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APPLIED KINESIOLOGY

P.A.K. INTERNATIONAL ANNUAL MEETING 2008

ANTWERP

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This hypotony can cause alterations in the growth of the bones and, consequently, important alterations in occlusions which can have postural, organic, and emotional consequences.

The knowledge of AK is fundamental for an adequate (practice of )odontology because we very frequently find patients with muscular hypotony due to sensibility to foods, heavy metal contamination, presence of candida in the system, among other reasons. These factors usually cause the patient to have muscular problems as well as mouth breathing. This problem causes lack of adequate development of all facial and cranial sinuses and can lead to a lack of proper neuro-muscular development of the patient.

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ROSELI LUPPINO PERES

ODONTOLOGY AND AK

For an efficient diagnosis, we do not find anything better than the muscular tests that are part of our work routine.

A perfect odontological treatment with state of the art techniques will be of no use if we do not have a good

diagnosis of the origin of odontological problems, because if we do not eliminate the causes, there will be recurrence, and

this frequently happens in treatments, specially in those related to buccal (oral) postures because one only sees the

buccal problem, and not, the systemic problem that has caused it. AK opens a fantastic number of possibilities for

efficient odontological diagnoses and treatments with minimal recurrences.

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The interconnection of the Trigeminal System with the musculature and the three first cervical segments explains the fact that we cannot observe cervical alteration without

occlusion problems and vice-versa.Occlusion problems can generate decrease of the oral hollow

and problems in the stomatognathic system and in the organic functioning. To change this, we use Functional

Orthopedics, when the patient can use appliances. We can use all that Odontology offers in order to recover the balance

of the mouth and the general balance of the patient as a consequence.

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The majority of the temporomandibular dysfunctions have as predisposing and coadjuvating factors

alterations at occlusion level, which have been pointed as responsible for the compromising of the muscular

system.The rest position of the mandible has been considered

the base position from which one can obtain the Vertical Dimension of the Occlusion, which can suffer

alterations, due to occlusion pathologies and para-functional habits.

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To keep the correct dimension of the mouth during the treatment, we use one tool called Aero-muscular Possibilitator. The AMP has been used as auxiliary in the diagnosis and it is also a way of treatment that aims at muscular relaxation. The AMP, whether anterior or posterior, is tested through muscular tests before and when put in the patient's mouth in order to confirm its efficiency.

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We also do a postural analysis before installing the appliances and immediately after it, which shows us, on the descendent cases, immediate alteration on the posture.

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The technique most preferably used is the Functional Dynamic Reabilitation of the Maxillaries developed by a Brazilian dental surgeon called Dr. Maurício Vaz de Lima. They are encapsulating appliances, which stimulate growth by utilizing resistance of the majority of the teeth against the minority of them.

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These appliances cause anteroposterior, lateral and posteroanterior movements. They cause a three-dimensional stimulus of growth.

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For those patients who will have their balance recuperated through prosthesis, we use splints with AMP, first the splint with anterior AMP, afterwards with posterior AMP, which will determine what the vertical dimension which re-establishes the balance is. For this, the muscular test will show us when we’ve got the postural balance of the patient. In these cases, the appliances with AMP are also utilized for the recuperation of the neuro muscular balance of the stomatognathic system so that it is possible, afterwards, to do a re-habilitation with prosthesis, whether they are fixed, implants, removable, or total, which has the function of maintaining the acquired balance.

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Another factor that must be observed is: the focuses we can have on the stomatognathic system, which can also be diagnosed through muscle tests. There is a predominance of focuses in areas where extractions have been made, especially of third molars. With the use of appliances, we can stimulate the eruption of those teeth, avoiding extractions.

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TMJ EXERCISES

In the present work, it has been demonstrated that when the mandible is out of the physiological position, there can be

alteration in the position of the skull and consequently, there can be alteration in the relationship between the skull and the

cervical column and the vertebral column.

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AGNÉ CERVO PERES

SCHEME OF THE FUNCTION ACCORDING TO BRODIE, MODIFIED BY CASTILHO MORALES

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CRANIO

MANDIBLE

HYOID

SPINAL COLUMN

MEMBRI SUPERIORIS CINGULUM

MEMBRI INFERIORIS CINGULUM

Temporo Mandibular disorders can have their origin on inflamatory processes, internal alteration of the articular disk, articular hypomobility or hypermobility, muscular dysfunction

or limitation of the amplitude of the articular moviment. In muscular disorders, the typical clinical diagnosis is the

muscular spasm, which, by compression of the blood vessels, will produce ischemia generating a vicious cycle of spasm-

pain-spasm: in this disorder there is a decrease of the level of mandible movement due to pain. The hyperactivity leads to fatigue and spasm, and it can cause dysfunction in all the

musculature of the head and the body.The therapy of the TMJ dysfunction focus on the oral

rehabilitation (occlusion) and the neuromuscular re-education, to re-establish the normal physiological rest position of the mandible, through the strengthening and the balance of the

pterygoideus lateralis muscles and consequently, the menisco-condylar coordination.

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Postural alterations can be related to the shortening of the posterior chain specially the suboccipital muscles that are

associated to the shortening of the Sternocleidomastoid and Escaleno muscles, and these to the cervico-thoracic-

abdominopelvic fascia muscles.On the anteriorization of the head there is a shortening of the

posterior muscles of the neck and head, specially the suboccipital and trapezium, which act as antagonists to

gravity, and can suffer a chronic functional overcharge, generating micro lesions and as a consequence muscular

pain. Etiology comprises of various functional,

anatomic and psychosocial elements; the treatment also deals with multi-factorial

aspects.

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One of the exercises used is done with a gadget developed in Brazil and called Hyperboloid. There are 5 different sizes available, which are used for various types of therapies such as muscular exercises to recover the correct muscular functions, chewing exercises with various different functions, but our main focus are TMJ exercises.

GGG M PP P

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These exercises aim to recover the articular disk; the first exercise is done to recover the articular disk that has had anterior dislocation, then the exercise aims to recover the disk that has had lateral, medial, and distal dislocation.

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Film

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FILM

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The second exercise comes from the Global Postural Reprogramming, it first stretches the elevating muscles of the mandible, and then it stretches the lowering muscles.

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The neuromuscular system is closely connected to the maintenance of the posture therefore any factor whatsoever will influence the skull cervical relationship causing compensatory mechanisms, for example, whenever there is a change in the posture of the head, compensatory mechanisms will be activated throughout the body, looking for the maintenance of the horizontal bipupilar plane . The recuperation of the balance of the Stomatognathic System is very important in relation to the body posture and the ocular convergence.

FILM FILM

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In some studies, it is possible to see the articulated connection of the mandible with the skull base and the skull

muscle and ligament connections to the cervical region, which together form a functional system called cranio-mandibular-

cervical system.According to some authors, different muscles do not work

isolated, but they form true synergic or antagonic clusters.It becomes clear in this work, that the professional

responsible for the treatment of the occlusion must know posturology perfectly well.

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Another point is the somatotopy between the palatine suture and the vertebral column, based on the principle that the bones in the skull are flexible and accept a certain deformation and they articulate themselves due to the sutures.   The Dura-mater, adherent to the bones, runs through the foramen in the base of the skull, accompanying the cranial nerves and the extra-cranial aponeuroses. There is a continuity of aponeuroses from the extremities to the interior of the cranium.  One can consider the dura-mater as a group of cables “whose role” is to unify the occipital to the sacrum; if there is a sacral torsion, the skull will adapt itself by an induced torsion by the membranous system.  The Occipital, sphenoid, and ethmoid bones function like “dented wheels” and are mobilized by the inter-cranial membranes. It is necessary to add the temporals to this system.  In the anamnesis, the examination (touch) informs about the shape of the skull, the position of each of its bones, allowing the comparison between one side and the other.

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THANK YOU