Dentaltown April 2020 - 72

the functional movements of the patient are more of
an outside-in movement in normal chewing.
These two concepts are not diametrically opposed,
as some would suggest. While anterior guidance is
defi nitely an "inside-out" movement, envelope of
function is an "outside-in" movement to be worked out.
Envelope of function is the path the lower incisor
edges travel, in an outside-in motion, during chewing,
speaking and closure.
Dawson's second requirement of occlusal stability
is very clear: anterior guidance in harmony with the
envelope of function. The lingual contour of the
anterior teeth have to be contoured in a way to provide
stable centric contacts, or teeth will erupt into contact;
be steep enough to disclude the posterior teeth; and
be concave enough to be in harmony with the envelope
of function.
There is no need to compromise on either anterior
guidance or envelope of function, and both are critical
when we need complete control of the occlusion.
Altering the vertical dimension of occlusion is one of
the times when we need complete control.

Measuring vertical dimension
of occlusion
The vertical dimension of occlusion is always
measured in the patient's maximum intercuspation.
The vertical dimension can be determined by picking
a fi xed point on the nose and a fi xed point on the
chin when the patient is in their habitual occlusion
(Fig. 1, p. 71).
It's important to understand the patient's VDO is
set as the person develops. The repetitive contracted
length of the masticatory muscles as we swallow
creates a physical space between the upper and lower
jaws. When the teeth erupt, they erupt through this
space until they meet an equal and opposite force:
the opposing teeth.
This sets up the patient's own vertical dimension
of occlusion. Further, if the teeth wear and erode, there
is compensatory eruption of the teeth and remodeling
of the alveolar process that keeps up with the wear.
Thus, even in extreme wear (as long as the person
hasn't lost all their back teeth) vertical has not been
"lost." Therefore, we don't actually restore VDO

Fig. 4

Fig. 5

72

Fig. 6

APRIL 2020 // dentaltown.com

DT0420_Cranham_VDO_AG.indd 72

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Dentaltown April 2020

Table of Contents for the Digital Edition of Dentaltown April 2020

Dentaltown April 2020 - Intro
Dentaltown April 2020 - Cover1
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Dentaltown April 2020 - 1
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