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A transdisciplinary approach for limiting treatment failures in orthodontics by Dr. Fernand Kimmel, Dr. Bruno Baudin, Dr. Patrick Berdillon and Dr. Yves ROBERT
Stabilometry is a metrological tool, developed for Posturology. It allows apprehending the famous "global" inter-reactivity, and - more specifically - the role of the cranio-mandibular complex.
It generates a transdisciplinary approach that is essential to re-integrate orthodontics, dentofacial orthopedics and gnathology to their medical, therapeutic dimension.
A transdisciplinary diagnostic tool, designed for our specialties, is proposed.
In the course of my orthodontic training, I was lucky enough to work in a Cranio-facial Abnormalities Center and to prepare at the same time a "Master of Dental Science", using 3D axiography and sirognathography, in Aarhus, Denmark. My scientific and clinical observations rapidly led me to adhere to functionalist theories (M. Moss, for example).
To remain schematic, after birth the function governs the structure. I believe - with reasonable certainty - that dysfunctions create structural drifts, positional and/or morphological, in the bones and/or joints and/or muscles and/or ligaments... Three remarks arise from that.
When assessing structure (clinically, on models, on X-rays), I am 100 years behind dysfunction. Then, assessing dysfunction is complex, due to the multiplicity of the anatomical components that can be held for responsible, the neuro-anatomical and neuro-physiological complexity, and local or regional possible implications. Still, they can only partially be measured. Worse, are these dysfunctions primary or secondary? In other words: are they causal, original or are they adaptations to deeper or more distant mechanisms?
Epidemiology shows that TMJs dysfunctions are frequently asymmetrical. So are bony or occlusal structures. In addition, the prevalence of dental occlusion in the statistical analysis of TMDs is only very partial. But connected pathologies can be numerous (headaches, neck pain, muscular pain...). A look toward medical disciplines as neurology, ophthalmology, speech therapy, osteopathy, physiotherapy, podiatry and many others, shows that they all have an evident link to the head and - more specifically - to the orofacial complex. A closer look clearly highlight A TRANSDISCIPLINARY LINK.
As this link is more and more evident, we have to admit that our dental specialties have a hard time adhering to it. Is our permanent work on structure limiting our capability to understand function? But it must be clear that the cause and effect relation is a two-way street: from the periphery toward the occlusion, but from the occlusion toward the periphery as well, real time.
Our goal is to transcend the oro-dental view of dentistry, to link local to general, structure to function, metrology to clinical observation, dentistry to other complementary specialties, through the barometer of equilibrium i.e. by the study of the fine tuned postural system (FTPS). We do not pretend to access primary dysfunctions but to have a more global view of our patients and, above all, to assess our therapeutic effects on the body through the barometer of the FTPS, in fact the neurosensorial regulation of equilibrium
We propose to integrate in our clinical assessments an appraisal of the static posture of the patient through a standardized photography and at the same time to make a standardized stabilometric recording of his/her equilibrium (or FTPS).
The criteria are those of the French Association of Posturology and physiology is the same as described by posturology and neuroscience researches.
For this purpose, we developed a standardized device including an electronic equilibrium-recording plate, data processing software, and digital cameras allowing a simultaneous photographic recording of the whole body (front and profile) and of the face.
Examination procedures are standardized as well through a stable and reproducible visual environment and standardized examinations (open mouth, clenched teeth, open eyes, eyes shut, bare feet, on a foam support, and - if necessary - with splints or cotton pellets).
The concept of postural diagnosis with a "dental aim" necessitates basic training, for the following reasons. It is essential to know the physiological and physio-pathological mechanisms. Then, it is important to get used to transdisciplinary collaboration with other medical specialties. And, finally, the visual tool and the measurements are elements for discussion that must be mastered in order to appreciate the full relevance of the observations, to root our rationale into these observations or to certify our requests to other disciplines in the therapeutic procedure.
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