It connects the lower jaw to the temporal bone in the skull in both sides and has two movements (Rosenstiel and Land, 2001). The TMJ along with muscles stabilization is the starting point to get the ideal maxilla-mandibular relationship in the centric relation. There is no way to register and transfer an accurate interocclusal record if patient has TMJ or muscles dysfunction. The patient with this dysfunction should be treated first before final restoration, cementation or construction. The conservative management of unstable joints and muscles via appliance therapy is the most common modality of management (Capp and Clayton, 1985).
4.2 Occlusal vertical dimension:
Perhaps one of the toughest and most intricate recuperative experiments for dentists in today's world is directly related to the occlusal vertical dimension (OVD). However, dentists have realized over the years that for the recuperation to work appropriately and the patients to get a good long-term solution to their needs, changes have to be made in the overall OVD structure (Guertin and Prostho, 2003).
4.2.1 Definition:
The OVD is normally described as the space between the two points that exist when the occlusal surfaces come in contact with each other. Hence, it is important to note that the OVD is a phenomenon that appears with the overall positioning of the teeth.
Hence, it is important to note here that the decision to change or alter the OVD at any stage cannot be a hasty or careless decision. This is so because any level of change, minor or major will require an appropriate recuperation plan for one arc, and at times, even both (Guertin and Prostho, 2003).
4.2.2 Vertical dimension at rest:
One of the biggest questions that people ask is whether or not dental wear and tear can directly lead to the overall deficiency of OVD? There are two different ideologies that emerge as an answer to this question (Guertin and Prostho, 2003).
Niswonger came up with the first concept after making observations and analyses of his personal experiences with his patients. His analyses helped him assert that that it was nature's course to preserve a consistent level of distance in the constant inter-occlusal space of nearly 3mm throughout an individual's life span. The methodology used to sustain this distance over the years is through the extrusion of the dento-alveolar composite which can help balance any natural or man-ensued dental wear that occurs. However, over the years, the advocates of this particular theory have concluded that the dental, muscular and articular spheres can possibly face sever damages with the alterations made in the VD of an individual (Guertin and Prostho, 2003).
The other ideology that was brought forth in response to the query of whether OVD was a direct result of dental wear has been supported by numerous cephalometric researches that have been conducted over the years. This ideology focuses on the impact of various scopes of facial structures, movements and expressions. The main idea that this particular phenomenon promotes is that the OVD undergoes changes at times after the dental wear process is finished or after the posterior teeth have been lost. The followers and advocates of this particular concept assert that the individual's natural neuromuscular structure is strong enough to adapt to the alterations that happen in the dento-alveolar construct (Guertin and Prostho, 2003).
However, it is important to note here that the deficiency or decrease of the OVD levels is nearly impossible to determine if the original location of the steady bony points of reference is not known i.e. before any dental alterations have taken place. This raises the important question of how, then, can an appropriate diagnosis be made? This is why dental history records play an important role. Furthermore, the methods mentioned in the prior paragraphs are all extremely helpful in allowing dentists to make an appropriate diagnosis. All of the methods mentioned here are established methods; none of them are new or experimental. Even though, all of these methods single-handedly might not be very helpful to a dentist but combining them together can also help a dentist make an informed diagnosis (Guertin and Prostho, 2003).
4.2.3 Increasing Occlusal Vertical Dimension:
Facial proportions
The sculpturer Phidias explains that the shapes that are agreeable to the human eye are formed when two separate entities are joined together respecting the proportions that each entity has. These, he calls, the golden number and the principle under which these shapes are formed, he calls, the golden rule. Hence, if we were to consider the golden rule in the dynamics of dentistry,...
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