Increasing occlusal vertical dimension--why, when and how

Total arch extrusion with skeletal anchorage to improve inadequate maxillary incisor display in a case of vertical maxillary deficiency

Inadequate maxillary incisor display can negatively impact facial esthetics. Various treatment options exist depending on the underlying cause and severity of the condition. Skeletal anchorage was used to extrude the maxillary dentition and rotate the mandible backward, enhancing visibility of the maxillary incisors. An extrusion assembly was introduced to achieve orthodontic extrusion. Use of bite raisers and interarch elastics was also discussed. Treatment results demonstrated successful achievement of the treatment goals. In addition to optimal occlusion, the patient's facial profile improved with increased lip fullness. There was an increase in vertical facial height, and maxillary incisor display was significantly improved, resulting in a more pleasant smile. Two-year postretention records evidenced the stability of total arch extrusion to improve maxillary incisor display.

Orthodontic considerations in hypodivergent craniofacial patterns

This article examines the characteristics of hypodivergent craniofacial patterns and explores treatment modalities in response to these features. It discusses the impact of robust masticatory muscles, which produce heavy occlusal forces. In addition, it examines the use of Botox or splints to reduce gonial angles in individuals with a square face. A nonextraction treatment approach supported by temporary skeletal anchorage devices is recommended; however, if anatomical limitations persist, extraction may be necessary when arch expansion, molar distalization, incisor proclination, or interproximal reduction cannot create the necessary space. In hypodivergent cases where a nonextraction approach is impractical, a single-arch extraction strategy may be considered to prevent a reduction in the vertical dimension. Emphasizing esthetics, particularly maxillary incisor display, a protocol of total arch extrusion of the maxillary dentition assisted with temporary skeletal anchorage device, bite raisers, and interarch elastics is suggested.

Interdisciplinary management of an adult patient with significant tooth wear

Adult patients may present with compromised dentitions which require extensive oral rehabilitation. This case report shows the fulfilment of both functional and aesthetic treatment objectives for a patient with significant tooth wear through carefully planned interdisciplinary management. © 2022 Australian Dental Association.

Full Mouth Rehabilitation Using the Twin Stage Procedure in a Patient with Amelogenesis Imperfecta: A Case Report

Amelogenesis imperfecta (AI) refers to a group of inherited odontological disorders that alter enamel formation. The AI variant is based on the primary enamel defect, classified as hypoplastic type I, hypo maturation type II, hypo calcification type III, and hypo maturation type IV. AI is commonly linked with the loss of the normal occlusal plane, the loss of the vertical dimension of occlusion (VDO), and impaired functions and esthetics. This case report describes the Hobo and Takayama twin-stage procedure for the rehabilitation of a patient with hypoplastic AI.

Influence of occlusal vertical dimension on lip positions at smile in completely dentulous adults

Aim

The study was conducted to evaluate the effect of increased vertical dimension on the lip positions at smile in dentulous subjects.

Settings and Design

Invivo - comparative study.

Materials and Methods

Thirty individuals aged between 22 and 30 years were selected for the study. Poly-vinyl siloxane (Jet Bite, Coltene, Switzerland) interocclusal bite records of varying thickness of +1, +2, +3, and +4 mm were made using articulated stone casts for all the participants, respectively. Posed smile photographs at different increased vertical dimensions of +1, +2, +3, and +4 mm were captured with D-SLR camera (Nikon D3200 of 18 megapixels with macro lens, Japan) mounted on tripod stand keeping a uniform distance of five feet from the face. Head positioning device (Genoray CBCT Machine Papaya 3D Plus, Unicorn DenMart, India) was used to stabilize the head position of the participants. Interlabial gap height, intercommissural width, smile index (width/height ratio), incisal edge-to-upper lip distance, incisal edge-to-lower lip distance, and display zone area measurements were made in AutoCAD software (Autodesk, Inc., California, USA).

Statistical Analysis Used

One-way repeated measures ANOVA tests (α = 0.05) and Bonferroni's post hoc tests were performed for statistical analysis.

Results

With increasing occlusal vertical dimension, the interlabial gap height, incisal edge-to-lower lip distance, and display zone area increased significantly (P < 0.001). The smile index decreased significantly as the occlusal vertical dimension increased (P < 0.001). No significant difference was found in intercommissural width and incisal edge-to-upper lip distance.

Conclusion

It was found that an increase in occlusal vertical dimension led to an increase in interlabial gap height, incisal edge-to-lower lip distance, and display zone area measurements, whereas the width of smile and incisal edge-to-upper lip distance did not change with increasing occlusal vertical dimension.

Two-year observation of the occlusal vertical dimension after bite raising via cone-beam computerized tomography: A preliminary study

Variation of the occlusal vertical dimension (OVD) has been discussed empirically for decades, but it has not been thoroughly explored with experimental data. In the present study, cone-beam computerized tomography (CBCT) of six selected patients was conducted to evaluate the bones of the lower facial structures. The anterior lower facial heights (ALFHs), alveolar process heights (APHs), vertical facial pattern (VFP), occluding dentition height (ODH) and condyle space (CS), which were evaluated by three-dimensional (3D) and two-dimensional (2D) lateral cephalometry derived from CBCT, were compared before and two years after the OVD increased full mouth rehabilitation. Consistent significant increases in ALFHs and the VFP indicated the OVD increase, while a significant decrease in the ΔODH indicated compressed dentition. In addition, 55 of the 56 sites (98.21%) of APH measurement illustrated no significant difference before and after treatment. The findings indicated that the increased OVD did not relapse to baseline and was sufficiently tolerated, with mostly constant APHs and an altered ODH after two years of observation in the six patients.

Worn is born: The role of the maxillo-mandibular relation in management of worn dentition

Worn dentition, often accompanied by occlusion changes such as reduced vertical dimension, poses a big challenge to both diagnosis and treatment. Current established causes fail to explain the observed tooth wearing patterns, and the treatments based on the documented pathogeneses are often unpredictable and require frequent maintenance. From the perspective of stomatognathic system, we postulate that the role of maxillo-mandibular relation is a crucial part in the tooth wear progression patterns, and should be well addressed in treatment planning. Incompatible occlusion with the inherent tendency of maxillo-mandibular relation has a profound effect on either wearing of natural teeth or failures of restorations. With the aid of cephalometrics and analysis of occlusion it is now possible to reduce this fallacy and achieve a harmony by re-designing the occlusion. According to our treated worn dentition cases, the restoring treatment guided by the tendency of maxillo-mandibular relation showed very promising results.

Effects of increased occlusal vertical dimension on the jaw-opening reflex in adult rats

OBJECTIVE

Malocclusion with deep overbite and facial esthetics improve when facial height is intentionally increased during orthodontic extrusion of the posterior teeth. Thus, a better understanding of post-treatment stability of increased occlusal vertical dimension (iOVD) in adult patients is important. We focused on the jaw-opening reflex (JOR), which plays an important role in the control of jaw movements during mastication, and investigated the effects of iOVD on the JOR in rats with an electrophysiological technique.

DESIGN

One hundred and twenty 13-week-old male Wistar rats were randomly divided into control and experimental groups. Rats in the experimental group received a 2-mm buildup of composite resin on the maxillary molars at 13 weeks of age. The JOR was induced by low-intensity electrical stimulation of the left inferior alveolar nerve. The electromyographic responses were recorded from the digastric muscle at 13, 14, 15, 17, 19, and 23 weeks of age. JOR properties including latency, duration, and peak-to-peak amplitude were measured and compared between the groups.

RESULTS

The latency of the JOR was significantly longer and the peak-to-peak amplitude was significantly smaller in the experimental group than in the control group from 14 to 19 weeks of age, while the reflex duration was not significantly different. Intra-group comparisons of the latency and peak-to-peak amplitudes among rats 14-19 weeks of age were significantly different between the experimental group and the control group.

CONCLUSIONS

iOVD affected the latency and amplitude of the JOR but not the duration. The JOR adapted after 10 weeks of iOVD.

Evaluation of the Correlation of Ramus Height, Gonial Angle, and Dental Height with Different Facial Forms in Individuals with Deep Bite Disorders

BACKGROUND

Restoring the vertical dimension is a critical procedure in prosthetic dentistry. Anterior facial height has a significant impact on the length of the ramus. Patients with deep bite will exhibit a shorter lower facial height; hence, restoring the vertical dimension esthetically without altering the facial form is highly challenging.

AIM

To evaluate the relationship of gonial angle, ramus height, and dental height with different facial forms.

SUBJECTS AND METHODS

A total of 51 subjects in all facial form aged between 20 and 40 with deep bite were randomly selected. Lateral cephalograms and facial photographs were made for each patient. Ramus height was measured on lateral cephalogram by measuring the distance from articulare to gonion. The gonial angles were calculated and anterior and posterior dental height were measured from cephalogram. Facial forms were evaluated using patient's photographs.

RESULTS

The obtained measurements were evaluated, and compared statistically with one way analysis of variance and regression correlation test. Statistical analysis revealed that there was no correlation found between the gonial angle and ramus height.

CONCLUSION

Correlation found between the ramus height and anterior and posterior dental height in patients with deep bite disorders. The ramus height can be calculated using the formulas 46.42 + (0.095 × AD height), 46.046+ (0.123 × PD height).

Functional and Aesthetic Full Mouth Rehabilitation of a Severely Worn Dentition to Restore Vertical Dimension: A Case Report

Deterioration or malfunction of any part should be viewed as an effect that has the direct or indirect result of one or more identifiable cause. The establishment of definitive goals is the foundation for the full mouth rehabilitation. Severe wear is common in prosthodontic patients whose teeth have been held in functional interference for long period of time. This case report presents a description of a patient's oral rehabilitation with metal ceramic restorations to increase vertical dimension while achieving canine guided occlusion.

Full mouth rehabilitation in a medically compromised patient with fluorosis

Severely worn out dentition needs to be given definite attention as it not only affects aesthetics but can also cause psychological distress to the affected individual. It can cause chewing difficulty, temporomandibular joint problems, headaches, pain and facial collapse. Before any attempt to restore severely worn dentition, aetiology of excessive tooth wear should be established. Severe wear can result from chemical cause, mechanical cause or a combination of various causes. Dental fluorosis can also result in severe wear of teeth. Teeth sometimes become extremely porous and friable with a mottled appearance ranging from yellow to brown-black. There occurs loss of tooth substance and anatomic dental deformities resulting in un-aesthetic dentition requiring full mouth rehabilitation. Here a similar case of full mouth rehabilitation of severely worn dentition due to dental fluorosis in a 27-year-old patient is presented. This case report conjointly presents the uncommon association of diabetes insipidus with dental fluorosis. Diabetes insipidus through its characteristic symptom of polydipsia can result in intake of more than permitted dose of fluoride thus causing dental fluorosis. In literature only few cases have been reported of dental fluorosis in association of diabetes insipidus. Full mouth rehabilitation of the patient was successfully accomplished through well-planned systematic approach to simultaneously fulfill aesthetic, occlusal and functional parameters.

Oral Rehabilitation of a Worn Out Dentition

Noncarious loss of the tooth surface continues throughout the life of a person. One of the most common causes of the noncarious tooth surface loss is tooth wear which is a common condition found in the elderly. A case is presented here which demonstrates the provision of full mouth rehabilitation to a patient with severe worn out dentition and highlights the complexity associated with the treatment of generalized worn out dentition.

How to cite this article

Farooq I, Siddiqui TM. Oral Rehabilitation of a Worn Out Dentition: A Case Report. World J Dent 2012;3(3):265-268.

Principles of smile design

An organized and systematic approach is required to evaluate, diagnose and resolve esthetic problems predictably. It is of prime importance that the final result is not dependent only on the looks alone. Our ultimate goal as clinicians is to achieve pleasing composition in the smile by creating an arrangement of various esthetic elements. This article reviews the various principles that govern the art of smile designing. The literature search was done using PubMed search and Medline. This article will provide a basic knowledge to the reader to bring out a functional stable smile.