DIMENSIÓN VERTICAL

DEFINICIÓN.

Es la longitud vertical facial ubicada en la línea media, convencionalmente ubicada desde

en el punto sub-nasal hasta el borde inferior del mentón.(1)

Existen 3 medidas de importancia clínica:

 Dimensión vertical oclusal
 Dimensión vertical postural
 Dimensión vertical de reposo neuromuscular o mínima actividad muscular.

Dimensión Vertical Oclusal: se define como la longitud del tercio inferior del rostro
medido desde el punto subnasal hasta el borde inferior de la mandíbula cuando el sujeto
esta en MIC o máxima intercuspidación. (1)

Dimensión Vertical Postural: es la longitud del tercio inferior del rostro, medido con los
mismos puntos (sub-nasal a borde inferior del mentón), aunque se tienen que cumplir los
siguientes requisitos: (1)

 Mantener la cabeza en posición erguida y el plano de Frankfort paralelo al suelo. La cabeza

no debe apoyarse en ningún lado.
 El paciente se encontrará relajado, de pie o sentado confortablemente.
 Los dientes no deberán estar en contacto o en inclusión.
 Los labios estarán en contacto, pero sin tensión en un equilibrio muscular facial.  

Dimensión Postural de Reposo Neuromuscular: es la longitud del tercio inferior del

rostro (medida en la línea media) donde la musculatura presenta la menor actividad
electromiográfica en donde: (1)

 En el musculo masétero se alcanzaba una distancia intercuspidea de 10 mm para

que este tuviera su menor actividad electromiográfica.
 El musculo temporal anterior alcanzaba su mínima actividad en un rango de entre 8
y 16 mm de distancia interincisiva.
 El musculo temporal posterior alcanzaba su mínima actividad entre los 13 y 16 mm
de distancia interincisiva.

Todo esto es importante cuando hablamos de fabricar dispositivos para "relajar" al paciente.
IMPORTANCIA CLÍNICA (2)

Mantiene un orden y estabilidad tanto morfo-mio-funcional.

Alteraciones a la DVO, pueden ocasionar: (2)

Alteraciones en la fuerza y rendimiento de la mordida.

Alteración en la postura de reposo de la mandíbula.
Patología de origen temporomandibular
Alteración en el engranaje de los dientes (oclusión).
Dependiendo del grado de cambio en la DVO, cambio en la función y estabilidad neuromuscular

Al modificar bruscamente la DVO. Solnit y Cornutte insisten en que:

1. Una nueva dimensión vertical oclusal puede obligar al sistema reflejo propioceptivo y los
músculos a adoptar un estado diferente de adaptación, pero, en ocasiones, determinados
pacientes no tienen esa capacidad de adaptación y puede resultar un factor contribuyente a
padecer un trastorno temporomandibular.

2. Un cambio en la dimensión vertical puede, también, desencadenar en algunos pacientes

un estado neuromuscular confuso con aparición de episodios de bruxismo e hiperactividad.

3. En posición de relación céntrica y al modificarse la dimensión vertical por falta de

soporte posterior puede modificarse la posición condilar idónea y pueden aparecer
hipercontactos en el grupo dental anterior, con lo que contribuye a crear una disfunción
neuromuscular en un intento del paciente por evitar esos contactos en esas áreas.

4. Una disminución en la DV, puede desencadenar una compresión del espacio retrodiscal,
rico en terminaciones nerviosas, que desencadena un proceso doloroso de protección.

Cuadros de hipoxia frente a una bursca pérdida de DVO. (3)

TÉCNICAS MÁS EFECTIVA EN LA ETAPA DIAGNÓSTICA.

The validity and utility of disease detection methods and of occlusal therapy for
temporomandibular disorders.
Clark GT, Tsukiyama Y, Baba K, Simmons M.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Jan;83(1):101-6. Review.
(NO LO PUEDO LEER EL ARTICULO).

1: Madani AS, Moeintaghavi A, Rezaeei M. Occlusal rehabilitation in a partially

edentulous patient with lost vertical dimension using dental implants: a clinical
report. J Contemp Dent Pract. 2010 Dec 1;11(6):E058-64.
(pedir que lo consigan).

1: Cutbirth ST. Increasing vertical dimension: considerations and steps in

reconstruction of the severely worn dentition. Pract Proced Aesthet Dent. 2008
Nov-Dec;20(10):619-26.
(pedir q lo consigan)
TÉCNICAS MÁS EFECTIVAS Y VALIDADAS PARA ETAPA TERAPÉUTICA.

Increasing vertical dimension: considerations and steps in reconstruction of

the severely worn dentition.
Cutbirth ST.

Center for Aesthetic and Restorative Dentistry (CARD), Dallas, TX, USA. stcutbirth@aol.com

Abstract
Clinicians often encounter dental patients who have lost tooth structure or demonstrate an insufficient vertical
dimension of occlusion (VDO). While reconstructing the proper VDO for such patients can be challenging, the
use of a systematic approach can facilitate a successful and predictable treatment outcome. Presented herein
are a series of considerations involved in managing and/or restoring the VDO and a reproducible clinical
protocol aimed at improving the dentist's ability to increase the VDO while reconstructing severely worn
dentition.

Enamel loss and occlusal vertical dimension. Causes and considerations for
treatment.
Chacona RL.

Abstract
Much of the accelerated or premature loss of vertical dimension experienced by patients is certainly
preventable, and prevention should be emphasized. Recommendations on limiting any nicotine and caffeine
use, supporting needs for fitness efforts, and assisted or self-management of damaging habits from stress are
vital Restoratively along with aesthetics, substantial, functional vertical dimension changes may now be
addressed conservatively, using a range of strategies and current state-of-the art materials. Patients should
become better informed about the importance of a good dentition for their better general health. Restorative
alteration of vertical dimension may not be universally essential. Nevertheless, the profession, patients, and
the third-party payment community must unequivocally recognize the physiologic advantage of restoring lost
FOVD. The simple replacement of missing or damaged teeth without also reviewing and often addressing
related facial proportions, occlusion, and vertical dimension concerns can be too limited a treatment option.
Treatment of this current and ever-increasing condition cannot be sparingly restricted to the realm of
specialists. In light of current population demographics, general dentists must inform themselves of extensive,
currently available information in order to improve their proficiency and gain more confidence in addressing
these multifaceted, ever more common problems. Examining all treatment variables in conjunction with the
proficient determination for improved masticatory function and durability will increase our potential for achieving
more favorable outcomes. New research in these areas will continue to be applied in order to optimally
compose and implement modern comprehensive treatment plans and better evaluate post-treatment success.
Not taking the interrelated issues discussed in this article into consideration, or a failure to assess and better
engage these increasingly widespread needs of our population, could severely compromise the dental health
of an increasing number of current and future patients.
Rehabilitation of partially edentulous patient with loss of vertical dimension.
[Article in English, Italian]

Faccioni F, Laino A, Papadia D.

Department of Biomeducal Morphologic Sciences, University of Verona, Italy. f.faccioni@clopd.univr.it

Abstract
A case of rehabilitation of an edentulous patient with loss of vertical dimension is presented here. This patient
presents with a Class III dental and skeletal malocclusion with an anterior cross-bite. The objective of this case
report is to demonstrate that an accurate assessment of vertical dimension is necessary for good rehabilitation.
The original vertical dimension was determined by a series of tests including, kinesiographic,
electromyographic and transcutaneous electronic neural stimulation (TENS). Subsequently, the lost vertical
dimension was re-established orthodontically. These examinations revealed a general hypertonicity of
masticatory muscles due to the lost vertical dimension. Additionally, radiographs of the temporomandibular
joint showed anteriorly displaced condyles. Following the completion of orthodontic treatment osseointegrated
implants were placed to restore the dental arches.

[Clinical using and observation of occlusion splint of RPD].

[Article in Chinese]

Zhang DG, Chen RR, Li CQ, Zhang H.

Department of Prosthodontics, College of Stomatology, Shandong University, Jinan 250012, Shandong Province,
China.

Abstract
PURPOSE: This article describes the design and restoration for 180 cases diagnosed with dentition defect
accompanied with medium to severe abrasion and attrition. The purpose of this study is to discuss the
rehabilitation of vertical dimension, the balance of occlusion and the whole occlusion system.
METHODS: Before clinical preparation of the 180 clinical cases, diagnostic casts were made. Entire
restoration treatment plan was adopted to make removable partial dentures with full crown restorations along
with occlusion splints. The clinical effect were evaluated at 2nd week, 4th week and 9th week.
RESULTS: Of the 180 cases, 148 patients (82.2%) adapted to the denture in 2-3 weeks, 24 patients (13.3%)
in 4-5 weeks, 8 patients (14.5%) in 5-6 weeks. The further observation were evaluated over 10-15 years with
clinical satisfaction.
CONCLUSION: This method not only reserves the tooth structure, but also restores configuration and function
of the lost tissues. It's really a constantly effective remedy.

Restoring lost vertical dimension of occlusion using dental implants: a

clinical report.
Balshi TJ, Wolfinger GJ.

Institute For Facial Esthetics, Fort Washington, Pennsylvania 19034, USA.

Abstract
The successful rehabilitation of a patient with severe vertical overlap resulting from the loss of posterior
occlusal support and excessive wear of the mandibular incisors is described. The treatment plan necessitated
extraction of the remaining periodontally compromised mandibular teeth and placement of eight implants. Lost
occlusal vertical dimension and morphologic facial height were restored using a fixed detachable implant-
supported mandibular prosthesis, and the maxillomandibular relationship was transformed from Class II to
Class I.

Diagnostically restoring a reduced occlusal vertical dimension without permanently altering

the existing dentures.
Hansen CA.

Abstract
The technique described provides the dentist with a means of diagnostically restoring the vertical dimension of occlusion for an
edentulous patient, without permanently altering the dentures. This procedure is accomplished with a removable mandibular splint,
which snaps over the mandibular denture. The procedure involves little clinical treatment time. The maxillary denture may also be
temporarily overlayed in a similar manner, but the procedure is generally not as esthetically acceptable. Since the mandibular
alveolar bone resorbs much faster than that of the maxillae in most edentulous patients, the mandibular denture usually is
responsible for most of the loss of occlusal vertical dimension. The mandibular denture is therefore most frequently indicated for
alteration to restore lost occlusal vertical dimension. Medicolegal implications, as well as practical considerations, suggest that the
patient's present dentures should not be permanently altered before new dentures are found to be satisfactory.

BIBLIOGRAFÍA
1.- JABLONSKI, Dictionary of Dentistry, ED. 1992, p250.

2.- Kois JC, Phillips KM. Occlusal vertical dimension: alteration concerns.
Compend Contin Educ Dent. 1997 Dec;18(12):1169-74, 1176-7; quiz 1180. Review.
PubMed PMID: 9656842.

3.- Lost
vertical dimension/hypoxia. A case report and commentary.
Niemann W.
Funct Orthod. 2005 Summer-Fall;22(2):14-9.

1 .- http://www.odontologia-online.com/php/phpBB2E/about1162.html

2 .- http://www.gacetadental.com/noticia/3441/

 
Pregunta:

Oaciente, intervención, comparación, resultado (putcome)

En pacientes desdentados, con uso exesivo de sus prótesis dentales, con alta pérdida de dimensión vertical, ¿Cuál
será el ex. Más preciso para determinar su falta o pérdida de dimensión vertical? Será certero el ex. Fónetico de
silverman para determinar la con presisión su dimensión vertical, en comparación con exámenes cefalométricos
 Tarea:
1.- Confeccione una pregunta.
¿Cuál es la exactitud de los examen fonéticos y cefalométricos frente a la determinación de la dimensión
vertical oclusal?.

2.-Indique términos claves

Dimensión, Vertical, Determinación, fonéticos (speech), cefalométricos.

3.-Realizar búsqueda en medline:

DImension Vertical (MESH) and Determination and speech

4.- Copiar búsqueda en Medline

1: Rivera-Morales WC, Goldman BM. Are speech-based techniques for determination

of occlusal vertical dimension reliable? Compend Contin Educ Dent. 1997
Dec;18(12):1214-5, 1219-23. Review. PubMed PMID: 9656845.

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2: Mays KA. Reestablishing occlusal vertical dimension using a diagnostic treatment prosthesis in the
edentulous patient: a clinical report. J Prosthodont. 2003 Mar;12(1):30-6. Review. PubMed PMID: 12677610.

3: Mack MR. Vertical dimension: a dynamic concept based on facial form and oropharyngeal function. J
Prosthet Dent. 1991 Oct;66(4):478-85. Review. PubMed PMID: 1791557.
Are speech-based techniques for determination of occlusal vertical
dimension reliable?
Rivera-Morales WC, Goldman BM.

Department of Oral Rehabilitation, School of Dentistry, Medical College of Georgia, Augusta, USA.

Abstract
This article describes the most common techniques used for clinical assessment of occlusal vertical dimension
(OVD), and includes a discussion of recently published data which strongly suggest that techniques based on
sibilant sounds are not as reliable as they are generally regarded to be for the evaluation of OVD. Assessment
and establishment of OVD are sometimes difficult in edentulous patients, as well as for dentate patients with
multiple missing posterior teeth and/or extensive wear. Techniques based on the use of interocclusal distance
and facial soft-tissue contours, along with techniques based on sibilant sounds, are discussed. Although
absolute scientific support for any technique is lacking, the careful use of the techniques described in this
article, in combination, will usually result in the establishment of a clinically acceptable OVD for most patients.

Facially generated occlusal vertical dimension.

Mack MR.

Abstract
Facial height has a profound effect on attractiveness. Occlusal vertical dimension (OVD) determines facial
proportion at maximum intercuspation and influences facial dimension at rest. Deficient facial height visibly
compromises optimal facial beauty. This article explores the dependent relationships between the OVD and
facial esthetics, and discusses the role of facial analysis in determining an optimal OVD.