Implications of the occlusal vertical dimension in the aesthetics of the facial lower third: a clinical study The OVD in facial aesthetics

Main Article Content

Judith Vilardell
María del Pilar Martín Santiago


vertical dimension, dental occlusion, dental aesthetics, golden proportion, lower facial third


Background and objective: An adequate occlusal vertical dimension (OVD) can decrease the fillers needed and better control of the volumes and symmetry, providing enhanced balance and better cosmetic results to the human face. The study’s objective was to show how an increase or decrease in the ideal measurement of the occlusal vertical dimension affects the aesthetics of the lower facial third and how restoring it through oral rehabilitation prior to facial aesthetic treatments helps optimize cosmetic results.

Methods: This was a single-center, comparative, non-randomized study including soft profile measurements using teleradiography to verify whether aesthetic standards were met before and after prosthetic rehabilitation, with other assessments based on frontal images of the patient’s face. The need to decrease fillers was assessed through the photographs obtained and with the patient’s input. A golden section gauge and an electronic vernier caliper were used to check the presence of a golden proportion before and after oral rehabilitation and restore the ideal occlusal vertical dimension.

Results: The study enrolled 12 patients, divided into three age groups (Group 1: 41−50 years old; Group 2; 51−60 years and Group 3: 61−70 years old), with a mean sample age of 57.25 years (SD 9.85). A direct relationship was found between the occlusal vertical dimension and orofacial aesthetics, so an early intervention in the intraoral treatment optimized the subsequent facial treatment.

Conclusions: Achieving optimal intraoral volume helps improve asymmetries resulting from edentulism while improving the vertical dimension of the lower third, in turn improving extraoral and facial patient management, minimizing the number of fillers, and avoiding more invasive surgical facial treatments. The study results highlighted the importance of establishing collaboration between dentists and aesthetic medicine specialists.

Abstract 205 | PDF Downloads 49


1. Ricketts RM. The biologic significance of the divine proportion and Fibonacci series. Am J Orthod. 1982 May;81(5):351–70.
2. Burden DJ. An investigation of the association between overjet size, lip coverage, and traumatic injury to maxillary incisors. Eur J Orthod. 1995 Dec;17(6):513–7.
3. Lee RL. Standardized head position and reference planes for dento-facial aesthetics. Dent Today. 2000 Feb;19(2):82–7.
4. Klages U, Bruckner A, Zentner A. Dental aesthetics, self-awareness, and oral health-related quality of life in young adults. Eur J Orthod. 2004 Oct;26(5):507–14.
5. Ahmad I. Anterior dental aesthetics: gingival perspective. Br Dent J. 2005 Aug;199(4):195–202.
6. Naini RB, Nokar S, Borghei H, Alikhasi M. Tilted or parallel implant placement in the completely edentulous mandible? A three-dimensional finite element analysis. Int J Oral Maxillofac Implants. 2011;26(4):776–81.
7. Levin L, Ofec R, Grossmann Y, Anner R. Periodontal disease as a risk for dental implant failure over time: a long-term historical cohort study. J Clin Periodontol. 2011 Aug;38(8):732–7.
8. Marin DOM, Leite ARP, de Oliveira Junior NM, Compagnoni MA, Pero AC, Arioli Filho JN. Reestablishment of Occlusal Vertical Dimension in Complete Denture Wearing in Two Stages. Case Rep Dent. 2015;2015:762914.
9. Yanikoğlu ND, Güldağ MU, Duymuş ZY. Determination of the occlusal vertical dimension: use of maxillary and mandibular posterior teeth measurement in edentate subjects. Eur J Prosthodont Restor Dent. 2005 Jun;13(2):75–7.
10. Martin Santiago M del P. Sistema Oclusal Postural Humano. In: Kinesiología médica odontológica y posturología. 2012. p. 561.
11. Dantas EM. The importance of restoring occlusal vertical dimension in the prosthetic rehabilitation. Odonto. 2012;20(40):41–8.
12. Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part I. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 1993 Apr;103(4):299–312.
13. Burstone CJ, James RB, Legan H, Murphy GA, Norton LA. Cephalometrics for orthognathic surgery. J Oral Surg. 1978 Apr;36(4):269–77.
14. Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg. 1980 Oct;38(10):744–51.
15. Powell K, Amin D, Sesanto R, Bryant A, Kukreja P, Waite P. Do oropharyngeal throat packs prevent fluid ingestion during orthognathic surgery? Int J Oral Maxillofac Surg. 2022 Mar;51(3):366–70.
16. Martín Santiago MP. La boca bajo sospecha. 2019. 200 p.
17. Farkas LG, Hreczko TA, Kolar JC, Munro IR. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg. 1985 Mar;75(3):328–38.
18. Swift A, Liew S, Weinkle S, Garcia JK, Silberberg MB. The Facial Aging Process From the “Inside Out”. Aesthetic Surg J. 2021 Sep;41(10):1107–19.
19. Mohindra NK, Bulman JS. The effect of increasing vertical dimension of occlusion on facial aesthetics. Br Dent J. 2002 Feb;192(3):164–8.
20. Sun J, Lin Y-C, Lee JD, Lee SJ. Effect of increasing occlusal vertical dimension on lower facial form and perceived facial esthetics: A digital evaluation. J Prosthet Dent. 2021 Oct;126(4):546–52.
21. Abduo J, Lyons K. Clinical considerations for increasing occlusal vertical dimension: a review. Aust Dent J. 2012 Mar;57(1):2–10.
22. Levartovsky S, Aharonov O, Emodi Perlman A, Winocur E, Sarig R. The effect of tooth wear, age and sex on facial height assessed by soft tissue analysis. J Oral Rehabil. 2020 Mar;47(3):346–52.
23. Popescu MR, Trană F, Manolea H, Rauten A-M, Șurlin P, Dragomir LP. Theoretical study on the mechanics of the conjunct gnatoprothetic devices in the context of occlusive function rehabilitation. Curr Heal Sci J. 2014;40(2):119–25.
24. Shell TL, Woods MG. Facial aesthetics and the divine proportion: A comparison of surgical and non-surgical Class II treatment. Aust Orthod J. 2004 Nov 12;20(2):51–63.
25. Pierce E. Aesthetics of simple forms. Psychol Rev. 1894;1:483–95.
26. Fechner GT, Höge H. Various Attempts to Establish a Basic Form of Beauty: Experimental Aesthetics, Golden Section, and Square. Empir Stud Arts. 1997;15:115–30.
27. Piehl J. The golden section: the “true” ratio? Percept Mot Skills. 1978 Jun;46(3 Pt 1):831–4.
28. Haines, T. H., & Davies AE. The psychology of aesthetic reaction to rectangular forms. Psychol Rev. 1904;11(4–5):249–81.
29. Godkewitsch M. The “golden section”: an artifact of stimulus range and measure of preference. Am J Psychol. 1974;87(1–2):269–77.
30. Mantelakis A, Iosifidis M, Al-Bitar ZB, Antoniadis V, Wertheim D, Garagiola U, et al. Proportions of the aesthetic African-Caribbean face: idealized ratios, comparison with the golden proportion and perceptions of attractiveness. Maxillofac Plast Reconstr Surg. 2018 Dec;40(1):20.