Updates:1/OrthoNeuroGnatodontics

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Article by Flavio Frisardi · Gianni Frisardi

OrthoNeuroGnathodontics on 2° Class patient

OrthoNeuroGnathodontic treatment on 2° Class patient, ipodivergente con Deep Bite

Presentation

12-year-old patient who shows to the cephalometric examination, a underdevelopment of the jaw, which is small and not very projected, and imprisoned in the maxilla. The hypodivergent growth also determines a severe deep bite that does not allow the eruption of the upper canines in the presence of class 2 molar. The trigeminal electrophysiological tests (not reported here) ensured that the patient, in the conditions in which he presented himself for the Ortho-NeuroGnathodontic treatment, was in a State of System Coherence such that the occlusal imperfection could be corrected through classic orthodontic masticatory rehabilitation. If the electrophysiological responses had shown neuromotor discrepancies, a State of system decoherence would have been added to the occlusal imperfection to be treated with functional neuro-gnathological therapies to restore the state of System integrity (Figures 1, 2 and 3)

The cephalometric analysis showed a skeletal Class 2 morphology, hypodivergent, biretrusive profile with SNA 80 °, SNB 75 ° and ANB 5 °.

Figure 1: Patient’s Right side view
Figure 2: Patient’s Front side view
Figure 3: Patient’s Left side view

Treatment/Operation

The 1st phase of the treatment consisted in restoring the maxillary spaces and volumes through molar distalization by means of NiTi Opencoil (nickel titanium open spring) between the first premolars and the molars which allows to obtain in addition to the recovery of the 1st molar class also the recovery on the sagittal plane of the space necessary for the canines. The use of class 2 elastics is essential to avoid the mesializing counter vector on the upper frontal group, as well as the lip bumper inserted in the tubes of the bands in the lower molars avoids the mesializing component on the lower arch through the lip thrust on the resin shield. (Figure 4)

Caso clinico di 2° Classe con deep bite (2) - 1st phase of OrthoNeuroGnathodontic treatment (001).jpg

Figure 4: Lateral aspect of the 1st phase of OrthoNeuroGnathodontics treatment
Figura 5: Left view of the occlusal raisebite on 14 and 24 performed with the aid of trigeminal electrophysiology (image on the right side) and in particular through analysis of the jaw jerk. The upper trace indicates the right masseter.
Figura 6: Right, front and left side view of the case being finalized
Figura 7: View of the pre and post treatment clinical case

Follow up

Finalization of the clinical case with stabilization of the increased Occlusal Vertical Dimension and of the Centric Occlusal

In this phase it is absolutely important to check the alignment torque and the occlusal asymmetries in order not to generate an incisal anterior wall and occlusal interference which, in increase of the Occlusal Vertical Dimension, could increase the spatial error in the intermaxillary relationship. As reported in the introduction of Masticationpedia, the evaluation of the Central Nervous and Peripheral Trigeminal System is a keystone to interpret the Masticatory System as a Complex System and guarantee or at least reduce the incidence of iatrogenic damage from treatment such as rrelapses. Figure 7 shows the success of Orthodontic Aesthetic Follow up 5 years: the occlusal aesthetic result is optimal and there are no relapses. This clinical result is not only due to a classic and careful orthodontic procedure, but also to the occlusal stability which does not generate interference or cleavage plans which can determine pairs of twisting forces on the teeth and even more seriously at the level of the Temporomandibular Joints. In Figure 8 we can see, in fact, the perfect symmetry of the jaw jerk and the Mechanical Silent Period. These trigeminal electrophysiological steps will be extensively exposed and discussed during the implementation of Masticationpedia while in this context they should only be considered in a demonstrative way. Note, in addition to the aesthetic of the smile, the perfect symmetry of amplitude of the jaw jerk (Figures 8, 9 and 10)

Figure 8: Clinical case concluded and at 5 years of following. Note the perfect amplitude symmetry of the jaw jerk
Figure 9: Clinical case completed and results at 5 years of following. The occlusal stability depends on the Coherence between the Neuromotor Systems
Figure 10: Clinical case completed and results at 5 years of following. Please note the perfect size symmetry of the integral area of the masseteric silent periods

Book Index

Next contents:

Source Chapter

Introduction

Logic of medical language
- Classical logic
- Probabilistic logic
- Fuzzy logic
- System logic
1^st Clinical Case: Emimasticatory spasm
Complex Systems
- Coherence and decoherence
Conclusive considerations

Bruxism

Status quo and Criticity
2^rd Clinical Case: Pineal Cavernoma
Conclusions

Occlusion and Posture

Status quo and Criticity
3^th Clinical Case: Meningioma
Conclusions

Orofacial Pain

Status quo and Criticity
4^th Clinical Case: Eaton Lambert myasthenia
5^th Clinical Case: Postpoly syndrome
6^th Clinical Case: Temporomandibular disorders
Conclusions

Are we really sure to know everything?

Status quo and Criticity
7^th Clinical Case: glioblastoma of the cranial base
Conclusions

Connectivity and Complex Systems

Definition of the Fundamental Unit
Structural and functional connectivity Separation
Understanding of "Emergent Behavior"
Connectivity measurement

System Inference vs Symptom Inference

System Stochasticity
Markov chains
Inference of nonlinear Markov processes
Understanding of Network nodes

Neurophysiology and network nodes

Center of the Masticatory Pattern
Mesencephalic mechanisms
Trigeminal Motor nucleus

Sensory network nodes

Proprioceptive mechanisms
- Neuromuscular spindles
- Sensory mechanisms from the depressor muscles
- Golgi Tendon Organs
Role of impulses from the neck muscles
Periodontal and Oral Sensory Factors
Pharyngeal sensory factors
Reflex of mandibular closure
Sensory factors of the TMJ

Conclusions to the Source Chapter

information transferred over time
System Coherence Recovery

8^th Clinical Case: Coherence Recovery in ort Orthognathic

Crisis of the Paradigm

Research Diagnostic Criteria (RDC)

Sensitivity, Specificity and Predictive Values
Advantages and limitations of the RDC

Masticatory cycles

Jaw opening width
Speed of mandibular movement
Complexity of chewing kinematics

Temporomandibular Joint

Computerized Tomography of the TMJ
Magnetic resonance imaging of the TMJM

Mandibular kinematic replicator

Advantages and limits of pantography
- Pantographic Reproducibility Index
Advantages and limits of axiography
Advantages and limits of the electrognatography

Transcutaneous Electric Nerve Stimulation

Free way space before stimulation
Free way space after stimulation
Closing trajectory from TENS

Electromyography(EMG)

Interferential EMG
EMG at rest position
Quantitative analysis of the EMG
- Fourier transform
- Wavelett

Extraordinary Science

Overall view of the Masticatory System

Trigemnal electrophysiology
Trigeminal electrophysiological segmentation
- Electric Motors Evoked Potentials
- Magnetic Motors Evoked Potentials
- Jaw jerk reflex
- M-wave
- Masseteric Mechanical Silent Period
- Masseteric Electric Silent Period
- Masseteric Laser Silent Period
- Recovery Cycle of Masseteric Inhibitory reflex

Trigeminal System Connectivity

Definition of the Fundamental Unit
- Maximal Neuronal Energy Evoked
- Organic motor symmetry
- Functional motor symmetry
- Renormalization
Separation of structural and functional connectivity
- Organic vs Functional Symmetry
  - Functional Neuro Gnathological Index "NGF"
New paradigm in masticatory rehabilitations
- Prosthetics
- Implantoprosthetics
- Orthodontics
- Orthognatics

Updates