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Dental Work & Vertical Dimension of Occlusion

What is the Vertical Dimension of Occlusion?  Laymen’s terms, please!

At its most basic, the vertical dimension of occlusion is a measurement between two specific points when the teeth are biting fully.  As teeth wear or shift, this measurement changes.   It is very important if you are having major dental work that your face and your mouth are comfortable when your teeth are fitting together.  Imagine the difficulty if you wanted much longer teeth and you received this from your dentist BUT the extra length did not allow you to bring your lips together!  If the teeth are too short or severely worn, the chin may get closer and closer to the nose and give you that scrunched in face as seen in many denture wearers when they take their teeth out.

Decreased vertical dimension of occlusion.

Note the photo to the left: When the teeth are this broken down – either from wear or erosion – the chin is probably closer to the nose. In other words, there is likely loss of vertical dimension!

So yes, we should (your dentist should) be concerned about the vertical dimension of occlusion when doing a Full Mouth Rehabilitation!

To begin journey we started by listening to our patient’s goals.

She had done a lot of research online about ways to improve a smile like hers and wondered if our office would be able to provide solutions to her concerns.  Our office was able to provide Jody with information about what her options were at this point and how to get from where she was now to where she wanted to be.

Jody’s combination of concerns will require a dentist skilled in comprehensive care and full mouth rehabilitation.

Jody’s smile displays some of her concerns; alignment, gums and color.

When you have a habit of grinding your teeth, this will cause wear and tear to one or more of the following:

  1. The teeth themselves
  2. The bone and gums around the teeth
  3. The TMJs
  4. The muscles

In Jody’s case as she continued this destructive habit, the teeth wore down.  The teeth that were the most affected by the wear were the lower teeth.  In general, whichever tooth surface is weaker is the one that will cause wear.  As the teeth wear, the chin may get closer and closer to the nose as the ‘Vertical Dimension of Occlusion’ is decreased or the teeth will continue to erupt to maintain a stable ‘vertical dimension of occlusion’.  The unusual thing that happened in Jody’s mouth was that the teeth wore down unevenly and the teeth on her left side continued to erupt so that eventually she had the appearance of more gums showing on this side.  The eruption happened slowly over time and as the teeth erupted, the gums and bone followed them the bite was not really closed.

Severe were and loss of about 75% of the original length of the teeth from the destructive oral habits.

The upper right lateral incisor – the one next to the right front tooth or central incisor – is a crown on an implant.  This tooth, because it is fully fused to the bone below could not change position like the other teeth and likely remained in its original position.  It seemed well positioned based on Jody’s smile and lip line.  We based our custom wax-up and preliminary design on this tooth being in the correct position for her full mouth rehabilitation.   We knew we would be having Jody wear custom provisional restorations to test out her new bite for several months before the final restorations were fabricated.

Much of the work done on models of Jody’s teeth could have been done digitally but I favor the hands on approach of working with wax and models to see what can feasibly be achieved.  Just as we all know that the kinds of changes that can happen to a photo with photoshop can not necessarily be achieved ‘in real life’ this, I believe can also happen with digital manipulation of teeth, gums and bone.  We want to present a realistic example to our patients of what we can achieve in our office.

Have a dental concern?  See what our office can do to help!  The best way to start is with a comprehensive examination where Dr Gillis and her fine team of talented dental professionals look at X-rays, evaluate your TMJs, look at the gums and the bone surrounding and supporting the teeth and the muscles that make everything work.  We will spend time discussing your concerns and goals about your teeth and offer ways to achieve these goals.  Our Grand Junction dental office has been providing excellent dentistry for people throughout our valley and beyond for years!

Yours for better dental health,

Julie Gillis DDS, AAACD

Restoring Teeth, Restoring Smiles