If your eyes are blinded by your worries, you cannot see the beauty of the sunset.Krishnamurti
- By far, the most practiced concept in clinical dentistry today
- Generally safe, easy, and predictable if the condyles are healthy
- Accepted by all insurance models
- Taught in all dental schools
Adaptation of the human body is why dentistry and medicine are successful. If we take off our medical hat and focus on the building or repair from one tooth to a system, then consider the idea that a dentist is a mechanic, a mechanic with an unlimited supply of engines to correct and maintain. Each engine has 32 (52 counting primary teeth) separate parts and a couple of hinges. Form and function must interact for the hinges to operate and ultimately create a force that stops when the parts interact.
When a part breaks the human reaction is to stimulate pain and/or inflammation as a red light indicator. The mechanic (dentist) is gifted at recognizing signs and symptoms of stress in and around the parts. Dentistry has wires, bonds, replacement parts and all the modern tools, gadgets, and paint to clean up the parts.
Most cars drive out happy with a simple one part replacement and a six month car wash. The more maintenance an owner puts into their car that is expected to last a lifetime generally means less wear and tear. A few owners want to upgrade to Ferrari status and have the finances and time to regain the showroom appearance. However, the reality is that most vehicles need parts patched to stay in the game.
Correcting parts generally slows down adaptation and extends the life of the vehicle. Insurance, if available, will fix the damage and we can be on our way. Each vehicle generally has two engines that power the systems and generate the energy to the parts. Most mechanics divide the engines into left side and right side. Some mechanics like to start with the hinge and work toward the parts and others prefer to fix only the parts. Parts are generally fixed front side (anterior) or back side (posterior) and often make one of the two engines work a little easier.
Fixing parts under the radar of the engines is why adaptation dentistry works. Fixing and maintaining parts generally decreases performance degradation over time. Lack of repair and maintenance will decrease performance efficiency and may accelerate stress on other parts. When a few key parts cannot perform to minimal standards and rapidly degrade. The system must accept a different performance level. Adaptation is a change in the human performance levels. Systems that maintain performance efficiency standards for the age of their vehicle will function in the adaptation zone. When performance standards are not in harmony with adaptation ten the vehicle is damaged forever.
The movie is a metaphor and the idea is to think about your thinking. No question, the human condyles do not grow, function and age exactly like a door hinge, but both condyles do not grow straight and condyles translate before, during, or after rotation. However, the analogy should be considered when teaching occlusion. Most are blinded by the idea that every patient has two TMJs and only one occlusion.
Dr. Frank Spear is the best and most practical teacher in the world at teaching the maxillo-mandibular relationship and believes that each clinician must decide what makes sense with each individual patient. In the article “Symposium Synopsis,” Rebecca M Bockow DDS states “many clinicians ask if all patients should be restored in CR. Many wonder if they can simply restore their patinets in CO. Dr. Spear believes that clinicians must decide what makes sense with each patient.”
In “Symposium Synopsis” Bockow states the disadvantages to only practicing Adaptation dentistry are:
- Limits the number of teeth restored-an entire arch cannot be prepared at one time.
- No change in vertical dimension. Restoring a patient in CO necessitates leaving multiple teeth in contact in order to preserve the patient’s maxilla-mandibular relationship.
- Replicates current symptoms.
- Unpredictable-if you prepare the initial point of contact, you run the risk of changing the patient’s entire occlusion. If this tooth was the prematurity guiding the patient into their centric occlusion, you have just disrupted their neuromuscular CO. If you now create a new point of initial contact, the patient will often have a “new bite,” or will experience extreme tooth sensitivity.
Appropriate use of Adaptation Dentistry is generally limited to:
- Asymptomatic occlusions
- Limited restrictions if the molars are not a primary centric interference. Please see Concepts in Anterior Guidance
This single point is at the heart of “Occlusion Confusion” and ultimately becomes a cross roads for every clinical dentist. Adaptation dentistry is the standard of care around the world. The problem with a purely mechanical ‘fix it’ practice is its limitations.
In other words, the dentistry has become more of a ‘business’ than a ‘profession.’ In reality, it is both. But in so many instances the ‘business model’ is in conflict with the ‘professional model.’ Eventually, every dentist on the ‘treadmill’ is looking for a way off or out. Our experience in dealing with dentists since 1978 is that after around 8-10 years of operating a level I, commodity, volume practice, the dentist begins to realize that this style of practice isn’t really congruent with his/her values. The revenues may be increasing, but the joy, fulfillment, meaning and profits are not. At a certain point, depending on how you were raised, your moral and ethical fiber, you sense that your deepest values are compromised and you realize that something is very, very wrong. You come to realize that you are ‘out of balance with yourself, with nature’ and you start to lose your energy and ‘apathy’ begins to set in.
If you’ve completed a continuum to the Pankey Institute, or the Dawson Center, The Kois Center, OBI or FACE, something happened to your viewpoint or vision. You no longer have the viewpoint of a dental student, looking for a part to fix here or there, a Cerac unit, a veneer, an implant: you are not beginning to see the ‘oral system’ as a whole system, not as individual parts to be fixed. You understand more deeply that when one part of the system isn’t functioning properly that the entire system is compromised, diseased or moving into entropy.Michael Schuster
Placing the medical hat and removing the mechanical parts approach improves the chances for maintaining performance standards within the harmony of adaptation.
Maintaining performance standards for the patient’s vehicle is found in the manual named “The Stomatognathic Puzzle.” A technician who improves performance standards with a combination of medical engine enhancements, will slow, stop and reverse adaptation within the Stomatognathic Puzzle we call oral function.
A technician who improves performance standards with a combination of medical enhancements, will slow, stop and reverse adaptation within the Stomatognathic Puzzle we call oral function.Dr. Robert C. Supple
- All anatomy grows to some form of an adaptive state
- All anatomy functions and adapts over time
- All anatomy has the ability to heal
- All anatomy ages