New Technology of the Twenty-First

Century
By Gerald H. Smith ::: Langhorne, Pennsylvania
Reprinted with permission from Dr. Gerald H. Smith (ICNR.com)

The term Craniodontics has been coined by this author to focus attention on the fact that
use of dental orthopedics/orthodontics or any restorative dental procedure that directly
changes the occlusion will affect the alignment of the 22 cranial bones (excluding the 6
ear ossicles). The effectiveness of dental orthopedics in expanding the maxillae both
transversely and sagittaly is well documented, however the time has come when dental
practitioners must look beyond the parameters of the teeth and alveolar bone to the highly
functional cranial system.

The Cranial, Dental, Sacral Complex

The cranial, dental, sacral complex is composed of our cranium, dental arches and teeth,
spinal column and sacrum area. All the bones of the skull are connected not only through
joints and/or sutures but also by muscles and the dural sheath.

Figure 1 ::: Parallel Planes of the Body

Dr. James Carlson observed that parallel relationships exist in the structurally stable
human body which permit it to maintain balance. These parallel planes include the ear
plane, eye plane, shoulder plane, elbow and knee planes and pelvic plane. Dr. Carlson's
observation revealed that the upper jaw or maxillae was another anatomic part that was
also parallel to these other planes.
 Figure 2 ::: Dural Membranes

The cranial dural membranes act as stabilizers to the vault bones. Physical trauma
(whiplash, injuries, blows to the head, forceful tooth extraction, etc.) and dental
malocclusions have the potential to disrupt dural membrane balance and normal cranial
rhythm. Such changes can cause adverse neurological function throughout the body.

Dental Malocclusion
Dental malocclusion (bad bite) like deep bite, cross bite (front or back), a constricted
narrow upper arch, faulty crowns or dentures, high cant of maxilla, or underdeveloped
lower jaw can all contribute to cranial distortion.

Figure 3 ::: Cranial Movement

The cranium is a dynamic structure that is in a constant state of micro-motion. This

motion can occur because of the inherent flexibility of bones plus the presence of the
expansion joints or sutures that lie between each bone. Architects design buildings,
bridges and roads with specific leeway for expansion, contraction and torsion. Nature
likewise provides for similar allowances in the flexibility of its hard and soft tissues and
their interconnections.
 Figure 4 ::: Reciprocal Body Movement

The body functions just like a slinky. A distortion at one end will be reflected to its area
of compensation. For example, the bones of the hands and feet work reciprocally as well
and the ankle and wrist, knee and elbow, pelvis and shoulders. One of the main
connecting links of the body that enables this slinky effect to occur is the dural tube. Joint
receptors and neuromuscular biofeedback provide other means by which the body
functions reciprocally.

I hope it has become clear that imbalances in any part of this system can interfere with
cranial motion and cause disease in our system. Physical traumas such as whiplash, injury
to the neck or pelvis trauma from falling off a horse, bad posture caused by working in
from of a computer extensively, and dental problems such as bad bite are examples of
things that can disturb the balance in the system. These can cause cranial distortion and
restrict cranial motion eliciting cranial symptoms such as headache, dizziness, numbness,
muscle spasm, faulty digestion, jaw pain, irregular heart beat, tinnitus, migraines (figure
5), circulatory problems, chronic fatigue, sinusitis, constipation, neck ache, shoulder
ache, eye pain and facial pain.
 Figure 5 ::: Dental Connection

Patients with a deep overbite, underdeveloped lower jaw, cross bite or collapsed bite may
experience cranial distortion and dural torque. Many of them suffer from headaches,
migraines, neck and shoulder stiffness and lowe back pain. Some may have itchiness in
the ears and many have clicking jaw joints.

Among the other dental conditions is conventional orthodontics that involved the
amputation of premolar teeth to mechanically achieve esthetic arches by moving back the
upper six front teeth. The caused restriction of the maxilla, palatine, vomer and sphenoid
skull bones and contributed further to an already forward head position and loss of
normal curvature of the cervical vertebra. Studies have shown that patients with the
above treatment have a limited neck movement and compressed upper cervical vertebra
especially at the level of C1 to C3. They are already at a disadvantage with regard to their
dental, cervical and cranial balance. If these individuals are involved in an accident and
experience a whiplash injury to their neck, they will never fully recover unless their
structural imbalance is addressed.
CRANIODONTICS

New technology of the twenty-first Century

See Also: Case Report: Skull/Teeth Connections.

By Gerald H. Smith • Langhorne, Pennsylvania

The term Craniodontics has been coined by this author to focus

attention on the fact that use of dental orthopedics/orthodontics or
any restorative dental procedure that directly changes the occlusion
will affect the alignment of the 22 cranial bones (excluding the 6 ear
ossicles). The effectiveness of dental orthopedics in expanding the
maxillae both transversely and sagittaly is well documented,
however the time has come when dental practitioners must look
beyond the parameters of the teeth and alveolar bone to the highly
functional cranial system.

In order for cranial bone motion to occur there has to be flexibility of

the cranial vault as well as expansion and contraction joints. As
stated in the 29th British edition of Gray's Anatomy, bones derived
from membrane, function like membrane throughout life. The
squama portion of the occipital and temporal bones as well as the
paired parietal and frontal bone structures is derived from
membrane. In addition, living bone is saturated with blood, which
further enhances inherent flexibility. Dr. John Upledger et al., 1 in the
early 1960's, documented histologically in human cranial bone
specimens (taken from living adult skulls at the time of brain
surgery) that sutural areas contain blood vessels, nerve plexuses,
connective tissue, Sharpey's fibers and red blood cells. Further
substantiation of sutural viability in adult skulls comes from the work
of the internationally known anatomist, Dr. Marc Pick. His 150 plus
cranial dissections unequivocally document that the dura mater that
surrounds the brain provides connective tissue extensions, which
pass through the sutures to form the outer periostial layer, which
surrounds the skull bones.2 Throughout the cranium there are
architectural design alterations of the bevels that exist along sutural
lines. These sutural variations enable hinge-like, sliding and pivotal
actions. Researchers describe sutures as having the potential for
micro-motion as a means of responding to biomechanical forces
and stresses, which occur in vivo.3
Retzlaff and other researchers in their "gross and microscopic
examination of the parieto-parietal and parieto-temporal cranial
sutures obtained by autopsy from seventeen human cadavers with
the age range of seven to seventy-eight years shows that these
sutures remain as clearly identifiable structures even in the oldest
samples. In no instance was there evidence of sutural obliteration
by ossification. There are morphological changes in both the cranial
bones and sutures which can be correlated with the aging process."
Retzlaff and co-workers suggest cranial suture design as appears
within skull bones can have movement at any age. Hubbard and
other researchers found "that cranial sutures are slightly more
compliant to flexure about an axis along the sutures than the
‘equivalent' layered cranial bone structures." Their clinical
observation revealed greater movement in the sutures of both
embalmed and unembalmed skulls. Based on their findings it would
be safe to imply that the living cranium would exhibit an even more
degree of flexibility than the sutures in vitro. The viability of the
cranial suture as a dynamic structure is well documented in the
literature. 6,7,8,9,10,11,13,14,15,16 In the total scheme of body design,
cranial sutures function to join other cranial bones together but
primarily serve as expansion-contraction joints to allow
accommodation for changes in meningeal, muscle and fascial
tensions, respiratory and cardiac rhythms and alterations in both
cerebrospinal and blood pressure.

The primary respiratory system (pumping action of the brain,

cerebrospinal fluid, cranial nerves and dural membrane system) lies
within this cranial system and is directly influenced every time the
screw is turned on a functional orthopedic appliance. Even
placement of a simple bend in an arch wire or attachment of a
chain elastic or use of an inter-arch elastic will cause changes in
dural membrane tension and cranial bone alignment. All
mechanical tensions placed on the teeth will be reflected into the
cranial system and if used by design can serve to correct cranial
lesions and improve the patient's quality of life. These various
cranial lesions can be diagnosed by means of manual palpation
and partially by radiographic analysis (because of its two-
dimensional limitations). By using four cranial indicators a road map
is provided of where you are before, during, and after treatment.
This simple system allows one to easily monitor the course of
treatment and to determine when treatment is completed.

Thanks to the clinical research of Drs. Darick Nordstrom, Bob

Walker, Granny Langly-Smith, Gaery Barbery, Jim Carlson, Runar
Johnson, James Jecmen, and others a level of knowledge now
exists that links the occlusal planes (transverse, sagittal, and
vertical) and malocclusions with specific misalignments of the
cranial bones and accompanied dural membrane tension. This
integration has now raised the level of dental
orthopedics/orthodontics to a higher standard of care.

Radiographic documentation validates the effects of

cranial manipulation

Because of the lightness of touch required for cranial techniques

some inexperienced practitioners have termed cranial therapy
hocus-pocus or spiritual. Uninformed evaluation leads to
misinterpretation. It is impossible for me to term hocus-pocus the
gentle, caring touch of thousands of experienced and respected
dentists and therapists who produce on a daily basis clinically
effective results with cranial therapy. A convenient and scientifically
reproducible technique,
DORA (Dental Orthogonal
Radiographic Analysis-
AAFO Journal, Vol. 14,
Number 3, May/June/July
1997), has now been
established by this author.
With the DORA system,
practitioners can now
scientifically document
transverse structural
changes that result from
cranial releases. This
diagnostic system helps
establish cranial
manipulation as a valid treatment modality within the scope of
dentistry.

Case. Mattie S. had headaches for 35 years and deep right thigh
pain for the past three years. The head pain started when she was
a child. After being thrown from a wagon she collided with a fence.
No medication, chiropractic or physical therapy resolved the
patient's problem during the 35-year period. Cranial manipulation
was provided by releasing the sphenoid bone by bilaterally
unwinding the external and internal pterygoids. This author followed
his standard cranial treatment protocol. Following the one-hour
cranial manipulation session, the head and thigh pains totally
resolved. The patient exhibited a remarkable increase in vertical
jaw opening and decompression between the atlas and axis
vertebrae. These changes are well documented in the pre and post
radiographs taken one hour apart.

Pre-Treatment P-A View One hour post initial exam

Pterygoid Sling By
sequentially releasing the
cranium and associated
muscle attachments the
cranial mechanism can be
effectively released. Since
the pterygoids, which attach
to the lateral pterygoid
plates, represent major
masticatory muscles they
will exert a strong influence
on the entire craniosacral
system via the tension
transmitted to the dural
membrane system. The pterygoid sling, which is comprised of the
internal and external pterygoid muscles, is directly affected by
distortions of the maxillae (transverse and sagittal cants) and
malocclusions. When the maxillae becomes transversely canted it
directly affects the position of the sphenoid. The sphenoid
articulates directly with 14 other cranial bones (occiput, frontal, 2
parietals, 2 temporals, 2 malars, 2 ethmoids, palatine, vomer, and 2
maxillae). The sphenoid articulation with the other 14 bones of the
skull represents a 50% direct influence on any changes that occur.
In addition, between the sphenoid and the temporal bones, 92% of
the cranial nerves pass either in close proximity or through these
two bones. Furthermore, the sphenoid bone has extensive dural
membrane attachments within the skull and houses the pituitary
gland. Torsions or sidebend lesions will greatly influence the dural
tube, spine, sacrum, pelvis and potentially the endocrine system.
An occlusal discrepancy as little as the thickness of two sheets of
typing paper can be adequate to perpetuate chronic pain. The
following case study drives home the significance of this fact.

Case: Mark B. is a 47-year old male who had been suffering fourteen
years with upper cervical and low back pain. In 1984, he had accidentally
fell two stories through an unguarded elevator shaft and impacted on a
cement slab. He suffered numerous spinal fractures and was not expected
to survive let alone ever walk. After a year in a body cast he progressed to
enter a rehabilitation program and managed to relearn to walk. Various
therapies were used to help alleviate the neck pain but to no avail.
Fourteen years after the original incident, the patient was referred to me
for Craniodontic evaluation. A cranial, dental and Dental Orthogonal
Radiographic Analysis was performed. The sphenoid was noted to be low
on the right along with compression between the atlas and axis vertebrae.
The transverse occlusal plane was canted high on the right and also lacked
vertical support on the right (reason for the low sphenoid). Treatment
consisted of extensive cranial manipulation, micro-current stimulation and
posterior occlusal support in the form of overlay resins. Three resins were
placed on the maxillary posterior right side. Within 24 hours the pain
started subsiding in the atlas-axis area and within six weeks the low back
pain reduced by 75%. The following pre and six-week post radiographs
document the impact of correcting a slight cant and vertical deficiency
equivalent to two thickness of typing paper.

Pre=Tx Radiograph Six week Post-Tx

Relationship of dental malocclusions and specific cranial
faults
The Class II Division I malocclusion presents itself with a high palatal
vault. This distortion results from the vomer bone being pulled upward
with a sphenobasilar extension type lesion. Correction of the
orthopedic/dental malocclusion helps corrects the cranial distortion.

Sphenobasilar Extension High palate is due to

sphenobasilar extension

Sphenobasilar Flexion Low palate is due to

sphenobasilar flexion
 The typical Class II Division II malocclusion exhibits a flexion type
cranial lesion. Since the vomer bone directly connects the hard palate with
the rostrum of the sphenoid bone, cranial lesions will be reflected as a flat
palatal distortion.

A sidebend lesion will be corrected when a sagittal force is appropriately

applied. Use of acrylic functional appliances that contact the palate and
restrict cranial motion will prevent the release of the cranial bones. Only a
lightwire functional appliance system, like the ALF or heavy wire Kernott,
can address these issues.

A right sidebend lesion usually results in a dental malocclusion

that manifests itself clinically as an arch length deficiency
resulting in a blocked out tooth on the lesion side.

In light of the validity of these integrated concepts and proven

practicality of their clinical use, the indiscriminate application of
force via orthopedic appliances and conventional orthodontic
braces can no longer be accepted as standard of care. Architectural
concepts dictate that the foundation of any structure must be level
prior to the start of construction. Since the maxillae represents the
anterior 2/3 of the base of the human skull and in essence its
foundation, it too must be leveled prior to beginning orthodontic
treatment. Albert Einstein defined insanity as "doing the same thing
over and over again and expecting a different result." We can no
longer continue striving for better results using the same old
concepts and appliances. The cranial road map must be read and
used to govern treatment if dentistry is to progress beyond the
mechanistic model and transcend into the new technology offered
by biologic dentistry.

References

1. Upledger, John E., D.O., Retzlaff, Ernest W., Ph.D. and

Vredevood, M.F.A.: "Diagnosis and Treatment of
Temporoparietal Suture Head Pain", Osteopathic Medicine,
pp. 19-26, July 1978.
2. Information obtained through personal communications.
3. Blum, Charles.: "Biodynamics of The Cranium: A Survey", J.
Craniomandibular Practices, Vol. 3, No. 2, pp. 164-171, 1985
4. Retzlaff, Ernest G., et al.: "Light and Scanning Microscopy of
Neuraxis in Human Cranial Sutures and Associated
Structures," Anatomical Records - 93rd Session of the
Association of Anatomists, p. 154-A, 1980.
5. Hubbard, R. P.: "Flexure of Layered Cranial Bone, J.
Biomechanics, Vol. 4, pp. 351-363, 1971.
6. Michael, David, K., and Retzlaff, Ernst, W.: "A Preliminary
Study of Cranial Bone Movement in the Squirrell Monkey,
The J. Amer. Osteopathic Assoc., Vol. 74, May 1975.
7. Tettambel, Melicien, et al.: "Recording of the Cranial
Rhythmic Impulse," The J. Osteopathic Assoc., Oct. 1978.
8. Upledger, John E., D.O., Retzlaff, Ernest W., Ph.D. and
Vredevood, M.F.A.: "Diagnosis and Treatment of
Temporoparietal Suture Head Pain," Osteopathic Medicine,
pp. 19-26, July 1978.
9. Babler, W. J., Persing, J. A.: "Experimental Alteration of
Cranial Suture Growth: Effects on the Neurocranium, Basic
Cranium, and Midface," Factors and Mechanisms
Influencing Bone Growth, Alan R. Lias, Inc., New York, NY
10011, pp. 333-345, 1982.
 10. Behrents, R. G., Carlson, D.S., Ardelnous, T.: "In Vivo
Analysis of Bone Strain About the Sagittal Suture in Macatta
Mulatta during Masticatory Movements," J. Dent. Res., Vol.
57, No. 9-10, pp. 904-908, 1978.
11. Meikle, M. C., Sellers, A., Reynolds, J. J.: "Effects of Tensile
Mechanical Stress on the Synthesis of Metalloproteinases by
Rabbit Coronal Sutures in Vitro," Calcif. Tissue Int., Vol. 30,
pp. 77-82, 1980.
12. Meikle, M. C., et al.: "Rabbit Cranial Sutures in Vitro: A New
Experimental Model for Studying the Response of Fibrous
Joints to Mechanical Stress," Calcif. Tissue Int., Vol. 28, pp.
137-144, 1979.
13. Retzlaff, E., et al.: "Aging of Cranial Sutures in Macaca
Nemestria," Anatomical Records 91st Session of the
Association of Anatomists, p. 520, 1978.
14. Retzlaff, Ernest, et al.: "Aging of Cranial Sutures in
Humans," Anatomical Records 92nd Session of the
Association of Anatomists, p. 663, 1979.
15. Foley, W. J., Kokich, V. G.: "The Effects of Mechanical
Immobilization on Sutural Development in the Growing
Rabbit," J. Neurosurg., Vol. 53, pp. 794-801, 1980.

16. Todd, T. Wingate and Lyon, D. W.: "Cranial Sutural Closure

Its Progress and Age Relationship, Part I-IV," Am. J. Phys.
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