Complete morphofunctional oral rehabilitation by physiological increase of occlusal vertical dimension according to...

Increasing the occlusal vertical dimension (OVD) is often indicated in complex oral rehabilitation to gain restorative space and improve the occlusal relationship and aesthetics. The effect of increasing the OVD on lower facial height and facial aesthetics is not well understood and evaluated. The authors present the philosophy of the neuromuscular concept and illustrate it through a case report of a 58-year-old female patient who presented severe deep bite, bruxism, and temporomandibular disorders (TMDs). After clinical evaluation, the extraoral examination showed a reduction of the lower facial height, protuberant lips, wrinkles, and over-closed commissures. In addition, intraoral examination showed a severe anterior deep bite articulation, and the upper incisors completely covering the lower incisors labial surfaces. Through the philosophy of the neuromuscular concept the diagnostic ability, the quality and stability of the treatment increases. A temporary long-term fixed prosthesis was made at the enlarged OVD to be used in the first stage of the rehabilitation. Compared to the initial situation, the new prosthesis was delivered at a vertical dimension (VD) higher with 7 mm. The purpose of the neuromuscular philosophy and methodology is to harmonize the facial profile, functional occlusion, the joint function, and neuromuscular control. Through the neuromuscular methodology, we can assess the patient's ability to manage a significant increase in VD and to restore a functional OVD by physiological measurements.