Gneuromuscular Dentistry (GNM)

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Gneuromuscular Dentistry – The Next Level of Advancement

The home of GNM dentistry is at Occlusion Connections an advanced teaching center in Las Vegas, NV, pioneered and developed by Dr. Clayton A. Chan.  Dr.Clayton A. Chan is the originator and author of the term “GNM – Gneuromuscular” (2008) as it is used in dentistry blending both gnathology (G) and neuromuscular (NM) terms together.

“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”  —Max Planck

HOW STABLE IS YOUR CASE? – This question best represents what GNM is about.

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GNM Optimized >> Read More

“GNM is a measured approach.”

G + NM = Gnathologics + Neuromuscular = GNM (an advance blend of occlusal protocols and techniques that enhance the dentist’s clinical effectiveness in achieving successful clinical outcomes based on objectively measured criteria as they relate to the gnathic and neuro-muscular systems in dentistry).  It focuses on the clinical application of neuromuscular occlusal principles at an advanced detailed level.

Gneuromuscular Dentistry (GNM) is really a combined understanding and advanced clinical application of skill sets required to effectively treat cases comprehensively – It goes beyond the present day concepts of “Neuromuscular Dentistry” (note the spelling).  It is dentistry that focuses on body alignment, optimal mandibular function (quality) and accurate occlusion (quality) that results in optimal function and form (based on objective measurements).  In reality, gnathologics (Gk. study of the jaw) is a missing key to neuromuscular dentistry and neuromuscular concepts are missing key principles and concepts of gnathological teachings. An emphasis on “quality” of physiologic function and quality of resting modes of the masticatory system beyond an optimally balanced terminal contact position (myocentric) is of significant interest when occlusal principles are implemented.  “Myo-function or myo-functional” relationships are established based on both gnathic and neuromuscular principles.

  • Both Gnathologic and Neuromuscular understanding is required….it’s not a matter of one or the other – It’s BOTH!
  • Clinicians need to understand to optimally apply the occlusal principles in a balanced way, thus “Gneuromuscular Occlusion”.

Defining GNM Occlusion: “Gneuromuscular Occlusion (gnathologically driven neuromuscular occlusion) is the art and science of analyzing and determining a starting treatment position where jaw joints and muscles are allowed to adapt to a healing process eliminating torque and tension in the masticatory and cervical neck. Often times, patients report reduction of headaches, neck pain and jaw joint relaxation. This position is tested and tried out before any final definite dental work is done”. – Jerry E.Y Lim, BDS, FRACDS, Singapore, July 25, 2017.

>  Neuromuscular Dentistry (NMD) implements the SCIENCE of electro-diagnostic measuring technology (such as scans, EMGS and CMS (jaw tracking) data in the dental practice).  It focuses on an establishing an occlusion based on physiologic parameters between the cranio and mandibular structures that are innervated by the trigeminal system (the 5th cranial nerve).

Gneuromuscular Dentistry (GNM) relates the CLINICAL application of occlusal therapies (the gnathologics) to TMD, restorative/prosthetics and orthodontics dentistry and to their relationship to the central nervous system (CNS) as well as the autonomic nervous system (ANS) based on NMD science and technology. It’s not an academic exercise of knowledge,  but rather importantly the skilled application of occlusal management disciplines at the highest level addressing how the teeth, muscles and joints optimally move and function (in HEALTH, not in dysfunction). GNM addresses these functional relationship comprehensively as they relate to the bio-physiology and neurology of the masticatory system based on the detailed application and measured assessments (before, mid and after treatment).

Another View Point:

NM has often, in my opinion, been just too dependent on the TENs driven, EMG guided “myocentric” position, leaving too many key principles of classic gnathology out of the  “NM mix”.

  1. TENs alone cannot overcome habitual muscle engrams and parafunctional spasm and torque.  
  2. EMGs alone cannot provide a primary reliable measure of optimal lower jaw positioning and muscle health.   
  3. The teeth and the “gearing’ they provide must support, stabilize and balance an “optimally jaw 6 dimensionally untorqed tracked ” position.

GNM is an investigative process in analyzing and reassessing the diagnostic quality of the patients resting and functional modes as well as implementing specific protocols in reassessing occlusal health provided by the clinician.

Clinical Focus of GNM: Quality of Functional Health & Attention to Details

These are a few of the topics that dentist come to OC to learn and better understand regarding GNM clinical concepts:

  1. Mounting model casts to a Modified Fox Plane (physiologic) vs. HIP occlusal plane (pathologic) is fundamental to neuromuscular stability.
  2. Occlusal schemes go beyond canine rise.  Lateral and protrusive movements with no posterior interferences (Class 4 prematurities) should not exist.  OC recognizes posterior interferences incur significant problems to all cases involving occlusal/TMD issues. Proper identification and remedying Class 4 interfering schemes are key to resolving the mystery of TMD myofacial and cervical pain problems to improve quality health.
  3. Orthotics design – GNM is different. OC’s design paremeters addresses quality functional and resting requirements for healthy for cervical muscle health, quality head rotational, side bending flexion and extension movements and postural body balance.  Without these, masticatory health is impaired.
  4. Anterior coupling –  Most of the conventional NM orthotics our doctors have seen have no “coupling” with very poor discluding schemes.
  5. Understanding the meanings and implications of high and low EMGs after TENS is a diagnostic key; OC GNM teachings recognizing key EMG patterns that will influence the diagnosis of the case as well as how the orthotic is occlusally managed during treatment.
  6. Differences in how to record a physiologic “Optimized Bite” both with and without scan 5.
  7. Reliance on EMG values – OC GNM is not dependent on EMG readings to determine an Optimized mandibular to maxillary bite relationship in 6 dimensions.  We take it a step further.  We learn the power of understanding and interpreting the K7 jaw tracking data to determine the most optimal VDO, AP and frontal/lateral mandibular relationships for our patients. This is often missing in most neuromuscular paradigms.
  8. Proper “B” group placement of electrodes as well as proper cervical group monitoring on EMGs is foundational to optimal scan interpretation and diagnosis.
  9. Implementation of advanced micro occlusal adjustment techniques and specific protocols that enhance gnathic principles of anatomic forum and function are based on an optimized myo-trajectory in both the frontal/lateral and antero-posterior domains of mandibular positioning.
  10. and so much more….

“It is trained adaptive reasoning first.  Tools and technology a distant second.”

GNM uses a “Thinking Process” which are doctors learn, not following some cook book recipe in use of instruments alone when interpreting the K7 data. It is a refined application in the clinical setting that helps make our trained dentists not robots of a certain philosophy but rather trains them to be “thinkers”, analyzers, discoverers, diagnosticians, and physicians of the mouth at a different level.

That is what GNM is to me. It is more than just using the tools, although we use them and can’t do without them, but we use them well. It is like training violinist to play concertos and mozarts, not squeeky scratching sounding music with our instruments. Our objective is to help train dentist to master dentistry. It is a process and we all are in training. That is what GNM is to me… another level… another spirit, another attitude another vision and an outlook beyond.

GNM Alignment

GNM A Discipline of Dentistry: Theoretical & Scientific
The concept of GNM is a discipline that requires attention to detail to the core gnathologic occlusal principles that every student of dentistry must learn and master if they desire to be world class clinicians. LEARNING the foundational gnathologic occlusal KEYS is crucial, thus enhancing a greater appreciation of technological advancements of jaw tracking and proper use and understanding of electromyography (a study of the patient responses of muscles activity relating to the muscle tonus and status of the masticatory system).  Clinicians today can objectively record and measure postural responses of abnormal occlusion and correlate these diagnostic findings to TMD occlusal therapy, restorative/prosthetic dentistry and orthodontic dentistry.  But even more importantly it is the trained clinician’s skills and his/her appreciation to details of anatomical forum for optimal mandibular function that makes the critical difference.

Gneuromuscular Dentistry recognizes and values the use of computerized mandibular scanning (CMS), low frequency Myomonitor TENS and electromyography (EMG) as a scientific basis to apply the principles of occlusion to enhance a more complete perspective of occlusal management (gnathologics) without guessing where one’s bite should be.  It plays a significant role in dentistry by documenting and recording data to address the following areas:

  1. Does your patient experience masticatory dysfunction (Physiologic function, impairment, or dysfunction)?
  2. Does your patient experience TMJ pain (tenderness and or discomfort)?
  3. Does your patient have TMJ derangement problems (physical abnormal changes to the shape, form and position of the condyles within the fossa)?

If your answered yes to anyone of these three questions than GNM dentistry is designed to address these factors scientifically, clinically and practically.  It is the clinical application of both technology and hands on skills, attention to occlusal details and experience that makes any case successful and relevant to today’s patient needs.

Read More: What Does the K7 Technology Measure? 

GNM occlusion skills and training is the additional discipline that is a must when properly implementing CMS, EMG with low frequency TENS technology to the next level of dentistry when addressing jaw problems, cervical neck posture and muscle activity conditions relating to the masticatory system.

NOTE: GNM is not the answer for everything and for everyone.

What drives me to post on GNM is because from my own experience I have observed that the blend of gnathology (clinical application) and the neuromuscular (bio-physiologic science) protocols might offer a better result than just one or the other approach. In my own practice and experience when I implemented both these approaches and techniques meticulously, I have found that by applying all that I have learned and recognized over the years these approaches have been more effective for my patients answering the clinical questions and concerns we are faced with. That does not mean that the “GNM approach” or “every GNM dentist” can cure every TMD patient. Most dentists are genuinely concerned for their patients and strive to do the best to help them but every dentist including myself knows and admits that he/she has limitations and he/she has cases they cannot resolve regardless of the approaches they take.

OC Triad 2

GNM is a logical and scientific approach that addresses all three disciplines effectively from a TMD perspective, an orthodontic/orthopedic perspective as well as a comprehensive restorative perspective.  Read more on What OC Teaches.

Dental GNM Experts: Advanced Trained Dentists

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