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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 68-71

Assessing the change in occlusal vertical dimension in complete dentures prosthesis after processing: A cephalometric study


1 Assistant Professor, Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
2 MDS Prosthodontics, Department of Restorative and Prosthetic Dental Sciences College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
3 Assistant Professor, Department of Restorative and Prosthetic Dental Sciences College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
4 Professor, Pacific Dental College and Research Centre, Bhilon ka Bedla, Udaipur, Rajasthan, India

Date of Submission24-Sep-2020
Date of Decision05-Jan-2021
Date of Acceptance16-Jan-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Sharayu Nimonkar
Datta Meghe Institute of Medical Sciences, Sharad Pawar Dental College and Hospital, Deemed to be University, Sawangi, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_339_20

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  Abstract 


Introduction: Recording of jaw relations is the most important step in complete denture fabrication. One of the main reasons for complete denture failure is the error, in recording the correct vertical dimension of occlusion and its reproduction in final prosthesis. Methods: Thirty completely edentulous participants were selected for the study. The physiologic rest position of the mandible was used to record the vertical dimension of occlusion, and denture was fabricated following all the steps meticulously for all the study participants. A lateral cephalograph for each patient was shooted twice one with adjusted wax rims at determined the vertical dimension and another at denture insertion appointment. The comparative evaluation of both the cephalographs for the change in the angle made by two projection lines drawn by joining the orientation landmarks was carried out using the software of all the participants. Data were statistically analyzed using the Student's paired t-test, and software used in the analysis was the SPSS software version 22.0. Results: Statistically significant difference was observed in the mean occlusal vertical dimension (OVD) recorded at the Jaw relation stage with OVD in processed complete denture (t = 5.84, P = 0.000). Conclusion: The OVD recorded using the physiologic rest position method was found to be increased in the finished complete denture.

Keywords: Complete dentures, physiologic rest position, vertical dimension of occlusion


How to cite this article:
Nimonkar S, Belkhode V, Thombare R, Singh YP, Saini M, Singh J. Assessing the change in occlusal vertical dimension in complete dentures prosthesis after processing: A cephalometric study. J Datta Meghe Inst Med Sci Univ 2021;16:68-71

How to cite this URL:
Nimonkar S, Belkhode V, Thombare R, Singh YP, Saini M, Singh J. Assessing the change in occlusal vertical dimension in complete dentures prosthesis after processing: A cephalometric study. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 16];16:68-71. Available from: http://www.journaldmims.com/text.asp?2021/16/1/68/322630




  Introduction Top


The mandible articulates in a specific relation with the maxilla, which is recorded in a three-dimensional space, called a jaw relation. The accurate recording of the jaw relation is considered important in successful dental practice.[1],[2] Clinical assessment of the occlusal vertical dimension (OVD) is mostly empirical. There are no reliable instrument-based clinical methods for determining OVD. The noticeable diversity in the methods of recording the OVD has been documented in the literature. Moreover, hence to record an acceptable OVD, a combination of 2–3 methods is suggested.[3] Among those physiologic rest position is considered to be one of the most accepted method described by Niswonger in 1934 and is commonly used in the clinical practice.[4]

Several authors have claimed that changes in the OVD lead to masticatory disorders. A decreased OVD causes temporomandibular disc perforation, problems related to breathing and deglutition, deafness, earache, and loss of masticatory muscle tone. Similarly, an increase in OVD has reported alveolar bone loss, muscle fatigue, bruxism, and signs and symptoms of temporomandibular disorders.[5] Dawson in 1989 stated: “Do not change the vertical dimension of occlusion.... Do not open the bite.” Moreover, hence, this study was undertaken to evaluate whether the OVD recorded at the time of jaw relation remains the same after acrylization of the prosthesis or not and if not how much change in the OVD is permissible to avoid the above said side effect.


  Methods Top


Ethical aspects

Approval for the study was obtained from the Institutional Ethical Committee (Ref. No. IEC/2012-13/843). The participants involved were informed regarding the study, and signed consent was obtained from the participants before starting the study.

Study design

A cross-sectional, observational study was conducted in a period of 2 years (2012–2014). Thirty completely edentulous patients, reporting to the department of prosthodontics, for complete denture prosthesis were included in the study. The sample size was determined by using a sample size formula with the desired error of margin.

Criteria for inclusion of study participants

  • Healthy participants from both the genders
  • Age group ranging between 40 and 60 years
  • Participants with well-formed and high rounded residual ridges
  • Participants with good neuromuscular control.


Criteria for exclusion of study participants

  • Uncooperative participants
  • Participants using denture for more than 2 years
  • Participants diagnosed and treated for temporomandibular disorders
  • Participants with a history of severing medical illness.


Intervention

Complete denture

Complete dentures were fabricated for selected participants. All the clinical and laboratory steps were meticulously followed with standard instruments and materials[6],[7] by a single operator for all the participants under the observation of two subject experts.

The physiologic rest position of the mandible was used to decide the vertical dimension at rest.

The mandibular occlusal rim was adjusted for all the participants using the following equation:

OVD = Vertical dimension at rest (VDR)−Inter-occlusal clearance

It was further verified by using esthetics and phonetics method. All the dentures were fabricated in heat cure acrylic resin Dental Products of India (DPI).

Investigation

Two lateral cephalographs were shooted during the study.

  • First cephalographs were shooted at the time of jaw relation by placing the adjusted maxillary and mandibular wax rims in the oral cavity. The participants were asked to close the mandible to have a rim to rim contact of both the occlusal rims
  • Second cephalogram was shooted with finished complete denture prosthesis in the state of occlusion.


Interpretation

The change in the vertical dimension of occlusion was measured in degrees by recording the angle formed by the intersection of two projection lines (Line I and II) drawn by joining the orientation landmarks [Figure 1].
Figure 1: Schematic diagram for measuring the vertical dimension of occlusion

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The line I: Joining the two points in vertical plane Nasion (N) and Pogonion (Pog).

Line II: A tangent drawn to the body of the mandible (bottom surface) (LM).

These lines were marked on cephalograph for each subject for both the cephalograph (shooted during jaw relation and at denture insertion). Both the lines intersect each other at point (O), denotes as an angle that was used to evaluate the level of accuracy. The changed value of the angle of the mandible was analyzed with standard software AUTO CAD 2013 (Prishi Enterprise, Ahmedabad, Gujarat, India).

Ethical clearance

The Institutional Ethics Committee of DMIMSDU has approved the Research work proposed to be carried out at Sharad Pawar Dental College & Hospital, Sawangi(M), Wardha. Date : 21st March 2012 with Reference no IEC/2012-13/843.


  Results Top


Mean OVD recorded during jaw relations was observed as 65.86 ± 4.48 and mean OVD observed in processed complete denture was 68.46 ± 4.27 [Table 1]. The mean change of the value of the angle of mandible was found to be 2.400 ± 1.720 [Table 2]. A statistically significant difference (t = 5.84, P = 0.000) was observed in mean OVD recorded during jaw relations and in the processed complete denture.
Table 1: Descriptive statistics

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Table 2: Student's paired t-test showing change in the angle of mandible

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  Discussion Top


Jaw Relation Record is one of the most vital steps while fabricating complete denture prosthesis. The proper establishment of OVD improving the functions and esthetics and improves the patient's quality of life.[8],[9],[10],[11],[12],[13] Determining the vertical dimension for an edentulous patient has remained a matter of “clinical judgment” for an operator. Many methods have been documented and proposed to determine the correct vertical dimension of occlusion such as preextraction records, the use of vertical dimension of rest by Thompson and Brodie et al., use of Closest Speaking Space by Silverman, Maximal bite force (Powerpoint and Boos Bimeter) by Boos and Facial and intraoral measurements suggested by Niswonger.[4],[14],[15],[16] Shanahan et al., in 2004, stated that swallowing saliva is the determinative factor in obtaining vertical dimension and also centric relation as mandible enjoy a close relationship with maxilla at this state and teeth of both arches comes in light contact with each other.[17]

None, of the above methods, establishes accurate values for establishing a vertical dimension, which may contribute to the failure of complete denture. Among these many methods used for establishing vertical dimension “Physiologic rest position” is widely used in clinical practice. It is the postural habitual relation of the mandible to the maxilla when the patient is in a relaxed state, and the head is in an upright position with the condyles in neutral unstrained position in glenoid fossa.[18]

However, it is not easy to determine the rest position of the mandible accurately, as a toxic equilibrium in musculature may be affected by several factors, namely. head position, neuromuscular control, age-related problems, etc.[18] MacKay Tingey et al. in 2001 also observed that VDR is influenced by the head position during the recording of jaw relations.[19]

In the present study, it is observed that the vertical dimension recorded during jaw relation using the physiologic rest position of mandible does not remain the same in processed complete dentures. The increase in the angle of mandible observed in this study can be attributed to the technique and the materials used while recording the vertical dimension. These findings are in agreement with the study by Tallgreen and Swerdlow.[20],[21]

To maintain and reduce the chances of alterations in the vertical dimensions after acrylization in the denture, the following factors should be considered:

  1. Wax used for recording jaw relation
  2. Adaption and extent of the permanent record bases
  3. Laboratory-related errors
  4. Properties of acrylic resin used for fabrication.


To minimize the changes, the best quality of bite registration material and wax used for making occlusal rim to be used. The permanent record bases to be used with a better quality of denture base resin materials.

Swords et al. in 2000 evaluated different acrylic resin materials used for denture fabrication and concluded that there were changes in the mean OVDs in different techniques used for the acrylization of dentures.[22]

A change in angle by 2.40 in the mandibular position after acrylization observed in this study is practically not very significant. However, the further increase in these values requires more occlusal correction during the denture insertion appointment or even may demand a new denture to be fabricated to avoid alveolar bone loss.

The values observed in the present study will help the clinicians to set a protocol related to occlusal corrections in the acrylizated dentures. The small sample size is a limitation of the present study. Advanced diagnostic imaging technologies can be considered as a further scope.[23],[24],[25],[26],[27],[28],[29]


  Conclusion Top


Within the limitations of the study, it can be concluded that:

  1. The OVD recorded at the time of jaw relation using a physiologic rest position appeared to be increased in the finished denture
  2. The angle of position of the mandible at the insertion stage of prosthesis showed an increase in the values with a mean of 2.40 when compared to the angle of position of the mandible at the time of jaw relation, which was nonsignificant statistically
  3. An increase in angle beyond 2.40 requires more occlusal correction during the use of a prosthesis or a new denture fabrication
  4. Deciding proper rest position is proportional to the ability of the operator. Physiologic rest position is considered to be the starting point, when other references are lost, but needs its confirmation again by using other methods to come to a conclusion while deciding OVD.


Acknowledgement

Authors wishes to acknowledge the help and support of all the teaching and non-teaching staff of the Department of Prosthodontics, Sharad Pawar Dental College and Hospital. This project is supported by Deanship of Graduate Studies and Scientific Research at Dar Al Uloom University.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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