Fox Occlusal Plane Angulation Questioned

by Clayton A. Chan, D.D.S., M.I.C.C.M.O.

If the occlusal plane is flatter relative to horizontal due to slight upward head tilt what kind of occiput to C1 axis relationship would occur?  How would that effect head movements?

I had a wonderful conversation with a doctor who had serious interest as to my method of establishing the occlusal plane using the Fox plane.  He was analyzing a case I posted on our www.occlusionconnections.com/Blog in the article/blog I posted titled, "What Angle is the Occlusal Plane Relative to Horizon".  He couldn’t quite envision the root angulation and position of my articulated mounted case.

So I decided to post the finished ceph to show the actual root position of the "actual" case.  He was worried that I had atlas/C1 restrictions in my finished case.  The patient has excellent range of motion (side bending, flexion/extension and side bending).  See the actual radiographs confirm that the patient has normalized occipital-C1 space (no restricted).  This Occiput to C-1 is well within normalized limits with an unposed angled occlusal plane as nature intended.  Remember form follows function.  Also note the root angulations, occlusal plane orientation and head postion as they relate to a level horizontal.

One cannot look at models and assume roots are out of line as they relate to an unposed horizontal level head position.  Patient is symptom free with no headaches, no neck aches and no TMD pain problems as previous.  Numerous cases have proven this.

Clinicians need to start get use to seeing what a normal occlusal plane looks like relative to a normalized head posture at horizontal level!

I know many can’t comprehend the angle of this occlusal plane mounting, since flat has been considered normal among some occlusal teachings and philosophies…..A new perspective and understanding of wha is "Physologic" is needed!

Lateral Ceph taken after final restorative was completed at optimized mandibular position.  Note occlusal plane and normalized level head position unposed at time ICAT image (raw) was taken.  Occlusal plane in the mouth is the same occlusal plane angle as articulated cast mounting above.

I know I have a reputation of not knowing anything about Occlusal Planes…what can I say….I just don’t want to reproduce pathology if I have an opportunity to bring the human body toward homeostasis - health!

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© 2008 Occlusion Connections™ All Rights Reserved
http://www.occlusionconnections.com/

Neuromuscular Dentistry

Fox Plane and HIP Plane Mounting Considerations

by Clayton A. Chan,  DDS

The leveling of the maxilla, the managing of the maxilla relative to a proper oriented head and cervical neck, and the concern of a proper occlusal plane are steps toward idealizing the finishing of the restorative case in a phase II treatment.  Leveling of the maxillary plane relates to both function and esthetics.

© 2009 Clayton A. Chan, DDS. All Rights Reserved.

Red dots = HIP reference line. Depending on how the clinician and technician chooses to mount the maxillary cast (classic HIP with fence post and Incisive pin (level) or Modified Fox Plane (angled)) will affect how much tooth reduction is necessary to accommodate the same curve of Spee.

Managing the GAP on an optimized trajectory regardless of cants and roller coaster occlusal planes either on the upper or lower arches using an orthotic based on a HIP or Fox plane technique is of little significance in phase I treatment. All that is basically required to assist in bringing normalacy to the dysfunctional head and neck system is the agreed upon physiologic GAP that is established on a proper trajectory. A lower orthotic placed between two distorted and skewed arches certainly fills in the missing components of occlusion to help relate the upper and lower arches together and with good anatomical occlusion has shown to help in maintaining the neuromuscular myo-trajectory, improving head levelness (from pathologic upward tilt to a physiologic leveled head tilt).

Many clinicians have observed these head re-orienting responses with their patients regardless of Fox Plane or HIP techniques, because the Fox and or HIP does not come into play during the Phase I stabilization phase. It becomes a factor when moving into the Phase II level of esthetic restorative finishing of the case as it relates to crown root ratios and smile lines. If the lab “truthfully and honestly” managed and maintained the classic HIP mounting position from start to finish of the case, the dentist will routinely see shorter upper posterior crowns and longer lower posterior crowns. This is not anatomically correct. This will often cause the labs to cheat the upper crown fabrication, by reorienting the maxillary cast, since the upper posterior preps will not have sufficient occlusal reduction (based on this mount) especially in the second molar regions. Because of this lack of occlusal prep height reduction the lab is forced to remount and alter the cast from the original HIP mount to accommodate the lack of occlusal height reduction. (This is what the labs don’t tell the dentist!) The lower crowns will show, routinely, a longer (higher) crown (crown root ratio) and does not reflect proper golden proportional relationships. We strive for golden proportioned anteriors (tooth width ratios and gingiva to gingiva relationships), yet the posterior uppers and posterior lowers are distorted in crown lengths ratios (a failure of the classic HIP concept!) and not evenly balanced in their upper to lower posterior crown lengths (another failure).

With the Fox plane technique the crown to root ratios in the upper and lower posterior regions are more proportional and reflect a better even distribution of crown to root ratios of both upper and lower posteriors (closer to golden proportions) due to a proper maxillary cast orientation due to a proper occlusal plane set up (see picture above).

Consider the same curve of Spee used in both situation.  Different crown root ratios of upper and lower teeth will result depending on which method is used to mount the maxilla.

 If you choose HIP, make sure you reduce the prep sufficiently so the lab doesn’t have to alter the maxillary mounting occlusally! Don’t be surprised if the lower posterior crowns look longer, the upper posterior crowns shorter and the upper first molar to second bicuspid region looks a bit more toothier.

If the HIP is the method of choice in Phase II restorative, make sure the lab doesn’t alter your mount during the finishing of the case. Over the years they all tend to cheat this step and don’t tell dentist that they altered the mount to accommodate the occlusal plane. The clinician can always confirm the HIP mount by telling the lab that you will be checking the maxillary prepped cast with the finalized porcelain crowns on the prep dies in place at the HIP mount referenced to the table before crowns delivery! Make sure they don’t change or alter the HIP mount if you chose to do so!

The dividing of the crown ratios between the upper and lowers (as seen in the diagram above) will vary depending on the maxillary cast orientation technique. Doctors and technicians have choices! We all need to understand these concepts thoroughly to make the proper choices for our patients.

For more information read Fox Plane Mount, Occlusal Plane

Neuromuscular Dentistry

What Angle is the Occlusal Plane Relative to the Horizon?

by Clayton A. Chan, DDS, MICCMO

Nature has amazingly design the masticatory system in such a manner to meet the functional demands in a very physiologic manner.  Our occlusal, cervical, airway and postural system has been pre-determined genetically to function optimally relative to earth’s gravitational forces.  An angled or slanted occlusal plane is natures design when the head is properly supported by balanced muscles.

Because of gravity, the muscles of the structural system as well as the masticatory system allows the human being to function with the head in properly balanced manner to avoid strains and fatigue to the overall postural system. A person with a forward neck posture will accommodate to maintain the flow of oxygen into his/her body.  This forward neck and head posture tendency is indicative of an upward head tilt with a resulting flatter occlusal plane.  The upward head tilt contributes to TMD and accommodative pathologic issues (e.g., shoulder pain, neck pain, temporal headaches).  This upward head tilt is the bodies way to accommodate due a mal-aligned bite which tries to defy natures gravitational vertical forces, resulting in a flatter more leveled occlusal plane which does not represent what nature originally intended in its design.

The SN (Sella-Nasion) Plane is noted in the dental literature as a standard objective leveling reference.  What you see in the lateral ceph below is one of one of my patients, male age 47 who presented with former TMD cervical neck problems. Symptoms were resolved with an orthotic. The previous upward head tilt responded positively to the orthotic therapy allowing nature to correct it's head posture including and an improved occlusal plane.  Based on this corrected and more normalized occlusal plane orientation as seen in the below lateral cephalogram I want to transfer this occlusal plane orientation to a flat analyzing table on my articulator to fabricate the upper and lower restorations for FM rehab esthetically and anatomically.

It seems to me that if SN plane is level, symptoms are gone, and patient’s head is now balanced.  Recording this position is the most logical to communicate with the lab to mount the case.

© 2009 Clayton A. Chan, DDS.   All Rights Reserved

to record this maxillary occlusal plane orientation I use the Fox plane as indicated in the blog articles and other publications I have written. It takes the guess work away from the laboratory as long as you implement the process properly like anything. Errors can occur during the following steps:

1. During the bite registration stage.  If one use computerized mandibular scanning (jaw tracking - eg. scan 4/5 with TENS) and does not have adequate training to accurately interpret and record this kind of neuromuscular bite registration error can occur before the case is even started.
2. If the EMG interpretation is not correct and one implements erroneous EMG diagnostic protocols (unable to decipher the differences between fatigued EMG patterns vs. normalized EMG patterns or does not monitor the cervical group EMGs believing that these EMG recordings are the same as SCM  EMG recordings one will be greatly mistakened.
3. Subjective interpretation in these areas of diagnostics will also lead to failed treatment results. 

I believe in using good artistic and scientific clinical judgments to record head levelness like any diagnostic protocol, using the Modified Fox Plane technique as I have formerly indicated is a simple, inexpensive and effective tool every dentist in North America can use.  (By the way, every dental student has been issued a Fox Plane in dental school as a basic learning tool). Note the angle of the occlusal plane.
(These are real time pictures that I routinely take during my clinical work up to document what I actually observed).

© 2009 Clayton A. Chan, DDS. All Rights Reserved

Note how the maxillary recording is simply recorded at level using fast set PV on the bite fork of the Fox Plane and the transferred to a level table. This nicely correlates with the lateral ceph occlusal plane which objectively confirms the mounting and occlusal plane transfer.

© 2009 Clayton A. Chan, DDS. All Rights Reserved

The maxillary cast is simply transferred to the table via the OPI (occlusal plane index) from the Fox Plane recording.  (Read more on Mounting the Maxillary Cast Using the Fox Plane and Occlusal Plane ).

This is the actual photo that some skeptics have tried to alter to disparage the modified Fox Plane technique I have been advocating.  (Important Note: In the background the level counter and bottles sitting on top shows that my patient's head is leveled.  The bottles and level counter top are not slanting and or angled as some scrupulous "instructor/teachers" have tried to convey in their lectures by altering this image in their lectures to distort the truth of my Fox Plane recording).  Level = Level!

In a purposeful attempt to disparage and misconstrue the facts of my published article, a dentist instructor "teacher" of a "cosmetic NM teaching center" used this picture and altered and flipped it in an attempt to discredit my teachings during during his lectures.  What is amazingly wrong with his attempt is that he failed to fully read and comprehend the article that was published in the ICCMO Anthology (Chan, CA: A Review of the Clinical Significance of the Occlusal Plane: Its Variation and Effect on Head Posture: Optimizing the Neuromuscular Trajectory – a Key to Stabilizing the Occlusal-Cervical Posture.  International College of Craniomandibular Orthopedics (ICCMO) Anthology VIII, 2007).  His biased publicized lecture subtitle shown in the below power point slide shows his unscrupulous dishonest disregard for scientific and academic teaching integrity and is in itself a "contradiction".  Additionally, it shows his lack of knowledge and understanding of basics in lateral cephalograms.

This is the altered and flipped picture by this "occlusion teachers" with the accompanying text.

Below is the unscrupulously altered photo by the same dentist (instructor "teacher" of an institute) who purposely altered  my photo again in a second power point slide (by rotating and altering the above photo) and used it without permission in a manner to give a misleading and false impression to the attending listening doctor audience about my occlusal plane teachings and understanding of how I advocate the use of the Fox Plane.  One of my dentist colleagues discovered and reported this poorly mishandled power point slide exposing this doctor/ "teacher's" credibility as an "occlusion instructor" by pointing out in the background the tipped bottles that were positioned on a counter in the background.  The unethical teacher/lecturer purposely rotated the photo to mislead, misguide and convey a false teaching about me and what I believe about head posture, the maxillary occlusal plane orientation and what I consider as horizontal level.

The lecturer/ "occlusion teacher" has exposed his credibility and lack of academic honor.  Such stupidity does not go unnoticed by those who have astute eyes to see beyond what is obvious.  Postural balance is maintained best when the head, neck, shoulders, pelvis and feet are leveled to Earth's horizontal level.  Dentists and the viewing audience clearly recognize what level is and realize that the angled human occlusal plane is simply determined when the dentist can clearly see things from a balanced perspective - not from a distorted biased and altered view). 

The unposed head posture clearly shows the natural angled occlusal plane of the same patient in this lateral cephalogram.

Lateral cephalogram (ICAT) after comprehensive restorative treatment.  Note: unposed natural head position and natural angled occlusal plane.  Images have not be altered or modified.  (You decided ...is the occlusal plane angled or flat?)

© 2009 Clayton A. Chan, DDS. All Rights Reserved

The wax up was done to match the mount using the maxillary transfer table.   Restorations were fabricated to the same mount without alterations to the mount.  (Dr. Chan proudly gives recognition for outstanding ceramic and waxing to Las Vegas Esthetics Lab, Ray Foster and Team).

© 2009 Clayton A. Chan, DDS. All Rights Reserved

I check the crown ratios (they shouldn’t look funny)…reconfirm my AP…check my patient’s subjective responses.  Many dentist and I have discover that when the correct occlusal plane is properly managed, the patient doesn't experience any neck, cervical and shoulder pain problems.  If one uses the classic HIP (hamular notch and incisive papilla) method to manage the case too completion that many are discovering that this can lead to unresolved TMJ/occlusal problems.  If everything seems to line up I go for it!

© 2009 Clayton A. Chan, DDS. All Rights Reserved

I mount my cases and check my cases from the lab to see if they maintained the correct maxillary orientation before delivery (labs are not allowed to cheat or change the mount unless it is wrong). I check my mount. I check the photos, I check and compare what is in the mouth, I check how the angle and slant is…I analyze and re-analyze and confirm with my lateral ceph, check my EMG data (making sure my patients are comfortable and stable), I check my Scan 4/5, scan 2’s, scan 8’s, etc. and decided that this orientation got to be right from the frontal and lateral views….then a re-check the patient and I re-check at the lab bench…. Seems right to me!

© 2009 Clayton A. Chan, DDS. All Rights Reserved

I am happy…that He is happy…. "Don’t lose sight of the Power of the Bite!” I have no regrets about the Fox…because I know it works for me and it works for all the talented clinicians who understand this concept. These pictures are immediately after lower seat, before any adjusting of any crowns….I had the patient come back the next day to TENS and refine the bite.
My patient is very pleased, no neck cervical TMD problems. The bite is awesome.  After gneuromuscular esthetic dentistry the patient no longer reports cervical pain, no shoulder pain, nor any TMD issues.  The patient is stable and very happy.  He is a public speaker and is on streaming internet video weekly and has a great pleasing smile.  You can view him at: http://www.iclv.com/ or spiritflow.net on Sunday mornings and Sunday evenings.

Although, there is some dental literature that tries to indicate that the occlusal plane is parallel to certain boney references as the hamular notch and incisive foramen) they often do not realize that cervical bones from C1 to C7 are not perpendicular, thus misleads and confuses the reader as to which horizontal they are refering to.  Dental literature both in the orthodontic, restorative and prosthetic arena clearly have reported on average an occlusal plane angle of 6-14 degrees when the horizontal gaze is parallel to earth's horizontal level.  Any dental referencing technique that advocates an occlusal plane horizontal to earth's horizontal plane certainly is contributing dental failure and postural/occlusal instability.

A physiologic occlusal plane, determined by balanced cervical neck, shoulder and masticatory muscles of the head is routinely angled by natures design to be perpendicular to a normalized lordotic curvature of the neck from C1 to C7.  This orientation is physiologically sound according to natures proportional design for optimal function of the pharyangeal airway (breathing), optimal head posture for physiologic functioning and positioning of the lower jaw, and proper shoulder posture.  Proper mandibular positioning relative to the cranium does effect and impact body balance, flexion, extension and rotational movements.

Dentists have ignored physiology far too long and have destroyed much with their hands, what nature has spent years growing and developing. A flat occlusal plane relative to horizontal level represents mal-alignment and dysfunction contributing to body fatigue.  Neuromuscular science supports normalize occlusal form.  If clinicians ignore what nature intends they WILL be building fatigue into their cases.  You cannot fool physiologic and anatomical science, especially when it is tested amongst thousands of great clinicians who understand the realities of conservative, ethical and thoughful judicious "gneuromuscular/neuromuscular" treatment for their patients.

As you all know I take a lot of records and this is just a small sampling of what many have been privately emailing me to show what I do. Some may not agree, but I am fine with that. My patient is extremely happy and satisfied.
The occlusal plane should look natural and balanced with the smile (that is how it should appear)…the mount is what tweaks our minds…the lateral ceph objectively confirms the reality, but it may be a need for a paradigm shift in occlusal thinking and re-evaluate whether your occlusal plane mount is too flat or not.  It's worth investigating.

Conclusion:
1) We ultimately desire the cervical neck muscles balanced, thus we observed that the head tilts downward from an upward pathologic TMD position which TMD patients present with (flatter occlusal plane relative to horizontal level), 2) we desire optimal esthetics smiles lines and our patients to be asymptomatic.  We observe on lateral cephalograms that the occlusal plane is angled – no symptoms and 3) we simply desire to reproduce what we actually see in a stable, symptom free system – angled occlusal plane, and not have our lab technicians guess or alter the mounts, thus the Fox plane method we advocate as many recognize as simple and logical is easily transfered via the Fox Plane method indicated at Occlusion Connections.

To read more: The Science of Aligning Body Parts To Improve Function - Part I

© 2009 Clayton A. Chan, DDS. All Rights Reserved.  

Neuromuscular Dentistry

The Occlusal Plane

Which Occlusal Plane Do You Undestand? Don't Get Confused

by Clayton A. Chan, DDS, MICCMO

Read my scientific article: "A Review of the Clinical Significance of the Occlusal Plane: Its Variation and Effect on Head Posture" - published in the International College of Craniomandibular Orthopedics Anthology, 2007.

"If you don't stand for anything you will fall for anything...."

Establishing the occlusal plane is an important aspect for every clinician and laboratory technician who desires to create beautiful soft smile lines, stable occlusion and supported normalized head and neck posture. Many of the dental goals and objectives for dental health correlate to esthetics as well as the physiologic function of natures dynamic masticatory system. The artistry and design of the smile is often subjective in nature and does not always lend itself to a cookbook receipe of hard fast numbers and values, but often is visualized by the designers and creators of dental occlusion. So it is the same with establishing the occlusal plane.

Reconstruction by Clayton A. Chan, DDS and Mike Milne, CDT & Team Sunrise Dental Laboratory, Las Vegas, NV

Dentistry is both an art as well as a science. Combining the artistry of tooth position, orientation, embrasure spaces (open or closed), occlusal plane position and arch shape development are all examples of the subjective clinical decision making ("non science", yet scientific) that must conform to good principles and universal laws of form and function. Implementing one's judgment, clinical experience in addition to a keen visual eye does not lessen ones position of being objective and clinically sound, especially in the arena of neuromuscular occlusion, orthodontics and restorative/prosthetic care.

There are basic laws in nature and science to support such and so it is the same when establishing the occlusal plane. There is nothing wrong neither is it any less than scientific with using leveling tools (e.g Fox Occlual Plane Analyser, face bows, leveling tables and photos) to help the clinician and technician visualize and capture the maxillary occlusal plane with a normalized head position as long as they are used properly. Subjective is certainly required when it comes to the art of dentistry, yet balanced with the physiologic neuromuscular sciences that can measure muscle function using EMG and CMS technology. I like to use all the scientific tools available in dentistry in addition to applying my artistic mind to create postural form for healthy function.

Note the various occlusal plane references as noted in dental literature.

Depending on boney landmarks alone as references to establish maxillary relationships is almost similar to using jaw joints to reference the mandible/bite. The astute clinician recognizes that neuromuscular and physiologic paradigms reference to healthy muscles not bones which often present with distortions, torques, skews and asymmetries. Repeated studies have shown that relaxed muscles can change the profile and soft tissue architecture over the hamular notch regions. Studies have also shown that relaxed cervical neck musculature with isotonic mandibular muscles will effect head posture and the occlusal plane, thus testing the occlusal plane teaching paradigms as to how these boney landmarks are actually referenced to horizontal level in a physiologic position, not pathologic ("level").

After studing numerous cephalometrics and lateral cervical spine films of patients it is clearly evident that the hamular notch and incisive papilla (HIP) landmarks actually are more closely parallel to the the Ala-Tragus plane, and Campers Plane, NOT parallel to horizontal level as some teach. This is a big misnomer! True HIP of the maxilla in a true physiologic head and cervical relationship actually angles or slants at a 6 to 10 degrees (average) relative to horizontal (see literature references in above article).

Key Point: The lab technicians are challenged when mounting the maxillary casts by artistically guessing because dentists fail to sending the necessary recordings that are essential to reliably fabricate the aesthetic restorative case. They do not rely on stick bites, inaccurate impressions, inadequate photos, distorted models (hamular notches) and wrong fox plane recordings. The artistic eye often comes into play regardless of advocated techniques.

Clinical and laboratory studies have shown when using the boney landmarks of the maxilla to mount the maxillary cast is in fact incorrect and will simulate an unnatural upward head tilt position with the maxillary cast displaying an anterior upward cant 57.6% of the time. That is why most labs ultimately do not complete the restorative cast to these references, but may use it as a guide. Anyone who honestly questions this can check for themselves by mounting the final restorations on the solid mounted maxillary cast to see the type of occlusal plane and what mounting position was actually used.

Labs will say they mount the case to HIP, but will often not dare finish the case to these references because of their experience and realization that this mount will lead to long toothy looking smiles. The technicians realize that the maxilla is not naturally oriented in that manner, thus they make the decision to change the cant of the cast purposely to avoid remakes and an undesirable result for the dentist. The maxillary cast mount should be determined by the dentist, but reality shows that the lab technicians will subjectively and artistically alter the doctors HIP recording to one that is more subtable for finishing the restorative case.

A flat/level HIP mount leads to a pathologic referenced position. A slanted/angled HIP mount is what nature designed physiologically. I advocate the second HIP mount (slanted or angled) which nature intends and is similar to Campers plane or ala tragus plane. This will lead to golden proportions not only in the anterior regions, but also will result in a more idealized crown to root ratio of both the upper to lower posterior molar regions. (Interesting to note that with the classic HIP mount it is often observed that the upper posterior molar crowns will typically look short (staulky) with longer looking lower molar crowns (This is not gold proportions, but results when the maxilla is erroneously mounted to a pathologic relationship). Neuromuscular science supports natures golden proportions and recognizes pathologic distortions! I prefer not to use the fence post and incisive pin as my mounting references to orient the HIP. I use the Fox Plane as indicated in the previous blog titled "Mounting the Maxillary Dental Cast Using the Fox Plane".







Note: A)Pathologic neck posture: Kyphosis resulting in a more flatter occlusal plane. B) Physiologic neck posture: Lordosis resulting in a normalized occlusal plane (angled slant).

If we were to establish boney maxillary cast references such as the hamular notch and incive papilla as some prefer to dogmatically advocate as scientifically objective and mount the maxillary cast to those references the dentist and technician will ultimately be reproducing an undesireable relationship (often resulting in a maxillary cast occlusal plane that appears level and often with the anterior incisal edges vertically upward relative to the posterior teeth). This does not truly represent what nature intended as dental health. Although this idea may appear to be simple to learn and easy to teach this maxillary cast mounting method is in fact one that ignores natures isotonic neutral head position. What we clinicians want to do is replicate healthy relationships of the head, neck and mandible as it relates to the cranum and not pathologic relationship when treating our patients occlusion.

The Fox Plane technique I advocate is a simple means to subjectively analyze and capture what nature intended (an angled HIP mount not flat or level). This is well supported by literature and the orthodontic and prosthetic community. It is a convenient way to capture a proper maxillary recording when the patient is stable and ready to move to the next phase of restorative dentistry. (The classic face bow also works, but is historically more complex and involved and not laboratory friendly). Objective science will always advocate healthy form to support healthy function. The neuromuscular minded clinician needs to learn to use their best judgement skills and understanding and not rely solely on pathologic boney references as their guide. "Nature does not think in mechanical terms". We need to learn from nature, its beauty,design, form and how it functions.

Students in a recent Level 6 course at Occlusion Connections mounted their maxillary casts using the Fox Plane technique. Note the natural angles that resulted and are represented in this series of mountings. This is key to dental aesthetics.

My View and Opinion: Use the Fox Plane technique to reference a physiologic occlusal plane, not depending on maxillary boney references. Capture a correct maxillary slant or angled HIP (Physiologic) keeping the Fox Occlusal Plane Analyzer level and parallel to the ground. Make sure the head is level (see Fox Plane Mount blog for technique). This will allow the clinician to easily capture a proper occlusal plane, not a flat or "level" occlusal plane (pathologic). Frontally the fox plane is perpendicular to the long axis of the face. I am sure the laboratory technician understands these techniques and the esthetic significance better then most clinicians since they actually have first hand experience of mount your dental casts daily!

Not all clinicians have comprehended these simple teachings of the Fox Plane concept and its significance to the head, neck and mandibular physiology. Not all teachers teach from a TMD/orthodontic-orthopedic/restorative perspective. Not all clinicians take cephalograms and cervical neck films to understand and see the relationship of the neck and occlusal plane as it relates to a leveled balanced head position, thus limiting their understanding of the significance of these occlusal plane concepts that are importantly related to head position, mandibular positioning and mandibular trajectory closing paths. Clinicians who have a scientific inquiring mind will have the maturity and desire to pursue these truths with certainty and apply the common sense techniques that naturally become logically apparent. We don't have time to waste when doing clinical dentistry on live patient's using wrong and misleading concepts. We need to take the opportunity and learn proper occlusal concepts that will lead our profession toward bring health to our patients, not for ease and convience of teaching.

"Clinicians and dental laboratory technicians have found it important to DIAGNOSTICALLY identify HIP plane so that the dentist does not restore to a distorted cranial base. Since the patient poplulation with chronic TMD and postural problems obviously has a higher than normal HIP plane variance from normal base plane parameters, it is important that the clinician does not replicate this distorted base. Ergo Hoc Proctor Hoc, if clinicians restore this patient using the HIP reference it will only replicate the anatomic manifestations of the etiologic problems." - Robert Jankelson, Summer 2005 .
Some may laugh, jeer and criticize me for my passion and beliefs of my occlusal plane perspectives as they relate to clinical dentistry, but one day those critics will quiet themselves when our profession begins to further mature to the next level to see that our application of neuromuscular dentistry brings the science as well as the art together. Don't be confused. Change is in the making! Let's be tolerant, thoughtful and respectful of another point of view!

"It's a curious thing that physical courage should be so common in the world and moral courage so rare." - Mark Twain

Neuromuscular Dentistry