Dentaltown January 2025 - 31

Introduction
Vertical dimension is one of the most
misunderstood aspects of dental
rehabilitation. Over the years, there
have been many varying opinions on
the subject as to when, why and how
to change the vertical dimension of
occlusion (VDO)-even suggestions
that a change is not possible. With so
many contradictions on the topic, it
is no wonder dentists are confused or
feel so intimidated that they avoid it
all together. With no shortage of worn
dentitions in everyday general practice,
this leaves a plethora of patients
unhappy with the appearance or
functionality of their teeth.
Typing " Vertical Dimension of
Occlusion in Dentistry " into Google
Scholar pulls up 46,000 results. Reducing
the search by years published to
2010-2024 cuts this down to a mere
17,700. Can you sense my sarcasm?
Many of these citations discuss or
reference the masticatory muscles,
Fig. 1
the temporomandibular joint, the
mandibular posture, rest position, bite
raising, occlusal space, hinge position,
centric relation, anterior guidance
and aesthetics. All these topics are
potential issues, so let's put this into
an easy-to-understand, systematic
approach.
Vertical dimension of aesthetics
The Glossary of Prosthodontic Terms
defines VDO as " the lower facial
height measured between two points
when the occluding members are in
contact. " 1
VDO refers to the vertical
position of the mandible in relation to
the maxilla when the upper and lower
teeth are intercuspated at the most
closed position. Although you may
have never performed a full mouth
rehabilitation or reconstruction with
teeth present, most of us have performed
a full mouth reconstruction
on a fully edentulous patient. Performing
removable reconstructions is
Fig. 2
very similar to performing fixed rehabilitations.
The starting point in both
disciplines is the maxillary central
incisor position. This is one reason
why I feel it is more appropriate to
call VDO the Vertical Dimension of
Aesthetics.
When evaluating patients with
worn dentition to determine where
the final position of the central incisor
should be, previously restored or
not, (Figs. 1-2) we must take facial
aesthetics into consideration.2, 3
I
feel a combination of evaluating the
patient's incisor position in both full
smile and rest (repose) should be used
to determine whether an addition is
required (Figs. 3-4). To photograph
the patient's rest position, I find it
helpful for the patient to say the word
" Emma " and then remain still (Fig.
4). While evaluating the rest position,
the central incisor average range is
2-4 mm in repose. However, a study
by Carl Misch demonstrated that the
Fig. 3
Fig. 4
JANUARY 2025 | 31 | DENTALTOWN.COM

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Dentaltown January 2025

Table of Contents for the Digital Edition of Dentaltown January 2025

Title
Office Visit: Dr. Conor Perrin
Simplifying Vertical Dimension - Dr. John Nosti
Don’t Jump to Extractions - Drs. Daniel Boehne and Shane White
High Visibility - Dr. David A. Wank
Howard Speaks: Orchestrating Success 
Professional Courtesy: Future Focused
First Immediate Implant Case Advice Needed   
Lost All Dignity Trying to Appease an Angry Patient 
Online CE: Pediatric Dentistry 
Poll: Sleep Dentistry 
Ad Index   
Dentaltown January 2025 - Intro
Dentaltown January 2025 - Cover1
Dentaltown January 2025 - Cover2
Dentaltown January 2025 - 1
Dentaltown January 2025 - 2
Dentaltown January 2025 - 3
Dentaltown January 2025 - 4
Dentaltown January 2025 - 5
Dentaltown January 2025 - Howard Speaks: Orchestrating Success 
Dentaltown January 2025 - 7
Dentaltown January 2025 - Professional Courtesy: Future Focused
Dentaltown January 2025 - 9
Dentaltown January 2025 - Online CE: Pediatric Dentistry 
Dentaltown January 2025 - Poll: Sleep Dentistry 
Dentaltown January 2025 - 12
Dentaltown January 2025 - 13
Dentaltown January 2025 - First Immediate Implant Case Advice Needed   
Dentaltown January 2025 - 15
Dentaltown January 2025 - 16
Dentaltown January 2025 - 17
Dentaltown January 2025 - Lost All Dignity Trying to Appease an Angry Patient 
Dentaltown January 2025 - 19
Dentaltown January 2025 - 20
Dentaltown January 2025 - Ad Index   
Dentaltown January 2025 - Office Visit: Dr. Conor Perrin
Dentaltown January 2025 - 23
Dentaltown January 2025 - 24
Dentaltown January 2025 - 25
Dentaltown January 2025 - 26
Dentaltown January 2025 - 27
Dentaltown January 2025 - 28
Dentaltown January 2025 - 29
Dentaltown January 2025 - Simplifying Vertical Dimension - Dr. John Nosti
Dentaltown January 2025 - 31
Dentaltown January 2025 - 32
Dentaltown January 2025 - 33
Dentaltown January 2025 - 34
Dentaltown January 2025 - 35
Dentaltown January 2025 - Don’t Jump to Extractions - Drs. Daniel Boehne and Shane White
Dentaltown January 2025 - 37
Dentaltown January 2025 - 38
Dentaltown January 2025 - 39
Dentaltown January 2025 - 40
Dentaltown January 2025 - 41
Dentaltown January 2025 - 42
Dentaltown January 2025 - 43
Dentaltown January 2025 - High Visibility - Dr. David A. Wank
Dentaltown January 2025 - 45
Dentaltown January 2025 - 46
Dentaltown January 2025 - 47
Dentaltown January 2025 - 48
Dentaltown January 2025 - Cover3
Dentaltown January 2025 - Cover4
Dentaltown January 2025 - ElitePractice
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