GNM is Not the Same as NM

GNM is Not the Same as NM — Understanding the Critical Distinctions That Separate Gneuromuscular Dentistry from Classical Neuromuscular Approaches

If you have been practicing neuromuscular dentistry and feel like something is still missing — cases that don’t fully resolve, cervical EMGs that won’t come down, patients who relapse after orthotic delivery — you are not wrong. Something is missing. And it is not simply the K7. It is not simply the J5 Dental TENS. Many NM dentists have the technology and still fall short — because what is missing is the GNM framework — the advanced understanding of bite optimization protocols, gnathologic occlusal principles and the neuromuscular synthesis that Occlusion Connections has developed and refined over decades of objective measured clinical practice. The classical NM approach to taking a bite registration with TENS and K7 is foundational — but it is not the same as the Chan Optimized Bite protocol — a quantifiable, identifiable and repeatable clinical process that uses Scan 4/5 on the optimized myo-trajectory with specific GNM techniques that most NM dentists have never been taught. Proven over 20 years of clinical application in the hands of OC trained dentists around the world — this protocol is one of the most significant distinctions that separates GNM from classical neuromuscular dentistry. GNM is not a repackaging of classical NM. It is an entirely new clinical paradigm — and understanding the difference is the first step toward resolving the cases that have been defeating you.

• Why Gneuromuscular Dentistry? – The Next Level of Advancement→

Gneuromuscular (GNM) dentistry is about being particular and detailed in the diagnostic and treatment process.  The application of the physiologic/neuromuscular and gnathic principles is key to our success. GNM principles effectively addresses the clinical needs of the 4 NM occlusal challenging type patient cases: 1) TMJ primary joint derangement pain case, 2) the Cervical dysfunction pain cases, 3) the retrognathic mandibular Class II division 2 type pain cases and 4) the anterior open bite pain cases.
The classical NM doctors need to understand that it is not simply G + NM.  The NM in GNM is NOT the same classical NM that they are thinking about.  It is an entirely new paradigm, but rather a NEW, advanced NM concept married with specific detailed gnathologic occlusal principles.
GNM was developed by Dr. Clayton Chan (Founder/Director of Occlusion Connections, Las Vegas, NV) to continue pursuit, further and deepen the neuromuscular principles set forth by Drs. Bernard and Robert Jankelson using Myotronics equipment (J5 Dental TENS unit and K7x for EMGs, ESGs and CMS) with a heavy emphasis on:

1. Optimized orthopedic position of the mandible
2. K7x scan interpretation to diagnose then guide treatment
3. Detailed adherence to gnathology (occlusal principles) with a neuromuscular emphasis.
   
4. GNM is dedicated to the physiologic principles pioneered and recognized from Myotronics K7x and J5 Dental TENS at advanced levels –  a foundation to objective measurements and occlusal detailed application.

• Bite Optimization→

With a plethora of literature supporting the specific use of approved Myotronics equipment, GNM essentially picked up the baton from NM and continues the “race” with the goal being to apply discipline and detail to dentistry for the relief of pain symptoms and optimal care for patients. At this time, NM/Physiologic Based centers have been abandoning the “NM” moniker and now are adopting a different paradigm that includes “some” traditional NM principles with other techniques and ideas that, as of yet, have not stood the test of time.  The term “physiologic” sounds great. NM and GNM have ALWAYS given attention to the whole body and the multi-factorial nature of TMJ problems. Continued research in areas such as airway, sleep, posture, etc., continue to add where valid to the NM/GNM world.

Today’s “NM” trained dentists continue to advocate an HIP (hamular notch, incisive papilla) plane of occlusion in their phase 2 treatment. Cosmetic minded restorative dentists use HIP to mount their maxillary cases in a simplistic, yet abnormally distorted orientation that is proven un-physiologic to long term stability of the cervical head posture.

GNM uses a modifed Fox Plane to orient the head and occlusal plane correctly to horizontal level (physiologic, better matching a normal head and maxillary occlusal plane orientation (see lateral cephalograms when the head is level to horizon).  Numerous tests and research has shown that HIP produces a flat occlusal plane parallel to horizontal level. This is absolutely pathologic and unstable. Modified fox plane technique as advocated at OC is physiologic – the occlusal plane is set up to a natural angled plane relative to horizontal level. This is important, significant and a principle related to head posture stability and mandibular stable positioning especially when phase 2 full mouth restorative treatment is involved to finish a case restoratively. GNM does not want to see patients with unresolved cervical neck problems passed off as whiners and complainers. NM does not believe in Fox Plane angled occlusal plane cervical stability as proven by their implementation of their teachings.

• A Review of the Clinical Significance of the Occlusal Plane: Its Variation and Effect on Head Posture: Optimizing the Neuromuscular Trajectory – a Key to Stabilizing the Occlusal-Cervical Posture. Chan, CA: International College of Craniomandibular Orthopedics (ICCMO) Anthology VIII, 2007.

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What Is GNM Dentistry?

Many dentists who use K7 technology and practice neuromuscular dentistry reach a ceiling with their most complex cases. Cervical pain that won’t resolve. Anterior open bites that relapse. Class II Division 2 cases that never fully stabilize. GNM — Gneuromuscular Dentistry — was developed specifically to answer those cases. It is not a rejection of neuromuscular principles. It is their completion — a precise clinical integration of gnathologic detail and neuromuscular objectivity that takes the dentist beyond the 80% and into the remaining cases the profession has never adequately solved.
GNM (Gneuromuscular) Dentistry is the evolutionary integration of time-tested gnathologic principles with advanced neuromuscular protocols (objective measured science and technology) —bringing optimized physiologic jaw positioning into functional reality.
It represents a new and improved paradigm that builds upon classical myocentric concepts, advancing them through:

• Detailed clinical application of gnathic principles, guided by objective measurements
• Precision in micro-occlusion, jaw positioning, and functional relationships that extend beyond traditional myocentric boundaries
• Advanced K7 data interpretation, offering insights that surpass classical NM frameworks
• Strategic sequencing of neuromuscular occlusal steps—where the order of implementation shapes the diagnostic and therapeutic thinking process
• Whole-body impact, bridging occlusion with optimal functional movement patterns across the cranio-cervical and postural systems

GNM is the Missing Link in Dentistry—bridging occlusion with systemic harmony through a layered, physiologically grounded approach. It restores clarity, confidence, and clinical precision to the doctor by anchoring treatment in objectively measured physiologic data.
Unlike any other occlusal or TMD teaching, only at OC is this level of diagnostic rigor and functional integration achieved—where gnathic principles and advanced neuromuscular protocols converge to produce verifiable, whole-body impact and stability.

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What is GNM Occlusion?

“A gnathologically derived maxillo-mandibular intercuspal stable position, that is in a physiologic homeostatic state within the cranio-cervical-masticatory complex. It is a synchronous bilateral jaw position along an isotonic, unstrained path of opening and closing trajectory that allows freedom of entry and exit to a myocentric end point that can be objectively measured and observed”.
Gneuromuscular (GNM) Dentistry is really a combined understanding and application of skill sets required to effectively treat the more complex TMD cases based on a comprehensive DIAGNOSIS – It goes beyond establishing a myocentric target.  At OC the NM is not the same, but a new paradigm and new and improved concept married with Gnathological principles.

1. Gneuromuscular (GNM) is a blend of both gnathological concepts as well as neuromuscular (NM) dentistry principles.
2. Gneuromuscular acknowledges the anterior functional contacts and occlusal design schemes that are crucial to resolve the cervical neck, TMJ primary, Class II div. 2 and anterior open bite case problems that the NM concepts have not effectively resolved over the many years.
3. By combining the gnathological concepts with neuromuscular teachings the progressive minded dentists realizes that combining both concepts makes total sense.  It is logical and clinically it blends the best of both worlds together to better solve the complex problems.
4. GNM conveys the bio-physiologic principles, concepts and methods based on muscle relaxation science (using the J5 Dental TENS and K7 technologies).  GNM has enhanced the gnathological with the neuromuscular perspectives – A Step Beyond.
5. Because there has been years of historical philosophical battles between gnathological and neuromuscular teachings, the term GNM (gneuromuscular) which conveys a blended approach makes sense to both sides of the political arena helping to bridge a gap.
6. GNM brings to light the importance of “clinical application” of overlooked details helping doctors reach their maximum dental diagnostic understanding and clinical treatment skills in order that their patients can reach maximum dental improvement in both the quality of function and quality of stability with less.

WE BELIEVE IN THE PRINCIPLE OF “LESS IS MORE”

My teachings have incorporated the best techniques and protocols that I have developed from my observations and experienced within my dental practice.  These techniques are now proven to bring a better result requiring skills and training that have helped me and other trained dentists in helping challenging TMD cases  Better response times with effective resolutions and solutions to clinical challenges have come about since I have advanced these teachings of the past.
In my previous neuromuscular teachings I emphasized and focused on the neuromuscular (NM) aspects even though I touched briefly on some of the gnathologic concepts. But now, our approach and teachings have gone more in depth in the gnathologic principles AND its detailed CLINICAL APPLICATION, truly blending the gnathic and NM approaches which no one has ever done before.
“Caring for the TMD/ GNM patient is like a journey, where we may uncover things along the way (journey) that we cannot see at this moment”.   Let’s remember, “It’s a journey, not a sprint”.

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What is NM?

As the Father of Neuromuscular Dentistry once said – “if you can measure it, it is a fact, if you can’t it is just an opinion”.  That is the standard by which neuromuscular dentistry has set the bar within the dental profession in order to enhance the clinicians approach to diagnosis and treatment –  using objective measuring and recording methods to scientifically support this position.
Neuromuscular Dentistry as Dr. Barney Janekelson (“Father of Neuromuscular Dentistry”) and Dr. Robert Jankeloon (son) defined it as:
1) the diagnosing and treatment of occlusal problems by objectively measuring and correlating it to muscle function and mandibular movement,
2) Restoring the masticatory muscles and TM Joints to an optimal function before restoring the occlusion and
3) Applying the same standards of diagnosis and treatment of the muscles as we do the teeth and joints, such as documenting and recording with objectivity like x-rays of the joints and teeth.  The neuromuscular clinician documents and records EMGs of muscles activity, and uses instrumentation to document as well as treat jaw movement and position.
A true neuromuscular approach is really using objective measuring methods to support and validate one’s position from a true “physiologically rested” starting position.  Not acquiring a jaw position from unrested muscles.
As many are aware, Dr. Chan is an advocate of Neuromuscular Dentistry in the purist sense.  The dental profession also recognizes that he has stronger beliefs and understanding in the gnathic GNM principles.  Because of this combined perspective he has been asked by many within the dental community to continue teaching these GNM concepts which rings positively within the hearts of many clinicians regardless of what perspective they believe.  His technical skills in occlusion along with his comprehensive understanding of dentistry (TMD, restorative, orthodontics, lab technology) allows him the opportunity to expertly remove the guess work out of his dentistry and answers clinical questions that have not adequately been addressed within the dental profession.  Blending objective clinical reality without the haunting guesswork of wondering why certain things are not working is what makes GNM effective in its approach.
This is why Occlusion Connections (OC) exists as a teaching center here in the United States – to advanced those dentists who own K7’s, their understanding as well as the gnathically minded clinicians who desire to further their confidence in the precision and accuracy of occlusion and gneuromuscular principles.

HOW STABLE IS YOUR CASE?

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UNDERSTANDING RELAXED MUSCLES

Individuals who are looking for optimal dental treatment must consider the status of their muscles of the face, jaw, neck and shoulders. Ideal treatment is typical rendered when muscles are not tender or strained and the jaw functions with a stable bite. If the muscles are tense and or strained they can affect the health and condition of the teeth, jaw joints as well as jaw posture. When dental restorative treatment, orthodontics and or TMJ treatment is rendered, especially if the biting surfaces of the teeth are changed or altered while the present chewing muscles are tense and or strained, it is possible that the patient may experience a shift in their bite during and after treatment. Any slight shift or change in jaw position can lead to an increased awareness of the teeth resulting in bite problems, headaches, facial pain, neck pain and shoulder aches.
Working with a dentist who understands and respects these issues is key to optimal care. Patients must recognize that there are various levels of philosophies as well as various levels of training among dentists. Those dentist who have training in gnathologic principles as well as neuromuscular principles have been found to be better qualified to address more complex bite problems that relate to TMJ, comprehensive restorative procedures and orthodontics.

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Definition of GNEUROMUSCULAR DENTISTRY

The field of dentistry that “clinically applies” the gnathologic principles with the neuromuscular science at the highest levels.  Gneuromuscular (GNM) uses objective measuring technology and principles to quantify the quality of those physiologic responses of the masticatory system which includes the morphology, anatomy, physiology and patho-physiology of the cranio-mandibular cervical complex.  It acknowledges the multi-faceted musculoskeletal occlusal signs and symptoms and relates them to an “optimal” mandibular to cranial/ cervical relationship associated with body posture and alignment.

Optimal function as well as optimal resting modes is key to addressing the central nervous system responses in order to reach “Maximum Dental Improvement” (MDI).

• Detailed application and protocols to addressing some of the more difficult and complex issues have been missing and have been realized by many NM clinicians.
• It acknowledges the entire masticatory system as it relates to mechanics of bordered movements relating to optimal disc and condylar positioning within the glenoid fossa as well as functional movements along an optimized isotonic trajectory supporting freedom of entry and exit to a stable terminal contact position of occlusion.
• It is a field of dentistry that bridges that gap between gnathologics and neuromuscular occlusal philosophies as advocated at occlusion connections.
• It is the refinement of clinical methods, protocols, knowledge and skills that allow dentists to perform at an optimal level using all their training, resources, thinking and understanding.
• It is based on the doctors “THINKING PROCESS” that distinguishes itself from cook book methods, other teaching philosophies and training.
• Treats more sophisticated complex TMD cases – A whole body postural awareness.
• Long standing joint and muscles issues in the mature person.
• Chronic problems.
• It recognizes the musculoskeletal occlusal problems at a more advanced level – recognizing there are clinical solutions to the chronic pain cases.
• GNM is focused on the muscles in the back of the neck, not just the front of the neck, with the EMGs.
• Addresses cervical problems at a more advanced level.
• Addresses TMJ and muscular problems at a more advanced level.
• It is a refined Occlusal management process at another gnathic level.
• Restricted mouth opening problems
• Restricted head rotation problems
• SCM pain and tension problems
• Shoulder tensions
• Occipital pain behind the head
• Unresolving temporal tension
• Facial/ masseter pain
• Pain at lower posterior corner of mandible
• Lateral pterygoid and medial pterygoid problems.
• Anterior open bite
• Joint derangement problems
• It addresses these occlusal problems at a more detailed level – elimination of EVERY inappropriate interference is a CRITICAL distinction!

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Gnathology:

1. a science dealing with the masticatory apparatus as a whole, including morphology, anatomy, histology, physiology, pathology, and therapeutics., thus gnatholog´ic
2. a field of dental or medical study that deals with the entire chewing apparatus, including its anatomic, histologic, morphologic, physiologic, and pathologic characteristics. Diagnostic, therapeutic, and rehabilitative procedures result from these studies.
3. the study of the functional and occlusal relationships of the teeth; sometimes also used to identify a specific philosophy of occlusal function.
4. the science dealing with the masticatory apparatus as a whole.

Neuromuscular:

Neuromuscular (NMD) dentistry is the foundation (basic) to understanding the musculoskeletal occlusal signs and symptoms – teeth, muscles and temporomandibular joints.

1. Addresses the basics dental treatment philosophy in which temporomandibular joints, masticatory muscles and central nervous system mechanisms are claimed to follow generic physiologic and anatomic laws applicable to all musculoskeletal systems.
2. It is a treatment modality of dentistry that focuses on correcting “misalignment” of the jaw at the temporomandibular joint (TMJ).
3. Neuromuscular dentistry acknowledges the multi-faceted musculoskeletal occlusal signs and symptoms as they relate to postural problems involving the lower jaw and cervical region.
4. Neuromuscular dentistry recognize that “misalignment problem(s)” can be corrected by understanding the relationships of the tissues involved, which include muscles, teeth, temporomandibular joints, and nerves.
5. In short, proponents of neuromuscular dentistry acknowledge technological instrumentation (objective measurements) innovations of this century adds objective data and understanding to previous mechanical models of occlusion.

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Gneuromuscular (GNM) Approach – A logical advancement that makes clinical sense:

Although gneuromuscular (GNM) approach may seem to be same or similar in nature to other neuromuscular (NM) dentistry concepts, they are not similar in the way the principles and concepts are practiced, clinically applied and understood.  

It is the combined approach applying and implementing both gnathic and neuromuscular concepts at their highest levels of understanding make GNM valued and unique.

Both GNM trained dentist use Myotronic K7x Occlusal Evaluation technology and J5 Dental TENS.  The OC GNM trained dentists understand the important diagnostic factors that distinguishes their diagnostic and treatment methodology when applying the K7 and TENS technology that most NM dentist do not:

• With GNM we understand why electromyography (EMG) recordings of muscles sometimes goes up after low frequency TENS — it is important for all dentists to understand why EMG recordings increase and under what circumstances EMGs may decrease. Knowing what causes the EMG patterns to go up or down is crucial to know if treatment is to be effective for the TMJ primary, cervical dysfunction, Class II Division 2 and anterior open bite tendency type cases.
• GNM understands why TENS does not always relax muscles — although classical NM has advocated that TENS relaxes muscles. OC continues to be a strong proponent of J5 Dental TENS since it enhances the GNM trained dentist’s diagnostic and clinical awareness.
• GNM understands why TENS is very important in helping to find a more accurate mandibular position when recording a bite registration using the K7 jaw tracking technology — we don’t like to manually manipulate or guess the patient’s maxillary to mandibular position and relationship physiologically.
• GNM trained dentists use specific techniques and bite optimization protocols learned at Occlusion Connections — different than other neuromuscular K7 techniques.
• GNM dentists use the J5 Dental TENS specifically for very important reasons in spite of many within the dental profession claiming it is not reliable or effective. Most dentists don’t measure their patient’s muscle responses objectively nor understand GNM optimization protocols using mandibular position technology — since they have limited understanding or training in this field of dentistry, thus it is only their opinion.
• GNM trained dentists use the Myotronics K7x brand of technology specifically for its precision and accuracy to achieve the diagnostic insights of the patient’s problems and effective clinical results.

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GNM (Gneuromuscular) dentistry is the advanced level of CLINICAL application of the science, TREATING the simple to complex problems at a more detailed level – treating the whole body.

These are just a some of the few things that distinguishes GNM teachings from NM teachings.  We recognized that low frequency TENS does not always relax muscles. The GNM dentist recognizes these factor as significant  diagnostic responses.  The GNM trained dentists knows why and implements that information strategically in their diagnosis and application of specific occlusal protocols. The OC teachings realizes why it is important for the GNM trained dentists to use J5 Dental TENS.  It is the training and understanding of these advanced GNM concepts that further distinguishes the Occlusion Connections (OC) teachings and perspectives beyond classical neuromuscular teachings.  
NOTE:  GNM may not be the answer for every one and for every situation.  People should temper their expectations, since no technique works for everyone, but GNM is an approach that is based on advanced GNM occlusal principles using objectively measuring K7x technology, specific detailed protocols and bio-physiologic science that requires the clinician to skillfully implement the knowledge and understanding they have acquired with their patients.

 

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Written by Clayton A. Chan, D.D.S. — Founder and Director, Occlusion Connections | Las Vegas, Nevada

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