Canine Guidance vs Group Function - Does it Matter?! - PDP182
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- Опубліковано 10 лип 2024
- When we studied occlusion at Dental School, our textbooks forced the idea of having dots at the back and lines at the front. We are continually told about CR and how to manage patients into canine guidance, but does this all work in practice?
Today we dive into the best way to approach occlusion cases with our patients, keeping in mind that there is no such thing as a silver bullet to treatment. Join Jaz and Dr Michael Melkers in this podcast to learn how it may just be time to throw away the textbooks and begin writing your own conclusions on occlusion… try saying that ten times quickly.
Dental Pearl
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Highlights of the Episode
00:00 Intro
02:05 The Protrusive Dental Pearl
02:52 Dr. Michael Melkers
02:53 Mentoring Journeys: AES and Beyond
04:04 Foundational Influences: Splint + Occlusion Mastery
04:30 Fear of Failure: A Dentist’s Drive
05:25 Early Beginnings: Lab Tech to Dental degree
06:00 Avoiding Full Mouth Rehab: A Dental Mission.
07:20 Homage to a Mentor: The Positive Impact
07:25 Group Function Vs Canine Guidance
08:00 Beyond textbooks: real-World Dental Challenges
09:00 Encouragement to Question: A lesson in Bravery
10:16 Chasing Perfection: A dental dilemma
12:00 Masters of Occlusion: Group Function Insights
14:31 Past as Prologue: Learning from destruction
15:10 Pain Points: Focusing on the At-Risk Patients
16:53 Smooth Transitions: The Ideal of Disclusion
18:30 Occlusal Schemes: Debunking the Malocclusion Myth
20:20 CR Reconsidered: The Healthy Majority
22:44 Diagnostic Vision: Seeing Beyond Occlusion
25:15 Rebuilding with Purpose: Beyond Aesthetics
34:35 Appropriate vs Ideal: A New treatment Paradigm
47:00 Key to Dental Success
Access the CPD quiz through our app on www.protrusive.app, either on your browser or by downloading our mobile app. For the full educational experience, our Ultimate Education Plan gives you access to all our courses, webinars, and exclusive monthly content. protrusive.co.uk/ultimate
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If you liked this episode please feel free to check out episode PDP160 - Fremitus and Occlusal Overload - Dental Occlusion Geekiness: protrusive.co.uk/160
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It's refreshing to hear a discussion that challenges traditional textbook teachings and encourages dental professionals to think critically about their approach to occlusion cases.
Dr Gulati I am a big fan of your podcast! Please could you get Steven T. Cutbirth of the Dental minute/DentistryMasterClasses on the show! I'd love you to pick his brain on so many topics, from both occlusion and TMJ issues to discussions of composite fillings and indirect restorations. I've learnt a lot from both you and Steven and I'd love for you to have an in depth discussion with him!
I'd love that too! I can only try to reach out to him 🙏 thank you
@@protrusive Thanks - it would be so epic! I listened to the TMJ series you had on and was super impressed with the technicalities of it. It reminded me of the 4 videos Dr Cutbirth released of him treating a patient with TMJ pain. Was searching to see if you had a podcast with him but couldn't find it! Here is his UA-cam channel: www.youtube.com/@centerforard PS: I just listened to the latest rubber dam podcast this morning and again it was great! I'll try to use RD more and not fear it. You are doing a great service for dental students and young dentists all around the world!
It's been years since I have been watching dental minute videos and Jaz videos! I appreciate the effort, such videos give hope to people in pain. When we know there is someone who can understand our problems, we become confident.
How would you approach reasoning through my anecdotal experience that I'm currently going through, problem solving: long story short, I have severe and uneven-odd wear on left and right side (more wear front right, more wear back left lower left vs. their opposites), and an initial orthotic by one dentist that used canine guidance was my preference - as it allowed resistance and stretching out and engaging more tissues at once [including simultaneously in my head and neck] by pressure being able to be applied consistently-constantly as part of a pattern of applied pressure, and without a break in that pressure - while being able to also get an extra stress by engaging the opposite muscles to create an adversarial quality of countering forces. That dentist however diverted from their out-of-date training and are 3D printing their own orthotics - that one which broke during eating, which it shouldn't have done - to maintain the space between lower jaw. Longer story short, I am now going to a new dentist who uses similar orthotic process - sends the 3D model to print the orthotics with a stronger material that won't break during eating - however unlike the first dentist, his philosophy is he doesn't believe in canine guidance; so I'm torn now as to whether I should find someone who 1) uses proper strength orthotic material, and 2) who also believes in canine guidance so they'll do a full mouth reconstruction once my proper bite is understood with canine guidance in place. I think there is something important about holistic systems, like how the full circuit, uninterrupted pressure as part of a jaw's autonomous reflexes, could easily be undervalued. Help! Any thoughts? From my experience so far struggling to find dentists with adequate training, I still haven't found one who seems to have a full understanding of biomechanics or how pain works in the body; an incidental finding from a relatively recent CBCT scan done is that I had bilateral Eagle's syndrome, of which I had surgeries for ~6 weeks ago, and where my neck pain is down ~80% - along with other systemic problems-symptoms also reduced some now that my vagus nerves, in particular, aren't being constantly compressed - and exponentially-dramatically worsened with turning my head. And now I'll admit I haven't watched your video yet - was at top of the Google search I did for "why do some dentists believe in canine guidance and others don't?" [2nd result, 1st UA-cam link for me] - and now I'll see if I can gain any useful insights that may help guide me! P.S. The wear pattern was due to a combination of high school football injuries, and then not knowing any better - nor that I was grinding - for over a year period in my late teens/early 20s I was put in 4mg of benzodiazepine per day, and so I ground my teeth down considerably during this time without realizing it - of course compromising-progressing my situation considerably worse; the up to 2 Litres of pop/cola per day as a mid-teen while I was an avid late night gamer didn't help with the enamel wear either.
How do we get our hands on this study he mentioned ‘after treating sleep apnoea they still brux’ - is frequency/intensity decreased though?
DM Mike on IG bud - I do not have this one but I have heard Lane mention it too before
GOAT
Sorry but he’s missing one point in the part about wear on canines, yes they destroyed their canines but the will not do it again if you teach them proper posture and function. I do ortho and full mouth reconstructions and I always tell my patients it will be in conflict with their current function patterns and that’s why most dentists think you need retention, so I do Oral physical therapy, to change their function and posture. It works! I developed this working on myself, and I haven’t had relapse or progressed wear of my teeth, rebuilt in composites, in 10 years. I don’t use retention and have now successfully treated loads of patients this way, most don’t need retention either. You would never treat a bad back resulting from bad lifting methods without addressing the lifting method. I see tons of patients with canine guidance on their preferred mastication side and partially distal occlusion on the neglected side resulting in wear and group function. I tell them to chem in both sides and the occlusion improves and their facial symmetry as well. This supports the claim that canine guidance is the intended relationship.
love this! We would love to learn more, would you be up for coming on the podcast to tell us more about this? Much appreciated, Jaz
Sure, but it’s hard to do without pictures, but the UA-cam format is great for it.
@jacobohlenschlager1 let's do it! kindly could you email me so I can arrange this with you? jaz@protrusive.co.uk thank you!
Ah, thank you for sharing this. It sounds like I need to find a dentist who does orthotics, who has similar philosophy-understanding as you do. May I ask where you're located? Is there any specific training you've done to help direct you, so that maybe I can search for a nearby dentist who has the same training? I wrote a long comment here - ua-cam.com/video/3Sk1paKW8d0/v-deo.html&lc=UgzkTbUkfcBpLhVMDNV4AaABAg - about my current situation that I've only recently gained more clarity on the path I need to find for treatment. Long story short, I've had a long and hard path the last 20+ years problem solving health issues that became dramatically worse ~12 years ago, and the most fascinating and infuriating aspect has been gaining the insights of the many interactions with many different doctors, types of doctors, to come to some fundamental conclusions that primarily their education-indoctrination into lineages of knowledge are very poor - arguably selecting doctors who are good at memorization but not critical thinking and/or observation. As I've had to deep dive into understanding to navigate through the blind spots to learn what I needed to search for to eventually find specialists who could help with specific issues, seemingly because the existing networks of doctors who know each other were essentially a circle jerk [the non-vulgar use of the term] seemed to all be indoctrinated into similar sets of knowledge, I've learned a lot - and primarily that most of the mainstream medical knowledge today hasn't been viewed or critically thought through from an evolutionary biology lens; Bret Weinstein and his wife Heather, both evolutionary biologists, have had at least one dentist on as a guest on their podcast called the Darkhorse Podcast. Holistic-systems thinking is sorely lacking lacking, and worse, sorely integrated into the silo'd specializations that has created a massive disconnect - and where from my experience, the lack of strict protocols being followed - and where that core protocol is required to intersect with all other fields - and any incongruences or disagreements or confrontations between understanding and practice, should be required to be under intense scrutiny and be a hypothesis generator for properly done research and clinical trials to be designed and executed on. I seem close to the end of this chapter of the excruciating-debilitating level of pain being gone, it's not been solely dental-TMJ pain, where I've had 9 surgeries in the last 2 years - I have another nerve decompression surgery booked for a few weeks from now, potentially need another artificial disc surgery, and I've lost count of how many stem cell treatments I've done to knock out the major to very minor sources of pain-injury - that were amplified due to the central sensitization state the overall level of pain has caused. In my prior life, before life was put on hold ~12 years ago, I had been doing web development and design since the age of 11, now 41. Assuming these next few steps resolve the majority of my pain, and greatly reduces the executive dysfunction that makes higher level-order thinking and mental organizing, then I plan to launch a network of platforms including one specific for holistic health that will create and facilitate a protocol system to allow the doctors at the leading edge of their profession-specific specialization to add their knowledge-understanding and practice protocol - and to support and drive an environment-ecosystem of thorough, deep, nuanced long-form exploration and debate - and more importantly, to allow, empower-enable patients to critically think to the best of their abilities to navigate through to help them better understand their own health issues that they're trying to problem solve - and to find practitioners who actually offer what they need investigated-diagnosed, and potentially treated; also with working from first principles of understanding and guiding towards preventative-proactive measures - from womb to tomb; my main coping mechanism from the pain these past years has been my mind, to try my best each day to not be completely lost in the pain, and so I have deeply and widely developed a vision and have vast project plans that I hope to be able to execute on soon, in a serious manner; I still have doubts I will reach that point, it may however be old trauma-feelings and patterns arising that no longer serve me but can dissipate as I process them - which could be the case, as there are still improvements slowly each week that I notice since the bilateral Eagle's syndrome surgeries - my vagus nerves no longer being constantly suppressed logically will have had a deep impact on my systems and will take longer to unwind from.
Is there some fancy device which scans a patients chewing patterns and forces etc.
forces: T scan
Chewing pattern: Modjaw
Other brands for both exist but those are the market leaders
BioPak will measure the muscles firing. One place know but no longer recommend, they figured out part of the protocol using BioPak, where they measure jaw-head muscle activity where they first ask the person to have jaw open and relaxed/hanging, and then check it asking them to "lightly" bite. If the bite is in a healthy-safe-comfortable position, then the muscles should reach a relative constant restful homeostasis - otherwise it will show there is guarding occurring and in which muscles, where reflexes are firing still struggling to find a comfortable landing page.
1st
You sound sick
those darn nursery bugs!