VDO Flashcards
intermaxillary records are what number visit?
Third patient visit
- 5th overall step
- lab portions between visits
what do we have at the intermaxillary record phase - sequence of this step
occlusion rims – adjusted in mouth THEN facebow registration and centric relation record and then mounted on articulator
inter-ridge space
when natural teeth are in occlusion, ridge crests are approximately a minimum of 12 mm apart in the anterior
posterior? 1-2mm
or height of tongue blade in anterior and width of it in posterior
Freeway space
Inter-occlusal distance
between the teeth when the mandible is at rest (VDR)
when does VDR and VDO occur?
VDR- after swallow – like saying EMMA - after saying the word emma - after say this word the space is the freeway space
VDO - during /end of swallow
movement from VDR to VDO
2-3 mm change when mandible moves up to go to VDO traveling 2-3 mm
freeway space?
increases with age?
average is approx 2-3 mm
closest speaking space
smaller than freeway space
.5-1mm at max
neutral zone
the potential space between the lips and cheeks on one side and the tongue on the other
forces come together
- where we put the teeth to remain in equilibrium
no equilibrium if push too far buccal/lingual
space of donders
space between palate and tongue in VDR - during rest
can be altered with VDO (increase VDO - increase this) and vise versa
can be altered independent of VDO if palate is too thick - can decrease this space
what do occlusal rims mimic?
temporarily the placement of teeth in the oral cavity for the purpose of making maxilla-mandibular relation records and arranging teeth
most clinically dense informational visit we have?
Intermaxillary Records
- adjust occlusion rim -VDO
sequence of intermaxillary records
occlusal plane vertical dimension of occlusion facebow registration centric relation registration tooth selection
beginnings of occlusal plane - what do you know
2/3 height of retro pad we have marked so know the height of this in that area
where do we start
maxillary centrals
where do we begin when adjusting for VDO
start with the upper rim
flare in occlusal rims is there for what?
there is a concavity in the lips and accounts for this
if set rim too far forward?
lips out too far forward
Fricative sounds? what contacts at these sounds? what does it indicate?
Vermillion border contact @ F
F or V sound “55” which determine teh position of incisal edges of central incisors
where lip makes sound against teeth – hits at or near the wet-dry line
how much tooth visible at rest?
about 1-2 mm of teeth visible @ rest
lips slightly parted
full smile? what is revealed? where does lip end up?
maximum visibility and tooth length (CEJ)
free gingival margin - little above CEJ or the gingival zenith
have to record high smile line on rim
acute naso-labial angle?
can see that the pt. is now wearing denture vs. when not - it is more 90 degrees or less acute because the teeth support the lips
what do the teeth do?
- support the lip – there is an acute naso-labial angle
- thicker vermillion border (w/out teeth this flattens and rolls inward)
- esthetics
high smile line is where?
at the CEJ of the centrals
adjust area A with patient to when at rest?
so can see 1-2 mm of the rim
midline comes from?
face
two occlusal planes
lateral - horizontal
and anterio-posterior
lateral plane is parallel?
ALWAYS parallel to the inter-pupillary line
antero-posterior plane is initially parallel to? then modified?
parallel to the ala-tragus line first
then modified upward as needed during rim try in – adjustments made to area D
area on rims that gets most adjustment?
D
fox occlusal plane
permits viewing of both planes on Maxilla simultaneously
what determines if you need to make adjustments to area A?
Phonetics with the fricative sounds - F and V
indicates the position of incisal edges of the central incisors
if too long - interferences
if too short– patient will just be blowing air - will not find their teeth
Area A adjusted for?
- phonetics
- esthetics
once complete
DON NOT TOUCH
after area A adjusted?
Go to the lower (leave area D alone for now)
what if lip has too much support?
if teeth too far forward - more support and see more tooth than want
adjustments to area B?
should be to lip length so B is AT HEIGHT OF LIP and approx. parallel to the dorsum of tongue
Area C measurment?
1/2 or 2/3 height of retromolar pad
flate plane tooth?
dont have to worry about curves - so starts and ends at 2/3 height retromolar pad
what is area D based upon after adjustments to other areas have been made?
initially - siblant sounds
siblant sounds – so adjustments made last
how to change area D?
- lubricate lower rim
- remove upper and warm area
- reset and close until A contacts B
VD
distance between U/L arches
VDO
vertical dimension of occlusion
- during occlusal contact
VDR
vertical dimension of rest
-during muscular rest
what hold VDO?
Posterior teeth
how to measure distance from VDR to VDO?
using tongue blade and dots placed on nose and chin, the distance traveled from VDR and VDO can be measured
because mandible moves upward from VDR to VDO
freeway space anterior posterior ratio?
what happens with age?
3:1
increases with age - but averages 2-3 mm
therapeutic VDO?
we establish this for the patient with almost 2-3 mm of inter-occlusal rest distance
minimum distance for freeway space of interocclusal distance
2-3 mm
do teeth touch in closest speaking space?
NO
Closest speaking space
is the small space between the occlusal surfaces during sibilant sounds
*about .5-1 mm
tiny space left after saying words like “66” mississippi
church
judge
is clicking of teeth ever normal?
NO - no clicking is not normal when VDO is correct - even if patient has porcelain teeth
examples of silibant sounds
66 mississippi church massachusettes sandwhich "j" jelly judge
S sounds determine
Incisor position
premolar position - lateral border of tongue hits here
VDO
sibilant sound on pre-molar area?
S sounds
if too constricted - whistle
too wide - like sh
space of dondors implication which is independent of VDO
if palate is TOO THICK - it will decrease this space and the patient will have difficulty swallowing
effect on space of dondors if increase or decrease VDO
increase VDO - increase space
decrease VDO - decrease space
commercial guidelines on max and mandibular
max = 22mm mand = 18 mm
anterior-posterior guidelines for anterior teeth position
- lip support
- naso-labial fold
- vermillion border of the lip
- Fricatives
inciso-gingival guidelines for anterior teeth position
- rest position (reveal)
- high smile line
- fricatives
- sibilants
incisal-occlusal plane orientation guidelines for determining teeth position
- 1/2-2/3 RMP
2. Inter-pupillary line
Areas (A,B,C,D)
which are adjusted for VDO which are not?
A- not adjusted for VDO
C- not adjusted for VDO
B and D can adjust for the right VDO
- both contributing to “S” sound
occlusal plane is determined by?
A and C
need an anterior and posterior component
area A =
esthetics and phonetics
area C=
anatomy of retromolar pad
VDO is altered by?
determined by?
altering areas B and D
B sibilants with A
D sibilants with C
determined by ‘A’ + B’ and ‘C+D’
VDR - VDO is about what?
3mm
what to do if rims are not flush? what results?
getting VDO by changing plane
D is changed by taking just a WEDGE AWAY
- this raises the plane from the ala-tragus line
Changing plane but NOT VDO
want to go from 2/3 to 1/2
changing C so you move from monoplane to curved
curved = 1/2 pad
changing VDO and Occlusal Plane
describe what is done to A, B, C, D
how?
A= NOT adjusted anteriorly B= totally adjustable C= NOT adjustable posteriorly D totally adjustable
VDO AND PLANE ARE CHANGED BY TAPERING THE RIMS (adding or removing a WEDGE of wax)
does changing the VDO always change the plane?
YES
does changing the plane always change the VDO?
NO
- may just need to change plane to go from 2/3 to 1/2 for monoplane vs curved dentition
plane of occlusion =
A + C
Vertical Dimension of Occlusion =
A+B and C+D
To change VDO, change
B+D
VDR-FWS =
VDO
which is posturial position?
VDR
when are ridges parallel to each other?
when in VDO
which is better or worse?
insufficient?
Excessive?
Excessive = INCREASE RIDGE RESORPTION
Insufficient may not be pretty - results in angular chelitis, possible muscle tone loss and hearing problems, esthetic problmes but excessive causes BONE LOSS and painful problems
how do you change the occlusal plane without changing VDO?
make adjustments to area C to either 1/2 or 2/3
2/3 = flat plane
1/2 = curved plane
can you change VDO without changing the occlusal plane?
NO
changing the VDO will always change the plane
see this with situations where D needs to be trimmed so we get flush
also see this with making adjustments to area B and D
bringing B up or D down by wedges of wax
after rims are flush sequence of events to get flush AND VDO?
- adjust B and D for VDR and FWS
- adjust B and D for VDO
- Adjust B and D for Sibilants
now flush and at VDO
