You may have noticed that your GNM orthotic is thicker on one side than the other. You may also notice a canted bite or facial asymmetry—and wonder if they are connected.

They absolutely are. Nothing is wrong. Here is what is actually happening.

A canted bite and facial asymmetry represent a system that has adapted over time. A properly built GNM orthotic meets your musculature where it actually is on day one, and over the weeks and months of treatment, the face, jaw, and cranial structures gradually level as the neuromuscular system reorganizes.

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The Canted System You’re Looking At

Most patients who come into our office for GNM treatment are carrying years — sometimes decades — of accommodation.

Look in the mirror. One eye may sit slightly higher than the other. The nose may deviate subtly off midline. One shoulder often rides higher. The smile line may cant to one side. The occlusal plane — the line formed by the biting surfaces of your teeth — is rarely level. The mandible, or lower jaw, may deviate to the right or left on opening and closing.

None of these findings are independent. They are the visible expression of a craniomandibular system that has adapted three-dimensionally to a malpositioned mandible and the neuromuscular imbalance that accompanies it.

The cant you see is not the cause of the problem. It is the end-stage visible finding of an entire postural compensation pattern that extends from the cranial base through the cervical spine and down into the shoulders and pelvis.

This matters, because how you understand the cant determines how you treat it.

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The Traditional “Just Shim It Level” Approach — And Why It Fails

A common approach in conventional TMJ and occlusal therapy is to look at the canted bite plane and build a splint thick enough on the low side to make the biting surfaces parallel.

This treats the cant as a carpentry problem.

It isn’t.

Building an orthotic to a visually-leveled bite plane imposes a position on the musculature that the musculature has never agreed to. The muscles then recruit abnormally to hold the mandible in that imposed position. The patient may tolerate it, or may not — but the underlying deviation has not been resolved. A new layer of compensation has simply been added on top of the old ones.

This is why so many patients arrive at our office having been through multiple splints, night guards, and appliances from well-meaning clinicians, only to still have symptoms. The appliances were built to what the eye saw. Not to what the neuromuscular system needed.

For a deeper discussion of why conventional occlusal adjustments and splints fall short, see Why Dental Bite Adjustments Fail — And How to Finally Get It Right→.

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Why a GNM Orthotic Starts Asymmetric

A Gneuromuscular (GNM) orthotic is built to a completely different reference point: the optimized myotrajectory.

The myotrajectory is the path the mandible naturally wants to follow when the musculature is relaxed. We measure this objectively — not by eye, not by hand manipulation — using:

• TENS (transcutaneous electrical neural stimulation) to relax the elevator and postural musculature over 45 to 60 minutes
• K7 jaw tracking to record the three-dimensional trajectory of the mandible as it closes from the relaxed position
• EMG (electromyography) to confirm that resting and functional muscle activity is within physiologic range
• Electrosonography (ESG) to evaluate joint sounds and condylar behavior

When we do this on day one, the trajectory the mandible wants to follow is almost never a midline, straight-up-and-down path. It reflects where the musculature actually lives after years of adaptation.

If the left elevators are more hypertonic, if the right condyle is more superiorly displaced in its fossa, if the lateral pterygoids are working at different lengths side to side — the relaxed trajectory will land the mandible in a position that requires more vertical dimension on one side than the other to keep the condyles decompressed and the musculature at optimal length.

The orthotic is thicker on one side because that is where the muscles need it to be in order to finally stop working overtime.

This is not a cosmetic decision. It is a measured, objective, physiologic decision.

Learn more about the instrumentation that makes this possible on the K7 Evaluation System page.

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What Happens Over the Following Weeks and Months

Here is the part that conventional thinking misses — and it is the key to understanding why asymmetric starting orthotics lead to symmetric final outcomes.

1. The musculature begins to deprogram.

Muscles that have been splinted and hyperactive for years do not relax instantly. But once they are given a stable, physiologic vertical and trajectory — where they no longer have to fight occlusal interferences, a deviated condylar position, or postural compensations — they begin to release. Tone normalizes. Length normalizes. Recruitment patterns normalize. Serial EMG recordings document this objectively.

2. The cranial bones respond.

The cranial bones are not fused solid blocks. They have sutures with micromotion. The maxilla is suspended in the facial skeleton by articulations with the sphenoid, ethmoid, zygomas, palatines, and vomer. When the chronic asymmetric muscular pull is finally removed, these articulations are free to release their adaptive strain. The sphenoid unwinds. The temporals re-equilibrate. The maxilla settles toward a more level orientation.

3. The mandible seats more symmetrically.

No longer being pulled off-trajectory by splinted muscles, the condyles begin to seat more symmetrically in the fossae. The midline shift reduces. The deviation on opening and closing diminishes.

4. The required orthotic thickness differential decreases.

This is the part clinicians without K7 instrumentation rarely see, because they are not measuring. As treatment progresses, we re-record the patient. The new myotrajectory is different from the starting one. The asymmetry in required vertical diminishes. What started as a 1.5 mm differential between left and right may reduce to 0.5 mm, or disappear entirely. We adjust the orthotic accordingly — not because we decided to level it, but because the patient’s neuromuscular system is now asking for a different, more symmetric position.

5. The whole system visibly levels.

Patients take a photo at month six and don’t recognize themselves compared to the starting photo. The shoulders are level. The head sits differently on the neck. The eyes look balanced. The smile line is straighter. The face looks more symmetric.

This is not because we shimmed the orthotic to make them level. It is because the underlying system reorganized once the neuromuscular cause of the asymmetry was finally resolved.

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Why Objective Measurement Is Not Optional

The reason conventional “eyeball the cant and shim it” approaches fail is that they are working without the data the musculature is actively providing.

The K7 Evaluation System — jaw tracking (CMS), electromyography (EMG), electrosonography (ESG), and the J5 Myomonitor for TENS — is how we stop guessing. Myotronics instrumentation received the ADA Seal of Recognition in 1986 for a reason. The science was and is sound.

Without objective measurement, the clinician is left with:

• Looking at the patient’s face and occlusion
• Manipulating the mandible by hand
• Making a subjective judgment about where the bite “should” go

None of these methods can detect the true myotrajectory. None can confirm that the musculature is physiologically relaxed. None can document the serial changes that occur as the system decompensates.

This is the fundamental methodological difference between GNM and every other occlusal philosophy.

For the evolution of the Centric Relation definition and its relationship to physiologic positioning, see The CR Definition That Changed Everything→.

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An Analogy Worth Considering

Think of a patient with chronic scoliosis who has adapted their gait, their shoulder carriage, and their pelvic tilt over decades.

You do not correct their posture by shoving a shoe lift under one foot based on a photograph. You work with the musculature, the fascia, the neurology — and over time, as the system reorganizes, the structures normalize.

A shoe lift built to what the system needs is very different from a shoe lift built to what the eye sees.

The GNM orthotic is the same principle applied to the craniomandibular system.

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What This Means for You

If you are a patient currently wearing a GNM orthotic that is thicker on one side than the other — that is not a flaw. That is the orthotic doing its job. What you are seeing is your neuromuscular system being met where it actually is, so that over time, it can finally reorganize toward balance.

For more on what to expect through GNM treatment, visit the Patient Education hub and the page on TMJ Orthotic vs. Night Guard — What Is the Difference?→

If you are a dentist who has been building splints and orthotics to a visually-leveled bite plane and wondering why patients don’t fully resolve — the answer is not a better technique for leveling acrylic. The answer is a completely different reference point: the measured myotrajectory, built on objective instrumentation, supported by a neuromuscular and gnathologic framework.

To learn how GNM is taught and applied in clinical practice, visit the GNM Masterclass Training page.

This is what GNM teaches. This is what Occlusion Connections exists to train.

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Frequently Asked Questions

🔹 Why is my GNM orthotic thicker on one side than the other? Because that is where your musculature actually needs it to be. A GNM orthotic is built to the optimized myotrajectory — the path the mandible naturally wants to follow once the elevator and postural musculature have been relaxed with TENS. After years of compensation, that trajectory is rarely a midline straight-up-and-down path. If the elevators on one side are more hypertonic, or one condyle is more superiorly displaced, the relaxed mandibular position will require more vertical dimension on that side to keep the joints decompressed and the muscles at optimal length. The asymmetry in the orthotic is not a flaw — it is the orthotic doing its job by meeting your neuromuscular system exactly where it is.

🔹 Will my facial asymmetry actually correct over time with a GNM orthotic? Yes — but it corrects through neuromuscular reorganization, not through cosmetic shimming. As the chronic asymmetric muscular pull is removed, the cranial articulations release their adaptive strain, the condyles seat more symmetrically in the fossae, and the maxilla settles toward a more level orientation. Patients commonly take a photograph at month six and barely recognize themselves compared to day one. The shoulders are level. The smile line is straighter. The face looks balanced. This is not because the orthotic was leveled — it is because the underlying system reorganized once the neuromuscular cause of the asymmetry was finally addressed.

🔹 Why doesn’t building the orthotic to a visually-level bite plane work? Because building to what the eye sees imposes a position on the musculature that the musculature has never agreed to. The cant is not the cause of the problem — it is the end-stage visible finding of an entire postural compensation pattern extending from the cranial base through the cervical spine. Treating the cant as a carpentry problem — shimming the low side until the bite plane looks parallel — adds a new layer of compensation on top of the old ones. The muscles then recruit abnormally to hold the mandible in the imposed position, and the patient’s symptoms persist. This is why so many patients arrive at our office having been through multiple splints and night guards and still have not resolved.

🔹 How does the dentist know when to adjust the orthotic for symmetry? By re-measuring — not by deciding. As the neuromuscular system reorganizes through GNM treatment, we re-record the patient using the K7 Evaluation System. The new myotrajectory is different from the starting one. What may have started as a 1.5 mm differential between left and right reduces to 0.5 mm or disappears entirely. We adjust the orthotic accordingly — not because we decided to level it, but because the patient’s neuromuscular system is now asking for a different, more symmetric position. This is the fundamental difference between guesswork and measurement-based clinical decision-making, and it is why objective K7 instrumentation is not optional in GNM dentistry.

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Continue Learning

🔹 Diagnosis & Measurement

• What Does the K7 Technology Measure?→
• Science of Computerized Mandibular Scanning (CMS)→
• Science of Electromyography (sEMG)→
• Functional Electrosonography (ESG)→
• Why Articulating Paper Does Not Reflect Functional Occlusion→
• The Lost Vertical Dimension Patient: What Actually Went Wrong →

🔹 GNM Principles

• What Is Gneuromuscular Dentistry?→
• The Optimized Myotrajectory Explained
• Why Dental Bite Adjustments Fail — And How to Finally Get It Right→
• GNM is Not the Same as NM — Why the Distinction Matters→
• CR vs Neuromuscular Dentistry — Why This Is the Wrong Debate →
• The Cervical Dysfunction Patient — Why the Bite Cannot Be Solved Without Addressing the Neck →

🔹 Core Science

• The CR Definition That Changed Everything→
• TMJ Orthotic vs. Night Guard — What Is the Difference?→
• Why TMJ Splints and Night Guards Fail→
• GNM Orthotic Effectiveness in Treatment→

🔹 Ready to Train

• OC GNM Masterclass Training — Levels 1–9→
• OC Recognition Awards Program — Fellowship, Mastership and Diplomate→

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About the Author

Dr. Clayton A. Chan, DDS is the Founder and Director of Occlusion Connections, a Gneuromuscular Dentistry (GNM) continuing education institute based in Las Vegas, Nevada. He holds Mastership and Fellowship status with the International College of Craniomandibular Orthopedics (ICCMO), one of the highest recognitions in the field of craniomandibular and neuromuscular occlusion. He previously served as Director of Neuromuscular Dentistry at LVI from 2000 to 2006 before founding Occlusion Connections as an independent educational platform dedicated to objective, measurement-based occlusal therapy. He is the lead clinician, researcher, and educator behind the OC Masterclass curriculum and teaches personally in small-group settings in Las Vegas.