Occlusal Stability Before Phase 2 Orthodontic or Restorative Treatment – A GNM Rule

If one can’t get the proper gearing in an orthotic (fixed or removable) to resolve the symptoms first, than there is something wrong with the application or the understanding of occlusion, especially when it comes to addressing the complex TMD cases involving cervical dysfunction, TMJ primary, Class II division 2 (retro inclined maxillary incisors) and or anterior open bite TMD pain problems.

The rule and principles of “NM” have always been to use an orthotic (Phase I) conservative and reversible treatment that re-establishes normalized resting and functional modes to a terminal contact position, free of pain and off medications prior to implementing orthodontics (phase 2 treatment), even if the teeth appeared to be in the way. These are the rules many of us OC GNM doctors have always followed to get the occlusal results we know is possible. Just because a muscular TMD problem is not going away and resolving in the time frame we wish with our orthotics does not taint our judgement and or our resolve and dedication to optimal detailed occlusal management (helping to get our patients pain free, comfortable and stably proven objectively) with our orthtoics before we conclude that phase 2 orthodontics or any restorative treatment (not reversible) is implemented.

A review of the patients Subjective Summary list of musculoskeletal items is of great value to keep score and assurance that all those items on that list are brought to a near zero score before concluding that ortho treatment is rendered.
Ortho is often a convenient method to scramble the teeth and CNS temporarily masking the underlying occlusal and muscular problems that often go undetected
and properly diagnosed….thus the dentists losing a great opportunity to learn how to achieve optimal stable occlusal with principles and protocols that are proven to work.

If the dentists don’t learn their lessons in knowing how to stabilize as TMD case in an orthotic, how will they really know if they can stabilize and bring the orthodontic occlusion to a neuromuscular level of stablity?