Difference between revisions of "Introduction"

Latest revision as of 13:55, 25 October 2024

Introduction

Article by Gianni Frisardi

Abstract: The masticatory system, encompassing teeth, occlusion, muscles, joints, and the central nervous system, is increasingly understood as a complex system rather than a simple biomechanical mechanism. This shift in perspective aligns with Thomas Kuhn's phases of paradigm shifts, where anomalies in traditional models trigger the search for new paradigms. In the context of Masticationpedia, a new interdisciplinary approach to diagnosing and treating malocclusion emerges, focusing on "Occlusal Dysmorphisms" rather than "malocclusion."

Recent advancements in electrophysiological testing, such as motor-evoked potentials and jaw reflexes, reveal functional symmetry in the masticatory system, even in patients with occlusal discrepancies. This finding challenges the traditional understanding of malocclusion, suggesting that neuromuscular dynamics play a crucial role in maintaining masticatory function. Consequently, interdisciplinary diagnostics that consider both occlusal and neuromuscular factors are necessary for accurate diagnosis and effective treatment.

This paradigm shift has implications for current rehabilitative therapies, including orthodontics and prosthetics, which have traditionally focused on achieving occlusal stability. However, considering the masticatory system as a complex system requires an integrative approach that incorporates both aesthetic and neurophysiological factors to prevent relapses and achieve long-term functional stability. The emerging field of OrthoNeuroGnathodontic treatments exemplifies this interdisciplinary approach, offering innovative strategies for addressing masticatory disorders.

By viewing the masticatory system through the lens of complexity science, the field of dentistry can expand its understanding of occlusal stability and dysfunction, ultimately leading to new treatment paradigms that enhance patient outcomes. This new model does not replace traditional treatments but seeks to enrich them with a broader interdisciplinary perspective, aligning with the evolving science of masticatory rehabilitation.

Ab ovo^[1]

Before delving into the analysis of Masticationpedia, we must first introduce some preliminary considerations, particularly regarding two fundamental dimensions—social and scientific-clinical aspect—that characterize both the present era and the one immediately preceding it.

The phases of paradigm change according to Thomas Kuhn

Over the past century, technological and methodological innovations^[2] have exponentially increased, especially in dentistry. These developments have significantly impacted decision-making, schools of thought, and fundamental principles, with the explicit goal of improving quality of life, as emphasized in the "Science of Exposure in the 21st Century".^[3] However, this exponential growth hides conceptual ambiguities—or, practically speaking, "side effects"—that, though often underestimated, can challenge scientific certainties, making them more probabilistic.^[4] These sensitive aspects of current social, scientific, and clinical reality, seemingly in conflict, will ultimately prove to be complementary by the end of this analysis. This evolution follows the concept of "Progress of Science," according to Kuhn’s interpretation of "Epistemology."

In his most famous work, Thomas Kuhn argues that science advances through distinct cycles reflecting its operational dynamics.^[5]^[6] Kuhn posits that science is structured around paradigms and establishes a clear demarcation between science and pseudoscience based on the presence of a shared paradigm. The evolution of scientific progress is depicted as a continuous curve interrupted by discontinuities, represented by paradigm shifts.

In these periods of crisis, scientists act as problem solvers, seeking to resolve anomalies. These "scientific revolutions" occur when the existing paradigm can no longer interpret new anomalies, pushing the scientific community toward new paradigms that better align with observations.

Kuhn's phases in Dentistry

Thomas Kuhn identifies five distinct phases in the evolution of a scientific paradigm—a process crucial for Masticationpedia. However, to align with the project’s scope, we will focus on the three most significant phases, as indicated in the book’s index.

Phase 2, or Normal Science: In this phase, scientists solve problems to strengthen the correspondence between the paradigm and natural reality. This phase establishes the principles on which future research is based, and it produces most of the scientific literature. Here, "anomalies" arise—events that contradict the dominant paradigm.

Phase 4, or the Crisis of the Paradigm: During this phase, new paradigms emerge as the dominant one is rejected. Masticationpedia will address the crisis in masticatory rehabilitation by reviewing theories, axioms, and diagnostic criteria, leading to Phase 5.

Phase 5, or the Scientific Revolution: During this period, the scientific community debates which paradigm to adopt. The chosen paradigm might not be the "truest" but the one gaining the most support. In Masticationpedia, a new model in masticatory rehabilitation will be introduced, focusing on data-driven inferences rather than symptom-based models.

Kuhn’s concept gives priority to discipline-specific expertise, yet this contradicts the interdisciplinary nature of modern science. A detailed analysis of this discrepancy is therefore appropriate.

Epistemology

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 swans are white?
	Kuhn used optical illusion to demonstrate how a paradigm shift can cause a person to see the same information in a completely different way.

Epistemology (from Greek ἐπιστήμη, epistēmē, meaning "certain knowledge" or "science", and λόγος, logos, "discourse") is the branch of philosophy that studies the necessary conditions for acquiring scientific knowledge and the methods through which it is achieved.^[7] Specifically, it refers to the investigation of the foundations, validity, and limits of scientific knowledge. In English-speaking countries, the term "epistemology" is often synonymous with the theory of knowledge or gnoseology, which examines the study of knowledge in general.

The central problem of epistemology, today as in the times of Hume,^[8]^[9] is the issue of verifiability. According to Hempel’s paradox, every example that does not contradict a theory confirms it, which is described as:

$A\Rightarrow B=\lnot A\lor B$ Let’s consider the statement: “If a person has TMDs, then they experience orofacial pain.” We can represent this in logic as $A\Rightarrow B=\lnot A\lor B$ , where: $A$ represents "The person has TMDs." $B$ represents "The person experiences orofacial pain." In this case, "If a person has TMDs, then they experience orofacial pain" is equivalent to saying “either the person does not have TMDs ( $\lnot A$ ), or they experience orofacial pain ( $B$ )”. The formula is true in the following cases: If the person does not have TMDs ( $\lnot A$ ), the statement is true, regardless of orofacial pain. If the person has TMDs ( $A$ ) and experiences orofacial pain ( $B$ ), the statement is true. The statement is false only if the person has TMDs ( $A$ ) but does not experience orofacial pain ( $\lnot B$ ), contradicting the implication condition.

No theory can be definitively true; while there are finite experiments to confirm it, an infinite number could refute it.^[10]

But it’s not all so obvious...

...because epistemology evolves continually, even in medicine:

P-value: In medicine, for example, we rely on statistical inference to confirm experimental results, specifically the 'P-value The p-value represents the probability that observed results are due to chance, assuming the null hypothesis $H_{0}$ is true. It should not be used as a binary criterion (e.g., $p<0.05$ ) for scientific decisions, as values near the threshold require additional verification, such as cross-validation. p-hacking (repeating tests to achieve significance) increases false positives. Rigorous experimental design and transparency about all tests conducted can mitigate this risk. Type I error increases with multiple tests: for $N$ independent tests at threshold $\alpha$ , the Family-Wise Error Rate (FWER) is $FWER=1-(1-\alpha )^{N}$ . Bonferroni correction divides the threshold by the number of tests, $p<{\frac {\alpha }{N}}$ , but can increase false negatives. The False Discovery Rate (FDR) by Benjamini-Hochberg is less conservative, allowing more true discoveries with an acceptable proportion of false positives. The Bayesian approach uses prior knowledge to balance prior and data with a posterior distribution, offering a valid alternative to the p-value. To combine p-values from multiple studies, meta-analysis uses methods like Fisher's: $\chi ^{2}=-2\sum \ln(p_{i})$ . In summary, the p-value remains useful when contextualized and integrated with other measures, such as confidence intervals and Bayesian approaches.' a "significance test" that assesses data validity. Yet, even this entrenched concept is now being challenged. A recent study highlighted a campaign in the journal "Nature" against the use of the P-value.^[11] Signed by over 800 scientists, this campaign marks a "silent revolution" in statistical inference, encouraging a reflective and modest approach to significance.^[12]^[13]^[14] The American Statistical Association contributed to this discussion by releasing a special issue of "The American Statistician Association" titled "Statistical Inference in the 21st Century: A World Beyond p < 0.05." It offers new ways to express research significance and embraces uncertainty.^[15]

Interdisciplinarity: Solving science-based problems increasingly demands interdisciplinary research (IDR), as underscored by the European Union’s Horizon 2020 project.^[16] Yet IDR poses cognitive challenges, partly due to the dominant "Physical Paradigm of Science" that limits its recognition. The "Engineering Paradigm of Science" has been proposed as an alternative, focusing on technological tools and collaboration. Researchers need "metacognitive scaffolds"—tools to enhance interdisciplinary communication and knowledge construction.^[17]^[18]

Interdisciplinarity

A superficial view might suggest a conflict between the disciplinarity of the "Physics Paradigm of Science The "Physical Paradigm of Science" describes an epistemological approach prevalent in the physical sciences, focusing on deterministic models and rigorous experimental methodologies. This paradigm relies on empirical observations and the scientific method to seek universal laws governing natural phenomena.Key Characteristics 1. Determinism: Assumes that natural phenomena follow fixed laws, allowing for accurate predictions based on initial conditions. 2. Measurability and Reproducibility: Emphasizes quantitative measurements and reproducible experiments to confirm results across different contexts. 3. Isolation of Variables: Focuses on analyzing specific effects by isolating variables, often idealizing systems under controlled conditions. While effective in classical natural sciences, the physical paradigm has limitations in complex fields like neurophysiology, where dynamic interactions and variability challenge deterministic models. Application in Masticatory Neurophysiology: In masticatory neurophysiology, the physical paradigm aids in developing basic models but falls short in explaining emergent behaviors, such as motor unit recruitment in response to complex stimuli. Towards an Integrated Paradigm: Emerging is an "Engineering Paradigm of Science," which offers a more adaptive approach that considers complexity, allowing for more flexible predictive models that account for non-linear interactions in biological systems." (which highlights anomalies) and the interdisciplinarity of the "Engineering Paradigm of Science The Engineering Paradigm of Science emphasizes practical applications, interdisciplinary collaboration, and the understanding of complex systems. It contrasts with traditional deterministic models, focusing instead on real-world problem-solving, particularly in fields like biology, medicine, and social sciences.Key Features Problem-Solving Orientation: Prioritizes solutions to complex issues over purely theoretical models. Interdisciplinary Collaboration: Encourages integration of knowledge from various disciplines, enhancing understanding through shared expertise. Complex Systems Focus: Acknowledges emergent behavior and the interconnectivity of system components, recognizing that outcomes can be unpredictable and non-linear. Iterative Process: Embraces an adaptive approach, refining models based on empirical data and feedback to improve responsiveness.Technological Integration: Applies engineering principles to enhance research design and data analysis, utilizing simulations and computational modeling. Application in Masticatory Neurophysiology In masticatory neurophysiology, this paradigm fosters innovative diagnostic tools and treatment approaches. By integrating neurophysiology, biomechanics, and material science, it provides a comprehensive view of jaw function and dysfunction.The Engineering Paradigm of Science promotes collaboration and innovation, ultimately leading to advancements that enhance our understanding of complex systems and improve practical outcomes across various fields." (focused on metacognitive scaffolds). However, these perspectives are not in conflict; they are complementary and drive "Paradigmatic Innovation" in science.

It could be said that "Innovations" represent "Progresses of Science," as illustrated in the article "Scientific Bases of Dentistry" by Yegane Guven, which explores the impact of biological and digital revolutions on dentistry.^[19] True scientific progress is not solely achieved through "Incremental Innovations" or "Radical Innovations" but through "Paradigmatic Innovations."

"Paradigmatic Innovations" represent a change in thinking that spreads through humanity, affecting society on many levels, from the Copernican revolution to the stochastic methods applied to biological phenomena.^[20]

This epistemological context, which includes initiatives like the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and Evidence-Based Medicine, aligns with Masticationpedia’s aim to highlight anomalies that stimulate changes in scientific thought, ultimately leading to "Paradigmatic Innovation."

Dental Malocclusion

"Malocclusion" derives from the Latin "malum," meaning "bad" or "wrong," and refers to improper closure of the teeth.^[21] The notion of "closure" may seem intuitive, but "bad" requires careful consideration in a medical context.

A search for "Malocclusion" on PubMed yielded 33,309 articles,^[22] reflecting a lack of consensus on the term. Smaglyuk and colleagues’ study underscores the importance of an interdisciplinary approach to diagnosing malocclusions.^[23]

«Diagnosis, treatment strategies, and prevention of anomalies and dento-facial deformities should be approached by considering the organism as a whole. This is especially important in children, whose physical structure is still forming. The interconnectedness of various organs and systems is crucial for effective treatment planning.»

Another notable observation from PubMed queries on interdisciplinary malocclusion diagnostics is the drastic drop to only four articles.^[24]

These findings suggest the emergence of phase 4 in Kuhn’s model, indicating a potential paradigmatic shift. Some prefer incremental innovations, while others favor a new path of "Paradigmatic Innovation."

What does "Malocclusion" mean?

In this clinical case of malocclusion, characterized by a unilateral posterior crossbite and anterior open bite, orthodontic appliances and possibly orthognathic surgery are recommended.^[25] The crossbite requires concurrent treatment due to its functional relationship with the open bite.^[26]

In this case, the patient refused treatment, insisting that their chewing function was fine. The dentist responded by explaining the long-term risks of leaving the malocclusion untreated, but respected the patient's decision to decline treatment.

The case illustrates the complexity of diagnosing malocclusion, which involves more than occlusal discrepancies. Specific electrophysiological tests, such as the motor-evoked potential and jaw reflex tests, can reveal functional symmetry in the masticatory system despite occlusal issues.

Figure 1a: Patient with malocclusion, open bite, and right posterior crossbite who should be treated with orthodontic therapy and/or orthognathic surgery.
Figure 1b: Motor-evoked potential test showing symmetry in the right and left masseter muscles.
Figura 1c: Jaw reflex test revealing functional symmetry in the masticatory system.
Figura 1d: Evoked mechanical silent period showing balanced neuromuscular dynamics despite malocclusion.

These electrophysiological results challenge conventional interpretations of malocclusion, highlighting the importance of interdisciplinary diagnostics that consider neuromuscular function as well as occlusal discrepancies.

Occlusal Dismorphisms and Not Malocclusion ......which, as we will see shortly, is an entirely different matter.

Conclusion

Before concluding, we must clarify that the masticatory system is a "Complex System"^[27], not a simple biomechanical mechanism focused solely on dental occlusion. Occlusion is just one subset within a broader context that includes periodontal receptors, neuromuscular spindles, motor units, the central nervous system, and the temporomandibular joint. This interaction creates "Emergent Behavior The **masseter silent period** (MSP) is a relevant example of emergent behavior in masticatory neurophysiology. This reflex is triggered by sudden chin taps, leading to a brief cessation of electrical activity in the masseter muscle, and is closely related to the recruitment of motor units. During the MSP, there is a specific modulation of motor unit recruitment, regulated by the central nervous system, to respond to external stimuli. In the context of emergent behavior, this reflex is not limited to a single muscle but represents a coordinated response involving synergies among various neuronal centers and antagonist muscles. This integration stabilizes the mandible, adapting in real time to the force of the stimulus and producing an adaptive response. Mathematically, we can describe the probability $P(R)$ of an emergent response as a function of the input variables $x_{1},x_{2},\ldots ,x_{n}$ that influence motor unit activation: $P(R)=f(x_{1},x_{2},\ldots ,x_{n})$ where $f$ represents the non-linear interaction among incoming stimuli (such as the type and intensity of the chin tap) and the central integration processes of the trigeminal system. This model helps to understand how the MSP reflects an integrated and adaptive response that emerges from complex neurophysiological circuits rather than a single neural pathway.," or masticatory behavior.

Emergent behavior cannot be fully explained by analyzing a single subset; instead, the integrity of the entire system must be assessed. A notable intellectual movement addressing this challenge is Kazem Sadegh-Zadeh’s work, "Handbook of Analytic Philosophy of Medicine."^[28]

The masticatory system's various subsets, such as teeth, occlusion, joints, and muscles, exhibit "Coherence" with the Central Trigeminal Nervous System, as shown in the electrophysiological tests. Therefore, "malocclusion" may not be the appropriate term; "Occlusal Dysmorphisms" would be more accurate.

«Viewing the masticatory system as a "Complex System" doesn’t deny existing rehabilitative therapies like prosthetics or orthodontics but instead aims to enrich them by considering a broader interdisciplinary perspective.»

This approach, exemplified in OrthoNeuroGnathodontic treatments, integrates aesthetic and neurophysiological aspects to achieve "Occlusal Stability" and prevent "Relapses."^[29]^[30] While not replacing traditional treatments, this model seeks to expand medical knowledge and interdisciplinary practices in dentistry.

In the meantime, let us pause with a question from Linus Sapiens, our curious yellow figure on the left. He reminds us of the importance of remaining open to new perspectives in masticatory science.

What do we mean by “Complex Systems” when we are talking about masticatory functions?

Bibliography & references

↑ Latin for 'since the very beginning'
↑ Heft MW, Fox CH, Duncan RP, «Assessing the Translation of Research and Innovation into Dental Practice», in JDR Clin Trans Res, 2019».
DOI:10.1177/2380084419879391 Oct 7:2380084419879391
↑ «Exposure Science in the 21st Century. A Vision and a Strategy», Committee on Human and Environmental Exposure Science in the 21st Century; Board on Environmental Studies and Toxicology; Division on Earth and Life Studies; National Research Council.».
ISBN: 0-309-26468-5
↑ Liu L, Li Y, «The unexpected side effects and safety of therapeutic monoclonal antibodies», in Drugs Today, 2014, Barcellona».
DOI:10.1358/dot.2014.50.1.2076506 Jan;50(1):33-50
↑ Thomas Samuel Kuhn (Cincinnati, 18 luglio 1922 – Cambridge, 17 giugno 1996) was an American philosopher of science.
↑ Kuhn Thomas S, «The Structure of Scientific Revolutions», Univ. of Chicago Press, 2012, Chicago».
ISBN: 9780226458113
↑ The term was coined by Scottish philosopher James Frederick Ferrier, in his Institutes of Metaphysic (1854); see Internet Encyclopedia of Philosophy, James Frederick Ferrier (1808—1864).
↑ David Hume (1711–1776) was a Scottish philosopher.
↑ Srivastava S, «Verifiability is a core principle of science», in Behav Brain Sci, Cambridge University Press, 2018, Cambridge».
DOI:10.1017/S0140525X18000869 Jan;41:e150.
↑ Evans M, «Measuring statistical evidence using relative belief», in Comput Struct Biotechnol J, 2016».
DOI:10.1016/j.csbj.2015.12.001 Jan 7;14:91-6.
↑ Amrhein V, Greenland S, McShane B, «Scientists rise up against statistical significance», in Nature, 2019».
DOI:10.1038/d41586-019-00857-9 Mar;567(7748):305-307.
↑ Rodgers JL, «The epistemology of mathematical and statistical modeling: a quiet methodological revolution», in Am Psychol, 2010».
DOI:10.1037/a0018326 Jan;65(1):1-12.
↑ Meehl P, «The problem is epistemology, not statistics: replace significance tests by confidence intervals and quantify accuracy of risky numerical predictions», 1997».
↑ Sprenger J, Hartmann S, «Bayesian Philosophy of Science. Variations on a Theme by the Reverend Thomas Bayes», Oxford University Press, 2019, Oxford».
↑ Wasserstein RL, Schirm AL, Lazar NA, «Moving to a World Beyond p < 0.05», in Am Stat, 2019».
DOI:10.1080/00031305.2019.1583913 73, 1–19.
↑ European Union, Horizon 2020
↑ Boon M, Van Baalen S, «Epistemology for interdisciplinary research - shifting philosophical paradigms of science», in Eur J Philos Sci, 2019».
DOI:10.1007/s13194-018-0242-4 9(1):16.
↑ Boon M, «An engineering paradigm in the biomedical sciences: Knowledge as epistemic tool», in Prog Biophys Mol Biol, 2017».
DOI:10.1016/j.pbiomolbio.2017.04.001 Oct;129:25-39.
↑ Guven Y, «Scientific basis of dentistry», in J Istanb Univ Fac Den, 2017».
DOI:10.17096/jiufd.04646 51(3): 64–71. Published online 2017 Oct 2. PMCID: PMC5624148 - PMID: 29114433
↑ Zhao XF, Gojo I, York T, Ning Y, Baer MR, «Diagnosis of biphenotypic acute leukemia: a paradigmatic approach», in Int J Clin Exp Pathol, 2010». Prepublished online 2009 Oct 10. PMCID: PMC2776262 - PMID: 19918331. 3(1): 75–86.
↑ Attributed to Edward Angle, the father of modern orthodontics, who coined it as a specification of occlusion.
↑ Pubmed, Malocclusion
↑ Smaglyuk LV, Voronkova HV, Karasiunok AY, Liakhovska AV, Solovei KO, «Interdisciplinary approach to diagnostics of malocclusions (review)», in Wiad Lek, 2019». 72(5 cz 1):918-922.
↑ Pubmed, interdisciplinary diagnostics of malocclusions
↑ Reichert I, Figel P, Winchester L, «Orthodontic treatment of anterior open bite: a review article--is surgery always necessary?», in Oral Maxillofac Surg, 2014».
DOI:10.1007/s10006-013-0430-5 Sep;18(3):271-7.
↑ Miamoto CB, Silva Marques L, Abreu LG, Paiva SM, «Impact of two early treatment protocols for anterior dental crossbite on children’s quality of life», in Dental Press J Orthod, 2018». Jan-Feb; 23(1) 71–78.
↑ https://en.wikipedia.org/wiki/Complex_system
↑ Sadegh-Zadeh Kazem, «Handbook of Analytic Philosophy of Medicine», Springer, 2012, Dordrecht».
ISBN: 978-94-007-2259-0
DOI:10.1007/978-94-007-2260-6 .
↑ Essam Ahmed Al-Moraissi, Larry M Wolford. 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.
↑ J Hoffmannová, R Foltán, M Vlk, K Klíma, G Pavlíková, O Bulik. Factors affecting the stability of bilateral sagittal split osteotomy of a mandible.Prague Med Rep. 2008;109(4):286-97.

Masticationpedia is a charity, a not-for-profit organization operating in dentistry medical research,
particularly focusing on the field of the neurophysiology of the masticatory system

[1] Latin for 'since the very beginning'

[2] Heft MW, Fox CH, Duncan RP, «Assessing the Translation of Research and Innovation into Dental Practice», in JDR Clin Trans Res, 2019».
DOI:10.1177/2380084419879391 Oct 7:2380084419879391

[3] «Exposure Science in the 21st Century. A Vision and a Strategy», Committee on Human and Environmental Exposure Science in the 21st Century; Board on Environmental Studies and Toxicology; Division on Earth and Life Studies; National Research Council.».
ISBN: 0-309-26468-5

[4] Liu L, Li Y, «The unexpected side effects and safety of therapeutic monoclonal antibodies», in Drugs Today, 2014, Barcellona».
DOI:10.1358/dot.2014.50.1.2076506 Jan;50(1):33-50

[5] Thomas Samuel Kuhn (Cincinnati, 18 luglio 1922 – Cambridge, 17 giugno 1996) was an American philosopher of science.

[6] Kuhn Thomas S, «The Structure of Scientific Revolutions», Univ. of Chicago Press, 2012, Chicago».
ISBN: 9780226458113

[7] The term was coined by Scottish philosopher James Frederick Ferrier, in his Institutes of Metaphysic (1854); see Internet Encyclopedia of Philosophy, James Frederick Ferrier (1808—1864).

[8] David Hume (1711–1776) was a Scottish philosopher.

[9] Srivastava S, «Verifiability is a core principle of science», in Behav Brain Sci, Cambridge University Press, 2018, Cambridge».
DOI:10.1017/S0140525X18000869 Jan;41:e150.

[10] Evans M, «Measuring statistical evidence using relative belief», in Comput Struct Biotechnol J, 2016».
DOI:10.1016/j.csbj.2015.12.001 Jan 7;14:91-6.

[:1-11] Amrhein V, Greenland S, McShane B, «Scientists rise up against statistical significance», in Nature, 2019».
DOI:10.1038/d41586-019-00857-9 Mar;567(7748):305-307.

[:2-12] Rodgers JL, «The epistemology of mathematical and statistical modeling: a quiet methodological revolution», in Am Psychol, 2010».
DOI:10.1037/a0018326 Jan;65(1):1-12.

[:3-13] Meehl P, «The problem is epistemology, not statistics: replace significance tests by confidence intervals and quantify accuracy of risky numerical predictions», 1997».

[:4-14] Sprenger J, Hartmann S, «Bayesian Philosophy of Science. Variations on a Theme by the Reverend Thomas Bayes», Oxford University Press, 2019, Oxford».

[wasser-15] Wasserstein RL, Schirm AL, Lazar NA, «Moving to a World Beyond p < 0.05», in Am Stat, 2019».
DOI:10.1080/00031305.2019.1583913 73, 1–19.

[16] European Union, Horizon 2020

[:0-17] Boon M, Van Baalen S, «Epistemology for interdisciplinary research - shifting philosophical paradigms of science», in Eur J Philos Sci, 2019».
DOI:10.1007/s13194-018-0242-4 9(1):16.

[18] Boon M, «An engineering paradigm in the biomedical sciences: Knowledge as epistemic tool», in Prog Biophys Mol Biol, 2017».
DOI:10.1016/j.pbiomolbio.2017.04.001 Oct;129:25-39.

[19] Guven Y, «Scientific basis of dentistry», in J Istanb Univ Fac Den, 2017».
DOI:10.17096/jiufd.04646 51(3): 64–71. Published online 2017 Oct 2. PMCID: PMC5624148 - PMID: 29114433

[20] Zhao XF, Gojo I, York T, Ning Y, Baer MR, «Diagnosis of biphenotypic acute leukemia: a paradigmatic approach», in Int J Clin Exp Pathol, 2010». Prepublished online 2009 Oct 10. PMCID: PMC2776262 - PMID: 19918331. 3(1): 75–86.

[21] Attributed to Edward Angle, the father of modern orthodontics, who coined it as a specification of occlusion.

[22] Pubmed, Malocclusion

[23] Smaglyuk LV, Voronkova HV, Karasiunok AY, Liakhovska AV, Solovei KO, «Interdisciplinary approach to diagnostics of malocclusions (review)», in Wiad Lek, 2019». 72(5 cz 1):918-922.

[24] Pubmed, interdisciplinary diagnostics of malocclusions

[25] Reichert I, Figel P, Winchester L, «Orthodontic treatment of anterior open bite: a review article--is surgery always necessary?», in Oral Maxillofac Surg, 2014».
DOI:10.1007/s10006-013-0430-5 Sep;18(3):271-7.

[26] Miamoto CB, Silva Marques L, Abreu LG, Paiva SM, «Impact of two early treatment protocols for anterior dental crossbite on children’s quality of life», in Dental Press J Orthod, 2018». Jan-Feb; 23(1) 71–78.

[27] ttps://en.wikipedia.org/wiki/Complex_system

[28] Sadegh-Zadeh Kazem, «Handbook of Analytic Philosophy of Medicine», Springer, 2012, Dordrecht».
ISBN: 978-94-007-2259-0
DOI:10.1007/978-94-007-2260-6 .

[29] Essam Ahmed Al-Moraissi, Larry M Wolford. 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.

[30] J Hoffmannová, R Foltán, M Vlk, K Klíma, G Pavlíková, O Bulik. Factors affecting the stability of bilateral sagittal split osteotomy of a mandible.Prague Med Rep. 2008;109(4):286-97.

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-{{Versions
- | en = Introduction
- | it =  Introduzione
- | fr = Présentation
- | de = Einführung
- | es = Inicio
- | pt = <!-- portoghese -->
- | ru = <!-- russo -->
- | pl = <!-- polacco -->
- | fi = <!-- finlandese/suomi -->
- | ca = <!-- catalano -->
- | ja = <!-- giapponese -->
- }}
-''We would like our reader to have an immediate perception of the topics that will be debated in Masticationpedia; we will review some of the most current issues concerning the epistemological evolution of science in general, and medical as well as dental medicine in particular.''
+{{main menu
+|link to German= Hauptseite
+|link to Spanish= Pàgina Principal
+|link to French= Page d'accueil
+|link to Italian= Introduzione
+}}
-[[File:Occlusal Centric view in open and cross bite patient.jpg|left|300px]]
+{{ArtBy|autore=Gianni Frisardi}}'''Abstract:''' The masticatory system, encompassing teeth, occlusion, muscles, joints, and the central nervous system, is increasingly understood as a complex system rather than a simple biomechanical mechanism. This shift in perspective aligns with Thomas Kuhn's phases of paradigm shifts, where anomalies in traditional models trigger the search for new paradigms. In the context of Masticationpedia, a new interdisciplinary approach to diagnosing and treating malocclusion emerges, focusing on "Occlusal Dysmorphisms" rather than "malocclusion."
-In this phase we will consider two fundamental aspects of '''Progress of Science''', according to the '''Kuhn Paradigms''', and '''Epistemology''' which questions the concepts of "Statistical Inference" and "Interdisciplinarity".
-These two themes, which apparently seem to be in conflict with each other, as the first one needs ''disciplinarity'' to highlight the "Anomalies in the Paradigm" and the second needs "''Interdisciplinarity''", they will integrate through a resolving element that consists of "''metacognitive scaffolds''", i.e. cognitive bridges between specialist disciplines. In this context, therefore, the reader will be better able to appreciate the ''stochastic approach'' towards one of the most controversial topics in masticatory rehabilitations, such as, "'''Malocclusion'''", from which come most of the masticatory rehabilitation procedures such as orthodontics, prosthesis and orthognathic surgery.
+Recent advancements in electrophysiological testing, such as motor-evoked potentials and jaw reflexes, reveal functional symmetry in the masticatory system, even in patients with occlusal discrepancies. This finding challenges the traditional understanding of malocclusion, suggesting that neuromuscular dynamics play a crucial role in maintaining masticatory function. Consequently, interdisciplinary diagnostics that consider both occlusal and neuromuscular factors are necessary for accurate diagnosis and effective treatment.
-So, in addition to anticipating the scientific and philosophical aspect of Masticationpedia, we will finally focus on topics such as "Complex Systems", the "Emergent Behaviour" of Complex Systems and "System’s Coherence": necessary steps to introduce scientific clinical topics which bring with them doubts, questions and at the same time paradigmatic innovations tending to change the status quo of the deterministic and reductionist clinical thinking ''<nowiki/>'routine''', before a stochastic and interdisciplinary language logic.
+This paradigm shift has implications for current rehabilitative therapies, including orthodontics and prosthetics, which have traditionally focused on achieving occlusal stability. However, considering the masticatory system as a complex system requires an integrative approach that incorporates both aesthetic and neurophysiological factors to prevent relapses and achieve long-term functional stability. The emerging field of OrthoNeuroGnathodontic treatments exemplifies this interdisciplinary approach, offering innovative strategies for addressing masticatory disorders.
-{{ArtBy|autore=Gianni Frisardi}}{{Bookind2}}
+By viewing the masticatory system through the lens of complexity science, the field of dentistry can expand its understanding of occlusal stability and dysfunction, ultimately leading to new treatment paradigms that enhance patient outcomes. This new model does not replace traditional treatments but seeks to enrich them with a broader interdisciplinary perspective, aligning with the evolving science of masticatory rehabilitation.
 ==Ab ovo<ref>Latin for 'since the very beginning'</ref>==
-Before getting to the heart of the Masticationpedia treatment, a premise is appropriate, that mainly concerns two aspects of the social, scientific and clinical reality of the current and the immediately preceding era.
+Before delving into the analysis of Masticationpedia, we must first introduce some preliminary considerations, particularly regarding two fundamental dimensions—social and scientific-clinical aspect—that characterize both the present era and the one immediately preceding it.
-In the last century, we witnessed exponential growth in technological and methodological "Innovations" specifically in dentistry<ref>{{cita libro
+===The phases of paradigm change according to Thomas Kuhn===
+Over the past century, technological and methodological innovations<ref>{{cita libro
   | autore = Heft MW
   | autore2 = Fox CH
@@ Line 43: / Line 34: @@
   | DOI = 10.1177/2380084419879391
   | OCLC =
-  }} Oct 7:2380084419879391</ref>; these innovations have in some way influenced decision-making strategies, opinions, schools of thought and axioms in order to improve quality of life, as stated in the "''Exposure Science in the 21st Century''"<ref>{{cita libro
+  }} Oct 7:2380084419879391</ref> have exponentially increased, especially in dentistry. These developments have significantly impacted decision-making, schools of thought, and fundamental principles, with the explicit goal of improving quality of life, as emphasized in the "Science of Exposure in the 21st Century".<ref>{{cita libro
   | autore =
   | autore2 =
@@ Line 62: / Line 53: @@
   | DOI =
   | OCLC =
-  }}</ref>. However, this exponential growth brings with it, implicitly, conceptual gray areas (in practical terms "side effects") which are sometimes underestimated, but which may call into question some Scientific Certainties or make them less absolute and more probabilistic.<ref>{{cita libro
+  }}</ref> However, this exponential growth hides conceptual ambiguities—or, practically speaking, "side effects"—that, though often underestimated, can challenge scientific certainties, making them more probabilistic.<ref>{{cita libro
   | autore = Liu L
   | autore2 = Li Y
@@ Line 76: / Line 67: @@
   | DOI = 10.1358/dot.2014.50.1.2076506
   | OCLC =
-  }} Jan;50(1):33-50</ref>
+  }} Jan;50(1):33-50</ref> These sensitive aspects of current social, scientific, and clinical reality, seemingly in conflict, will ultimately prove to be complementary by the end of this analysis. This evolution follows the concept of "Progress of Science," according to Kuhn’s interpretation of "Epistemology."
-[[File:The phases of paradigm change according to Thomas Kuhn.jpg|right|thumb|The phases of paradigm change according to Thomas Kuhn]]
-The two sensitive aspects of the current social, scientific and clinical reality (which seem to conflict with each other, but as we will see at the end of this reading will be complementary) are the "Progress of Science" according to Kuhn and the "Epistemology".
-==Progress of Science according to Thomas Kuhn==
+In his most famous work, Thomas Kuhn argues that science advances 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
-'''Thomas Kuhn'''<ref>Thomas Samuel Kuhn (Cincinnati, 18 luglio 1922 – Cambridge, 17 giugno 1996) was an American philosopher of science.<br>See Treccani, ''[http://www.treccani.it/enciclopedia/thomas-samuel-kuhn/ Kuhn, Thomas Samuel]''. Or Wikipedia, ''[[:wpen:Thomas Kuhn|Thomas Kuhn]]''.
-</ref> in his most famous work states<ref>{{cita libro
   | autore = Kuhn Thomas S
   | titolo = The Structure of Scientific Revolutions
@@ Line 96: / Line 82: @@
   | DOI =
   | OCLC =
-  }}</ref> that ''science cyclically passes through some phases indicative of its operation''. According to Kuhn, ''science is paradigmatic'', and the demarcation between science and pseudoscience can be traced back to the existence of a '''paradigm'''. The evolution of scientific progress is assimilated to ''a continuous curve which undergoes discontinuity in paradigm changes''.
+  }}</ref> Kuhn posits that science is structured around paradigms and establishes a clear demarcation between science and pseudoscience based on the presence of a shared paradigm. The evolution of scientific progress is depicted as a continuous curve interrupted by discontinuities, represented by paradigm shifts.
-For example, in phase 2 of the Kuhn Paradigms, called '''Normal Science''', scientists are seen as problem solvers, who work to improve the agreement between the paradigm and nature.
-This phase, in fact, is based on a set of basic principles dictated by the paradigm, which are not questioned but which, indeed, are entrusted with the task of indicating the coordinates of the works to come. In this phase, the measuring instruments with which the experiments are made are developed, most of the scientific articles are produced and its results constitute significant growth in scientific knowledge. In the normal science phase both successes and failures will be achieved; the failures are called by Kuhn ''anomalies'', or ''events that go against the paradigm''.
-As a good problem solver, the scientist tries to solve these anomalies.
-Kuhn, however, divides the evolution of a paradigm into '''five phases'''; this is a fundamental process for Masticationpedia, but to keep tuned with the project, we will limit ourselves to describing the two most significant phases:
+In these periods of crisis, scientists act as problem solvers, seeking to resolve anomalies. These "scientific revolutions" occur when the existing paradigm can no longer interpret new anomalies, pushing the scientific community toward new paradigms that better align with observations.
-=== Kuhn's phases in Dentistry===
+===='''Kuhn's phases in Dentistry'''====
+Thomas Kuhn identifies five distinct phases in the evolution of a scientific paradigm—a process crucial for Masticationpedia. However, to align with the project’s scope, we will focus on the three most significant phases, as indicated in the book’s index.
-Kuhn, on the other hand, divides the evolution of a paradigm into five phases; this is a fundamental process for Masticationpedia, but to stay tuned with the project we will limit ourselves to describing the three most significant phases shared in the project and indicated in the index of the book:
 {|
-|
-|
-* <u>'''''Phase 2'''''</u>, or the Normal Science<br>For example, in phase 2 of the Kuhn Paradigms, called '''Normal Science''', scientists are seen as problem solvers, who work to improve the agreement between the paradigm and nature. This phase, in fact, is based on a set of basic principles dictated by the paradigm, which are not questioned but which, indeed, are entrusted with the task of indicating the coordinates of the works to come. In this phase, the measuring instruments with which the experiments are made are developed, most of the scientific articles are produced and its results constitute significant growth in scientific knowledge. In the normal science phase both successes and failures will be achieved; the failures are called by Kuhn ''anomalies'', or ''events that go against the paradigm''.
 |-
-|&nbsp;
+| <blockquote>'''Phase 2''', or '''Normal Science''':
-|
+In this phase, scientists solve problems to strengthen the correspondence between the paradigm and natural reality. This phase establishes the principles on which future research is based, and it produces most of the scientific literature. Here, "anomalies" arise—events that contradict the dominant paradigm.</blockquote>
-*<u>'''''Phase 4'''''</u>, or the '''Crisis of the Paradigm'''<br>As a consequence of the crisis, different paradigms will be created during this period. These new paradigms will, therefore, not arise from the results achieved by the previous theory, but rather from the abandonment of the pre-established schemes of the dominant paradigm. <br>Following this path, in Masticationpedia, the '''crisis of the masticatory rehabilitation paradigm''' will be discussed reviewing theories, theorems, axioms, schools of thought and the Research Diagnostic Criteria and then the focus will shift on phase 5.
 |-
-|&nbsp;
+|<blockquote>'''Phase 4''', or the '''Crisis of the Paradigm''':
-|
+During this phase, new paradigms emerge as the dominant one is rejected. Masticationpedia will address the crisis in masticatory rehabilitation by reviewing theories, axioms, and diagnostic criteria, leading to Phase 5.</blockquote>
-*<u>'''''Phase 5'''''</u>, or the '''Scientific Revolution'''<br>Phase 5 deals with the (scientific) revolution. In the period of extraordinary scientific activities, a discussion will open within the scientific community on which new paradigm to accept. But it will not necessarily be the most "true" or most efficient paradigm to come to the fore, but the one that will be able to capture the interest of a sufficient number of scientists and to gain the trust of the scientific community. <br>The paradigms that participate in this clash, according to Kuhn, share nothing, not even the bases and, therefore, are not comparable (they are "immeasurable"). The paradigm is chosen, as said, on socio-psychological or biological basis (young scientists replace older ones). The battle between paradigms will resolve the crisis, the new paradigm will be named and science will be brought back to Phase 1. <br>For the same principle of Phase 4, Masticationpedia will propose, in the chapter titled ''Extraordinary science'', a '''new paradigmatic model in the field of rehabilitation of the Masticatory System''' discussing its principles, motivations, clinical scientific experiences and, above all, a ''radical change'' in the field of medical diagnostics. This change is essentially based on '''System Inference''', rather than on Symptom Inference, giving mainly absolute value to the objectivity of the data.
+|-
+|<blockquote>'''Phase 5''', or the '''Scientific Revolution''':
+During this period, the scientific community debates which paradigm to adopt. The chosen paradigm might not be the "truest" but the one gaining the most support. In Masticationpedia, a new model in masticatory rehabilitation will be introduced, focusing on data-driven inferences rather than symptom-based models.</blockquote>
 |}
-It is almost obvious that Kuhnian scientific philosophy prefers disciplinarity, as an anomaly in the genomic paradigm will be noticed better by a geneticist than by a neurophysiologist. Now this concept would seem to be in contrast with the epistemological evolution of Science, so it is better to stop a minute upon it in detail.
+Kuhn’s concept gives priority to discipline-specific expertise, yet this contradicts the interdisciplinary nature of modern science. A detailed analysis of this discrepancy is therefore appropriate.
+----
 ==Epistemology==
@@ Line 129: / Line 109: @@
 {|
 |-
-| 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>
+| 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 swans are white?''</small>
 | align="center" |[[File:Black_Swan_(Cygnus_atratus)_RWD.jpg|175px|center]]
 |-
-|&nbsp;
+| align="center" |[[File:Duck-Rabbit illusion.jpg|203px|center]]
-|-
+| 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.''</small>
-| align="center" |[[File:Duck-Rabbit illusion.jpg|203px|center]]
-| 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>
 |}
 </center>
-----
+'''Epistemology''' (from Greek ἐπιστήμη, epistēmē, meaning "certain knowledge" or "science", and λόγος, logos, "discourse") is the branch of philosophy that studies the necessary conditions for acquiring scientific knowledge and the methods through which it is achieved.<ref>The term was coined by Scottish philosopher [[:wpen:James Frederick Ferrier|James Frederick Ferrier]], in his ''Institutes of Metaphysic'' (1854); see Internet Encyclopedia of Philosophy, ''[https://www.iep.utm.edu/ferrier/ James Frederick Ferrier (1808—1864)]''.</ref> Specifically, it refers to the investigation of the foundations, validity, and limits of scientific knowledge. In English-speaking countries, the term "epistemology" is often synonymous with the theory of knowledge or gnoseology, which examines the study of knowledge in general.
-'''Epistemology''' (from the Greek ἐπιστήμη, ''epistème'', "certain knowledge" or "science", and λόγος, ''logos'', "speech") is that branch of philosophy which deals with the conditions under which scientific knowledge can be obtained and the methods for achieving such knowledge. The term<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> specifically indicates that part of gnoseology which studies the foundations, validity and limits of scientific knowledge. In English-speaking countries, the concept of epistemology is instead mainly used as a synonym for gnoseology or knowledge theory — the discipline that deals with the study of knowledge.
-Incidentally, the basic problem of epistemology today, as in Hume’s time<ref>[[:wpen:David Hume|David Hume]] (Edimburgo, 7 maggio 1711[1] – Edimburgo, 25 agosto 1776) was a Scottish philosopher. He is considered the third and perhaps the most radical of the British Empiricists, after the Englishman John Locke and the Anglo-Irish George Berkeley.</ref>, remains that of verifiability.<ref>{{cita libro
+The central problem of epistemology, today as in the times of Hume,<ref>[[wikipedia:David_Hume|David Hume]] (1711–1776) was a Scottish philosopher.</ref><ref>{{cita libro
   | autore = Srivastava S
   | titolo = Verifiability is a core principle of science
@@ Line 156: / Line 132: @@
   | DOI = 10.1017/S0140525X18000869
   | OCLC =
-  }} Jan;41:e150. </ref>
+  }} Jan;41:e150.</ref> is the issue of verifiability. According to Hempel’s paradox, every example that does not contradict a theory confirms it, which is described as:
-The Hempel paradox tells us that each sighted white swan confirms that crows are black<ref>Here we obviously refer to the well-known paradox called "of the crows", or "of the black crows", formulated by the philosopher and mathematician [[:wpen:Carl Gustav Hempel|Carl Gustav Hempel]], better explained in Wikipedia's article ''[https://en.wikipedia.org/w/index.php?title=Raven_paradox&oldid=942633026 Raven paradox]'':<br>See {{cita libro
- |autore = Good IJ
- |titolo=The Paradox of Confirmation
- |opera=Br J Philos Sci
- |volume=11
- |numero=42
- |url=https://www.jstor.org/stable/685588
- |anno = 1960|pag=145-149}}</ref>, that is, ''each example not in contrast with the theory confirms a part of it'':<br>
-::<math>A\Rightarrow B = \lnot A \lor B</math> <br>
+<math>A \Rightarrow B = \lnot A \lor B</math>{{Tooltip||Let’s consider the statement: “If a person has TMDs, then they experience orofacial pain.” We can represent this in logic as <math>A \Rightarrow B = \lnot A \lor B</math>, where:<math>A</math> represents "The person has TMDs."<math>B</math> represents "The person experiences orofacial pain." In this case, "If a person has TMDs, then they experience orofacial pain" is equivalent to saying “either the person does not have TMDs (<math>\lnot A</math>), or they experience orofacial pain (<math>B</math>)”. The formula is true in the following cases: If the person does not have TMDs (<math>\lnot A</math>), the statement is true, regardless of orofacial pain. If the person has TMDs (<math>A</math>) and experiences orofacial pain (<math>B</math>), the statement is true.
+The statement is false only if the person has TMDs (<math>A</math>) but does not experience orofacial pain (<math>\lnot B</math>), contradicting the implication condition.}}
-According to the objection of falsifiability, instead, no theory is ever true because, while there are only a finite number of experiments in favour, there is also theoretically an infinite number that could falsify it.<ref>{{cita libro
+No theory can be definitively true; while there are finite experiments to confirm it, an infinite number could refute it.<ref>{{cita libro
   | autore = Evans M
   | titolo = Measuring statistical evidence using relative belief
@@ Line 182: / Line 150: @@
   | DOI = 10.1016/j.csbj.2015.12.001
   | OCLC =
-  }} Jan 7;14:91-6. </ref>
+  }} Jan 7;14:91-6.</ref>
 {{qnq|But it’s not all so obvious...}}
-...because the very concept of epistemology meets continuous implementations, like in medicine:
+...because epistemology evolves continually, even in medicine:
-{|
+'''P-value''': In medicine, for example, we rely on statistical inference to confirm experimental results, specifically the 'P-value{{Tooltip||2=The p-value represents the probability that observed results are due to chance, assuming the null hypothesis <math> H_0 </math> is true. It should not be used as a binary criterion (e.g., <math> p < 0.05 </math>) for scientific decisions, as values near the threshold require additional verification, such as cross-validation. ''p-hacking'' (repeating tests to achieve significance) increases false positives. Rigorous experimental design and transparency about all tests conducted can mitigate this risk. Type I error increases with multiple tests: for <math> N </math> independent tests at threshold <math> \alpha </math>, the Family-Wise Error Rate (FWER) is <math> FWER = 1 - (1 - \alpha)^N </math>. Bonferroni correction divides the threshold by the number of tests, <math> p < \frac{\alpha}{N} </math>, but can increase false negatives. The False Discovery Rate (FDR) by Benjamini-Hochberg is less conservative, allowing more true discoveries with an acceptable proportion of false positives. The Bayesian approach uses prior knowledge to balance prior and data with a posterior distribution, offering a valid alternative to the p-value. To combine p-values from multiple studies, meta-analysis uses methods like Fisher's: <math> \chi^2 = -2 \sum \ln(p_i) </math>. In summary, the p-value remains useful when contextualized and integrated with other measures, such as confidence intervals and Bayesian approaches.}}' a "significance test" that assesses data validity. Yet, even this entrenched concept is now being challenged. A recent study highlighted a campaign in the journal "Nature" against the use of the P-value.<ref name=":1">{{cita libro
-|-
-|
-*'''''<math>P-value</math>''''': <br>In medicine, for example, to confirm an experiment, a series of data coming from laboratory instruments or from surveys, the "''Statistical Inference''" is used, and in particular a famous value called "" 'significance test' '" or <math>P-value</math>. Well, even this concept, now part of the researcher's genesis, is wavering. In a recent study, attention was focused on a "Campaign" conducted on "Nature" against the concept of "significance tests"<ref>{{cita libro
   | autore = Amrhein V
   | autore2 = Greenland S
@@ Line 206: / Line 171: @@
   | DOI = 10.1038/d41586-019-00857-9
   | OCLC =
-  }} Mar;567(7748):305-307.</ref>.<br />With over 800 signatories supporting important scientists, this "campaign" can be considered an important milestone and a "Silent Revolution"<ref>{{cita libro
+  }} Mar;567(7748):305-307.</ref> Signed by over 800 scientists, this campaign marks a "silent revolution" in statistical inference, encouraging a reflective and modest approach to significance.<ref name=":2">{{cita libro
   | autore = Rodgers JL
   | titolo = The epistemology of mathematical and statistical modeling: a quiet methodological revolution
@@ Line 219: / Line 184: @@
   | DOI = 10.1037/a0018326
   | OCLC =
-  }} Jan;65(1):1-12.</ref> in statistics on logical and epistemological aspects<ref>{{cita libro
+  }} Jan;65(1):1-12.</ref><ref name=":3">{{cita libro
   | autore = Meehl P
   | titolo = The problem is epistemology, not statistics: replace significance tests by confidence intervals and quantify accuracy of risky numerical predictions
@@ Line 232: / Line 197: @@
   | DOI =
   | OCLC =
-  }}, 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><ref name=":4">{{cita libro
   | autore = Sprenger J
   | autore2 = Hartmann S
@@ Line 246: / Line 211: @@
   | DOI =
   | OCLC =
-  }}</ref>. The campaign criticizes the too simplified statistical analyses that can still be found in many publications to date.<br>This eventually led to a discussion, sponsored by the American Statistical Association, which spawned 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 forward-looking statisticians<ref name="wasser">{{cita libro
+  }}</ref> The American Statistical Association contributed to this discussion by releasing a special issue of "The American Statistician Association" titled "Statistical Inference in the 21st Century: A World Beyond p < 0.05." It offers new ways to express research significance and embraces uncertainty.<ref name="wasser">{{cita libro
   | autore = Wasserstein RL
   | autore2 = Schirm AL
@@ Line 261: / Line 226: @@
   | DOI = 10.1080/00031305.2019.1583913
   | OCLC =
-  }} 73, 1–19. </ref>. The special question proposes both new ways to signal the importance of research results beyond the arbitrary threshold of a <math>P-value</math>, and some guides to conduct of research: the researcher should accept uncertainty, be reflective, open and modest in his/ her statements<ref name="wasser" />. Future will show whether or not those attempts to statistically better support science beyond the significance tests will be reflected in future publications<ref>{{cita libro
+  }} 73, 1–19.</ref>
- | autore = Dettweiler Ulrich
- | titolo = The Rationality of Science and the Inevitability of Defining Prior Beliefs in Empirical Research
+'''Interdisciplinarity''': Solving science-based problems increasingly demands interdisciplinary research (IDR), as underscored 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> Yet IDR poses cognitive challenges, partly due to the dominant "Physical Paradigm of Science" that limits its recognition. The "Engineering Paradigm of Science" has been proposed as an alternative, focusing on technological tools and collaboration. Researchers need "metacognitive scaffolds"—tools to enhance interdisciplinary communication and knowledge construction.<ref name=":0">{{cita libro
- | url = https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01866/full
- | volume =
- | opera = Front Psychol
- | anno = 2019
- | editore =
- | città =
- | ISBN =
- | LCCN =
- | DOI = 10.3389/fpsyg.2019.01866
- | OCLC =
- }} Aug 13;10:1866.</ref>. In this field too, we are on the same wavelength as the Progress of Science according to Kuhn, in that we are talking about the re-modulation of some descriptive statistical contents within the scope of disciplinarity.
-|-
-|
-*'''Interdisciplinarity''': <br>In science policy, it is generally recognized that ''science-based problem solving requires interdisciplinary research'' ('''IDR'''), as proposed by the EU project called Horizon 2020<ref>European Union, ''[https://ec.europa.eu/programmes/horizon2020/en/h2020-section/societal-challenges Horizon 2020]''</ref>. In a recent study, the authors focus on the question why researchers have cognitive and epistemic difficulties in conducting IDR. It is believed that the loss of philosophical interest in the epistemology of interdisciplinary research is due to a philosophical paradigm of science called "Physics Paradigm of Science", which prevents recognition of important IDR changes in both the philosophy of science and research.<br>The proposed alternative philosophical paradigm, called "''Engineering Paradigm of Science''", makes alternative philosophical assumptions about aspects such as the purpose of science, the character of knowledge, the epistemic and pragmatic criteria for the acceptance of knowledge and the role of technological tools. Consequently, scientific researchers need so-called ''metacognitive scaffolds'' to assist them in the analysis and reconstruction of how "knowledge" is constructed in different disciplines.<br>In interdisciplinary research, metacognitive scaffolds help interdisciplinary communication analyse and articulate how the discipline builds knowledge<ref name=":0">{{cita libro
   | autore = Boon M
   | autore2 = Van Baalen S
@@ Line 305: / Line 256: @@
   | OCLC =
   }} Oct;129:25-39.</ref>
-|}
+==Interdisciplinarity==
+A superficial view might suggest a conflict between the disciplinarity of the "Physics Paradigm of Science{{Tooltip||2=The "Physical Paradigm of Science" describes an epistemological approach prevalent in the physical sciences, focusing on deterministic models and rigorous experimental methodologies. This paradigm relies on empirical observations and the scientific method to seek universal laws governing natural phenomena.'''Key Characteristics''' 1. ''Determinism'': Assumes that natural phenomena follow fixed laws, allowing for accurate predictions based on initial conditions.
-==Anomaly ''vs.'' Interdisciplinarity==
+. ''Measurability and Reproducibility'': Emphasizes quantitative measurements and reproducible experiments to confirm results across different contexts.
+. ''Isolation of Variables'': Focuses on analyzing specific effects by isolating variables, often idealizing systems under controlled conditions.
-Given the above, on a superficial view of the epistemic evolution of the Science, the two aspects of disciplinarity ("''Physics Paradigm of Science''", highlighting the anomaly) and Interdisciplinary ("''Engineering Paradigm of Science''", metacognitive scaffold), might seem to be in conflict with each other; in reality, however, as we are just going to see right in this chapter, they are two sides of the same coin because both tend to generate "Paradigmatic Innovation" without any conflict at all.
+While effective in classical natural sciences, the physical paradigm has limitations in complex fields like neurophysiology, where dynamic interactions and variability challenge deterministic models. '''Application in Masticatory Neurophysiology''': In masticatory neurophysiology, the physical paradigm aids in developing basic models but falls short in explaining emergent behaviors, such as motor unit recruitment in response to complex stimuli. '''Towards an Integrated Paradigm''': Emerging is an "Engineering Paradigm of Science," which offers a more adaptive approach that considers complexity, allowing for more flexible predictive models that account for non-linear interactions in biological systems.}}" (which highlights anomalies) and the interdisciplinarity of the "Engineering Paradigm of Science{{Tooltip||The '''Engineering Paradigm of Science''' emphasizes practical applications, interdisciplinary collaboration, and the understanding of complex systems. It contrasts with traditional deterministic models, focusing instead on real-world problem-solving, particularly in fields like biology, medicine, and social sciences.'''Key Features''' ''Problem-Solving Orientation'': Prioritizes solutions to complex issues over purely theoretical models. ''Interdisciplinary Collaboration'': Encourages integration of knowledge from various disciplines, enhancing understanding through shared expertise. ''Complex Systems Focus'': Acknowledges emergent behavior and the interconnectivity of system components, recognizing that outcomes can be unpredictable and non-linear.
+''Iterative Process'': Embraces an adaptive approach, refining models based on empirical data and feedback to improve responsiveness.'''Technological Integration''': Applies engineering principles to enhance research design and data analysis, utilizing simulations and computational modeling. '''Application in Masticatory Neurophysiology''' In masticatory neurophysiology, this paradigm fosters innovative diagnostic tools and treatment approaches. By integrating neurophysiology, biomechanics, and material science, it provides a comprehensive view of jaw function and dysfunction.The Engineering Paradigm of Science promotes collaboration and innovation, ultimately leading to advancements that enhance our understanding of complex systems and improve practical outcomes across various fields.}}" (focused on metacognitive scaffolds). However, these perspectives are not in conflict; they are complementary and drive "Paradigmatic Innovation" in science.
-Now we could conclude that the "Innovations" are already "Progress of Science" in themselves, as stated in the article "''Scientific basis of dentistry''" by Yegane Guven<ref>{{cita libro
+It could be said that "Innovations" represent "Progresses of Science," as illustrated in the article "Scientific Bases of Dentistry" by Yegane Guven, which explores the impact of biological and digital revolutions on dentistry.<ref>{{cita libro
   | autore = Guven Y
   | titolo = Scientific basis of dentistry
@@ Line 324: / Line 276: @@
   | DOI = 10.17096/jiufd.04646
   | OCLC =
-  }} 51(3): 64–71. Published online 2017 Oct 2. PMCID: PMC5624148 - PMID: 29114433 </ref> in which the effect of biological and digital revolutions is considered on dental education and daily clinical practice, such as personalized regenerative dentistry, nanotechnologies, virtual reality simulations, genomic information and stem cell studies. The innovations mentioned by Guven are obviously to be considered as technological and methodological in nature; however, the Progress of Science does not move forward with this kind of Innovations, which are called "''Incremental Innovations''" and "''Radical Innovations''", but it occurs substantially through "''Paradigmatic Innovations''".
+  }} 51(3): 64–71. Published online 2017 Oct 2. PMCID: PMC5624148 - PMID: 29114433 </ref> True scientific progress is not solely achieved through "Incremental Innovations" or "Radical Innovations" but through "Paradigmatic Innovations."
-In the strictest sense of the phrase, "Paradigmatic Innovations" are essentially '''a change of thought and awareness''' that pervades the whole of humanity, starting from different social strata, from the Copernican scientific revolution to the current trend of Stochastic approach to the biological phenomenon<ref>{{cita libro
+"Paradigmatic Innovations" represent a change in thinking that spreads through humanity, affecting society on many levels, from the Copernican revolution to the stochastic methods applied to biological phenomena.<ref>{{cita libro
   | autore = Zhao XF
   | autore2 = Gojo I
@@ Line 343: / Line 295: @@
   | DOI =
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-  }} Prepublished online 2009 Oct 10. PMCID: PMC2776262 - PMID: 19918331. 3(1): 75–86.</ref>.
+  }} Prepublished online 2009 Oct 10. PMCID: PMC2776262 - PMID: 19918331. 3(1): 75–86.</ref>
-In this epistemological context (in addition to other initiatives such as the ''Research Diagnostic Criteria'' in the field of the Temporomandibular Disorders — RDC/TMDs), of the Evidence Based Medicine (and other), the Masticationpedia project inserts itself in order to highlight the dialectics dynamism about the progress of the masticatory rehabilitation science. Masticationpedia tends, moreover, to highlight the anomalies that inevitably stimulate a change of thought and therefore a "Paradigmatic Innovation".
+This epistemological context, which includes initiatives like the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and Evidence-Based Medicine, aligns with Masticationpedia’s aim to highlight anomalies that stimulate changes in scientific thought, ultimately leading to "Paradigmatic Innovation."
-Before proceeeding, it could be appropriate to observe a very concrete and significant case.
+==Dental Malocclusion==
-==Malocclusion==
+"Malocclusion" derives from the Latin "malum," meaning "bad" or "wrong," and refers to improper closure of the teeth.<ref>Attributed to [[:wpen:Edward Angle|Edward Angle]], the father of modern orthodontics, who coined it as a specification of ''occlusion''.</ref> The notion of "closure" may seem intuitive, but "bad" requires careful consideration in a medical context.
-''Malocclusion'': it literally means a bad (''malum'', in Latin) closure of the dentition<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
- | autore = Gruenbaum T
- | titolo = Famous Figures in Dentistry
- | url =
- | volume =
- | opera = Mouth – JASDA
- | anno = 2010
- | editore =
- | città =
- | ISBN =
- | LCCN =
- | DOI =
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- }}, 30(1):18. </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<ref name="Smaglyuk">{{cita libro
+A search for "Malocclusion" on PubMed yielded 33,309 articles,<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=%22malocclusion%22 Malocclusion]''</ref> reflecting a lack of consensus on the term. Smaglyuk and colleagues’ study underscores the importance of an interdisciplinary approach to diagnosing malocclusions.<ref>{{cita libro
   | autore = Smaglyuk LV
   | autore2 = Voronkova HV
@@ Line 374: / Line 311: @@
   | titolo = Interdisciplinary approach to diagnostics of malocclusions (review)
   | url = https://www.ncbi.nlm.nih.gov/pubmed/31175796
   | volume =
   | opera = Wiad Lek
   | anno = 2019
@@ Line 383: / Line 320: @@
   | DOI =
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-  }} 72(5 cz 1):918-922.
+  }} 72(5 cz 1):918-922.</ref>
-</ref>, a somewhat "sensational" article that deals with the interdisciplinary approach in the diagnosis of malocclusions:
-{{q2|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}}
+{{q2|Diagnosis, treatment strategies, and prevention of anomalies and dento-facial deformities should be approached by considering the organism as a whole. This is especially important in children, whose physical structure is still forming. The interconnectedness of various organs and systems is crucial for effective treatment planning.}}
-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>.
+Another notable observation from PubMed queries on interdisciplinary malocclusion diagnostics is the drastic drop to only 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”.
+These findings suggest the emergence of phase 4 in Kuhn’s model, indicating a potential paradigmatic shift. Some prefer incremental innovations, while others favor a new 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=|right|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.]]
 {{qnq|What does "Malocclusion" mean?|}}
-We will answer this question by reporting a clinical case of evident “Malocclusion”.
+In this clinical case of malocclusion, characterized by a unilateral posterior crossbite and anterior open bite, orthodontic appliances and possibly orthognathic surgery are recommended.<ref>{{cita libro
-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 =
- }} Mar;62 Suppl 1:51-57.</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
@@ Line 429: / Line 345: @@
   | DOI = 10.1007/s10006-013-0430-5
   | OCLC =
-  }} Sep;18(3):271-7. </ref>. Crossbite is another element of disturbance in normal occlusion<ref>{{cita libro
+  }} Sep;18(3):271-7.</ref> The crossbite requires concurrent treatment due to its functional relationship with the open bite.<ref>{{cita libro
   | autore = Miamoto CB
   | autore2 = Silva Marques L
@@ Line 445: / Line 361: @@
   | DOI =
   | OCLC =
-  }} Jan-Feb; 23(1) 71–78.</ref> because of which it is obligatorily treated together with the openbite<ref>{{cita libro
+  }} Jan-Feb; 23(1) 71–78.</ref>
- | 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 =
- }} Jan-Mar; 3(1): 1–6.</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 =
- }} Jan;5(1):21-7.</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.]]
+In this case, the patient refused treatment, insisting that their chewing function was fine. The dentist responded by explaining the long-term risks of leaving the malocclusion untreated, but respected the patient's decision to decline treatment.
-{|
+The case illustrates the complexity of diagnosing malocclusion, which involves more than occlusal discrepancies. Specific electrophysiological tests, such as the motor-evoked potential and jaw reflex tests, can reveal functional symmetry in the masticatory system despite occlusal issues.
-|-
-|&nbsp;&nbsp;&nbsp;&nbsp;
-|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.
+<gallery mode="slideshow">
-[[File:Jaw Jerk .jpg|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.]]
+File:Occlusal Centric view in open and cross bite patient.jpg|'''Figure 1a:''' Patient with malocclusion, open bite, and right posterior crossbite who should be treated with orthodontic therapy and/or orthognathic surgery.
+File:Bilateral Electric Transcranial Stimulation.jpg|'''Figure 1b:''' Motor-evoked potential test showing symmetry in the right and left masseter muscles.
+File:Jaw Jerk .jpg|'''Figura 1c:''' Jaw reflex test revealing functional symmetry in the masticatory system.
+File:Mechanic Silent Period.jpg|'''Figura 1d:''' Evoked mechanical silent period showing balanced neuromuscular dynamics despite malocclusion.
+</gallery>
-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.
+These electrophysiological results challenge conventional interpretations of malocclusion, highlighting the importance of interdisciplinary diagnostics that consider neuromuscular function as well as occlusal discrepancies.
-[[File:Mechanic Silent Period.jpg|thumb|'''Figura 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.]]
+<blockquote>''Occlusal Dismorphisms and Not Malocclusion ......which, as we will see shortly, is an entirely different matter.''</blockquote>
-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.
-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|Occlusal dysmorphism and not Malocclusion (which, as we shall see a little further on, is quite another thing)|}}
 ==Conclusion==
-Even before drawing conclusions, conceptual clarity must be made on some fundamental points which of course will be treated in detail in the specific chapters of Masticationpedia.
+Before concluding, we must clarify that the masticatory system is a "Complex System"<ref>https://en.wikipedia.org/wiki/Complex_system</ref>, not a simple biomechanical mechanism focused solely on dental occlusion. Occlusion is just one subset within a broader context that includes periodontal receptors, neuromuscular spindles, motor units, the central nervous system, and the temporomandibular joint. This interaction creates "Emergent Behavior{{Tooltip||The **masseter silent period** (MSP) is a relevant example of emergent behavior in masticatory neurophysiology. This reflex is triggered by sudden chin taps, leading to a brief cessation of electrical activity in the masseter muscle, and is closely related to the recruitment of motor units. During the MSP, there is a specific modulation of motor unit recruitment, regulated by the central nervous system, to respond to external stimuli. In the context of emergent behavior, this reflex is not limited to a single muscle but represents a coordinated response involving synergies among various neuronal centers and antagonist muscles. This integration stabilizes the mandible, adapting in real time to the force of the stimulus and producing an adaptive response. Mathematically, we can describe the probability <math>P(R)</math> of an emergent response as a function of the input variables <math>x_1, x_2, \ldots, x_n</math> that influence motor unit activation: <math>P(R) = f(x_1, x_2, \ldots, x_n)
+</math> where <math>f</math> represents the non-linear interaction among incoming stimuli (such as the type and intensity of the chin tap) and the central integration processes of the trigeminal system. This model helps to understand how the MSP reflects an integrated and adaptive response that emerges from complex neurophysiological circuits rather than a single neural pathway.}}," or masticatory behavior.
-The Masticatory System should be considered as a “'''Complex System'''”<ref>''[[wpen:Complex system|Complex system]]'' on [https://en.wikipedia.org/wiki/ Wikipedia]</ref>, not as a Biomechanical System focused exclusively on dental occlusion, because in this sense the “Occlusion” is nothing more than a subset of the Complex System interacting with the other subsets, such as periodontal receptors, neuromuscular spindles, recruitment of motor units, central nervous system, temporomandibular joint, etc., to give shape to an “Emerging Behaviour”, the masticatory one.
-The peculiarity of this concept is that it is not possible to interpret or predict the “Emerging Behaviour” of a System by extracting objective data from a single subset. Instead, ''the integrity of the System must be quantified in its entirety'', and only then can a segmentation of the whole be attempted to make an analytical description of the node itself. There are very important intellectual and scientific movements that are engaging with this issue; in this regard, the extraordinary work of Prof. Kazem Sadegh-Zadeh: ''Handbook of Analytic Philosophy of Medicine'' comes to mind.<ref>{{cita libro
+Emergent behavior cannot be fully explained by analyzing a single subset; instead, the integrity of the entire system must be assessed. A notable intellectual movement addressing this challenge is Kazem Sadegh-Zadeh’s work, "Handbook of Analytic Philosophy of Medicine."<ref>{{cita libro
   | autore = Sadegh-Zadeh Kazem
   | titolo = Handbook of Analytic Philosophy of Medicine
@@ Line 521: / Line 397: @@
   }}.</ref>
-In the presented case, the question is resolved in the following language logic:
+The masticatory system's various subsets, such as teeth, occlusion, joints, and muscles, exhibit "Coherence" with the Central Trigeminal Nervous System, as shown in the electrophysiological tests. Therefore, "malocclusion" may not be the appropriate term; "Occlusal Dysmorphisms" would be more accurate.
+{{q2|Viewing the masticatory system as a "Complex System" doesn’t deny existing rehabilitative therapies like prosthetics or orthodontics but instead aims to enrich them by considering a broader interdisciplinary perspective.}}
-:The subsets of the Masticatory System (teeth, occlusion, Temporomandibular joints, muscles, etc.) are in a state of "Coherence” with the Central Trigeminal Nervous System (see figures 1b, 1c and 1d), so the term “Malocclusion” cannot be used, the phrase “Occlusal  Dismorphism” should be considered instead.
+This approach, exemplified in OrthoNeuroGnathodontic treatments, integrates aesthetic and neurophysiological aspects to achieve "Occlusal Stability" and prevent "Relapses."<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.
-:{{q2|This does not mean abolishing prosthetic, orthodontic and orthognathic masticatory rehabilitation treatments: on the contrary, this forma mentis tends to restore medical knowledge to dental rehabilitation disciplines, as well as offering an alternative to the scientific reductionism that converges in a deterministic interpretation of the biological phenomenon.|}}
+</ref><ref>J Hoffmannová, R Foltán, M Vlk, K Klíma, G Pavlíková, O Bulik. [https://pubmed.ncbi.nlm.nih.gov/19537679/ Factors affecting the stability of bilateral sagittal split osteotomy of a mandible].Prague Med Rep. 2008;109(4):286-97.
+</ref> While not replacing traditional treatments, this model seeks to expand medical knowledge and interdisciplinary practices in dentistry.
-Going beyond the specialist perimeters of the disciplines, as previously reported on interdisciplinarity, helps expanding the diagnostic and therapeutic models as it can be seen in the ''[[Aggiornamenti:1/OrthoNeuroGnatodontics|Clinical Case]]'' in which a patient was treated with the OrthoNeuroGnathodontic method is reported.
+In the meantime, let us pause with a question from Linus Sapiens, our curious yellow figure on the left. He reminds us of the importance of remaining open to new perspectives in masticatory science.
-In this way, an overall view of the entire Masticatory System is presented in order to gather the aesthetic and functional-neurophysiological components together to determine “Occlusal Stability” and to avoid “Relapses”, especially in orthodontic and orthognathic treatments.<ref>{{cita libro
- | autore = Al-Moraissi EA
- | autore2 = Wolford LM
- | titolo = Is Counterclockwise Rotation of the Maxillomandibular Complex Stable, Compared With Clockwise Rotation, in the Correction of Dentofacial Deformities? A Systematic Review and Meta-Analysis
- | url = https://www.ncbi.nlm.nih.gov/pubmed/27371873
- | volume =
- | opera = J Oral Maxillofac Surg
- | anno = 2016
- | editore =
- | città =
- | ISBN =
- | LCCN =
- | DOI = 10.1016/j.joms.2016.06.001
- | OCLC =
- }} Oct;74(10):2066.e1-2066.e12.</ref><ref>{{cita libro
- | autore = Hoffmannová J
- | autore2 = Foltán R
- | autore3 = Vlk M
- | autore4 = Klíma K
- | autore5 = Pavlíková G
- | autore6 = Bulik O
- | autore7 =
- | titolo = Factors affecting the stability of bilateral sagittal split osteotomy of a mandible
- | url = https://www.ncbi.nlm.nih.gov/pubmed/19537679
- | volume =
- | opera = Prague Med Rep
- | anno = 2008
- | editore =
- | città =
- | ISBN =
- | LCCN =
- | DOI =
- | OCLC =
- }} 109(4):286-97.</ref>
 [[File:Question_2.jpg|left|150px]]
-These are just some of the topics that will be covered extensively both in this chapter and in what we call “Extraordinary Science”. Meanwhile, in a fitting diversion our colourful friend ''Linus Sapiens'', the little yellow man on the left, asks us:
+{{qnq|What do we mean by “Complex Systems” when we are talking about masticatory functions?}}
-{{qnq|What do we mean by “Complex Systems” when we are talking about masticatory functions?}}
 {{Bib}}
 {{apm}}[[Category:Introduction]]
-<onlyinclude> </onlyinclude>
+<onlyinclude></onlyinclude>