Not wanting to be down on something I'm not up on

Omer K. Reed, DDS

During the late 1950s, I met Bernie Jankleson, who frequented a study group in Amarillo, Tex. I had the opportunity to learn about his research in neuro-musculature and his development of the myo-monitor, a TENS unit.

During the 1960s when the hardware became available, I used the unit for determining the vertical interrelationship between the mandible and the maxilla for denture patients who had destroyed or modified their proprioceptive records beyond usefulness. I found the unit to be very effective for that purpose.

I spent a lot of time with L.D. Pankey, Clyde Schuyler, and Arvid Mann during those same early years (before there was a Pankey Institute, and before there was a Dawson Institute). I'm very familiar with the procedures Pankey used to determine where he wanted to build his cases, and the interesting position he took regarding occlusion. Pankey wanted the buccal cusp of the lower in the central fossa of the upper without cross-tooth or cross-arch balancing, and he enjoyed and appreciated cuspid disclusion and incisal guidance.

Dr. Bailint Orban, concerned with traumatic occlusion — teeth that are loose and sore as a result of excessive stress — was fascinated by the work of Bernie Jankleson in the same study environment in Amarillo. Then, there was the subjective "magic" he built in, called "long centric." Now, just guess where the condyle goes when the mandible moves forward? Then I watched Niles Guichet as he did his gig with the Denar articulator and the philosophy and process of placing the mandible in relationship to the maxilla. During the later parts of his experience, he also used the myo-monitor to assist in those decisions.

Gnathology and tripodization is not an unknown, yet little practiced by general dentists today. The armamentaria and the exactness of that procedure and its philosophy are beyond the general dentists' interest or, perhaps, even ability. There are definitions and schools of thought — hostile camps, if you will — in reference to centric occlusion, centric relationship, and generally where the mandible and the maxilla should be when they interrelate, in a healthy sense, with each other.

Recently, I counted no less than eight such camps. As you sit on the sidelines, it helps to apply some of Viktor Frankl's counsel in regard to attitude and see some humor in the elevated voices and combative positions.

Over the years, I have been in and out of several of these camps and, notably, there's nothing more exhilarating in life than being shot at without results. At this point, we have a phenomenon that has been accepted and widely used — the anterior repositioning appliance. It is an immediate appliance that is used to keep the muscles from "triggering" for bruxers, clenchers, and even people with chronic headaches.

Give some thought as to where you go once the necessary muscular relief has been achieved with these appliances to determine where the mandible should be as it relates, in a healthy sense, with the maxilla. I know that going from these appliances to a relationship, whether you call it centric or not, is presently the subject being studied by those principals who spend a lot of their time with these appliances.

One of the very successful ways to go "from here to there" is to work the lactic acid out of the muscles. Get the muscles to relax — it only takes about 45 to 60 minutes — and let the person come into a relaxed position with the muscles and nerves deprogrammed. I know of no more brilliant academician in this field than the general dentist, Clayton Chan. Clayton has magnificently exhausted the literature, created a lot of his own, and has vigorously presented, defused, and defended his findings among the various hostile camps. I find the computerized mandibular scanning and myotronic instruments are extremely useful tools. They aren't difficult for a general practitioner to use successfully and, for those who choose to have some formal training in that area, like it or not, one of the 17 institutes that exist in the United States is willing to have you join them for three days. During that time, you will apply this philosophy, vision, techniques, and instrumentation with a "hands-on" experience.

Not wanting to be down on something I wasn't up on, I recently attended the occlusion course at Las Vegas Institute to personally experience what I choose to be "up" on. I found the experience with the Jankleson philosophy and instrumentation to be valid. My application in the treatment room since the course has proven to be effective and helpful for the people coming to me for care.

I had lunch recently with George Obst of the Dental Services Group. It is, I believe, the largest laboratory affiliation in the United States. We were discussing the interrelationships between the dentist and the laboratory in regard to philosophy and tactics and the centric relationship, centric occlusion among them. We reviewed the various philosophies over lunch and mused over the violent energy that seems to present today in the literature and in the atmosphere regarding these subjects. When we discussed the fact that dental schools were pretty light in their teaching of this and that there certainly isn't a standard that laboratories could seek out and depend on, George chuckled and said, "You know, many people feel that the Las Vegas Institute is America's finest dental school."

As one travels this trail, many decide to leave it early on. After 15 or so years, they "retire" to do something else or to just escape that which they find to be unpleasant. Dr. Richard V. Tucker, in Washington state, is in his 80s and actively practices the cast-gold inlay rehab procedures. He was recently awarded an honorary doctorate by the University of Vancouver for his work with cast gold in dentistry. Dr. Perry Ratcliff, a periodontist in Scottsdale, practiced well into his 80s as well.

A number of people in our profession decided not to die or to retire, and as a result, have become reservoirs of historical observation, however prejudiced.

I'm slowly, but surely, becoming one of them. I find it to be an extremely pleasant position. I'm certainly available for any discussion you might choose to initiate, and there are plenty of empty holes in my back where the old arrows have been. I'm not shy, nor do I choose anger, on any of these occasions.