12- Establishing VDO in Fixed and Removable Prosthodontics (Dr. Nui)

Epulis fissuratum

Can you make an intellectual guess what the diagnosis is?

- Epulis fissuratum

- Edentulus areas

- Make sure denture will not cover pterygomandibular raphe

- Might need new mandibular cast (poor capture of retromolar pad and lingual sulcus)

When you see these images, what comes to your mind?

1. Determine Vertical Dimension at Rest (VDR)

2. Determine Freeway Space = VDR−VDO

3. Evaluate Facial Esthetics + phonetics

4. Verify comfort/function

How do you establish VDO?

1. Comfort

2. Function (phonetics and occlusion)

3. Appearance

What are the 3 factors do you need to consider to determine that you have established the proper VDO?

Vertical dimension

What is the length of the face as determined by the amount of separation of the jaws?

Occlusal vertical dimension

What is the distance between two selected anatomic or marked points when in Maximum Intercuspation?

Establishing VDO

These are methods of what?

1. Physiological Rest Position

2. Closest Speaking Space (Phonetic Test)-pre-extraction measurement

3. Pre-extraction record

4. Distance from the bony shelf under the nose to the bottom of the mandible = distance from pupil of the eyes to the rima oris or parting line of the lip

5. 40 mm occlusal vertical dimension

6. Maximum biting force

7. VDR-VDO= 3 mm

8. Pt's own judgement

9. Use F and V sound

10. Lateral ceph radiograph

Establishing VDO

These are methods of what?

- 40 mm occlusal vertical dimension

- Maximum biting force

- VDR-VDO= 3 mm

- Pt's own judgement

- Use F and V sound

- Lateral ceph radiograph

A 40 mm occlusal vertical dimension

Which method to establish VDO?

2-4mm

after analyzing the facial appearance and phonetics, you evaluate the Interocclusal Rest Space (Freeway Space). What is the average Freeway Space?

VDR - 3 mm

With this measurement, how do you find VDO?

tip of nose and chin

When finding VDR, where do the lines go?

Semi-adjustable articulator

Use record bases + occlusal rims as a tool to transfer Pt's VDO to a ___________

1. VDO

2. CR

3. Function ("s" sound and occlusion)

4. Appearance

During teeth try-in, what 4 factors do you need to ensure are correct?

"m" sound

What sound do you have the patient make to determine VDR?

No teeth

When a patient says "Mississippi or 66", when they stop on the "s" sound, what teeth should be touching?

Maxillary central incisors

"F/V" sounds aid in setting which denture teeth?

S

Pronouncing "___" sound will slightly advance the mandible to recordable, repetitive horizontal and vertical position when the patient is at the /____/ position during speech. This position is almost closed to the correct VDO.

1. Record bases

2. Occlusal rims

Distal extension RPD requires which 2 lab records?

Check clearance and make sure no interferences

What do you have to check on the casts before the patient leaves?

Restore VDO

What do you need to do here?

Excessive VDO

If a patient has a functional problem (speech, clicking noise), what is most likely the problem?

Loss of VDO

If a patient has angular cheilitis, functional problem, whistling or air escaping, what is most likely the problem?

Cheek biting (always set posterior teeth with horizontal overlap)

If posterior teeth are set in edge-to-edge, what is the most likely problem going to be?

true

T/F: You should always follow a pts existing max/mand relationship, if not, you can cause the denture to tip

Worn down dentition

How would you describe the dentition?