Report about postural function and osteopathy in dental practice.

The interdisciplinary approach is becoming more widely used by modern Russian dentistry. This

approach covers both dentistry disciplines and general medical field. It often leads to hyper

diagnostics and inadequate treatment, with results in a patient’s overtreatment and their

psychological state.

Osteopathy has gained a lot of popularity, especially cranio-osteopathy, to treat patients with

TMD (TemporoMandibular Disorders). It becomes obvious that the relation between supporting-

motor apparatus and masticatory system evokes great interest.

Some authors claim that TMD is caused by poor posture and spine disorders but not by

problems in maxillofacial area.

Many scientific conferences have been held all over the world. A lot of clinics have taken on

osteopaths.

The use of alternative medicine techniques in our field is very risky as no enough scientific

evidence has been found yet to prove the effectiveness of such methods of treatment.

The aim of our research is to determine the effectiveness of the use of cranio-osteopathic

methods in dentistry field.

Therefore a number of questions arise.

1. What is cranio-osteopathy? What are the basic principles regarding dentistry?

2. Is there any significant relation between posture and dento-facial system? As osteopathy aims

at treating spine and posture disorders.

3. How effective and specific are osteopathic treatment techniques for TMD patients?

Method

1. Reviewing scientific literature on osteopathy.

2. Examining teenagers (aged 16-19) with infantile cerebral palsy (ICP) on the presence of TMD

symptoms.

Introduction

J. Carlson introduced the term “orthocranial occlusion” in his work “Physiological occlusion”

(2009). He defines this type of occlusion as the one which occurs when plane of occlusion is

orthogonally aligned to the forces of occlusion. It is the author's opinion that, in turn chewing

forces are putting pressure on vomer and forth on the spheno-basilar synchodrosis setting in

motion the bones of the base and a roof of the skull. Upon violation of these movements and

develop cranio facial dysfunction.

This work is becoming one of the main sources for those who use cranio-osteopathic and

neuromuscular theories in their dental practice. Their diagnostic and treatment techniques are

also based on this theory.

The ideas about scull bones movement and the relationship between masticatory system and

supporting–motor apparatus developed within cranio-osteopathy.

Sutherland W.G. (1873-1954) developed one of the main movements in osteopathy which he

called craniosacral osteopathy.

Sutherland discovered so-called cranial rhythm. It is the author's opinion that this rhythm is a

result of rhythmic contractions of the brain and the entire nervous system, which is called the

craniosacral mechanism (CSM). According to craniosacral theory, this mechanism of osteopathy

is the base, and it explains all the basic processes in the human body.

CSM is based on the following five principles:

I. Mobility is an inherent property of the tissue of the brain and spinal cord

II. Fluctuation of the cerebrospinal fluid

III. Mobility membranes of reciprocal tension

IV. Mobility of the skull bones

V. Sacrum has the mobility between the iliac bones

These five basic principles underlie cranio-osteopathy different methods of treatment and

diagnosis, so-called osteopathic techniques.

In osteopathic sources paid little attention to these basic principles, which are discussed

briefly in very ambiguous terms. After that the authors go on quick directly to the techniques of

treatment, or to describe the successful results of observations and experience of the authors.

Besides, the craniosacral mechanism is not explain in any way as "the primary source of all"

in the body, except are some vague assumptions and it simply postulated as a given - it exists and

it explains everything.

Mobility of brain structures, some authors associated with the ability of glial cells to reduce

rhythmic. Further, this movement is transmitted throughout the body through the hydraulic

system and mechanical system liquor membranes (1).

Although, there is another opinion, "... the most compelling theory appearance craniosacral

rhythm, is the theory of cyclic changes of cerebrospinal fluid pressure developed JE Upledger»

(3).

YE Moskalenko and colleagues used methods elektroimpedansografii and found slow-wave

oscillations with frequencies of 6-12 cycles per minute, along with breathing and pulse

fluctuations. While on serial images using the phase-contrast MRI cranial and cervical spine

during diastole of the heart was observed during downward in lumbar CSF spine. After 2-3

cardiac cycles they observed reverse current liquor. Suggesting that the relationship between

cardiac cycles during which there is a kind inflating lumbar spine liquor followed by the reverse

current of cerebrospinal fluid caused by the reduction of response surrounding the tonic muscles

and ligaments. On this basis, the authors proposed a concept gemolikvorodinamicheskuyu

craniosacral mechanism (6). Also, they confirmed the role of respiration in the redistribution of

liquor, which is associated with a change in the amount of blood in the space of the skull (5).

Also, in some experiments, were found some undulation than the pulse and respiratory waves

(5, 6, 7, 8).

These fluctuations occur with a frequency of 9.54 cycles per minute, which does not coincide

with the frequency of the respiratory system (17 - 20 cycles per minute), or with the frequency of

heart rate (60 - 80 min). The data should be cause for hesitation "cranial breath" - flexion

(extension), and "cranial exhale" - extensions (decrease) in the entire skull.

"During the initial phase of the cranial inhalation is an active reduction of brain tissue in the

anteroposterior direction and extending in the lateral direction. Vertical diameter decreases.

During the initial phase of the cranial passive exhalation occurs brain relaxation in the

anteroposterior direction and compression in the lateral direction. Vertical diameter increases

"(1).

Thus, according to supporters of this theory, the skull as a balloon expands uniformly, then

narrowed. That is, for about 6-10 seconds skull is steadily expanded or contracted state, which is

caused by a current of cerebrospinal fluid (CSF) in the brain likvorosoderzhaschey system. Or,

alternately, "contracting and relaxing" brain tissue.

Fig.2 of Viola M. Frymann. Der Zusammenhang von Störungen des Kraniosakralen

Mechanismus mit der Symptomatik bei Neugeborenen: Eine Studie mit 1250 Neugeborenen /

Genehmigter Nachdruck aus JAOA. - 1966. - № 65. - R.1059-1075 (9).

The possibility of such metamorphoses caused micromotion in cranial sutures, rotation and

other deformities of the skull bones, which is a hydraulic pressure of cerebrospinal fluid.

That is, according to this theory, the cranial sutures neither more nor less than the joints. The

"swing" motions in these "joints" is from 1 to 1.5 mm (1)

One of the most voluminous and long-term research in this area was conducted Viola M.

Frimann, 1971 (10).

Through constant and persistent search movements of the skull bones they were able to record

the vibrational waves with a frequency that does not coincide with any breath or with a pulse.

Ms. Freeman spent more than seven years in search of movement of the skull bones, the

amplitude of which was 0.002 - 0.025 mm, ie from 2 microns to 25 microns. For comparison, the

thickness of the erythrocyte 2 microns, a diameter of 8 microns.

For reference, the thickness of the parietal bone for men ranges from 4.0 to

8.9 mm, an average of from 6.0 to 6.9 mm (15). That is, the maximum

possible movement of the floor percent of the thickness of the displaceable

bone. Flexural deformation of bones have large values.

Micrometer is a standard tolerance of deviations from the specified size (for guests) in

mechanical engineering and in almost any industry where extreme precision is required sizes.

It could be the error of the instrument, or they registered peristalsis. Because, under such

measurement sensitivity can not be excluded microvibration biological objects. Which confirms

itself Freeman, describing the research process. Registration was possible for a subject who "...

brilliantly mastered his body and could hold his breath for a long time." In addition, if there is no

isolation from external vibrations, the noise will be recorded from passing transport, slamming

doors and stuff.

Fig. 6 - meter when applied to the frontal bone was not detected movements.

fig. 3 fig.4

However, some movements were registered, and we must deal with the fact that they caused.

Flexion occurs when the uniform expansion of the skull, with extensions contrary narrowing

is caused, according to osteopaths, the hydrostatic pressure of the cerebrospinal fluid on the inner

walls of the skull. Which corresponds to Pascal's law (XVII c.) "Liquid or gas enclosed in a

closed vessel is transmitted to them produced surface pressure in all directions equally," Fig. 2.

This relieves the pressure on the walls of the skull liquor must remain within normal limits,

otherwise the high numbers will cause pathological symptoms - Cushing's triad (high blood

pressure, persistent bradycardia, respiratory failure).

Thus, in normal adult human supine intracranial pressure (ICP) ranging from 3 to 15 mmHg

in children 3-7 mmHg and neonatal 1.5-6 mmHg

Also, there can be significant fluctuations in ICP to 50 - 60 mmHg coughing, sneezing, with a

sharp rise in intra-abdominal pressure. These zenith ICP does not lead to disturbances in the

central nervous system, but if you follow the logic of flexion, in this moment there is a dramatic

expansion of the cranium.

fig. 6

Fig.7 Alperin N. From cerebral fluid pulsation

to noninvasive intracranial compliance and

pressures measured by MRI flow studies /Alperin

N., Mazda M., Lichtor T. // Current Medical

Imaging Reviews. – 2006. – Vol. 2, No. 1 – Р. 117-

129.

Moreover, under certain pathological conditions, patients are able to for a long period of time

to carry very high numbers of ICP (for example, slow-growing brain tumors or benign

intracranial hypertension). It can be assumed that the head of such patients is in constant flexion.

Thus, the pressure of the cerebrospinal fluid rhythmic changes within 3 - 15 mm Hg. Art. that

leads to a shift of the skull bone. It should be understood that 1 mm Hg. Art. = Pressure of 1.36

grams force per 1 m. See That is, the pressure set at 4 - 20 grams of bone causes displacement of

the roof and base of the skull. What then can be said about the impact of blood pressure on the

skull.

As already mentioned above, the pressure of the cerebrospinal fluid is considered as a kind of

uniform pressure distribution within the cranial cavity. However, the contents of the skull is a

heterogeneous and complex variety of interconnected cavities. Availability volumetric

anatomical structures creates additional insulation of certain departments of the cranium. For

example, the cerebellum shares gallop supra-and infratentorialnye space. Infratentorialnoe space

is a closed cavity having a limited connection with supratentorial space near tentorial scraps with

spinal subarachnoid space through the foramen magnum. Supratentorial space is divided into two

symmetrical parts relatively rigid barrier, brain sickle (falx cerebri). In addition, the anterior

temporal lobes are also enclosed in its own space formed by the temporal bone, the main bone

and cerebellum tentorium. Within each of these spaces are not only the substance of the brain,

but also the blood vessels, as well as elements of the ventricular system. All this leads to the fact

that quite often increase (or decrease) in one of the ICP intracranial spaces may not reflect the

overall level of ICP.

According to the Monroe Doctrine Kelly all intracranial volume (brain matter 80-85%, 5-15%

of cerebrospinal fluid, blood, 3-6%) enclosed in a rigid wall of the skull and the change in any of

the components occurs a compensatory change in the other (11).

Of course, when the intracranial pressure in the first place will change the volume of liquor

and indicators of cerebral blood flow, and not to expand the walls of the skull bone.

When the level of ICP more than 15 mm Hg included compensatory mechanisms maintaining

constancy of intracranial volume. Initially, there is a moving fluid from the cranial department in

spinal simultaneously increases its resorption (CSF production rate is constant). Isobaric level of

compensation is effective for ICP less than 30 mm Hg. Art. With further increase in the level of

ICP is a reduction of intracranial blood volume (11, 13).

Also, if the skull bones move at such low pressure indicators, it's frightening to think what

should be done with the head of swimmers, divers, and a barometric pressure of 760 mm Hg.

Art. would be a danger.

This problem should be considered from the perspective of function. Why are these

movements of the skull bones body? Or do they only want to somehow explain craniosacral

mechanism?

Let us not forget that one of the main functions of the skull bones, the skeleton is. These are

fixed set of muscles that develop every second large enough combined and mixed load. If the

skull bone could easily be displaced, and with an amplitude of 1 - 1.5 mm, that it would face to

our example, when chewing? After all, the masseter is one of the strongest in the body.

Fig.8

Fig. 8 Scheme of M. Nordin. Basic Biomechanics of the Musculoskeletal System / M. Nordin, V.

Frankel / / Lippincott Williams & Wilkins, New York. - 2001. - 468 p.

Figure 7 shows the distribution of loads per unit time on cortical bone of the tibia at a slow

human walking and running. Of this scheme can be seen that the load can vary between 10 MPa

and wearing a very versatile character.

For comparison with the cerebrospinal fluid pressure, which "causes a displacement of

bones," we need to put pressure that develops muscles when walking in mm Hg. Art.

So, if 1 mm Hg. Art. = 133 Pa, a load in run up to 10 MPa (106 Pa) or in mm Hg. Art. it will

load equivalent 75188.6 mm Hg. Art. or about 100 kg per sq. cm.

That is, the pressure on the bones of the skull, muscles develop during the function,

cerebrospinal fluid pressure may exceed tens or even hundreds of times.

The form itself is a type of seam compound "spike", which inherently gives the smallest

opportunity to any whatsoever displacement. For example, the Russian built the Church of the

Transfiguration on Kizhi Island, without a single nail. Using the compound spike logs.

Moreover, the seams "fit" is very accurate.

Fig. 9

Fig. 9. Scheme of Beatrix Renaux. Anatomie, Histologie und Entwicklung der Suturen des

menschlichen Schädels / Diplomarbeit. Schule für Craniosacrale Osteopathie. - 2007. - 23 p.

Intrasuturalnye fibers are arranged so that the amount of space vnutrishovnogo is 250 microns,

ie, 0.25 mm (17).

Fig. 10 Scheme of Beatrix Renaux. Anatomie, Histologie und Entwicklung der Suturen des

menschlichen Schädels / Diplomarbeit. Schule für Craniosacrale Osteopathie. - 2007. - 23 p.

From the point of view of the skull and the brain department skull base develop differently.

Calvarial bones are formed by intramembranous reconstruction without preliminary formation of

cartilage.

Reconstruction and bone growth occurs due to activity on the surface of the periosteal bone.

First of all the points of contact of adjacent periosteum of the skull bones. Apposition of bone in

the cranial sutures of the cranial vault is the main source of bone growth.

Fig. 11 Skull of a newborn (20).

Base of the skull is formed initially in the form of cartilage and bone is converted by

vnutrihondralnogo ossification. Ossification centers are formed at an early stage of embryonic

development, setting the position of the bones of the skull base. In the process of ossification of

bones retained between portions of the cartilage of the compound called synchondrosises (21).

Fig. 12. Synchondrosises skull base. Fig. 13 Diagram of growth in mezhklinovom

synchondrosises.

Figure 13 is a diagram synchondrosises growth. In the center you can see the accumulation of

immature proliferating cells. More mature cartilage cells are pushed toward the periphery,

intracartilaginous ossification occurs at both edges, which leads to a lengthening of the bones of

the skull base.

Fig. 14. Epiphyseal plate - growth areas of long bones.

Growth of bones of the skull base is similar to the growth of long bones. Epiphyseal plate is

involved in longitudinal bone growth. Plate chondrocytes are in constant mitosis. Daughter cells

are collected from the pineal gland, are pushed to the parent metaphysis. On the background of

the old degeneration of chondrocytes, osteoblasts form new bone tissue. After puberty

epiphyseal cartilage cells stop dividing, and the entire cartilaginous tissue is gradually replaced

by bone except for a thin line epiphyseal.

Thus, the function of the cranial sutures is to maintain the growth of the skull bones, and not

movement.

This is well illustrated by the example of craniosynostosis (craniosynostosis). When there is

one or more fusion joints (Fig. 15) that leads to the cessation of growth of the skull, with

continued growth of the brain. Only problem is solved surgically.

Also, the final cessation of "mobility" comes with age. Since the joints 20 - 30 years are

fused. According to the survey Andreeva IV Age-related changes of thickness of the calvarium,

2000 - "... diagnosis age the skull had been ongoing for a long time and is usually applied in

forensic medicine. Analyze the complete closure of individual sections of the seams on the outer

surface of the cranial vault. According to this principle were built numerous tables "(15).

Fig. 15. Scaphocephaly - overgrowing premature sagittal suture.

Movement of the bones of the skull base sets, according to supporters of the craniosacral theory,

"hour" mechanism of bone movements. Ie, bone-like toothed gears hours cling to each other,

forming a variety of rotation.

Fig. 16. Scheme based on John E. Upledger. Lehrbuch der CranioSacralen Therapie I / John E.

Upledger, Jon D. Vredevoogd / / MVS Medizinverlage, Stuttgart - 2009. - 378 p.

Fig. 17 and 18. Scheme based Sinel'nikov RD Atlas of Human Anatomy Volume 1 / Sinel'nikov

RD and Sinel'nikov YR / / Moscow. Medicine. - 1996. - 344.

This idea is based on the fact that neither seams nor synchondroses not overgrow.

But if the seams are not fused, the "clockwork" should be even more interesting.

As can be seen from the diagram in Figure 18, osteopaths are not limited mobility in fixed

joints. There is rotated within the bone itself, in this case the forehead. And the goal of "therapy"

to make this rotation "right."

Movement of the bones of the skull creates tension of the dura mater, and thus, in accordance

with the sacred mechanism occurs twitching sacrum between the iliac bones. This is a key

transmission mechanism of pelvic dysfunction in the maxillofacial region, so you can not ignore

it. After further efforts osteopath in treating problems of the temporomandibular joint will focus

on the alignment of the sacrum and iliac bones symmetrical position.

In addition, it is biomechanically absurd, it is clear that even the "vibrations of the skull bones

with an amplitude of 1 - 1.5 mm" will be extinguished within the elasticity of structures: "... calls

the" tightening "of the spinal dural sac that in turn, initiates the movement of the sacral spine.

This explanation seems unrealistic with biomechanical position, since the mobility of the skull

bones, measured in fractions of a millimeter, and if calls "pulling" of the spinal dural sac, it is

small enough and likely extinguished its elongation along the spine "(6).

Just look at the anatomy of the joint to completely calm about the sacro-coccygeal

movements.

Fig. 18

Sacroiliac joint (articulatio sacroiliaca) formed ear-shaped articular surfaces of the

sacrum and ilium. The shape of the articular surfaces of the joint refers to the flat. Articular

surfaces are covered with fibrous cartilage. Joint strengthened strong ligaments, which virtually

eliminates motion in it. Fig. 19

With regard to the principle of "reciprocal tension membrane mobility", that this postulate,

apparently postulated for the possibility of extending the techniques of osteopathic treatment on

the entire body. Since "... fascia form three-dimensional network connecting the body from head

to toe." This also added and peritoneum, and pleura and etc.

These formations have different origin, function and structure, and it does not fit into such a

simplified mechanistic model of pathology.

Fig. 20 Model few fascial restriction (3).

Violations are reduced to the limits of mobility data fascias so-called restriction. Which in

turn leads to disruption of all, only (3). Treatment is reduced to smoothing data restriction.

Title osteopathic medical techniques despite its exceptional variety and "ingenuity" reduced to

a few tricks:

- Superficial and deep sliding palpation

- Shift tissues

- Vibration low and high frequency

- Stretching of the skin and deeply lying tissues

- Registration of movements musculoskeletal system

- Registration of local and referred pain convulsive response

- Twisting, etc.

All these techniques are identical to those used in therapeutic massage, chiropractic,

chiropractic, applied kinesiology, etc. The only exceptions are exotic as motion detection skull,

liquor and other organs, palpation of the skull, stretching the dura mater and some "energy",

sacred art. The "registration" is based on the subjective impression of the operator, which leads

to wide interpretation and speculation of the data.

The subject of the influence of these treatments is the musculoskeletal system and its

elements.

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