Case Report
Reestablishment of Occlusal Vertical Dimension in
Complete Denture Wearing in Two Stages

Danny Omar Mendoza Marin, Andressa Rosa Perin Leite,
Norberto Martins de Oliveira Junior, Marco Antonio Compagnoni,
Ana Carolina Pero, and João Neudenir Arioli Filho

Department of Dental Materials and Prosthodontics, Araraquara Dental School, UNESP, Paulista State University,
Humaitá Street 1680, 14801-903 Araraquara, SP, Brazil

Correspondence should be addressed to Marco Antonio Compagnoni; compagno@foar.unesp.br

Received 6 August 2015; Revised 7 October 2015; Accepted 15 October 2015

Academic Editor: Miguel de Araújo Nobre

Copyright © 2015 Danny Omar Mendoza Marin et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

The assessment and reestablishment of the occlusal vertical dimension (OVD) are considered important factors in the treatment of
complete denture wearers. The long-time use of a complete denture can result in jaw displacement due to abrasion of the artificial
teeth and residual ridge resorption, causing esthetic complications. Most patients with old dentures and incorrect OVD accept
reestablishment of the OVD with new complete dentures, even if they were used to their old dentures. The present clinical report
describes a method of gradual reestablishment of OVD using a diagnostic acrylic splint on artificial teeth in old complete dentures
before the manufacture of new complete dentures. Clinical Significance. The use of a reversible treatment for reestablishment of
the OVD in old complete dentures with a diagnostic occlusal acrylic splint allows for the reestablishment of the intermaxillary
relationship, providing physiological conditions of masticatory performance associated with the recovery of facial esthetics in
edentulous patients.

1. Introduction

The establishment of appropriate occlusal vertical dimension
(OVD) is a fundamental factor in the manufacture of new
complete dentures in harmony with the patient’s masticatory
system [1, 2]. However, the long-time use of the same
complete denture can result in jaw displacement due to
abrasion of the artificial teeth and residual ridge resorption,
causing a decrease of the OVD [1, 3–6].

The decrease of the OVD can compromise the esthetic
and cause morphologic changes in the complete denture
wearers, such as hyperactivity or hypoactivity of the mastica-
tory muscles, increase or decrease in masticatory force, tem-
poromandibular disorders, decreased facial height as a result
of mandibular ridge resorption and a downward and forward
rotation of the mandible [1, 5, 6], and increasing mandibular
prognathism [6]. These complications can significantly affect
the function and comfort, aswell as the phonetics and esthetic
of the patient [3, 7, 8].

The reestablishment of the OVD is considered one of
the most challenging and complex procedures during oral
rehabilitation of edentulous patients [9]. It is related to
the head and cervical spine postures and anterior facial
height [10], the esthetics of the entire face and mandibular
position, and reestablishment of themasticatory function and
phonetics [11, 12].

For this reason, it is usually believed that changes in the
OVD should be conservative and for a trial period, with
an interim prosthesis if necessary [13], especially before the
manufacture of a new complete denture set. One technique
that has advocated for reestablishment of OVD includes the
use of an acrylic splint in an appropriated OVD [10]. This
process allows assessing the patient’s tolerance, esthetics, and
phonetics at the proposed restored OVD before irreversible
changes in the natural dentition or with a new partial
denture [13]. This technique has also been described for the
edentulous patient with old complete dentures [14].

Hindawi Publishing Corporation
Case Reports in Dentistry
Volume 2015, Article ID 762914, 5 pages
http://dx.doi.org/10.1155/2015/762914



2 Case Reports in Dentistry

(a) (b)

Figure 1: Record for reestablishment of 7mm in the OVD. (a) Record in wax with 7mm; (b) first master cast set mounted in a semiadjustable
articulator.

The present case report describes a method of gradual
reestablishment of an appropriate OVD using a diagnostic
acrylic splint on artificial teeth in an old complete denture
before manufacture of a new complete denture.

2. Case Description

A 65-year-old woman came to the Araraquara Dental School,
UNESP, Paulista State University, Araraquara, São Paulo,
Brazil, for assessment and manufacture of a new complete
denture. The complete dentures were fabricated 23 years
ago and her principal complaint was poor esthetics and ear
pain. Intraoral and extraoral examinations were performed
that included supporting structures, oral hygiene, temporo-
mandibular joints, and facial height and symmetry with the
OVD, the physiologic rest position, esthetics, and phonetics.

The initial examination revealed that the patient had
been wearing a maxillary and a mandibular denture with
excessive wear of the artificial teeth, causing decreased OVD
and, consequently, an excessive freeway space, downward
turn of the commissures, and overrotation and protrusion
of the mandible with the dentures in position. In addition,
the patient had been experiencing moderate pain in the
temporomandibular joint.

An occlusal vertical dimension assessment was per-
formed, according to customary procedures at the depart-
ment [15], as follows: the patient was instructed to reach a
resting position after licking the lips, swallowing, and saying
/m/ without occlusion of the artificial teeth. This procedure
was repeated 3 times. Mean distance from chin to base of the
nose, minus 3mm, was considered the OVD. Measurements
were made using calipers. Following these measurements, an
esthetic appraisal was done with occlusion of the artificial
teeth in position. Finally, OVDwas assessed using a phonetic
method [16]. The occlusion of the artificial teeth was not
allowed to touch each other during pronunciation of the
sibilant sounds.

After determining the OVD through the association of
the metric, phonetic, and esthetic methods, the need of
14mm for the reestablishment of the OVDwas demonstrated
in the current prostheses. Due to the clinical conditions and
the needs of the patient, an oral rehabilitation was proposed

in two stages, commencing with using occlusal acrylic splints
on the old dentures, like a pretreatment of the OVD, before
the manufacture of the new complete denture set.

Three impressions with alginate (Hydrogum, Zhermack,
Badia Polesine, Italy) of the complete denture (1 maxillary
denture and two mandibular dentures) were performed and
poured with special plaster type IV (Vel-Mix Stone, Kerr
Corporation, Orange, California, USA). Next, two occlusal
records with a wax roller were taken (one reestablishing the
OVD with 7mm and the other with 14mm) for reestab-
lishment of the OVD in two stages. All master casts were
mounted in a semiadjustable articulator (Bio-Art Equipa-
mentos Odontológicos Ltda.©, São Carlos, São Paulo, Brazil)
for the manufacture of the occlusal acrylic splints. First, the
maxillary master cast was mounted in the semiadjustable
articulator and, after that, each mandibular master cast, with
the respective record (7mm and 14mm), was mounted using
the same maxillary master cast (Figures 1 and 2).

The first mandibular master cast was performed to
determine an increase of 7mm in the OVD. After waxing
the maxillary cast (Figure 3), an autopolymerizing acrylic
resin (Vipi Cor, Dental Vipi, Pirassununga, São Paulo, Brazil)
was used to manufacture an occlusal acrylic splint with an
increase in OVD of 7mm; then, an occlusal adjustment in
the semiadjustable articulator was made. Next, the maxillary
occlusal acrylic splint was positioned together with the
second mandibular master cast (OVD = 14mm) and waxing
in the mandibular cast was performed to manufacture a
second occlusal acrylic splint (Figure 4).

The maxillary occlusal splint was first positioned on
the old maxillary denture, fixed with composite resin, and
an intraoral occlusal adjustment was made to evaluate the
patient’s ability to tolerate this increase of 7mm for a period
of 30 days. After this period of adaptation, the mandibular
occlusal acrylic splint was fixed in the oldmandibular denture
(Figure 5), an intraoral occlusal adjustment was made, and a
new period of 30 days was performed for the final adaptation
of the patient to the appropriateOVD. Finally, after evaluating
the adaptation of the patient to the increased OVD of 14mm,
all procedures for manufacturing a complete denture were
performed and a new set was installed (Figure 6). This
process allowed for the verification of the patient’s ability



Case Reports in Dentistry 3

(a) (b)

Figure 2: Record for reestablishment of 14mm in the OVD. (a) Record in wax with 14mm; (b) second master cast set mounted in a
semiadjustable articulator.

Figure 3: Waxing of the maxillary cast for manufacturing a
maxillary occlusal splint for a 7mm increase in OVD.

to tolerate the proposed reestablishment of the OVD and
evaluate her ability to adapt.

3. Discussion

The assessment and reestablishment of the OVD is con-
sidered an important factor in the treatment of complete
dentures wearers [17]. The decrease in occlusal vertical
dimension is a characteristic of complete denture wearers,
mainly due to a marked resorption of the lower ridge with
a resulting upward rotation of the mandible and an increase
in mandibular prognathism [6]. Therefore, regular controls
and early adjustments of the complete dentures are necessary
in order to prevent marked changes in the jaw and occlusal
relationships [6].

When controls and adjustments are not performed,
changes of the OVD could interfere with the physiology
of the masticatory system and the patient’s ability to adapt
[3, 18]. Matsuda et al. [4] conducted a study to identify
how changes in the OVD can affect the sensory perception
and activity of the brain in complete denture wearers. The
present study [4] demonstrated that complete dentures with
a lower vertical dimension decreased the masticatory force

and a higher vertical dimension revealed an increase in
psychological distress after gum chewing.

Although it has been observed that complete denture
wearers can tolerate an increase in OVD with new den-
tures [19], the consequences of an inadequate OVD such
as hyperactivity of the masticatory muscles and elevation
in masticatory forces and TMDs have been related [3].
Therefore, it is prudent to evaluate the patient’s OVD [1]
and the reestablishing of the OVD must be based on the
masticatory system’s capacity to accept change and must be
determined prior to fabrication of a new denture [1].

Most patients with old dentures and decrease in the OVD
accept a gradual increase in the OVD, even if they are used
to their old dentures [5]. This could be explained by the
improvement in chewing functions and a gradual increase
might be better tolerated than a reestablishment in one step
[5]. It is desirable that the reestablishment of the OVD be
carried out gradually, allowing the patient to adapt to their
new OVD. The clinician should be capable of determining
if a patient presents an inadequate OVD and then carry out
an appropriate but reversible treatment before compromising
the patient to a position that may not be able to function
effectively [1, 13, 20].

Theuse of a diagnostic acrylic splint is a reversible therapy
that could improve head and cervical spine postures and
reestablish the OVD [21, 22], slowly and gradually allowing
physiological postural repositioning, promoting relaxation of
the suprahyoid muscles and retreatment of the hyoid bone
[23], generating changes in craniocervical posture through
the improvement of respiratory function [24], and improving
the facial esthetic standard, resulting in a high self-esteem of
edentulous patients.

In the present case report, a two-stage reestablishment of
the OVD was performed due to the necessity to increase the
OVD by 14mm. This could allow for a reversible treatment
if the patient does not adapt in the second increase phase.
Therefore, a gradual reestablishment was necessary to eval-
uate the patient’s ability to tolerate this increase, and it was
demonstrated that this technique is an adequate alternative
treatment.



4 Case Reports in Dentistry

(a) (b)

Figure 4: (a) Maxillary occlusal acrylic splint positioned in the second master cast set. (b) Waxing in the mandibular cast for manufacturing
the second occlusal acrylic splint.

Figure 5: Installation of the mandibular occlusal splint after a 30-
day period of adaptation.

Figure 6: Installation of the new complete denture set after the
adaptation of OVD of 14mm.

4. Conclusion

The use of diagnostic occlusal acrylic splints on old complete
dentures with an altered OVD is an effective and reversible
treatment, gradually allowing reestablishment in the OVD,
verifying the patient’s ability to tolerate the proposed increase
before manufacturing a new complete denture set.

Conflict of Interests

The authors declare that there is no conflict of interests
regarding the publication of this paper.

References

[1] K. A. Mays, “Reestablishing occlusal vertical dimension using
a diagnostic treatment prosthesis in the edentulous patient: a
clinical report,” Journal of Prosthodontics, vol. 12, no. 1, pp. 30–
36, 2003.

[2] S. Yamashita, M. Shimizu, and H. Katada, “A newly proposed
method to predict optimum occlusal vertical dimension,” Jour-
nal of Prosthodontics, vol. 24, no. 4, pp. 287–290, 2015.

[3] J. Abduo and K. Lyons, “Clinical considerations for increasing
occlusal vertical dimension: a review,” Australian Dental Jour-
nal, vol. 57, no. 1, pp. 2–10, 2012.

[4] R.Matsuda, Y. Yoneyama,M.Morokuma, and C. Ohkubo, “The
influence of vertical dimension of occlusion changes on the
electroencephalograms of complete denture wearers,” Journal of
Prosthodontic Research, vol. 58, no. 2, pp. 121–126, 2014.

[5] S. M. Fouda, M. S. Al-Attar, J. I. Virtanen, and A. Raustia,
“Effect of patient’s personality on satisfaction with their present
complete denture and after increasing the occlusal vertical
dimension: a study of edentulous egyptian patients,” Interna-
tional Journal of Dentistry, vol. 2014, Article ID 635943, 7 pages,
2014.

[6] A. Tallgren, B. R. Lang, G. F.Walker, andM.M. Ash Jr., “Roent-
gen cephalometric analysis of ridge resorption and changes in
jaw and occlusal relationships in immediate complete denture
wearers,” Journal of Oral Rehabilitation, vol. 7, no. 1, pp. 77–94,
1980.

[7] Z. Ormianer and A. Palty, “Altered vertical dimension of
occlusion: a comparative retrospective pilot study of tooth and
implant-supported restorations,” The International Journal of
Oral & Maxillofacial Implants, vol. 24, no. 3, pp. 497–501, 2009.

[8] M.D. Gross and Z. Ormianer, “A preliminary study on the effect
of occlusal vertical dimension increase on mandibular postural
rest position,”The International Journal of Prosthodontics, vol. 7,
no. 3, pp. 216–226, 1994.



Case Reports in Dentistry 5

[9] E. M. Dantas, “The importance of restoring occlusal vertical
dimension in the prosthetic rehabilitation,” Odonto, vol. 20, no.
40, pp. 41–48, 2012.

[10] M. Fujimoto, I. Hayakawa, S. Hirano, and I. Watanabe,
“Changes in gait stability induced by alteration of mandibular
position,” Journal of Medical and Dental Sciences, vol. 48, no. 4,
pp. 131–136, 2001.

[11] B. Solow and A. Tallgren, “Head posture and craniofacial
morphology,” American Journal of Physical Anthropology, vol.
44, no. 3, pp. 417–436, 1976.

[12] N. K. Mohindra and J. S. Bulman, “The effect of increasing
vertical dimension of occlusion on facial aesthetics,” British
Dental Journal, vol. 192, no. 3, pp. 164–168, 2002.

[13] L. Jahangiri and S. Jang, “Onlay partial denture technique for
assessment of adequate occlusal vertical dimension: a clinical
report,” Journal of Prosthetic Dentistry, vol. 87, no. 1, pp. 1–4,
2002.

[14] C. A. Hansen, “Diagnostically restoring a reduced occlusal
vertical dimension without permanently altering the existing
dentures,” Journal of Prosthetic Dentistry, vol. 54, no. 5, pp. 671–
673, 1985.

[15] R. F. de Souza, J. Marra, A. C. Pero, and M. A. Compagnoni,
“Effect of denture fabrication and wear on closest speaking
space and interocclusal distance during deglutition,” Journal of
Prosthetic Dentistry, vol. 97, no. 6, pp. 381–388, 2007.

[16] M. M. Silverman, “The speaking method in measuring vertical
dimension,”The Journal of Prosthetic Dentistry, vol. 85, no. 5, pp.
427–431, 2001.

[17] W. C. Rivera-Morales and N. D. Mohl, “Relationship of occlusal
vertical dimension to the health of the masticatory system,”The
Journal of Prosthetic Dentistry, vol. 65, no. 4, pp. 547–553, 1991.

[18] M. Igić, N. Krunić, L. Aleksov et al., “Determination of vertical
dimension of occlusion by using the phonetic vowel ‘O’ and ‘E’,”
Vojnosanitetski Pregled, vol. 72, no. 2, pp. 123–131, 2015.

[19] W. D. Owen and J. R. Douglas, “Near or full occlusal vertical
dimension increase of severely reduced interarch distance in
complete dentures,” The Journal of Prosthetic Dentistry, vol. 26,
no. 2, pp. 134–138, 1971.

[20] K. Baba, Y. Tsukiyama, and G. T. Clark, “Reliability, validity,
and utility of various occlusal measurement methods and
techniques,” The Journal of Prosthetic Dentistry, vol. 83, no. 1,
pp. 83–89, 2000.

[21] G. Zanatta, W. A. B. Silva, F. A. Silva, G. G. Ramos, and H.
Casselli, “Assesment of painful symptomatology in patientswith
temporomandibular disorders bymean a combined experimen-
tal scale,” Brazilian Journal of Oral Sciences, vol. 5, no. 19, pp.
1244–1248, 2006.

[22] H. Casselli, A. B. Landulpho, W. A. B. Silva, and F. A. Silva,
“Electrognathographic evaluations of rehabilitated edentulous
patients,” Brazilian Oral Research, vol. 21, no. 4, pp. 355–361,
2007.

[23] M. Urbanowicz, “Alteration of vertical dimension and its effect
on head and neck posture,” Cranio, vol. 9, no. 2, pp. 174–179,
1991.

[24] P. S. Vig, K. J. Showfety, and C. Phillips, “Experimental manip-
ulation of head posture,” American Journal of Orthodontics, vol.
77, no. 3, pp. 258–268, 1980.



Submit your manuscripts at
http://www.hindawi.com

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Oral Oncology
Journal of

Dentistry
International Journal of

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

International Journal of

Biomaterials

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

BioMed 
Research International

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Case Reports in 
Dentistry

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Oral Implants
Journal of

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

 Anesthesiology 
Research and Practice

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Radiology 
Research and Practice

Environmental and 
Public Health

Journal of

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

The Scientific 
World Journal
Hindawi Publishing Corporation 
http://www.hindawi.com Volume 2014

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Dental Surgery
Journal of

Drug Delivery
Journal of

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Oral Diseases
Journal of

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

 Computational and  
Mathematical Methods 
in Medicine

Scientifica
Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Pain
Research and Treatment
Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Preventive Medicine
Advances in

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Endocrinology
International Journal of

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014

Orthopedics
Advances in