES :
↑V.D
↓
↑ IN OCCLUSAL PLANE
↓
↓STABILITY OF THE DENTURE
HIGH OCCLUSAL PLANE WILL DISPLACE THE LOWER
DENTURE WHEN TONGUE BRINGS FOOD TO THE LOWER
POSTERIOR TEETH FOR MASTICATORY PURPOSE
9.MUSCLE FATIGUE:
↑ V.D. DOES NOT ALLOW THE MANDIBLE TO REACH THE
PHYSIOLOGICAL REST POSITION, SO THE MUSCLES ARE IN
CONTINOUS CONTRACTION, THIS WILL LEAD TO MUSCLE
FATIGUE

75. 10.DIFFICULTY IN SWALLOWING :
DUE TO ↑ V.D. TEETH WILL MAKE PREMATURE CONTACT,
BECAUSE OF PREMATURE CONTACT OF TEETH THERE WILL
BE DIFFICULTY IN SWALLOWING.
11.MID LINE FRACTURE OF MAXILLARY COMPLETE DENTURE :
DUE TO LEVERAGE IN MID PALATINE AREA THERE WILL BE
MID LINE FRACTURE OF MAXILLARY COMPLETE DENTURE.