Reabilitação oral com próteses parciais removíveis após restabelecimento de dimensão vertical de oclusão e tratamento multidisciplinar: relato de caso / Oral rehabilitation with removable partial dentures after restoration of the vertical dimension of occlusion and multidisciplinary treatment: case report

As próteses parciais removíveis (PPRs) são uma alternativa de tratamento viável na prática clínica para reabilitar arcos parcialmente desdentados. Entretanto, o planejamento dessas próteses e preparo bucal prévio são frequentemente negligenciados. O presente artigo tem como objetivo relatar o caso clínico de uma reabilitação oral com PPRs superior e inferior após abordagem multidisciplinar, de modo a enfatizar as fases de um planejamento criterioso e de preparo prévio dos dentes pilares, visando o sucesso e a longevidade da reabilitação. Paciente do sexo masculino de 57 anos de idade compareceu à clínica da Faculdade de Odontologia de Bauru, Universidade de São Paulo, queixando-se da estética de seu sorriso e de algumas ausências dentárias. O indivíduo utilizava uma PPR provisória inferior insatisfatória e apresentava perda de dimensão vertical de oclusão (DVO). Após o exame clínico, radiográfico e estudo do caso em articulador semi-ajustável, realizou-se o planejamento com abordagens restauradoras, endodônticas, periodontais e protéticas. Após tratamento periodontal, foi realizada endodontia dos elementos 12, 15 e 47, confecção de núcleos e coroas nos dentes 12 e 15, restauração a nível gengival para apoio residual no dente 47, restaurações nos dentes 11, 13, 22, 24 e 44 e, por fim, a confecção das PPRs superior e inferior. A abordagem multidisciplinar utilizada neste caso clínico viabilizou o restabelecimento da DVO e possibilitou o sucesso da reabilitação protética(AU)

Removable partial dentures (RPDs) are a viable treatment alternative in clinical practice to rehabilitate partially edentulous arches. However, the planning of these dentures and prior oral preparation are often neglected. This article aims to report the clinical case of an oral rehabilitation with upper and lower RPDs after a multidisciplinary approach, to emphasize the phases of careful planning and prior preparation of the abutment teeth, aiming at the success and longevity of the rehabilitation. A 57-year-old male patient came to the clinic of the Bauru School of Dentistry, University of São Paulo, complaining about the esthetics of his smile and some missing teeth. The subject was using an unsatisfactory lower provisional prosthesis and had a loss of vertical dimension of occlusion (OVD). After the clinical and radiographic examination and the case study in a semi-adjustable articulator, planning was carried out with restorative, endodontic, periodontal and prosthetic approaches. After periodontal treatment, endodontics were performed on elements 12, 15 and 47, creation of cores and crowns on teeth 12 and 15, restoration at the gingival level for residual support on tooth 47, restorations on teeth 11, 13, 22, 24 and 44 and, finally, the making of the upper and lower PPRs. The multidisciplinary approach used in this clinical case enabled the restoration of the OVD and enabled the success of the oral rehabilitation(AU)

Métodos de Registro de Dimensión Vertical Oclusal en Pacientes Dentados: Revisión Sistemática

RESUMEN: La Dimensión Vertical Oclusal, es la distancia entre un punto anatómico fijo en el maxilar y otro sobre la parte móvil de la mandíbula cuando los órganos dentarios están en contacto oclusal. La obtención de este registro determina el espacio vertical necesario para la rehabilitación de los pacientes. En la actualidad existen distintos métodos para el registro de la Dimensión Vertical Oclusal, en este estudio se analizaron: Métodos fisiológicos y métodos mecánicos. El objetivo fue realizar una revisión sistemática, sobre los métodos de registro, para determinar la Dimensión Vertical Oclusal en pacientes dentados. Se recopiló información científica desde Mayo 2019 hasta Julio 2020 en diferentes bases de datos electrónicas, encontrando un tota l de 13948 artículos, después de eliminar artículos repetidos, por título, por resumen y por metodología PICO se seleccionaron un total de 24 artículos para su análisis y clasificación. Más de un autor menciona que no existe un método unirversalmente aceptado o exacto para determinar la Dimensión Vertical Oclusal. Se sugiere la combinación de varios métodos de registro de Dimensión Vertical Oclusal, se debe de considerar la manera más adecuada para lograr un registro más acertado.

ABSTRACT: Occlusal Vertical Dimension is the distance between an anatomical point in the maxilla and another on the mobile part of the mandible when the teeth are in occlusal contact. Obtaining this record determines the vertical space necessary for the rehabilitation of patients. Nowadays there are different methods for the record of the Occlusal Vertical Dimension, in this study the following were analyzed: physiological methods and mechanical methods. The objective was to do a systematic review of the registration methods to determine the Occlusal Vertical Dimension in dentate patients. Scientific information was collected from May 2019 to July 2020 in different electronic databases, finding a total of 13,948 articles, after eliminating repeated articles, by title, by abstract and by PICO methodology, a total of 24 articles were selected for analysis and classification. More than one author mentions that there is no universally accepted or exact method for determining Occlusal Vertical Dimension. A combination of several methods of Occlusal Vertical Dimension registration is suggested; it should be considered the most appropriate way to achieve a more accurate registration.

Full mouth rehabilitation of a severely worn dentition using intraoral scanner and the CAD/CAM double scanning technique / 대한치과보철학회지

With the evolution of the computer-aided design/computer-aided manufacturing (CAD/CAM) technology, the intraoral scanners are playing an increasingly important role, as they are the first step towards a completely digital workflow. The CAD/CAM double scanning technique has been used to transfer the information from provisional restorations to definitive restorations. In this case, a 67-year-old male with esthetically compromised anterior teeth, generalized severe attrition of teeth, and reduced vertical dimension was treated with full mouth rehabilitation including a re-establishment of the lost vertical dimension of occlusion assisted by the crown lengthening procedure. The provisional restorations were fabricated using an intraoral scanner and the CAD/CAM double scanning technique. After the period of adaption, the definitive monolithic zirconia restorations were delivered. The CAD/CAM double scanning technique successfully transferred the occlusal and morphological characteristics, obtained from the provisional restorations, to the definitive restorations.

Impacto da alteração de dimensão vertical na disfunção temporomandibular: revisão integrativa / Impact of vertical dimension change on temporomandibular dyfunction: integrative review

Introdução:A Disfunção Temporomandibular (DTM) é uma condição bastante frequente na população mundial e a identificação de fatores causais, junto ao seu tratamento é de suma relevância para a qualidade de vida dos indivíduos.Objetivo:Objetivou-se por meio de uma revisão integrativada literatura de todos os tipos de estudos, avaliar se a alteraçãode dimensão vertical impacta no aparecimento das disfunções temporomandibulares.Método:As estratégias de busca foram realizadas nas bases de dados "Cochrane Library", "MEDLINE", "Web of Science", "Scopus", "LILACS", "Scielo" e "Google Acadêmico", utilizando os seguintes descritores e/ou palavras: "Temporomandibular Joint Disorders"; "Craniomandibular Disorders"; "Occlusion Vertical Dimension"; "Occlusion Vertical Dimensions"; "Vertical Dimension of Occlusion"; "Vertical Dimension".Resultados:Um total de 4 artigos foram incluídos nesta revisão.A maioria dos estudos demostram que na presença de uma DVO diminuída, o sistema estomatognático é capaz de adaptar-se, não provocando o aparecimento de DTM.Conclusões:Como conclusão, os resultados indicam que não há evidência científica suficiente que permita afirmar que a perda de dimensão vertical predispõe ao aparecimento de sinais e sintomas relacionados à disfunção temporomandibular (AU).

Introduction:TemporomandibularDysfunction (TMD) is a very frequent condition in the world population and the identification of causal factors, along with its treatment, is extremely relevant to the quality of life of the individuals.Objective:The aim of this study was to integrativereview the literature of all types of studies to assess whether loss of vertical dimension has an impact on the appearance of temporomandibular disorders.Methods:The search strategies were performed in the Cochrane Library, Medline, Web of Science, Scopus, Lilacs, Scielo and Google Scholar databases using the following descriptors and / or words : "Temporomandibular Joint Disorders"; "Craniomandibular Disorders"; "Occlusion Vertical Dimension"; "Occlusion Vertical Dimensions"; "Vertical Dimension of Occlusion"; "Vertical Dimension". Results:A total of 4 articles were included in this review. Most of the studies show that in the presence of a reduced OVD, the stomatognathic system is able to adapt, not provoking the appearance of TMD. Conclusions:In conclusion, the results indicate that there is insufficient scientific evidence to show that the loss of vertical dimension predisposes to the appearance of signs and symptoms related to temporomandibular dysfunction (AU).

Evaluation Of The Co-Relation Between The Vertical Dimension Of Occlusion And The Length Of The Right-Hand Palm- An Anthropometric Study

CONTEXT: The accurate determination of vertical jaw relation is extremely important for successfully achieving comfort, function and esthetics for an edentulous patient.AIM:The aim of this study was to find a correlation between vertical dimension of occlusion (VDO) and length of right hand palm.METHODS AND MATERIAL:The study was conducted on 60 dentate subjects (30 Males and 30 Females) who fulfilled the inclusion criteria. Anthropometric measurements of vertical dimension of occlusion and length of right hand palm were recorded. Correlation between VDO and length of right hand palm was studied using Pearson's correlation test and unpaired t test used to find correlation among males and females VDO & right palm.RESULTS:Pearson's correlation test showed that VDO in both males (r=0.8001, p value=000) and females (r= 0.9556, p value=000) has strong coefficient correlation with the length of right hand palm. The study also suggested by unpaired t test that there is no statistical correlation between the males and females VDO (t= -0.3366, p value=0.7377) and length of right palm (t= -0.1046, p value=0.9170)CONCLUSIONS: Within the limitations of this study, it was concluded that for males and female subjects VDO and length of right hand palm was highly correlated and this anthropometric measurement can be used to determine VDO in edentulous patient.

Correlation of Vertical Dimension of Occlusion with Various Facial Dimensions in Male Kashmiri Populationan Anthropometric Research

The study was conducted in male Kashmiri population to correlate VDO with various facial measurements, since there is no absolute method to determine the VDO for all individuals. The facial landmarks can reliably be used to determine occlusal vertical dimension in edentulous patiens since they are accessible and relatively unchanged throughout the life. Objectives of the study: To correlate various facial measurements with vertical dimension of occlusion in male Kashmiri population.Methods:A total number of 200 dentate male kashmiri subjects in the age group of 20-50 years were selected for this study. The vertical dimension of occlusion was measured between subnasion to menton.DigitalVerniercaliper was used for measuring different facial parameters that were selected for this study. The results were tabulated by employing Student’s independent t-test. Graphically the data was presented by bar diagrams. A P-value of less than 0.05 was considered statistically significant.Results: The results of this study revealed that parameter superior surface of right ear to inferior surface of right ear, center of pupil of right eye to center of pupil of left eye and distance from the outer canthus of the right eye to right ear show no significant difference with VDO in male gender and hence can be correlated positively with VDO in males.

Consideraciones para el incremento de dimensión vertical de oclusión. Reporte de un caso / Considerations for the increase of occlusal vertical dimension. Report of a case

RESUMEN La dimensión vertical de oclusión (DVO) está representada por la distancia entre dos puntos, que no se pierde; sin embargo, puede verse aumentada o disminuida. Depende en buena medida de la dentición presente. Entidades patológicas como la atrición severa pueden influir su condición. La ruta clínica para llegar a la determinación de realizar un incremento de DVO es un proceso meticuloso, parte de un diagnóstico certero, cuantificación de la misma, así como la vía para realizar el procedimiento. Existen múltiples métodos para la terapéutica del incremento de DVO: dispositivos removibles o fijos. La elección del plan de tratamiento será con base en las particularidades de cada paciente. No existe tratamiento universal sino uno ideal para cada situación específica. Este caso describe las consideraciones previas al aumento de DVO en un paciente masculino de 68 años con atrición generalizada. Se evaluó la magnitud de la reducción de DVO, perfil facial y estética mediante análisis fotográfico y video; el esquema oclusal y la estructura dental presente. La literatura propone calcular con diferentes métodos el restablecimiento de la DVO; antes de elegir alguno se requiere definir y especular qué tanto se encuentra disminuida, para ello no basta un análisis estático o de simple apreciación, debe considerarse el aspecto facial, así como la dinámica mandibular. El incremento de la DVO en una sola intención, mediante restauraciones provisionales, mantenidas dentro de los parámetros de comodidad, es un excelente recurso para ejecutarla, el paciente experimenta una fase de adaptación favorable y sin complicaciones sintomáticas.

ABSTRACT Occlusal vertical dimension (OVD) is represented by the distance between two points, which is not lost, however, can be increased or decreased. Depends to a good extent on the present dentition. Pathological entities such as severe attrition can influence their condition. Clinical route to arrive at the determination to perform an increase of OVD is a meticulous process, part of a correct diagnosis, quantifi cation of the same, as well as the way to perform the procedure. There are multiple methods for this treatment: removable or fi xed devices. Choice of treatment will be based on the particularities of each patient. There is no universal treatment but an ideal for each specific situation. This case describes the considerations prior to the increase of OVD in a 68-year-old male patient with generalized attrition. Magnitude of OVD reduction, facial and aesthetic profi le was evaluated by means of photographic and video analysis; the occlusal scheme and the dental structure present. Literature consulted proposes to calculate with different methods the reestablishment of OVD, before choosing one it is necessary to defi ne and to speculate how much it is diminished, for it is not enough a static analysis or of simple appreciation must consider the facial aspect, as well as the mandibular dynamics. Increasing OVD in a single intention, through provisional restorations, maintained within the parameters of comfort, is an excellent resource to execute it, the patient undergoes a phase of favorable adaptation and without symptomatic complications.

Dimensión vertical oclusal mediante antropometría de los dedos de la mano: validación del método antropométrico de Ladda / Occlusal vertical dimension by anthropometry of fingers: validation of Ladda´s anthropometric method

RESUMEN: Objetivo: Validar en población chilena, el método antropométrico indio de Ladda que estableció en la población chilena una correlación positiva entre la dimensión vertical oclusal y longitud de ciertos dedos de la mano. Materiales y métodos: Estudio de tipo transversal, 151 adultos jóvenes, 76 hombres y 75 mujeres. Se replicó el trabajo referencial, utilizando un pie de metro digital, realizando mediciones de los dedos índice y meñique y la distancia desde la punta del pulgar a la punta del índice de la mano derecha, correlacionando las mediciones obtenidas con la dimensión vertical oclusal y aplicando el coeficiente de correlación de Pearson. Resultados: La dimensión vertical oclusal presenta correlación estadísticamente significativa con los parámetros estudiados. En hombres, la correlación fue más consistente con la longitud del dedo índice (r=0.908), mientras que, en las mujeres, fue más consistente con la longitud del dedo meñique (r=0.827). Conclusiones: Las variaciones obtenidas caen dentro del intervalo de 3-4mm, estando en consonancia con otros métodos antropométricos publicados, confirmando la predictibilidad de la dimensión vertical oclusal obtenida mediante este método objetivo. El procedimiento es sencillo, económico y no invasivo, por lo que podría ser recomendado para la práctica clínica cotidiana.

ABSTRACT: Objective: The purpose of this study was to validate in the Chilean population, the anthropometric method by Ladda which found a significant correlation between the length of the fingers and the vertical dimension of occlusion. Materials and methods: A cross-sectional study, with 151 Chileans: 76 males and 75 females. Anthropometric measurements of vertical dimension of occlusion, length of index finger, length of little finger, and distance from tip of thumb to tip of the index finger of the right hand were recorded clinically using digital Vernier caliper. Correlation was studied using Pearson's coefficient. Results: Vertical dimension of occlusion was significantly correlated with all the parameters analyzed. In males, correlation of vertical dimension of occlusion was stronger with the length of the index finger (r=0.908) whereas in females, it was stronger with the length of the little finger (r=0.827). Conclusions: Since the variations between vertical dimension of occlusion and finger lengths are within the range of 3-4 mm, as with other anthropometric methods published, VDO prediction through this method is reliable, and reproducible. This method is simple, economic, and non-invasive; hence, it could be recommended for everyday clinical practice.

Rehabilitation in a patient with limited restorable space using double scanning technique: A case report / 대한치과보철학회지

Loss of posterior support may cause extrusion of antagonistic teeth and excessive wear of remaining teeth which often leads to the destruction of the occlusal plane. In such cases, it is critical to verify the need to increase vertical dimension of occlusion (VDO). Should you increase VDO, provisionalization is crucial in evaluating function and esthetics. Double scanning technique is a useful method when fabricating definitive restoration that mimic provisional restoration. In this case, a patient with apparently no loss of VDO and insufficient interocclusal space for dental materials due to loss of posterior support and extrusion of antagonistic teeth was rehabilitated using double scanning technique.

Full mouth rehabilitation in a severe worn dentition with vertical dimension gaining: A case report / 대한치과보철학회지

The progressive attrition of teeth is a normal process by aging. However, excessive tooth wear with decreased vertical dimension of occlusion and collapse of occlusal plane may cause pathologic pulpal condition, occlusal disharmony, functional disorders and esthetic problems. The change of vertical dimension is required in case that there is no sufficient clearance for restoration or in case that the occlusal relationship is modified. For gaining the vertical dimension, a careful diagnosis is essential prior to starting the restoration treatment. After evaluating adaptation of neuromuscular system of patient during provisional phase, the final restorations can be fabricated. In this case, a 78 year old male with severely worn down dentition was treated. To improve the esthetic appearance and to achieve the ideal occlusal relationship, the full mouth rehabilitation with minimal increase of vertical dimension is planned and diagnostic wax-up was performed at the increased vertical dimension. After evaluation of provisional restorations for 12 weeks, final restorations were fabricated and routine clinical assessments were made. After 1 year, the restorations with newly established occlusal scheme are well maintained without significant complications and esthetically and functionally satisfactory results were obtained.

Full-mouth rehabilitation without changing the vertical dimension in patient with worn dentition / 대한치과보철학회지

Although physiologic abrasion in normal range need not to be corrected, when hard tissue of teeth are worn abnormally fast, it can cause severe damage and destroy esthetics and, functional structure of occlusion consequently. To establish a correct occlusal plane and space for the patient with worn dentition, it is necessary to increase vertical dimension. However, actual occlusal vertical dimension remains unhanged with compensation for the increase of alveolar bone height equivalent to the decrease of teeth length. A 74-year-old male presented with worn dentition and fractured tooth. Based on the assessment of OVD including clinical findings, full-mouth rehabilitation without increase of OVD was planned. This case presents that a satisfactory clinical result was achieved by restoring the worn dentition without changing occlusal vertical dimension.

A study of lower facial change according to facial type when virtually vertical dimension increases / 대한치과보철학회지

PURPOSE: The aim of this study was to evaluate the effect of increased vertical dimension of occlusion on lower facial changes by facial type. MATERIALS AND METHODS: Lateral cephalograms from 261 patients were obtained and classified by sagittal (Class I, II, and III) and vertical (hypodivergent, normodivergent, and hyperdivergent) facial patterns. Retrusive displacement of soft tissue Pogonion and downward displacement of soft tissue Menton were measured in each group after 2 mm of vertical dimension of occlusion was increased at the lower central incisor using a virtual simulation program. The ratio of both displacements was calculated in all groups. The statistical analysis was done by 2-way ANOVA and Post hoc was done by Tukey test (5% level of significance). RESULTS: Retrusive displacement of soft tissue Pogonion in Class III group was statistically different compared to Class I and II, and in vertical facial groups all 3 groups were significantly different (P<.05). Downward displacement of soft tissue Menton showed statistically significant difference between all sagittal groups and vertical groups (P<.05). The ratio of both displacements showed statistically significant difference in all sagittal groups and vertical groups (P<.05), and Class II hyperdivergent group had the highest value. CONCLUSION: Lower facial change was statically significant according to the facial type when vertical dimension of occlusion increased. Class II hyperdivergent facial type showed the highest ratio after increase in vertical dimension of occlusion.

A new technique to determine vertical dimension of occlusion from anthropometric measurements of fingers.

Purpose: The purpose of this study was to find the correlation between vertical dimension of occlusion (VDO) and length of fingers. Materials and Methods: A cross-sectional study was conducted on 400 dentate subjects comprising of 200 males and 200 females. Anthropometric measurements of VDO, length of index finger, length of little finger, and distance from tip of thumb to tip of index finger of right hand were recorded clinically using modified digital vernier caliper. Correlation between VDO and length of fingers was studied using Spearman's coefficient. For the execution of regression command and preparation of prediction equations to estimate VDO, Statistical Package for Social Sciences Software Version 11.5 was used. Results: VDO was significantly and positively correlated with all the parameters studied. In males, correlation of VDO was strongest for length of index finger (r-0.406) whereas in females, it was strongest for length of little finger (r-0.385). VDO estimation using regression equation had a standard error of ± 3.76 in males and ± 2.86 in females for length of index finger, ±3.81 and ± 2.74 in males and females respectively for length of little finger, ±3.99 and ± 2.89 in males and females respectively for distance from tip of thumb to tip of index finger. Conclusions: Since the variations between VDO and finger lengths are within the range of 2-4 mm, VDO prediction through this method is reliable, and reproducible. Also the method is simple, economic, and non-invasive; hence, it could be recommended for everyday practice.

Full mouth rehabilitation of the patient with worn dentition using full-contour monolithic zirconia prostheses at an increased vertical dimension of occlusion: a case report / 대한치과보철학회지

Excessive occlusal wear results in unacceptable damage to the occluding surfaces, and can cause pulpal injury, occlusal disharmony, impaired function, and aesthetic deformity. Patients with severely worn dentition need to be classified as several categories relative to the vertical dimension of occlusion (VDO) and the interocclusal distance for the prosthetic space. When treating patients classified as those who have excessive wear without loss of occlusal vertical dimension but with limited space, we could consider treating them at an increased vertical dimension of occlusion. Treatments at an increased vertical dimension of occlusion may provide stability, given that the amount of its increase was minimal, and a perfected occlusion was achieved after enough stabilization period. A 50-year-old male visited the department of Prosthodontics in Yonsei University Dental Hospital with the chief complaint of worn teeth on lower anterior area. Reconstruction at an increased vertical dimension of occlusion was planned. After the compatibility of the new vertical dimension of occlusion had been confirmed under interim fixed restorations, definitive fixed restorations composed of full-contour monolithic zirconia prostheses were placed. This case presents that a satisfactory clinical result was achieved by restoring the worn dentition at an increased vertical dimension of occlusion with an improvement in esthetics and function.

Full mouth rehabilitation of the patient with severely worn dentition: a case report

The severe wear of anterior teeth facilitates the loss of anterior guidance, which protects the posterior teeth from wear during excursive movement. The collapse of posterior teeth also results in the loss of normal occlusal plane and the reduction of the vertical dimension. This case report describes 77-year-old female, who had the loss of anterior guidance, the severe wear of dentition, and the reduction of the vertical dimension. Occlusal overlay splint was used after the decision of increasing vertical dimension by anatomical landmark, facial and physiologic measurement. Once the compatibility of the new vertical dimension had been confirmed, interim fixed restoration and the permanent reconstruction was initiated. This case reports that a satisfactory clinical result was achieved by restoring the vertical dimension with an improvement in esthetics and function.