Difference between revisions of "Introduction"

Before diving into the analysis of Masticationpedia, it is necessary to introduce some preliminary considerations. These concern, in particular, two fundamental dimensions - social, scientific, and clinical - that are characteristic of both the current era and the one immediately preceding it.

=== The phases of paradigm change according to Thomas Kuhn ===

In the course of the last century, there has been an exponential increase in technological and methodological "Innovations",<ref>{{cita libro  

  }} Oct 7:2380084419879391</ref> especially in the field of dentistry. These advancements have significantly influenced decision-making strategies, opinions, schools of thought, and axioms, aiming explicitly at improving the quality of life, as highlighted in the "Science of Exposure in the 21st Century".<ref>{{cita libro  

  }}</ref> However, this exponential growth implicitly hides conceptual ambiguities - or, in practical terms, "side effects" - which, although sometimes underestimated, have the power to challenge some scientific certainties, making them less rigid and more subject to probability.<ref>{{cita libro  

  }} Jan;50(1):33-50</ref> The sensitive aspects of the current social, scientific, and clinical reality, which may seem contrasting, will be revealed to be complementary by the end of this reading; this is the "Progress of science" according to Kuhn's interpretation and "Epistemology".

In analyzing the progress of science, Thomas Kuhn, in his most famous work, argues that science develops through distinct cycles, reflecting its operational dynamics.<ref>[[wikipedia:Thomas_Kuhn|Thomas Samuel Kuhn]] (Cincinnati, 18 luglio 1922 – Cambridge, 17 giugno 1996) was an American philosopher of science.

</ref><ref>{{cita libro  

  }}</ref> Kuhn advances the idea that science is structured around paradigms and establishes a clear demarcation between science and pseudoscience, based on the presence of a shared paradigm. For him, the evolution of scientific progress is seen as a continuous curve, yet interrupted by discontinuities represented by paradigm shifts.

Taking on the role of a skilled problem solver, the scientist is engaged in resolving these anomalies. These moments of discontinuity, or scientific revolutions, occur when the existing paradigm can no longer adequately interpret new anomalies, thereby pushing the scientific community towards the exploration and eventual adoption of new paradigms that better align with emerging observations.

Thomas Kuhn identifies in the evolution of a scientific paradigm five distinct phases, a process that holds crucial importance for Masticationpedia. To stay in line with the project's objectives, we will focus on the description of the three most significant phases, as outlined in the book's index.[[File:The phases of paradigm change according to Thomas Kuhn.jpg|right|thumb|The phases of paradigm change according to Thomas Kuhn]]

 

 

 

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*<u>'''''Phase 4'''''</u>, or the '''Crisis of the Paradigm'''<br>In response to the crisis, there will be the formation of several new paradigms during this period. These emerging paradigms, therefore, will not originate from the successes of the previous theory, but rather from the rejection of the established models of the dominant paradigm. Continuing along this line, Masticationpedia will dedicate attention to the crisis of the masticatory rehabilitative paradigm, through the review of theories, theorems, axioms, currents of thought, and diagnostic research criteria. Subsequently, the focus will shift to the fifth phase.

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*<u>'''''Phase 5'''''</u>, or the '''Scientific Revolution'''<br>Phase 5 is characterized by the scientific revolution. During the period of extraordinary scientific activities, a debate will develop within the scientific community on which new paradigm to adopt. However, the prevailing paradigm will not necessarily be the "truest" or most efficient one, but rather the one that manages to arouse the interest of a sufficient number of scientists and earn the trust of the community. According to Kuhn, competing paradigms have nothing in common, not even the foundations, making them "incommensurable." The choice of paradigm, as mentioned, occurs on socio-psychological or biological bases, with younger scientists replacing the older ones. This battle between paradigms will resolve the crisis, the new paradigm will be named, and science will return to Phase 1. Following the same principle of Phase 4, Masticationpedia will introduce, in the chapter named "Extraordinary Sciences," a new paradigmatic model in the field of Masticatory System rehabilitation, examining its principles, motivations, scientific clinical experiences, and particularly, a radical change in the field of medical diagnostics. This change is fundamentally based on "System Inference," rather than symptom-based inference, assigning primary importance to the objectivity of data.

It's almost taken for granted that Kuhn's scientific philosophy gives priority to discipline, since an anomaly within the genetic paradigm will be more easily recognized by a geneticist rather than a neurophysiologist. This concept, however, seems to contradict the epistemological evolution of Science, thereby making a detailed analysis of this apparent discrepancy appropriate.

| align="right" width="250" |<small>''The black swan symbolizes one of the historical problems of epistemology: if all the swans we have seen so far are white, can we decide that all the swans are white?<br>Really?''</small>

| width="250" |<small>''Kuhn used optical illusion to demonstrate how a paradigm shift can cause a person to see the same information in a completely different way: which animal is the one here aside?<br>Sure?''</small>

 

'''Epistemology''' (from the Greek ἐπιστήμη, epistēmē, meaning "certain knowledge" or "science", and λόγος, logos, "discourse") represents that branch of philosophy dedicated to the study of the necessary conditions for acquiring scientific knowledge and the methods through which such knowledge can be achieved.<ref>The term is believed to have been coined by the Scottish philosopher [[:wpen:James Frederick Ferrier|James Frederick Ferrier]], in his '' Institutes of Metaphysic '' (p.46), of 1854; see Internet Encyclopedia of Philosophy, ''[https://www.iep.utm.edu/ferrier/ James Frederick Ferrier (1808—1864)]''.</ref> This term specifically refers to that section of gnoseology that investigates the foundations, the validity, and the limits of scientific knowledge. In English-speaking countries, the concept of epistemology is commonly employed almost as a synonym for gnoseology or theory of knowledge, that is, the discipline that examines the study of knowledge in general.

 

It is important to emphasize that the central problem of epistemology, today as in the times of Hume, is the issue of verifiability.<ref>[[wikipedia:David_Hume|David Hume]] (Edimburgo, 7 maggio 1711[1] – Edimburgo, 25 agosto 1776) was a Scottish philosopher. lo-Irish George Berkeley.</ref><ref>{{cita libro  

  }} Jan;41:e150. </ref>

The Hempel's paradox asserts that the observation of every white swan provides support to the statement that all ravens are black;<ref> [[wikipedia:Carl_Gustav_Hempel|Carl Gustav Hempel]]. See {{cita libro

|autore = Good IJ

|anno = 1960|pag=145-149}}</ref> in other words, every example that does not contradict the theory confirms a part of it. According to this paradox:

 

According to the criterion of falsifiability, no theory can be considered definitively true, as although there is only a finite number of experiments that can confirm it, theoretically there is an infinite number of experiments that could refute it.<ref>{{cita libro  

  }} Jan 7;14:91-6. </ref>

...because the very concept of epistemology meets continuous implementations, like in medicine:

*'''''<math>P-value</math>''''':   In medicine, for example, to confirm an experiment or validate a series of data collected through laboratory instruments or surveys, reliance is placed on "Statistical Inference," and in particular on a well-known value called "significance test" (P-value). However, even this concept, now rooted in the practice of researchers, is being questioned. A recent study has focused attention on a campaign conducted in the journal "Nature" against the use of the "significance test."<ref>{{cita libro  

  }} Mar;567(7748):305-307.</ref> With over 800 signatories, including eminent scientists, this campaign can be seen as an important turning point and a "Silent Revolution" in the field of statistics, touching logical and epistemological aspects.<ref>{{cita libro  

  }}, in eds Harlow L. L., Mulaik S. A., Steiger J. H.,  ''What If There Were No Significance Tests?'' - editors.  (Mahwah: Erlbaum, 393–425. [Google Scholar]</ref><ref>{{cita libro  

  }}</ref> The critique is aimed at overly simplified statistical analyses, still present in numerous publications. This has stimulated a debate, sponsored by the American Statistical Association, which led to the creation of a special issue of "The American Statistician Association" titled "Statistical Inference in the 21st Century: A World Beyond p < 0.05", containing 43 articles by statisticians looking towards the future[16]. This special issue proposes new ways to communicate the significance of research findings beyond the arbitrary threshold of a P-value and offers guidelines for research that accepts uncertainty, is reflective, open, and modest in claims.<ref name="wasser">{{cita libro  

  }} 73, 1–19. </ref> The future will reveal whether these attempts to provide more solid statistical support to science, beyond traditional significance tests, will find resonance in future publications.<ref>{{cita libro

*'''Interdisciplinarity''': <br>In the field of science policy, it is universally recognized that solving science-based problems requires an interdisciplinary research approach (IDR), as highlighted by the European Union's Horizon 2020 project.<ref>European Union, ''[https://ec.europa.eu/programmes/horizon2020/en/h2020-section/societal-challenges Horizon 2020]''</ref> Recent studies have explored the reasons for the cognitive and epistemic difficulties that researchers encounter in conducting IDR. One identified cause is the decline of philosophical interest towards the epistemology of IDR, attributed to the dominant "Physical Paradigm of Science." This paradigm limits the recognition of significant developments in IDR, both in the context of the philosophy of science and in the practice of research itself. In response, an alternative philosophical paradigm has been proposed, called the "Engineering Paradigm of Science," which offers alternative philosophical perspectives on fundamental aspects such as the purpose of science, the nature of knowledge, the epistemic and pragmatic criteria for the acceptance of knowledge, and the role of technological tools. Consequently, it highlights the need for researchers to make use of metacognitive support structures, called metacognitive scaffolds, to facilitate the analysis and reconstruction of the processes by which knowledge is constructed across different disciplines. In the context of IDR, such metacognitive scaffolds are essential for promoting effective communication between disciplines, allowing scholars to analyze and articulate how each discipline contributes to the construction of knowledge.<ref name=":0">{{cita libro  

  }} Oct;129:25-39.</ref>

 

It could then be argued that "Innovations" themselves represent "Progresses of Science," as illustrated in the article "Scientific Bases of Dentistry" by Yegane Guven. This work explores the impact of biological and digital revolutions on education and daily clinical practice in dentistry, covering topics such as personalized regenerative dentistry, nanotechnologies, virtual reality simulations, genomic information, and stem cell research.<ref>{{cita libro  

  }} 51(3): 64–71. Published online 2017 Oct 2. PMCID: PMC5624148 - PMID: 29114433 </ref> Although the innovations mentioned are technological and methodological in nature, it is crucial to recognize that true scientific progress does not occur exclusively through "Incremental Innovations" or "Radical Innovations," but is fundamentally achieved through "Paradigmatic Innovations."

In the strictest sense of the term, "Paradigmatic Innovations" are a change in thinking and awareness that spreads throughout all of humanity, affecting different social layers, from the Copernican revolution to the recent trend of approaching biological phenomena with a stochastic method.<ref>{{cita libro  

This epistemological context, which includes initiatives such as the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Evidence-Based Medicine, and others, is further explored in the Masticationpedia project. The latter aims to highlight the dynamics and dialectics of progress in the science of masticatory rehabilitations, emphasizing the anomalies that stimulate a change in thought and, consequently, a "Paradigmatic Innovation."

 

"Malocclusion" derives from the Latin "malum," meaning "bad" or "wrong," and literally refers to an improper closure of the teeth.<ref>The creation of the term is generally attributed to [[:wpen:Edward Angle|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; see {{cita libro

}}, 30(1):18. </ref> The notion of "closure" may seem intuitive; however, the adjective "bad" requires careful consideration, as its application in the medical context is less obvious than it may appear.

To approach an understanding of the term, this introduction poses a seemingly simple yet profoundly complex question, which in turn raises a series of related inquiries in the field of masticatory rehabilitation and, more specifically, in orthodontic disciplines: what exactly is meant by "Malocclusion"? It's interesting to note that, in 2019, a search for the term "Malocclusion" on PubMed yielded a whopping 33,309 articles,<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=%22malocclusion%22 Malocclusion]''</ref> indicating a lack of uniform terminological consensus on the subject. Among these articles, some may provide conclusions of significant relevance, as strikingly demonstrated by the work of Smaglyuk and colleagues. This particularly significant study explores the interdisciplinary approach in diagnosing malocclusions:<ref name="Smaglyuk">{{cita libro  

  | volume =

  }} 72(5 cz 1):918-922.

</ref>

{{q2|Diagnosis, treatment strategies, and prevention of anomalies and dento-facial deformities should be approached by considering the organism as a whole, especially in children, where the physical structure is still in the formative stage. It is essential to recognize the interconnectedness between the form and function of various organs and systems of the body, as these relationships are crucial for devising an effective treatment plan that respects and promotes the harmonious development of the patient.}}

Another noteworthy piece of data emerged when, also in 2019, PubMed was specifically queried for interdisciplinary approaches in diagnosing malocclusions: the results drastically decreased to only four articles.<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=interdisciplinary+diagnostics+of+malocclusions interdisciplinary diagnostics of malocclusions]''</ref>

This observation regarding the topic of "Malocclusion" underscores two critical points: firstly, it highlights a growing awareness of anomalies that could trigger phase 4 of Kuhn's model, suggesting a potential moment of paradigmatic shift. Secondly, it signals a bifurcation in epistemic choices regarding the topic: on one hand, the tendency to generate Incremental Innovations, as evidenced by the other 33,309 articles, and on the other hand, a propensity towards a new gnoseological trajectory that favors a "Paradigmatic Innovation".

 

 

 

 

[[File:Occlusal Centric view in open and cross bite patient.jpg|alt=|thumb|'''Figure 1a:'''<br>Patient with malocclusion, open bite and right posterior crossbite who in rehabilitation terms should be treated with orthodontic therapy and/or orthognathic surgery.|500x500px]]

To answer the previously posed question, let's examine a clinical case that clearly exemplifies "malocclusion".

 

The case involves a patient presenting a type of occlusion commonly defined by orthodontists as "malocclusion", characterized by a unilateral posterior crossbite and an anterior open bite;<ref>{{cita libro

}} Mar;62 Suppl 1:51-57.</ref> these conditions represent a form of malocclusion that can be effectively treated through the use of fixed orthodontic appliances, sometimes in combination with orthognathic surgery if necessary.<ref>{{cita libro  

  }} Sep;18(3):271-7. </ref> The crossbite is identified as a significant alteration from normal occlusion, which requires concurrent treatment with the open bite due to their functional interrelationship.<ref>{{cita libro  

  }} Jan-Feb; 23(1) 71–78.</ref><ref>{{cita libro

 

 

 

 

 

 

'''Patient:''' "I appreciate your concern, doctor, but really, I have no problems chewing or swallowing. And as for bruxism or postural issues, I don't suffer from them. I'm also very physically active. For me, undergoing treatment that I don't feel is necessary would be excessive."

----The situation becomes particularly critical when we consider the patient's verbal language regarding their chewing functionality. This can be misleading, as it may not reflect a detailed understanding of the pathophysiology of the occlusal state. On the contrary, it could paradoxically indicate an intact system if interpreted through a "machine language" converted into verbal terms. In this impasse, neither the patient nor the observer (dentist) can assert with certainty the presence of an actual "Malocclusion."

 

 

The interdisciplinary approach becomes crucial in interpreting the biological phenomenon of "Malocclusion" through a stochastic mindset, which will be explored in more detail later.

 

A stochastic observer might note that, at time <math>T_n </math>, there is a low probability that the patient is in a state of occlusal disease, given their expression of optimal psychophysical well-being. This leads to the conclusion that occlusal discrepancy does not necessarily entail a neuromuscular and psychophysical functional disorder. Therefore, the masticatory system should not be normalized solely to occlusion but requires a broader understanding that includes the Trigeminal Nervous System.

 

To assess the integrity of the patient's Trigeminal Nervous System in the presence of "malocclusion," specific electrophysiological tests were performed. The results of these tests, shown in Figures 1b, 1c, and 1d (with explanations in the captions), should be interpreted as a "Conceptual Rationale" within the context of the "Malocclusion" issue. These introductory data reveal an apparent discrepancy between the occlusal state, which traditionally might be considered pathological, and the neurophysiological data demonstrating perfect synchronization and symmetry of trigeminal reflexes.

File:Bilateral Electric Transcranial Stimulation.jpg|'''Figure 1b:''' Figure 1b displays the results of a motor-evoked potential test obtained through transcranial electrical stimulation of the trigeminal nerve roots. The focus is on structural symmetry, which was calculated by comparing the peak-to-peak amplitude of the evoked potentials in the right masseter muscle (upper trace) and left masseter muscle (lower trace).

File:Jaw Jerk .jpg|'''Figura 1c:''' This figure shows the jaw reflex evoked by percussion of the chin with a piezoelectric neurological hammer. Once again, what stands out is the observed functional symmetry, highlighted by the analysis of peak-to-peak amplitude in the right and left masseter muscles. Functional symmetry in a malocclusion condition suggests that reflexive responses of the masticatory system can remain effectively balanced despite occlusal discrepancies. This further reinforces the argument that a diagnosis of malocclusion does not necessarily translate into manifest neuromuscular dysfunctions, and that the integrity of the masticatory system can be maintained.

File:Mechanic Silent Period.jpg|'''Figura 1d:''' Illustrates the evoked mechanical silent period elicited by percussion of the chin with a triggered neurological hammer. This type of measurement focuses on the integral area of the right and left masseter muscles, and what emerges prominently is the functional symmetry between the two sides. The presence of this symmetry underscores that, despite the malocclusion condition, neuromuscular dynamics, specifically in terms of reflex inhibition after stimulation, are maintained in a balanced equilibrium.  

Through the examination of these electrophysiological data – Figures 1b, 1c, and now 1d – a picture emerges that challenges conventional interpretations of malocclusion and its clinical implications. The observed functional symmetry in these measurements indicates that the approach to diagnosing and treating malocclusions could significantly benefit from a broader evaluation, including detailed analysis of neuromuscular function. These results emphasize the importance of an interdisciplinary and integrated diagnostic and therapeutic model that goes beyond simply correcting occlusal discrepancies to include an overall assessment of the well-being of the masticatory system and, by extension, the patient.

Before proceeding with any conclusion, it is crucial to clarify some fundamental concepts that will be explored in more detail in specific chapters of Masticationpedia.

The masticatory system should be interpreted as a "Complex System"<ref>https://en.wikipedia.org/wiki/Complex_system</ref> rather than being reduced to a simple biomechanical mechanism focused solely on dental occlusion. From this perspective, occlusion represents only one of the numerous subsets operating within a broader context. These subsets include periodontal receptors, neuromuscular spindles, motor unit recruitment, the central nervous system, and the temporomandibular joint. The interaction among these components gives rise to what we can define as "Emergent Behavior", specifically masticatory behavior.

 

This notion implies that the emergent behavior of the system cannot be interpreted or predicted solely based on objective data extracted from a single subset. Instead, it is necessary to assess the integrity of the system as a whole before proceeding with an analytical segmentation for a detailed description. There are significant intellectual and scientific movements addressing this challenge. A notable example is found in the work of Kazem Sadegh-Zadeh, "Handbook of Analytic Philosophy of Medicine".<ref>{{cita libro  

In light of these considerations, the discussion on the case at hand follows the following linguistic logic: the various subsets of the masticatory system, such as teeth, occlusion, temporomandibular joints, and muscles, exhibit "Coherence" with the Central Trigeminal Nervous System (as illustrated in Figures 1b, 1c, and 1d). Consequently, the use of the term "Malocclusion" is inadequate; it would be more appropriate to speak of "Occlusal Dysmorphisms".

:{{q2|The proposition to consider the masticatory system as a "Complex System" does not imply the denial of existing rehabilitative therapies, such as prosthetic, orthodontic, and orthognathic treatments aimed at correcting masticatory dysfunctions. On the contrary, this innovative approach aims to reintegrate and enrich medical knowledge in rehabilitative dental disciplines, providing an alternative perspective to the scientific reductionism that tends to interpret biological phenomena in an overly deterministic manner.|}}Adopting a perspective that transcends the boundaries of individual specializations, as highlighted by the importance of interdisciplinarity, is crucial for enriching diagnostic and therapeutic models in dentistry. This approach is exemplified in the clinical case of a patient treated with the OrthoNeuroGnathodontic methodology, which provides an integrated overview of the masticatory system, combining aesthetic and functional-neurophysiological aspects. This interdisciplinary model aims to achieve "Occlusal Stability" and prevent "Relapses," particularly relevant in orthodontic and orthognathic treatments.<ref>Essam Ahmed Al-Moraissi, Larry M Wolford. [https://pubmed.ncbi.nlm.nih.gov/27371873/ Is Counterclockwise Rotation of the Maxillomandibular Complex Stable Compared With Clockwise Rotation in the Correction of Dentofacial Deformities? A Systematic Review and Meta-Analysis]. J Oral Maxillofac Surg.. 2016 Oct;74(10):2066.e1-2066.e12.doi: 10.1016/j.joms.2016.06.001. Epub 2016 Jun 11.

</ref> This perspective does not aim to eliminate existing rehabilitative practices but, on the contrary, seeks to enrich and restore value to dental rehabilitative disciplines, while offering an alternative to the reductionistic view that often dominates the interpretation of biological phenomena. In this context, an "Extraordinary Science" is introduced, which leverages interdisciplinarity to expand the boundaries of medical knowledge and practice. In the meantime, let us take a reflective pause thanks to a provocative question from our curious companion, Linus Sapiens, the yellow figure positioned on the left. This allegorical interaction invites us to consider the complexity of the masticatory system with a sense of wonder and curiosity, emphasizing the importance of remaining open to new perspectives and innovative solutions in the field of dentistry.

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