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Prima di procedere, potrebbe essere opportuno osservare un caso molto concreto e significativo. | Prima di procedere, potrebbe essere opportuno osservare un caso molto concreto e significativo. | ||
==Malocclusion== | |||
''Malocclusion'': it literally means a bad (''malum'', in Latin) closure of the dentition<ref><!--84-->The creation of the term is generally attributed to Edward Angle, considered the father of modern orthodontics, who coined it as a specification of ''occlusion'' to signal the incorrect opposition in closing of the lower teeth and upper, especially the first molar ([[:wikipedia:Edward Angle|Wikipedia]]); <!--85-->see {{cita libro | |||
| autore = Gruenbaum T | |||
| titolo = Famous Figures in Dentistry | |||
| url = | |||
| volume = | |||
| opera = Mouth – JASDA | |||
| anno = 2010 | |||
| editore = | |||
| città = | |||
| ISBN = | |||
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}}</ref>. The ''closure'' is easy to understand, we believe, but the epithet "''bad''" must be understood with care as well, because it is not as simple as it seems. | |||
To briefly grasp the concept, in this first introductory reading we will try to present a simple but highly debatable question that involves a series of other questions in the field of masticatory rehabilitation and especially in orthodontic disciplines: ''what is "Malocclusion"?'' Bear in mind that in 2019, a Pubmed query about this term returned a result of "only" 33,309 articles<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=%22malocclusion%22 Malocclusion]''</ref>, which says it all about the hypothetical terminological agreement on the subject; and, therefore, very meaningful conclusions could be drawn every now and then from these articles, such as the ones we reproduce in full from an article by Smaglyuk and collaborators, a somewhat "sensational" article that deals with the interdisciplinary approach in the diagnosis of malocclusions<ref name="Smaglyuk">{{cita libro | |||
| autore = Smaglyuk LV | |||
| autore2 = Voronkova HV | |||
| autore3 = Karasiunok AY | |||
| autore4 = Liakhovska AV | |||
| autore5 = Solovei KO | |||
| titolo = Interdisciplinary approach to diagnostics of malocclusions (review) | |||
| url = https://www.ncbi.nlm.nih.gov/pubmed/31175796 | |||
| volume = | |||
| opera = Wiad Lek | |||
| anno = 2019 | |||
| editore = | |||
| città = | |||
| ISBN = | |||
| LCCN = | |||
| DOI = | |||
| OCLC = | |||
}}</ref>: | |||
{{q2|<!--89-->The diagnostics, treatment tactics and prevention of dento-facial anomalies and deformations should be considered in the context of the integrity of the child's unformed organism, the interdependence of the form and functions of its organs and systems}} | |||
Another noteworthy fact is that if in the same 2019 Pubmed was questioned on interdisciplinarity in the diagnosis of malocclusions, the result dropped drastically to just four articles<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=interdisciplinary+diagnostics+of+malocclusions interdisciplinary diagnostics of malocclusions]''</ref>. | |||
These premises to the "Malocclusion” question indicate, on one hand, an alert about anomalies that tend to activate Kuhn phase 4 and, on the other, a bifurcation in the epistemic choice on the subject: one that generates Incremental Innovations (others 33,309 articles, perhaps) and another that prefers a new gnoseological path of "Paradigmatic Innovation”. | |||
Let’s try to approach part of the concept that considers the "Paradigmatic Innovation” as essential, asking ourselves for example: | |||
[[File:Occlusal Centric view in open and cross bite patient.jpg|alt=|thumb|'''<!--93-->Figure 1a:'''<br><!--94-->Patient with malocclusion, open bite and right posterior crossbite who in rehabilitation terms should be treated with orthodontic therapy and / or orthognathic surgery.|400x400px]] | |||
{{qnq|<!--95-->What does "Malocclusion" mean?|}} | |||
We will answer this question by reporting a clinical case of evident “Malocclusion”. | |||
Patient is with an occlusion that orthodontists call “Malocclusion” because it has a posterior unilateral crossbite and anterior openbite<ref>{{cita libro | |||
| autore = Littlewood SJ | |||
| autore2 = Kandasamy S | |||
| autore3 = Huang G | |||
| titolo = Retention and relapse in clinical practice | |||
| url = https://www.ncbi.nlm.nih.gov/pubmed/28297088 | |||
| volume = | |||
| opera = Aust Dent J | |||
| anno = 2017 | |||
| editore = | |||
| città = | |||
| ISBN = | |||
| LCCN = | |||
| DOI = 10.1111/adj.12475 | |||
| OCLC = | |||
}}</ref>; it is a malocclusion that can be treated with a fixed orthodontic therapy and possibly in combination with an orthognathic intervention<ref>{{cita libro | |||
| autore = Reichert I | |||
| autore2 = Figel P | |||
| autore3 = Winchester L | |||
| titolo = Orthodontic treatment of anterior open bite: a review article--is surgery always necessary? | |||
| url = https://www.ncbi.nlm.nih.gov/pubmed/23949448 | |||
| volume = | |||
| opera = Oral Maxillofac Surg | |||
| anno = 2014 | |||
| editore = | |||
| città = | |||
| ISBN = | |||
| LCCN = | |||
| DOI = 10.1007/s10006-013-0430-5 | |||
| OCLC = | |||
}}</ref>. Crossbite is another element of disturbance in normal occlusion because of which it is obligatorily treated together with the openbite<ref>{{cita libro | |||
| autore = Miamoto CB | |||
| autore2 = Silva Marques L | |||
| autore3 = Abreu LG | |||
| autore4 = Paiva SM | |||
| titolo = Impact of two early treatment protocols for anterior dental crossbite on children’s quality of life | |||
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962250/pdf/2176-9451-dpjo-23-01-00071.pdf | |||
| volume = | |||
| opera = Dental Press J Orthod | |||
| anno = 2018 | |||
| editore = | |||
| città = | |||
| ISBN = | |||
| LCCN = | |||
| DOI = | |||
| OCLC = | |||
}}</ref><ref>{{cita libro | |||
| autore = Alachioti XS | |||
| autore2 = Dimopoulou E | |||
| autore3 = Vlasakidou A | |||
| autore4 = Athanasiou AE | |||
| titolo = Amelogenesis imperfecta and anterior open bite: Etiological, classification, clinical and management interrelationships | |||
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24987656/ | |||
| volume = | |||
| opera = J Orthod Sci | |||
| anno = 2014 | |||
| editore = | |||
| città = | |||
| ISBN = | |||
| LCCN = | |||
| DOI = 10.4103/2278-0203.127547 | |||
| OCLC = | |||
}}</ref><ref>{{cita libro | |||
| autore = Mizrahi E | |||
| titolo = A review of anterior open bite | |||
| url = https://www.ncbi.nlm.nih.gov/pubmed/284793 | |||
| volume = | |||
| opera = Br J Orthod | |||
| anno = 1978 | |||
| editore = | |||
| città = | |||
| ISBN = | |||
| LCCN = | |||
| DOI = | |||
| OCLC = | |||
}}</ref>. | |||
It is self-evident that an observer with a ''deterministic mindset'' facing a phenomenon of such evident occlusal incongruity considers crossbite and openbite the cause of malocclusion (cause/effect) or vice versa; and it is obvious, as well, that the observer recommends an orthodontic treatment to restore a “Normocclusion”. This way of reasoning means that the model (masticatory system) is “normalized to occlusion”; and if read backwards, it means that the occlusal discrepancy is the cause of malocclusion and, therefore, of disease of the Masticatory System. (Figure 1a). | |||
But let's hear what the two players say, the dentist and the patient, in the informative dialogue.[[File:Bilateral Electric Transcranial Stimulation.jpg|thumb|'''Figure 1b:''' Motor evoked potential from electrical transcranial stimulation of the trigeminal roots. Note the structural symmetry calculated by the peak-to-peak amplitude on the right and left masseters.|400x400px]] | |||
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|The dentist tells the patient that he is suffering from severe malocclusion and that it should be treated to improve its aesthetics and chewing function. The patient, however, replies firmly: «''No way, I haven't the slightest idea to do it at all, doctor, because I might even have an unrepresentative smile, but I eat very well.''»<br>The dentist’s reply is ready, so the practitioner insists by saying: «''but you have a serious malocclusion with an openbite and a unilateral posterior crossbite, you should already have problems with bruxism and swallowing, as well as posture.''»<br>The patient closes the confrontation in a decisive way: «''absolutely false: I chew very well, I swallow very well and at night I snore alot so I don’t grind; besides, I’m a sportsman and I don’t have any postural disturbance''». | |||
|} | |||
Now the conclusion remains very critical because we might be finding ourselves in front of a verbal language of the patient which is misleading because it is not specific and does not respond to a detailed physiopathogenetic knowledge of the occlusal state; or, paradoxically, we are otherwise facing a machine language converted into verbal language which guarantees the integrity of the system. At this point the situation is truly embarrassing because neither the patient nor the observer (dentist) will be able to say with certainty that the System is in a “Malocclusion” state. | |||
[[File:Jaw Jerk .jpg|alt=|left|thumb|'''Figure 1c:''' Mandibular reflex evoked by percussion of the chin through a triggered neurological hammer. <br>Note the functional symmetry calculated by the peak-to-peak amplitude on the right and left masseters.|400x400px]] | |||
It is precisely at this moment that one remembers the criticism of the American Statistician Association titled “''Statistical inference in the 21st century: A World Beyond p <0.05''”, which urges the researcher to accept uncertainty, be sensible reflective, open and modest in his statements<ref name="wasser" />: which basically translates into a search for interdisciplinarity. | |||
Interdisciplinarity, in fact, could answer such a complex question; but it is nonetheless necessary to interpret the biological phenomenon of "“Malocclusion”" with a ''stochastic forma mentis of'' which we will discuss in detail later. | |||
A stochastic observer may observe that there is a low probability that the patient, at the moment <math>T_n </math>, is in a state of occlusal disease, as the patient's natural language indicates ideal psychophysical health; he/she then concludes that the occlusal discrepancy could not be a cause of neuromuscular and psychophysical functional disorder. In this case, therefore, the Masticatory System can not only be normalized to the occlusion only, but a more complex model is needed too, so it has to be normalized to the Trigeminal Nervous System. The patient was then served a series of trigeminal electrophysiological tests to assess the integrity of his/her Trigeminal Nervous System in these “"Malocclusion”" clinical conditions. | |||
[[File:Mechanic Silent Period.jpg|thumb|'''Figure 1d:''' Mechanical silent period evoked by percussion of the chin through a triggered neurological hammer. Note the functional symmetry calculated on the integral area of the right and left masseters.|400x400px]] | |||
We can see the following output responses, which we report directly in figures 1b, 1c and 1d (with explanation in the caption, to simplify the discussion). These tests and their description by now should only be considered as “Conceptual Rationale” for the “Malocclusion” question; later they will be widely described and their analysis detailed in the specific chapters. It can already be noted in this first descriptive approach to the masticatory phenomenon that there is an evident discrepancy between the occlusal state (which at first would support the orthodoxy of classical orthodontics in considering it as “Malocclusive State”) and the neurophysiological data indicating incredible synchronization and perfect symmetry of the trigeminal reflexes. | |||
These results can be attributed to anything less than a "malocclusion": we are obviously in front of an error of the logic Language in medicine, in this case it is in fact more appropriate to talk about... | |||
{{qnq|<!--119-->Occlusal dysmorphism and not Malocclusion (which, as we shall see a little further on, is quite another thing)|}} | |||