Dr. Sanjay Arora, an eminent Implantologist, Endodontist, Occlusion specialist, (eminent Neuro Muscular Dentist and a Cosmetologist. His clinic Alchemist Dental and Cosmetic Research Institute redefines “The state of the art” in India. A trainer, thinker and an ace clinician acclaimed by international researchers, Send your queries to firstname.lastname@example.org or facebook page “Alchemist Academy for Dental Education”, a site for postgraduate level participation into dental discussions and publications. The focus of this article would be NEW TECHNOLOGY IN DENTISTRY.
Full mouth rehabilitation, is familiar term for most people above 55, if they have been visiting a modern Dentist. Most people by this age and some at a younger age have lost enough tooth enamel and sometimes dentin that the worn out dentition has led to the following:
- Collapsed facial height.
- Sharp tooth margins
- Cuts on sides of teeth or abfraction.
- Gaps between teeth.
- Worn out dentition.
- Increased wrinkling and deep furrows on the face.
- Broadening of the lower face.
Worn out dentition
Worn out dentition
Loss of facial height and the wrinkled look.
Narrow lower face is a sign of youth, broadening is either seen with aging due to late horizontal forces and therfore wear of teeth or early developmental or inherited bite promoting horizontal forces.
It’s like retreading worn out tyre. The material must be replaced, which has been lost.
Why Does It Happen?
It happens because it is normal for things to wear off with use. However, it’s common knowledge that if objects are out of alignment then they wear off many times faster, like engines, tyres, machines, etc. same is true for the teeth.
Why Does Abnormally High Wear Take Place?
Abnormally high wear takes place because, teeth are out of alignment. Unluckily the definition of word “Alignment” or better still “Occlusion” is still ill defined in dentistry. But the dentists, who understand that dental teeth fit or bite is based upon the engineering principles of mechanics, know very well that this misalignment is the cause of tooth wear and tear.
Although all the principles of perfect alignment and fit with each other are still wanting, but sticking to some very well-known principles minimizes the wear and tear of the teeth.
Essentially a dentition that allows horizontal components of forces is prone to attrition. In strong male this will become more pronounced.
This fitting of teeth with each other is mostly studied in
- Static – that is in a state of fit – “Occlusion”- A main stay for Full Mouth Rehabilitation.
- Dynamic – that is what is happening in the final stages of fitting of teeth, as that carries a significant momentum. How are those forces being dissipated? – “Occluding”- A mainstay for Cranio-Sacral Rehabilitation or TMJ friendly rehabilitation of the dental bite.
Most dentistry revolves around, static state and hence
Full Mouth Rehabilitation, is an attempt to replace the lost tooth structure, in almost the same state of jaw relations as on that day that the work is initiated. Vertical loss of height is the only parameter that is attempted to be reclaimed with caution and graduation. This is not however attempted always.
Cranio-Sacral Rehabilitation or TMJ Friendly Rehabilitation, a term not used in literature yet or is closely related to Neuromuscular Dentistry, Neuromuscular Dentistry and Cranio-Sacral Dentistry. It is based on the premise of “Occluding” primarily and secondarily on “Occlusion”
This bite takes into account
The reasons for faster bite destruction in the first place. One cannot ignore people with excellent tooth anatomy even at the ages above 80. And remember these people belong to an age where dentistry was primitive. Even if we discount some teeth lost, the anatomy is excellent.
The natural or artificial discrepancies in “Yaw”, “Pitch” & “Roll”, complex scientific terms and their scientific description is much more complex. But essentially it points to the planes of landing of the lower jaw with its teeth and massive force must match with the upper jaw and its teeth. Any discrepancy in the match can lead to massive wear or breakage of the repair material. This angle of collision when viewed from all three dimensions, gives rise to the above mentioned terms.
“Engineered Occluding”, a concept defined by me but its fundamentals learnt and modified from probably the greatest Dentist of all times, Robert Barry Kerstein, adds the fourth dimension, to the above. The manner of landing of the teeth, while landing is an essential component in dissipating these forces. Please note, that a protocol developed by me is helping lot of diabetics in reducing or eliminating Type2 diabetes. This came in as an observation during a fine tuning exercise. Further work is being designed to study this observation scientifically and not yet claimed as a treatment option. This however may be an added benefit, while increasing finesse.
Any wanderings of the jaw must not be there in the final closure of 2mm, as the purpose of wanderings is to position the food correctly, which for example a dog can’t do and has to replace the food repeatedly in the mouth to position it correctly. A Cranio-Sacral Rehabilitation bite, keeps all these into account. Now comes the most important part and that is
- What is the ideal vertical height of teeth? Older concepts are junked.
- What trajectory of closure of the lower jaw will produce a normo-tonic or ideal tone scale of closure muscles of jaw?
- What will promote the jaw joint ball or the condyle to be in such a position that it does not cause
1. Slippage of the disc.
2. Remains in the same trajectory that it was prior to grinding away of its guiding bone’s architecture – “Articular Eminence”
3. Does not tilt in any direction more than what is required to prevent irritation of vital nerves and blood vessels medial to or on the inside of it. (Infratemporal Catastrophe theory by Dr. Sanjay Arora), can be confirmed to some extent by a MAT-SCAN, Sway analysis.
The above points can help one attain a least disturbed Cranio-Sacral axis and prevent or minimize lot of chronic body pains and some more medical diseases, which can find mention in my other articles along with exact genesis route and as has been described by many authors before me.
200-300 hours of clinical work to finish, compared to a Full mouth rehabilitation which should be finishable in 60-90 odd hours. Needless to say, the former may be little less esthetic to the latter as in order to rebuild on genetic or developmental defects one will need to sacrifice current principles of esthetics, which is perception based, while the former is truly function based.
- Reduced wear and tear of the constructed bite.
- Correction of aches and pains of entire body in a high percentage of patients.
- Resolution/Reduction of several diseases in many patients – like asthma, respiratory allergies, hormonal imbalances, etc.
- Resolution of Myo Facial Pains and Old Headaches.
Tooth loss may indicate cognitive, physical decline later in life
March 16, 2015, London – Tooth loss may be an early indicator of cognitive and physical decline in older adults, according to a University College London study published January in the Journal of the American Geriatrics Society.
The longitudinal study of 3,166 adults who are 60 years old and older in England showed the memory and walking speeds of those who have lost A dental bite constructed as per the above laid down principles, is called by me as a TMJ friendly bite or a Cranio-Sacral bite and will take almost