The ten minutes that shook the world

I just returned from Helsinki. I was attending to a hands-on course.

I am utterly grateful to dr. Robert Kerstein, who had once again endured the inconveniences of trans-Atlantic flights and the fog and gloominess of our mid-winter sub-arctic darkness. The course-attendants, however, were well protected from the harsh weather and the inconvenient realities of the world that surrounds us. Revolutionary enthusiasm prevailed around the coffee-brewer in the cozy and smart lobby of the clinic “Albin” – a private practice owned by a digital-occlusion-minded dentist-couple Satu and Kai. The patient waiting room served as an improvised lecture hall. An open door and a video connection into the operatory room showed Robert Kerstein demonstrating his work with live patients. We were a small group of Tscan users and would-be users, all aware and united with great expectations of a huge leap, a revolution that is actually happening in dentistry. A change of paradigm is underway in the sciences of occlusion and jaw-closing, anyone can see it. We, the attendants of this study-club, we felt we were the standard-bearers of a new age to come. How many times it has happened in the history of science that a new invention completely changes the way the scientist think. It is like a few centuries ago, when majority of honest-minded scientist rejected the idea of our world being flat, because of the advent of telescopes, more accurate time-measuring devices, and other new tools for astronomy studies. Technology makes the old views obsolete.

As yet of today, the digital processing of data from occlusion forces, has not yet been propagated to the hordes of wet-finger, working-class dentists. Furthermore, there is a curious attitude, almost a political resistance movement among the established scientific community not to pay attention to the data presented in Tscan studies since almost three decades. Instead, the mainstream of the established authorities in the field of TMJ-diseases elaborate consensus papers and protocols for diagnosis and treatment, where the digital occlusal force measuring is not even mentioned.

Our study-club comprised of practicing dentists, young and more seasoned ones, and a hygienist, all devoted to understanding the fundamental role of the teeth as the sensory organ that guides the muscles of mastication. We all shared the need to promulgate the new way of thinking for the wellbeing of TMD patients all over. All of us were convinced that the proper use of modern digital technology will help our patients better than the treatment protocols offered by the non-digital-old-school-establishment.

Personally, with my only two years of experience with Tscan in my practice, I loved to see Robert, the old master, explain the diagnosis and perform the ICAGD procedure. The essential of this procedure is to change the way teeth occlude in such a way, that as the lateral movement from the maximum intercuspation begins, as we do the lateral excursion test, the shape of the upper and lower canine teeth immediately deflect the laterally moving mandible so that the back teeth disclude in shortest possible time. The ICAGD procedure involves possibly reshaping of the canine tooth and practically always the grinding down of small amounts of tooth enamel from the molar and premolar region.

I was relieved to find out that the clinical conduct I had been learning by myself by trial and error in my own practice, was not so bad. It is a rare occasion that a dentist sees his/her colleagues do their work. In the art of dentistry there are so much details in the procedures that can only be learnt by trial and error and by repetition of each step thousands of times. Repetition is the mother of learning. For a novice there can’t be better thing to do than to first carefully observe a skilled master do the job. And then do the repetition oneself ten thousand times over.

Robert meticulously discussed the Tscans he took from the live patients. Interpretation of events proceeding in a Tscan is always a challenge to your intellect. There are millions of bits of data in a single scan, which bits are of clinical importance? Here again, repetition helps, but now for once – I could ask Robert!

Helsinki January afternoons turn to dusk early. The warm and comradely union of visionaries of occlusion continued at the premises of Albin Dental Clinic. Discussions were flowing freely. We all shared the awareness of historical changes happening not only in dentistry. The exceptionally warm weather, gloomy drizzle of rain was an ominous sign of the global change of weather conditions. Talking of science, the newly introduced meme “the alternate facts” was not uncommonly used punch line in our discussions. I am writing this article only ten days since the inauguration of president Trump.

The world outside of our cozy den was undergoing historical, even frightful events. These are the days that will be remembered in history writing. The whirl of events that had started days earlier in Washington D.C. will surely be remembered by generations after us. The pace of the world order changing is breath-taking.  I can’t help but comparing these days to the famous writing by journalist John Reed. He reported the historical events in the city of St. Petersburg one hundred years ago and titled it “Ten days that shook the world”. Today, we really are living the ten days of our century that will be remembered to have shaken the world.

In the world of science, however, the significant events may be described as revolutions, but the pace of change is less daunting. Of nature, the academic ranks prefer the null of any new idea hypothesised. I tend to believe the nullishness of hypothese-preferring is a sort of pride for them, if I may say.

Whatever will be the course of time needed for the general acceptance of digital occlusion force scanning in the diagnosis of TMD patients, the fundamental revolution occurred very rapidly. I was curious to know, how did Robert come to the idea that the deflection of the laterally moving mandible should be caused by the canine teeth, not the back teeth. When did this idea strike to him?

Robert related:

“It happened 1987. By the time I was in my academic studies with the first versions of the Tscans. In the evenings I used to do clinical work, that consisted of treating patients with TMD problems. It was late in the evening and I was in the middle of doing bite-adjustment of the type that we used to give our patients in those times. I had not finished my patient yet as the telephone rang and I had to leave the patient to answer the phone in the other room. The telephone call lasted ten minutes.

As I returned to the operatory room, my patient was amazed. She asked me what had I done, since now for ten minutes her bite had never felt more relaxed and easy. It was kind of late and I thought there probably would not be any problem not to finish her bite that night –  I would finish adjusting her bite a few days later.

To my astonishment when she arrived the next time she was still very happy with her bite. I immediately realized that there was something unknown to our profession in what I did to that lady. So I took her to the early Tscan test and there I realized that the canine-guided lateral excursion proceeded so much faster compared to what happens with a group function…”

This finding proceeded to a study plan and the publishing of the study in the Journal of Prosthetic Dentistry. Since that Robert Kerstein has written dozens of articles on occlusion dynamics. In my opinion the scientific work of Robert Kerstein should be regarded a revolution in dentistry. Any new research on dynamics of occlusion can’t be regarded valid unless the data is proven with digital measuring.

Plato, the philosopher said, it is the ideas that run the material world. New ideas may be welcome for some, for others the changes brought by new ideas may be frightening. However, once an idea has been let out of the Pandora’s box it can never be ignored again.

Sometimes, it only takes ten minutes to shake the world irreversibly.

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