PEOPLES' DENTAL COLLEGE AND HOSPITAL

THESIS PROPOSAL
ON

Influence of occlusal vertical dimension on lip

positions at smile in completely dentulous adults.

Presented by:-
Niraj Dhyako
PG Resident
Department of Prosthodontics
 Introduction
• With the advancing age or alteration in the harmony between the orofacial
musculoskeletal complexes, patient may undergo various changes in hard
and soft tissue of the oral cavity.
• It may compromise the esthetics of face along with the biomechanical
function of the oral cavity.
• This may be due to the wear or the loss of the tooth structure followed by
decrease in vertical dimension or supraeruption of the tooth into the opposing
edentulous space.
• But determining whether vertical dimension of occlusion is truly lost or not is
often difficult.
 Introduction
• Loss in vertical dimension of occlusion also alters the soft tissue profile of the
lower third of the face.
• Maintaining the relationship between the teeth and lips during smile is
important aspect of esthetic correction.
• During a normal smile, the upper lip should rest at the level of the mid-facial
gingival margins of the maxillary anterior teeth.
 Introduction
• It is implicated that alteration in vertical dimension of occlusion apparently
alters these soft tissue esthetics.
• It is obvious that alteration in the vertical dimension changes the distance
between the maxilla and mandible.
• This increased distance is more likely to change the relationship of the lip and
tooth during smiling.
 Introduction
• Prosthodontic restoration of these patients frequently require alteration in the
vertical dimension of occlusion.
• However, this loss in vertical dimension is difficult to determine if pre existing
records are lacking.
• Therefore it would be logical to use esthetic, function and comfort as the
guide to restore the vertical dimension of occlusion.
• In this study, influence of vertical dimension of occlusion in dimensions of
smile will be studied; so that it can be quantified scientifically and can be
applied in future treatment planing.
 Rationale and justification of study
• Determination of the esthetic outcome during full mouth rehabilitation is
utmost important aspect of the treatment planning.
• Maintaining harmony between occlusion, function and esthetics has been
one of the main interest of the prosthodontists.
• During restoring the vertical dimension, it has been implicated to alter the
esthetics of patient but it lacks the scientific data.
• Therefore the purpose of this study is to determine influence of occlusal
vertical dimension on lip positions at smile.
 Objectives of the study
General
To determine the influence of vertical dimension of occlusion at smile in
dentulous patients.
 Objectives of the study
Specific
1. To determine the influence of vertical dimension of occlusion in interlabial
height.
2. To determine the influence of vertical dimension of occlusion in
intercommisural width.
3. To determine the influence of vertical dimension of occlusion in incisal edge
to upper lip distance.
4. To determine the influence of vertical dimension of occlusion in incisal edge
to lower lip distance.
5. To determine the influence of vertical dimension of occlusion in display zone.
 Methodology
Study Design
Quantitative - cross sectional study

Study Place /Site and Justification

This study will be conducted in Department of Prosthodontics, Peoples
Dental College and Hospital as I’m doing my Post Graduate residency in this
department and there is ample number of patient flow which will be helpful for
me in obtaining data.
 Methodology
Study Population
This Study can include any patient visiting department of Prosthodontics
meeting inclusion and exclusion criteria.

Sampling method and Technique

Convenience sampling
 Selection Criteria
Inclusion Criteria:
Subjects with:
1.No missing anterior teeth
2.At least three teeth in occlusion in both posterior segments
3.Age : 20 -30 years
4.Voluntary participation
 Selection Criteria
Exclusion Criteria:
Subjects with:
1. History of trauma and injury to facial structure, neurological disorders
2. Inablity or unwillingness to smile
3. Allergic to silicon, acrylic or irreversible hydrocolloid materials
 Data Collection Technique/ Methods
• Data collection technique is divided into two phase.
• In first phase, impression of both upper and lower arch is made with
reversible hydrocolloid impression material and is disinfected and poured
with dental stone.
• On the same appointment day, tentative facebow transfer is done using a
hanau spring bow and the bite registration is made with bite registration wax.
• Casts of the subject are mounted using the obtained facebow and bite
registration record in a semi adjustable articulator.
 Data Collection Technique/ Methods
• To prepare the occlusal records, self cure acrylic is mixed and is adapted on
the occlusal suface of the mounted mandibular cast from 1st premolar to 2nd
molar.
• Vertical dimension is increased by +1, +2, +3, +4mm in articultor using the
incisal pin and occlusal records of individual vertical dimension is prepared
using above mentioned procedure.
• After complete setting of the acrylic, excess material is trimmed off and
polished to ensure proper fit on the occlusal surface.
• Later these records are used intra orally to increase the vertical dimension at
occlusion.
• These records are disinfected and stored in a labeled plastic bag.
 Data Collection Technique/ Methods
• In second phase, patient is prepared for a photograph.
• Patient is drapped and is made to achieve natural head position by looking at
a distant point.
• A DSLR camera ( Nikon D5600 with lens 18-55mm lens, aperture… shutter
speed… and ISO… ) mounted on a tripod in a fixed distance from a patient is
used to photograph the patient.
• 3 photos for each vertical dimension of occlusion i.e. from 0mm to +4mm are
made during smiling.
 Data Collection Technique/ Methods
• These photos are transferred to a Adobe photoshop software and
measurements are done as follows.
– Width of two central incisor
– interlabial distance
– Incisal edge to upper lip
– incisal edge to lower lip
– Intercommisural width
– Display zone area
• These data are recorded in milimeter and stored in microsoft excel and later
analysis is done in SPSS.
 Data Collection Tools
Instruments:
• Impression tray
• Hanau spring facebow
• Hanau wide view semi adjustable articulator
• DSLR camera

Materials:
• Alginate
• Dental stone
• Mounting plaster
• Self cure acrylic
Pretesting the data collection tools (if applicable)
Not applicable

Validity and Reliability of the study tools: Mention how will you assess validity
and reliability)
All the observation and process will be performed by researcher only.
Potential Biases (if applicable)
No any

Limitations of the study

This study is only conducted in the limited subjects so may not denote the
whole population.
 Data Management and Analysis
Software that will be used:
Adobe Photoshop
SPSS

Statistical tests:
Statistical analysis will be done with the help of biostatistician
 Expected Outcome of the study
• With the increase in occlusal vertical dimension of the individual, it has been
expected to increase inter labial gap height, incisal edge to lower lip distance
and display zone area but in addition change in width of smile and incisal
edge to upper lip distance should not be expected with changing occlusal
vertical dimension.
 Work Plan
Wo Dur May- June July 2020- July August - October - Janaury -
rk a tion 2020 2021 september December Feburary 2022
p la 2021 2021
n
Proposal
submission and
approval
Data collection

Data analysis

Thesis writting

Thesis
submission
 Ethical Considerations
1. Are human participants included in the study? Yes/ No Justification if yes
– Yes, human participants are included in the study but only observational study will
be done.

2. How many participants are required for the research? Explain

3. What is the frequency of the participant’s involvement in the research?

Explain.
– Two visits are required for this research but these appointments will be made only
during patients appointment day for his/her undergoing treatment. No additional
visits will be made.
 Ethical Considerations
4. Clearly indicate the participant's responsibilities in the research. What is
expected of the research participants during the research?

5. Are vulnerable members of the population required for this research?

(includes age under 18, pregnant women etc) If yes, provide justification.
– No

6. Are there any risks involved for the participants? If yes, identify clearly what
are the expected risks for the human participants in the research and
provide a justification for these risks.
– No
 Ethical Considerations
7. Are there any benefits involved for the participants? If yes, identify clearly
what are the expected benefits for the participants.
– Yes. The result from the study can be used for the prosthodontic rehabilitation and
also gives the idea about the tentative vertical dimension of occlusion upto which
alteration can be made without changing esthetics of the patient.
 Obtaining the Informed Consent
1. How will the informed consent be obtained from the research participants?
– Written

2. Who will obtain the consent from the study participants?

– Researcher himself will obtain the consent form the study participants.

3. Is there anything being withheld from the research participants at the time
the informed consent is being sought?
– No
 Obtaining the Informed Consent
4. Is the research sensitive to the Nepali culture and the social values? If yes,
explain
– No

5. Is health insurance (if applicable) being made available to the research

participants? If yes, please provide the necessary insurance data.
– No