Gnathologic orthodontics

Lloyd L. Cottingham, D.D.S.

San Diego, Calv.

Gnathology is the science that treats of the biologics of the masticatory mechanism; that is the
morphology, anatomy, histology, physiology, pathology and the therapeutics qf the oral organ,
especially the jaws and teeth and the vital relations of this organ to the rest of the body.
-Harvey Stallard*

I f we change the name in the definition from gnathology to orthodontics, we

would find it synonymous. Isn’t orthodontics a science that treats of the biologics of the
masticatory mechanism? We could also interpose periodontics, prosthodontics, or oral
surgery with its recent developments; these specialties also are sciences that treat the
biologics of the masticatory mechanisms. The authors of gnathology were purposely
broad in their definition so as to be overinclusive of the disciplines of dentistry. They
wanted gnathology to be more than the filling of holes, the removal of defective teeth, or
the mere making of false plates. To them, gnathology was to be the complete care of the
oral organ-an organ as vital as the organs of sight, smell, digestion, or any of the other
organs receiving medical care. Gnathology is a science that embraces all of the systems of
the mouth. It is the study of the morphology of each tooth-each tooth as a single entity,
and each tooth as a member unit of the mouth. It includes the study of the investing tissues
anchoring the teeth to their underlying structures. It continues to include the union of the
underlying structures, their motivating musculature with their radial neural feedbacks and
the binding sinews attaching the separate bony configurations of the jaw joint.

Orthodontic approach to gnathology

The orthodontic approach to gnathology is the science of moving teeth to a place
where they will reside in a healthy culture that respects and conforms to all of the
disciplines of the gnathic system. In brief, the gnathologic approach to orthodontics aims
to put each tooth in a position where it will coordinate with the articulation of the
mandible, where it will be in line with the forces of the musculature, and where it will be
tranquil in its investing anchor tissues.
This approach requires mounting the plaster casts of the teeth upon an articulator that
will accept and duplicate the diagnostic jaw relations, so that the intermaxillary positions
of the teeth are as they are in the patient’s face and cranium. The mandibular joints are
important cranial parts. Their union must be included when casts are to be mounted on the
articulator. For this reason, the mandibular posterior terminal hinge axis position and

Presented at the February, 1966, annual meeting of the Pacific Coast Society of Orthodontists in
Portland, Ore.

454 0002~9416/78/100454+03$00.30/O 0 1978 The C. V. Mosby Co.

Volume 74
Gnnthologic orthodontics 455
Number 4

rotation must be located and recorded first. Then, the mandibular closure must be deter-
mined when the mandible is at this position. It is the starting post. It is the first base. It is
the only reproducible position from which the mandible can be moved to its other
positions.

Orthognathic diagnosis
A diagnosis based upon gnathologically articulated models is an aid to put alongside
other orthodontic diagnostic records. It will show where the teeth are in the face and how
they are related in the cranium. It will show how the teeth come together when the
mandible rotates at its hinge axis closure.
The first concern of gnathology is: “How does the centric occlusion of the closed teeth
fit the rearmost closure of the jaw ?” That is what orthodontists have long been trying to do
with casts mounted in their hands, and by looking at the closure in the mouth, and by
means of headplates. Gnathology has a three-dimensional cephalometric instrument to
measure discrepancies.
In many dentitions mounted upon an articulator, a few pairs of opposing teeth will
make occlusal contacts before any of the others. They contact first. For this reason, they
have been called prematurities. As a patient crunches his teeth further together, the jaw is
deflected forward or to the side. For this reason, we say that the teeth causing the jaw to
deflect are the deflectors of the jaw closure. They cause a “deflective malocclusion.”
All of us have seen a lingually inclined maxillary central incisor cause a patient to bite
furthe; forward in order to shut his teeth. This is a gross observation of a deflective
malocclusion. The orthodontist using gnathologically mounted casts can see how the
mandible would close if such a deflector tooth were not present. This is a gross description
of what he can detect in all cases. He can see, in any case, the teeth and the individual
cusps that are the deflectors. He can see whether an incisor, a canine, a premolar, or a
molar is deflecting the mandible.
He may see what would appear as a Class III relationship change to a Class I or even to
a Class II condition. An accepted Class I occlusion, from a casual observation, may
change into a traumatic Class II malocclusion. What appears to be a unilateral cross-bite
will often change to a bilateral distal occlusion, because of a lateral jumped bite. Most
patients will show a deflection that hides the severity of distoclusion.
With a gnathologic diagnosis, the orthodontist can see and measure the total amount of
malocclusion. He can see and measure how far he must move each tooth. He can then
engineer his mechanical therapy so as to move each tooth into a healthy periodontal
medium allied with all the other supporting structures, including the mandibular joint.

Posttreatment
Following mechanical therapy, a new set of casts can be mounted on an articulator.
These mounted models can be used first as an after-treatment diagnosis to see how well the
prescription was followed.
Then, they can be used in a setup for the fabrication of a clear thermoplastic
positioner.’ which will compliment active treatment by moving teeth to perfection. Such a
positioner will promote better coordination of teeth with the mandibular articulations, with
the muscles of mastication, with the periodontium, and with the facial tissues.
An orthodontist fortified with this diagnostic information can better engineer his
 Am. J. Orrlwd.
October 1978

technical procedures so that the positioner will be an adjunct to active treatment. The
treatment time can be shortened, and the retention care problems will be minimized. The
accomplished perfected results will enhance the patient’s chewing as well as the cosmetic
appearance of his teeth and face.

REFERENCES
I. McCollum, B. B., and Stallard, H.: Considering the mouth as a functioning unit as the basis of a dental
diagnosis: a research report, South Pasadena, Calif., 1955, Scientific Press.
2. Cottingham, Lloyd L.: Gnathologic clear plastic positioner, AM. J. ORTHOD. 55: 23-31, 1969.

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