Assessment of the Vertical Dimension of Occlusion Using Palm Width and Finger Length.

Background and Objectives: The vertical dimension of occlusion's (VDO) assessment is a highly important issue in the everyday dentist's practice. Patients with unstable occlusion, lost occlusal stops, extensive tooth loss in the lateral area, or complete edentulism need a proper assessment of the VDO before the prosthetic restoration is carried out. Subjective and objective methods were used over time for the restoration of VDO. The study aimed to investigate the possible correlation between finger length, palm width and the vertical dimension of occlusion. Materials and Methods: Assessment of the VDO for 236 subjects, Romanian and French dental students, was performed using the Willis Bite Gauge. The left hand of the subjects was scanned using a flat-bed scanner, and then measurements of palm width and finger length were carried out for each subject. Comparison between VDO values and finger length/palm width was conducted using one-way ANOVA and Student t-Test. Results: Higher VDO average values were found in French subjects compared with Romanian students. The same results were found according to gender; in both female and male subjects, lower values of VDO were found in the Romanian group. Higher values were obtained for women within each group when comparing to men. Statistically significant correlations of the analyzed parameters and VDO values were found. Higher statistical correlations of the studied variables were found for men compared to women in both groups. The highest statistical correlation was obtained between the VDO and the palm width measured at the fingerbase, followed by the middle finger length. Conclusions: The results showed the highest statistical correlation between the vertical dimension of occlusion and the palm width measured at the fingers' base. Statistical correlations were also found between the VDO and the middle finger length. Simple formulas using finger length/palm width can be used for a rapid VDO determination.

The "Smile Design and Space" Concept for Altering Vertical Dimension of Occlusion and Esthetic Restorative Material Selection.

OBJECTIVE: This article introduces the smile design and space (SDS) concept for managing the vertical dimension of occlusion (VDO) in full-mouth reconstructions and its influence on the selection of esthetic restorative materials. Limitations of traditional VDO adjustment methods are being addressed through a facially driven treatment approach that enhances esthetics improves function and minimizes invasiveness. CLINICAL CONSIDERATIONS: The SDS concept involves detailed evaluations of the incisal edges of the maxillary central incisors in relation to the upper lip at rest and at full smile. This includes analyzing variations in incisal exposure due to differing lip mobility, which can significantly impact gingival esthetics, particularly in cases with gingival exposure during smiling. The concept employs a strategic formula to determine the necessary alterations in VDO based on specific dental relationships and wear patterns. CONCLUSIONS: The SDS concept provides guidelines for full-mouth reconstructions, emphasizing minimal invasiveness and the integration of esthetics with functional dynamics to enhance the predictability of clinical outcomes and reduce complications associated with traditional restoration techniques. CLINICAL SIGNIFICANCE: The SDS concept enhances the precision of full-mouth reconstructions through individualized adjustment of the VDO, tailored to the esthetic and functional requirements of each patient.

Myths surrounding vertical dimension of occlusion in restorative dentistry: A scoping review.

OBJECTIVE: This scoping review aims to clarify the concept of vertical dimension of occlusion (VDO) in prosthetic dentistry, addressing prevalent myths, and controversies regarding its clinical management and impact on the stomatognathic system. METHODS: This paper critically examines common beliefs about VDO alteration and its effects on temporomandibular disorders (TMD) through an extensive literature review and an international survey. The survey included 862 general dentists and prosthodontists and explored their approaches to altering VDO and their perceptions of the clinical implications. The literature review provided a thorough analysis of existing research on VDO modification techniques, the adaptability of the stomatognathic system, and the relationship between VDO changes and TMD. RESULTS: The survey revealed insights into dentists' perspectives on VDO, showing that while many practitioners test a new VDO due to concerns about patient adaptation, a significant majority observed that patients typically adjust well to a new VDO regardless of the technique used. The survey highlighted differing beliefs about the need for a gradual process and trial phase for VDO alteration, as well as the stability of modified VDO. Literature review suggests the stability and adaptability of VDO changes due to muscle adaptability and indicates no direct causal or curative link between VDO changes and TMD. Traditional methods for determining VDO in complete dentures may not be suitable for worn dentition, underscoring the need for tailored approaches. CONCLUSION: This paper suggests that the traditional belief in the need for a prolonged trial phase for VDO alterations may be reconsidered in light of evidence supporting the adaptability of the stomatognathic system. Moreover, it emphasizes the importance of distinguishing between methods suitable for complete dentures and those for managing cases of worn dentition. The purported link between VDO alterations and TMD is also found to lack scientific evidence, highlighting the need for individualized patient care based on current evidence and clinical judgment.

Correlation Between Nose-to-Chin Distance and Other Measurements Used to Determine Occlusal Vertical Dimension.

OBJECTIVES: Accurate occlusal vertical dimension (OVD) establishment is an essential component of prosthodontic treatment. No accurate approach exists to determine the appropriate OVD for patients without posterior teeth. This study aimed to correlate the accuracy of the nose-to-chin distance with various facial measurements and thumb length in dentulous and edentulous Saudi patients. MATERIALS AND METHODS: The participants comprised 100 fully dentulous Saudi male dental students aged 20-30 years (group 1) and 20 completely edentulous patients aged 60-70 years (group 2). We evaluated the correlations between the OVD (nose-to-chin distance) and the distance from the pupil to the corner of the mouth, the vertical length at midline of the nose (from subnasion to glabella), the distance from the outer canthus of one eye to the inner canthus of the other, twice the distance between the inner canthi, and the distance from the thumb tip to the index fingertip. STATISTICAL ANALYSIS: Spearman's correlation and regression analysis were performed to analyze and assess the correlations between the clinically measured nose-to-chin distance and other parameters, with significance set at 0.05. RESULTS: In edentulous patients, the results showed a significant, strong, positive correlation between the nose-to-chin distance and the distance between the pupil and the mouth corner. In dentate subjects, a significant, strong, positive association was found between the nose-to-chin distance and the distance from the outer canthus of one eye to the inner canthus of the other. The linear regression analysis revealed that the distance between the pupil and the mouth corner in edentulous patients significantly predicted the OVD. CONCLUSIONS: In both groups, the distance from the outer canthus of one eye to the inner canthus of the other and the distance from the pupil to the mouth corner were reliable and accurate for OVD measurements. These could be considered appropriate methods for OVD determination during full-mouth rehabilitation.

Reliability of a face scanner in measuring the vertical dimension of occlusion.

OBJECTIVE: This study evaluated the reliability of a face scanner in measuring the vertical dimension of occlusion (VDO). METHODS: Fully dentate volunteers (n = 20; mean-age = 30.0 ± 10.7 years) were recruited. Clinical facial measurements were obtained using a digital caliper and a face scanner (Obiscanner, Fifthingenium, Italy). The scans were imported into a mesh-processing software, and the distances were measured digitally. Measurements were obtained for each participant with the jaws positioned in maximal intercuspation (MI) and with increased vertical distances of 2, 4, and 6 mm. Vertical and horizontal measures were obtained using facial anatomical landmarks: Glabella (GL), Pronasale (PrN), Subnasale (SbN), inferior border of the right and left Alare, Labiale superius (Ls), right and left Cheilion (Ch), Soft Pogonion (SPg), right and left Tragus of the ear (Tr), for all selected vertical positions. Data analysis included intra-class correlation coefficient (ICC), pairwise comparison tests, Bland-Altman plots, and Passing-Bablok regression. RESULTS: 120 VDO measurements (clinical=60, digital=60) were recorded by two independent evaluators. Mean differences between digital and clinical measurements ranged from 0.054 ± 0.14 mm to 0.203 ± 0.13 mm. All parameters were strongly correlated (r > 0.93; p < 0.001). ICC estimates revealed excellent reliability, and the measuring procedure yielded the same results on repeated trials irrespective of the raters and measurement methods. Bland-Altman plots revealed a difference, between digital and clinical measurements, of 1.7 % for the vertical measurements. Regression analysis revealed no significant proportional difference between the two methods, so both can be used interchangeably. CONCLUSIONS: The findings of this study demonstrate that VDO can be measured accurately from face scans using 3D mesh-processing software and that even small changes in the VDO could be detected using the digital methods. CLINICAL SIGNIFICANCE: Findings provide evidence about the reliability of a digital method for jaw relation registrations and may be applied towards incorporating this method into clinical workflows for computer-aided-design/ computer-assisted-manufacturing (CAD-CAM) dentures.

An Aesthetic and Economic Approach of Smile Designing for a Patient With Dentinogenesis Imperfecta: A Rare Case Entity.

This is a case report presenting a female patient in her twenties suffering from severely stained, unaesthetic, and worn-out teeth since her childhood. It was a major aesthetic and functional concern for her. This clinical presentation describes the prosthetic rehabilitation of a patient with generalized discolored and worn-out teeth to have enhanced aesthetics and masticatory function of the patient. This is a referred case of dentinogenesis imperfecta- II (DGI-II) from the Department of Oral Medicine and Radiology and Oral Pathology, as diagnosed by them after a thorough clinical, radiographical, and histopathological examination. DGI is a disorder of teeth characterized by discoloration and rapid wear and belongs to a group of disorders of the development of teeth. Due to the rapid wear and generalized intrinsically stained and discolored teeth, there is a loss of vertical dimension of occlusion (VDO) and an unesthetic look of the patient respectively. Therefore, the main objective of the case report is to re-establish the aesthetic and regain the VDO and functionality of the damaged teeth using the Pankey Mann Schuyler philosophy in which the first anterior teeth were rehabilitated with porcelain fused to metal (PFM) crowns based on aesthetics and phonetics of the patient. This was followed by posterior PFM crowns based on Broadrick's flag analysis for posterior occlusal plane determination and centric occlusion.

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)

Reclaiming the Smile: Full Mouth Rehabilitation of a Generalized Attrition Patient Using the Hobo Twin-Stage Technique.

This clinical report details the successful rehabilitation of a 63-year-old male patient with severe tooth wear, a reduced vertical dimension of occlusion, and esthetic concerns. The Hobo twin-stage procedure addressed these issues while improving the patient's oral health and quality of life. After ensuring adequate oral hygiene, the treatment began with scaling and root planning, followed by diagnostic impressions. An occlusal splint was fabricated, followed by a diagnostic wax-up and tooth preparation. Full-arch impressions of prepared teeth were made using the addition of silicon elastomeric impression material, and chairside provisional crowns were fabricated. The working casts were mounted on a semi-adjustable articulator, and the metal copings were tried on before being built up in porcelain. The patient achieved successful outcomes and expressed satisfaction with the treatment. The Hobo twin-stage technique and porcelain-fused-to-metal crowns can be viable approaches for restoring the teeth's form and function while enhancing the patient's oral health and esthetics. However, regular follow-up appointments and good oral hygiene maintenance are essential for the long-term success of the treatment.

Increased vertical dimension of occlusion for varying periods differentially impairs learning and memory in guinea pigs.

There is an increasing number of studies showing that occlusal dysfunction impairs learning and memory. We previously demonstrated that the brain has a mechanism to calibrate between the activities of spindle afferents and periodontal-mechanoreceptor afferents for controlling the chewing movement, and the accurate calibration can be done only at the proper vertical dimension of occlusion (VDO). Then, the chewing at an inappropriate VDO may induce a severe mental stress due to a mal-calibration. However, it is not clear how the impairment of learning/memory progresses over the period of stress induced by occlusal dysfunction. We investigated by passive avoidance test how the behavior and learning/memory are altered in guinea pigs in which the VDO was raised by 2-3 mm over the period up to 8 weeks. We found that the guinea pigs reared under the raised occlusal-condition (ROC) for 1 week showed a very high sensitivity to electrical stimulation whereas this did not cause the memory consolidation in the 1st-day retention trial, suggesting that such hypersensitivity rather hampered the fear learning. In the guinea pigs reared under the ROC for 2 and 8 weeks, the learning ability was not largely affected and memory consolidation occurred similarly whereas the memory retention deteriorated more severely in the latter guinea pigs than in the former ones. In the guinea pigs reared under the ROC for 3 and 4 weeks, learning was severely impaired, and memory consolidation did not occur. These results suggest that the occlusal dysfunction for varying periods differentially impairs learning and memory.

EPA Consensus Project Paper: The Vertical Dimension of Occlusion. How to Determine and How to Alter? A Systematic Review.

PURPOSE: The aim of this systematic review was to explore the dental literature to identify high quality clinical studies that introduced methods of determining the vertical dimension of occlusion (VDO), and additionally to find studies which assessed alterations in the VDO. MATERIALS AND METHODS: An electronic search of the literature was conducted through PubMed , Embase, and Cochrane Library databases referring to the determination and alteration of the VDO by 12/2021. RESULTS: A total of 215 records were obtained from the initial search. After the first two screenings, 33 studies were selected for inclusion. Correlations in the morphometric group ranged between r=0.18-0.87, p⟨0.05-0.001, correlations in the cephalometric group ranged between r=0.28-0.92, p⟨0.05-0.001, and correlations in the mechanometric group ranged between r=0.21- 0.75, p⟨0.05-0.01. Regarding the alteration of VDO, in all studies the increase ranged between 1.8-8 mm and the patients adapted . CONCLUSIONS: No clear guidelines can be established yet, in relation to the determination and alteration of the VDO. There is no apparent benefit in using more invasive and complex methods compared to the use of the facial anatomical landmarks. Patient adaptation seems to be successful when the range of VDO increase was 1.8-6.0 mm.

Digital jaw relation recording to evaluate a new vertical dimension of occlusion using CAD/CAM-fabricated tooth-colored splints: a case report.

Pronounced defects of the dental hard tissue can be caused by different etiologic factors. Most frequently, they are associated with changes in the vertical dimension of occlusion (VDO), which may also influence the condylar positions. These defects can lead to irreversible loss of tooth structure and have dramatic functional and esthetic consequences, often requiring complex rehabilitation. In this situation, CAD/CAM-fabricated occlusal splints made of tooth-colored polycarbonate are a proven and safe pretreatment approach in terms of esthetics and function. Rebuilding lost dental hard tissue to restore the occlusion and VDO to an adequate condylar position is a prerequisite for any sustainable and functional rehabilitation. In the future, digital systems will support this complex process, customizing it and making it simpler and more precise. The DMD-System (Ignident) provides patient-specific jaw movement data to optimize the CAD/CAM workflow. This system allows real movement patterns to be digitized and analyzed for functional and potential therapeutic purposes, integrating them into the dental and laboratory workflow. In the present case, the familiar tooth-colored CAD/CAM-fabricated occlusal splint is supplemented by digital centric jaw relation recording and individual movement data.

Occlusal splints-types and effectiveness in temporomandibular disorder management.

Background: Occlusal splints are routinely used in dental offices to diagnose and treat abnormalities of the masticatory system. There are different occlusal splints, each of which can address various conditions. They may treat individuals with temporomandibular disorders (TMDs) and bruxism or be used for occlusal stabilization and dentition wear reduction. Methods: The literature in the National Library of Medicine's Medline Database was reviewed using the Mesh terms 'occlusal splints' AND 'Temporomandibular Disorders. Conclusion: Occlusal splints can treat a wide variety of TMDs. They can treat bruxism, headaches, postural imbalances related to TMDs, and decreased vertical dimension of occlusion (VDO). However, there is no clear evidence that occlusal splints are superior to physiotherapy in treating TMDs. In the long-term follow-up, they were equally effective as other therapies.

Posterior Dahl: A Minimally Invasive Method for the Treatment of Localized Posterior Tooth Wear.

PURPOSE: This retrospective case series of 9 patients aimed to describe clinical outcomes and patient satisfaction following the implementation of the posterior Dahl concept to manage localized posterior tooth wear. MATERIALS AND METHODS: Localized occlusal space was created in the posterior dentition. Supra-occluding direct restorations were placed bilaterally for the restoration of molars. Intraoral scans were taken at the pre-treatment stage, immediately post-restoration, and during follow-up appointments. Scans were used to undertake analysis of any occlusal changes and re-establishment of the occlusion. A questionnaire was used to assess patient satisfaction, alleviation of any pre-treatment concerns, and evaluation of post-treatment complaints. RESULTS: Immediately post-treatment, all patients showed an increase in the vertical dimension. Opening of the bite in the untreated areas following restoration of worn posterior molars resulted either in a tendency towards or the actual reestablishment of the occlusion. One patient completely lacked compensatory vertical tooth movement in the untreated areas, culminating in the persistence of a vertical open bite. One restoration displayed cohesive fracture after 4 months. Pre-treatment problems (eg, sensitivity) were fully resolved amongst all patients after 6 months. Post-treatment complaints were minor and demonstrated resolution within a relatively short period of time. Eight patients reported being "very satisfied" with their treatment outcomes. CONCLUSION: Application of the posterior Dahl concept appears to offer a promising, relatively simple, minimally invasive and effective approach for the management of localized posterior tooth wear, which is well accepted by patients.

Prototyping of increased vertical dimension of occlusion using an existing removable partial denture and composite resin: a case report.

Full-mouth rehabilitation can be challenging due to the complexity of restoring the vertical dimension of occlusion (VDO) and replacing missing teeth. In partially edentulous patients, the concept of a bonded composite resin prototype for increasing the VDO has previously been applied through the use of an overlay removable partial denture (RPD) with acrylic resin covering the existing dentition. Unfortunately, this type of prosthesis does not always accurately model the function and phonetics intended for the definitive prostheses, and the esthetic result often is less than ideal. It would be advantageous if direct bonding could be used with the patient's existing RPD to model the increased VDO, but this approach has not been reported in the literature. This case report describes the direct bonding of an existing RPD to create a prototype for increased VDO in a partially edentulous patient with a skeletal Class II malocclusion. The successful outcome has been maintained for more than 1 year.

The mechanism for regulating the isometric contraction of masseter muscles is involved in determining the vertical dimension of occlusion.

We previously demonstrated that accurate regulation of isometric contraction (IC) of jaw-closing muscles to counteract the ramp load applied to the jaw in the jaw-opening direction is achieved through the calibration between the two sensations arising from muscle spindles (MSs) and periodontal mechanoreceptors (PMRs). However, it remains unclear whether this calibration mechanism accurately works at any jaw positions, i.e., any vertical dimensions of occlusion (VDO). In the present study, we examined the effects of altering VDO on the IC of the masseter muscles in complete dentulous and edentulous subjects. At a VDO higher than the original VDO (O-VDO), the root mean square (RMS) of masseter EMG activity increased more steeply with a load increase, resulting in an over-counteraction. The regression coefficient of the load-RMS relationship significantly increased as the VDO was increased, suggesting that the overestimation became more pronounced with the VDO increases. Consistently also in the edentulous subjects, at a higher VDO than the O-VDO, a steeper increase in the RMS emerged with a delay in response to the same ramp load whereas a similar steeper increase was seen surprisingly even at a lower VDO. Thus, the edentulous subjects displayed a delayed overestimation of the ramp load presumably due to less and slowly sensitive mucous membrane mechanoreceptor (MMR) in alveolar ridge compared with the PMR. Taken together, the accurate calibration between the two sensations arising from MSs and PMRs/MMRs can be done only at the O-VDO, suggesting that the O-VDO is the best calibration point for performing accurate IC.NEW & NOTEWORTHY Since 1934, the vertical dimension of occlusion (VDO) in edentulous individuals has been anatomically determined mostly by referring to the resting jaw position. However, such a static method is not always accurate. Considering the dynamic nature of clenching/mastication, it is desirable to determine VDO dynamically. We demonstrate that VDO can be accurately determined by measuring masseter EMG during the voluntary isometric contraction of jaw-closing muscles exerted against the ramp load in the jaw-opening direction.

Clinical Influence of Mandibular Flexure on Oral Rehabilitation: Narrative Review.

AIM: The current paper aims to review mandibular flexure and its clinical implications in the field of oral rehabilitation. Mandibular flexure is a deformity of the mandible, which occurs during jaw movements. METHODS AND MATERIALS: An electronic database search was conducted using the PRISM model, with a total of 49 articles included. RESULTS: Mandibular flexure affects various stages of oral rehabilitation treatments. Effects of mandibular flexure are more significant in periodontal patients, and in implant-supported restorations, compared to natural teeth, due to differences in the force absorption by the periodontal ligament. Various adjustments must be made to the prosthodontic framework to enable long-term survival of the restorative treatments. CONCLUSIONS: Dental practitioners should pay attention to the following: (1) digital impressions are preferred over conventional; (2) mouth opening should be kept to a minimum (as possible, up to 10-20 mm) while also avoiding any anterior movements of the mandible (protrusion); (3) the number of abutment teeth should be kept to a minimum; (4) structures in the lower jaw should be splitted; (5) non-rigid connectors should be used to reduce the effort exerted; (6) in periodontal patients, the preference is for short-span restorations and non-rigid connectors; (7) in implant-supported restorations, it is preferable to divide the framework into two or three segments, utilizing rigid materials with a low elastic modulus. There is no agreement in the literature about the preferred location of the implants in the jaw.

Retrospective 1- to 8-Year Follow-Up Study of Complete Oral Rehabilitation Using Monolithic Zirconia Restorations with Increased Vertical Dimension of Occlusion in Patients with Bruxism.

AIM: The aim of this paper is to perform a retrospective assessment of the clinical performance of the complete oral rehabilitation of patients with bruxism treated with implants and teeth-supported veneered and non-veneered monolithic zirconia restorations with increased occlusal vertical dimension. METHODS: In this retrospective follow-up study, 16 bruxer patients, mean age 59.5 ± 14.9 years, were treated with 152 veneered and 229 non-veneered monolithic zirconia and followed for a mean of 58.8 ± 18.8 months (range 1-8 years). The patients were examined clinically and radiographically, annually. Clinical data were extracted from the medical records. In the recall appointments, modified California Dental Association (CDA) criteria were used to evaluate the restorations. Implant and restoration survival and success rates were recorded and analyzed. RESULTS: The cumulative survival rates of implants and restorations were 97.7% and 97.6%, respectively. Nine restorations were replaced: three due to horizontal tooth fractures, two because of implant failure and four had secondary caries. A total of 43 biologic and technical complications were recorded. In the veneered group, the predominant complication was minor veneer chipping (16.4%), which required polishing only (grade 1). In the non-veneered group, the main complication was open proximal contacts between the implant restorations and adjacent teeth (14.5%). CONCLUSIONS: The survival rates of restorations and implants in patients with bruxism are excellent, even though veneered zirconia restoration exhibited a high rate of minor veneer chipping, which required polishing only. The biologic complication of fractured single-tooth abutment may occur.

Reabilitação oral de paciente portador de amelogênese imperfeita: relato de caso / Oral rehabilitation of a patient with amelogenesis imperfect: case report

A amelogênese imperfeita (AI) é uma condição de origem genômica que causa um defeito na estrutura dentária, se apresentando exclusivamente no esmalte e, altera tanto sua formação quanto seu conteúdo. Ela se manifesta na dentição decídua e permanente e é hereditária, podendo se apresentar de quatro formas que foram classificadas como: Hipoplásica (tipo I), Hipomaturada (tipo II), Hipocalcificada (tipo III) e Hipomaturada-Hipoplásica com Taurodontismo (tipo IV). Elas apresentam alteração na tonalidade e podem envolver cores que variam do branco opaco, branco- amareladas, amarelo ao marrom-amarelado e ou marrom. O presente estudo, tem como objetivo apresentar um relato de caso de reabilitação oral, funcional e estética em paciente portador de amelogenese imperfeita do tipo hipomaturada. Foi apresentado um plano de tratamento para este tipo de paciente, com uma técnica para alteração de dimensão vertical de oclusão (DVO). Modelos superior e inferior foram obtidos com o objetivo de realizar uma montagem em articulador semi-ajustável para enceramento diagnóstico e planejamento do caso. Foi proposto uma alteração de DVO para mais com a confecção de restaurações provisórias resina acrílica auto polimerizável pela técnica da pré moldagem a partir do enceramento e também na técnica da faceta com dente de estoque nos dentes anteriores. Desta forma, a terapia proposta poderemos restabelecer a função mastigatória e a estética ao paciente, contribuindo assim, para elevação de sua autoestima e melhoria na qualidade de vida.

Amelogenesis imperfecta (AI) is a condition of genomic origin that causes a defect in the tooth structure, presenting exclusively in the enamel and altering both its formation and its content. It manifests itself in the deciduous and permanent dentition and is hereditary, and can present in four ways that have been classified as: Hypoplastic (type I), Hypomaturated (type II), Hypocalcified (type III) and Hypomature-Hypoplastic with Taurodontism (type IV). They present a change in tonality and may involve colors ranging from opaque white, yellowish white, yellow to yellowish-brown and/or brown. The present study aims to present a case report of oral, functional and aesthetic rehabilitation in a patient with hypomature amelogenesis imperfecta. A treatment for this type of patient was presented, with a technique for altering the vertical dimension of occlusion (DVO). Assembly was carried out in a semi-adjustable articulator, diagnostic wax-up for case planning, alteration of DVO to more, provisional making from wax-up with pre-molding and from the veneer technique with stock tooth. In this way, the proposed therapy reestablished masticatory function and restored aesthetics to the patient, thus contributing to raising their self-esteem and improving their quality of life.

Reliability of anthropological measurements in determining vertical dimension of occlusion in Saudi population: A cross sectional study.

BACKGROUND: Range of techniques have been described in traditional prosthodontics to establish Vertical dimension of occlusion (VDO). Experienced clinicians agree that there is no one single method, which is universally accepted record VDO precisely and consistently. Many facial and body landmarks have been proposed in the literature correlating to the VDO. Presence of so many methods to determine VDO further leads to confusion in the minds of clinicians. There is always a need for a research to both substantiate the findings in the literature and check reliability of such correlations in local population. Such correlation between the anthropological measurements and VDO would give clinician an evidence based approach to establish VDO during prosthetic rehabilitation. Hence this study was planned to check reliability of various anthropometric measurements in measuring VDO in a cross section of Saudi population. MATERIAL AND METHOD: Total of 500 subjects selected for the study following an inclusion and exclusion criteria. Anthropological readings such as Index finger, Little finger, Thumb finger, Distance between Inner canthus of left eye to outer canthus of right eye and Outer canthus of the right eye to corner of mouth (rima oris) were recorded using digital Vernier caliper. The data were analyzed statistically. RESULTS: Strong positive correlation was observed between VDO and anthropological landmarks selected in the study. Pearson's correlation test showed VDO in males has strong coefficient correlation with Index finger (r = 0.7341) and in females strong coefficient correlation with Little finger. (r = 0.5827). CONCLUSION: In Saudi Males, VDO could be correlated to the index finger measurements followed by Thumb finger. In Saudi females subjects, VDO correlated with little finger measurements followed by outer canthus of the eye to corner of the mouth reading. It is always appropriate to use one or more methods to approximate the measurements of VDO initially and then use the other methods to test the appropriateness of the dimensions initially established.

A novel digital technique for maintaining maxillomandibular relations in fixed prosthetic rehabilitations.

INTRODUCTION: In fixed prosthetic rehabilitations, the restorations must be designed and fabricated in a proper maxillomandibular relationship, with correct vertical dimensions of occlusion (VDO) and centric relation (CR). This short communication introduces a novel digital technique that allows to obtain the maxillomandibular record and transfer it throughout the treatment procedure. METHODS: The protocol consisted of the following steps: 1. scan-jig planning and production; 2. maxillomandibular record prior to tooth preparation; 3. sequential tooth preparation and post-operative data recording through a cut-out and re-scan protocol; 4. control of the pre- and post-operative alignment of the scans in the correct VDO and CR, design and delivery of the definitive restorations. RESULTS: There was no clinical difference in the spatial positions of the virtual models and the relationships between the arches throughout every step of the treatment. CONCLUSION: The main advantages of this technique are that it allows to maintain the therapeutic maxillomandibular relationship after its clinical evaluation, to reduce chair time and to avoid inaccuracies determined by multiple bite registrations.