DENTAL TECHNIQUE

An intraoral method of verifying interocclusal distance for

completely edentulous patients
Majid Bissasu, DDS, PhDa and Sami Bissasu, DDS, MSc, PhDb

Determining the correct ABSTRACT

occlusal vertical dimension
This article describes a method of verifying the interocclusal distance of edentulous patients by
(OVD) for an edentulous pa- using acrylic resin wafers of different thicknesses. The wafers are attached to the occlusal surface
tient is one of the most of the maxillary wax occlusal rim in the first premolar region to facilitate intraoral verification of
important steps in making the proposed interocclusal distance. This method is straightforward and reduces the registration
complete dentures,1 with of an incorrect interocclusal distance. (J Prosthet Dent 2020;-:---)
different methods having been
described for determining the OVD.2 The presence or fingers when the mandible is in the PRP and observing the
lack of an appropriate interocclusal distance (IOD) is distance or lack of distance between the occlusal rims or
used to evaluate the OVD.1 The IOD, which is also called artificial teeth. However, when evaluating the IOD in the
the freeway space, is the distance between the occluding premolar region, some patients tend to separate their lips
surfaces of the maxillary and mandibular teeth when the in an attempt to help the dentist, and this may result in
mandible is in a specific position.3 It is essential that an contraction of the muscles that determine the PRP.
adequate IOD exits between the maxillary and mandib- Moreover, Boucher13 stated that it is difficult to observe or
ular teeth when the mandible is in the physiologic rest even measure the IOD because such attempts in the
position (PRP). In most people, this distance is 2 to 4 mm mouth disturb the physiologic rest of the mandibular
in the first premolar region.1,4-6 If the IOD is greater than musculature. Winkler4 recommended locating the PRP by
4 mm, the OVD may be decreased, and if it is less than 2 gently touching the lower border of the mandible with the
mm, the OVD may be increased. Many complete den- index finger and asking the patient to close until contact. If
tures fail because the OVD is registered without the index finger detects movement, an IOD exists, if not,
considering the IOD.1,4 The lack of an appropriate IOD the VDO is increased. Toolson and Smith14 recommended
can lead to soreness of the supporting tissues, rapid bone instructing the patient to relax the mandible and lightly
resorption, and clicking of the artificial teeth.4-6 There-
fore, an appropriate IOD between the maxillary and
mandibular wax rims must be determined and perfected.1
Different methods have been used to evaluate whether
the IOD is correct, most commonly by subtracting the
measurement of the PRP from that of the OVD by using a
chin point as a reference.4 Unfortunately, this method is
unreliable1,4,5 because of the instability of the PRP,7,8
movement of the skin at the chin,9 hard and soft tissue
movement of the mandible,10,11 and head posture.12 Zarb
and Bolender1 recommended separating the lips using Figure 1. Acrylic resin wafers.

a
Private practice, Homs, Syria.
b
Clinical teacher, Restorative department, Institute of Dentistry, Queen Mary University of London, London, UK.

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Figure 2. Placement of acrylic resin wafers. A, Occlusal view. B, Lateral view.
touch the lips together. With the mandible at the PRP, the
patient should then be instructed to lightly occlude until
the occlusal rims or artificial teeth make contact. While the
patient is in this position, the lower border of the mandible
is observed to see if there is movement from the rest po-
sition to physical contact. If no movement of the mandible
is observed, the IOD is insufficient, and the OVD should
be reevaluated.
Unfortunately, the methods used for verifying the
IOD of edentulous patients lack accuracy. The purpose
of this article was to present a straightforward and
practical intraoral method of verifying and/or correcting
the proposed IOD for completely edentulous patients.
TECHNIQUE
Eight pairs of acrylic wafers were made of heat-
polymerizing acrylic resin by flasking baseplate wax
(Tenatex; Associated Dental Products LTD) wafers. All
the resin wafers had the same base dimension of
approximately 11 mm in height and 8 mm in width. The
thicknesses of the resin wafers ranged from 1 to 8 mm,
with 1 mm difference between one pair and another
(Fig. 1). A selected pair of wafers should be used to
evaluate the IOD as follows:
1. Seat the patient in a comfortable upright position
unsupported by the head rest.
2. Mark 2 points: at the tip of the nose and at the tip
of the chin.
3. Adjust the maxillary wax rim by following the usual
guidelines.
4. Adjust the mandibular wax rim to meet the maxillary
wax rim evenly in the retruded jaw position and at a
vertical relationship that allows for 3 mm of IOD.
5. Evaluate the retention and stability of the
maxillary and mandibular record bases; any
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
unstable base should be stabilized with denture
adhesive.
6. Select a pair of the resin wafers of the appropriate
thickness. The 3-mm thickness may be used for
most edentulous patients with normal occlusion.
Thicker resin wafers may be used for patients who
need excessive IOD, for example, existing complete
denture wearers with decreased OVD, patients
with severe residual alveolar ridge resorption, or
patients with class II skeletal relationships. Thinner
resin wafers may be used for patients who need
small IOD, for example, patients with class III
skeletal relationships.
7. Remove the maxillary occlusal rim from the pa-
tient’s mouth. With a hot wax spatula, attach the
resin wafers over the occlusal surface of the
maxillary rim in the first premolar region on both
sides (Fig. 2).
8. Insert the maxillary and the mandibular bases into
the patient’s mouth.
9. Ask the patient whether there is contact between
the mandibular rim and the resin wafers when the
mandible is in the PRP. If the height of the
mandibular rim is such that it does not contact
the resin wafers, add thin layers of baseplate wax
over the entire occlusal surface of the mandibular
rim, one at a time, until the patient can barely feel a
touch while closing in the PRP. If the patient feels
heavy contact, reduce the vertical height of the
entire mandibular wax rim and return it to the
patient’s mouth. Repeat this step until the patient
does not feel a touch or can just barely feel a touch
while closing in the PRP.
10. Remove the resin wafers and adjust the mandib-
ular wax occlusion rim to meet the maxillary wax
occlusal rim evenly in the retruded jaw position.
Bissasu and Bissasu
- 2020
11 Record the patient’s maxillomandibular
relationships.
DISCUSSION
The wafers can be made of acrylic resin, baseplate wax, or
metal. Because the IOD ranges from 1 to 10 mm in the
natural dentition,15 the thicknesses of the resin wafers
ranged from 1 to 8 mm, with an approximately 1-mm dif-
ference between one pair and another, enabling the clinician
to verify the proposed value of the IOD. The most recom-
mended IOD for complete denture patients is 2 to 4 mm.1,4-6
Therefore, resin wafers of 3 mm in thickness may be used for
most edentulous patients with normal occlusion.
Regardless of the method used to determine the OVD
for edentulous patients, the OVD should be evaluated by
observing adequate IOD.1,4,14,16 Unfortunately, the
methods used for verifying the proposed IOD for
completely edentulous patients lack reliability.1,4,13
Moreover, Sharry5 stated that an accurate determina-
tion of the IOD is difficult when measurements are made
from movable skin tissue. Therefore, the use of the resin
wafers method can be a more reliable method of verifying
the IOD for completely edentulous patients.
SUMMARY
The presence or lack of an acceptable amount of IOD is
used to evaluate the OVD. Unfortunately, the methods
used for verifying the IOD while determining the OVD for
edentulous patients are not accurate. Three-millimeter-
thick acrylic resin wafers are attached to the occlusal sur-
face of the maxillary wax occlusal rim in the first premolar
region on both sides to verify or correct the proposed 4-
mm IOD for a completely edentulous patient.
Bissasu and Bissasu
3
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Corresponding author:
Dr Sami Bissasu
Department of Restorative Dentistry
Queen Mary University of London
2 Hill Court, Main Rd, Romford
London, RM1 3DA
UNITED KINGDOM
Email: samimbg@hotmail.com
Copyright © 2020 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2020.07.027
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