EPA Consensus Project Paper: The Vertical Dimension of Occlusion. How to Determine and How to Alter? A Systematic Review

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  • Argirios L. Pissiotis
  • Savvas N. Kamalakidis
  • Yvoni Kirmanidou
  • Eleftheria Zahari
  • Rafailia Karpouzi
  • Konstantinos Michalakis


Purpose: The aim of this systematic review was to explore the dental literature to
identify high quality clinical studies that introduced methods of determining the vertical
dimension of occlusion (VDO), and additionally to find studies which assessed alterations
in the VDO. Materials and methods: An electronic search of the literature was
conducted through PubMed , Embase, and Cochrane Library databases referring to the
determination and alteration of the VDO by 12/2021. Results: A total of 215 records were
obtained from the initial search. After the first two screenings, 33 studies were selected
for inclusion. Correlations in the morphometric group ranged between r=0.18-0.87,
p<0.05-0.001, correlations in the cephalometric group ranged between r=0.28-0.92,
p<0.05-0.001, and correlations in the mechanometric group ranged between r=0.210.75,
p<0.05-0.01. Regarding the alteration of VDO, in all studies the increase ranged
between 1.8-8 mm and the patients adapted . Conclusions: No clear guidelines can be
established yet, in relation to the determination and alteration of the VDO. There is no
apparent benefit in using more invasive and complex methods compared to the use of
the facial anatomical landmarks. Patient adaptation seems to be successful when the
range of VDO increase was 1.8-6.0 mm.

Temporomandibular Joint Disorder
Vertical Dimension Of Occlusion
Cephalometric Analysis
Vertical Dimension At Rest
Interocclusal Rest Space