1 2 3 4 5

VERTICAL JAW RELATION

PRESENTED BY – DR. SHAILJA SHARDA
1-MDS
SEMINAR 3
 CONTENTS

1 2
INTRODUCTION CLINICAL
PHYSIOLOGIC CLASSIFICATION MECHANICAL
SIGNIFICANCES
REST POSITION AND
OF JAW
AND THEORIES PHYSIOLOGICAL
RELATION
METHODS

EFFECTS OF EFFECTS OF CONCLUSION REFRENCES

PHYSIOLOGIC
PHYSIOLOGIC INCREASED DECREASED REST POSITION
REST POSITION VERTICAL
VERTICAL AND THEORIES
AND TIES DIMENSION
DIMENSION
 • The main objective of prosthetic dentistry is to restore the missing dental and oral
structures in such a way that there is harmonious relationship between the teeth,
bones, joints and muscles.
INTRODUCTION

• In case of edentulous patient all the tooth guidance is lost.

• So in order to construct the complete denture, prosthodontist should discover the

relations of the mandible to the maxilla, when natural teeth were present.

• As the rest position of mandible remains fairly constant for reasonable period of
time after the loss of teeth, it is important in determining the vertical relation
during jaw relation records.
3
Maxillomandibular relations are of 3 Types:

V
e
r
t
Orientation
i
Relations
c
a
l

R
e Horizontal
l Relations
a 4

t
i
 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.
(GPT8)
DEFINITIONS

The vertical jaw relations are those established by the amount of separation of the
two jaws in a vertical direction under specified conditions.
(Boucher)

5
 VERTICAL DIMENSION AT REST
/PASSIVE VERTICAL DIMENSION
It is the vertical separation of the jaws when the opening and closing
muscles of the mandible are at rest in tonic equilibrium (Heart well).

Head should be in
upright position

6
 VERTICAL DIMENSION AT REST
/PASSIVE VERTICAL DIMENSION
It is the vertical separation of the jaws when the opening and closing
muscles of the mandible are at rest in tonic equilibrium (Heart well).

Head should be in
upright position
Muscles in equilibrium
in tonic contraction

7
 VERTICAL DIMENSION AT REST
/PASSIVE VERTICAL DIMENSION
It is the vertical separation of the jaws when the opening and closing
muscles of the mandible are at rest in tonic equilibrium (Heart well).

Head should be in
upright position
Muscles in equilibrium
in tonic contraction

Condyles in neutral
unstrained position
8
 VERTICAL DIMENSION OF
OCCLUSION /ACTIVE VERTICAL
DIMENSION

The distance between two selected anatomic or marked points

when in maximal intercuspation position. (GPT 9).

FREEWAY SPACE/INTER-OCCLUSAL SPACE

VDR- VDO
9
11
Physiologic Rest Position

The postural position of the mandible when an individual is resting comfortably in an

upright position and the associated muscles are in a state of minimal contractural
activity. (GPT 8).

• The mandible is said to be in its physiologic rest position when all the muscles that
close and open the jaws are in a state of minimal tonic contraction only to maintain
posture. (Boucher).

12
 PHYSIOLOGIC REST POSITION-HYPOTHESIS
• 1st hypothesis (active ): muscles - minimal contraction to maintain posture of mandible
• 2nd hypothesis (passive): elastic elements of jaw musculature & no muscle activity,-
balance the influence of gravity.

Studies have shown evidence of EMG activity in patients at rest position.

• Current concensus : physiologic rest position= actively determined.
• Rest position 2 to 10mm below maximum intercuspation has been recorded.
• So,its more accurate to refer to a range of posture rather than a single rest position-
RANGE OF POSTURE
13

Prosthodontic treatment for edentulous patients: 12 th ed, Boucher.

Significance of Physiologic Rest Position
• It is a measurable distance,
• A repeatable reference within an acceptable range, and
• A useful reference when determining the vertical dimension of occlusion.

17

Textbook of complete dentures: 5th ed by Arthur O. Rahn and Charles M. Heartwell.

 VERTICAL DIMENSION AT REST
METHODS TO MEASURE IT

MEASUREMENT

FACIAL OF
TACTILE FACIAL
ANATOMICAL SPEECH
MEASUREMENTS SENSE EXPRESSION
LANDMARK
 Classification of methods of Recording
ACCORDING TO SWENSON:

I Ridge relation
 Distance of incisive papilla from mandibular incisors .
 Distance of Incisive papilla from crest of lower ridge.
 Esthetic values
 Esthetic values

II. Measurement of Former Dentures

23

Swenson’s Complete Denture. Fifth Edition. Pg-156-157

IV. Pre-extraction records
V. Boos Bimeter
VI. Wright (interpupillary distance)
VII. Phonetics & Esthetics as guides
VIII. Swallowing threshold

24
 ACCORDING TO BOUCHER

Mechanical methods
Physiological methods
Pre-extraction records
 phonetics
 profile radiographs
 esthetics
 casts of teeth in occlusion
 swallowing threshold
 facial measurements
 tactile sense and patient
 ridge relation
 measurement of ridges percieved comfort

25

Boucher’s textbook.12th edition pg- 274-282

26
 According to Sharry

 Pre-extraction determination
 Post extraction records
Niswonger’s method
Power point / Bimeter / Boos method
Concept of equal third
 Will’s measurements
 Electromyography
Lytle Method (Neuromuscular perception)

27
WHICH ARE THE PRE -EXTRACTION
RECORDS USED FOR DETERMINING
VERTICAL JAW RELATION?

28
 MECHANICAL METHODS
Profile Radiographs

• Is a useful preextraction record

• A 1:1 ratio of cranium to image radiograph is obtained with lateral skull film - made before
and after extraction, when mandible assumes physiological rest position or centric occlusion
and measurements are made between bony land marks of maxilla and mandible

• Later used as reference - patient becomes edentulous – present radiograph is compared with
the previous one.

. Clinical assessment of vertical dimension- JPD 2006,96;79-83

• Questionable.
• Not practical for routine use
• Frequent exposure to irradiation
• Can be used for research purpose
• Constancy of rest position and occlusal vertical height from dentulous to
edentulous condition is disputed.
• Not applicable on patients with any congenital and acquired
Orofacial deformity, facial asymmetry or patients not willing to undergo
radiography
 Profile photographs:
• Profile photographs are made with the teeth in maximum occlusion.
• Enlarged to life size.
• Measurements of anatomic landmarks is done - before and after extraction - on photographs

Angulation of the photographs might differ with patient’s posture.

Accuracy doubtful - Enlargement may cause some inaccuracies.
Can serve as guide to compare the fullness of the face 31
 Facial Measurements

Goodfriend suggested that the distance from the pupil of the eye to
junction of the lips equal to that from the subnasion to the gnathion

32

Clinical assessment of vertical dimension- JPD 2006,96;79-83

McGee correlated VDO with 3 facial measurements which he claimed remain constant
throughout life. These were:
• the distance from the center of the pupil of the eye to a line projected laterally from the median
line of the lips;
• the distance from the glabella to the subnasion; and
• the distance between the angles of the mouth with the lips in repose.

According to him atleast two of these three measurements will be invariably equal

GLABELLA

SUBNASION

Clinical assessment of vertical dimension- JPD 2006,96;79-83

 Articulated casts
• Articulated casts of patient before and after the extraction are compared.
• Simple method of recording -vertical overlap relation , size and shape of the teeth

 Cannot be used where there is a long waiting period for fabrication of

denture after extraction.
 Not useful if there is excess loss of bone during extraction
 Measurement of former dentures
• Boley’s gauge

Several reasons for not accepting the measurements :

• Residual ridge resorption under the denture increases the IO distance
• Can be used only if the patient’s old denture is available
• Can be adopted only if existing VDO and occlusal plane are within normal limits

Use of a patient’s old complete denture to determine vertical dimension of occlusion. Majid Bissasu. JPD 2001: 85(4);
413-414.
 Profile tracing (Lead wire adaptation)
• A piece of soft lead wire…
• Moulded to contour the face starting from the eye brow to just below the chin along the
midline.

Not simple ..wire may bend during storage

Possibility of change in the facial contour and vertical height subsequent to 36

extraction of teeth should be considered

 The Dakometer
• This instrument records both the VDO and position of
upper central incisors.
• In most cases recording can be obtained with an error
range of 1mm.
• Place on patient face when the patient is in maximum
intercuspation.
• Edge moves to engage incisal edge of maxillary teeth…
record the measurement .
• The Dakometer is reported to be an accurate measuring
device.

Clinical assessment of vertical dimension- JPD 2006,96;79-83

 Willis gauge
• Used for recording vertical height before extraction.
• Upper part is place in contact with the base of the nose.
• Lower member is moved on the slide until it touches the lower border of the chin.
• Difficult to generate anthropometric measurements in all patients .

• Measurements are difficult to obtain as there are no precise measurable fixed points .

• Soft tissue landmarks vary.

• Difficult to fix an exact point on the chin to measure the distance .

 Acrylic Resin Mask
• By Swenson
• Acrylic resin face mask is made before the extraction .
• Hydrocolloid impression of patients face is made ..this is reinforced with plaster before it is
removed from the face ..poured in stone ..2-3mm baseplate wax is adapted ..this wax mask is
the processed with clear acrylic resin

Complete denture prosthodontics, 3rd ed by John J. Sharry.

• Cumbersome method - More time and experience required .
• Hydrocolloid material requires precise procedure large quantities must be warmed to
the correct temperature and then painted on the face.
• The face assumes a different topography in the erect posture from that in the
recumbent or semi recumbent position.
• In supine position – VDR cant be accurately determined
• Less accurate than profile soft wire tracing method
• Displaces skin with inaccuracy of up to 2mm
POST EXTRACTION METHODS
 RIDGE RELATION
• Victor Sears
• Paralleling of the maxillary and mandibular ridges plus 5-degree opening in the posterior.
• Because the clinical crowns of the anterior & posterior teeth have nearly the same length,
their removal tends to leave the residual alveolar ridges nearly parallel to each other
•

Prosthodontic treatment for edentulous patients: 12 th ed, Boucher.276

• In most people the teeth are lost at different times and so by the time the patients are
edentulous, residual ridges are no longer parallel

• Edentulous ridges of the mandible and maxillae will become progressively more
discrepant from the standpoint of width .

• Difficult to visualize parallelism intraorally

 Distance of incisive papilla from mandibular incisors

Questionable use:
• In absence of lower anterior teeth.
• Patients with severe resorption.
• Average measurements – subjected to variations

Prosthodontic treatment for edentulous patients: 12 th ed, Boucher. 276

 Niswonger’s method
• Based on Niswonger’s concept that mandible moves 1/8 inch (3mm) upward from rest
position to centric occlusal position.
Most commonly used…
• Simple
• Accurate

Manual on maxilla- mandibular relations, face bow and articulators, E.G.R Solomon 47

Complete denture prosthodontics, 3rd ed by John J. Sharry.

• The patient is seated so that ala-tragus line is parallel to floor.
• Two marks ….
• Swallow and relax…
• Distance is measured….
Power point or Bimeter or Boos method :
• device registers the biting force at varying degrees of jaw separation.
• Suggested by Ralph Boos (1940) .
• Attach the bimeter to mandibular record base.
• And a metal plate in the vault of maxillary record base.

Clinical assessment of vertical dimension- JPD 2006,96;79-83

• The gauge indicates pounds of pressure generated during closure at different degrees of jaw
separation.

• Vertical height is adjusted by altering occlusal rims till maximum biting force pressure is
obtained

Clinical assessment of vertical dimension- JPD 2006,96;79-83

Complete denture prosthodontics, 3rd ed by John J. Sharry.
• Time consuming
• The vertical level of maximum closing power is indicated only on the
effective parallelism of the ridges.
• It was reported that this didn’t represent an occlusal position but rather
represented rest position .Since then it has been shown that vertical
dimension has no definite relationship to the powerpoint. Neither the
occlusal nor rest position does necessarily coincide with the powerpoint.
Therefore use of power point as reference in vertical dimension is not
always accurate.

Clinical measurement and evaluation of vertical dimension JPD

2006, 95; 335-9
 WILLIS MEASUREMENTS
• Willis gauge.
• At VDR , A=B
• Soft tissue landmark measurements are debatable.
• Also willis gauge is not as precise as Dakometer, pointed steel dividers and precision
calliper.

Clinical assessment of vertical dimension- JPD 2006,96;79-83

Complete denture prosthodontics, 3rd ed by John J. Sharry.
 ELECTROMYOGRAPHY

• Based on fact that minimal muscular activity occurs when the mandible is in the rest position
• Produces more consistently reliable determination of VDR than conventional methods
• Uses a special device that measures the tone of masticatory muscles, when the tone is at its
least, this means these muscles and jaws are in rest position

Rest position: An Electromyographic and Clinical Investigation. JPD 1962:12(5);895-911.

• This appears simple – but not a practical method
• The equipment is too expensive.
• Cumbersome procedure .
• Requires trained personnel.
• It may not be practical to install an electromyogram in the dentist office for the
purpose of recording vertical dimension
• Inability of the patient to relax ,cooperate and understand instructions are other
difficulties
• Ramford EMG study indicated resting range for muscles rather then a position.
Clinically determined Rest position dosent often agree with minimal muscle
activity as determined electromyographically.
TENS (Transcutaneous Electrical Neural Stimulation )

Special device produces electric current to stimulate nerves

For recording VD, ultra low frequency TENS is used.
Electrodes are applied over coronoid notch area.
Current is passed to stimulate contraction of muscles via cranial nerves.
EMG activity before and after application of current is recorded.
VDR is achieved when muscles are at their lowest level of activity.

Rest position: An Electromyographic and Clinical Investigation. JPD 1962:12(5);895-911.

• Researches have indicated that rapid adaptations take place after the changes in
vertical dimension, leading to another rest position and a change in IOD.

• Therefore rest position alone is not a reliable basis.

• Should be combined with ….. Phonetics, esthetics and patient comfort.

Prosthodontic treatment for edentulous patients: 12 th ed, Boucher.

 PHONETICS

• Phonetic tests of VD include :

Listening to speech sound production

Observing relationship of teeth during speech

Prosthodontic treatment for edentulous patients: 12 th ed, Boucher.pg 278-279

 Methods:
• During production of “M” sound, lip contact is passive.
• So it can be used as an aid in obtaining correct VD
• F and V – requires adequate freeway space for pronunciation
• When patient is asked to pronounce two words thick-thin alternatively, the tongue usually fills
into the gap between upper and lower occlusal surface. This is again useful to judge the
adequacy of free way space.
• During pronunciation of Mississipi, Fifty five- appropriate freeway space is checked .
If teeth click= VD is more
If pronounced as sh, or with a whistling sound= VD is reduced.
Phonetic method only serves as a check to verify dimension obtained by other
methods and to judge extent of available freeway space.
 • SILVERMEN’S METHOD OR SILVERMEN’S CLOSEST-
SPEAKING SPACE METHOD.

• Meyer Silvermen (1952)

• production of the certain sounds like ‘S’, ‘Yes’, ‘Miss’, ‘Buzz’ brings the anterior
teeth very close together.
• When correctly placed, the lower incisor are moved forward to a position nearly
directly under the upper central incisors and almost touching them.

Prosthodontic treatment for edentulous patients: 12 th ed, Boucher.

 PHONETICS IN COMPLETE DENTURE –A
REVIEW
DR. RENU GUPTA, DR. R.P. LUTHRA, DR. DEEPAK GAUTAM
• Phonetic tests while patients are producing sibilant sounds enable the dentist to identify the smallest speaking
vertical separation of the anterior teeth occlusal rims (Burnett, 1994). Silverman (1952) affirms that the
closest speaking space (CSS) of each individual is constant throughout life; this would allow dynamic
determination of the vertical dimension of occlusion (VDO) in both dentate and edentulous patients.
• The `CSS Technique', has gained wide acceptance and has been used in clinical research (Pound, 1966, 1977;
Gillings, 1973). Morrison (1959) suggested using the words sixty-six and Mississippi.
• Clemencon (1967) believes it is possible to increase the CSS by thickening the resin palatal vault of a
complete denture. This procedure could allow an increase of the VDO, in cases in which it is too low from
the aesthetic stand-point, avoiding contact between opposing teeth during speech.
• The clinical rest position (CRP) is a commonly used reference point in the determination of OVD and when
in this position there is a variable space between the maxillary and mandibular teeth, or alveolar ridges,
which is referred to as the interocclusal distance.
International Journal of Healthcare Sciences Vol. 4, Issue 1, pp: (373-377), Month: April 2016 - September 2016
• “Silverman” suggested that incorrect determination of the vertical dimension of occlusion and improper
placement of anterior teeth frequently results in a lisp or substitution of the /th/ sound for the /s/ sound.“
Tanaka” found that in edentulous patients the placement of a denture resulted in overall improvement of
speech with time. He noted that the sounds most frequently in error were the sibilant sounds and that
palatal contour can affect certain speech sounds.
• “Boucher” and “Allen” reported that edentulous patients tend to return to normal speech patterns relatively
soon after insertion of dentures, whereas “Troffer” and “Beder” found that normal speech patterns were
not observed weeks after the insertion of immediate dentures.
• Fymbo (1936) pointed out that defective speech is most frequently associated with increased vertical
dimension which may result in difficulty in pronouncing sounds like b, m, p, f, v. Landa (1947)
recommended various phonetic tests to determine proper vertical dimension using sounds such as s, c, z.

International Journal of Healthcare Sciences Vol. 4, Issue 1, pp: (373-377), Month: April 2016 - September 2016
 • Silverman (1956) stated that sibilant sound “s” as a mean for determining the correct vertical
dimension. He established the closest speaking space‖ and used this as clearance area between
the dentures. The bilabial sounds like “m” is useful in determining the vertical dimension, when
this sound is pronounced there will be passive contact between the upper and the lower lip,
which aid in obtaining the correct vertical dimension.

International Journal of Healthcare Sciences Vol. 4, Issue 1, pp: (373-377), Month: April 2016 - September 2016
• Useful as:
1. A pre extraction record.
2. To determine VD.
3. To verify VD
1. As a pre extraction record.

Patient is seated in upright position and made to close

in centric relation.

Draw the centric occlusion line with a sharp pencil

on a lower anterior tooth at the horizontal level of the
incisal edge of the opposing upper anterior tooth.

This line is called centric occlusion line.

The speaking method in measuring vertical dimension. JPD 2001,85(5); 427- 431.
 Patient now pronounces words containing an end sibilant
such as yes, miss, buzz..
Draw the closest speaking line on the same lower anterior
tooth at the horizontal level of the upper incisal edge.

• The distance between the centric occlusion line (lower line)

and the closest speaking line (upper line) is called the
closest speaking space.
• Usually 2-3 mm(Thompson),2-
5mm(sicher),3mm(Niswonger),3mm(Pleasure).

The speaking method in measuring vertical dimension. JPD 2001,85(5); 427- 431.
2. To determine VD after extraction

• Occlusal rims are adjusted until a minimum of 2mm of closest speaking space exists when
the patient pronounces ‘s’ or other sibilants.

3. To verify JR

•Require fair degree of judgement to obtain and assess closest speaking space.

•Applicable mostly in class I JR.

•Patient’s speech may be strained due to the presence of occlusal rims.

 SWALLOWING THRESHOLD
• Thomas 1955
• The position of mandible at the beginning of swallowing act has been used as guide for
determining VDO.
• Technique: Uses soft wax cones on the rims; this induces the patient to salivate and gradual
swallowing will reduce height to VDO
swallowing may be used only as a guide to the VDO.
Previous dentures if any should be removed for some time before recording the VDO to
obliterate the memory of acquired neuromuscular patterns.
COMPARISON OF FOUR METHODS TO DETERMINE REST POSITION OF THE MANDIBLE. ALLYN G. WAGNER. JPD 1971:25(5); 506-514.

• REST 1,M,M,M, SWALLOW, OPEN-CLOSE, and REST 2.

• ….in order to compare the rest vertical dimensions from the two separate REST trials.
• Electronic and electromagnetic equipment was used to record the readings.
• The REST method, based on natural relaxation, appeared to be an acceptable method to
determine the rest position, because the measurements presented less high and low readings.
• The M,M,M method tended to produce a large rest vertical dimension and the swallowing
method a smaller one.
 RELIABILITY OF DIFFERENT FACIAL MEASUREMENTS FOR
DETERMINATION OF VERTICAL DIMENSION OF OCCLUSION IN
EDENTULOUS SUBJECTS, USING ACCEPTED FACIAL DIMENSIONS
RECORDED FROM DENTULOUS SUBJECTS.J INDIAN PROSTHODONT SOC.
2014 SEP;14(3):233-42

• A study was done to evaluate the reliability of different facial measurements for determination
of vertical dimension of occlusion in edentulous subjects using accepted facial dimensions
recorded from dentulous subjects.
• Glabella –subnasion, pupil-rima oris, outer canthus of eye to angle of mouth distance ,chin-nose
distance,subnasion-menton
• Conclusion- The outer canthus of eye to angle of mouth distance was found to be a valuable
adjunct in the determination of occlusal vertical dimension.
 CAD CAM DENTURES
CAD/CAM technology has already made significant strides in the field of dentistry.

Recently, CAD/CAM technology has become commercially available for fabrication of

complete dentures through the introduction of AvaDent™ digital dentures by Global
DentalScience.

It is a system by which impressions, interocclusal records, and teeth selection can be completed
in one appointment. The dentures are then fabricated using CAD/
CAM technology and placed in the second appointment.

CAD/CAM technology: application to complete dentures. Loma Linda University Dentistry. Summer / Autumn 2012.
Volume 23, Number 2
 CAD CAM DENTURES

Maxillary Anatomical Measuring Device Mandibular AMD with recording plate and
(AMD) showing wrench used to move the maxillary AMD with adjustable stylus
adjustable lip support flange

CAD/CAM technology: application to complete dentures. Loma Linda University Dentistry. Summer / Autumn 2012. Volume 23,
Number 2
 Maxillary AMD filled with recording
material

Maxillary and mandibular AMD placed

fairly parallel to each other

CAD/CAM technology: application to complete dentures. Loma Linda University Dentistry. Summer / Autumn 2012.
Volume 23, Number 2
 Occlusal vertical dimension being adjusted Confirming occlusal
with a centrally located adjustable stylus vertical dimension

CAD/CAM technology: application to complete dentures. Loma Linda University Dentistry. Summer / Autumn 2012. Volume 23,
Number 2
 AvaDent™ ruler attached to the Maxillary Determining the appropriate occlusal plane wit
AMD AvaDent™ orientation ruler

CAD/CAM technology: application to complete dentures. Loma Linda University Dentistry. Summer / Autumn 2012. Volume 23,
Number 2
 CLINICAL SIGNIFICANCE AND
CHARACTERISTICS OF VERTICAL DIMENSION
 INCREASED VERTICAL DECREASED VERTICAL
DIMENSION DIMENSION
• Discomfort to the patient. • Inefficient biting forces

• Loss of free way space • Cheek biting

• Clicking sound • Facial distortion

• Elongated appearance of face • Angular chelitis (perleche)

• Trauma and pain under the basal seat • Pain in tempromandibular joint
areas of dentures.
• Difficulty in swallowing

Registration: Stage II —intermaxillary relations BRITISH DENTAL JOURNAL, VOLUME 188, NO. 11, JUNE 10 2000
 CONCLUSION
• An accurate vertical limit of occlusion with provision for a desirable freeway
space in CD is of paramount importance.

• Several methods have been described to obtain vertical dimension of the

edentulous jaws, but no one particular method has proved to be completely
reliable by itself .A knowledge of most of them combined with clinical
judgement gives reasonable degree of accuracy and satisfaction .
 REFERENCES
• Swenson’s complete dentures textbook.fifth edition
• Complete denture prosthodontics, 3rd ed by John J. Sharry
• Prosthodontic treatment for edentulous patients: 12th ed, Boucher.
• Text book of Complete dentures – 5th edition heartwell
• Role of Cephalometery in evaluation of vertical dimension-Pakistan Oral &
Dental Journal Vol 33, No. 1 (April 2013) 183
• Use of a patient’s old complete denture to determine vertical dimension of occlusion. Majid
Bissasu. JPD 2001: 85(4); 413-414.

• Establishing the vertical relation of occlusion. Brente L. Ward et al. JPD;1963(3);432

• Registration: Stage II —intermaxillary relations BRITISH DENTAL JOURNAL, VOLUME
188, NO. 11, JUNE 10 2000
• Reliability of different facial measurements for determination of vertical dimension of
occlusion in edentulous using accepted facial dimensions recorded from dentulous subjects. J
Indian Prosthodont Soc. 2014 Sep;14(3):233-42
• The speaking method in measuring vertical dimension. JPD 2001,85(5); 427- 431.
• Rest position: An Electromyographic and Clinical Investigation. JPD 1962:12(5);895-911.
• Clinical assessment of vertical dimension- JPD 2006,96;79-83
• Phonetics in complete denture – A Review. International Journal of Healthcare Sciences Vol. 4,
Issue 1, pp: (373-377), Month: April 2016 - September 2016
• CAD/CAM technology: application to complete dentures. Loma Linda University Dentistry.
Summer / Autumn 2012. Volume 23, Number 2
• A new technique to determine vertical dimension of occlusion from anthropometric
measurements of fingers.Ruchi et al. Indian Journal of Dental Research, 24(3), 2013
THANK YOU