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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 4  |  Page : 459-462
Determination of the comfort zone for intergingival height and its practical application to treatment planning: A survey


Department of Orthodontics, V. S. Dental College & Hospital, Bangalore, India

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Date of Web Publication20-Dec-2012
 

   Abstract 

Background: The concept of the 'comfort zone' for intergingival height is a simple guideline to help establish the correct vertical dimension necessary for occlusal harmony in any individual. It can be used as a guide for identifying individuals at relatively greater risk of developing temporomandibular dysfunction and also when rebuilding the occlusion in the treatment of patients with temporomandibular dysfunction. The intergingival height varies according to the patient's age and stage of development, as well as with the height of the incisor crowns. In orthodontics this parameter can be used to track the progress of a patient being treated with functional appliances. This parameter has not been studied in detail and hence this survey was designed and conducted to gain information regarding its significance.
Objectives: The objectives of this survey were to estimate the value of 'comfort zone' for intergingival height in the region of the central incisor and to establish the norm for the comfort zone in males and females.
Materials and Methods: The intergingival height was measured in the region of the right central incisor using a vernier caliper. The intergingival height was measured as the vertical distance from the midpoint of the free gingival margin of the right maxillary central incisor to a similar point on the right mandibular central incisor, with the teeth in occlusion.
Results: According to the results of this, the range for the comfort zone for intergingival height in all subjects was 15.96-16.55 mm. The range for female subjects was 14.86-15.32 mm and the range for male subjects was 17.12-17.67 mm.
Conclusion: The comfort zone of intergingival height should become a part of our vocabulary and should be routinely utilized as a guideline for consistently achieving the correct vertical dimension at the end of treatment. The areas of utilization of this measurement are many and it should be used to assist in achieving better and more stable clinical results.

Keywords: Comfort zone, functional appliance, temporomandibular dysfunction, vertical dimension

How to cite this article:
Pareek S, Rani M S. Determination of the comfort zone for intergingival height and its practical application to treatment planning: A survey. Indian J Dent Res 2012;23:459-62

How to cite this URL:
Pareek S, Rani M S. Determination of the comfort zone for intergingival height and its practical application to treatment planning: A survey. Indian J Dent Res [serial online] 2012 [cited 2019 Oct 21];23:459-62. Available from: http://www.ijdr.in/text.asp?2012/23/4/459/104949
The concept of the 'comfort zone' for intergingival height is a simple guideline to help establish the correct vertical dimension necessary for occlusal harmony in any individual. It can be used for identifying individuals at relatively greater risk of developing temporomandibular dysfunction and also when rebuilding the occlusion during treatment of patients with temporomandibular dysfunction. Patients whose intergingival height varies significantly from the comfort zone are at greater risk of developing temporomandibular joint dysfunction. This applies to patients with deep overbite, in whom intergingival height is significantly reduced, as well as to patients with anterior open bite, who have increased intergingival height. [1]

The intergingival height varies according to the patient's age and stage of development, as well as with the height of the incisor crowns. It is relatively less in a young patient whose incisors have recently erupted and relatively more in an older patient with gingival recession. In a young patient, a range of 15-17 mm is normal, and allowance should be made for the diminutive height of the clinical crowns. [1]

In orthodontics this parameter can be used to track the progress of a patient being treated with functional appliances. It can be used as a simple means of keeping track of progress in opening or closing the bite. It assists in establishing the correct vertical opening during twin-block treatment.

Various diagnostic parameters like overbite, overjet, molar relation, canine relation, etc., are being utilized to assist a clinician in analyzing a case, reaching a diagnosis, and devising a treatment plan. Intergingival height can be another crucial piece of information for the dental clinician.

This parameter has not been studied in detail and hence this survey was designed and conducted to gain information regarding its significance. This study is a step towards establishing a norm for intergingival height in the adult population, which can be used for establishing the same at the end of any occlusal rehabilitation treatment.


   Objectives Top


The objectives of this survey were to estimate the value of the comfort zone for intergingival height in the region of the central incisor and to establish the normal range for the comfort zone in males and females.


   Materials and Methods Top


A sample of 100 subjects (50 males and 50 females) in the age-group of 18-25 years was selected based on predefined inclusion and exclusion criteria.

Inclusion criteria

  • Presence of all permanent teeth (excluding 3 rd molars)
  • Age-group of 18-25 years
  • Angle's class I molar relation
  • Normal overjet and overbite
Exclusion criteria

  • History of orthodontic intervention
  • Abnormal periodontal condition
  • Abnormal temporomandibular joint condition
  • Presence of occlusal interferences
  • Presence of occlusal/incisal wear facets
The intergingival height was measured in the region of the right central incisor using a vernier caliper. It was measured as the vertical distance from the midpoint of the free gingival margin of the right maxillary central incisor to a similar point on the right mandibular central incisor, with the teeth in occlusion [Figure 1].
Figure 1: Measurement of intergingival height

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The values thus obtained were tabulated separately for males and females. The data was subjected to appropriate statistical analysis.


   Results Top


Among the female subjects, 44% had a comfort zone of 15 mm; among male subjects, the majority had a comfort zone of 18 mm [Figure 2] and [Figure 3].
Figure 2: Pretreatment intergingival height=11 mm

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Figure 3: Mid-treatment intergingival height=12 mm

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The comfort zone for intergingival height for the total sample in this survey was found to be in the range of 15.96-16.55 mm [Table 1]; for male subjects the comfort zone was 17.12-17.67 mm [Table 2] and [Graph 1] and for female subjects it was 14.86-15.32 mm [Table 3] and [Graph 2]. [Graph 3] gives the mean intergingival height according to the age and sex for the subjects included in the study.
Table 1: Descriptive statistics of intergingival height of the subjects


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Table 2: Descriptive statistics of intergingival height of male subjects


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Table 3: Descriptive statistics of intergingival height of female subjects

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   Practical Application of the Concept of Comfort Zone for Intergingival Height Top


The following steps can be used when utilizing intergingival height as a parameter to establishing the correct vertical dimension for a patient:

  • The comfort zone for intergingival height for a patient undergoing functional therapy is calculated as follows: Comfort zone = (sum of the heights of the maxillary and mandibular left/right central incisor) − (normal overbite).
  • The patient's pretreatment intergingival height [Figure 2] is recorded.
  • At each subsequent visit, the measurement of the intergingival height is noted on the patient's record card [Figure 3], [Figure 4] and [Figure 5].
    Figure 4: Mid-treatment intergingival height=16 mm

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    Figure 5: Post-treatment intergingival height=19 mm

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  • This vertical measurement is overcorrected by about 2-3 mm to allow for some vertical settling to take place in the retention phase
This simple procedure can help the clinician in achieving and maintaining the correct vertical dimension that is specific to a particular patient and thus help achieve a stable result.


   Conclusion Top


The comfort zone of intergingival height should become a part of our vocabulary and should be routinely utilized as a quick guideline for achieving the correct vertical dimension with greater consistency at the end of treatment. The areas of utilization of this measurement are many and it should be used to assist in achieving better and more stable clinical results.

 
   References Top

1.Clark WJ. Twin Block Functional therapy: Applications in Dentofacial Orthopaedics. 2 nd ed. Mosby; 2002. p. 93.  Back to cited text no. 1
    

Top
Correspondence Address:
M S Rani
Department of Orthodontics, V. S. Dental College & Hospital, Bangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.104949

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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