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Vertical jaw relation

Definition –it is the relation of the mandible to the maxilla in


vertical dimension.
- In all the dentulous individuals the teeth act as a vertical stop
to the movement of the mandible when the mouth is closed.
- The muscles & the ligaments attached to the mandible act as
a vertical stop to the movement of the mandible during
mouth opening.
- When all the natural teeth are lost, the vertical stop to the
mandible, during closure of the mouth is lost.
- As long as the muscles and the ligaments attached to the
mandible function normally, the vertical stop of the mandible
during mouth opening functions normally.
- That is the limit of the mandible in a verticle direction during
wide opening of the mouth remains constant for any
individual as long as the muscles, the ligament the joints the
CNS function normally.
- Mandible assumes two position in the direction & gives 2
measurement or dimensions
(1) vertical dimensions at rest position (VDR)
(2) vertical dimension at occlusion position (VDO)
-vertical dimension at rest position is established by the vertical
height of the two dentures when they are in contact.
-The natural teeth establish the occlusal vertical dimension
during jaw development & in (place.
-In the coarse of person’s life time some teeth are lost ,some
are so consequently patient who have retained their natural
teeth may reduce their VD.
CLASSIFICATION:-
(1) MECHANICAL METHODS
(1) pre extraction records
(a) profile radiographs
(b) cast bounded on articulator before extraction
(c) facial measurement before extraction
(2) ridge relation
(a) incisive papilla relation with incisive ridges
(b) ridge parallelism
(3) measurement of former dentures
(2) PHYSIOLOGICAL METHODS
(a) facial measurement
(b) esthetics
(c) phonetics
(d) swallowing threshold
(e) factile sence method
*MECHANICAL METHODS
(1) pre extraction records
(a) profile radiographs –
It is used in research of vertical dimension of occlusal but not
used because of radiation risks they cannot be considered for
routine considered for routine clinical use.
(c) cast bounded on articulator before extraction-
- VD can be measured by using diagnostic casts mounted on
articulator.
- The cast give an indication of amount of space required
between the ridges for teeth of this size.
(d) facial measurement before extraction –
Various devices have been used in different forms making facial
measurement.
-records the relation of the head to the central incisors vertically
anteroposteriorly by placement of a face bow with spectacle
suspension.
-Another method is to record distance for chin to the base of the
nose by pair of caliper &dividers.
(2) RIDGE RELATIONS:-
(a) Incisive papilla relation with incisial edge –
-The incisive papilla is a state land mark that changes little
resorption of the alveolar ridge.
- The distance of the papilla from the incisal edge of the
mandible teeth is app 4mm.
-The incisal edge of the maxillary central incisor is an average
of 6mm below the incisive papilla.
- Therefore the mean vertical overlap of the opposing central
incisor is about 2mm.
- Therefore variations are there so they should be used with
caution.
(b) Parallelism of ridges:
- parallelism of the maxillary & mandibular ridges , plus 5-
degree opening in the posterior region ,often gives a clue as to
appropriate amount of jaw separation .
- The clinical crown of the anterior & posterior has nearly the
same length & their removal tends to leave the parallel alveolar
ridges.
- In some patient teeth are lost at different times & person
finally becomes edentulous it is observed that residual ridges are
no longer parallel.
- The mandibular ridge becomes wider & the maxillary ridges
become narrower.
(3)MEASUREMENT OF THE FORMER DENTURES:
- It can be corrected with observation of the patient‘s face.
- The measurement are made b/w the ridge creasts in the
maxillary & mandibular denture with boley gauge .
- The observation of patient’s face indicates that the distance is
too short or too long a corresponding change can be made in
new dentures.
*PHYSIOLOGYCAL METHODS –
(a) It is not considered as accurate method because it requires
patient’s co-operation, which is variable & alteration in jaw
position can occur during this procedure.
- For it ask the patient to sit upright with his head unsupported.
- After insertions of obvious lips are carefully parted to reveal how
much space is called free-way space, it should be 2-4 mm.
- Formula: - VD at rest = VD at occlusal + freeway space
- If free way space is more than 4mm the VD at occlusal is
considered to be small & if space is less than 2mm the VD at
occlusion may be too great.
(b) Phonetics – The phonetics test of VD include listening &
observing the relationship of the teeth during speech.
- When sounds like CH, S, J are pronounced the upper & lower
teeth reach their closest relation without contact. This minimal
amount of space b/w upper & lower teeth in this position is called
the Silverman’s closest speaking space. This space indicates the
VD of the patient.
-In ideal case the lower incisor should almost touch the palatal
surface of the upper incisors.
- If the distance is too large, it means small VD & if the anterior
touch when sounds are made the VD is too great.
-Effect of high VD- discomfort, trauma, loss of free way space,
clicking teeth.
-Effect of reduced VD- inefficiency, cheek biting, soreness at
corners of mouth, pain at TMJ.
(c) Esthetics –
Esthetics can be used to aid to determine the correct VD
-skin, if the VD is too high the skin of the cheeks will appear
stretch obliterated, & the nasolabial angle will increased.
-lips, if contour & fullness of the lip is affected by thickness of the
labial flange.
- The occlusal rim should be contour to aim in lip support.
- The flattened appearance of the lip indicates lack of lip support.
- The flattened appearance of the lip indicates lack of lip support.
- In some cases VD should not be increased to provide lip support
as it would lead to failure of the denture.
(c) Swallowing threshold –
It considers that at the beginning of the swallowing, the teeth of the
upper & lower jaws almost come in contact.
-This factor can be used as a guide to determine VD.
- A conical occlusal rim made of soft wax is fabricated on the
mandibular record base.
- The upper & lower base is inserted in patient’s mouth, saliva is
stimulated & the patient is asked to swallow.
-The height of the conical wax is reduced due to the pressure
developed while closing the mandible during swallowing.
(d) Tactile sense:-
-In the method a central bearing screw / central bearing plate is
used.
-The central bearing screw fit into the depression
Of the central bearing plate.
- The central screw is progressively tightened so the rims
come towards each other.
- When patient will feel discomfort in his jaw due to over –
tightened, this point is recorded.
- The same procedure is repeated with central bearing plate in
mandibular rim & central bearing screw in maxillary rim.
- The central bearing point is slowly reduced till the patient
indicated a comfortable.
- The repeated procedure avoids errors. The problem with this
method relates to presence of foreign objects in the palate &
tongue space.
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