CLASSIC ARTICLE

Clinical measurement and evaluation of vertical dimension

L. Brian Toolson, DDS, MSD,a and Dale E. Smith, DDS, MSDb
University of Washington, School of Dentistry, Seattle, Wash

etermining the vertical dimension of occlusion is

a critical procedure for a totally or partially edentulous
patient. Many edentulous patients have adapted to a vertical dimension which has decreased due to bone resorption and posterior tooth wear. Restoring the proper
vertical dimension is further complicated because the
rest position may be subject to change.1 Swerdlow2
found that the vertical dimension of rest varies after natural tooth contacts are lost. Also, the rest vertical dimension can undergo a reduction comparable to the loss of
occlusal vertical dimension.
A variety of techniques have been proposed to determine measurements for the correct vertical dimension of
occlusion.3-6 When selecting the best method to use,
criteria to be considered are accuracy and repeatability
of the measurement, adaptability of the technique,
type and complexity of the equipment needed, and the
length of time required to secure the measurement.
This report will discuss the accuracy and repeatability of two simple methods of determining vertical dimension of occlusion: (1) the Sorenson Profile Scale
(Dento-Profile Scale Co, Fond du Lac, Wis) and (2)
measurement of vertical dimension from the base of
the nasal septum to the inferior border of the chin as
shown by Smith.7

EVALUATION OF FACIAL
MEASUREMENTS
The following methods may be used to verify the correctness of facial measurements.
A freeway space or interocclusal distance of about
3 mm should be present between the maxillary and
mandibular occlusion rims. This interocclusal distance
is determined by subtracting the measurement of vertical dimension of occlusion from the vertical dimension
of rest. Clinically, an accurate determination of the interocclusal distance is difficult when measurements are
taken from movable skin tissue.

Read before the Pacific Coast Society of Prosthodontists, Monterey,

Calif.
Read before the American Prosthodontic Society, New Orleans, La.
a
Associate Professor, Department of Prosthodontics.
b
Professor, Department of Prosthodontics.
Reprinted with permission from J Prosthet Dent 1982;47:236-41.
J Prosthet Dent 2006;95:335-9.

MAY 2006

Two methods may be used to determine whether an

adequate interocclusal distance is present.

Observation
The patient is instructed to relax the lower jaw, lightly
touch the lips together, and remain in this position while
the lips are separated and the distance or lack of distance
between the occlusion rims or artificial teeth is observed.
When the lips are separated, a space of approximately
3 mm should be observed between the occlusion rims
or artificial teeth (Fig. 1).
Frequently, a patient will either open when the dentist is parting the lips or will keep the lips tense. When
this happens, the procedure must be repeated a few
times to enable the patient to relax and cooperate.

Movement of the mandible

While the patient is standing, he should be instructed
to relax the lower jaw and lightly touch the lips together.
With the mandible at the physiologic rest position, the
patient should then be instructed to lightly close together until the occlusion rims or artificial teeth make
contact. While the patient is closing, the lower border
of the mandible is observed to see if there is movement
from the rest position to physical contact (Fig. 2). If no
movement of the mandible is observed, there is insufficient interocclusal distance, and the vertical dimension
of occlusion should be reevaluated.
The closest speaking space is defined as the distance
between the occlusion rims or artificial teeth when
the patient is saying words that contain the sounds /s/
or /ch/. There should be a minimum of 1 to 2 mm of
clearance between the occlusion rims or artificial teeth
when the patient is making sounds which contain the
letters /s/ or /ch/ (Fig. 3). Having the patient read aloud
or count will also help in evaluating the closest speaking
space.
If the teeth or rims contact during speech, the vertical
dimension of occlusion is too great. However, if more
than 1 to 2 mm of posterior speaking space exists, it
does not automatically follow that the opening should
be increased. The closest speaking space at the correct
vertical dimension of occlusion for certain Class I
and many Class II patients may be greater than
1 to 2 mm. When the closest speaking space is used to
evaluate vertical dimension, the important feature is
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TOOLSON AND SMITH

Fig. 3. Clearance between artificial teeth while patient is

pronouncing words with /s/ or /ch/ sounds.
Fig. 1. Interocclusal distance between artificial teeth is
present when mandible is at rest position.

Fig. 4. Patient with trial dentures in place, with excessive

vertical dimension. There is obvious facial strain.

Fig. 2. Lower border of base of mandible is observed for

movement while patient closes from vertical dimension of
rest to vertical dimension of occlusion.

that the teeth should not touch at any time during

speech.
The use of speech to determine anterior tooth position and vertical dimension of occlusion has been discussed by Pound.8
When evaluating facial measurements, a few minutes
should be spent observing and talking with the patient.
336

The patient should be comfortable and should not

exhibit any facial strain (Figs. 4 and 5). It is also helpful
to question the patient about the comfort of the vertical
dimension of occlusion that has been determined. This
is not a time to be in a hurry; input from the patient at
this time can prevent a multitude of future problems.

ACCURACY OF TWO METHODS USED

TO DETERMINE VERTICAL DIMENSION
OF OCCLUSION
As discussed by Smith,7 the Sorenson Profile Scale
and chin-nose measurement using a millimeter ruler
and tongue blade are two simple methods of determining and evaluating vertical dimension of occlusion that
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Fig. 5. Same patient as shown in Fig. 4. Vertical dimension

has been corrected, and there is absence of facial strain.

can be used to record a preextraction measurement of

vertical dimension of occlusion for patients who are
having immediate dentures made.
To test the accuracy and repeatability of these two
methods, a group of 13 patients who were treated
with at least one arch of an overdenture, were observed
over a 2-year period. Any changes in the periodontal
health of overdenture abutments,9 incidence and control of caries,10 and changes in the vertical dimension
of occlusion were observed. At each appointment, the
vertical dimension of occlusion was measured by having
the patient bring the posterior teeth lightly together in
centric relation and checking with the Sorenson Profile
Scale and the chin-nose method.
The Sorenson Profile Scale measurement was taken
by placing the nasion locator of the instrument firmly
in the depression at the bridge of the nose and raising
the chin seat until it lightly touched the most inferior
and anterior border of the chin. The measurement was
made to the nearest 0.5 mm (Fig. 6).
The chin-nose distance was determined by placing a
plastic ruler under the base of the nasal septum and placing a tongue blade at a right angle to the ruler and bringing the tongue blade into light contact with the most
inferior part of the chin (Fig. 7) The distance was recorded to the nearest 0.5 mm. All measurements were
made independently, without prior knowledge of previous measurements from other examinations.
In addition, a cephalometric roentgenogram was
completed at each recall examination using a standardized cephalometer. Each patient was instructed to have
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Fig. 6. Measurement of vertical dimension of occlusion using

Sorenson Profile Scale.

Fig. 7. Measurement of vertical dimension of occlusion using

millimeter ruler and tongue blade.

the posterior teeth in light contact while the roentgenogram was made.
The measurements from the cephalometric films
were made between the nasion (nasofrontal suture)
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TOOLSON AND SMITH

Fig. 8. Tracing of cephalometric film showing high contrast structures which were recorded and used to measure changes in
vertical dimension. n, Nasion; ans, anterior nasal spine; s, sella turcica; ptm, pterygomaxillary fissure; m, menton.

and the menton (most interior point on the symphysis of

the mandible) (Fig. 8). The films were perforated at
these points, and a dial caliper measuring device was
used to estimate the distance to the nearest 0.1 mm.
To control tracing errors, the film for each patient was
traced on semitransparent acetate paper using structures
of high contrast such as the body of the mandible, base
of skull, and the sella turcica as guides. The point nasion
was punctured using a sharp point, and the point menton was registered using the mandible and symphysis
as guides for placing the film.
The measurements taken from the cephalometric
films and the measurements obtained by using the
Sorenson Profile Scale and chin-nose distance were
compared using the Pearson Correlation Coefficient
and Student t-test.

RESULTS
Table I shows the decrease in millimeters of the
vertical dimension of occlusion as measured by each of
the methods described previously. The algebraic differences between the chin-nose and cephalometric
measurement and the Sorenson Profile Scale and cephalometric measurement are shown parenthetically in each
column.
Table I also shows the arithmetic mean error between
the chin-nose and cephalometric measurement and the
Sorenson Profile Scale and cephalometric measurement.
The mean errors of the chin-nose and Sorenson Profile
Measurements were computed to determine how close
they were to the cephalometric measurements regardless
of whether they were plus or minus.
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Table I. Measurement of change in vertical dimension of

occlusion over 2-year period

Subject

Type of
prosthesis*

Cephalometric
measurement

1
OVD/OVD
21.5
2
CD/OVD
20.3
3
OVD/RPD
20.2
4
CD/OVD
20.2
5
OVD/OVD
21.4
6
OVD/OVD
20.2
7
CD/OVD
21.1
8
CD/OVD
22.1
9
OVD/CD
23.9
10
OVD/NAT
21.6
11
CD/OVD
20.1
12
OVD/RPD
21.3
13
OVD/OVD
24.5
Arithmetic mean error between
cephalometric and chin-nose and
cephalometric and Sorenson
Profile measurements

Sorenson Profile
Chin-nose
Scale
measurement measurement

25 (23.5)
25 (23.5)
24 (23.7)
21 (20.7)
20 (10.2)
20 (10.2)
22 (21.8)
23 (22.8)
21 (10.4)
20 (11.4)
23 (22.8)
22 (21.8)
20 (11.1)
11 (12.1)
25 (22.9)
25 (22.9)
23 (10.9)
28 (24.1)
25 (23.4)
25 (23.4)
22 (21.9)
23 (22.9)
23 (21.7)
20 (11.3)
27 (22.5)
24 (10.5)
 = 2.06
 = 2.12
X
X
SD = 6 0.92 SD = 6 1.08

OVD, Overdenture; RPD, removable partial denture; NAT, natural teeth, no

prosthesis present; CD, complete denture.
*Dentures were remade between recall appointments due to lack of interocclusal distance.

The Pearson Correlation coefficient showed a significant correlation between the chin-nose and cephalometric measurement (0.4; P ,.02) and a highly
significant correlation between the cephalometric and
Sorenson Profile Scale measurements (P ,.0001).
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DISCUSSION
Considering that the measurements were taken at
yearly intervals, the measurements taken from both the
Sorenson Profile Scale and the chin-nose methods
were within reasonable limits when compared to the
cephalometric films. It did not require a great amount
of time to take the measurements. The chin-nose
method of measuring vertical dimension of rest and
occlusion is convenient, accurate, and practical because
it requires no sophisticated or expensive equipment
and is easily mastered.
Smith7 found that both the Sorenson Profile Scale
and the chin-nose measurements were reliable methods
to record a preextraction vertical dimension of occlusion. The chin-nose measurement was recorded in an
average of 1.6 minutes,7 which was the approximate
length of time used to record vertical dimension of
occlusion in this study.
The measurement is difficult to record when a patient
has a round facial profile or facial hair. In these situations, it is difficult, if not impossible, to place the tongue
blade and millimeter ruler with consistent accuracy. The
measurements are more consistent and accurate with
patients who have a flat facial profile and absence of
facial hair.

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occlusion. The chin-nose measurement is convenient

and one of its primary advantages is that the measurement is not taken from chin tissue, which is movable.
Regardless of the method used to record measurements, they should be evaluated by observing adequate
interocclusal distance, closest speaking space, and absence of facial strain or patient discomfort.

REFERENCES
1. Atwood DA. A cephalometric study of the clinical rest position of the
mandible. Part I: the variability of the clinical rest position following
the removal of occlusal contacts. J Prosthet Dent 1956;6:504-9.
2. Swerdlow H. Roentgencephalometric study of vertical dimension changes
in immediate denture patients. J Prosthet Dent 1964;14:635-50.
3. McGee GF. Use of facial measurements in determining vertical dimension. J Am Dent Assoc 1947;35:342-50.
4. Boos RH. Intermaxillary relation established by biting power. J Am Dent
Assoc 1940;27:1192-9.
5. Lytle RV. Vertical relation of occlusion by the patients neuromuscular
perception. J Prosthet Dent 1964;14:12-21.
6. Silverman MM. Determination of vertical dimension by phonetics. J Prosthet Dent 1956;6:465-71.
7. Smith DE. The reliability of pre-extraction records for complete dentures.
J Prosthet Dent 1971;25:592-608.
8. Pound E. Let /S/ be your guide. J Prosthet Dent 1977;38:482-9.
9. Toolson LB, Smith DE. A 2-year longitudinal study of overdenture patients.
Part II: assessment of the periodontal health of overdenture abutments.
J Prosthet Dent 1982;47:4-11.
10. Toolson LB, Smith DE. A 2-year longitudinal study of overdenture patients.
Part I: incidence of control of caries on overdenture abutments. J Prosthet
Dent 1978;40:486-91.

CONCLUSIONS AND SUMMARY

Two methods of determining vertical dimension of
rest and occlusion were compared with measurements
taken from cephalometric films to determine their reliability and accuracy. Both methods using the chin-nose
and Sorenson Profile Scale measurements were reliable in recording preextraction vertical dimension of

MAY 2006

0022-3913/$32.00
Copyright 2006 by The Editorial Council of The Journal of Prosthetic
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doi:10.1016/j.prosdent.2006.03.013

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