Completedentures
Clinical assessment of vertical dimension
A. J. W. Turrell, M.D.S.*
Charles Clifford Dental Hospital, Shefield, England
A lthough advances in techniques and materials are being made in prosthodontics,
still no accurate method of assessing the vertical dimension of occlusion in edentu-
lous patients is available to dentists. Clinical judgment plays a major role in the
assessment of this important component in the construction of dentures.
In this article, many of the methods of assessing vertical dimension will be de-
scribed. Some techniques are included which may be considered obsolete. Their
inclusion is justified because they have been reintroduced in recent years along with
the use of more sophisticated devices.
PRE-EXTRACTION RECORDS IN DETERMINING VERTICAL DIMENSION
In spite of the fallibility of most pre-extraction recording instruments, some are
more accurate in the assessment of the vertical dimension of occlusion than are the
numerous postextraction aids. The Dakometer is reputed to be an accurate measuring
device, but the Willis gauge is so inaccurate as to be almost useless.1l2 A modification
of this instrument enables the approximate angle at which it is applied to the face
to be reproduced during denture construction. 1 A more reliable method is to measure
the distance between upper and lower labial frena with dividers when the teeth are
in centric occlusion.1
Turner? developed a (‘cut-out method” using a simple pantograph. A headstrap
holds a card in a supporting frame close to the median line of the face. The panto-
graph pointer is brushed against the facial contour which is automatically drawn
on the card by a pencil. Olsen4 painted a strip of plaster of Paris down the midline
of the face from which a cut-out is made. Swenson5 described the construction of
a clear resin mask of the lower part of the face. All of these methods displace the
skin when the cut-out is formed and when it is applied to the face. The inaccuracy
may be 2 mm. or more.
*Senior Lecturer in Dental Mechanics, Dental Materials, and Prosthetics, University of
Sheffield.
238
!i%re:
u ‘3” Clinical assessment of vertical dimension 239
UStNG PHYSEOLOGIC REST POSITION AS A GUIDE
TO THE VERTICAL DIMENSION OF OCCLUSION
Many authorities do not accept the concept of a constant rest position in the
strictest sense.G-10 ThompsonZ1 related variations in rest position to hypotonicit)r and
hypertonicity of the musculature and described short- and long-term variations.
Short-term variations occur in times of stress, respiration, and head movement.
Long-term variations occur in debilitated patients, “mouth-breathers,” and as ‘1
result of attrition of the teeth. Tallgren7 studied changes which occurred in thf%
vertical dimension of occlusion and rest position and the effect that these change<
had on the interocclusal space. She concluded that the vertical dimension of rest
position adapted to changes in the vertical dimension of occlusion in both clentulou,>
and edentulous patients. Other research workers have verified her findings.“‘, I1
AtwoodI contended that rest position is a dynamic rather than a static concept
and that it varies from person to person and within each person. He stated that
the vertical zone of suppressed electromyographic activity found by Jarabakl& sup-
ported this concept of a postural range. Atwoodl” suggested that a cinefluoroscopt
technique coupled with electronics could provide a better insight into the variahilit\
of rest position.
Tallgren7 tested the accuracy of three methods in establishing the vertical dimen-
sion of rest position cephalometrically on people with normal dentitions. Thrsc
were fatiguing the jaw musculature, phonetics, and tht: “no command” metlrotl
of physical and mental relaxation. Cephalometric radiographs showed no significant
statistical difference when comparing these three methods. Tallgren7 prefer& :i
combination of mild fatigue followed by a swallow and relaxation with eyes closed.
Carlsson and Ericson15 found that the phonetic method produced a greater vertic;.rl
distance reading than did the relaxation method. Atwoodl” used a combination of
swallowing and phonetics in cephalometric studies of rest position. He judged relasa-
tion by facial expression. Relaxation is essential in all of these techniques; it is ;I
state of mind which is difficult for the patient to assume when attached to a cepha-
lometer by ear plugs. However, the results obtained by workers using cephalomrtric
radiology as a research tool have given some evaluation of the clinical methods
routinely used to establish rest position.
MEASUREMENT OF CLOSING FORCES TO
ESTABLISH VERTICAL DIMENSION
This theory is based on the premise that maximum closing force can be exerted
when the mandible is at the vertical dimension of rest positionl” A force meter is
attached to upper and lower baseplates and registers the pressure the patient cati
exert as the vertical dimension is varied. SmithI: stated that the Boos bimetcr wits
the best approach to a simple reliable device for determining the vertical dimension
of rest position. However, the bimeter has been condemned, because the closing
power of the patient is influenced by pain and apprehension. A correlation of results
with the bimeter and those obtained by clinical and electromyographic methods
showed that use of the bimeter produced increased vertical dimensions.ls’ I9
Tueller20 used an electronic method to determine the vertical separation of the
jaws at which the subjects could exert the maximum closing force. This device con-
J. Prosthet. Dent.
240 Turrell September, 1972
sisted of a steel spring and strain gauge mounted in the palate of a resin baseplate.
The lower baseplate carried a central-bearing point. The strain gauge was linked
to an amplifier and pen recorder. The vertical dimension which produced the
greatest deflection was called the power point. Tueller, like Boos, considered the
power point to represent the rest position of the mandible.
The strain gauge gnathodynamometer technique was described by Ann.21 He
claimed that the closing force increased as the vertical dimension was increased
above the vertical dimension of occlusion established by clinical means. The closing
force reached maximum levels at vertical dimensions up to 9 mm. above the
established vertical dimension. He could not produce a typical hyperbolic-type
curve as depicted by Boos when closing force and vertical dimension values were
plotted graphically, and he deduced that closing force could not be used to de-
termine the vertical dimension of rest position. To determine the effect of pain
as a limiting factor in the force which could be applied, An+ administered an
anesthetic to all of the denture-bearing tissues. The subjects could not increase the
closing force at the established occlusal vertical dimension. However, up to 9 mm.
above the established occlusal dimension, an increase of up to 20 per cent was re-
corded in the closing force.
TACTILE SENSE IN ESTABLISHING VERTICAL DIMENSION
In this method, the patient presses a very soft lower wax occlusion rim against
the upper occlusion rim. By tactile sense, the patient is supposed to recognize when
he has reached the degree of jaw opening which was attained when the natural
teeth were present. Lytlez2 and Timmer23 have adopted a more refined technique
using a central-bearing device fixed to upper and lower occlusion rims.
McGee24 stated that methods which relied upon the patient’s muscular percep-
tion transferred the responsibility of registering the occlusal dimension from the
dentist to the patient. He found patients tended to register a reduced vertical dimen-
sion of occlusion because they felt more comfortable in that position.
FACIAL DIMENSIONS IN ESTABUSHING VERTICAL DIMENSION
Iv,25 according to Bowman and Chick,26 mentioned the use of facial measure-
ments to determine vertical dimension for the edentulous patient. Goodfriend2’
suggested that the distance from the pupil of the eye to the junction of the lips
equalled that from the subnasion to the gnathion. However, Willis28 has been given
the credit for popularizing these measurements.
HarveyZD conducted a survey of the Willis measurement on 100 young men with
natural teeth. He found the upper and lower measurements corresponded in only
27 per cent of the subjects. Bowman and Chick,2E in a survey of 133 subjects with
natural teeth, found that the measurements corresponded in only 9 per cent, most
of these being patients with Class I jaw relationships.
The facial measurements proposed by McGee24 have the support of Harvey,aQ
Pound,30 and Paquette. 31 McGee correlated the known vertical dimension of occlu-
sion with three facial measurements which he claimed remain constant throughout
life. The three measurements are: the distance from the center of the pupil of the
eye to a line projected laterally from the median line of the lips; the distance from
Y!i%fe:
” Y Clinical assessment of vertical dimension 241
the glabella to the subnasion; and the distance between the angles of the mouth
with the lips in repose. McGee stated that two of these three measurements will be
invariably equal, and occasionally all three will be equal to one another. He claimed
that, in 95 per cent of his subjects with natural teeth, two or three of these measure-
ments corresponded to the vertical dimension of occlusion.
The method adopted by Hurst32 is based upon the length of the upper lip and
the amount of the central incisor that is exposed when the lips are parted in repose.
Measurements were made on selected subjects with natural teeth. The subjects were
divided into five types whose upper lips ranged from extra short to extra long. He
measured the interocclusal distances by a method advocated by Pleasurez3 and found
that this space ranged from 1 mm. for the group with the shortest upper lips to IO
mm. for the group with the longest upper lips. He gave other interocclusal distances
for the intervening types. This information enabled him to develop a table which
can be used for determining the occlusal vertical dimension for all edentulous pa-
tients. Paquette 31 developed a method based on similar facial measurements.
PHONETICS IN ESTABLISHING THE OCCLUSAL VERTICAL DIMENSION
Phonetics to check an arbitrary vertical dimension of occlusion. This theory is
dependent upon a correlation during speech of the interocclusal distances, the posi-
tion of the occlusal plane, and the position of the tongue relative to the occlusion rims
or teeth. The most popular sound used as an aid in determining rest position is the
labial m sound which can be said without the use of teeth. However, the m sound
often leaves the lips in contact. As soon as they are parted by the dentist to observe
the space between the occlusion rims, the mandible is depressed and the rest position
is lost. To overcome this difficulty the sound m is often extended to the word emma
or followed by the labial p sound which leaves the lips apart; hence, the popularity
of the word Mississippi. Some patients depress the mandible when pronouncing p.
Larkin3’ developed a device in which wires attached to the upper and lowet
occlusion rims emerge from the corners of the mouth and are positioned over a milii-
meter scale. The patient closes into the vertical dimension of occlusion, and a read-
ing is made on the scale. Then, the patient is induced to assume mandibular rest
position. The difference between the two readings gives an indication of the inter-
occlusal distance. Langer and Michman 35 designed a similar device, but to avoid
wires emerging from the mouth, the gauge is attached to the upper occlusion rim.
Both methods are probably more accurate than measuring reference points on the
face.
Phonetics used before occlusion is developed. Triangles of adhesive tape are
placed on the tip of the nose and the chin, and the distance between them is mea-
sured with dividers when the mandible is in rest position.33 The methods used to
guide the mandible into rest position vary. Some dentists prefer the m sounds in
conjunction with complete relaxation. Boos36 suggested conditioning exercises. Mild
sedation has been suggested by Block.37 PoundzO and Terre11,38 in addition to the
m sound, prefer to engage the patient in conversation. The measurements are re-
peated after the patient has stopped talking.
When the vertical dimension of rest position has been measured between the
triangles of tape on the face, the occlusion rims are built up until the vertical dimen-
242 Turrell J. Pros&et. Dent.
September, 1972
sion of occlusion equals this measurement. Then, the height of the lower occlusion
rim is reduced 2 to 4 mm. according to the beliefs of the dentist. Usually, the older
the patient, the greater the reduction. Ismail and George3g concluded that this
method is questionable since the vertical dimension of rest position adapts itself to
the vertical dimension of occlusion.
Phonetics used to establish the closest speaking space. SilvermarPO maintains that
it is easier and more accurate to record a measurement which relies upon muscular
phonetic enunciation when the patient loses voluntary muscular control of the man-
dible than to record a measurement which relies upon relaxation. Thus, he records
the closest speaking space before the teeth are extracted. The patient is seated up-
right with the plane of occlusion parallel to the floor. With an upper incisal edge as
a guide, a pencil line is drawn on a lower incisor when the teeth are in centric
occlusion. Then, a second line is drawn above the other after the patient has said
s or yes or siss repeatedly. The closest speaking space is the distance between the
lines. This space should be the same at the try-in when it is again checked phonet-
ically and the vertical dimension of occlusion adjusted if necessary.
DEGLUTITION IN ESTABLISHING VERTICAL DIMENSION
Shanahan41 indicated that the mandibular pattern of movement during degluti-
tion is the same for the edentulous infant as it is for the edentulous adult. He main-
tained that eruption of teeth is held at the occlusal plane by the act of swallowing
which establishes the vertical dimension of occlusion. When constructing compIete
dentures, the advocates of the swallowing technique believe that soft wax on the
occlusion rim is reduced during deglutition to give the correct vertical dimension
of occ1usion.41-43
Ismail and George3g checked the swallowing method by using cephalometric
radiographs to record the vertical dimension of occlusion before the teeth were
extracted and after dentures were inserted. The swallowing technique produced
an increase of 0 to 5 mm. (mean 2.8 mm.) in the vertical dimension of occlusion in
the edentulous group. He found that the increase was directly proportional to the
number of missing posterior teeth prior to extraction of the teeth.
Ward and Osterholtz44 concluded that swallowing may be used only as a guide
to the vertical dimension of occlusion. They advised that dentures should be removed
for some time before recording the occlusal vertical dimension to obliterate the
memory of acquired neuromuscular patterns.
Finnegan45 used a hydraulic system to measure the force exerted by the lower
teeth on the upper teeth during swallowing. He hoped to find that the magnitude
of this force would change with the vertical dimension. He was unable to establish
a relationship between the force exerted between the teeth on swallowing and the
correct vertical dimension of occlusion.
ESTHETIC APPEARANCE IN ESTABLISHING VERTICAL DIMENSION
The estimation of vertical dimension by appearance is based upon the esthetic
harmony of the lower third of the face relative to the rest of the face, upon the
contour of the lips and the appearance of the skin from the margin of the lower lip
to the lower border of the chin, and upon the labiomental angle.46 With the lips in
contact, the elevation of the mandible and the compression of the lips should bcs
just discernible on mandibular closing from rest position to the vertical dimension oi
occlusion. This guide applies to normal young patients or middle-aged patients with
good tonus of the skin. Difficulties arise when the tonus of the skin is poor, whcill
resorbed denture-bearing tissues preclude full restoration of the contour of the lij).
in “mouth-breathing” patients, and in those patients described by Ballarda wirli
varying degrees of incompetent lip morphology. Under these conditions, diffrrcnt
techniques for establishing the vertical dimension of occlusion must be used.
OPEN-REST METHOD IN ESTABLISHING VERTICAL DIMENSION
Douglas and Maritato 48 described the open-rest method of establishing the vertical
dimension of occlusion. Open-rest position is an unstrained mouth-breathing posi-
tion. The lips are slightly parted to permit observation of the mcsial marginal ridges
of the upper and lower first bicuspids. Their positions, which represent the uppc’t
and lower posterior occlusal planes, are related to the corners of the mouth. Prc-
extraction cephalometric radiographs of 20 patients made with the mandible in thl;
open-rest position indicated that the upper occlusion rim should be 3 mm. above.
the corner of the mouth in the premolar region and that the occlusal plane of th(‘
lower rim should be 2 mm. below the corners of the mouth. The authors.” clainl
that this method is more accurate than a previous study using rest position. t:\c:til~~
sense, and swallowing methods to determine thy vertical dimension of occlusion.
Willie4g conducted a survey to determine the most common methods of estab
lishing the vertical dimension of occlusion. The most popular were the esthetic
appearance and phonetic methods. Methods reiyin g on deglutition and tact&,
muscle sense of the patient were next in popularity. Those dentists who preferred
the use of the Willis measurement and Boos bimeter were in the minority. The most
popular combination of methods was that employing phonetics, rsthetic appcar-
ante, and deglutition.
Basler, Douglas, and Moulton5” used cephalometric radiography to evaluate tht,
comparative accuracy of phonetics in conjunction with esthetics, tactile muscle sense
of the patient, and deglutition in establishing the vertical dimension of occlusion
They found all three methods to be equally reliable, but all had a tendency towal.tl
a reduced vertical dimension of occlusion.
The fact that many writers found that clinical methods usually produced a rc-
duced vertical dimension of occlusion may account for most dentures being well
tolerated, especially when the lower residual ridge is markedly resorbed. A vertical
dimension of occlusion that is too far closed does not allow the muscles of masticatioli
to function at their normal length resulting in a reduction of their efficiency. I,cs?
forcr is applied during mastication, and less stress is placed on the residual ridges.
Unfortunately, this condition results in lack of support to muscles of facial expression
The tonus of the overlying skin suffers giving rise to premature wrinkles, deep KISO-
labial furrows, and folds at the angles of the mouth. This condition may pcrmi:
saliva retention, promoting angular cheilosis, and it is also conducive to trmporo-
mandibular joint dysfunction.
To offset these conditions, particularly with markedly resorbed residual ridges.
the degree to which one should restore the vertical dimension of occlusion withoui
244 Tune11 J. Prosthet. Dent.
September, 1972
impairing stability and comfort is a difficult decision to make. When no pre-
extraction records are available, one cannot even determine accurately, as a starting
point, the position the mandible should occupy to restore the occlusal vertical di-
mension, An accurate scientific method of assessing the vertical dimension of occlu-
sion clinically is a pressing need of paramount importance.
SUMMARY
Many methods of assessing and recording vertical jaw relations in edentulous
patients have been presented and evaluated. When no accurate pre-extraction records
exist, the dentist must rely upon esthetic appearance supplemented by aids which are
often misleading.
References
1. Turrell, A. J. W.: The Pre-extraction Recording of the Vertical Dimension by an Intra-
oral Method, Dent. Pratt. Dent. Rec. 6: 68-72, 1955.
2. McMillan, D. R., and Imber, S.: The Accuracy of Facial Measurements Using the Willis
Bite Gauge, Dent. Pratt. Dent. Rec. 18: 213-217, 1968.
3. Turner, L. C.: The Profile Tracer: Method for Obtaining Accurate Pre-extraction Records,
J. PROSTHET. DENT. 21: 364-370, 1969.
4. Olsen, E. S.: The Dental Clinics of North America, Complete Denture Prosthesis, Phila-
delphia and London, 1964, W. B. Saunders Company, p. 611.
5. Swenson, M. G.: Complete Dentures, ed. 4, St. Louis, 1959, The C. V. Mosby Company,
p. 125.
6. Leof, M.: Revision of Accepted Dicta on Mandibular Position, N. Y. J. Dent. 20: 8-14,
1950.
7. Tallgren, A.: Changes in Adult Face Height Due to Ageing, Wear and Loss of Teeth
and Prosthetic Treatment, Acta Odontol. Stand. (Suppl. 24) 15: 1-112, 1957.
8. Berry, D. C.: The Constancy of the Rest Position of the Mandible, Dent. Pratt. Dent.
Rec. 10: 129-132, 1960.
9. Coccaro, P. J., and Lloyd, R.: Cephalometric Analysis of Morphologic Face Height, J.
PROSTHET. DENT. 15: 35-44, 1965.
10. Ismail, Y. H., George, W. A., Sassouni, V., and Scott, R. H.: Cephalometric Study of
Changes Occurring in Face Height Following Prosthetic Treatment, J. PROSTHET. DENT.
19: 321-330, 1968.
11. Thompson, J. R.: Concepts Regarding Function of the Stomatognathic System, J. Am.
Dent. Assoc. 48: 626-637, 1954.
12. Atwood, D. A.: A Cephalometric Study of the Clinical Rest Position of the Mandible.
Part I. The Variability of the Clinical Rest Position Following the Removal of Occlusal
Contacts, J. PROSTHET. DENT. 6: 504-519, 1956.
13. Atwood, D. A.: A Critique of Research of the Rest Position of the Mandible, J. PROSTHET.
DENT. 16: 848-854, 1966.
14. Jarabak, J. R.: An Electromyographic Analysis of Muscular Behavior in Mandibular
Movements From Rest Position, J. PROSTHET. DENT. 7: 682-710, 1957.
15. Carlsson, G. E., and Ericson, S.: Postural Face Height in Full Denture Wearers, A Longi-
tudinal X-ray Cephalometric Study, Acta Odontol. Stand. 25: 145-162, 1967.
16. Boos, R. H.: Intermaxillary Relation Established in Biting Power, J. Am. Dent. Assoc.
27: 1192-l 199, 1940.
17. Smith, E. S.: Vertical Dimension and Centric Jaw Relation in Complete Denture Con-
struction, J. PROSTHET. DENT. 8: 31-34, 1958.
18. O’Rourke, J. T.: Significance of Tests for Biting Strength, J. Am. Dent. Assoc. 38: 627-
633, 1949.
19. Boucher, L. J., Zwemer, T. J., and Pflughoeft, F.: Can Biting Force be Used as a cri-
terion for Registering Vertical Dimension 7, J. PROSTHET. DENT. 9: 594-599, 1959.
p$yz* ‘3” Clinical assessment of vertical dimension 245
20. Tueller, V. M.: The Relationship Between the Vertical Dimension of Occlusion and Forces
Generated by Closing Muscles of Mastication, J. PROSTHET. DENT. 22: 284-288, 1969.
21. Ann, L. K.: Determination of Vertical Dimension by Biting Force, Malaysian Dent. J.
7: 23-38, 1967.
22. Lytle, R. B.: Vertical Relationship of Occlusion by the Patient’s Neuromuscular Prr-
ception, J. PROSTHET. DENT. 14: 12-20, 1964.
23. Timmer, L. H.: A Reproducible Method for Determining the Vertical Dimension of
Occlusion, J. PROSTHET. DENT. 22: 621-630, 1969.
24. McGee, G. F.: Use of Facial Measurements in Determining Vertical Dimension, J. Am.
Dent. Assoc. 35: 342-350, 1947.
25. Ivy, R. S.: Dental and Facial Types. The American System of Dentistry. Operative and
Prosthetic Dentistry, vol. 2, Edinburgh, 1887, Pentland, p. 1030.
26. Bowman, A. J., and Chick, A. 0.: A Note on Facial Proportions, Br. Dent. J. 112: 28%
289, 1962.
27. Goodfriend, D. J.: Symptomatology and Treatment of Abnormalities of the Mandibular
Articulation, Dent. Cosmos 75: 844; 947; 1106, 1933.
28. Willis, F. M.: Features Involved in Full Denture Prostheses, Dent. Cosmos 77: 851-854,
1935.
29. Harvey, W.: Investigation and Survey of Malocclusion and Ear Symptoms With Particular
Reference to Ottic Barotrauma, Br. Dent. J. 85: 221-225, 1948.
30. Pound, E.: Recapturing Esthetic Tooth Position in the Edentulous Patient, J. Am. Dent.
Assoc. 55: 181-191, 1957.
31. Paquette, N. J.: Establishing Positive Vertical Dimension Without Appliances, Dent.
Survey 42: 62-65, 1966.
32. Hurst, W. W.: Vertical Dimension and Its Correlation With Lip Length and Interocclmal
Distance, J. Am. Dent. Assoc. 64: 496-504, 1962.
33. Pleasure, M. A.: Correct Vertical Dimension and Free-way Space, J. Am. Dent. Assuc.
43: 160-163, 1951.
34. Larkin, J. D.: Means of Measuring InteroccIusaI Distance, J. PROSTKET. DENT. 17: 24i-
250, 1967.
35. Langer, A., and Michman, J.: Intraoral Technique for Recording Vertical and Horizontal
Maxillomandibular Relations in Complete Dentures, J. PROSTHET. DENT. 21: 599-606,
1969.
36. Boos, R. H.: Physiologic Denture Technique, J. PROSTHET. DENT. 6: 726-740, 1956.
37. Block, L. S.: Common Factors in Complete Denture Prosthetics, J. PROSTHET. DENT. 3:
736-746, 1953.
38. Terre& W. H.: Fundamentals Important to Good Complete Denture Construction. J.
PROSTHET. DENT. 8: 740-752, 1958.
39. Ismail, Y. H., and George, W. A.: The Consistency of the Swallowing Technique in
Determining Occlusal Vertical Relation in Edentulous Patients, J. PROSTHET. DENT. 19:
230-236, 1968.
40. Silverman, M. M.: The Speaking Method in Measuring Vertical Dimension, J. PROSTHET.
DENT. 3: 193-199, 1953.
41. Shanahan, T. E. J.: Physiologic Vertical Dimension and Centric Relation, J. PKOSTHET.
DENT. 6: 741-747, 1956.
42. Geller, J. W.: Prosthetic Dentistry, J. PROSTHET. DENT. 10: 33-36, 1960.
43. Malson, T. S.: Recording Vertical Dimension of Occlusion, J. PROSTHET. Deri?. 10:
258-259, 1960.
44. Ward, B. L., and Osterholtz, R. H.: Establishing Vertical Relation of Occlusion. J.
PROSTHET. DENT. 13:432-436, 1963.
45. Finnegan, F. J.: Determination of Maxillofacial Force Generated During Deglutition,
J. PROSTHET. DENT. 17: 134-143, 1967.
46. Turrell, A. J. W.: Vertical Dimension as It Relates to the Etiology of Angular Cheilosis,
J. PROSTHET. DENT. 19: 119-125, 1968.
47. Ballard, C. F.: Mandibular Posture, Dent. Pratt. Dent. Rec. 17: 377-383, 1967.
246 Turrell J. Pro&et. Dent.
September, 1972
48. Douglas, J. R., and Maritato, F. R.: “Open Rest,” a New Concept in the Selection of the
Vertical Dimension of Occlusion, J. PROSTHET. DENT. 15: 851-856, 1965.
49. Willie, R. G.: Trends in Clinical Methods of Establishing an Ideal Interarch Relationship,
J. PROSTHET. DENT. 8: 243-251, 1958.
50. Basler, L. F., Douglas, J. R., and Moulton, R. S.: Cephalometric Analysis of the Vertical
Dimension of Occlusion, J. PROSTHET. DENT. 11: 831-835, 1961.
THE CHARLES CLIFFORD DENTAL HOSPITAL
WELLESLEY ROAD
SHEFFIELD
SlO 2sz
ENGLAND
