Thoughts on Articulating Paper and Comparable GNM Techniques

Question from antagonistic skeptic: “Clayton I’m perplexed by your response. You say you are not into studies but instead clinical outcomes (which I can appreciate) but you typically talk about how superior GNM tx modality is because it uses tens and K7 to “measure” and measuring is superior to not measuring. Those positions seem contradictory to me. If someone is only using old fashioned articulating paper and their skills but gets good outcomes would that technique be comparable to GNM?”

Answer from Dr. Clayton Chan: “Don’t be perplexed. I am more clinical oriented and a wet fingered dentist than an academic. Yes, I appreciate and value objective measurements and quantifying the things I can’t see, but know exist. There is no contradictions in my experience between objective NM science, G+NM occlusal
principles and my clinical experience. Years ago, I thought there was, but now I realize there is not. It may be a matter of perspective and realizing the world expresses itself in various colors, shades and tones, not just black and white. There are various layers of details, various levels how one diagnosis, various levels of how one examines, various levels of how one treats and various levels of how one implements and applies what they have learned.

I am very familiar with articulating papers. I am also familiar with gnathic contacts. But the GNM dentists also realizes that just because contacts can mark nicely and precisely from one’s perspective (8 micron, 10-20 micron levels), we also appreciate the fact that quantifying what looks balanced with paper may not always adequately address the underlying musculoskeletal occlusal issues that are not seen with paper marks even thought the TMD patient maybe complaining about issues such as unresolving temporalis anterior headaches or facial masseter soreness/ pain or cervical neck/ SCM and shoulder tightness or occipital pains. These are factors that I know go beyond accuracy of marking paper, especially for those patients who have been treated by great occlusal operators. Just as many others have also realized, the limitations of paper, even it if was used meticulously and accurately, for some it is not good enough.

This is where it gets fun, quantifying and measuring with objectively scientific principles…what we think is great success, now is pressed to another level…I got personally see what I didn’t realize from my former gnathic training…. to open up into arenas I did not formerly realize, now I have another awareness of what exists and is possible.

This is where I realized my great gnathologic understanding can be measured and quantified and where neuromuscular (NM) principles can be further challenged as to whether these concepts are complete or whether there is something missing (not complete) in the application of all the principles of occlusion. This is how our understanding of treating TMD pain, occlusion and associated problems have evolved.”

Clayton Dentistry