---

Rational for Diagnosis and Treatment

The basis for the diagnosis of the structural component of temporomandibular joint dysfunction (TMD) and for cranial-mandibular-cervical (CMC) orthodontics comes from a massive anthropological study of what was termed "non-orthodontic norm" skulls. In other words, the researchers were looking for skulls, which they knew had no orthodontic treatment and which met all the criteria, which were used to define "health" of the gnathologic system. Afterwards, all the skulls which met the selection criteria for health were studied to determine if there were any "common threads" or qualities which could be attributed to any and all of the skulls. The findings were quite remarkable.

In order to qualify for the study, the skull had to present:

1. No degenerative changes in the bone of the head of the condyle or the mandibular fossa.
2. No degenerative changes in the bone of the alveolus.
3. No excessive wear of the teeth.
4. No fractures of the teeth.
5. No loosening of the teeth in their sockets.
6. No crowding or flaring of the teeth. (Straight teeth)

It was felt that if a skull presented all these qualities, then it should represent a healthy gnathological system.

Surprisingly enough, when the selected skulls were studied, numerous "common threads" were found both orthopedically and orthodontically.

The orthopedic common threads discovered were that:

1. The bony midlines of the upper (maxilla) and lower (mandible) were aligned and centered in the skull. (No side-shifts)
2. There was no pivoting of the maxilla around a vertical axis. (No slant)
3. There was no pivoting of the maxilla around an antero-posterior horizontal axis. (No cant)
4. There was no pivoting of the maxilla around a lateral (right to left) which exceeded 10 degrees when measured from an arbitrary horizontal (Frankfort) plane.
5. There was never a negative rotation around this axis.

A line drawn to connect the centerpoint of the axis of rotation of the heads of the mandibular condyles and the centerpoint between the tips of the mesio-incisal line angles of the maxillary central incisor teeth always formed an equilateral triangle. (Amazing!!!) In essence, this determines the correct antero-postero position of the maxilla, and together with the other findings, allows us to get a correct three-dimensional fix on the position of the maxilla in the skull.

The orthodontic common threads included:

• No deep over-bite.
• No severe over-jet.
• The tooth mid-line on center.
• A Class I molar relationship.
• A Class I cuspid relationship.
• Cuspid protection in any lateral or antero-lateral movement of the mandible. (A cuspid protected occlusion)
• A level plane of occlusion.
• No spaces or gaps between the teeth, with the exception of primate spacing and occasionally a small space between the maxillary central incisors. (Primate spacing is a small space distal to the maxillary cuspids.)
• The marginal ridges level.
• The vertical dimensikon commpatable with the facial growth pattern of the individual.

Over 15 years ago, I began using incorporating the selection criteria for the above-mentioned study into our diagnostic protocol. I also began using the orthopedic and orthodontic "common threads" findings as the basis for our treatment objectives. Ways have been developed to allow us to accomplish those results non-surgically and with only minimal discomfort and/or inconvenience. The results have been quite marvelous and they absolutely speak for themselves.

---