Assessment of the intercanine gingival zenith distance as a method for determining occlusal vertical dimension

Assessment of the intercanine gingival zenith distance as a method for determining occlusal vertical dimension | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Assessment of the intercanine gingival zenith distance as a method for determining occlusal vertical dimension Cristian Abad-Coronel, Mariam Portocarrero Miranda, Kelly Malla Bernal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7153587/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Nov, 2025 Read the published version in BMC Research Notes → Version 1 posted 10 You are reading this latest preprint version Abstract Objective The objective of this study was to evaluate the validity of the distance between the gingival zenith of the maxillary canine and the gingival zenith of the ipsilateral mandibular canine as a clinical method for determining occlusal vertical dimension in fully dentate individuals with skeletal Class I occlusion. Results A cross-sectional clinical evaluation was conducted on 210 adult dental students with complete dentition, healthy periodontium, and bilateral molar Class I relationship. The mean intercanine distance was 16.7 mm on the right side and 16.9 mm on the left side, demonstrating strong bilateral symmetry (correlation coefficient = 0.859; p < 0.001). Male participants had significantly higher measurements than females, with mean differences of approximately 1.15 mm, while no significant differences were observed across age groups. The overall mean value of 16.8 mm supports the clinical validity of this biometric measurement as a stable and accessible anatomical reference for determining occlusal vertical dimension in similar populations. Occlusal vertical dimension Biometric assessment Prosthodontic planning Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Vertical dimension (VD) is defined as the distance between two selected anatomical or marked points, one on a fixed part and the other on a movable part ( 1 ). This parameter is fundamental in dental clinical practice, as inadequate VD can lead to neuromuscular disorders and negatively impact function, phonetics, and esthetics ( 2 – 9 ). Reduced VD is associated with masticatory muscle hyperactivity, altered occlusal forces, and temporomandibular disorders ( 10 – 12 ). Occlusal vertical dimension (OVD) specifically refers to the distance between two anatomical points on the lower facial third at maximum intercuspation ( 2 , 7 , 13 – 15 ). In this context, Angle’s molar classification is key due to its impact on vertical dimension variations ( 16 ). Although some authors suggest that OVD remains constant throughout life ( 10 , 11 ), it must be clinically determined for each patient, balancing anatomical, neuromuscular, and esthetic factors ( 2 , 7 ). In dentate patients, existing OVD is assumed ideal and should be preserved during prosthodontic treatment ( 2 ). However, no universally validated method exists to precisely determine OVD ( 17 ), and some proposed methods depend on subjective criteria or complex equipment. A recent alternative suggests measuring the distance between the gingival zeniths (or cementoenamel junctions) of the maxillary and ipsilateral mandibular canines in skeletal Class I patients ( 13 ), with a threshold below 18 mm indicating potential OVD loss ( 14 ). This method has not been validated in Latin American populations, where ethnic craniofacial variability may influence its applicability ( 19 ). Therefore, the objective of this study was to assess the clinical validity of this measurement in an Ecuadorian population with complete dentition and Class I occlusion. Methods Study Design This was a quantitative, observational, descriptive, and cross-sectional study based on clinical evaluations of undergraduate dental students from the Faculty of Dentistry, University of Cuenca, Ecuador. Data were collected between September 2024 and Abril 2025. Population and Sample The study population comprised 455 individuals aged 18 to 34 years with complete dentition (excluding third molars), healthy periodontium, bilateral molar class I (Angle), absence of dental tissue loss, and presence of maxillary and mandibular canines and molars. Individuals not meeting these inclusion criteria were excluded. Sample size was calculated for a finite population, with 95% confidence level, 5% margin of error, and response distribution of 50%, resulting in a representative sample of 210 individuals. A non-probabilistic sampling method was applied. Data Collection Procedures and Instruments Structured observation and direct clinical measurement were performed without intervention, ensuring objectivity and repeatability. A data collection form was created in Microsoft Excel. Each participant occluded in habitual intercuspation while a cheek retractor provided access. Measurements were made using a dry-point divider (Rotring, Mod. S0676580), from the gingival zenith (or CEJ, when applicable) of the maxillary canine to the corresponding point on the ipsilateral mandibular canine, bilaterally (Fig. 1 ). Distances were recorded with a digital caliper (Stanley, 78–440) (Fig. 2 ). All raw data are available in Supplementary File 1. Calibration and Reliability Testing Prior to data collection, intra- and inter-observer reliability was assessed using five randomly selected subjects. A pilot study standardized measurement procedures and tool calibration. Intra-class correlation coefficient (ICC) values > 0.75 indicated good reproducibility. Both instruments were calibrated before use. Statistical Analysis Data were entered into a Microsoft Excel 2021 database. Variables included sex, age, left-side canine-to-canine vertical distance (LSVDCEJ), and right-side measurement (RSVDCEJ). Descriptive statistics (means, standard deviations, minima, maxima) were calculated using IBM SPSS Statistics version 27. Ethical Approval The study was approved by the Institutional Ethics Committee of the University of Cuenca (Approval No. CEISH-UC-2024-004EO-OD). Written informed consent was obtained from all participants. 3.7. Data Availability The dataset generated and analyzed during this study is available in Supplementary File 1. Results Data were processed using IBM SPSS Statistics version 27, with significance set at 5%. Descriptive statistics were calculated for the distances between the CEJ of the upper and lower canines on both sides (RSVDCEJ and LSVDCEJ), stratified by sex and age group. The Kolmogorov-Smirnov test confirmed normal distribution for both variables. Parametric tests were used: Student’s t-test for sex comparisons, ANOVA for age groups, paired t-test for bilateral comparison, with effect sizes and Pearson’s r. A total of 210 patients (73.3% female, mean age 21.4 ± 3.3 years) were analyzed (Table 1). The mean distances were 16.7 mm (RSVDCEJ) and 16.9 mm (LSVDCEJ), with low variability. A very strong positive correlation between sides was observed (r = 0.859; p < 0.001). Although a statistically significant difference was found (p = 0.025), the effect size was minimal, indicating no clinically relevant asymmetry (Table 2). Sex differences were significant: males showed greater mean distances on both sides (p = 0.001 and p = 0.005, respectively), with moderate effect sizes (Table 3). In contrast, no significant differences were detected between age groups. Although a slight upward trend was observed with age, it was neither statistically nor clinically meaningful. Overall, these results suggest that the intercanine vertical distance is a bilaterally symmetrical, stable anatomical measurement, influenced by sex but not significantly affected by age (Table 4). Table 1. Demographic characteristics of the patients Sex Age N (%) µ (σ) (min-max) Female 154 (73.3%) 21.5 (3.5) 18 - 34 Male 56 (26.7%) 21.2 (2.8) 18 - 29 Total 210 (100%) 21.4 (3.3) 18 – 34 Table 2. Validity analysis of CEJ distance from upper to lower right and left canines Statistic RSVDCEJ (mm) LSVDCEJ (mm) N 210 210 Mean 16.7 16.9 Median 16.6 16.9 Standard deviation 2.2 2.2 Minimum 11.0 10.5 Maximum 23.6 23.5 Statistic (t) -2.3 p value 0.025 Correlation coefficient (r) 0.859 p value < 0.001 Cohen’s d -0.155 95% CI (-0.292; -0.019) Significance level 5%. Paired samples t-test, Cohen’s d effect size, Pearson correlation coefficient (r). Table 3. Distance in mm between CEJs of upper and lower canines, by age and sex groups Distance Sex/Age N Mean Standard deviation Minimum Maximum p value RSVDCEJ Female 154 16.4 1.9 11.1 20.8 0.001 Male 56 17.6 2.5 11.0 23.6 LSVDCEJ Female 154 16.6 1.9 10.5 21.0 0.005 Male 56 17.7 2.6 11.1 23.5 RSVDCEJ 18 to 19 years 70 16.3 2.1 11.2 20.3 0.086 20 to 24 years 110 16.8 2.2 11.0 22.5 25 to 34 years 30 17.2 2.4 12.0 23.6 LSVDCEJ 18 to 19 years 70 16.6 2.2 11.1 21.5 0.354 20 to 24 years 110 17.0 2.1 10.5 22.5 25 to 34 years 30 17.1 2.6 12.8 23.5 Table 4. Effect sizes for sex and age comparisons Distance Estimate 95% Confidence Interval Lower Upper RSVDCEJ (sex) -0.591 -0.901 -0.279 LSVDCEJ (sex) -0.513 -0.823 -0.203 RSVDCEJ (age) 0.023 0.000 0.072 LSVDCEJ (age) 0.010 0.000 0.046 Discussion The present study demonstrated consistent results for intraoral measurement, in millimeters, of OVD using anatomical landmarks such as the gingival zenith or the CEJ of the upper and lower canines on the same side, in a specific population. Various methods have been proposed to determine OVD; however, approaches based on external skin points may yield inaccurate results due to individual variability ( 15 ). Pre-treatment records, historical diagnostic models, and previous photographs have also been suggested ( 2 ). Initially, biometric measurements similar to those applied here were introduced to assess dental wear severity ( 20 ). Limitations include difficulty in measuring OVD loss at diagnosis and the influence of anterior misalignment on measurement accuracy ( 14 ). However, the objective here was to establish a validated reference value for a defined population, focusing on patients with optimal occlusion and anterior tooth alignment. According to the results, the overall mean biometric measurement was 16.8 mm, slightly lower than a value reported in a recent review ( 14 ). Despite statistical significance, this difference was small and clinically irrelevant. Male participants showed a slightly higher mean (1.15 mm difference), considered clinically meaningful despite the smaller male subgroup. Outliers were noted, possibly due to individual factors such as height, build, or facial features. Intra-subject left-right differences averaged less than 1 mm and were not clinically significant. The literature emphasizes the influence of facial traits and anatomical patterns, supporting the clinical use of this measurement as a reference for OVD in this geographic population ( 14 ). Participant age did not affect variability, likely reflecting the inclusion of individuals with healthy periodontium and complete dentition. OVD alterations in cases of dental tissue loss were beyond the scope of this study. Other methods for determining OVD have notable limitations. Techniques based on phoneme pronunciation are subjective ( 2 , 21 – 25 ). Evaluating physiologic rest position, neuromuscular status ( 14 , 21 , 26 , 27 ), and facial soft tissue analysis ( 14 ) can be challenging, particularly for less experienced clinicians. Radiographic evaluation increases cost and radiation exposure and may not be justified solely for OVD assessment ( 14 , 21 , 28 ). Similarly, facial morphometric proportions ( 21 , 29 ) are subject to examiner interpretation and technique variability. Alternative methods such as measuring the distance from the outer canthus to the mouth corner, from the base of the nose to the chin, or assessing OVD after swallowing have also been proposed but are poorly reproducible and mainly intended for edentulous patients or denture planning ( 21 , 29 , 30 ). This study highlights the biometric evaluation used—based on the CEJ or gingival zenith of the maxillary and mandibular canines—as relying on two easily identifiable landmarks, suitable for both experienced and less trained clinicians. This method allows straightforward assessment of the patient’s position in maximum intercuspation. Furthermore, this approach could be applied in the diagnostic or treatment planning phases by confirming the measurement on digital models or study casts mounted on a semi-adjustable articulator. It may also be incorporated into a functional mock-up for evaluating OVD in a proposed rehabilitation plan. Importantly, skeletal and molar classification must correspond to Class I for this methodology to be applicable. Limitations. This study was conducted in a single, relatively homogeneous population of young Ecuadorian adults with skeletal Class I occlusion and complete dentition, limiting the generalizability of the findings to other populations, ethnic groups, age ranges, or individuals with occlusal or skeletal variations. In addition, anatomical variations such as individual tooth position or gingival morphology were not considered, and their influence on the intercanine measurement requires further investigation.Some minor variations observed could not be fully explained within the current study design and warrant further research. Conclusions Considering the findings and limitations of this study, the biometric measurement of the distance between the gingival zenith or CEJ of the ipsilateral upper and lower canines in skeletal Class I patients yielded a mean value of 16.8 mm. These results support the clinical validity of this method as a tool for evaluating and determining OVD in populations with similar characteristics. Further research in diverse populations, ethnic groups, and wider age ranges is recommended to confirm these findings and enhance the clinical applicability of this approach. Abbreviations VD Vertical dimension OVD Occlusal vertical dimension RVD Resting vertical dimension IF Interocclusal free space CEJ Cementoenamel junction LSVDCEJ Left-side vertical distance between cementoenamel junctions RSVDCEJ Right-side vertical distance between cementoenamel junctions ICC Intra-class correlation coefficient SD Standard deviation Declarations Ethics approval and consent to participate The study was approved by the Institutional Ethics Committee of the University of Cuenca (Approval No. CEISH-UC-2024-004EO-OD). Written informed consent was obtained from all participants prior to their inclusion in the study. Consent for publication Not applicable. Availability of data and materials The dataset generated and analyzed during this study is available in Supplementary File 1. Competing interests The authors declare that they have no competing interests. Funding The authors received no external funding for this study. Authors' contributions Cristian Abad-Coronel conceptualized and supervised the study. Mariam Gabriela Portocarrero Miranda and Kelly Tatiana Malla Bernal, contributed to data collection and analysis. All authors read and approved the final manuscript. Acknowledgements The authors thank the undergraduate students who participated in this study and the Faculty of Dentistry, University of Cuenca, for institutional support. Authors’ information (optional) Not applicable. References “The Glossary of Prosthodontic Terms: Ninth Edition”. The Journal of ProstheticDentistry 117.5s(2017): e1-e105. Alhajj MN, Khalifa N, Abduo J, Amran AG, Ismail IA. Determination of occlusal vertical dimension for complete dentures patients: an updated review. Journal of Oral Rehabilitation. 2017;44(11):896–907. Espinosa-Valarezo JC, Irribarra-Mengarelli R, González-Bustamante H, Espinosa-Valarezo JC, Irribarra-Mengarelli R, González-Bustamante H. Métodos de evaluación de la Dimensión Vertical Oclusal. Revista clínica de periodoncia, implantología y rehabilitación oral. 2018 Aug;11(2):116–20. Fradeani M, Barducci G, Bacherini L, Brennan M. Esthetic rehabilitation of a severely worn dentition with minimally invasive prosthetic procedures (MIPP). Int J Periodontics Restorative Dent. 2012 Apr;32(2):135–47. Joanna K, Teresa S, Maria G. Evaluation of functional parameters in the occlusion of complete denture wearers before and after prosthetic treatment. J Prosthodont Res. 2017 Oct;61(4):480–90. Quiroga Del Pozo R, Riquelme Belmar R, Sierra Fuentes M, Del Pozo Bassi J, Quiroga Aravena R. Determinación de la Dimensión Vertical Oclusal en desdentados totales: comparación de métodos convencionales con el craneómetro de Knebelman. Revista clínica de periodoncia, implantología y rehabilitación oral. 2012 Apr;5(1):20–4. ResearchGate [Internet]. [cited 2025 May 5]. Vertical dimension of occlusion: The keys to decision. Available from: https://www.researchgate.net/publication/225599917_Vertical_dimension_of_occlusion_The_keys_to_decision Remiszewski D, Bidra AS, Litt MD. Ability of General Dentists and Prosthodontists to Discern and Identify Incremental Increases in Occlusal Vertical Dimension in Dentate Subjects. Int J Prosthodont. 2017;30(4):327–33. Keim R. The Editor´s Corner. 2017 [cited 2025 May 5]. Controlling the vertical dimension. Available from: https://www.jco-online.com/archive/2017/07/375/ Schuyler CH. Problems Associated with Opening the Bite Which would Contraindicate It as a Common Procedure. The Journal of the American Dental Association. 1939 May 1;26(5):734–40. Tench RW. Dangers in Dental Reconstruction in-Volving Increase of the Vertical Dimension of the Lower Third of the Human Face. The Journal of the American Dental Association and The Dental Cosmos. 1938 Apr 1;25(4):566–70. Turner KA, Missirlian DM. Restoration of the extremely worn dentition. The Journal of Prosthetic Dentistry. 1984 Oct 1;52(4):467–74. Montero J, Dib A. The effect of age and prosthodontic status on the clinical and electromyographic assessment of the interocclusal rest space. The Journal of Prosthetic Dentistry. 2019 May 1;121(5):791–6. Abduo J, Lyons K. Clinical considerations for increasing occlusal vertical dimension: a review. Australian Dental Journal. 2012;57(1):2–10. Fabbri G, Sorrentino R, Cannistraro G, Mintrone F, Bacherini L, Turrini R, et al. Increasing the Vertical Dimension of Occlusion: A Multicenter Retrospective Clinical Comparative Study on 100 Patients with Fixed Tooth-Supported, Mixed, and Implant-Supported Full-Arch Rehabilitations. Int J Periodontics Restorative Dent. 2018;38(3):323–35. Mageet A. ResearchGate. [cited 2025 May 10]. Classification of Skeletal and Dental Malocclusion: Revisited. Available from: https://www.researchgate.net/publication/334406161_Classification_of_Skeletal_and_Dental_Malocclusion_Revisited Chou JC, Thompson GA, Aggarwal HA, Bosio JA, Irelan JP. Effect of occlusal vertical dimension on lip positions at smile. The Journal of Prosthetic Dentistry. 2014 Sep 1;112(3):533–9. Yanikoğlu N. ResearchGate. [cited 2025 May 10]. Determination of the occlusal vertical dimension: use of maxillary and mandibular posterior teeth measurement in edentate subjects. Available from: https://www.researchgate.net/publication/7733851_Determination_of_the_occlusal_vertical_dimension_use_ of_maxillary_and_mandibular_posterior_teeth_measurement_in_edentate_subjects Majeed MI, Haralur SB, Khan MF, Al Ahmari MA, Al Shahrani NF, Shaik S. An Anthropometric Study of Cranio-Facial Measurements and Their Correlation with Vertical Dimension of Occlusion among Saudi Arabian Subpopulations. Open Access Maced J Med Sci. 2018 Apr 15;6(4):680–6. Murphy T. Compensatory mechanisms in facial height adjustment to functional tooth attrition. Australian Dental Journal. 1959;4(5):312–23. Calamita M, Coachman C, Sesma N, Kois J. Occlusal vertical dimension: treatment planning decisions and management considerations. Int J Esthet Dent. 2019;14(2):166–81. Silverman MM. Accurate measurement of vertical dimension by phonetics and the speaking centric space: Part two. Dent Dig. 1951 Jul;57(7):308–11. Silverman MM. The speaking method in measuring vertical dimension. 1952. J Prosthet Dent. 2001 May;85(5):427–31. Silverman SI. Vertical dimension record: A three dimensional phenomenon. Part I. The Journal of Prosthetic Dentistry. 1985 Mar 1;53(3):420–5. Pound E. Esthetic dentures and their phonetic values. The Journal of Prosthetic Dentistry. 1951 Jan 1;1(1):98–111. Niswonger ME. The Rest Position of the Mandible and the Centric Relation. The Journal of the American Dental Association (1922). 1934 Sep 1;21(9):1572–82. Niswonger M. Obtaining the Vertical Relation in Edentulous Cases That Existed Prior to Extraction. The Journal of the American Dental Association and The Dental Cosmos (1938). 1938;25(11):1842–7. Orthlieb JD, Laurent M, Laplanche O. Cephalometric estimation of Vertical Dimension of Occlusion. Journal of Oral Rehabilitation. 2000;27(9):802–7. Willis FM. Esthetics of Full Denture Construction*. The Journal of the American Dental Association (1922). 1930 Apr 1;17(4):636–42. Shanahan TEJ. Physiologic jaw relations and occlusion of complete dentures. 1955. J Prosthet Dent. 2004 Mar 1;91(3):203–5. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.xlsx Cite Share Download PDF Status: Published Journal Publication published 29 Nov, 2025 Read the published version in BMC Research Notes → Version 1 posted Editorial decision: Revision requested 08 Sep, 2025 Reviews received at journal 04 Sep, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviews received at journal 28 Jul, 2025 Reviewers agreed at journal 23 Jul, 2025 Reviewers invited by journal 22 Jul, 2025 Editor invited by journal 21 Jul, 2025 Editor assigned by journal 21 Jul, 2025 Submission checks completed at journal 21 Jul, 2025 First submitted to journal 17 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7153587","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":489794914,"identity":"b6655a06-df6f-45a3-a61d-41a477ef3b1a","order_by":0,"name":"Cristian Abad-Coronel","email":"data:image/png;base64,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","orcid":"","institution":"University of Cuenca","correspondingAuthor":true,"prefix":"","firstName":"Cristian","middleName":"","lastName":"Abad-Coronel","suffix":""},{"id":489794915,"identity":"14716e93-d227-4daa-921e-2db24420c7e7","order_by":1,"name":"Mariam Portocarrero Miranda","email":"","orcid":"","institution":"University of Cuenca","correspondingAuthor":false,"prefix":"","firstName":"Mariam","middleName":"Portocarrero","lastName":"Miranda","suffix":""},{"id":489794917,"identity":"f3e2c85d-d739-4642-a9dc-9b69c518ff13","order_by":2,"name":"Kelly Malla Bernal","email":"","orcid":"","institution":"University of Cuenca","correspondingAuthor":false,"prefix":"","firstName":"Kelly","middleName":"Malla","lastName":"Bernal","suffix":""}],"badges":[],"createdAt":"2025-07-18 03:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7153587/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7153587/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13104-025-07571-y","type":"published","date":"2025-11-29T15:58:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87552784,"identity":"18381e5f-facd-4337-9e79-7ca1d38b03d3","added_by":"auto","created_at":"2025-07-25 06:32:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":6256147,"visible":true,"origin":"","legend":"\u003cp\u003eOVD measured from the gingival zenith of the upper canine to the ipsilateral lower canine.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/16d640c432964ddfc152c76c.jpg"},{"id":87554695,"identity":"c468114e-0e5c-4e0a-8047-c809182325fe","added_by":"auto","created_at":"2025-07-25 06:48:16","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54167,"visible":true,"origin":"","legend":"\u003cp\u003eDetermination of the distance using a digital caliper.\u003c/p\u003e","description":"","filename":"Figure2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/673b91a9d060506ddbb5dcc7.jpeg"},{"id":87554232,"identity":"74fe50a6-209f-4da6-904a-c20279ca5905","added_by":"auto","created_at":"2025-07-25 06:40:16","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":22842,"visible":true,"origin":"","legend":"\u003cp\u003ePlot of 95% confidence intervals for RSVDCEJ and LSVDCEJ.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/02d09b81427c5a304a88b147.jpg"},{"id":87552776,"identity":"b99232aa-46f4-49e2-b98d-a8fed95bdfd5","added_by":"auto","created_at":"2025-07-25 06:32:16","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":24325,"visible":true,"origin":"","legend":"\u003cp\u003e95% confidence interval plot for RSVDCEJ by sex.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/3a0b1f31d48604fadacf87a7.jpg"},{"id":87552774,"identity":"1ace3670-38e3-4069-8698-9186efe40700","added_by":"auto","created_at":"2025-07-25 06:32:16","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":23466,"visible":true,"origin":"","legend":"\u003cp\u003e95% confidence interval plot for LSVDCEJ by sex.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/e1b11b5faab4598531651823.jpg"},{"id":87552778,"identity":"439e2555-e153-4ce2-8f8c-140f33a9a222","added_by":"auto","created_at":"2025-07-25 06:32:16","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":30087,"visible":true,"origin":"","legend":"\u003cp\u003e95% confidence interval plot for RSVDCEJ by age group.\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/cec45ff48a72aa408da0e3d9.jpg"},{"id":87552788,"identity":"8b59e9c0-df2d-40a3-93c3-55e94251ddaf","added_by":"auto","created_at":"2025-07-25 06:32:16","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":25706,"visible":true,"origin":"","legend":"\u003cp\u003e95% confidence interval plot for LSVDCEJ by age group.\u003c/p\u003e","description":"","filename":"Figure7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/ce6d7e9c0f032d857771330e.jpg"},{"id":97178975,"identity":"2b4b32ec-5ca6-4db0-995a-b4c07a556375","added_by":"auto","created_at":"2025-12-01 16:14:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6979460,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/fd43b92c-db30-4479-b033-8e2ba7bc2b66.pdf"},{"id":87552770,"identity":"d9db1ce6-e3b2-476c-9c58-341d224f7eaf","added_by":"auto","created_at":"2025-07-25 06:32:16","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19082,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7153587/v1/bf03376f525d6f20f8c10d5a.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of the intercanine gingival zenith distance as a method for determining occlusal vertical dimension","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVertical dimension (VD) is defined as the distance between two selected anatomical or marked points, one on a fixed part and the other on a movable part (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This parameter is fundamental in dental clinical practice, as inadequate VD can lead to neuromuscular disorders and negatively impact function, phonetics, and esthetics (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Reduced VD is associated with masticatory muscle hyperactivity, altered occlusal forces, and temporomandibular disorders (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOcclusal vertical dimension (OVD) specifically refers to the distance between two anatomical points on the lower facial third at maximum intercuspation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In this context, Angle\u0026rsquo;s molar classification is key due to its impact on vertical dimension variations (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Although some authors suggest that OVD remains constant throughout life (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), it must be clinically determined for each patient, balancing anatomical, neuromuscular, and esthetic factors (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In dentate patients, existing OVD is assumed ideal and should be preserved during prosthodontic treatment (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). However, no universally validated method exists to precisely determine OVD (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and some proposed methods depend on subjective criteria or complex equipment.\u003c/p\u003e\u003cp\u003eA recent alternative suggests measuring the distance between the gingival zeniths (or cementoenamel junctions) of the maxillary and ipsilateral mandibular canines in skeletal Class I patients (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), with a threshold below 18 mm indicating potential OVD loss (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This method has not been validated in Latin American populations, where ethnic craniofacial variability may influence its applicability (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Therefore, the objective of this study was to assess the clinical validity of this measurement in an Ecuadorian population with complete dentition and Class I occlusion.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a quantitative, observational, descriptive, and cross-sectional study based on clinical evaluations of undergraduate dental students from the Faculty of Dentistry, University of Cuenca, Ecuador. Data were collected between September 2024 and Abril 2025.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePopulation and Sample\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study population comprised 455 individuals aged 18 to 34 years with complete dentition (excluding third molars), healthy periodontium, bilateral molar class I (Angle), absence of dental tissue loss, and presence of maxillary and mandibular canines and molars. Individuals not meeting these inclusion criteria were excluded.\u003c/p\u003e\u003cp\u003eSample size was calculated for a finite population, with 95% confidence level, 5% margin of error, and response distribution of 50%, resulting in a representative sample of 210 individuals. A non-probabilistic sampling method was applied.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection Procedures and Instruments\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStructured observation and direct clinical measurement were performed without intervention, ensuring objectivity and repeatability. A data collection form was created in Microsoft Excel. Each participant occluded in habitual intercuspation while a cheek retractor provided access.\u003c/p\u003e\u003cp\u003eMeasurements were made using a dry-point divider (Rotring, Mod. S0676580), from the gingival zenith (or CEJ, when applicable) of the maxillary canine to the corresponding point on the ipsilateral mandibular canine, bilaterally (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Distances were recorded with a digital caliper (Stanley, 78\u0026ndash;440) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). All raw data are available in Supplementary File 1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCalibration and Reliability Testing\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePrior to data collection, intra- and inter-observer reliability was assessed using five randomly selected subjects. A pilot study standardized measurement procedures and tool calibration. Intra-class correlation coefficient (ICC) values\u0026thinsp;\u0026gt;\u0026thinsp;0.75 indicated good reproducibility. Both instruments were calibrated before use.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were entered into a Microsoft Excel 2021 database. Variables included sex, age, left-side canine-to-canine vertical distance (LSVDCEJ), and right-side measurement (RSVDCEJ). Descriptive statistics (means, standard deviations, minima, maxima) were calculated using IBM SPSS Statistics version 27.\u003c/p\u003e\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Ethics Committee of the University of Cuenca (Approval No. CEISH-UC-2024-004EO-OD). Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.7. Data Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analyzed during this study is available in Supplementary File 1.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eData were processed using IBM SPSS Statistics version 27, with significance set at 5%. Descriptive statistics were calculated for the distances between the CEJ of the upper and lower canines on both sides (RSVDCEJ and LSVDCEJ), stratified by sex and age group.\u003c/p\u003e\n\u003cp\u003eThe Kolmogorov-Smirnov test confirmed normal distribution for both variables. Parametric tests were used: Student\u0026rsquo;s t-test for sex comparisons, ANOVA for age groups, paired t-test for bilateral comparison, with effect sizes and Pearson\u0026rsquo;s r.\u003c/p\u003e\n\u003cp\u003eA total of 210 patients (73.3% female, mean age 21.4 \u0026plusmn; 3.3 years) were analyzed (Table 1).\u003c/p\u003e\n\u003cp\u003eThe mean distances were 16.7 mm (RSVDCEJ) and 16.9 mm (LSVDCEJ), with low variability. A very strong positive correlation between sides was observed (r = 0.859; p \u0026lt; 0.001). Although a statistically significant difference was found (p = 0.025), the effect size was minimal, indicating no clinically relevant asymmetry (Table 2).\u003c/p\u003e\n\u003cp\u003eSex differences were significant: males showed greater mean distances on both sides (p = 0.001 and p = 0.005, respectively), with moderate effect sizes (Table 3). In contrast, no significant differences were detected between age groups. Although a slight upward trend was observed with age, it was neither statistically nor clinically meaningful.\u003c/p\u003e\n\u003cp\u003eOverall, these results suggest that the intercanine vertical distance is a bilaterally symmetrical, stable anatomical measurement, influenced by sex but not significantly affected by age (Table 4).\u003c/p\u003e\n\u003cp\u003eTable 1. Demographic characteristics of the patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 31px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 45px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026micro; (\u0026sigma;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e(min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e154 (73.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e21.5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e18 - 34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e56 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e21.2 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e18 - 29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e210 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e21.4 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e18 \u0026ndash; 34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Validity analysis of CEJ distance from upper to lower right and left canines\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eRSVDCEJ (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003eLSVDCEJ (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e23.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eStatistic (t)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eCorrelation coefficient (r)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e(-0.292; -0.019)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSignificance level 5%. Paired samples t-test, Cohen\u0026rsquo;s d effect size, Pearson correlation coefficient (r).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Distance in mm between CEJs of upper and lower canines, by age and sex groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eDistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eSex/Age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eRSVDCEJ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e23.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eLSVDCEJ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 13px;\"\u003e\n \u003cp\u003eRSVDCEJ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e18 to 19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e20 to 24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e25 to 34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e23.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 13px;\"\u003e\n \u003cp\u003eLSVDCEJ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e18 to 19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e20 to 24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e25 to 34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. Effect sizes for sex and age comparisons\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eDistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 25px;\"\u003e\n \u003cp\u003eEstimate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e95% Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRSVDCEJ (sex)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e-0.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e-0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e-0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eLSVDCEJ (sex)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e-0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e-0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e-0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRSVDCEJ (age)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eLSVDCEJ (age)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study demonstrated consistent results for intraoral measurement, in millimeters, of OVD using anatomical landmarks such as the gingival zenith or the CEJ of the upper and lower canines on the same side, in a specific population. Various methods have been proposed to determine OVD; however, approaches based on external skin points may yield inaccurate results due to individual variability (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePre-treatment records, historical diagnostic models, and previous photographs have also been suggested (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Initially, biometric measurements similar to those applied here were introduced to assess dental wear severity (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Limitations include difficulty in measuring OVD loss at diagnosis and the influence of anterior misalignment on measurement accuracy (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, the objective here was to establish a validated reference value for a defined population, focusing on patients with optimal occlusion and anterior tooth alignment.\u003c/p\u003e\u003cp\u003eAccording to the results, the overall mean biometric measurement was 16.8 mm, slightly lower than a value reported in a recent review (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Despite statistical significance, this difference was small and clinically irrelevant. Male participants showed a slightly higher mean (1.15 mm difference), considered clinically meaningful despite the smaller male subgroup. Outliers were noted, possibly due to individual factors such as height, build, or facial features. Intra-subject left-right differences averaged less than 1 mm and were not clinically significant.\u003c/p\u003e\u003cp\u003eThe literature emphasizes the influence of facial traits and anatomical patterns, supporting the clinical use of this measurement as a reference for OVD in this geographic population (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Participant age did not affect variability, likely reflecting the inclusion of individuals with healthy periodontium and complete dentition. OVD alterations in cases of dental tissue loss were beyond the scope of this study.\u003c/p\u003e\u003cp\u003eOther methods for determining OVD have notable limitations. Techniques based on phoneme pronunciation are subjective (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Evaluating physiologic rest position, neuromuscular status (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), and facial soft tissue analysis (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) can be challenging, particularly for less experienced clinicians. Radiographic evaluation increases cost and radiation exposure and may not be justified solely for OVD assessment (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Similarly, facial morphometric proportions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) are subject to examiner interpretation and technique variability.\u003c/p\u003e\u003cp\u003eAlternative methods such as measuring the distance from the outer canthus to the mouth corner, from the base of the nose to the chin, or assessing OVD after swallowing have also been proposed but are poorly reproducible and mainly intended for edentulous patients or denture planning (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study highlights the biometric evaluation used\u0026mdash;based on the CEJ or gingival zenith of the maxillary and mandibular canines\u0026mdash;as relying on two easily identifiable landmarks, suitable for both experienced and less trained clinicians. This method allows straightforward assessment of the patient\u0026rsquo;s position in maximum intercuspation.\u003c/p\u003e\u003cp\u003eFurthermore, this approach could be applied in the diagnostic or treatment planning phases by confirming the measurement on digital models or study casts mounted on a semi-adjustable articulator. It may also be incorporated into a functional mock-up for evaluating OVD in a proposed rehabilitation plan. Importantly, skeletal and molar classification must correspond to Class I for this methodology to be applicable.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted in a single, relatively homogeneous population of young Ecuadorian adults with skeletal Class I occlusion and complete dentition, limiting the generalizability of the findings to other populations, ethnic groups, age ranges, or individuals with occlusal or skeletal variations. In addition, anatomical variations such as individual tooth position or gingival morphology were not considered, and their influence on the intercanine measurement requires further investigation.Some minor variations observed could not be fully explained within the current study design and warrant further research.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eConsidering the findings and limitations of this study, the biometric measurement of the distance between the gingival zenith or CEJ of the ipsilateral upper and lower canines in skeletal Class I patients yielded a mean value of 16.8 mm. These results support the clinical validity of this method as a tool for evaluating and determining OVD in populations with similar characteristics. Further research in diverse populations, ethnic groups, and wider age ranges is recommended to confirm these findings and enhance the clinical applicability of this approach.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eVD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVertical dimension\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eOVD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOcclusal vertical dimension\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eRVD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eResting vertical dimension\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eIF\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterocclusal free space\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCEJ\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCementoenamel junction\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eLSVDCEJ\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLeft-side vertical distance between cementoenamel junctions\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eRSVDCEJ\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRight-side vertical distance between cementoenamel junctions\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eICC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntra-class correlation coefficient\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Ethics Committee of the University of Cuenca (Approval No. CEISH-UC-2024-004EO-OD). Written informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analyzed during this study is available in Supplementary File 1.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors received no external funding for this study.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eCristian Abad-Coronel conceptualized and supervised the study. Mariam Gabriela Portocarrero Miranda and Kelly Tatiana Malla Bernal, contributed to data collection and analysis. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors thank the undergraduate students who participated in this study and the Faculty of Dentistry, University of Cuenca, for institutional support.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; information (optional)\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u0026ldquo;The Glossary of Prosthodontic Terms: Ninth Edition\u0026rdquo;. The Journal of ProstheticDentistry 117.5s(2017): e1-e105.\u003c/li\u003e\n \u003cli\u003eAlhajj MN, Khalifa N, Abduo J, Amran AG, Ismail IA. Determination of occlusal vertical dimension for complete dentures patients: an updated review. Journal of Oral Rehabilitation. 2017;44(11):896\u0026ndash;907.\u003c/li\u003e\n \u003cli\u003eEspinosa-Valarezo JC, Irribarra-Mengarelli R, Gonz\u0026aacute;lez-Bustamante H, Espinosa-Valarezo JC, Irribarra-Mengarelli R, Gonz\u0026aacute;lez-Bustamante H. M\u0026eacute;todos de evaluaci\u0026oacute;n de la Dimensi\u0026oacute;n Vertical Oclusal. Revista cl\u0026iacute;nica de periodoncia, implantolog\u0026iacute;a y rehabilitaci\u0026oacute;n oral. 2018 Aug;11(2):116\u0026ndash;20.\u003c/li\u003e\n \u003cli\u003eFradeani M, Barducci G, Bacherini L, Brennan M. Esthetic rehabilitation of a severely worn dentition with minimally invasive prosthetic procedures (MIPP). Int J Periodontics Restorative Dent. 2012 Apr;32(2):135\u0026ndash;47.\u003c/li\u003e\n \u003cli\u003eJoanna K, Teresa S, Maria G. Evaluation of functional parameters in the occlusion of complete denture wearers before and after prosthetic treatment. J Prosthodont Res. 2017 Oct;61(4):480\u0026ndash;90.\u003c/li\u003e\n \u003cli\u003eQuiroga Del Pozo R, Riquelme Belmar R, Sierra Fuentes M, Del Pozo Bassi J, Quiroga Aravena R. Determinaci\u0026oacute;n de la Dimensi\u0026oacute;n Vertical Oclusal en desdentados totales: comparaci\u0026oacute;n de m\u0026eacute;todos convencionales con el crane\u0026oacute;metro de Knebelman. Revista cl\u0026iacute;nica de periodoncia, implantolog\u0026iacute;a y rehabilitaci\u0026oacute;n oral. 2012 Apr;5(1):20\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eResearchGate [Internet]. [cited 2025 May 5]. Vertical dimension of occlusion: The keys to decision. Available from: https://www.researchgate.net/publication/225599917_Vertical_dimension_of_occlusion_The_keys_to_decision\u003c/li\u003e\n \u003cli\u003eRemiszewski D, Bidra AS, Litt MD. Ability of General Dentists and Prosthodontists to Discern and Identify Incremental Increases in Occlusal Vertical Dimension in Dentate Subjects. Int J Prosthodont. 2017;30(4):327\u0026ndash;33.\u003c/li\u003e\n \u003cli\u003eKeim R. The Editor\u0026acute;s Corner. 2017 [cited 2025 May 5]. Controlling the vertical dimension. Available from: https://www.jco-online.com/archive/2017/07/375/\u003c/li\u003e\n \u003cli\u003eSchuyler CH. Problems Associated with Opening the Bite Which would Contraindicate It as a Common Procedure. The Journal of the American Dental Association. 1939 May 1;26(5):734\u0026ndash;40.\u003c/li\u003e\n \u003cli\u003eTench RW. Dangers in Dental Reconstruction in-Volving Increase of the Vertical Dimension of the Lower Third of the Human Face. The Journal of the American Dental Association and The Dental Cosmos. 1938 Apr 1;25(4):566\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eTurner KA, Missirlian DM. Restoration of the extremely worn dentition. The Journal of Prosthetic Dentistry. 1984 Oct 1;52(4):467\u0026ndash;74.\u003c/li\u003e\n \u003cli\u003eMontero J, Dib A. The effect of age and prosthodontic status on the clinical and electromyographic assessment of the interocclusal rest space. The Journal of Prosthetic Dentistry. 2019 May 1;121(5):791\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eAbduo J, Lyons K. Clinical considerations for increasing occlusal vertical dimension: a review. Australian Dental Journal. 2012;57(1):2\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003eFabbri G, Sorrentino R, Cannistraro G, Mintrone F, Bacherini L, Turrini R, et al. Increasing the Vertical Dimension of Occlusion: A Multicenter Retrospective Clinical Comparative Study on 100 Patients with Fixed Tooth-Supported, Mixed, and Implant-Supported Full-Arch Rehabilitations. Int J Periodontics Restorative Dent. 2018;38(3):323\u0026ndash;35.\u003c/li\u003e\n \u003cli\u003eMageet A. ResearchGate. [cited 2025 May 10]. Classification of Skeletal and Dental Malocclusion: Revisited. Available from: https://www.researchgate.net/publication/334406161_Classification_of_Skeletal_and_Dental_Malocclusion_Revisited\u003c/li\u003e\n \u003cli\u003eChou JC, Thompson GA, Aggarwal HA, Bosio JA, Irelan JP. Effect of occlusal vertical dimension on lip positions at smile. The Journal of Prosthetic Dentistry. 2014 Sep 1;112(3):533\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eYanikoğlu N. ResearchGate. [cited 2025 May 10]. Determination of the occlusal vertical dimension: use of maxillary and mandibular posterior teeth measurement in edentate subjects. Available from: https://www.researchgate.net/publication/7733851_Determination_of_the_occlusal_vertical_dimension_use_\u003cbr\u003eof_maxillary_and_mandibular_posterior_teeth_measurement_in_edentate_subjects\u003c/li\u003e\n \u003cli\u003eMajeed MI, Haralur SB, Khan MF, Al Ahmari MA, Al Shahrani NF, Shaik S. An Anthropometric Study of Cranio-Facial Measurements and Their Correlation with Vertical Dimension of Occlusion among Saudi Arabian Subpopulations. Open Access Maced J Med Sci. 2018 Apr 15;6(4):680\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eMurphy T. Compensatory mechanisms in facial height adjustment to functional tooth attrition. Australian Dental Journal. 1959;4(5):312\u0026ndash;23.\u003c/li\u003e\n \u003cli\u003eCalamita M, Coachman C, Sesma N, Kois J. Occlusal vertical dimension: treatment planning decisions and management considerations. Int J Esthet Dent. 2019;14(2):166\u0026ndash;81.\u003c/li\u003e\n \u003cli\u003eSilverman MM. Accurate measurement of vertical dimension by phonetics and the speaking centric space: Part two. Dent Dig. 1951 Jul;57(7):308\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eSilverman MM. The speaking method in measuring vertical dimension. 1952. J Prosthet Dent. 2001 May;85(5):427\u0026ndash;31.\u003c/li\u003e\n \u003cli\u003eSilverman SI. Vertical dimension record: A three dimensional phenomenon. Part I. The Journal of Prosthetic Dentistry. 1985 Mar 1;53(3):420\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003ePound E. Esthetic dentures and their phonetic values. The Journal of Prosthetic Dentistry. 1951 Jan 1;1(1):98\u0026ndash;111.\u003c/li\u003e\n \u003cli\u003eNiswonger ME. The Rest Position of the Mandible and the Centric Relation. The Journal of the American Dental Association (1922). 1934 Sep 1;21(9):1572\u0026ndash;82.\u003c/li\u003e\n \u003cli\u003eNiswonger M. Obtaining the Vertical Relation in Edentulous Cases That Existed Prior to Extraction. The Journal of the American Dental Association and The Dental Cosmos (1938). 1938;25(11):1842\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eOrthlieb JD, Laurent M, Laplanche O. Cephalometric estimation of Vertical Dimension of Occlusion. Journal of Oral Rehabilitation. 2000;27(9):802\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eWillis FM. Esthetics of Full Denture Construction*. The Journal of the American Dental Association (1922). 1930 Apr 1;17(4):636\u0026ndash;42.\u003c/li\u003e\n \u003cli\u003eShanahan TEJ. Physiologic jaw relations and occlusion of complete dentures. 1955. J Prosthet Dent. 2004 Mar 1;91(3):203\u0026ndash;5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Occlusal vertical dimension, Biometric assessment, Prosthodontic planning","lastPublishedDoi":"10.21203/rs.3.rs-7153587/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7153587/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThe objective of this study was to evaluate the validity of the distance between the gingival zenith of the maxillary canine and the gingival zenith of the ipsilateral mandibular canine as a clinical method for determining occlusal vertical dimension in fully dentate individuals with skeletal Class I occlusion.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA cross-sectional clinical evaluation was conducted on 210 adult dental students with complete dentition, healthy periodontium, and bilateral molar Class I relationship. The mean intercanine distance was 16.7 mm on the right side and 16.9 mm on the left side, demonstrating strong bilateral symmetry (correlation coefficient\u0026thinsp;=\u0026thinsp;0.859; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Male participants had significantly higher measurements than females, with mean differences of approximately 1.15 mm, while no significant differences were observed across age groups. The overall mean value of 16.8 mm supports the clinical validity of this biometric measurement as a stable and accessible anatomical reference for determining occlusal vertical dimension in similar populations.\u003c/p\u003e","manuscriptTitle":"Assessment of the intercanine gingival zenith distance as a method for determining occlusal vertical dimension","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 06:32:11","doi":"10.21203/rs.3.rs-7153587/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-08T10:39:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-04T14:29:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277294431458813491243157417013409231001","date":"2025-08-03T17:24:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-28T13:04:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248663294873256188926564766628205706326","date":"2025-07-23T13:35:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-22T11:14:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-21T10:55:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-21T10:12:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-21T10:12:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2025-07-18T03:46:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e3ae3db0-4eb4-41c9-8e49-097795357c34","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:08:14+00:00","versionOfRecord":{"articleIdentity":"rs-7153587","link":"https://doi.org/10.1186/s13104-025-07571-y","journal":{"identity":"bmc-research-notes","isVorOnly":false,"title":"BMC Research Notes"},"publishedOn":"2025-11-29 15:58:30","publishedOnDateReadable":"November 29th, 2025"},"versionCreatedAt":"2025-07-25 06:32:11","video":"","vorDoi":"10.1186/s13104-025-07571-y","vorDoiUrl":"https://doi.org/10.1186/s13104-025-07571-y","workflowStages":[]},"version":"v1","identity":"rs-7153587","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7153587","identity":"rs-7153587","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}