Difference between revisions of "Logica di sistema"

This chapter closes the loop of the 'Logic of medical language' to introduce a diagnostic model in the field of masticatory functions that combines the conceptuality of system logic with quantum mechanics. The statistical mathematical models of a system logic, therefore, cannot be subjective, nor approximate, much less vague and non-formal in the context of the clinical model. To obtain these characteristics it is necessary to consider the basic concepts of 'Systems Theory'.

The irrefutable diagnostic breakthrough in most medical disciplines lies in bioengineering, technological advances and specifically systems theory. It allows to verify the state of a system by comparing output variables generated by input variables. This huge step forward lies in the introduction of the trigger concept. Bioengineering in the trigeminal electrophysiological context has allowed the use of a series of triggers (transcranial electrical stimulation, transcranial magnetic stimulation, mechanical stimulation of the trigeminal district) that let us test the system with a much higher resolution than that in which the system is tested without responding to an external trigger. Another key element is that the trigger model is able to provide a snapshot of the system state many years before an obvious pathological clinical sign occurs.

In this chapter we will explain some basic steps to take in modeling diagnostic methods following systems theory.  

 

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==Foreword==

Why did we come to the 'System Logic'? The steps are neither trivial, nor personal, and in order to perceive the added value of the 'System Logic' we cannot help but mention two essential reasons that have marked this path: that of ''dental clinical indices'' and of ''logic of medical language''.  

===Dental clinical indices===   

There are 'Indices' that can be considered elements of System Logic as objective data, such as the 'Henderson-Hasselbalch equation' (for blood pH analysis) and other 'Indices' developed in the medical field in disparate disciplines.<ref>{{cita libro  

A test, a normative reference datum or an 'Index' (as well as a 'Constant') are strategies related to mathematical-statistical models that generate data. These data are mandatory for the accuracy of the diagnosis, for the differential diagnosis as well as for the therapeutic guidelines. On these reference data, in the times of scientific dental history, implementations and modifications have been generated but also uncertainties and beliefs that in the form of axioms or schools of thought have set guidelines that are not always scientifically justifiable, and sometimes untrue.  

In a recent article by Andrea Scribante and collaborators,<ref>{{cita libro  

  }}</ref> for example, the following paragraphs are deduced:  

#The introduction states that the evaluation of the outcomes of orthodontic treatment has traditionally been carried out using the experience and subjective opinions of clinicians.<ref>{{cita libro  

  }}</ref> ''In this first paragraph the limit of the concept expressed is understood and that is a diagnostic test and / or therapeutic guideline should never be scientifically weighed using subjective parameters.''

#However, since the 1990s, specific indices have been developed to objectively evaluate health outcomes by analyzing the quality of treatment.<ref name=":0">{{cita libro  

  }}</ref> These indices compare pre- and post-treatment data to determine the outcome of orthodontic therapy<ref>{{cita libro  

  }} - [https://grortho.gr/associations-between-pretreatment-age-and-treatment-time-with-orthodontic-treatment-outcome-a-comparison-by-means-of-two-orthodontic-indices/?lang=en see also]</ref> and to improve the quality of future treatments.<ref>{{cita libro  

  }}</ref> ''This second scientifically acceptable paragraph highlights the purpose of the 'Indices' and that is the pre- and post-comparison - but who says that the post is in a state of 'normocclusion' and the pre in 'malocclusion', the dental alignment?''

#The most commonly used index for evaluating orthodontic success is the Peer Assessment Rating Index (PAR), which was developed to measure how far a patient deviates from normal occlusion and alignment.<ref name=":0" /> This index was used to evaluate the effects of therapy in different circumstances: the use of fixed and mobile devices,<ref>{{cita libro  

  }}</ref> the comparison of orthodontic treatment between private practices and orthodontic schools,<ref>{{cita libro  

  }}</ref> the evaluation of occlusal stability after orthodontic treatment,<ref>{{cita libro  

  }}</ref> early treatments<ref>{{cita libro  

  }}</ref> and results of orthognathic surgery.<ref>{{cita libro  

  }}</ref> ''We have to consider that PAR would not indicate the healthy or the sick, normocclusion or malocclusion depending on whether it moves away from the cutoff but in the face of a series of incoming characteristics it would return a broad spectrum response (Index), valid for orthodontic treatments and orthognathic.'' ''This state of mind is legitimate but the clinicians have to be careful because the input variables (the 'Constructors') of the model or input, may not be related to the reference context or there may be other hidden variables that would invalidate the result itself. We will appreciate these assertions more strongly in the exposition of the chapters of Masticationpedia.''

The fact is that the primum movens of the studio of Andrea Scribante and collaborators is concentrated in the following point:

{{q2|The most commonly used index to assess orthodontic success is Peer Assessment Rating Index (PAR), which was developed to measure how much a patient deviates from normal occlusion and alignment|Limitative .... the index can have an accuracy and truthfulness in dental alignment but not to validate a normocclusion, this latter assertion is much more complex to formulate and certainly cannot be reduced exclusively to an 'Occlusal observable'. }}   

  }}</ref> in a very interesting study exposes a corageous statement that confirms what has just been exposed:

:Noticeable long-term occlusal changes are observed in the post-debond, which mostly favor better settlement. The higher quality finish at the debond significantly influenced the possibilities for improvement. However, setting a cutoff score to denote treatment excellence has shown considerable instability over time.

Other authors state that relapse after orthodontic treatment can also occur in cases with good functional occlusion.<ref>{{cita libro  

===Further considerations===

The etiology of recurrence is neither fully understood nor can it be fully predicted from a single factor,<ref>{{cita libro  

  }}</ref> but includes factors such as the response of the traction and deconstructed periodontal fibers,<ref>{{cita libro  

  }}</ref> physiological maturation of the human dentition which affects its width, length or perimeter<ref>{{cita libro  

  }}</ref>, alterations of the craniofacial complex<ref>{{cita libro  

  }}</ref> and parafunctions.<ref>{{cita libro  

  }}</ref>

Retention of treatment results is therefore considered to be one of the most difficult problems in orthodontics, and relapses, especially of the mandibular incisors, could also be observed with the use of retention devices after debonding.<ref>{{cita libro  

  }}</ref> Most of the existing post-treatment stability studies evaluate short-term relapses of the anterior region by primarily measuring the irregularity of the incisors after extractive or non-extractive treatment and compare different retention patterns. These studies largely use the Peer Assessment Rating (PAR) index<ref>{{cita libro  

de Freitas, K.M., Janson, G., de Freitas, M.R., et al. [https://pubmed.ncbi.nlm.nih.gov/17920494/ Influence of the quality of the finished occlusion on postretention occlusal relapse]. American Journal of Orthodontics and Dentofacial Orthopedics, 132, 428.e9-14.</ref> which is not a trigeminal electrophysiological analysis approach in considering 'Normocclusion' much less the details of a well balanced occlusion (such as contacts, inclinations and alignment of each tooth) or changes in retention only in the short term.<ref>Hoybjerg, A.J., Currier, G.F., Kadioglu, O.  [https://pubmed.ncbi.nlm.nih.gov/23810041/ Evaluation of 3 retention protocols using the American Board of Orthodontics cast and radiograph evaluation.] American Journal of Orthodontics and Dentofacial Orthopedics, 2013, 144, 16-22.</ref>

 

{{q2|The aforementioned study is not only interesting but also stimulating, from a scientific point of view, as it states that relapses could occur even in the presence of adequate functional occlusion. |Constructive criticism, however, is inherent in the statement itself: how is an efficient masticatory function and, therefore, a 'Normocclusion' defined? }}