Center for Neural Occlusion

CNO4-TMJ Pathology Screening (TPS) using nuclear medicine, genetic mapping, 3D MRI and CBCT imaging, blood assay, Kinesiology and more, is now available as of late 2019.

CNO5-that will be announced in 2020.

Off-site study: hi-quality HD video recordings of the various CNO levels do exist. Contact info@CNOtmj.com for more information. This is designed for doctors that do not have the time or resources to make the trip to CNO training sessions in person.

Some words from the CNO founder, Dr. Nick Yiannios:

Measured Matters and “Responsible DIAGNOSES must always PRECEDE responsible treatment!” My name is Dr. Nick Yiannios. I'm a U.S. dental practitioner who has been heavily involved in diagnosing and treating patients with confounding bite and TMD issues for many years. I have recently penned chapters in both the 1st and 2nd editions of the world’s first dental textbook relating to computerized measurements of dental occlusion (the bite), the "Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine". IGI Global is the publisher, Dr. Robert Kerstein is the editor. Over the years, I have published several more times relating to the usage of digital metrics and the efficacy of using these tools to objectively measure not only the human bite, but the orthopedic TMJ’s as well. In July of 2015, I created the Center for Neural Occlusion (CNO), an organization whose mandate is to help health care professionals treat TMD patients based upon objective and reproducible measured metrics, using digitally objective equipment such as MRI, CBCT, EMG, and T-Scan digital occlusal (bite) analysis technologies. We are training doctors how to measure parameters objectively, and treat accordingly (when indicated) and referring to appropriate professionals as needed for each unique case. The CNO is creating an online resource to help patients identify practitioners who are adept at our novel Neural Occlusion screening protocols and Measured Anterior Guidance Development (MAGD) "bite alignment" therapy. This list may be seen on our orgs website, CNOTMJ.com. I have been diagnosing confounding bite and TMD patients quite successfully for many years now, employing the "Neural Occlusion" screening principles. I could write for hours on the TMD topic, but won't. I'm going to hit highlights and refer the reader to videos that my practice has posted on YouTube and VuMedi. We have posted in excess of 250 bite and "TMJ" patient testimonial videos (as of April 2020) on the drnickdds homepage of YouTube over the past 8 years. Many of these patients have traveled internationally to see us in Rogers, Arkansas, U.S.A. from all over the globe. We have particularly high success rates when treating patients who are found to have muscular TMD issues and possess a pair of relatively stable and adapted joints (per objective 3D orthopedic imaging). These joints are not necessarily in perfect shape (most aren't), but they need not be unstable and acutely inflamed for occlusal therapy to be efficacious. We use the rarely inaccurate objective digital modality known as Joint Vibration Analysis (JVA) coupled with highly accurate and objective 3D MRI and cone beam (CBCT) imaging + history and exam to identify those joints that are relatively stable and adapted, and patients are given a rating per the CNO Classification system. CNO type A, CNO type B, and CNO type C. If that patients given CNO Classification system rating is amenable to our treatment processes, our success rate for treatment is very high, and usually accomplished in a single visit. The treatment does not involve splints and is objectively guided by using objective digital metrics known as EMG and Tscan digital occlusal analysis, whereas both technologies are slaved to one another in 3/1000 second increments. We identify appropriate patients via detailed screening questionnaires and something as simple as an ice water swish. I know that sounds ludicrous, but it is a documented fact in the scientific literature that muscular TMD patients tend to have hypersensitive teeth. If you are a patient who cannot tolerate cold drinks, and you happen to lack exposed dentin, there is an excellent chance that you have hyperactive muscles of mastication since the muscular load upon your dentition may cause what's known as torsional flexure and subsequent Frictional Dental Hypersensitvity (FDH). FDH is one of the topics in my chapter in the new textbook and is a novel (new) descriptor. I actually conducted a pilot study on 32 TMD patients and posted statistical proof that FDH exists and is typically present in most muscular TMD patients. In November of 2016, I was first author on another paper relating to FDH, whereby we showed statistically that 100 patients had a reduced FDH score after undergoing the ICAGD precise occlusal adjustment procedure. In other words, their tooth sensitivity went away when their muscles of mastication were made more efficient resultant of a digitally directed "bite" adjustment procedure. Many in the scientific literature claim that the bite has nothing to do w/ TMD issues, yet the only joint in the human body that has a hard tissue stop are the 2 TMJ's...? There exist millions of exquisitely sensitive tiny ligaments that hold the roots of teeth into the bone known as periodontal ligaments (PDL's). Dr. Kerstein's research since the early 1990's has shown that excessive compression of the PDL's leads to hyperactive muscles of mastication (angry chewing muscles). So, if one overworks a muscle, what happens? One gets sore... We generate excessive lactic acid because we have kicked through the amount of ATP (energy) available via aerobic metabolic pathways, and kick into anaerobic pathways. The byproduct of the former pathway is carbon dioxide (CO2). The byproduct of the latter anaerobic pathway is lactic acid. Lactic acid in excess quantities is toxic to every mammal on the planet! In 2008, Japanese researchers found that there exists a special nerve fiber within the dental pulp known as an A-beta fiber, and tracked this to the somatosensory cortex in the brain in humans (Kubo et.al, 2008). The somatosensory cortex is that part of the brain that "feels" things, like touch, rub, friction, etc. When someone touches you, your somatosensory cortex alerts you to that fact. My point? Well, the A-beta fibers are confined to the inside of your teeth, surrounded by not only the hardest substance in the human body, enamel, but dentin and cementum as well. So, though encased in a hard place, the pulp (nerve) can feel things like touch, friction and rubbing. How does the pulp/nerve feel within the hard tooth? It does, due to flexing resultant of muscular output. Muscle "bends" the tooth, activating the A-beta fibers. "Bend" it too much for too long and brain cranks up the muscle more, due to excessive compression of the PDL's AND the A-beta nerve fibers. This is part of the reason the bite can stimulate muscular TMD problems. We study and manipulate this fact to great effect everyday in our "Neural occlusion" and Measured Anterior Guidance Development treatments. Control what the Central Nervous System "feels" through the "sensory organs" that are the teeth in force and time (dependent upon MUSCLE), and we can neurologically control the muscles of mastication. So, based upon objective modalities, one can help SHUT THE HYPERACTIVE MUSCLES DOWN, thereby decreasing the excessive lactic acid production, leading to a resolution of many TMD myalgic (muscle-related) symptoms. Some bullets: -85% of symptomatic TMD is muscular in nature based upon the literature -bite splints do not effect a permanent physiological change, as they are removable -bite splints also remove the bodies ability to adapt the teeth to the status of the damaged TMJ's via muscular output from the Central Nervous System -the CNO believes that splints are only indicated when there exists objectively confirmed, acutely inflamed, and unstable or maladapted set of joints, and that these splints should only be constructed after gleaning the condition of the TMJ's per objective MRI and CBCT imaging. Controlling the timing and efficiency of how our teeth interact can control or even eliminate symptoms of muscular TMD -what moves the mandible? Muscle! We will upload information and videos that will help the TMD patient find answers that are not available anywhere else. These treatments are validated in the scientific literature and are not subjective conjecture. We three use these principles in everyday practice to great effect and want the rest of the world to learn about, use, and apply these principles. The principles of Neural Occlusion screening will greatly benefit TMD patients. Why? It will lead to properly DIAGNOSING a patient prior to the implementation of treatment! An objectively derived list of diagnoses in “TMJ” world? Think about that...where else can you find this?! The human bite can be intricately related to TMD issues when objectively measured using computerized metrics! None of these video case studies could have been accomplished with such a high success rate if this statement were not true for the human organism! “Measured Matters” when it comes to abnormal bites and TMD! Dr. Nick Yiannios, April 2020.

CNO Board of Advisors:

Dr. Mark Piper (FL – TMJ Surgeon)

Dr. David Hatcher (CA – Oral and Maxillofacial Radiologist)

Dr. Robert Kerstein (MA – Prosthodontist)

Dr. Ed Zebovitz (MD – TMJ Surgeon)

Dr. Tom Faerber (KS – Oral and Maxillofacial Surgeon)

Dr. Terry Alford (FL – General Dentist)

Dr. Allen Sprinkle (TX – General Dentist)

Dr. Jonathan Blansett (AR – Periodontist)

Dr. Marcelo Mattos (Brazil – TMJ Specialist & Radiologist)

Dr. Scott Green (MT – General Dentist)

Dr. Salvador Romero (Mexico – Orthodontist)

Dr. Craig Hadgis (MI – Orthodontist & Biomedical Engineer)

Dr. Samuel Paglianite (AR – Medical Radiologist)

Mr. Brent Thompson (UT – Industry Advisor)

Mr. John Radke (WI - Engineer, Researcher, Author, & Industry Advisor)