Masticationpedia

Difference between revisions of "Introduction"

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==Ab ovo<ref>Latin for 'since the very beginning'</ref>==
==Ab ovo<ref>Latin for 'since the very beginning'</ref>==


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


=== The phases of paradigm change according to Thomas Kuhn ===
=== 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  
Over the past century, technological and methodological innovations<ref>{{cita libro  
  | autore = Heft MW
  | autore = Heft MW
  | autore2 = Fox CH
  | autore2 = Fox CH
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  | DOI = 10.1177/2380084419879391
  | DOI = 10.1177/2380084419879391
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  | OCLC =  
  }} 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  
  }} 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  
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  }}</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  
  }}</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
  | autore = Liu L
  | autore2 = Li Y
  | autore2 = Li Y
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  | DOI = 10.1358/dot.2014.50.1.2076506
  | DOI = 10.1358/dot.2014.50.1.2076506
  | OCLC =  
  | OCLC =  
  }} 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".
  }} 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."


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.
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  
</ref><ref>{{cita libro  
  | autore = Kuhn Thomas S
  | autore = Kuhn Thomas S
  | titolo = The Structure of Scientific Revolutions
  | titolo = The Structure of Scientific Revolutions
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  }}</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.
  }}</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.


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.
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 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]]
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.
 
'''Thomas Kuhn''' in his most famous work states 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''. 
 
===Kuhn's phases in Dentistry ===
 
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:


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*<u>'''''Phase 2'''''</u>, or the Normal Science<br>For instance, in the second phase of Kuhn's paradigms, called "Normal Science," scientists are considered problem solvers engaged in strengthening the correspondence between the paradigm and natural reality. This phase is based on a set of fundamental principles established by the paradigm itself, which are not subject to dispute but are instead used to define the guidelines for future research projects. During this phase, the development of the necessary measurement tools to conduct experiments takes place, and the majority of the scientific literature is produced. The results obtained in this phase contribute significantly to the advancement of scientific knowledge. In normal science, both successes and failures occur; the latter are identified by Kuhn as "anomalies," i.e., events that contradict the prevailing paradigm.
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|<blockquote>'''Phase 2''', or '''Normal Science''':
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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>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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|<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>
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|<blockquote>'''Phase 5''', or the '''Scientific Revolution''':
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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>
*<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.
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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.
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.
 
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| 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]]
| align="center" |[[File:Black_Swan_(Cygnus_atratus)_RWD.jpg|175px|center]]
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| align="center" |[[File:Duck-Rabbit illusion.jpg|203px|center]]
| 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>
| 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>
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</center>
</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.


 
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  
'''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  
  | autore = Srivastava S
  | autore = Srivastava S
  | titolo = Verifiability is a core principle of science
  | titolo = Verifiability is a core principle of science
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  | DOI = 10.1017/S0140525X18000869
  | DOI = 10.1017/S0140525X18000869
  | OCLC =  
  | 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'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
<math>A \Rightarrow B = \lnot A \lor B</math>
|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> in other words, every example that does not contradict the theory confirms a part of it. According to this paradox:


<math>A\Rightarrow B = \lnot A \lor B</math>
No theory can be definitively true; while there are finite experiments to confirm it, an infinite number could refute it.<ref>{{cita libro  
 
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  
  | autore = Evans M
  | autore = Evans M
  | titolo = Measuring statistical evidence using relative belief
  | titolo = Measuring statistical evidence using relative belief
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  | DOI = 10.1016/j.csbj.2015.12.001
  | DOI = 10.1016/j.csbj.2015.12.001
  | OCLC =  
  | OCLC =  
  }} Jan 7;14:91-6. </ref>
  }} Jan 7;14:91-6.</ref>


{{qnq|But it’s not all so obvious...}}
{{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:


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*'''''<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  
*'''P-value''': In medicine, for example, we rely on statistical inference to confirm experimental results, specifically the P-value, 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>{{cita libro  
  | autore = Amrhein V
  | autore = Amrhein V
  | autore2 = Greenland S
  | autore2 = Greenland S
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  | DOI = 10.1038/d41586-019-00857-9
  | DOI = 10.1038/d41586-019-00857-9
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  }} 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  
  }} 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>{{cita libro  
  | autore = Rodgers JL
  | autore = Rodgers JL
  | titolo = The epistemology of mathematical and statistical modeling: a quiet methodological revolution
  | titolo = The epistemology of mathematical and statistical modeling: a quiet methodological revolution
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  }}, 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>{{cita libro  
  | autore = Sprenger J
  | autore = Sprenger J
  | autore2 = Hartmann S
  | autore2 = Hartmann S
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  }}</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  
  }}</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
  | autore = Wasserstein RL
  | autore2 = Schirm AL
  | autore2 = Schirm AL
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  | DOI = 10.1080/00031305.2019.1583913
  | DOI = 10.1080/00031305.2019.1583913
  | OCLC =  
  | OCLC =  
  }} 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
  }} 73, 1–19.</ref>
| autore = Dettweiler Ulrich
| titolo = The Rationality of Science and the Inevitability of Defining Prior Beliefs in Empirical Research
| url = https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01866/full
| volume =
| opera = Front Psychol
| anno = 2019
| editore =
| città =
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| DOI = 10.3389/fpsyg.2019.01866
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}} Aug 13;10:1866.</ref> This evolution aligns with Kuhn's concept of scientific progress, reflecting a reworking of some descriptive statistical content within the discipline.
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*'''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  
*'''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  
  | autore = Boon M
  | autore = Boon M
  | autore2 = Van Baalen S
  | autore2 = Van Baalen S
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  | DOI = 10.1016/j.pbiomolbio.2017.04.001
  | DOI = 10.1016/j.pbiomolbio.2017.04.001
  | OCLC =  
  | OCLC =  
  }} Oct;129:25-39.</ref>
  }} Oct;129:25-39.</ref>
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==Interdisciplinarity==
==Interdisciplinarity==
A superficial view might suggest a conflict between the disciplinarity of the "Physics Paradigm of Science" (which highlights anomalies) and the interdisciplinarity of the "Engineering Paradigm of Science" (focused on metacognitive scaffolds). However, these perspectives are not in conflict; they are complementary and drive "Paradigmatic Innovation" in science.


A superficial view might suggest that the epistemic evolution of science is marked by an apparent opposition between the aspects of disciplinarity, highlighted by the "Physics Paradigm of Science" (which sheds light on anomalies), and those of interdisciplinarity, represented by the "Engineering Paradigm of Science" (and the related concept of metacognitive scaffold). However, as will be explored in this chapter, these two perspectives are not actually in conflict; on the contrary, they prove to be complementary, as both contribute to the generation of a "Paradigmatic Innovation" without any form of conflict.
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  
 
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  
  | autore = Guven Y
  | autore = Guven Y
  | titolo = Scientific basis of dentistry
  | titolo = Scientific basis of dentistry
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  | DOI = 10.17096/jiufd.04646
  | DOI = 10.17096/jiufd.04646
  | OCLC =  
  | OCLC =  
  }} 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."
  }} 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 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  
"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
  | autore = Zhao XF
  | autore2 = Gojo I
  | autore2 = Gojo I
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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>


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."
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 proceeding, it might be appropriate to observe a very concrete and significant case.
==Dental Malocclusion==


== Dental 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" 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
| autore = Gruenbaum T
| titolo = Famous Figures in Dentistry
| url =
| volume =
| opera = Mouth – JASDA
| anno = 2010
| editore =
| città =
| ISBN =
| LCCN =
| DOI =
| OCLC =
}}, 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  
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
  | autore = Smaglyuk LV
  | autore2 = Voronkova HV
  | autore2 = Voronkova HV
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  | titolo = Interdisciplinary approach to diagnostics of malocclusions (review)
  | titolo = Interdisciplinary approach to diagnostics of malocclusions (review)
  | url = https://www.ncbi.nlm.nih.gov/pubmed/31175796
  | url = https://www.ncbi.nlm.nih.gov/pubmed/31175796
  | volume =
  | volume =  
  | opera = Wiad Lek
  | opera = Wiad Lek
  | anno = 2019
  | anno = 2019
Line 364: Line 315:
  | DOI =  
  | DOI =  
  | OCLC =  
  | OCLC =  
  }} 72(5 cz 1):918-922.
  }} 72(5 cz 1):918-922.</ref>
</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.}}
{{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 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>
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>


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".
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."


To explore the concept of "Paradigmatic Innovation", considered essential in this context, let's begin by posing a specific question:
[[File:Occlusal Centric view in open and cross bite patient.jpg|alt=|thumb|'''Figure 1a:''' Patient with malocclusion, open bite, and right posterior crossbite who should be treated with orthodontic therapy and/or orthognathic surgery.|500x500px]]
 
Another noteworthy piece of data is that if in the same year, 2019, PubMed was queried about the interdisciplinarity in diagnosing malocclusions, the result dropped drastically to only four articles.
 
These premises regarding the question of "Malocclusion" indicate, on one hand, an alertness to anomalies that tend to trigger phase 4 of Kuhn and, on the other hand, a bifurcation in epistemic choice on the topic: one that generates Incremental Innovations (other 33,309 articles, perhaps) and another that prefers a new gnoseological path of "Paradigmatic Innovation".
 
Let's try to approach part of the concept that considers "Paradigmatic Innovation" essential, asking, for example:
 
[[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]]


{{qnq|What does "Malocclusion" mean?|}}
{{qnq|What does "Malocclusion" mean?|}}


To answer the previously posed question, let's examine a clinical case that clearly exemplifies "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  
 
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
| 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> 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  
  | autore = Reichert I
  | autore = Reichert I
  | autore2 = Figel P
  | autore2 = Figel P
Line 417: Line 342:
  | DOI = 10.1007/s10006-013-0430-5
  | DOI = 10.1007/s10006-013-0430-5
  | OCLC =  
  | OCLC =  
  }} 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  
  }} 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
  | autore = Miamoto CB
  | autore2 = Silva Marques L  
  | autore2 = Silva Marques L  
Line 433: Line 358:
  | DOI =  
  | DOI =  
  | OCLC =  
  | OCLC =  
  }} Jan-Feb; 23(1) 71–78.</ref><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 becomes clear that a deterministic approach to diagnosing such obvious occlusal incongruence might lead to considering both the crossbite and the open bite as both causes and effects of malocclusion, consequently suggesting orthodontic intervention to restore "Normocclusion". This mode of thinking would presuppose that the model (the masticatory system) should be "normalized" with respect to occlusion. Interpreted conversely, this would imply that the occlusal discrepancy is the cause of malocclusion and, by extension, pathology of the Masticatory Apparatus. (Figure 1a).
 
In the context of a clinical case highlighting the presence of malocclusion, with particular attention to the unilateral posterior crossbite and anterior open bite, the importance of dialogue between dentist and patient emerges. This informative conversation is crucial not only for sharing the diagnosis and treatment options but also for understanding the patient's concerns, expectations, and desires. Here's how such a dialogue might unfold:
 
 
'''Dentist:''' "Considering your malocclusion situation, which includes an open bite and unilateral posterior crossbite, treatment is recommended to improve both aesthetics and chewing functionality. Without intervention, you may experience future problems such as bruxism, swallowing difficulties, and potential postural issues."
 
'''Patient:''' "Absolutely not, doctor. I have no intention of undergoing any treatment. I may have an imperfect smile, but my chewing function is excellent. I eat without any issues, so I don't see why I should worry."
 
'''Dentist:''' "I understand that you feel comfortable with your current chewing condition. However, it's important to consider that some problems may not be immediately evident but could manifest over time, affecting not only oral health but also overall well-being."


'''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."
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.


'''Dentist:''' "I understand your position. It's crucial that you feel comfortable with any decision made regarding your health. My role is to inform you about potential long-term implications and available treatment options. If you ever change your mind or need further information, know that I'm here to assist you."
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.
----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."
 
In this context, the reference to the American Statistical Association's critique entitled "Statistical inference in the 21st century: A World Beyond p < 0.05" becomes relevant, as it invites the researcher to navigate uncertainty with sensitivity, reflexivity, openness, and modesty in assertions.<ref name="wasser" /> This stance paves the way for interdisciplinarity as a key to addressing such complex issues.
 
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.


<gallery mode="slideshow">
<gallery mode="slideshow">
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: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:''' 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:Jaw Jerk .jpg|'''Figura 1c:''' Jaw reflex test revealing functional symmetry in the masticatory system.
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.  
File:Mechanic Silent Period.jpg|'''Figura 1d:''' Evoked mechanical silent period showing balanced neuromuscular dynamics despite malocclusion.
</gallery>
</gallery>


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


<blockquote>''Occlusal Dismorphisms and Not Malocclusion ......which, as we will see shortly, is an entirely different matter.''</blockquote>
<blockquote>''Occlusal Dismorphisms and Not Malocclusion ......which, as we will see shortly, is an entirely different matter.''</blockquote>


==Conclusion==
==Conclusion==
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.
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," or masticatory behavior.


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.
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  
 
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  
  | autore = Sadegh-Zadeh Kazem
  | autore = Sadegh-Zadeh Kazem
  | titolo = Handbook of Analytic Philosophy of Medicine
  | titolo = Handbook of Analytic Philosophy of Medicine
Line 518: Line 392:
  }}.</ref>
  }}.</ref>


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".
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.}}


:
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|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><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><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> 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.
</ref> 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.


[[File:Question_2.jpg|left|150px]]
[[File:Question_2.jpg|left|150px]]


{{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?}}




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{{apm}}[[Category:Introduction]]
{{apm}}[[Category:Introduction]]
<onlyinclude> </onlyinclude>
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Revision as of 11:51, 16 October 2024

Introduction

 

Masticationpedia
Article by  Gianni Frisardi

 

Ab ovo[1]

Before delving into the analysis of Masticationpedia, we must first introduce some preliminary considerations, particularly regarding two fundamental dimensions—social, scientific, and clinical—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?
Black Swan (Cygnus atratus) RWD.jpg
Duck-Rabbit illusion.jpg
 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:

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, 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" (which highlights anomalies) and the interdisciplinarity of the "Engineering Paradigm of Science" (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."

Figure 1a: Patient with malocclusion, open bite, and right posterior crossbite who should be treated with orthodontic therapy and/or orthognathic surgery.

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 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," 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.

Question 2.jpg

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


Bibliography & references
  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.
  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.
  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.
  13. ↑ Meehl P, «The problem is epistemology, not statistics: replace significance tests by confidence intervals and quantify accuracy of risky numerical predictions», 1997». 
  14. ↑ Sprenger J, Hartmann S, «Bayesian Philosophy of Science. Variations on a Theme by the Reverend Thomas Bayes», Oxford University Press, 2019, Oxford». 
  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
  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. ↑ https://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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