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It takes a true curiosity with conviction to find the truth as to where and how a “physiologic” jaw position should be and how it optimally functions.
Where is the true CR position that is most optimal and where the musculature are at their physiologically rested position when the mandible is at a physiologic rest position (PRP).
Dentist need to ask themselves how they can best determine the “physiologic rest position” according to the present definition of CR (Glossary of Prosth, Terms, May 2017) if they desire to find an optimal performance position for their patient’s or athletes.
The term “Physiologic” infers that the dentist would need to measure and quantify muscle physiology, resting and functional modes. As well as define what they mean as “optimal” based on bio physiologic parameters that can be measured and quantified with available technology. Scientific parameters have already been defined in the scientific literature. Without using physiologic measured references to quantify the patient’s muscle status, one will never be able to arrive at a reasonable understanding as to what approach is best when attempting to achieve optimal occlusal stability, optimal muscle resting modes and or optimal functional modes without accurate physiologic measurements. Guessing, perpetuating historical dogma and assumptions is not scientific!
- Can the dental community agree that EMG measurements is a reasonable scientifically proven method to validate muscle rest and function? (See previous 1/24/23 posting on “Re: Science – Validity of Using Electromyography in Dentistry thread)… I posted a lot of scientific references there).
- Can the dental community agree that computerized mandibular scanning jaw tracking is a scientific and reasonable method to validate jaw position? (See https://occlusionconnections.com/diagnostics/science-of-k7-electronic-diagnostic-instrumentation/computerized-mandibular-scanning-cms-advanced-techniques-for-precision-and-accuracy/).
Not until the North American dental community begins to accept these scientific measuring tools as valid (which have already been acknowledge and scrutinized by governing panels of the ADA and FDA as valid) recognizing EMGs, CMS and TENS as effective aids to accurate measuring in the diagnosis and treatment of occlusal/ TMD problems can one have a reasonable scientific discussion as to what literature is valid or not and what methodology is optimal or effective or not.
What kind of research do the CA skeptics have to support and validate their method of finding the optimal position is superior and physiologic? Ask and challenge them.
We know an optimal mandibular position for optimal athletic performance one must address any restricted airway problems. Certainly, the “tried and true” mechanical methods of finding the optimal airway using “Centric Relation” CR method has been proven to not pass that test of physiologic airway health. The mandible cannot be positioned in an upper most position (old CR), not the midmost (CR) position, nor in the anterior superior CR under load position. Measuring studies of muscle activity with EMGs have proven differently. Why would these skeptics continue to question the bio-physiology of the neuromuscular approach (an approach based on objective measurements), especially when the NM advocates use measuring technology to quantify the muscle and mandibular position with EMGs and CMS jaw tracking in their clinical practice? The international dental community as you insightfully referenced 9 out of 12 speakers have progressed beyond the mechanical North American dogmas and have recognized the validity and value of bio-physiologic measuring science of EMGs and computerized mandibular scanning CMS/ jaw tracking along with low frequency TENS internationally. It’s clear which dentist and their philosophy are ahead in understanding and who are the one’s behind in their understanding regarding mandibular positioning and muscle physiology.
Academics hide behind the “scientific research and literature” to justify their position, when in reality when other scientific literature is presented they don’t want to believe it. They cherry pick what they want to believe rather than do the hard work of finding the needed answers to the CR/CO discrepancies with scientific analysis.
Wet fingered clinicians practice with conviction and want to find the optimized bite answers for reasons of determining treatment effectiveness and stable outcomes using scientific methodology.
Most wet fingered clinicians are busy trying to find the clinical answers to the mysteries of bio-physiologic responses of their patient’s. Academics don’t have such interest. Clinicians measure and treat patients who have provide feedback and their feelings about what they feel is right or wrong. Academics perpetuate statistics, numbers and theory and review published research, and perpetuate the patient’s complaints with further literature and academic responses. Clinicians focus on real patient care, real outcomes and learn how effective is their treatment.
There will never be enough literature to satisfy the academics in this world. Dedicated clinicians who are searching for real answers to their patient’s problems are few. Clinicians search for best results, outcomes and real clinical answers. The clinician finds ways to actually measure those parameters the academics don’t seem to provide after these past 50+ years of all the scientific research provided. The NM/GNM clinician finds ways to measure those parameters themselves in a scientific manner, determining what muscle optimization, health, rest, function and optimal mandibular positioning actually means. They find those answers in their own offices rather than wait for academics to give their approval and endorsement of a particular approach.
If Elon Musk waited for the scientific community, literature and academics to prove what he had to offer and did with the Tesla car company did with their validating endorsement, his company would not exist today.
The NM community has already defended ourselves years ago with science, debating the questions, giving the answers night after night for 4-5 years back and forth (years 2000-2005). It’s the skeptics who now have to defend what they are holding onto as bio-physiologically and scientifically sound…where is their science??
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Leader in Gneuromuscular and Neuromuscular Dentistry