Osseous factors influencing distal tibial rotation in biplane medial opening wedge high tibial osteotomy.

PURPOSE: There is a lack of studies investigating the distal tibial rotation (DTR) during medial opening wedge high tibial osteotomy (MOWHTO). This study was designed to evaluate osseous factors influencing DTR in patients who underwent biplane MOWHTO. METHODS: A total of 106 knee joints in 69 patients who underwent surgery for varus malalignment of knee were reviewed. Based on several software, standard and actual hinge positions were defined in pre-operative and post-operative CT data. Pearson's correlation and Spearman's correlation analysis were performed with DTR change as the dependent variable. Independent variables included angles between standard and actual hinge in the sagittal (ASAHS) and axial (ASAHA) planes, pre-operative and post-operative medial proximal tibial angle, opening width (OW), tuberosity osteotomy angle, flange angle (FA), gap ratio, and hinge fracture. RESULTS: The distal tibia rotated approximately 0.35° internally. Pearson's and Spearman's correlation analysis showed that DTR change was associated with ASAHS, OW, and FA. Larger OW and FA resulted in higher external rotation angles. CONCLUSIONS: DTR change was significantly associated with ASAHS, followed by OW and FA rather than ASAHA if only considering osseous factors in biplane MOWHTO. The distal tibia tended to rotate externally when the actual hinge was inclined posteriorly to the standard hinge in the sagittal planes, but rotate externally or internally when the actual hinge was inclined anteriorly.

Maxillomandibular relationship and virtual facebow integration in complete-arch intraoral implant scan: A novel clinical technique.

This clinical report introduces a novel clinical technique to create a 3D virtual patient for transferring the edentulous maxillary arch position with maxillomandibular relationship by using a facial scan device and an intraoral scanner and omitting CBCT imaging.

A Novel Technique to Align the Intraoral Scans to the Virtual Articulator and Set the Patient-Specific Sagittal Condylar Inclination.

Customized cast orientations and parameter settings of the virtual articulator according to the patient's condyles are indispensable parts of today's digital workflows in prosthodontics. This article describes a digital technique to align the intraoral scans to a virtual articulator by using a facial scanner to locate the patient's cutaneous landmarks of the arbitrary hinge axis and the reference plane, and to customize the sagittal condylar inclination of the virtual articulator through a digital protrusive interocclusal record and a dental computer-aided design software program. It enables individual cast orientations and virtual articulator parameter settings without conventional facebow transferring and bite registration procedures and can be easily integrated with most virtual articulator systems on the market to allow clinicians and technicians to work in a complete digital workflow and facilitate customized treatment planning and dental prosthesis fabrication.

Investigation of sequence features of hinge-bending regions in proteins with domain movements using kernel logistic regression.

BACKGROUND: Hinge-bending movements in proteins comprising two or more domains form a large class of functional movements. Hinge-bending regions demarcate protein domains and collectively control the domain movement. Consequently, the ability to recognise sequence features of hinge-bending regions and to be able to predict them from sequence alone would benefit various areas of protein research. For example, an understanding of how the sequence features of these regions relate to dynamic properties in multi-domain proteins would aid in the rational design of linkers in therapeutic fusion proteins. RESULTS: The DynDom database of protein domain movements comprises sequences annotated to indicate whether the amino acid residue is located within a hinge-bending region or within an intradomain region. Using statistical methods and Kernel Logistic Regression (KLR) models, this data was used to determine sequence features that favour or disfavour hinge-bending regions. This is a difficult classification problem as the number of negative cases (intradomain residues) is much larger than the number of positive cases (hinge residues). The statistical methods and the KLR models both show that cysteine has the lowest propensity for hinge-bending regions and proline has the highest, even though it is the most rigid amino acid. As hinge-bending regions have been previously shown to occur frequently at the terminal regions of the secondary structures, the propensity for proline at these regions is likely due to its tendency to break secondary structures. The KLR models also indicate that isoleucine may act as a domain-capping residue. We have found that a quadratic KLR model outperforms a linear KLR model and that improvement in performance occurs up to very long window lengths (eighty residues) indicating long-range correlations. CONCLUSION: In contrast to the only other approach that focused solely on interdomain hinge-bending regions, the method provides a modest and statistically significant improvement over a random classifier. An explanation of the KLR results is that in the prediction of hinge-bending regions a long-range correlation is at play between a small number amino acids that either favour or disfavour hinge-bending regions. The resulting sequence-based prediction tool, HingeSeek, is available to run through a webserver at hingeseek.cmp.uea.ac.uk.

The determination of the terminal hinge axis: a fundamental review and comparison of known and novel methods.

Different concepts are used for the analysis and transfer of mandibular movements to virtual or conventional articulating systems. Some common procedures and analyses include the determination of the terminal hinge axis. However, despite the widespread use of different methods for hinge axis determination, very little information on the applicability and quality of these methods is currently available in the literature. The aim of this study was to provide an overview of the methods already being applied and to search for novel algorithmic methods, comparing them with respect to achievable accuracy and indication. This comparison was based on new extensive computer simulations, where the influence of measurement noise on the result of the hinge axis position could be investigated. The assumptions used for the simulations were set so that the conditions allowed for the most accurate hinge axis determination: this comprised a pure rotation during mouth opening, within an incisal pathway of 15 mm, a measurement accuracy of 50 µm, and an optimal positioning of the entire measurement setup. The results of the computer calculations show that the best accuracy can be guaranteed by the novel least squares method, introduced in this article for temporomandibular joint (TMJ) measurements. Additionally, only methods tracking two and more (iterative or parallel) independent markers or equivalent jaw position measurements provide enough information for reliable accuracy. Using actual technical equipment, the highest accuracies can be achieved in a TMJ-near measurement setup. However, even in that best-possible setup, the error of hinge axis determination cannot be expected to be less than ±1 mm. For a better characterization of actual electronic recording systems, manufacturers need to provide more insight into the evaluation processes.

Hinge axis determination of the temporomandibular joint and its interpretation: what do we really measure?

Terminal hinge axis (THA) determination is recommended in some clinical situations and for some diagnostic purposes. Different methods are described and are available for this task. In particular, circle fitting or iterative trace recording methods, in the conventional process known as the pantographic or Lauritzen method, have mostly been applied in clinical settings and have even been used as exact reference measures in many studies. The aim of this study was to investigate whether the conditions for THA determination by these methods principally allow for the differentiation between a pure rotational movement and a combined translational and rotational movement. A further question relates to how large the uncertainties are if an additional translational movement is present during the first phase of mouth opening or closing. These questions were investigated by an exact simulation. The methods under consideration are seen to be able to detect a pure rotational movement, if one or both of the following conditions are met: a) the traces recorded around the rotational center perform a circlelike motion, and b) a point or pin on the rotational center remains at rest during movement. It can be proven that in the relevant clinical situation these conditions also hold in the case of a combination of translational and rotational movement. Furthermore, small translations of 1.1 mm lead to a deviation of the THA of around ± 6.7 mm, and a translation of 2.2 mm to an uncertainty of even ± 13.5 mm. The significance of these results suggests that the commonly used methods for THA determination should be reevaluated, and the literature on this topic should be carefully scrutinized.

The effect of osteotomy depth and hinge axis orientation on biplanar surgical accuracy in medial opening-wedge high tibial osteotomy-a deeper understanding by 3D simulations.

Background: Not all surgical osteotomy steps have been properly investigated for their potential impact on surgical accuracy. The main study objective was to investigate the osteotomy parameters that have respectively major and minor impact on coronal and sagittal bony accuracy in medial opening-wedge high tibial osteotomy (MOWHTO). Methods: Three tibias from an existing 3D MOWHTO osteotomy database were chronologically selected based on segmentation quality, tibial plateau size and the presence of tibial varus. The study consisted of three parts: (I) translating the hinge axis in the coronal plane and switching the osteotomy starting point (30-40 mm) and depth, (II) the hinge axis was rotated stepwise by 10° to perform five simulations, (III) the hinge axis was rotated in the axial plane stepwise by 10° towards anterolateral to perform four simulations (0°, +10°, +20°, +30°). The medial proximal tibial angle (MPTA) and lateral tibial slope were the primary outcomes. Simulations were performed with 5, 10 and 15 mm gap distraction. Results: In the coronal plane, maximum difference in osteotomy depth was 10 mm which represented an MPTA difference of 0.8°-1.1° in 10 mm gap distraction and 1.2°-2.0° in 15 mm gap distraction. Tibial slope remained unchanged. Rotating the hinge axis in the sagittal plane delivered minor changes on both MPTA (<0.5°) and tibial slope (<1.5°) at 10 mm gap distraction. Per 10° of axial rotation of the hinge axis towards anterolateral, the tibial slope increased by 1.0°-1.3° in 10 mm gap distraction while the MPTA remains nearly unchanged. Conclusions: The study showed that the medio-lateral osteotomy length is the main parameter for obtaining bony accuracy in the coronal plane and maintaining a strict perpendicular axial hinge axis position is crucial in preserving the native tibial slope. Correct axial alignment of the hinge axis can be obtained by creating an equal osteotomy depth of the anterior and posterior tibial cortices in the lateral metaphyseal area.

Factors Causing Unintended Sagittal and Axial Alignment Changes in High Tibial Osteotomy: Comparative 3-Dimensional Analysis of Simulation and Actual Surgery.

BACKGROUND: Unintended secondary changes in the posterior tibial slope (PTS) and tibial torsion angle (TTA) may occur after medial open-wedge high tibial osteotomy (MOWHTO). In surgical procedures using patient-specific instruments (PSIs), it is essential to reproduce the PTS and TTA that were planned in simulations. PURPOSE: To analyze the factors causing unintended sagittal and axial alignment changes after MOWHTO. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Overall, 63 patients (70 knees) who underwent MOWHTO using a PSI between June 2020 and June 2023 were retrospectively reviewed. Preoperative and postoperative computed tomography scans were 3-dimensionally reconstructed. Simulated osteotomy was performed so that the weightbearing line could pass through the target point. A PSI gapper was 3-dimensionally printed to fit the posteromedial corner of the osteotomy gap in the simulated HTO model. After MOWHTO using the PSI gapper, the actual postoperative model was compared with the preoperative or simulation model. This assessment included PTS, TTA, hinge axis, and osteotomy-related parameters. Cortical breakage around the lateral hinge was evaluated to assess stability. RESULTS: The mean PTS and TTA did not change in the simulation. However, significant changes were observed in the actual postoperative PTS and TTA (change, -2.4°± 2.2° and -3.9°± 4.7°, respectively). The PTS was reduced, while the TTA decreased with internal rotation of the distal fragment. The difference in the axial hinge axis angle (AHA) between the simulation and actual surgery was the factor most correlated with the difference in the PTS (r = 0.625; P < .001). In regression analysis, the difference in the AHA was the only factor associated with the difference in the PTS (ß = 0.558; P = .001), and there were no factors that showed any significant associations with the difference in the TTA. In subgroup analyses for the change in the TTA, the correction angle and anterior osteotomy angle were significantly higher in the more internal rotation group (P = .023 and P = .010, respectively). The TTA change was significantly higher in the unstable group with lateral cortical breakage (P = .018). The unstable group was more likely to show an internal rotation of ≥5° (odds ratio, 5.0; P = .007). CONCLUSION: The AHA was associated with a difference in the PTS between the simulation and actual surgery. The change in the TTA was caused by a combination of multiple factors, such as a large correction angle and anterior osteotomy angle, but mainly by instability of the lateral cortical hinge.

Centric relation definition: a historical and contemporary prosthodontic perspective.

Centric relation (CR) is a core topic of dentistry in general and prosthodontics in particular. The term CR has become thoroughly confusing because of many conflicting definitions. Unfortunately definition of CR changed repeatedly over past ten decades. All the existing definitions in the dental literature, for the past 81 years, are segregated into definitions from 1929 to 1970, 1970-1980, and 1980-2010 and are critically analyzed. Both PubMed (key words: centric relation/centric jaw relation) and hand searches were employed, from citation in other publications, to identify relevant articles in English language peer reviewed PubMed journals from 1956 to 2010; although the review is from 1929. Numerous definitions for CR have been given, however, no consensus exists and the definition given by a current glossary of prosthodontic terms is confusing. It relates CR to many clinically invisible parts and cannot guide a dental surgeon to record the CR following its description. The purpose of this article is not only to review all the definitions critically but to propose a self explanatory definition to minimize the confusion in the minds of dental practitioners and students for better understanding of the concept of CR. Centric relation is clinically significant since it is the only clinically repeatable jaw relation and the logical position to fabricate prosthesis.

The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning-A k-Means Cluster Analysis.

The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients was conducted. A k-means cluster analysis was performed on the mounting parameters: the angle α between the upper occlusal plane (uOP) and the axis orbital plane (AOP); the perpendicular distance (AxV) from the uOP to the hinge axis; and the horizontal length (AxH) of the uOP from upper incisor edge to AxV, with subsequent statistical analysis of related cepalometric values. Three clusters of mounting data were identified, representing three skeletal phenotypes: (1) balanced face with marginal skeletal class II or III and α=8∘, AxV = 36 mm and AxH = 99 mm; (2) vertical face with skeletal class II and α=11∘, AxV = 27 mm and AxH = 88 mm; (3) horizontal face with class III and α=2∘, AxV = 36 mm and AxH = 86 mm. The obtained data on the position of the hinge axis can be applied to any digital planning in orthognathic surgery using CBCT or a virtual articulator, provided that the case can be clearly assigned to one of the calculated clusters.

A preoperative simulation of medial open-wedge high tibial osteotomy for predicting postoperative realignment.

Three-dimensional preoperative surgical simulation of the medial open-wedge high tibial osteotomy (OWHTO), simplified as the rigid rotation around the hinge axis, has been performed to predict postoperative realignment. However, the practicality of this highly simplified simulation method has not been verified. This study aimed to investigate the validity of realignment simulation simplified as a rotation around a hinge axis compared with a postoperative CT model. A three-dimensional surface model of the tibia and femur was created from preoperative computed tomography (CT) images (preoperative model) of three patients. The simulation of medial OWHTO created sixty computer simulation models in each patient simplified as the rigid rotation of the proximal part of the tibia relative to the distal part from 1° to 20° around three types of hinge axes. The simulation models were compared with the actual postoperative model created from postoperative CT images to assess the reality of the simulation model. The average surface distance between the two models was calculated as an index representing the similarity of the simulation model to the postoperative model. The minimum value of average surface distances between the simulation and postoperative CT models was almost 1 mm in each patient. The rotation angles at which the minimum value of average surface distances was represented were almost identical to the actual correction angles. We found that the posterior tibial tilt and the axial rotation of the proximal tibia of the simulation model well represented those of the postoperative CT model, as well as the valgus correction. Therefore, the realignment simulation of medial OWHTO can generate realistic candidates for postoperative realignment that includes the actual postoperative realignment, suggesting the efficacy of the preoperative simulation method.

Reliability of 3D planning and simulations of medial open wedge high tibial osteotomies.

Purpose: In medial open-wedge high tibial osteotomy (HTO) hinge axis and osteotomy plane influence the resulting anatomy, but accurate angular quantifications using 3D-planning-simulations are lacking. The objectives of this study were developing a standardized and validated 3D-planning method of an HTO and to perform several simulated realignments to explain unintended anatomy changes. Methods: The cutting direction of the main osteotomy was defined parallel to the medial tibial slope and the hinge axis 1.5 cm distal to the lateral plateau. For interobserver testing, this 3D planning was performed on 13 digital models of human tibiae by two observers. In addition, four different hinge axis positions and five differently inclined osteotomy planes each were simulated. The osteotomy direction ranged from medial 0°-30° anteromedial, while the tilt of the osteotomy plane compared to the tibial plateau was -10° to +10°. All anatomic angular changes were calculated using 3D analysis. Results: Multiple HTO plannings by two medical investigators using standardized procedures showed only minimal differences. In the 3D-simulation, each 10° rotation of the hinge axis resulted in a 1.7° significant increase in slope. Tilting the osteotomy plane by 10° resulted in significant torsional changes of 2°, in addition to minor but significant changes in the medial proximal tibial angle (MPTA). Conclusion: Standardized 3D-planning of the HTO can be performed with high reliability using two-observer planning. 3D-simulations suggest that control of the osteotomy plane is highly relevant to avoid unintended changes in the resulting anatomy, but this can be a helpful tool to modify specific angles in different pathologies in the HTO.

Methods of mandibular condyle position and rotation center used for orthognathic surgery planning: a systematic review.

We aimed to evaluate whether there is a consensus among bi- (2D) and three-dimensional (3D) evaluations of mandible condyle position and its rotation center. Also, if this data can be replicated in orthognathic surgery planning. The survey was carried out on the major databases (PubMed, SCOPUS, Embase, Cochrane). Human or human bio models evaluations in 2D or 3D of mandibular condylar position concerning its fossa and rotational axis for orthognathic surgery planning were eligible. The heterogeneity of the studies and uncertainties in methodological biases did not allow us to identify the superiority of 2D or 3D methodology in determination of the condylar rotational axis. There is a lot of divergences in the definition of occlusal relationships among dental specialties. Although there was no consensus regarding condylar position in relation to the fossa, the most reported axis of rotation was positioned posterior-inferior. Weak scientific evidence and divergences in dental vocabulary shows the need for clinical studies with more accurate and transparent methodological design to standardize concepts. Despite we cannot affirm, we can suggest that the centric relation (CR) is not the condylar position when clinically manipulated in the posterior superior direction. This condylar position is the retruded contact position (RCt) while CR is the functional position of the condyle. In this way, the orthognathic surgery has two occlusal relationships during planning and execution. The ideal axis of rotation for orthognathic surgery planning must be fixed, permit individualization for each condyle and be reproducible. The 2D planning is obsolete as cannot provide all the necessary tools for an accurate planning.

Is it possible to detect a true rotation axis of the temporomandibular joint with common pantographic methods? A fundamental kinematic analysis.

The location of the terminal hinge axis of the temporomandibular joint is still a very wide-spread procedure in dentistry in order to replicate the movement in various articulator devices. Especially pantographic methods are claimed to provide accurate measurements and, additionally, are seen to be able to separate a pure rotation of the joint from a movement with an arbitrary combined shift and rotation. In the latter application, these methods were used in a lot of studies as a reference standard. The aim of this study was to analyze, whether common pantographic methods in general are able to distinguish between a pure rotation and a movement with rotational and translational portions. The mathematical proof of this analysis was done with theoretical kinematic considerations and compared with computer simulations. The results show for the first time that there exist combinations of rotational and translational movements of the temporomandibular joint which cannot be separated from pure rotational movements using actual pantographic methods. Even more, the consequence is a shifted location of the (combined) finite center (axis) of rotation in comparison to the true center (axis) of rotation: in case of a translational portion of only 1 mm, this is a displacement of around ±6 mm and, in case of 2 mm translation, a displacement of ±12 mm. This finding necessitates a critical reinterpretation of former studies using pantographic methods as a reference standard. Further, under some circumstances it may also affect the applicability of articulator concepts and the interpretation of functional signs.

Methodological improvements for the analysis of domain movements in large biomolecular complexes.

Domain movements play a prominent role in the function of many biomolecules such as the ribosome and F0F1-ATP synthase. As more structures of large biomolecules in different functional states become available as experimental techniques for structure determination advance, there is a need to develop methods to understand the conformational changes that occur. DynDom and DynDom3D were developed to analyse two structures of a biomolecule for domain movements. They both used an original method for domain recognition based on clustering of "rotation vectors". Here we introduce significant improvements in both the methodology and implementation of a tool for the analysis of domain movements in large multimeric biomolecules. The main improvement is in the recognition of domains by using all six degrees of freedom required to describe the movement of a rigid body. This is achieved by way of Chasles' theorem in which a rigid-body movement can be described as a screw movement about a unique axis. Thus clustering now includes, in addition to rotation vector data, screw-axis location data and axial climb data. This improves both the sensitivity of domain recognition and performance. A further improvement is the recognition and annotation of interdomain bending regions, something not done for multimeric biomolecules in DynDom3D. This is significant as it is these regions that collectively control the domain movement. The new stand-alone, platform-independent implementation, DynDom6D, can analyse biomolecules comprising protein, DNA and RNA, and employs an alignment method to automatically achieve the required equivalence of atoms in the two structures.

Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy.

BACKGROUND: To assess the axial rotational change of distal tibia and posterior tibial slope (PTS) change after OWHTO in 3-D planes and to identify the causal relationship on the effect of variation in the posterior slope angle and rotational errors. METHODS: A total of 21 patients (23 knees) underwent OWHTO and were evaluated with 3D-CT before and after surgery. Medial proximal tibial angle in the coronal plane, PTS in the sagittal plane, and rotational axis in axial plane were evaluated and compared between pre- and post-operative 3D models constructed by applying reverse-engineering software. As a selective osteotomy parameter, hinge axis and gap ratio were measured in the postoperative 3D models RESULTS: The increasing tendency of internal rotation of the distal tibia after OWHTO was positively related to hinge axis (ß=0.730, p=0.001, R2=0.546) and gap ratio (ß=-0.283, p=0.001, R2=0.520), which also showed statistically significant linear correlations to PTS changes after multivariate regression analysis that controlled for the rotational change of the distal tibia (hinge axis: ß=0.443, p=0.006; gap ratio: ß=0.144, p=0.017). CONCLUSION: Hinge axis more posterolaterally was related to a greater increase in internal rotation after biplane medial open-wedge HTO, and hinge axis and gap ratio were significant predictors of PTS change after rotational change was controlled for. Hinge axis has to be considered an important independent variable for limiting unintended axial rotation change as well as PTS change as secondary. CLINICAL RELEVANCE: The relationship of the hinge axis with the rotational change and its influence to PTS change, acknowledged from by-product of the statistical analysis, might provide a deeper understanding of HTO, and should have constitutional effects on the development of HTO procedures and implants.

Influence of the Hinge Axis Transfer Modality on the Three-Dimensional Condylar Shift Between the Centric Relation and the Maximum Intercuspation Positions.

PURPOSE: The purpose of the study was to determine whether the hinge axis registration and the transfer modality (facebow transfer vs. average mounting) from the subject to the articulator affect the three-dimensional condylar shift between the centric relation (CR) and the maximum intercuspation (MI) position. MATERIAL AND METHODS: The study was comprised of 32 fully dentate subjects (16 male and 16 female). Only the asymptomatic participants with normal occlusal relations (Angle class I) aged 20 - 33 (mean age 22.6 ± 4.7) met the inclusion criteria. Three-dimensional condylar shift (anteroposterior, superoinferior and mediolateral shift) between the centric relation position (CR) and the maximum intercuspation (MI) position was analyzed by means of Mandibular Position Indicator (SAM Prazisionstechnik GmbH, Muenchen, Germany). RESULTS: The average three-dimensional condylar shift was 0.13 ± 0.12 mm for facebow transfer and 0.22 ± 0.23 mm for average mounting. There were no statistically significant differences noted between genders. The results of the Mann-Whitney test showed statistically significant differences for anteroposterior and superoinferior condylar shift (P < 0.001). However, the difference in the mediolateral shift was not statistically significant. CONCLUSIONS: In order to find discrepancies within the three-dimensional condylar shift, facebow transfer proved to be more accurate than the average mounting in the semi-adjustable articulator. However, the average value of three-dimensional shifts of the condyle did not differ from normal values and they did not have clinical significance. Thus, both ways of transfer modalities (facebow transfer and average mounting) in asymptomatic subjects with normal occlusion can be considered reliable.

Hinge axis - location, clinical use and controversies

The hinge axis is an imaginary line around which the condyles can rotate without translation. Terminal hinge position is the most retruded hinge position and it is significant because it is a learnable, repeatable and recordable position that coincides with the position of centric relation. There are many schools of thought regarding hinge axis. The proponents of Gnathology say that there is one transverse hinge axis common to both condyles which can be accurately located. The proponents of transographics claim that each condyle has a different transverse hinge axis and that a transograph is the only instrument that can duplicate this. Still others claim that an exact duplication of jaw movement is not possible on any machine. The aim of this article is to throw light on location, clinical use and controversies of hinge axis.

Oclusión dental: ¿doctrina mecanicista o lógica morfofisiológica? / Dental occlusion: mechanistic doctrine or morphophysiological logical?

Las escuelas de oclusión han creado un constructo mecanicista que busca explicar, bajo un modelo reduccionista y determinista, una dinámica cráneo-cervical y estomatognática compleja. Estos modelos de oclusión le dedican más importancia a la morfología dental y sus geometrías interpretativas que a la morfofisiología estomatognática. La configuración musculo-esquelética cráneo-cervical tiene el poder ganado de influir concomitantemente en la ubicación espacial de la mandíbula e implícitamente en las relaciones interoclusales. La visión actual de la oclusión sigue basándose en observaciones empíricas de un siglo de antigüedad que carecen de soporte apropiado en el marco del nivel de evidencia. En la dimensión funcional los modelos de oclusión conservan los mismos vacíos que existían desde su estructuración en el siglo pasado, particularmente en sus representaciones espaciales estáticas, uniáxicas y anti-dinámicas que desestiman la individualidad de cada sujeto. Cada especialidad puede tener tantas razones como puntos de vista diferentes de "maloclusión" así como formas de tratarla.

Occlusion schools have created a mechanistic construct that seeks to explain, under a reductionist and deterministic model, a craneal-cervical and stomatognathic complex dynamic. These occlusion models dedicate more importance to dental morphology and its interpretative geometries than a stomatognathic morphophysiology. Craneocervical musculoskeletal configuration has the gained power to concomitantly influence the jaw location in the space and implicitly in the interocclusal relations. The current vision of the occlusion is based on empirical observations of almost a century that lack support in the level of evidence framework. In the functional dimension occlusion models maintain the same gaps that existed from its origins since the last century, particularly in its static, uniaxic and anti-dynamic spatial representations that dismiss the individuality of each subject. Each specialty can have as many reasons as different points of view about "malocclusion" as well as techniques to treat it.