CLASSICAL ARTICLE

The speaking method in measuring vertical dimension

Meyer M. Silverman, DDS
Washington, D.C.

The exact measurement of the natural vertical

dimension is most essential in the successful practice of
many phases of dentistry. It has been found that the
greatest cause of full denture difficulties is the failure
to duplicate the normal vertical dimension. In occlusal
reconstruction, many fine dentists have found,
through experience, that increasing the vertical dimen-
sion for patients with supposedly shortened vertical
dimension ended in failure.
The dental profession realizes that it has never had
an accurate, scientific, and practical method with
which to measure the patient’s natural vertical dimen-
sion. It is now possible by the use of the speaking
method to measure a patient’s vertical dimension
before the loss of the remaining natural teeth, and to Fig. 1. Position of patient when measuring vertical dimen-
record this in terms of millimeters, and to reproduce sion with the speaking method.
this measurement in full dentures at a later date. The
terminology of the initial report1 has been simplified
to describe the same method of measuring vertical
dimension. The revision of the dental terminology ment of the mandible, as any variation from normal
helps to avoid the present-day confusion in the study might affect the measurements.
of vertical dimension and jaw relationship. Direct the patient to close into centric occlusion,
It is now possible to prove scientifically by the with the upper and lower teeth together in maximum
speaking method that vertical dimension must not be occlusal contact. Draw the centric occlusion line (Fig. 2)
increased.2 Those dentists who reconstruct the occlu- with a sharp pencil on a lower anterior tooth at the
sion of patients will generally find that failures can be horizontal level of the incisal edge of the opposing
avoided by completing the treatment without the upper anterior tooth.
increase of vertical dimension. If this dimension Have the patient say “yes,” and while the phonetic
should be increased, this treatment must be based on sound s is being pronounced, draw the closest speak-
scientific proof and not on the opinion of the operator. ing line (Fig. 3) on the same lower anterior tooth at
the horizontal level of the upper incisal edge. The dis-
THE SPEAKING METHOD
tance between the centric occlusion line (lower line)
The method of measuring vertical dimension is dis- and the closest speaking line (upper line) is called the
cussed in order to present the practical means for its closest speaking space. This closest speaking space is
use. The patient is seated in an upright position (Fig. 1) the measurement for vertical dimension.
without the use of the headrest, with the eyes forward, In some patients, the mandible will move forward
and the occlusal surfaces of the upper posterior teeth during the pronunciation of some or all speech
parallel to the floor. The measurement is taken under sounds.1,3 This forward movement will not affect the
identical conditions of posture and vigor of speech. accuracy of the measurement because the same move-
The head must not tilt forward or backward, and the ment occurs, and the vertical distance between the
patient should speak rapidly in a calm and relaxed lines is always remeasured in the same manner with
manner. A particular observation must be made that both natural and artificial teeth.
the patient does not consciously control the move- The closest speaking space may vary in different
individuals. In the series of patients examined,1 the
measurements ranged from 0 to 10 mm., which proves
Received for publication Oct. 21, 1952. that there is no such thing as “an average” in measur-
Reprinted with permission from J Prosthet Dent 1953;3:193-99. ing vertical dimension. Measurement must be made
doi:10.1067/mpr.2001.116139 with accuracy as it has been found that increasing the

MAY 2001 THE JOURNAL OF PROSTHETIC DENTISTRY 427

THE JOURNAL OF PROSTHETIC DENTISTRY SILVERMAN

Fig. 2. Marking the centric occlusion line on a lower anterior tooth while the teeth are closed
together in centric occlusion.

Fig. 3. Marking the closest speaking line while the patient pronounces a word with one of the
sibilants, like s in yes. The distance between the (lower) centric occlusion line and the (upper)
closest speaking line is the closest speaking space. This space is the measurement of vertical
dimension.

vertical dimension only one millimeter will cause dis- maximum contraction during the stimulus of function.
comfort to the patient.2 The closest speaking space has Because this system of measuring vertical dimension is
been found to be constant in each individual, in based on physiologic function of muscles while used in
patients observed since February, 1950. It is felt that speaking under similar conditions, the same levels of
the closest speaking space should be constant through- the mandible are caused by maximum function of the
out life. Records are being kept to determine the specific muscle fibers involved.
accuracy of this supposition. This belief may be Out of the 44 phonetic sounds of the English lan-
accounted for by the “all or none law” of muscle phys- guage, one or more of the six sibilants s, z, sh, zh, ch,
iology which states that each muscle fiber is in and j in such words as yes, buzz, fish, measure, church,

428 VOLUME 85 NUMBER 5

SILVERMAN THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 4. Shows the centric occlusion of artificial dentures with no vertical overlap. The centric
occlusion line is at the incisal edges of the lower anterior teeth of this edge-to-edge arrangement.

Fig. 5. Shows the measurement of the closest speaking space when there is a space between the
centric occlusion line (lower incisal edge) and the closest speaking line (upper incisal edge).

and judge are the sounds which cause the closest level constant nor accurate and could not be relied upon as
of the mandible to the maxilla while speaking, in 90 a guide to the measurement of vertical dimension.
per cent of the cases surveyed. In the exceptional cases Therefore, to save time and be assured of accuracy,
where other sounds caused the closest level, it was vertical dimension should be measured with only the
found that the sibilants caused a constant and accurate six sibilants of the 44 phonetic sounds of the English
level of the mandible in relation to the maxilla. The language.
remaining of the 44 phonetic sounds caused wider In some patients, it is found that not all six sibilants
spaces between the mandible and the maxilla, but will cause the closest level of the mandible to the max-
through experience of making over 10,000 measure- illa while speaking. Only one or more sounds of this
ments, it was found that these wider levels were not group will cause the closest level. If such is the case,

MAY 2001 429

THE JOURNAL OF PROSTHETIC DENTISTRY SILVERMAN

the sound or sounds with its measurement of the clos- The speaking method for measuring vertical dimen-
est speaking space in terms of millimeters should be sion must not be confused with other methods. It is a
recorded on the patient’s record. physiologic phonetic method based on the movement
The closest speaking line should first be located and of the mandible while the patient speaks. It is based on
marked by the use of individual words containing the the science of phonetics used to teach the deaf and
six sibilants as described above. In order to be certain hard of hearing to speak, and is newly applied to den-
the patient did not control the movements of the tistry in order to measure the distance between the
mandible consciously, it is advisable to check further upper and lower jaws.
for accuracy. Have the patient say “Mississippi” which The closest speaking space to measure the vertical
contains many sibilants. Then a magazine is given to dimension in this speaking method must not be con-
the patient to read aloud. While the sibilants of the fused with the free-way space of the centric relation
talking or reading matter are pronounced, it should be method.5,6 The free-way space establishes vertical
noted whether the incisal edges of the upper tooth dimension when the muscles involved are at complete
coincide with the closest speaking line drawn on the rest, and the mandible is in its rest position. The clos-
lower tooth as determined by the use of individual est speaking space measures vertical dimension when
words. If there is variation in the position of the clos- the mandible and muscles involved are in the active
est speaking line, it is generally due to a voluntary full function of speech. Experience has shown that the
muscular control of the lower jaw. When the patient measurements for the free-way space and the closest
speaks or reads rapidly, the function of the mandible is speaking space of the same patients are generally not
unconsciously accurate because all conscious control the same.
of the mandible is eliminated. I have found it difficult to measure the free-way
Whenever lines cannot be drawn on the lower ante- space accurately. It can, at times, consume hours of
rior tooth due to space between the upper and lower checking and rechecking and may require cephalo-
teeth, Figs. 4 and 5 show how the closest speaking graphic roentgenograms. The measurements are not
space is measured. In this example, there is no vertical only difficult, but lead to inaccuracy and its measure-
overlap in the dentition which is to be measured for its ment and reproduction in full dentures is in terms of
closest speaking space. The centric occlusion line of “an average.” The measurement of vertical dimension
this edge-to-edge relationship is at the incisal edges of with the closest speaking space is simple and consumes
the lower anterior teeth. The closest speaking line is at only minutes instead of hours in checking and recheck-
the incisal edges of the upper anterior teeth. The clos- ing. It is practical because the measurement can be
est speaking space is the distance between these two made by the dentist in his own office in less than one
lines as measured. minute. It is scientific, and the measurement is made
The closest speaking space as measured in the nat- with accuracy for each patient. It is recorded on that
ural dentition must be reproduced in full dentures patient’s record to give us the most practical, scientific,
after the loss of the remaining natural teeth. and accurate method of measuring vertical dimension
When we build full dentures for patients without of all our patients for present and future use.
pre-extraction records of the closest speaking space,
SUMMARY
we are back again to guessing at the proper vertical
dimension. With an understanding of the speaking The speaking method of measuring vertical dimen-
method and its closest speaking space, we can more sion is a physiologic phonetic method which measures
intelligently approximate the vertical dimension, and vertical dimension by means of the closest speaking
eventually record the patient’s natural vertical dimen- space. This space is measured before the loss of the
sion after the shrinkage of the alveolar ridges or wear remaining natural teeth to give us the patient’s natur-
of the artificial teeth. The accurate closest speaking al vertical dimension which can be recorded and used
space is eventually obtained by measuring at intervals at later dates.
until the patient is free of sore spots and is relatively The same closest speaking space should be repro-
comfortable. duced in full dentures as is found in the natural
It is always advisable to measure the closest speaking dentition. This space is also the means of proving that
space of all full denture patients at least once a year until vertical dimension must not be increased.
it is found that there is an end to discomfort, and per- It is advisable to measure and record the closest
haps to alveolar shrinkage or wear of the artificial teeth. speaking space of all patients after they are past 20
If the closest speaking space remains constant in the full years of age, for possible use in later years. For exam-
dentures, it is simple to duplicate this same vertical ple, if we should feel that a certain patient might need
dimension when registering the maxillo-mandibular occlusal reconstruction the measurement of the closest
relation of new dentures, with the additional help of tat- speaking space can be made which can be compared to
too dots on the alveolar ridges.4 the space existing in earlier years. If this space should

430 VOLUME 85 NUMBER 5

SILVERMAN THE JOURNAL OF PROSTHETIC DENTISTRY

be larger during later years in life, it could be assumed REFERENCES

that the vertical dimension was decreased, and treat- 1. Silverman, Meyer M.: Accurate Measurement of Vertical Dimension by
ment needed to increase the vertical dimension with Phonetics and the Speaking Centric Space, Dental Digest 57:261-265,
308-311, 1951.
occlusal reconstruction. This is an assumption based 2. Silverman, Meyer M.: Vertical Dimension Must Not Be Increased. J. Pros.
on the hope and feeling that the speaking method with Den. 2:188-197, 1952.
its closest speaking space will prove constant through- 3. Silverman, Meyer M.: Spaking Centric, Dental Digest 55:106-111, 1950.
4. Silverman, Meyer M.: Successful Full Dentures Through Accurate
out life, as records seem to indicate at the present time. Centric Occlusion, Dental Digest 56:494-497, 1950.
The measurement of vertical dimension by use of 5. Niswonger, M. E.: Rest Position of Mandible and Centric Relation,
the speaking method with its closest speaking space J.A.D.A. 21:1572-1582, 1934.
6. Thompson, John R.: The Rest Position of the Mandible and its
has been found in my experience to be the missing link Significance to Dental Science, J.A.D.A. 33:151-180, 1946.
in successful full denture construction. It will prove
most valuable to dentists doing occlusal reconstruction 3500 14th St., N.W.
and to periodontists in the treatment of their patients. Washington 10, D.C.

Access to The Journal of Prosthetic Dentistry is reserved for print subscribers!

Full-text access to The Journal of Prosthetic Dentistry Online is available for all print sub-
scribers. To activate your individual online subscription, please visit The Journal of Prosthetic
Dentistry Online, point your browser to http://www.mosby.com/prosdent, follow the prompts to
activate online access here, and follow the instructions. To activate your account, you will need
your subscriber account number, which you can find on your mailing label (note: the number
of digits in your subscriber account number varies from 6 to 10). See the example below in
which the subscriber account number has been circled:

Sample mailing label

**************************3-DIGIT 001
This is your subscription
SJ P1
account number
FEB00 J010 C: 1 1234567-890 U 05/00 Q: 1
J. H. DOE
531 MAIN ST
CENTER CITY, NY 10001-001

Personal subscriptions to The Journal of Prosthetic Dentistry Online are for individual use
only and may not be transferred. Use of The Journal of Prosthetic Dentistry Online is subject
to agreement to the terms and conditions as indicated online.

MAY 2001 431