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[Interceptive treatments for deformities in the vertical dimension].

Vertical dimension deformities result from an interference of multiple etiological factors acting during the growth period. They include maxillary and mandibular growth, dento-alveolar compensations as well as the functional environment. These deformities do not work in total isolation, but usually combine with others present in sagittal and transverse dimensions. Our intervention has to be three-dimensional and take into consideration the interaction of the three dimensions of space. It must address soft tissue components as well as the dento-alveolar and the skeletal ones of the maxilla and the mandible. Interceptive treatment of vertical dimension deformities rests on two pillars: the diagnosis and therapeutics. The diagnostic pillar aims to show how different structures relate to each other as well as with neighboring structures. These structures consist of the soft tissue components that will eventually control the smile, the dento-alveolar component that influences occlusal plane inclination and the skeletal component that determines the vertical facial type. Using this analysis, we classify our patients in categories that facilitate our later therapeutic intervention. The therapeutic pillar is constructed in an attempt to find solutions for the list of problems established during diagnosis and to encourage development of logical individualized thinking, independently of the orthodontic technique used. All of this underlines the importance of choosing an Individualized Orthodontic Therapy based upon concepts that respond to different individual clinical situations and work most effectively to achieve treatment objectives.

Cephalometry↗

Vertical dimension. Part 2: the changes in electrical activity of the cervical muscles upon varying the vertical dimension.

This study was conducted in order to determine the effect of vertical dimension variation on the electromyographic (EMG) activity of the sternocleidomastoid and trapezius muscles. The study was performed on 15 healthy subjects. Basal tonic electromyographic (BT-EMG) recordings were performed by placing surface electrodes on the left sternocleidomastoid and trapezius muscles. BT EMG activity was recorded upon varying the vertical dimension every five millimeters from vertical dimension of occlusion to 45 millimeters of jaw opening (series 1), following the habitual opening path. Afterward, BT-EMG activity was recorded every millimeter from vertical dimension of occlusion to 4 mm, and then every two millimeters from four to ten millimeters (series 2). In series 1, a significant increase of BT-EMG activity was observed in both muscles (simple logarithmic regression analysis). In series 2, a significant increase was observed in the sternocleidomastoid muscle whereas trapezius muscle did not present a significant change. BT-EMG behavior of the sternocleidomastoid muscle in series 2 could be relevant when dentists increase vertical dimension by means of intermaxillary appliances during a short-term period. Moreover, these results add further information to the concept of the interrelatedness between the different components of the cranio cervical-mandibular system.

Adult↗

[Class II--vertical dimension].

The vertical dimension and its implication in the etiology of the class II are described. This dimension is analysed at the level of the cranial base, the maxillary and mandibular bones and alveolar processes. Then, the facial architecture as a whole is considered and particularly the key position of the upper molar. The dorsal and low position of these teeth in the hyperdivergent cases is fundamentally different from the one they occupy in the hypodivergent cases. The therapeutic approach is completely different in both cases and is illustrated by means of three deep overbite and three open bite cases.

Alveolar Process↗

Occlusal vertical dimension in prosthodontics.

Occlusal vertical dimension is important in all aspects of prosthodontics. Unfortunately, there is no scientific method of determining the correct occlusal vertical dimension. The amount of interocclusal rest space (IRS) is a rough guide since muscle tone, which determines the space, is variable. IRS varies greatly from one patient to the next. It will automatically be correct when the occlusal vertical dimension is correct. IRS should not be interfered with regardless of its size. Many techniques have been used for determining occlusal vertical dimension in dentulous and edentulous patients. Regardless of the technique, the occlusal vertical dimension must be determined carefully by the dentist for a successful prosthesis.

Biometry↗

Determination of occlusal vertical dimension: a literature review.

The vertical dimension of occlusion refers to the length of the face as determined by the amount of separation of the jaws. Its determination is important for fabrication of all restorations. Many techniques have been used for measurement of the vertical dimension of occlusion in dentulous and edentulous patients. These range from using preextraction records to the use of swallowing, functionally acquired jaw positions associated with phonetics, and cephalometric radiographs and evaluation of radiopaque paste in the vestibular fornix. There is no universally accepted or completely accurate method of determining the vertical dimension of occlusion in edentulous patients. There seem to be no significant advantages of one technique other than those of cost, time, and equipment requirements. It is the end result that matters. It should be satisfactory to the dentist and the patient from an esthetic point of view and not induce degenerative changes from a functional standpoint. Regardless of the technique, the vertical dimension of occlusion must be determined carefully by the dentist for a successful prosthesis.

Dental Occlusion↗

A comparison of the accuracy of two methods used by pre-doctoral students to measure vertical dimension.

STATEMENT OF PROBLEM: Measuring vertical dimension is a soft-tissue measurement. Therefore, inaccuracy may occur. PURPOSE: The purpose of this study is to compare the accuracy of the Willis gauge method with the caliper method. MATERIALS AND METHODS: The Willis gauge measures the distance between the septum of the nose and the chin. The caliper method measures the distance between reference points on the tip of the nose and the chin. Twenty predoctoral students applied both methods 10 times in measuring the rest vertical dimension (RVD) and the occlusal vertical dimension (OVD) of a single edentulous patient. The measurements obtained from one experienced clinician were selected as controls for the interocclusal distances (IOD) for the Willis and the caliper methods, respectively. One-sided t tests and a 1-sided nonparametric test were used to determine significant differences between the 2 methods (alpha=.05). RESULTS: The variances in the RVD values for the Willis gauge method were higher than for the caliper method for most students. A Wilcoxon signed rank test showed that the accuracy of the OVD measurements for the caliper method was significantly better than for the Willis gauge method (P=.001). This was not the case for the RVD measurements (P=.073). The average IOD for the Willis method was significantly higher than the control IOD (P=.026). The average IOD for the caliper method was not significantly larger than the control (P=.1303). CONCLUSION: This study showed that the use of the caliper method by predoctoral students was a significantly more reliable method of measuring the OVD for the patient evaluated.

Chin↗

Increased occlusal vertical dimension in adult monkeys.

Splints which opened the vertical dimensions on all posterior teeth in five rhesus monkeys were studied over a period of 3 to 36 months. Findings were as follows: 1. The increased vertical dimension of occlusion did not have a pathologic effect on the TMJs. 2. The posterior teeth attached to the splint and the teeth opposing the splint were intruded into the alveolar processes. 3. The nonoccluding incisor teeth extruded, but the epithelial attachment remained close to the cementoenamel junction. 4. The vertical dimension as measured between the markers in the bones of the mandible and maxillae gradually returned toward the pretreatment vertical dimension, although complete closure to this position was not accomplished during the time period of the experiment. 5. The relationship between the epithelial attachment and the cementoenamel junction remained undisturbed by the experiment. 6. After completion of growth, there appeared to be a definite tendency for rebound to the normal pretreatment vertical dimension following increase of the vertical dimension. This was recorded by measurable movements of the teeth.

Animals↗

[Review of the treatment of decreased vertical dimension].

The decreasing of vertical dimension, specially in extremely cases (more than three clinical standard deviations) is a border problem between orthopedics, orthodontics, prosthetics and surgery. The authors reviewed the treatments possibilities proposed by the different specialties.

Adult↗

Influence of vertical dimension on masseter muscle electromyographic activity in patients with mandibular dysfunction.

Occlusal splints were adjusted to different vertical heights and used to single out the influence of vertical dimension of occlusion in increments on BT-EMG activity of the masseter muscle in patients with mandibular dysfunction. The vertical dimension of least EMG activity was determined for each of 60 patients, who were randomly divided into three groups according to the vertical dimension at which the occlusal splint was adjusted: group No. 1, 1 mm from occlusal vertical dimension; group No. 2, mean vertical dimension, 4.25 mm; group No. 3, mean vertical dimension, 8.25 mm. Results showed a significant reduction of masseter BT-EMG activity (series A and B) at the end of the 3-week treatment period for patients in group Nos. 2 and 3 in comparison with group No. 1. Furthermore, the short-term use of occlusal splints with a vertical height that exceeded the so-called physiologic interocclusal distance did not result in an increase in masseter BT-EMG activity. This study suggests that an increase of vertical dimension of occlusion to or near the vertical dimension of least EMG activity by means of occlusal splints can be an effective way to obtain a reduction in masseteric muscle activity.

Adolescent↗

[Determination of vertical dimension of dental occlusion].

Principles and concepts in determining the vertical dimension of occlusion in mutilated dentitions are summarized. Historically, most concepts have been developed for full dentures. However, in the rehabilitation of a mutilated dentition it is often necessary to increase or change the vertical dimension of occlusion. If the vertical dimension of occlusion has to be altered the patient's adaptability to the new position should be tested during a trial period. Determination of the vertical dimension of occlusion is apparently a combination of art, science and experience.

Adaptation, Physiological↗

Rehabilitation of partially edentulous patient with loss of vertical dimension.

A case of rehabilitation of an edentulous patient with loss of vertical dimension is presented here. This patient presents with a Class III dental and skeletal malocclusion with an anterior cross-bite. The objective of this case report is to demonstrate that an accurate assessment of vertical dimension is necessary for good rehabilitation. The original vertical dimension was determined by a series of tests including, kinesiographic, electromyographic and transcutaneous electronic neural stimulation (TENS). Subsequently, the lost vertical dimension was re-established orthodontically. These examinations revealed a general hypertonicity of masticatory muscles due to the lost vertical dimension. Additionally, radiographs of the temporomandibular joint showed anteriorly displaced condyles. Following the completion of orthodontic treatment osseointegrated implants were placed to restore the dental arches.

Adult↗

Vertical dimension: a dynamic concept based on facial form and oropharyngeal function.

Craniofacial vertical dimension is a more accurate measure of facial proportion than mere measurement of the mid and lower part of the face. Craniomaxillary dimension is skeletally determined, whereas facial height of the lower part of the face is partly dependent on the vertical dimension of occlusion. Alterations in the vertical dimension of occlusion can dramatically affect the esthetics of the soft facial tissue. The "Golden Proportion" quantitatively defines ideal measured relationships and encourages a scientific appreciation of beauty. Faces with deficiencies in lower facial balance (brachyfacial) often exhibit insufficient height of the occlusal plane. The scientific literature has suggested a pliability of skeletal muscle allowing for physiologic variance in vertical facial height. Temporomandibular joint compliance is demonstrated with elevations in resting muscle length. Facial balance and location of the occlusal planes are the primary determinants for establishing an appropriate vertical dimension of occlusion.

Electromyography↗

Adaptation of guinea-pig superficial masseter muscle to an increase in occlusal vertical dimension.

To study the effect of increased occlusal vertical dimension on the fibre phenotypes of the superficial masseter muscle, the composition of myosin heavy-chains (MHC), myosin light-chains (MLC) and tropomyosin was investigated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and two-dimensional gel electrophoresis in conjunction with densitometric analysis in normal (control) and bite-opened (5.7 mm increase in the vertical dimension for 1 week) guinea-pigs. The superficial masseter contained two fast-type MHC isoforms, II-1 and II-2, in both the bite-opened and control groups; their relative content (mean+/-SD, n = 7) was 47.8+/-2.9% and 52.2+/-2.9%, in the bite-opened and 44.4+/-3.0% and 55.6+3.0% in control preparations, indicating no significant (p>0.05) changes in MHC composition in association with the bite opening. On the other hand, significant differences in MLC and tropomyosin composition were found between the two preparations. Although the MLC consisted of three components, LC1f, LC2f and LC3f, in both preparations, their relative content (mean+/-SD, n = 7) was 37.1+/-2.4%, 49.6+/-1.6% and 13.2+/-3.2%, respectively, in the bite-opened and 28.1+/-3.1%, 50.9+/-1.6% and 21.0+/-3.5% in the control preparations, indicating that the bite opening induced a significant (p < 0.0001) increase in the relative content of LC1f at the expense of that of LC3f. Although the tropomyosin consisted of two components, TM-alpha and TM-beta, in both preparations, their relative content (mean+/-SD, n = 7) was 91.8%+/-1.9% and 8.2+/-1.9%, respectively, in the bite-opened and 95.9+/-0.7% and 4.1+/-0.7% in the control preparations, showing a significant (p < 0.001) increase in the relative content of TM-beta in relation to the bite opening. These results indicate that in guinea-pigs an increase in occlusal vertical dimension for 1 week changes the composition of MLC and tropomyosin, with no significant change in MHC, in the masseter muscle. These changes might be required to meet altered functional demands.

Adaptation, Physiological↗

Influence of the vertical dimension in the treatment of myofascial pain-dysfunction syndrome.

Occlusal splints constructed at three different vertical heights were used to study the influence of vertical dimension in the etiology of bruxism and MPD syndrome. The vertical dimension of least EMG activity was determined for each of 75 patients who were randomly divided into three groups according to the vertical dimension at which the occlusal splint was constructed. Group I occlusal splints were constructed at 1 mm from the occlusal vertical dimension, group II splints at 4.42 mm, and group III splints at 8.15 mm. Results showed a faster and more complete reduction in clinical symptoms for groups II and III than for group I. The temporary use of occlusal splints with a vertical height exceeding the physiologic rest position did not encourage a greater muscular tonus or hyperactivity of jaw muscles. It can be concluded that elongation of elevator muscles to or near the vertical dimension of least EMG activity by means of occlusal splints is more effective in producing neuromuscular relaxation.

Adolescent↗