This 6 y.o. child came for a midlines discrepancy and a crossbite on the left side when in maximum intercuspation. In centric occlusion the midlines are close to aligned, there is a lateral edge-to-edge relationship and occlusal contacts only on the right side
Assembling these 2 images leads to the concept of “occlusal dynamics” in opposition to “occlusal statics”
What is the occlusal plane under construction?
In this situation, what happens in the under construction TMJs?
at the jaws level?
Can this be an explanation for later anatomical and functional asymmetries?
– provide an explanation for these wrong tooth positions observed in the 3 directions of space.
-allow to predict the way this situation can evolve according to the laws of development.
– correlatively, these laws can provide an explanation for later asymmetries:
(compare the transversal development of each maxilla, the relative positions of the tips of the cuspids and of buccal teeth…)
For a fully comprehensive diagnosis, a cephalometric study is required.
However, it will be interesting to be able to explain by these signs the frequent
“Class II div 1 subdivision”: this situation progressively arose during the growth period according to the laws of the physiology of growth, whose positive effects can be observed in discrepancy-free subjects.
The practitioner who subscribes to this diagnostic vision, modestly considers that, through his/her therapy, he/she will act on only a few elements of the general balance of the individual.
So, he/she will provide his patient with a great service, by giving him/her the possibility to “take care of him/herself”.
Planas used to say “we are mouth Doctors”.
The NOR’s general therapeutic principle
the static situation we observe results from the functional dynamics (FD).
According to this therapeutic principle, the practitioner will use functional mechanisms to modify the occlusal plane, archforms and tooth positions… (bone discrepancies, all the more installed when we act late, will then be taken care of, and then individual malpositions.)
The tools of the NOR will be, (directly on the dentition) sometimes grinding or bonded appositions, or – most frequently – appliances. Those will be removable appliances, that will act as functional tutors on each dental arch and on their relationship (whence the famous “Planas’ tracks” that complete tooth contacts in the context of the dynamic functional occlusion)
A tutor does not exert forces… the tracks will be positioned beside the occlusal surfaces in order to establish a proper occlusal plane.
This way, we will see the mouth progressively evolving, becoming more functional through the activation of numerous physiological phenomenons, with all favorable consequences on the occlusion, the face et beyond, breathing, swallowing and posture.
Functions are not separable and improving one has effects on the whole of them. Even so, the mouth Doctor remains a dental specialist.
The service is excellent for the child of today and for the adult to come, and practicing this “prevention” is fascinating for the practitioner.
Any means at the disposal of the therapist will be objectively reviewed with this essentially physiological take.
The proper solution for the first case will be the installation of composite-made direct tracks.
The solution for the other cases will be the installation of either indirect tracks or unobtrusive removable appliances.
The principles of NOR can be a major standard for any mouth Doctor who must restore an “integrated as naturally as possible” occlusion.