Vertical Jaw

Relation
Presented by :
Aravind.M | IVBDS|2007 batch
Under the guidance of Dept. of prosthodontics

RELATION
RELATION

Jaw Relation
Any spatial relationship of the
maxilla to the mandible or any one of
the infinite relationships of the
mandible to the maxilla.

MAXILLO MANDIBULAR RELATION

Jaw Relation
Orientation Jaw relation
Vertical Jaw relation
Horizontal Jaw relation

Vertical Jaw Relation / Vertical

Dimension
Vertical dimension refers to the length of
the face.
It is maintained either by the occlusion of
the teeth or the balanced tonic
contraction of the opening and closing
muscles of mandibular movements.

SIGNIFICANCE
Provides optimal separation
between maxilla and mandible.
If not measured accurately, the
joint will be strained.
If the VD is altered, severe
discomfort to both TMJ and
muscles of mastication.

FACTORS AFFECTING VD
Tooth : Acts as a vertical
stop.
Musculature : Opening and
closing muscles tend to be
in a state of minimal tonic
contraction.

Two measurable lengths of

the face are important
guides in making maxillo
-mandibular relation records
and are referred to as :
Vertical dimension of rest or
physiologic rest position.
(VDR).
Vertical dimension of occlusion
(VDO).

Vertical dimension of
physiologic rest position
(VDR)
Vertical separation of the
jaws when the opening and
closing muscles of mandible
are in a state of minimal
tonic contraction sufficient
only to maintain posture.

Physiologic rest position

The position assumed by
the mandible when the head
is in an upright position, the
muscles are in equilibrium
in tonic contraction and the
condyles are in a neutral
unstrained position is the
physiologic rest position of
the mandible.

Vertical dimension of
occlusion (VDO)
Vertical separation of the
jaws when the teeth or
occlusion rims are in
contact.

Interocclusal Distance
(IOD)
It is generally considered that the teeth should
not be in contact when the jaws are at the
vertical dimension of rest position. The 2 to

FREE WAY SPACE

4mm distance between the upper and lower

teeth when the mandible is at physiologic rest

position is called interocclusal distance (IOD)
frequently referred to as the free way space.

VDR = VDO + IOD

VDR IOD = VDO

EFFECTS OF ALTERED VD
INCREASE IN VDO / DECREASE IN IOD
The chin-nose distance will increase, and then
patients will have an appearance of open
mouth.
Constant pressure to the basal seat area which
will lead to bone resorption.
Soreness of the tissues of the basal seat.
Clicking, of dentures during speech.
Improper phonetics

DECREASE IN VDO / INCREASE IN

IOD
Potentially damaging to the TMJ.
The normal tongue space is limited. Facial

distortion appears more noticeable with over

closure that with the slightly opened closure
because with over closure the chin appears to
be closer to the nose, the commissure of the lips
turns down and the lips lose their fullness.
The muscles of facial expression lose their

tonicity and the face appears flabby instead of

firm and full.
Over closure of jaws may lead to angular chelitis

METHODS OF DETERMINING
VDR
FACIAL MEASUREMENT AFTER
SWALLOWING AND RELAXING.
SPEECH
TACTILE SENSE
MEASUREMENT OF ANATOMICAL
LANDMARKS
FACIAL EXPRESSION.

FACIAL MEASUREMENTS AFTER

SWALLOWING AND RELAXING

Patient is asked to sit upright and

comfortably, eyes looking straight
ahead.
Insert maxillary occlusal rim.
Place 2 points of reference.
Instruct the patient to wipe his lips
with his tongue, to swallow and to
drop his shoulders rest position.
Measure - repeat and take
average.

TACTILE SENSE

Instruct the patient to stand

erect and open the jaws wide
until strain is felt in the muscles.
When the opening becomes
uncomfortable, ask him to close
slowly until the jaws reach a
comfortable relaxed position.
Measure the distance and
compare it.

SPEECH
2 methods:
1st method :
Ask the patient to repeatedly
pronounce the letter M, a certain
number of times. Distance is
measured immediately after the
patient stops.
2nd method:
keep talking to the patient and
measure the distance immediately
after the patient stops talking.

ANATOMIC LANDMARKS

Distance between the pupil of

the eye and Rima oris and the
distance between anterior
nasal spine and lower border
of mandible is measured
using Willis guide.
If both the distances are
equal, jaws are considered at
rest.

FACIAL EXPRESSION

Patients jaw will be in rest

position when he is relaxed.
Skin around the eyes and
chin should be relaxed.
Nostrils are relaxed and
breathing is unobstructed.
Upper and lower lips have
slight contact in one plane.

METHODS OF DETERMINING
VDO
a) Mechanical methods
Ridge relation

Distance from incisive papilla to mandibular

incsiors.
Parallelism of ridges.

Pre-extraction records:
Profile photographs
Profile silhouettes
Radiography
Articulated casts
Facial measurements

Measurement from former dentures

b)Physiological methods

Power point
Using wax occlusal rims
Physiological rest position
Aesthetics
Swallowing threshold
Tactile sense or neuromuscular
perception
Patients perception of comfort.

MECHANICAL METHODS
Ridge relation :
Defined as positional relationship of the
mandible ridge to the maxillary ridge.
a) Distance from the incisive papilla to
the mandibular incisors.
The distance of the papilla from the
incisal edges of lower anterior teeth
averages approximately 4mm in
natural dentition. The incisal edges of
the maxillary central incisors are an
average 6mm below the incisive
papilla. Based on this value VDO can be
calculated.

b) Parallelism of the ridges:

Sears suggested that
correct vertical dimension of
occlusion is at a point where
the jaws are parallel with a
5 degree opening in the
posterior region.

Measurement of the former

dentures:
A Boleys gauge is used to
measure the distance
between the border of the
max and mand denture ,when
the dentures are in
occlusion.This measurement is
used to determine the VDO.

Pre extraction records

Profile radiographs :
Made with teeth in
occlusion. These are
compared with those made
with occlusion rims in
position.
DISADV- Time consuming,
Image distortion, Radiation
hazard.

Profile Photographs
Taken in maximum occlusion
of teeth. The photographs
should be enlarged to the
actual size of the patient. The
distance between the two
anatomic landmarks is then
compared with that of patient
to avoid errors.
Casts of the teeth in
occlusion

Facial Measurements:
Tatoo points are marked on tip of
the nose and base of the chin.
The vertical dimension between
the anatomic landmarks is then
compared with that of patient to
avoid errors. Willis gauge is also
used to measure facial dimension
. One arm contacts the base of
the nose and the other arm
contacts the base of the chin.

PHYSIOLOGIC METHODS
Niswongers
method(1934) :
Two markings are made , one on the
upper lip below the nasal septum, and
the other on the chin.The patient is
told to swallow and relax. The distance
between the marks is measured. The
occlusal rims are adjusted until the
distance between the marks is 2-4
mm less during occlusion.

Disadv- The marks move with the

skin.

Phonetics and
esthetics.
The dentist asks the pt to
speak certain words and then
makes certain observations
of the relationship of the
occlusion rims to each other
and to the lips.

Using msound:
The pt repeats the letter m.
When the lip just touches ask the
patient to hold the jaws still. The
distance between tip of the nose
and chin is measured (VDR).The
occlusion rims are adjusted and
again measured. The second
measurement should be 2-4mm
less than the first
measurement(VDO)

The ch,s,and j sounds:

There should be 1mm space
between the occlusion rims in
the anterior area at correct VDO.
Using 33 :
When repeating this word there
should be enough space for the
tip of the tongue to protrude
between the anterior teeth.
Using f or v sounds:
The max incisors/occlusion rims
should lightly contact the lower
lip at the vermillion border when
pt pronounces these words.

SILVERMANS CLOSEST
SPEAKING SPACE
The 2mm space between the
incisors at correct VDO when
pt pronounces words
containing S eg.
The closest speaking space
measures vertical dimension
when the mandible and
muscles involved are in
physiologic function of
speech.

ESTHETICS
In normal relaxed position the
lips are even
anteroposteriorly and in slight
contact. If the face appears
strained the vertical height
may be more. If the corners
of the mouth droop, making
the chin appear too close to
the nose, then vertical
dimension may be too less.

Swallowing threshold.
The technique is based on
the fact that when a person
swallows, the teeth come
together with a very light
contact at the beginning of
the swallowing cycle. If the
occlusion rims do not come
into contact during
swallowing then the VDO is
less.

Method:
Cones of soft wax having
excessive height are placed
on the lower base. Salivation
is stimulated ( using candy)
and the pt is instructed to
swallow. The repeated
swallowing reduces the height
of the wax to the occlusal
vertical dimension.

 Tactile sense and Patientperceived comfort.

The pts tactile sense is used as a
guide to the determination of the
correct vertical dimension. Using a
central bearing plate attached to
mand: occlusion rim and central
bearing screw attached to max:
occlusion rim, VD is increased too
high. Then in progressive steps the
screw is adjusted downward until
the pt signifies overclosure. The
procedure is then reversed until the
pt signifies that its just right.

 BOOS BIMETER(POWER
POINT)
Boos(1940) stated that
maximum biting force occurs at
VDO.A device that measures the
biting force (Bimeter) is
attached to the mand: record
base and a metal plate to
maxillary.A screw is turned to
adjust the vertical relation . The
maximum power point on the
gauge indicates the correct
VDO.

 Electromyography
Rest position can be
determined by recording the
minimal activity of muscles of
mastication.
SCRIBING GUIDE LINES

Its