Vertical Dimension of Occlusion and Rest

OsseoNews:  What is your protocol for establishing the vertical dimension of occlusion and the vertical dimension of rest in an edentulous patient?

Dr. Jameson: As is customarily done, I first establish the rest position of the mandible. But instead of closing the vertical dimension 2-3mm and then making the occlusal registration, this position is recorded and used as the vertical dimension of occlusion with linear occlusion. To determine the vertical dimension of rest position, I use the artistic concept of facial proportion, i.e., dividing the face into thirds (Figure 1). With the patient standing and instructed to relax and let the mandible “hanging loose and limp” with the lips lightly touching, I make a judgment as to whether the face appears to be within normal proportion. In other words, the chin is not too close to the nose or giving the appearance of being stilted open. A measurement is then made to determine if the distance from below the chin to the bottom of the nose is equal to the distance from the bottom of the nose to the eyebrows (Figure 2). It can be verified by having the patient lick the lips, swallow and then relax and check the measurement. But basically, if the face has normal proportions, the mandible is at rest.

Dr. Jameson is a board certified Prosthodontist who has done considerable work in disseminating information concerning the concept of linear non-interceptive occlusion. He was a consultant in Prosthodontics to the Surgeon General, USAF prior to his retirement from active duty and has been a consultant to the Department of Veterans Affairs.

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5 thoughts on “Vertical Dimension of Occlusion and Rest

  1. you assume by this principle,that all the faces are normocephalic,equal thirds,which is not the case,so what if the face is originaly brachy or dilchocehalic ?

  2. The above concept is just what it is a concept. It merely serves as a guideline for falling in a range of normal. After all what is wrong about “normal”. Generally , in our profession falling under the so called bell curve is a good start to fall into the patients threshold for ADAPTION. There are also the extremes of the bell curve as well. This is well pointed out by the second doctor who brings up the individual varriations of NORMAL ie. long vs. round face. However, these are features that follow as normal for these modicications of so called normal. Dolocephalic and long face with a high mandibular plane angle, vs. brachieocephalic and a flatter angle and more of a horizontal function in the physiology of the mandible. There is so much more on this that it would fill volumes. In short I go back to the origional prosthetics concepts of complete dentures. When you set the teeth correctly in the face for esthetics that is usually the correct vertical dem. of the face. The system normally will adjust to a new rest position with out consequences. Thus, set the teeth vertically for esthetics and horizontally in the face for function. And generally if it looks right, it is right. Please forgive my spelling do to my haste in completing the thoughts. Thanks

  3. I have found that the width of the hand equals te distance from the bottom of the nose to the bottom of the chin.if you set vertical st this distace or slightly less…you have a winner

  4. There is an instrument called the Craniometer.It is an excellent tool in finding a Starting point for vertical dimension. The use of the craniometer and intraoral tracing device is a very accurate way to establish vertical and centric.Using linear occulsion with the above mentioned would be a great start for the edentulous patient.Very effective for the dentate patient also.

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