Occlusion Wars: Which is the Best Occlusal Religion? – PDP099

Jaz’ Introduction: Hello, Protruserati. I’m Jaz Gulati and welcome to Occlusion Wars episode 99 with Dr. Bobby Supple. This episode was inspired by a blog post I saw Dr. Bobby Supple right in his website. And it was about the differences between the different occlusal camps or these occlusal religions. Hencewhy the name occlusion wars because the most common questions I get is Jaz, What should I do? Should I study with Dawson? Or should I study with Pankey or Should I study with Kois or Spear and neuromuscular? So there’s a lot of these occlusal religions and that’s what we call them throughout this episode, you know, tongue in cheek kind of thing. And which one is the best one, which is the correct religion. That’s what we’re hoping to answer in this episode. And the main question I asked Dr. Bobby Supple was exactly that. And really, I don’t want to give too much away from this episode. But one thing to consider is that the end goal of no matter who you train with, whether it is Spear or Pankey, Kois whoever. You will do wonderful dentistry, you will do it for the benefit of the patient, you will have more fun as a comprehensive dentist. So whoever you train with, just do everything they say and do it properly and follow that system. But don’t be afraid to expose yourself to other ways of thinking because essentially, what these religions, these occlusal religions argue about is the processes. How do you get from A to B, the B is the same, A is the same. A is your patient. B is a stable position, whereas a better smile, a nice comfortable bite, all those things, right? So A and B are the same. What we’re fighting about is everything in the middle. And that really doesn’t matter. We should be outcome based ie a longevity in our restorations, happy patients. And I think all those whose religions deliver exactly that. That’s one of the sentiments that Dr. Bobby Supple passed on. I just want to echo that. Now if you want to really skip to that bit. It’s probably somewhere in the middle to the end of the episode where we really get to nitty gritty. We start off in this episode, discussing the origin story. I mean, origin stories always really powerful of these clinicians that we speak to Dr. Bobby Supple has so much experience to share. So we learn about his origin story, but also the origin story of how it goes from gnathology to then Pankey to then Dawson, Spear and how they came about in the east coast and west coast, the bio aesthetic group, how that played into it. And eventually, in part two, we’ll cover something really deep I mean, the direction this podcast goes in is really thought provoking, essentially, that the message is that we find these patients who have destroyed their dentition. And we’re arguing about how we’re going to restore this destroyed situation. So we’re all arguing about how to restore the patient. Whereas what Dr. Bobby Supple says that we need to think preventatively, we need to screen our children for airway issues, and consider the correct assessment at the right age and nasal breathing so that we can avoid those bigger issues in the future. So it’s amazing how much of a tangent we go into in terms of posture, airway, which really is the biggest growth area in dentistry in the next 20 years and I’m sure of that. Now, if you’re new to the podcast, Welcome. Thanks so much for listening on episode 99. Almost 100. Wow. Okay, so if you’re new to the podcast, and a lot of the episodes are occlusion based, if you are new to occlusion and your knowledge of occlusion is quite basic, and you haven’t started with big schools or big occlusal religions, then maybe want to go back to Episode 90 basics of occlusion. This is again for the season occlusal practitioner, who has been to maybe a few of these occlusal school thoughts and this loves to learn about what the different camps have to say. So this is really made for the ultra geek when it comes to occlusion, but you can still listen and follow along I think I’m sure you’ll gain so much from it as well. The Protrusive Dental Pearl I want to share with you for this episode is something that you guys have requested, the community, the protrusive dental community have request this for me, and I’ve now finally delivered, okay? It’s about how to give a buccal infiltration for a lower first molar. So a lot of people still doing ID blocks which is fine. I still do ID blocks but I’m doing them way less now compared to five, six years ago when I wasn’t using buccal articaine for lower first molar. So pretty much the only time I’ll be giving a ID block or an inferior alveolar nerve block is if I’m doing an extraction of a lower second molar or a wisdom tooth. And most other scenarios, I’m doing infiltrations with articaine. So I have a video that I’ve posted to YouTube. I toyed with the idea of putting it in this video, but I think for my audio listeners, it just won’t make sense, you want to see exactly where I insert the needle and how we do it. And again, everything that I’m sharing with you guys is stuff that has been taught to me over time. This is nothing new. I’m just passing it on. I’m trying to make it tangible for some young dentists who haven’t done buccal infiltration successfully or you’ve done it before and you found that the anesthesia hasn’t been sufficient. I’m going to share the secrets with you through a clinical video which my patient kindly let me record and that’s going to go on YouTube. So it’s going to be the Protrusive Dental Pearl is how to successfully give lower first molar anesthesia using articaine Without an inferior alveolar nerve block. Anyway, hope you enjoy that. And I’ll catch you in the outro. Here’s quite a long and meaty and geeky episode with Dr. Bobby Supple. Hope you enjoy.

Main Interview:
[Jaz] Dr. Bobby Supple, Welcome to the Protrusive Dental podcast. How are you?

[Bobby]
I’m well today, thank you from the US.

[Jaz]
Thank you so much for coming on. It was a Thanksgiving yesterday and you had some lovely family time, we just catching up before I hit the record button. I had been super excited. I mean, for the listeners that I know and everyone kind of has got the feel for the podcasts now, Protrusive Dental podcast, the cornerstone of this podcast is furthering ourselves in the field of occlusion and learning from lots of different educators. Amazing to have you on today, someone who’s done so much recently. I’ve seen a lot of stuff on digital. But I initially found out about you through a Google search. I was at one stage looking for the differences between what we’ll call the different occlusal religions if you can use that term, you know, what’s the difference between Dawson and Kois and Panky and Spear and neuromuscular? And I came across one of the articles. And I thought okay, I’ve got to get this guy on. I’ve got to get Dr. Bobby on to share with my listeners, because this is something that confused a lot of people, like many things do outside dental school, and I’m just looking for some clarity to pass on. I personally, Bobby, I want to learn about you in terms of which religions you have prayed with. But I have prayed with Dawson. You know Ian Buckle I’ve done you know the Dawson Academy UK. I’ve done lots with Spear Academy online. I’ve done where my mentors and my principles in the past have been Pankey trained. Michael Melkers, Hap Gil. So I’ve got a bit of a background. The only people I haven’t really had training with is neuromuscular. So how about yourself, Bobby, tell us about yourself, where you are? And what is your pathway in terms of the schools of thoughts when it comes to occlusion?

[Bobby]
Okay, and that’s a long story. But I’ll try and make it as quick as short as possible. I was at Tufts, I went to dental school at Tufts. And I’m now, I got started in [pre clan] on my first day by a lab partner. His name was John Sumaha, his dad was actually head of prosthetics at Harvard. And John did all of his dad’s lab work growing up. And so I was that Thanksgiving. So that was I don’t know, but 40 years ago, almost did the day. And then John invited me to New Hampshire because I couldn’t. I’m from New Mexico. So I didn’t go home for Thanksgiving. But anyway, I’m sitting literally after three months of dental school, with the chairman of prosthetics at Harvard at his Thanksgiving table. So John learned it all from the lab. So I learned it from the lab perspective. And so then out of a no free claim partner that knew all about occlusion and everything like that, and I got off to a awesome start. I had a tremendous dental school experience. There was a another prosthodontist at Harbor, Tufts, his name was Lloyd Miller. Lloyd Miller had a laboratory in Boston. And you had to be somebody just to send your stuff to this lab. Everything had to be fully mounted. And Lloyd Miller was a good friend of Peter Dawson’s. When I finished dental school, I was broken. I wasn’t gonna really hang around in Boston too much because it was gray and cloudy. I’m from New Mexico. So back to the sunshine in the southwest. But Lloyd Miller, he told me Look at your why I need you to just start at Pankey when you’re ready, go to Pankey. So then it was like two years later. So there’s 1982 then I started at Pankey Institute, and then that just got me just often run. And I have to understand growing up as a kid as a swimmer, I hit my jaw on the diving board. I broke my jaw here and here. So I had a condylar fracture was the surgeon in the orthodontist who put me back together, who got me interested in dentistry, so I had no family connections or anything with dentistry. My dad was an engineer. So it was more was the artist person in the family, the odd person out but What happened is simply I was just always always interested in TM. So I’m at dental school, didn’t learn much about my job, that sort of thing. But we didn’t know, we didn’t even have imaging. We didn’t have panels. We didn’t even have anything that could just like image the joints and anything like that. And so when I first went to Pankey, there was a guy named [??] and he had written the radiology textbook that I have studied for my boards I walked in, he’s like seven years old, one of those pure, pure master teachers. And I go, I know you, because I had to study you. And I told him my little story, he sat me down, he did a transcranial and just kind of talking about the lateral Pole in and I’ve literally going, Wait a second, I’m in a world that I know absolutely nothing about. So I kind of made it my life’s work. And then that started me on the journey. Now quickly in Pankey, you just, you go through these curriculums in continuums and things like that. So I was through Pankey pretty much by the through the 80s. There was a gentleman there named Parker Mahon. Parker Mahon was Peter Dawson’s roommate and confidant in dental school. He ran the Florida occlusal pain management from the University of Florida, but he was this Master master teacher. So I did all of my job, dissections with him. And then the real breakthrough started way in 1989. I went to with my fiancee at the time, and we went to St. Thomas Virgin Islands. And there was a week. And the week was Peter Dawson, Parker Mahon and Mark Piper. So they called it the Peter Parker Piper show.

[Jaz]
That is fantastic.

[Bobby]
It was a week where you were just literally on the beach at times back and forth. And so I got to be tremendous brands with all three of them. And then I just Mark Piper, he was my TM coach and Pete was my occlusion coach and Parker was medical and TM and dental and all that sort of thing. And so that’s where I got the whole big start. So basically, I’m Pankey born bred Dawson prototype. So I understood CR or the concept of centric very, very well. And then now I’m in New Mexico starting in the 90s. And then now the occlusion war sort of started. Honestly, he called it blood on the walls. He actually liked that, he wanted the fight. He was always up for the fight. So he actually was a proctor. And so when anytime another philosophy kind of came into the scenario, then he wanted the debate. Okay? [Jaz] Excellent. [Bobby] In New Mexico, I’m in a different scenario because I’m in the middle of the country. Pankey, Dawson Academy had not started yet. So the east coast was definitely all centric, oriented. Just put condyles back in the sockets go from there. Okay? And then what happened is the gnathology group was the very first one that I was with, No, they were actually pre Pankey, the nathologists were the ones who invented the Charlie Stewart was fully functional articulators they were into gold, and they would do the points and back and lines in the Front and all of the when you would put it on the articulator, but they were the ones who actually invented the articulator, so they were working through it. The problem with gnathology is that you did all your adjustments on the articulator and everything was done in gold. So you would do gold and you’d have these buttons. And then you would seek the whole case, a Peter K Thomas and some of these brains in the, you know, the history of dentistry, but then they would take off the little buttons, put it back on it, remounted, do all the adjustments on the articulator and come back because they actually believe the articulator was better than now. So that’s kind of how, that part of it started, the natholology guys, they sort of went out of the way because it was way too hard, way too much work. You’re always remounting. And then the whole idea is that we weren’t allowed to adjust in the mouth which turned out to be their downfall.

[Jaz]
So Bobby, you can argue that the gnathology to practice, like an gnathological dentist, it was not practical and not universal and the point of entry was perhaps too high for someone who wanted to be pragmatic dentist.

[Bobby]
Absolutely. But the concepts is what we learned in dental school. We like point groove mesial buccal cusp and mesial buccal groove, slide, all of those sorts of things. So, we actually learned all of the gnathology concepts when we first picked up our very first articulator in dental school. Alright, so the next group that kind of came around was a group called Bio aesthetic dentist. Bio aesthetic came out of Southern California, Bob Lee was the general behind all of that. And then, so that they put condyles in centric, they totally believe put them in CR this, they come back and CR but then, then you had to add, not subtract, okay? So they would add composite and a new build up in and everything was all pointed cause so if you were wearing down a canine on one side, and oh my gosh, you have to stop now you got pathology going on. So you got to build back the canine and get all the points back. And so their concept was build up all the anatomy in the front, don’t let it all wear down. Okay, now then, we got into a problem with terms and words because the word ‘Equilibration’, at that time was under attack. So this is in the 90s when Equilibration first started getting attacked. The biosynthetic endace would do what you would call negative coronaplasty. So it was okay for them to adjust the tooth but if you called an Equilibration, then that was nicknamed mutilation. And so Equilibration became mutilation. And then what you were doing is you were just subtracting and everything you were just cutting down the backs in order to get to the trends when they’re thinking was No you have negative coronaplasty but you also have positive coronaplasty. So then by doing composite and adding so, it was sort of the add and subtract. And to this day, I still use those concepts. I’m still use composites and I’ll build some things up in the front and that sort of thing. Okay?

[Jaz]
Just to make the bio esthetics, tangible, I mean, it’s essentially re-gain anterior guidance and then fill in the spaces at the back to the new vertical dimension. Is that a philosophy that the sums it up well?

[Bobby]
Yeah, exactly. So you can still use that. So in a sense, what they do is they put him in, they wind up lay close all the way down till you get the first point of contact. Okay, so now you have your first point of contact. So Dawson calls that your anterior control. Now you have to know that the word anterior has been bastardized in dentistry because to the master dentist anterior means anterior to the condyle. We think of anterior as anterior guidance. Anterior guidance is the entire occlusion. We think of it and fond of it as canine disclusion. So all of dentistry thinks, Okay, well the anterior guidance is from canine to canine, when in reality, anterior guidance is from second molar to second molar. So if you close down and the condyles are seated, say young, okay, when there really isn’t any kind of damage or anything adaptations, things like that, you can put them back pretty much every 14, 15 year olds condyles are fine and you stick them back in the condyle socket, goes down, and then that’s your first point of contact. No, that’s called your anterior control, though anterior means in front of the condyle. So you may have a posterior teeth controlling the whole entire occlusion. That’s how I got started with the T scan. So back in Tufts, so T scan came out of Tufts, I go back for my five year reunion. I’m with all of my, you know, dental school teacher friends, but they were into the T scan at that time, because there was a guy named Dr. Magnus who taught so T scan came out of Tufts. So then they’re one of my other professors. He just goes, No, you got to look at this, Bobby, you’re going to love this, you’re just going to absolutely love this. And so anyway, then I became an early adopter to the T scan. So I had a T scan back in the 1990s. So now you’re looking at 30 years, and gone

[Jaz]
30 years before me, Bobby, because as some of my listeners now know I’ve only recently just got my T scan. I’m about four weeks away from it being delivered at the time of recording. So I’m super excited. And I’ve also recorded with the [Rob Kurstin]. It’s not been published yet. Maybe by the time this comes out. And maybe so we’ve discussed a little bit about the T scanner. So my listeners know a little bit about the T scan research and the applications.

[Bobby]
Perfect. So I’ve gone through now six, seven generations. So now we’re at T scan 10 Sorry, four, five years, it’s like your cell phone, it comes back out and things like that. And so each generation had a you know when upgrade and that sort of thing. Okay, so we’ll talk a little bit about that later. But the T scan, what I would do is I would literally look for my anterior control. So I wanted to know what was the first tooth that touch, which teeth touch, how hard they touch it and what sequence that they touch into so then, Dr. Dawson, he loved the T scan. Christensen, Gordon Christensen loved it. So I’m in his office in Utah, and there’s his T scan in it, and Dawson had it in his operatories. And so, you know, one time I just asked Pete about it and, and he goes, Yeah, well, we use it in the laboratory all the time. So Dr. Dawson’s dad was a dentist, he grew up in the lab, so he would been doing his dad’s work since he was six years old. So anyway, in the lab, then what they would do is they would take the T scan out the models, and then check it on the models and then go to the mouth. And so then they were using the T scan to check the validity of their mountings to see if they all match that well. Lo and behold, things match up pretty damn good. But you kind of started to realize no, the problem is that the mouth is a little bit more perfect than the articulator because you have flaws where you would take the impression, pour the models and then mount it and all of that sort of thing. So we were close with mountings. But guess what? We never really ever did hit a homerun when we mounted it in, send it into the lab, because you always knew that as a dentist, it would come back but you will always have to do some kind of adjusting in the mouth. Even as close as nice as the dentistry in the lab technician might be. But anyway, that so that’s the whole sort of T scan story. So the bio aesthetic guys, they actually were a bit of a problem in my community because there was a number of bio aesthetic, and they were anti equilibration. So for a little while, it was sort of like I was under attack. But my MO was the T scan and I would sit down in my study clubs, we were in RB Tucker gold study clubs. These are my friends. I mean, I grew up with them in dentistry, we just had a different philosophy of where we were coming from, from an occlusion standpoint.

[Jaz]
Can I just ask on that regard? You mentioned that bio aesthetics, they had this term called Negative Coronaplasty. Just to make it extremely obvious, for those listening and watching. Do you mean that essentially they were equilibrating, but they didn’t want to admit they were equilibrating, Is that what you’re alluding to?

[Bobby]
Like Kois, Spear you know, yeah. So yeah, they waited, adjust a cusp tip. But then their concept was, well, we’re never adjusting vertical, we’re just adjusting like left and right lateral slides and things like that, which is fine. But they were adjusting nonetheless.

[Jaz]
But they’re very much prescriptive in terms of I believe it’s one of the measurements they prescribe is that between the gingival zenith of the upper canine to lower canine it must be 19 millimeters and whatnot. Were they quite prescriptive in those sorts of parameters?

[Bobby]
Exactly, exactly. They would have it all mounted up in CR, okay? Because CR hadn’t really been totally attacked back then. It really wasn’t adapted centric and things that, that was coming next, that was the next fire storm with because you have imaging in the joints. And then now you were starting to see changes in the joint so that all fired up with the neuromuscular guys that came if the year at the turn of the century. But what happened later in the 90s is occlusion in the US switch from what we would think of as East Coast and West Coast. So you had said Southern California, the gnathology and in east coast was all the centric type guys. Okay. Yeah, bio aesthetics was in there. But it all moved to the northwest part of the country. It all moved to Seattle. So at the Pankey Institute, you would have Dawson masters week. So Pete Dawson every year would have a week and then so I would go, but he always brought in that guest. Okay, so his guests were Kois and Spear, you know, they were the best in the world of dentistry Piper. So I went to two of those, but you’re sitting in an entire week, and then you have Dawson and Spear in the same room for a week. Okay? But this was before Frank was famous and had gotten into it, but the thinking was coming all out of Seattle, Kois, Spear says ortho how you bring ortho into it. And then they formed what was called the Seattle Study Club. So the Seattle Study Club, we had a branch of it in New Mexico and then every quarter you would get a magazine and the magazine would have people’s pictures on it and things like that I should running show you real quick and then a whole stack of all these beautiful beautiful Seattle Study Club pictures and things like that. And so then every single quarter then these magazines would come out but then what they would do is case, So hang on for just a second. You can talk to your audience. I’m gonna go grab those

[Jaz]
Yes, please. Yeah, that sounds good. So, while Dr. Bobby gets those magazines were very amazing to have him do that. So those who remember, you can watch these episodes on YouTube. And on Facebook, I post snippets on the Instagram @protrusivedental. And a lot of people they like listening to the episodes as they’re driving, commuting. Some people may chop onions, while it’s in the podcast, we know that already. And then of course, for those who want to watch the full experience, they catch it on YouTube. There is the app coming out soon as well. But I’ll keep you updated on that.

[Bobby]
Okay, so every quarter, you would get a magazine. So four times a year. So we got Kois, you got Spear on the cover. You got everybody. I mean,

[Jaz]
These are amazing. I love it.

[Bobby]
Yeah, there’s Peter Dawson. So each one of these would have a case and then there was perio probate and then they would have it and it was, then the case was done, start to finish. Oh, my gosh, it was a textbook every single quarter coming in.

[Jaz]
These are essentially like for these full protocol cases that are coming. And what we see now Bobby is on the way that learning has become a social experience now with social media, we see these full protocol cases, so much, and then I do believe it’s never been a better time to be a dentist than now, if you’re hungry for knowledge. These cases are great dentists are sharing their full cases, full six point pocket chartings to mountings. Everything the young dentists can learn so much, it’s almost accelerates your learning pathway, compared to when you had to wait a quarter to get that magazine without one case in it. Now you can literally binge case after case after case and you can reach out to any mentor in the world.

[Bobby]
Oh, no, you’re exactly right is never ever been a better time. And honestly, these occlusion work, they’re all over. We’ll talk about that the second half of this whole thing because we’re now, so for myself, we’re decade almost two decades out in front of all of this, but you’ve got the idea. So that was pre internet. The Seattle Study Club, like you said, it’s every quarter, but I couldn’t wait I’d salivate the next time the magazine, who’s going to be on the cover. You know,

[Jaz]
I love you. I love you. I’m so glad

[Bobby]
You know, it always coming from the Northeast, is all coming from Seattle. And then that’s where then the Spear Institute employees. They started there. You had Colin one of the greatest orthodontists in the country. And so these guys were all in the think tank. And if you ever heard any of them lecture like Frank lecture, you just knew that you were in the presence of some kind of Saint that because the way that they would talk about vertical and then it just all made sense. So anyway, they were all centric guys. They were literally they all grew up with the whole concept of CR and putting it back when and they knew the imaging and they would address the joints with the perio with everything else. Now the puzzle part that they actually did not have that came in real quickly at the turn of the century was the neuromuscular guy. So Jake Wilson, he’s out of Seattle, so he’s into posture, airway, tongue, swallowing, breathing, okay? Now this is where I kind of really ended up in a situation where I was one of the few people in the country who was seeing it from all sides. So at the turn of the century, I switched my practice to instead of prosthetics, I mean, we were into empress and gold and everything like that, but I knew that every acute problem had a chronic condition, a crack and abscess and everything like that. So I’m going okay, well, when does this start? Where does it start? How would a dentist then learn about occlusion from beginning to end because what happened is, we would wait till it all broke down, and then argue about how to fix it. In just absolutely, it was like politics, you would just blast anybody that didn’t have your kind of philosophy on how to fix it. One of the philosophies, religions, as Christensen called them, he called them religions. Every one of them was if you did it perfectly worked. So you can’t not say that they don’t work and we learned stuff from all of them. Seriously, I learned a lot of things from the biosynthetic doc. So it was it’s not like any of these things were bad. Okay. It’s just that we couldn’t agree. So at the turn of the century, I joined two I joined the American Equilibration society, of which I’m going to be president in 2025. So be careful when You

[Jaz]
Amazing. I will come to Chicago to go to a conference. I look forward to it. Amazing.

[Bobby]
And it’s going to be international. That’s going to be the whole

[Jaz]
Amazing. Yeah.

[Bobby]
So it’ll be incredible. Anyway. Then I also joined at the time what was called the American Academy of head, neck and facial pain. So two groups, both of them said, we’re the best in the world at TMD. And then I would go to each of them, each of the academies and it was you were on two different planets, you were literally not even talking the same. And a lot of the head neck and facial pain guys. It was started by an orthodontist, a Brendan Stack, and Stack was the airway guy. Stack was the orthodontist who went okay, the cranium is a criminal. It’s all up in the here. It’s all about how the face grows in the mid face, cranium grows and things like that. And they were the docks that were the first ones into the airway. At these docks, were not really dentist per se, they weren’t clinical dentist. And just down the street was somebody who was on the board. His name was Dan Clifford. So he kind of mentored me, he was the one who got me into this group. But they did not practice clinical dentistry. They literally practice plants, TM, posture and things like that. Okay. They were the ones that jumped in there. And then they said, okay, the condyles do not rotate right out of the starting blocks symmetrically. So they are for CR sucks. So you knew, anytime a neuromuscular dentist was on a podium, they would start off, and the first thing that they would say is, you know, there are seven definitions of centric. So therefore, we don’t know what centric means. And they were the ones who literally machine gun down. They just wanted to destroy it. And they said, like, Dawson is wrong. He’s like, these condyles don’t rotate outside, but one always will translate before the other finishes rotation and back and forth. So therefore, the concept of CR is no good. Blow it away. Jay Levy, today actually wants an eighth definition of CR. He wants to add the Atlas into it, because we’ll call out okay. We’ll do this quick little demo. And Neil kinda understand how posture fits into this real quickly.

[Jaz]
And while we’re on that, Bobby, if you don’t mind, it’s just going down with a small mini tangent, the definitions obviously, keep changing. And nothing’s created more interferences than the changing definitions, the old recurring joke, obviously, but with the latest definition, it’s funny how there’s no mention of the disc. There’s no mention of the disc or being in a stable position on the condyle, which a lot of people were like, well, what’s the point of having definition if you don’t mention a healthy disc to condyle relationship, so?

[Bobby]
No, no, you’re right. It’s a theoretical position. So centric means center. And relationship means the relationship of the condyle to the fossa. So you kind of wanted to get it up into the fossa, like Dawson was start with a ball and take a pencil and put a pencil on the ball and then and hold the pencil like that. And then with the ball didn’t tilt, and that was called CR. So it was a theoretical relationship. Now the problem turned out to be it wasn’t the condyles in the disc itself, it turned out to be the sockets, it was the socket center of the problem. So if you have an airway, like a little deviates up into one sider, we’ll get into what’s called Epigenetics, when you have allergies, postnasal drips, why the tongue creates this asymmetry in the cranium. So all of the asymmetry is across the mid face. So if the airway is off, and then one cheekbone is off center, and one year is off a little bit to the difference, and you’re looking at it, or you’ll see one eye tilt down a little bit. Anyway, what simply happens is, you have cartilage base growth. So in an infant growing, so when you’re born, then you have two types of growth patterns in the cranium. So you have what’s called the Cartilage Paste. I’m going to show you a little like picture here if you can see [Jaz] Yeah, sure. [Bobby] Okay, so this is an article that we wrote, it’s called Epigenetics, okay, because this is why we’re in trouble. And this is why dentistry is going to be at the forefront of healthcare for the next couple of decades is like so unbelievable. Okay, but look at, there’s two types of growth patterns in the skull. Okay, so this is cartilage based. So when you’re born, okay? Anything to do with airway, anything to do with your nasal airway, including the sphenoid bone, okay, because that’s the rod in the middle, it’s cartilage based. The mandible is cartilage based. The hyoid bone is cartilage, okay? So they grow by cell division, but that’s your basic architecture inside the cranium. Alright, so all that grows for your ability to breathe and swallow because the brain wants oxygen every few seconds. And so literally as a child, if you’re born premature your tongue swallow reflex isn’t really mature. So in the last month in utero, that’s when the swallow reflex is set. So literally, the infant is just re circulating embryonic fluid, like oil in a car. And then when you’re born, you gasp. Okay, so that reflex is started. Now, that is the exact same reflex that you have in apnea, close, swallow, squeeze, stop breathing gasp. So you start your very first breath off of a reflex and in breathe, okay? Any child then who can actually breathe through their nose correctly as they’re growing all the way through age six. So what you have is what’s called an infantile swallow and infantile swallow is where you swallow, breathe, can breastfeed. And so between zero and six years old before the first molar come in, your tongue is your bite splint. Your tongue is your splint, it’s suckling and swallowing and everything is set. But as that child swallows in the tongue, so anything from a tongue tie to swallow back, but if that child has allergies, then you have a post nasal drip, and in the back of the tongue is not going to let anything drip into your lungs because that’s an ammonia and you die. So you’re basically your brain says, okay, adapt your swallow in order to facilitate your airway. And now the child isn’t really breathing like this. So they’re tilting like this. So that’s how they sit, sleep. Okay? They’re literally growing into this little bit of an asymmetry. So it’s, you know, a bonus twisting a little bit. So now the two sides, so the temporal bones that housed the eminence, they literally slap right on to the sphenoid bone. Okay, so there’s a little wing of the sphenoid bone, but the temporal bones attached to a clip, the two temporal bones aren’t symmetrical. The two maxillas are not symmetrical, they bone based growth, they’re not cartilage based growth, and they’re just growing to the ability for the child to breathe. So it’s all about nasal airway. Well, that, when Stack started in on that I’m like, so confused because I was so into jaw bite for 20 years. The whole idea that actually the cranial architecture was the source of the problem. And then the sockets didn’t grow symmetrical. They didn’t grow symmetrical in shape, height, everything they’re off center. So you can ball, the condyle had to go to the socket, but the sockets aren’t right, so the ball never did fit into the socket. And in the condyle heads are cartilage, but the temporal bones are not, they’re hard bone. So they’ve got a cartilage base growing into it, so it changes shape. So right away the two condyles, they don’t really they’re not symmetrical. No human has really a left side and a right side that are exactly it’s kind of like throwing a ball left handed and right handed. And it’s all tied to how you close, swallow, breathe. And so then now the curve od spee, curve of Wilson, all that it’s going to grow a little bit asymmetric. Alright, so now, the neuromuscular guys, they were into the airway, they had the basic problem with neuromuscular as a philosophy is you had Dickerson. Dickerson and Hornbrook and Rosenthal were the best cosmetics Doc’s at the time of the turn of the century. So we had a study club in New Mexico where we had a cosmetic Study Club, so we wanted to learn all the cosmetics when Empress came out. But what we decided as a group is, Hey, instead of us flying out to California all the time, why don’t we just get a mentor and we’ll bring them to Mexico. So our mentor was David Hornbrook. So we get David before David was famous, and then he would fly out because he loved New Mexico and Santa Fe, and there was a dozen of us, and then he would come in, and then you had to do the whole case photograph and everything like that. And then you would sit down clinically and he would be right behind you when you’re doing prepping, you’re prepping. So back then they called it Pack Live in California. So Pack Live was in Montgomery and Hornbrook and they would bring people in and then you were literally in the 90s learning how to prep veneers, okay? Back then. So anyway, David was our cosmetic coach. We’re still good friends today. Oh my gosh, I love the guy. And But anyway, he and Dickerson, they were together, but they actually got into an argument they had different philosophy. So hornbrook was more Dawson, Panky, Spear, put the condyles back into that close down. But then some of the empresss was breaking. So then that’s when it all started, Oh, you better get everything lined up where you’re going to crack your cosmetics. And so you needed the rear end to match the front end, or you were going to get into trouble. Today, we kind of get around some of that with the materials, we just make the material strong. We don’t have things as much. But back in the day, it was all literally glass. But the materials were changing, and they were beautiful. And yet, there’s no turning back. Once you get a couple of Emperess crowns on the front, you are never doing a PVC. So all that sort of started stopped with me at the turn of the century. We didn’t, we were often running with the new materials, but they were breaking no question in my practice, they were breaking. So it’s like, okay, how do we get around all of this sort of thing?

[Jaz]
So at that time, when you were using these, what were the time novel restorations, and you were falling in love with the beauty of them and applying them based on what you learned from the courses. But they were coming back and they are breaking. This was despite you putting your knowledge and experience and expertise into putting it setting it up mounting it in what you felt was the most appropriate occlusion, most appropriate force management for that patient.

[Bobby]
Exactly. And I would have the back somewhat a equilibrated and taken care of. So literally, I have the rear end, I have the condyles and the rear teeth and I knew on the T scan, I had them balanced, okay? And then you would do it across the front. And sometimes then you would have the gingival. So you would use a little lasers and line it all up and everything. But basically what we were doing is we were manufacturing this front to look better for the cosmetics so that when you smile, your lip posture and everything like that, so then you have these just flat out gorgeous smiles, okay, but it would only be a year or two somewhere down the road. And then a lateral would crack right on a corner. And there’s almost always a lateral coming around. Sometimes it can, sometimes it was a central in the middle and stuff like that. But some of them were catastrophic in that it cracked the whole veneer and then you had to go back in and then you went to a crown instead of a veneer. But you would literally spent a number of years with these what we thought were beautiful, perfect cases everything lined up. And I’m kind of doing it like the Spear guys and stuff, or the Seattle City Club guys, you know. And sometimes you finish a case and you’re just like, Oh man, I’m hot stuff, look at this. And then the reality check and they come back but I put every single patient on the T scan when they come in for their cleanings and prophys and things like that. So again, at the turn of the century, it was about 2003 or 2004, I get a call from the CEO of X scan in Boston, he goes, Hey, you order more sensors than anybody in the world. What are you doing? So they started sending software engineers to the practice and then chiropractors and then these neurologist guys who were interested in the neuro network back in the day, they all would just come through my office, they were literally shadowing and stuff like that. Now, it was a little bit of a hassle for me, but I loved it because I was learning stuff that I’m going like whoa. But I was starting to get this concept around 2005 that it’s not really jaw teeth, what we do in dentistry, the way we do dentistry, the way we were taught MIP all that sort of stuff. It’s awesome. It’s what we do, it’s what 90% of all the dentists around the world do it works. It’s how dentistry should be done, okay? The only thing with the philosophies is okay, if it’s breaking down and you want to restore it all the way back to a perfect system, then that’s when the philosophies jumped in and started arguing with each other and, okay, so you could still even after the cases, even if they broke, you could still do a little bit of adjusting. So a lot of it was like in protrusive, that person would slide forward but a canine would hit the lateral on this side, but a canine would hit a canine on the other side. So you always had these little asymmetries and then it was pretty obvious that Okay, wait a sec. The architecture of the bones is where the issue is. And the argument always in occlusion with the orthodontist, the orthodontist would go, it’s a class one occlusion. Well, Class One to them man, the mesial buccal cusp of the first molar hit the mesial buccal groove in the lower and if those lined up, it was all good and everything else didn’t matter even if you’re taking out teeth and all of that. But no, it’s has to do with the bones. So we take a class one like a teeth and orthodontic started, and they were just ramming it down dentistry through, No class one means that you have the teeth in the right position, when in reality, it’s the bones were never ever in the right position coming out. So you have class one, so we think of it as class one, class two, class three skeletal relationships. That’s how we’re taught, okay? But you could retrofit a tooth in the class one in a basically a class two skeletal thing. And now what happens is you had all this power here, so the teeth were just in the way of the bones, and then cracks and all of that sort of thing. And then it really wasn’t until about 2010, where orthodontics now got the memo. So the younger orthodontists coming out of school, they’re brilliant. They’re like they get it, they grew up digital, they understand digital, they’re not in the old concepts. They’re not doing retrofit extraction or those anything.

[Jaz]
And obviously imaging has helped so greatly with our understanding.

[Bobby]
Yeah, it’s all over now. I still in my community have a couple old time orthodontists. But they were a pain in my ass for decades, because they were literally like, No, this is it. This is the highway, you’re just a general dentist, I’m a God. And so they wouldn’t, they couldn’t switch and change. But they never ever learned it correctly from a joint situation, they never put in, these ortho cases would come back and they’d be 15, 16 years old, I would put them on the T scan, have them close down and go, Oh my gosh, this thing’s not even we’re close to being in some kind of harmony, where the envelope of function on one side is equal to the envelope of function on the other. So then we started putting all the kids on the T scan, I put them when they were six years old, 10 years old, 12, pre-orth, post-ortho and quickly figured out it takes about age eight 910 Somewhere in that girl’s a little sooner than the guy so when the girls hit their hormones and they’re starting to grow so so what happens is age six, the first molars come in and seven and eight, the anterior start to come in, the lip posture should start to seal and then about age 12. When the bites and the canine are set, then you have your what I call your ‘adult envelope of function’. So your adult T scan pattern is set at age 12. Pretty much routine, okay? So it’s kind of like if think of it, like if you had one leg shorter than another, you can step fine, but it’s the push up where the problem so everything is fine, symmetrical you go to step. Okay, so think of closing everybody can close, you can close fine, that’s MIP, right? You’re like, okay, but the push off is where the problem is. And that’s where the T scan is just invaluable. Now, the scanners, the scanners will show the force map before and then you do like Invisalign or something like that. And then it shows you the force mapping afterwards. So the scanners are gonna teach dentistry, about balance force, because the computer is doing it. It’s just that the dentist don’t know exactly what it’s doing because they don’t understand the dynamics of the trays moving and why TIF lined up and then why things are better balance but that’s the future of ortho, you’re gonna have a lot of trays and things like that into it. Kids, it’s all about the airway. You if they’re jammed up and they have that what’s called their infantile swallow should actually break at age seven and eight. So it’s seven years old. Okay, anterior teeth start to come in. Lips should seal, tongue should seal, child’s could breathe through their nose. Okay? If that doesn’t happen, and they don’t breathe through their nose, close, swallow, squeeze gasp, lips roll size up like that. They’ll have a little dark eye right here because bloods trying to get into the nasal lacrimal duct and the veins fill up and then the child has a dark eye, and you’ll quickly see where they’re starting to grow off center. Now think of this as literally it wasn’t just five generations ago. Pretty much everybody in the world had room for all 32 teeth, okay? How in our country and our culture, when anytime you came in industrialized, then literally you’re looking at maybe one or two out of 100 skulls, where the child has root for all 32 teeth. So now that’s just in five generations. Okay, so now all of that sort of evolution, what’s happening is, were insulting the system so much with inflammation and nutrition and inside and being. So kind of life expectancy is about 80%, where you’re born and who you’re born to. The other 20% has to do with your environment that you’re living in and working into and stuff like that. But what happens in epigenetics is your grandparents could have been heavy smokers. And so you have a recessive gene, it’s not your genetic gene. It’s your epigenetic gene, where now you are totally prone to inflammation. And so inflammation is now the problem in the future. Okay. I’ll stop there, you catch up, Catch me up in where we want to go. Cuz I can see

[Jaz]
All the things you’re saying about airway are so important in my own journey in airway and TMD. I think I’ve spoken about this in the podcast before where in the UK, we are a little bit behind, I look at US, I look at Australia as doing a lot of good work, groundbreaking work in terms of furthering our knowledge in dentistry, about this. So only in the UK was we’re starting to catch up. We’re about 15, 20 years behind. And even in my own son, when I look at him, I’m like, Is he nasal breathing? Was he mouth breathing, I’m like, very picky. And now then I’m applying that to my patients. And I’m having those daily conversations with children, mothers, and then on adult patients screening for airway. So that’s huge. And I love your explanations of epigenetics. I think that’s so needed. And and I like how you evolved from Okay, these were schools of thoughts, we’re all fighting about teeth and jaws. But really, the problem is a higher level up, it’s a basal issue, skeletal issue, which therefore affects the entire chewing system, just so that I can give those answers I promised the community. I think you said that when it comes to the Spear group, Kois and Dawson, what I think what you’re trying to say is really, they’re not too different. They’re just arguing a little bit about slightly different ways to fix the problem. Would you say there’s any more nuances or differences that perhaps we didn’t go into that is that worth mentioning between those religions?

[Bobby]
So, as it kind of turned out, then they were all the same, except for neuromuscular. Neuromuscular was the odd one out, okay? So it’s kind of getting into that because of a Dickerson and Hornbrook. So they broke apart and so, and they differed over basically condyle position, okay? Now, if you’re neuromuscular, so if you tense the jaw, so you literally put 10 units on it, okay, and then you turn it on for, like, 10, 15 minutes. We used to do a mile monitor, I used to do that do a mile monitor in the 80s. And then that’s how I would set my bites. Literally I just like Paul said, okay, and then

[Jaz]
like Jenkinson Orthotic appliance, right?

[Bobby]
The jaw would just kind of hang open, okay, and then I go, Alright, so then just took that relationship. And then when I went to adjust the splint, I have less adjustments to do and it’s like, okay, and then the patient’s their headaches went away and things like that I didn’t really understand. I always thought it was these muscles that were doing the issue I didn’t understand it was a head and neck posture, which will just get into an adjuster the next step here, okay? But what happened is, is the neuromuscular they would tense it and then the jaw would hang open. Okay, so it opens literally, after you turns it, you vertical opens about three millimeters on the average and forward about a millimeter and to the side left or right about a millimeter. Okay, so it’s a pretty standard, you pull some all out pretty predictable, falls into position. Why? Because you pulled the condyles out of the socket, so they just dropped down and now they’re kind of hanging open. So now what they go is now the neuromuscular says, Okay, well now we can rotate out of the starting block, you’re not jammed up so one isn’t turning to rotate and to get to the other level. Well, as it turns out, there was a temporal bones that were up so once I’d have to drop like one leg shorter than the other in order to get to that position but open three millimeters forward, one off to the side, one and now that’s pretty much a neuromuscular bite left side or right side, okay? And so then what they would do is then they saw Okay, well then putty so you’re hanging open you tense for 20, 30 minutes, your jaw sits in rest position hanging open, and then hurry up get some goop Go in there, take that registration. And then they would build a lower orthotic, awesome thinking, okay, lower orthotic, they would actually the neuromuscular guys use the T scan way more than anybody else. Oh, it was crazy, they were using the T scan, but to balance their orthotics. So they would make the lower splint and then they would hold it in the vertical and let the patient chew but then the thinking was okay, that’s where the teeth need to go. So now everything’s a full mouth reconstruction.

[Jaz]
Everything needs to crowns, which is the what the computer says.

[Bobby]
Okay, so you do the full mouth reconstruction, alright? But then a year or two later, okay, they’re not cracking the front. So the CR guys, we would line it all up, we would set it and then on protrusive and sliding was always a little bit like this away or that away or a little bit stressed. Okay? Nueromuscularly you line up everything in the back, okay? And then the condyles are literally out of the socket. So now they’re coming down, okay? All right, front teeth are fine, but you open the vertical. Okay, so now what happens in a neuromuscular case is the condyle, one of them wants to seek, so one of them wants to go back. Well, now you start cracking back teeth. So the neuromuscular, which is crack in the backwards, in the backwards, in the backwards and they would just go like dominoes, you know. And then that got into a bunch of lawsuits. Because these were $50,000 cases, at a minimum to start with gorgeous, beautiful, beautiful smiles. I mean, everything was just like, Absolutely, but they couldn’t function correctly. You actually have that same problem now with all on four cases when you’re doing these implant cases and we’re building them in zirconium. And then the zirconium, the teeth are so hard but you you retrofit it all in sort of a quick, fast time and you really haven’t planned out everything and so now the teeth are so hard that there is no give anywhere else. So a lot of these cases they’re going into neurologic overload and then they’re literally in pain. So there’s percentage of these all zirconium cases that are thrown into patients into these neurological overloads that are landing in the

[Jaz]
Something has to give in the system and that sometimes is the patient’s chewing system.

[Bobby]
Exactly. Sometimes you want to teach the crack. I mean, if you think about it, before we ever started doing crown and bridge, all you would do is chew out all the uppers and all the lower posteriors and so I when I was first starting it , I teach patients I make a denture and all they had was lower 60s. That was it. Because everything else they broke apart, trying to find neutral just by retrofitting and we just took out all the teeth but honestly it’s only been 50 years that we’re actually saving the teeth. Okay? So dentistry is still young in that scenario.

Jaz’ Outro: Well there we have it guys Dr. Bobby Supple part one. Okay, now the next episode we’re gonna go a little bit different. It’s going to be the Pascal Magne at BCD. Episode 100 is a homage to Pascal Magne. It is my experience of flying to Edinburgh and everything that happened. It’s like a slightly different quirky, fun episode slightly different what we usually do, like I’m there, I’ve got my sort of camera and microphone. I’m speaking to other dentists at the conference. And me and Ricky have a little like chat at the conference itself to share some of the lessons that we learned from Pascal Magne and we pass them on to you. So do check out episode 100. And then we’ll rejoin Dr. Bobby supple for part two. And we really go deeper into posture, airway, assessment, the role of what we call myofunction therapy and all those things in comprehensive dentistry. So it does take a couple of tangents but I think it’s important because what he, what Bobby Supple argues and he’s suggesting really convinced me as well as that there’s so much more to it, than the occlusion at a tooth level, we need to look higher up, we need to look at the skeletal and airway. And that really is the future about how dental and medical will talk to each other so much more. And the future is looking bright, you know the innovations looking great. So that’s exactly what the next episodes about. It’s a bigger picture stuff. So hope you join me for that as well. Anyway, I’ll let you have a fantastic day wherever you’re doing. Thanks so much for listening. As always, if you enjoy these episodes, do consider leaving a review on Apple, if you listen on Apple, please do consider leaving a review. It’s how the podcast grows. Thanks so much and I’ll catch you in episode 100!