VERTICAL DIMENSION AND CENTRIC JAW RELATION IN

COMPLETE DENTURE CONSTRUCTION

EARLE S. SMITH, D.D.S.*

State University of Iowa, College of Dentistry, Iowa City, Iowa

RECORDS preparatory to mounting casts on an instru-

0 NE OF THE IMPORTANT
ment for the construction of complete upper and lower dentures is the centric
jaw relation record. The vertical dimension record is at least of equal importance.
Centric jaw relation has been defined as “the most retruded relation of the man-
dible to the maxillae when the condyles are in the most posterior unstrained posi-
tion in the glenoid fossae from which lateral movement can be made, at any given
degree of jaw separation.“l This statement is inexact. The anteroposterior and
lateral relationship between the mandible and the maxillae for a given individual
can be recorded at varying degrees of jaw separation. However, a recording at
other than the correct vertical dimension is not the true centric jaw relation for
this individual. Centric jaw relation is three-dimensional, and the vertical di-
mension should be considered as one of these three dimensions.

VERTICAL DIMENSION

The vertical dimension of the face at the physiologic rest position should be
such that the elevator and the depressor muscles attached to the mandible are in
equilibrium in tonic centric contraction. At this vertical dimension, the condyles
occupy a neutral unstrained position beneath the anterior part of the glenoid fossae.
This is the position of the condyles in relation to the glenoid fossae which is con-
sidered as normal when movements of mastication are initiated.
A vertical dimension greater or a vertical dimension less than the correct
vertical dimension of occlusion will be accompanied by adverse results. If it is
greater than the correct vertical dimension of occlusion, the muscles of closure will
be under constant strain, there will be no free-way space (interocclusal distance),
and excessive resorption of the residual ridges will take place. The patient will
experience difficulty when he opens his mouth sufficiently wide for the incision of
food, and he will experience constant discomfort, a discomfort he will find hard
to analyze as to location and cause.
If the vertical dimension is less than the correct vertical dimension of occlu-
sion, the muscles of closure will not be extended to their full capacity. This in
turn will result in loss of muscle tone and efficiency. Folds and wrinkles will de-
velop, and the patient will become disturbed about his facial appearance.
Since so much concerning the comfort, efficiency, and esthetics of the patient
depends on the vertical dimension of the centric jaw relationship record, careful
work in its estimation is essential. Also, since the other two dimensions involved in
centric jaw relation are dependent on the vertical dimension, the determination of
~-
Read before the Academy of Denture Prosthetics, Columbus, Ohio, April 29, 1957.
Received for publication April 29, 1957.
*Professor Emeritus, Clinical Prosthetic Dentistry.

31
the vertical dimension logically has precedence ~II tht> t ethnical sec~~~e~xw f (1 Iw

followed.
Accuracy in establishing patient jaw relations may be obliterated by an overl!,
complicated routine. Thereforct, it seems appropriate that the mention of son~e
simple procedures may have interest and value.
Thompson’ has stated, “The vertical dimension associated with ‘sinking-in’ of
the lips is greater than the occlusal vertical dimension made before the teeth were
extracted. The facial change is not the result of a decrease in vertical dimension.
but rather of the loss of support given the lips by the teeth and alveolar processes.”
I’ropcr lip support being a prerequisite if accurate measurements are to be
made, the maxillary occlusion rint should be so formed on its labial aspect that it
gives the desired support. The location t,f the plane of orientation should tlicil
be established.

The height of the occlusal plane anteriorly should be in harmony with the
type of lip. Rather than to follow a set rule for establishing the anterior segment
of this plane slightly below the border of the relaxed upper lip, as is so often
recommended, the plane of orientation should be above and hidden if the lip is long
and flexible, or it should be below and plainly in view if the lip is short, tight,
and tense. It is only for those patients who have lips of average length that the
plane of orientation should be slightly below the relaxed upper lip.
From the frontal aspect, the plane of orientation should be horizontal. It may
not be parallel with a line through the pupils of the eyes, as this line is not
always horizontal. The plane of orientation should be parallel with the floor as
the patient stands erect. An estimation of this parallelism can be made easily
by observation while the dentist stands at arms’ length in front of the patient and
stretches the corners of the patient’s mouth.
The approximate height of the plane posteriorly can be estimated by placing
the tip of one’s index finger over the mandibular ridge anteriorly and having the
patient close upon it. Then, while the mandible is thus held in a position of
approximate centric relation, the imaginary plane can be projected posteriorly.
If the plane is properly located, it will intersect the retromolar pad at or near its
base.
Based upon the conclusions reached from the observations made, the Iocation
of the plane of orientation (plane of occlusion) on the maxillary trial base can
be established.

IISTABLISIIISG VERTICAL DIMENSION FOR CENTRIC REI.ATIoN

It would be valuable if there were some simple mechanical device by which

the vertical dimension for the centric jaw relation could be determined. The
nearest approach to such a device is the Boos Rimeter. However, its use is
somewhat difficult and several adverse variables may be involved.
A routine of making vertical measurements between two small marks on the
face is quite often followed in attempting to determine the rest vertical dimension.
One mark is placed just below the nose and the other is placed over the tip of the
chin. Measurements are made between the marks while the facial muscles are
Volume 8 VERTICAL DIMENSION AND CENTRIC JAW RELATION 33
Number 1

relaxed. The occluding vertical dimension is computed by subtracting 3 mm. from

the measurement obtained between the two marks at the rest position.
Complete relaxation of the muscles of mastication is necessary when making
the measurements. In fact, complete relaxation of the body as a whole is desirable.
Conditioning exercises as suggested by Boos3 can be highly recommended. The
patient practices opening and closing the mouth and moving the mandible from
side to side and backward and forward several times a day for a period of several
days before denture construction is instituted. The use of hot packs and mild seda-
tion as suggested by Block4 may be necessary to attain complete relaxation.
There are various routines which may be followed in attempting to get the
mandible into the desired position when making the measurements. Among these
are :
1. The patient is instructed to open his mouth widely, then to relax his jaw
and close it to a position of rest. The lips may, or may not, come into contact.
(Some patients are mouth breathers.)
2. Th e patient is instructed to close his mouth after he has held it open for a
period of time sufficient to create tiredness of the involved musculature.
3. Phonetic tests, such as the pronunciation of “m,” “Iowa,” or “Ohio,”
may be used.
4. The patient is asked to balance a drop or two of water in the mouth
without swallowing. This is accomplished at the physiologic rest position. He
then swallows the water and the jaw assumes the occluding position.
5. The strained or unstrained facial appearance of the patient may be used
as a guide. None of these routines is without fault, and much depends upon the
judgment of the dentist.
Because of the importance of the development of the correct amount of inter-
arch space in determining the vertical dimension desired for the centric jaw rela-
tion, the routine followed should not be complicated.
With this in mind, a mandibular trial base with an abbreviated wax occlusion
rim extending from lateral incisor to lateral incisor or cuspid to cuspid is used
to develop the correct amount of interarch space. The maxillary and mandibular
occlusion rims contact in a limited area when placed in the mouth and brought into
occlusion. Vertical dimension alone is to be considered at this time. The simple
procedures of increasing or reducing the height of the mandibular occlusion rim
and the remeasuring of the distance between the marks on the face are carried out
until the vertical dimesion desired has been attained.
When the correct degree of interarch separation has been determined by the
contact anteriorly, the mandibular occlusion rim is ready for completion posteriorly.
Wax that can be made quite soft and that will set reasonably hard is added to the
lower rim posteriorly from the abbreviated anterior segment. The wax is added
in slight excess to the areas on both sides of the mandibular rim. These masses of
wax are then softened uniformly, and the occlusion rims are reinserted in the
patient’s mouth. The patient is directed to relax the jaw muscles and to close
until the occlusion rims contact anteriorly. Tests are then made to determine
whether the opposing rims come into uniform contact. If they do not, corrections
are made.
 Once uniformity of col&xt has IKYV accc,illl)lishrtl, Shanallan’s Illctlloti’ I( ‘1.
determining physiologic vc~rtical dirncnsion will be foiii~~t blpf~il in wrifyiikg lhe
accuracy of the vertical tlimcizion tlctc~riiiined by the method just dexril)c.cl.
Three small balls of soft was arc l~l:~etl on the occlusal surface of the n~:itidibi~l:tr
occlusion rim. One is placed at the nlidline and one in the region of the bicuspi(ls
on each side of the occlusion rinl. The balls of was arc sul,jected to closiiig prc+
sures during repeated swallowing movements, and the degree to which they l)r~ccxtlr*
flattened is the criterion.
THIS CENTRIC RELATIOK RECORD

When the vertical dimension of the centric jaw relation of an individual has
been established, but not until then, it becomes logical to incorporate the antertj-
posterior and the lateral dimensions of this relation.
The method to be followed depends on the preference 06 the dentist. Arrow
point tracings are used by some, and occlusion rims brought into occluding con-
tact are used by others. Whichever method is followed, the objectives are to find
the most retruded position of the mandible in relation to the maxillae when the
condyles are in their most posterior unstrained positions in the glenoid fossae
from which lateral movements can be made and to record this relationship at tke
specific vertical dimension oj occll~~io~ selected as being plorvnal for this partichr
individua.1. It is logical to consider that this is a recording of the centric jttM
relation for this individual and that recordings made at other degrees of jaw
separation are not the true centric relation.
Even though the condyles were in correct anatomic position for centric jaw
relation when the interarch relationship was recorded, the distance from and the
relationship to the condylar axis of the patient were not included in this record.
This orientation is desirable if the casts are to be properly positioned on the
articulator. The relationship of the jaws to the condylar axis, anteroposteriorly,,
laterally, and vertically, can be determined and transferred to the articulator by
means of a face-bow. It seems outside of the province of this article to discuss
the face-bow other than to recommend its use at some stage in the mounting oi
the casts on the articulator.

An accurate centric jaw relationship record is important when constructing

clentures. It is a three-dimenisonal record and, to be accurate for a given individual,
the relationship, anteroposteriorly and laterally, should be recorded at the occlusal
vertical dimension deemed correct for this individual. A recording made at other
than the correct vertical dimension of occlusion is not a true centric jaw relation
record.

1. Glossary of Prosthodontic Terms, J. PROS. DEN. 6:11, 1956.

2. Thompson! John R.: The Rest Position of the Mandible and Its Significance to Dental
Science, J.A.D.A. 33:151, 1946.
3. Boos, Ralph H. : Physiologic Denture Techniqu:, J. PROS. DEN. 6:726-740, 1956.
4. Block, L. S. : Tensions and Intermaxillary R@latmns! J. PROS.DEN. 4:204-Z@, 1954.
5. Shanahan, Thomas E. J. : Physiologic Vertical Drmension and Centric Relation, J. PROS.
DEN. 6:741-747, 1956.
STATE UNIVERSITY OF IOWA
C~LLECE OF DEKTISTRV
IOWA CITY, JOWA