VERTICAL JAW

RELATION
Presented By:
65 Dr. Kelly Norton 1
 INTRODUCTIO
N in the treatment of edentulous
• Recording of jaw relations
patients aims at facilitating the adaptation of the complete
denture to the masticatory system to give them an optimal and
comfortable function.
• To achieve this goal, the recording must include an approximate
vertical dimension of occlusion, stable occlusal contacts in
harmony with the existing TMJ and masticatory muscle
functions.
. 2
65
 Definitio
n
Maxillomandibular relationship - GPT VIII
• Any spatial relationship of the maxillae to the mandible;
• Any one of the infinite relationships of the mandible to the
maxillae

65 3
 Classification of Jaw
relations

• Orientation jaw
relation.

• Vertical jaw relation.

• Horizontal jaw relation.

65 4
 Classificatio
n

• The vertical jaw relation can be classified as

follows:
1)Vertical dimension at rest- VDR
2)Vertical relation at occlusion-VDO

65 5
 Definitio
n
Vertical dimension, GPT VIII
The distance between two selected anatomic or marked
points
(usually one on the tip of the nose and the other upon the
chin), one on a fixed and one on a movable
member

65 6
 Principl
e
The single most important factor in deciding the vertical
dimension is:
the mandibular musculature and occlusal stops or occlusion rims
from the teeth.

65 7
HISTORY
PROPONENT THEORY
HUNTER(1771) Lies in the middle of extremes of motion by which all the
muscles and ligaments are equally relaxed.
WALLISCH(1906) All muscle action eliminated
Mandible passively
suspended Opposing teeth
no contact
NISWONGER(1934) -1st investigator to study extensively the rest position of
Constancy concept of mandible by recording measurements on patients.
face height -Rest position is a neutral position of the mandible since the
opening and closing muscles are in a state of equilibrium.
-Jaw relator-A gauge to measure the vertical dimension of the
face
Thompson and Thomson believed that the rest position is determined by a
Brodie (1942) balance of tension in the musculature which suspends the
mandible and that the rest position is not affected by the
presence or absence of teeth. They stated, “The proportions
6
of face as far as vertical height is concerned, are 8
5 constant through out life
Leof (1950) -Stressed that muscle tone rather than muscle length
controls the rest position, and that muscle tone can
vary.
-Muscle tone can be increased by exercise and decreased
by excessive rest.

Meyer M Presented a physiologic phonetic method of measuring

Silverman the vertical dimensions of the closest speaking space
(1952-
1953)

65 9

Toolson LSmith D. Clinical measurement and evaluation of vertical

dimension. The Journal of Prosthetic Dentistry. 2006;95(5):335-339.
Zarb, Bolender Two hypothesis about rest position
– 1.Active mechanism
This position is assumed only when the muscles
that close the jaws and that open the jaws are
in a state of minimal contracture to maintain
the posture of the mandible.

2.Passive mechanism
Elastic elements of the musculature, and not
any muscle activity, balance the influence of
gravity.

65 10
 Physiologic rest
position GPT-
VIIIassumed when the head is in
• 1: The mandibular position
an upright position and the involved muscles,
particularly the elevator and depressor groups, are in
equilibrium in tonic contraction, and the condyles are in
a neutral, unstrained position
• 2: The position assumed by the mandible when the attached
muscles are in a state of tonic equilibrium. The position is
usually noted when the head is held upright
• 3: The postural position of the mandible when an
individual is resting comfortably in an upright position and
the associated mu scles are in a state of minimal
65 11

contractual activity
 Significance of Physiological
Rest position

• Bone to bone relation

• Fairly constant throughout the
life in absence of any pathosis.
• Can be recorded and measured
within acceptable limits.
• Used to determine the VDO.

65 12

Textbook of complete dentures : Charles M. Heartwell Jr., Arthur O Rahn, 5th

Edition
Vertical dimension of occlusion, GPT
VIII

Occlusal vertical dimension

The distance measured between two points when the occluding
members are in contact.

65 13
 Vertical Dimension at
•
Rest
Definition: -
• The distance between two selected points (one of which is on the middle of the face or
nose and the other of which is on the lower face or chin) measured when the mandible
is in the physiologic rest position-GPT-8

• It is essential to record the vertical dimension at rest as it acts as a reference point

during recording the vertical dimension at occlusion.
• The VD at rest should be recorded at the physiological rest position of the mandible.

65 14
 Inter-
VDR-VDO=Freeway relationship
space or
the interocclusal rest
space
Interocclusal rest space- GPT
VIII
The difference between the
vertical dimension of rest
and the vertical dimension
while
in occlusion.
It ranges from 2-4 mm in
vertical direction at the
65 15

position of the 1st

premolar
 Gravity

Factors
considere
calm, cool Neuromuscula
and d for rest r
relaxed position disturbances

make
measurement
s without
delay

No one method for determining rest position can be accepted as being valid for all
patients.
65
Several methods are available to confirm this record 16
Syllabus of complete dentures : Charles M. Heartwell Jr., Arthur O Rahn, 4 th

Edition
 Classification of the
methods
• Mechanical : Physiological
1.Physiological Rest Position
• 1. Ridge relation
2. Phonetic and Esthetics as
A.Incisive papilla to mandibular guides
incisors 3.Swallowing threshold
4.Tactile Sense
B. Parallelism of the ridges
• 2. Measurement of the former
dentures
• 3. Preextraction records
A. Profile radiographs
B. Casts of teeth in occlusion
65 17
C. Facial mesurements
 MECHANICAL METHODS
RIDGE RELATIONS

• 1.Incisive papilla to mandibular incisors

• Incisive papilla – stable landmark
• Distance :
Papilla -Incisal edges of mandibular anterior teeth : 4
mm Papilla -Incisal edges of maxillary central incisors :
6 mm Mean vertical overlap : 2 mm

• Individual variations
• Not relevant in patients with severe resorption

65 18
 PARALLELISM OF THE RIDGES

• Paralleling and a 5 degree opening in the

posteriors is acceptable as suggested by
Sears. Marked resorption of the ridges
makes this rule void.
• Natural, provided there has been no abnormal
change in the alveolar process such as a
previous advanced periodontal disease or
gross supra-eruptions.

• Most people – ridges are not

parallel Teeth lost at different
times Resorption pattern

65 19
MEASUREMENT OF THE FORMER DENTURES

• Measurements are made from the borders of with a Boley

gauge.
• Correlated with the observations of the patient’s face
• Distance is too short or long – Corresponding change can
be made.

• Problems:
• Loss of the ridges under the dentures results in an
increase in interocclusal distance.

• Patients can shift the mandible, or the denture can be

shifted on its support to accommodate for errors in
occlusion.

• Inaccurate adaptation of the denture base to the support

results in
65 displacement of the denture 20
PREEXTRACTION RECORDS
These data reveal the progressive changes which occur when the
natural teeth are extracted.

They provide information about –

• Occlusal vertical dimension
• Anteroposterior angle of occlusal plane
• Position and inclination of maxillary central incisors
• Horizontal and vertical overlap of each tooth.
• Length and width of teeth.

(A pre-extraction profile record. -J. Prosth. Dent. 45: 479,

1981) 65 21
1. PROFILE
•RADIOGRAPHS
Much used in research of vertical dimension
of
occlusion
• Lateral skull radiographs before and
after extraction are compared.

Disadvantages:
• Radiation risks – So cannot be considered
for routine clinical use.
• Considerable time
• Unreliable-
-Inaccuracies that exist in the technique
-Inaccuracies in the method of
comparing
65
measurements 22
2.PROFILE
•PHOTOGRAPHS
Made with the teeth in maximum occlusion
• Enlarged to life size
• Measurements of anatomic landmarks on the
photograph are compared with measurements
using the same anatomic landmarks on the
face.
• These measurements can be compared
when the records are made and again
when the artificial teeth are tried in.
•Disadvantages :
Angulation of the photos might
differ.
Photo 65enlargements cause inaccuracies. 23
3.PROFILE
SILHOUETTES
• Lead wire adaptation along the
midline helps preparing a
cardboard cutout, which is
preserved after extraction.
• Repositioned to the face after the
vertical dimension has been
established at the initial
recording and/or when the
artificial teeth are tried in.

(A pre-extraction profile record.

-J. Prosth. Dent. 45: 479,
1981)

65 24
4. CASTS OF TEETH IN
OCCLUSION
• Practical method
• Measurements:
• - Incisive papilla and crest of the lower ridge
-Extended height of upper and lower buccal
frena
-Hamular notch and retromolar pad

• Indicate the amount of space required

between the ridges for teeth of this size.

• Valuable in patients whose ridges are not

sacrificed during the removal of teeth or
resorbed during a long waiting period for
denture65 construction. 25
5. RESIN FACE MASKS:
SWENSON
(1959)-
• Acrylic resin face masks are made before
the extractions and later, when the
patient is edentulous, fitted on the face
to see whether the vertical dimension
has been restored properly.

Disadvantages:
• Requires a great deal of time
• Extensive experience with the use of
facial
impressions and casts.
• Different topography of face in erect 26
and recumbent posture.
65

Swenson’s Complete Dentures, Boucher, Editor, Fifth

 6.FACIAL
MEASUREMENTS

a.To record the relation of the head to the

central incisors vertically and
anteroposteriorly by placement of a face
bow with auditory meatus plugs and with
spectacle suspension.

b. To record the distance from the chin to the

tip of the nose by means of a pair of
calipers or dividers before the teeth are
extracted.
65 27
 c.Willis
•guage.
Pupil of the eye to rima oris = anterior nasal spine to
inferior border of mandible.

65 28

J Prosthet Dent 2004;91:59-

d) Equal- thirds
concept :
The face can be divided into equal thirds – the forehead,
the nose and the lips and chin.

65 29
 PHYSIOLOGICAL METHODS
1.PHYSIOLOGICAL REST POSITION
• Indication of the appropriate vertical dimension at rest

• Rest vertical dimension – Occlusal vertical dimension=

Interocclusal
distance

• Interocclusal distance : 2-4mm when observed at the position of

first premolars.
• May no t be an exact
65 30

guide
• METHOD :
-Patient relaxed, with trunk upright
and the head unsupported.

-After insertion of the occlusal rims the

patient should be asked to swallow
and let the jaw relax.

-The lips are parted to reveal how

much space is present between the
occlusal rims.

- The interocclusal distance should be

2- 4mm at the premolar region.
65 31
->4mm- occlusal vertical
dimension is too
small.
-< 2mm- occlusal vertical
dimension is too
great.

- Occlusion rims are adjusted

until adequate interarch
space is obtained and patient
comfort and phonetic and
esthetic considerations are
satisfactory. 32
65
2.PHONETICS
• Listening to speech sound production and observing the relationships of teeth
during speech.

65 33
 1. CH, S, AND J
•– Bring the anterior teeth close together.
• Lower incisors should move forward to a position
nearly directly under and almost touching the upper
incisors.

• If anterior teeth touch when these sounds are made or if

the teeth click together during speech, the vertical
dimension is too great.

65 34
 2. Have the patient repeat the name ‘Emma’ or ‘ Om’ until
he is aware of the contacting lips as the first syllable ‘m’ is
pronounced. When the patient has rehearsed this procedure,
ask him to stop all jaw movement when the lips touch. At
this time measure between the two points of reference.

• 3. Engage the patient in a conversation that will divert

his attention from conscious participation in the
procedure. A pause in the speech, followed by relaxation
as indicated by a drop of mandible, is an indication for
another
65 measurement. 35
 4.CLOSEST SPEAKING SPACE:
• SILVERMAN
Measures the vertical dimension when the
mandible and muscles involved are in physiologic
function of speech.

• The occlusion rims are placed in the mouth and the

height is adjusted until a minimum of 2 mm space
exists when the patient pronounces the letter “S”.
• Closest speaking space – vary from 0-10mm

• Disadvantage: Patient who has an 8-10mm

closest65 speaking space will require other means 36
determination
for of the vertical
dimension.
 5. THE ‘F’ OR ‘V’ AND ‘S’ SPEAKING
ANTERIOR TOOTH RELATION: POUND
AND MURRELL
‘f’ and ‘v’ sounds - The incisal edges of
the maxillary anterior teeth create a
seal on the moist area of the vermilion
border of the lower lip.

•‘s’ - The position of the mandibular

anterior teeth is determined when the
patient says
words beginning with ‘s’. When the ‘s’
sounds are articulated, the mandible
moves 65forward. The incisal edges of the 37

anterior teeth do not make contact.

3.ESTHETICS
• Labial surfaces of the occlusion
rims should be contoured to
replace or restore the tissue
support provided by the natural
structures.

• If lips are not properly supported

anteriorly- tendency to increase
the vertical dimension is great-
leads to increased lower face
height.
• Recent evidence – this method
is unrelia ble
65 38
4.FACIAL
EXPRESSION
• In normal related jaws, the lips will be
even
antero-posteriorly and in slight contact.
• Patient with a retruded mandible has
uneven lip position and the two are not in
contact. Vice versa is observed in case of
prognathic mandibles.
• Skin around the eyes and over the chin
will be relaxed.
• Relaxation around the nares reflects
unobstructed breathing. 39

65
 5.SWALLOWING
THRESHOLD
• Powell and Zander(1965), Boucher
(1955) and Shanahan (1955)
• Teeth come together with a very light
contact at the beginning of the
swallowing cycle.
• Highest point of jaw during deglutition
= VDO
Technique:
• Build cones of wax on the lower
denture base in such a way that they
contact the upper occlusion rim when
the jaws are opened65too wide. 40
• The flow of the saliva is stimulated
by food, such as a piece of candy.
• Repeated action of swallowing the
saliva will gradually reduce the height
of the wax cones to allow the mandible
to reach the level of occlusal vertical
dimension.
• Length of the time to complete this
action and the relative softness of the (The consistency of the the swallowing
wax cones will affect the results. technique in determining occlusal
vertical relation in edentulous patients -
• No consistency in the final vertical J Prosth. Dent., 36: 159, 1976)
positioning of the mandible has
been found.
65 41
 6.TACTILE SENSE
A. PERCEIVED COMFORT
PATIENT

• Instruct the patient to stand erect

and open the jaws wide until strain
is felt in the muscles.

• When this opening becomes

uncomfortable , ask him to close
slowly until the jaws reach a
comfortable , relaxed position.

65 42
B) Lytle’s Neuromuscular perception - Lytle RB in
1964 It relies on patient’s perception of different vertical
•
height.
• A central bearing device is attached to accurately
adapted record base
• Bearing pin is adjusted beyond the rest position,
pin is then lowered by half turn. Patient has to
signify over- closure.
• Pin is raised again till excess opening is seen.
• Appropriate vertical relation is judged by the
patient.
• Disadvantage :
• it cannot be used in patients with poor
neuromuscular coordination.
• Presence of foreign objects in the palate and the 43
tongue space.
• Conflicting65 results on the precision of this method
 7. POWER POINT ( BOOS BIMETER ,
1940):
• Attach the bimeter to an accurately adapted
mandibular
record base.
• Attach a metal plate in the vault of an accurately
adapted
maxillary record base to provide a central bearing
point.
• Adjust the vertical distance by turning the cap.
• The gauge indicates the pounds of pressure generated
during closure at different degrees of jaw separation.
• When the maximum power point is determined, lock
the set nut.
• Make plaster registrations and transfer the cast to an
articulator. 44
65

• Disadvantage: Such a device offers no more accuracy

than Niswonger’s or Silverman’s method.
8.WAX OCCLUSION
•RIMS
1.Establish the vertical dimension at rest

• 2.Maxillary occlusion rim contoured to the tentative

occlusal plane is not altered unless absolutely
necessary. When they must be , reduce the rim distal
to the cuspid and retain the guides for positioning the
anterior teeth.

• 3.Make the interocclusal distance approximately 3-4

mm less than the interocclusal distance at rest
position.

• 4.Thinly
65
coat the maxillary occlusion rim with 45

petrolatum.
• 5.Soften a roll of baseplate wax in a
waterbath at 130o F and contour it
in a triangular shape with the base
on the occlusion rim and attach it
to the occlusal surface of the
mandibular occlusion rim.

• 6.Seat the mandibular record base in

the mouth and place the tips of the
index fingers bilaterally on the buccal
flanges in the area of the second
bicuspids to assure that the record
base is stable when the jaw is moved.
65 46
• 7.Request the patient to retrude
the mandible and close on the
back teeth but to stop closing the
jaw when he feels that the closure
is sufficient.

• 8. Allow the wax to harden before

removing the tentative record
from the mouth.

65 47
• 9.Reinsert the record and have
the patient close to maximum
occlusion. Measure the
distance between the points
of reference and compare with
the measurements made with
the mandible at rest.

- If the measurement is less than

the measurement at rest and the
baseplate wax is not penetrated
through to make occlusion rim
contact,
65
the record is acceptable. 48
 Niswonger’s
• The
method
camper’s plane or the ala-
tragus line and the inter-
pupilliary line are the
hallmarks of this procedure.

• An upright position leads the

planes to be parallel to the
floor.

• The marks are made on the tip

of the nose and the most
stable
65
area on the chin. 49
• The distance between the
marks is recorded after the
patient is asked to swallow
and relax.

• Subsequently occlusal rims

are fabricated so that when
they occlude, have a
measurement 1/8” less than
the original measurement.

• This 1/8” average gives a

freeway
65 space of 2 to 4 mm. 50
 Preparing for
evaluation
• Relate the mandibular cast to the face-bow
mounted maxillary cast and attach the mandibular
cast to the articulator with plaster.

• Orient the plane of occlusion and arrange the anterior

and posterior artificial teeth to meet the functional and
esthetic requirements in centric occlusion.

• Co n tour the wax in the form of the finished

6 5 51

denture.
 Evaluating vertical
dimension
Patient’s tactile sense:
• Place the trial dentures in the patient’s mouth.

• Instruct the patient to open and close until the teeth contact.

• Ask the patient if the teeth appear to touch too soon, if the
jaws seem to close too far before they touch, or if the teeth
feel just right.

• This
65 method is not very effective with senile patients or with 52
who
thosehave impaired neuromuscular
coordination.
Swallowing followed by
relaxing

1.With the dentures in place instruct the patient to wipe the lips with the
tip of the tongue, swallow and let the shoulders drop in a relaxed
position.

• If the teeth are together it can indicate that no interocclusal distance

exists.

2.Two small cones of a soft wax are placed, one in each central sulcus of
the mandibular first molars.

• Encourage the patient to swallow several times.

• If6t5 he vertical dimension of occlusion is correct, the wax will be 53

penetrated and reduced to tooth contact.

 Phonetic
s

• Three, thirty-three : There should be enough space for the tip of

the tongue to protrude between the anterior teeth.

• Fifty-five : Incisal edges of the maxillary central incisors should

contact the vermilion border of the lower lip at the junction of
the moist and dry mucosa.

• Emma and Mississippi : Teeth should not

65 54

contact.
 Effects of increased vertical
• dimension
Discomfort to the patient.

• Trauma and pain under the basal seat areas of dentures: The jarring
effect of the teeth coming into contact sooner than expected may
not only cause discomfort but in most cases it will also cause pain
owing to the bruising of the mucosa

• Loss of free way space : Muscular fatigue of any one or group of

muscles of mastication. In turn results in annoyance from the inability
to find comfortable resting position.

• Clicking sound : When occlusal vertical dimensions is increased,

opposing
sound 65
cusp will frequently meet each other producing an embarrassing
55

.clicking
• Appearance : Elongated appearance and at rest the lips are parted;
Patient tries to close them together producing an expression of
strain.

• Bone resorption : Due to continuous pressure on the residual

alveolar
ridge it undergoes rapid resorption.

• Loss of retention and stability : Leverages are caused due to

premature
contacts, further loss of ridge leads to loss of retention and
stability.

• Generalized Hyperemia : Space between the teeth is essential when

65 56
mandible is at rest. If no space is present between the teeth in
denture, it may result in generalized hyperemia.
 Effects of decreased vertical
relation
Inefficiency : Pressure which is possible to exert with teeth in
contact decreases considerably with over closure because the muscles
of mastication acting from attachments have been brought closer
together.

Cheek, Tongue and lip biting : Loss of muscular tone, as well as

reduced vertical height, the flabby cheek tend to become trapped
between the teeth during mastication.

Appearance (Denture look) : The general effect of over closure

on facial appearance is of increased age because of closure
approximation of nose to chin, soft tissue sag and fall in and the lines
on the face are deepened.
65 57
Angular cheilitis (perleche):
A reduced vertical dimension results in a crease at the
corners of the mouth beyond the vermilion border and
the deep fold thus formed becomes bathed in saliva
thus leading to infection and soreness.

Pain in temporomandibular joint :

Over closure may cause pain in temporomandibular
joint probably due to strain of the joint and associated
ligaments.

65 58
 Costen’s syndrome (Mild catarrhal
deafness):
There will be a tendency to push the tongue towards the throat, adjacent
tissues will be displaced, which may in turn result in occlusion of Eustachian
tubes which would interfere with function of ear which may cause ear
discomfort and impaired hearing.
• Tinnitus or snapping noises in joint.
• Tenderness to palpation over T.M.J.
• Dryness of the mouth.
• Various neurologic symptoms such as burning or picking sensation of the
tongue.

Prognathism :
Over the years as a result of resorption of ridges and abrasion of
denture teeth, there is a loss of occlusal vertical dimension. So the
lower jaw over- closes in a forward and upward direction.Then the
patient may appear prognathic.
Weinberg
65
L, Role of condylar position in TMJ dysfunction-pain syndrome, J 59
Prosthet Dent, Vol 41, 6, Jun 1979, Pages 636–
643
 REFERENCE
S

65 60
 Reestablishment of Occlusal Vertical Dimension in Complete Denture
Wearing in Two Stages
A 65-year-old woman came to a Dental School, Brazil, for assessment of a new complete denture.
The complete dentures were fabricated 23 years ago and her principal complaint was poor esthetics and ear
pain.

65 6
1

Case Reports in Dentistry. 2015;2015:1-

 The Study of the Effect of Altering the Vertical Dimension
of Occlusion on the Magnitude of Biting Force
• Aim: To develop a device capable of measuring the biting force generated during
maximum biting, during a change in VD and to determine, the relationship between the
VDO and the biting force.

• Materials and Methods: Indigenously fabricated electronic gnathodynamometer was

used to record biting force of 10 individuals at altered VD. The range of alteration was
chosen from increased 7.5 mm to decreased 4.5 mm and established VDO as base line.

• Results: Bite force was maximum at the VDO in edentulous subjects. Maximum
biting force recorded at VDO was reduced with subsequent increase or decrease in
VD.
• Clinically highest biting force could act as an aid in determining and verifying VDO
for edentulous
65 patients 62

Journal of International Oral Health 2015; 7(11):1-

5
 Reliability of determining vertical dimension of occlusion
in complete dentures: A clinical study.
• Objectives :1. To assess the reliability of the
conventional methods in obtaining vertical dimension.
2. To analyse changes in morphologic face height after
extraction. 3. To assess the reliability of measuring base
of nose to chin distance in obtaining vertical
dimensions.

• Results: Nose-chin measurement has a significant

corelation with cephalometric measurements, hence it is
found to be a very effective pre extraction aid in
determining vertical dimension. However, reliability of pre
extraction records in long period of edentulousness is
limited. The conventional methods used to determine the
vertical dimension
65
are not reliable 63

The Journal of Indian Prosthodontic Society.

 Conclusio
relationsn
• Many methods of assessing and recording vertical jaw
in edentulous patients have been presented
and evaluated.

• Since there is no precise scientific method of

determining the correct vertical relations, the
registration of vertical relations depends upon the
clinical experience and judgment of the dental
surgeon himself.

• Several methods should be used to verify the

vertical dimension and there is no one single best
method to do so.

65 64
 REFERENCES AND CROSS
REFERENCES
1. Prosthodontic treatment for edentulous patients : Boucher 9th Edition
2. Textbook of complete dentures : Charles M. Heartwell Jr., Arthur O Rahn, 4th and 5th Edition
3. Marin D, Leite A, de Oliveira Junior N, Compagnoni M, Pero A, Arioli Filho J. Reestablishment of
Occlusal
Vertical Dimension in Complete Denture Wearing in Two Stages. Case Reports in Dentistry.
2015;2015:1-5.
4. Gosavi SS, Ghanchi M, Patil S, Sghaireen MG, Ali AH, Aber AM. The Study of the Effect of Altering
the Vertical Dimension of Occlusion on the Magnitude of Biting Force. Journal of International Oral
Health. 2015 Nov 1;7(11):110.

65 65
 REFERENCES AND CROSS
REFERENCES
5. Bhat VGopinathan M. Reliability of determining vertical dimension of
occlusion in complete dentures: A clinical study. The Journal of Indian Prosthodontic
Society. 2006;6(1):38.
6. Irving M. Sheppard, Stephen M. Sheppard, “Vertical dimension measurements”, JPD 1975,
34(3) : 269 – 277
7. A.J. Turell; “Clinical assessment of vertical dimension”, JPD 1972, 28(3) : 238 – 246
8. Silvermann MM; “The speaking method in measuring vertical dimension”, JPD 1953, 3(2) :
193 – 199
9. Swerdlow H; Vertical Dimension literature review, J Prosthet Dent March April 1965, Vol 15,
no. 2. 241-247.

65 66
65 67