Cimf1016 englintro

Diapositive 1
Club International de Morphologie Faciale
60ème anniversaire
Salzburg 2016
Dr. M. Lacroix / www.orthoglobal.ch
temporary clinical results
Occlusal balance follows postural balance
Coordination between the implementation of the first three-dimensional
determinants of occlusal balance with those of postural balance through the
first stages of the sensorimotor and the first orofacial neuromotor loops
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Dr. M. Lacroix / www.orthoglobal.chDr. M. Lacroix / www.orthoglobal.ch
2
“That which brings life to this research… It is the awareness that
that which makes us fail the most, is not that which we do not yet
know, but rather the ability to believe what we already know. »
Edgar MORIN 1980
« la Méthode tome 2: la Vie de la Vie »
Usually, I prefer to close with this quote from Edgar Morin in 1980, but it seems more and more pertinent
in today’s exponentially expanding information jungle.
“That which brings life to this research… It is the awareness that that which makes us fail the most, is not
that which we do not yet know, but rather the ability to believe what we already know. »
And, today, I chose to start with this idea and use it as my theme, as it ties in perfectly with the subject of
this meeting.

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Efficiency and stability of the ODF
“…that which makes us fail is not the awareness of that which we do not
know, but rather the ability to believe what we already know…»
Club International de Morphologie Faciale
60ème anniversaire
Salzburg 2016
I believe, and I will try to convince you, that the answers to our limitations in efficiency and stability will not
be found in future technical improvements; those which will continue to be useful to us. Rather, these
solutions are already before our eyes. We must, therefore, improve our organization, our thought
processes, and how we formulate our conclusions. We must use all the scientific knowledge at our
disposal.
In other words : our limitations in efficiency and stability are due to our lack of thoughtful reflection and
organization, in terms of the complexity of the premature nature and entirety of the origins of dysmorphia
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Starting with the fundamental data of the ‘80s (1) combining with the tools of neuroscience, (2) we can
detail furthermore the complexity of the implementation of neuromotor orofacial loops (3) ... and investigate
their very tight synchronization with sensorimotor implementation of the determinants for crânio-cervical
posture (4) ... This route will allow us to emphasize the fundamental importance of the first 3 orofacial neuro-
loops (5) and their central role in the cohesion between anterior and posterior postural chains (6) ...
But what do we know..? Let’s try to sort out then reassemble all the known variables we have at our
disposal
To further explain, there are certain important data from the 80s, (1), in reviewing the tools of
neuroscience, (2) we can begin to define the complexity of the initial establishment of the orofacial
neuromotor loops (3)… to observe the very tight synchronisation of the establishment of the sensorimotor
determinants of cranio-cervical posture (4)… and to emphasize the fundamental importance of the 3
primary orofacial loops, (5) and their key place in the coherence between the posterior and anterior
postural chains.

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This allows us to consider 3 theoretical propositions
1. The theory of 3 primitive orofacial neuromotor loops : the initial contact of
the primary incisors plays a crucial role as antagonists (Damasio) in order to erase
the neuroplasticity of the loop of the tongue, and to permit the maturation of 3
distinct loops (tongue-palate, tooth-tooth, lip-lip).
2. Dentition follows posture : establishment of the
three-dimensional references for the future occlusion
is synchronized by the progressive differentiation of
the neuromuscular chain controlling head posture
throughout the early stages of sensorimotor
development of the newborn.
3. A 3rd definition of human orality = Orality of cohesion : the closed mouth
position, as opposed to open mouth (speaking and eating), because it permits the
permanent synchronization of the respiration with all postural positions
(neuromuscular, psychic and social).
These studies bring us to 3 theoretical concepts I first mentioned at the AIODF Convention in November
2015 in Ostende
1.The concept of the importance of the proper neurosensory establishment of the 3 primitive orofacial
loops.
These 3 loops, that become progressively more specialized and give rise to themselves, occur
predominantly during the first 12 months, up until the child begins to walk, by the following 3 connections:
In A : the touching of the tongue to the palate to transmit sensory information to the cranial vault,
regulate the spatial position of the mandible, and also contribute to posture and tonus in the vertical plane.
in A’ : the touching of the lips to close the orifice and maintain the integrity of the facial envelope, as well
as that of the anterior muscular chain, but also indirectly influences nasal respiration.
in B : that which separates the first two, and allows them to function independently and allows contact
between the gingiva of the anterior portions of the alveolar ridges, then slowly and progressively, contact
between the incisors, which begins to construct the future occlusion.
2. the second concept : dentition follows posture: this is the key point of my talk today.
3. the third idea : the orality of cohesion (closed mouth) as a new and third definition of human orality,
which will be pursued in another presentation.
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Rapport et Congrès SFODF / Montpellier 1988 > 2 fundamental datas :
 Couly : predominance of Paccini corpuscles
(baro-receptors) that run the length of the
alveolar crest, well before the teeth = law
of intrinsic proprioceptive regulation.
 Gaspard : between 0-3 years,
differentiation of the superficial fascia of
the masticatory muscles, which controls
movement, followed by the deep fascia,
which controls power.
“…that which makes us fail is not the awareness of that which we do not know, but rather the ability to believe
what we already know…» But what do we know..?

, What do we know since the 1980s –let’s remember 2 fundamental pieces of information as a theme for
our research:
• Marcel Gaspard told us to count on the differentiation of the fascia (the fascia responsible for
movement) of the masticatory muscles occurs between 0-3 years, prior to development of the deeper
fascia (responsible for power), which occurs with the eruption of the second deciduous molars.
• The law of intrinsic proprioceptive regulation (G. Couly) forces us to consider the onset of orofacial
neurosensorality, where there is a predominance of the baroreceptor corpuscles of Paccini the length
of the alveolar crest, before birth, thus well before tooth eruption.
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Rapport et Congrès SFODF / Montpellier 1988 > 2 informations fondamentales:
Gaspard: between 0-3 years, differentiation of the
superficial fascia of the masticatory muscles, which
controls movement, followed by the deep fascia, which
controls power.
This first fundamental idea provided by Gaspard is very important as it allows us to apply the same
reasoning to the differentiation of the fascia of the muscles of the tongue…. Not simply with respect to the
intrinsic muscles of the tongue, as we have done for some time …
Why not consider the entire chain of supra- and sub-hyoid musculature as one solitary functional unit
where all the component fascia differentiates and establish themselves, not all at once, but progressively,
step by step from birth until the arrival of occlusal contact of the second deciduous molars
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Gaspard: between 0-3 years, differentiation of the superficial
fascia of the masticatory muscles, which controls movement,
followed by the deep fascia, which controls power.

In effect, when we use our knowledge of the early stages of sensorimotor development in the newborn,
the most important aspect is not the effort to elongate the muscles to catch the giraffe. The most
important point is the fulcrum! (the heel of the right foot) And this allows us to think more broadly and
more comprehensively about the muscles of the tongue and establishment of the entire chain of muscle
fascia from the tongue to the sternum. This provides progressively for the establishment of the fulcrum, as
well as for the mobility of the hyoid bone, and for the motor function of the tongue.
So… The hyoid bone can thus be seen as a major relay as well as a privileged witness to the maturation of
the anterior neuromuscular chain.
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1 million synapses per second..!
 Couly : predominance of Paccini corpuscles
(baro-receptors) that run the length of the
alveolar crest, well before the teeth = law of
intrinsic proprioceptive regulation.
And, then, the second idea from the 80s: the law of intrinsic proprioceptive regulation (G. Couly)… This
can be attributed to studies about the onset of orofacial neurosensorality, where there is a predominance
of the baroreceptor corpuscles of Paccini, that run the length of the alveolar crest, prior to birth. This is,
thus, well before tooth eruption. This lets us consider the edentulous arches when the two jaws first
begin to touch each other, recognize each other, and come into contact with each other to provide a
neuronal network prior to birth… And the brain begins to memorise these new references... 1 million
synapses per second.
What should interest us are the details of the formation or the primary neuronal network, starting at point
zero, birth. This means the neonate has no autonomy.

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So what is the basic question?
– the establishment of the first sensorimotor loops.
development - posture - denture… illustration…
right: 15 minutes after birth with the father ... the powerful imitation mirror neuron and at the left a baby
of 5 minutes. If the reflex suction-swallowing is genetically programmed, please admire the perfect
coordination between the support from the hands and the synchronical movements tongue-mandible….
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développement - posture - denture… illustration…
So what is the basic question?
– the establishment of the first sensorimotor loops.

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At birth there are 3 vital urges: breathing, eating, and fighting gravity…!!!
1 million synapses per second..!
1 location et 3 key words:
Tronc cérébral = sensation – recrutement tonique - homéostasie
Stress and distress at birth…:
Because it is difficult to conceptualise and remember, we must take a moment to discuss the stress and
distress of birth.
At the moment of birth, the newborn is faced with 3 vital urges: to breathe, to eat, and to fight against the
effects of gravity (and this we never discuss!)
As stated by Gaspard Ansermet:
“At the beginning it is the overwhelming nature of living… the newborn is incomplete at birth, and is the
most atonic of all living beings . The baby drops into the world in a state of distress, invaded by the life
thrust upon it, unable to express itself as it has no reference point to attach a meaning to what is
happening.
“That which the baby will learn to identify, such as hunger, thirst, being hot, being cold, being wet, being
dirty, having a wet nappie, make no sense in the beginning. This is not retroactive, it begins with the
response of others to the baby’s needs; that satisfaction lies beyond the distress. Here is where these
stimuli will find their significance…” (p.59)
Central table : To sum up, as Ansermet further states: “ inside the little man there is an absence of R (
representations ) and an invasion of S, (somatic feeling) which dominates… (p. 65)
That’s why for the baby all the sensory captors are working at full speed, and it registers all it perceives,
fabricating up to one million synapses per second… which will allow it to construct a neuronal network
and neuromotor loops, to permanently adapt, and, if possible, return to homeostasis each successive
second of life…
On the right figure : at the onset, all these first sensorimotor loops get organized at the level of the motor
cores of the brainstem, we should not especially think, as we use too much), that the passage of the
bottom above the red line, representing the passage from the sub-cortical automatism to the processes of
mentalisation of the cortical areas appropriate to the primates and in more elaborate to the human being,
we should not believe that this passage is made entirely and quickly in particular concerning the oral
functions.

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Couly 2015: the 2 brains of orality :
primary orality = brain stem; secondary orality = frontal cortex
At birth there are 3 vital urges: breathing, eating, and fighting gravity…!!!
Stress and distress at birth…:
Gerard Couly restated in his latest work from 2015: “Swallowing in primary and secondary orality are
controlled by the same unique programmer that undergoes more and more complex and sophisticated
reconfigurations, facilitated by the flexibility of the interneuronal network. In particular, birth involves
abrupt changes in the new oral and respiratory modalities
During the first year of life the sucking switch of the primary orality unlocks the switch for swallowing, then
it is replaced by the pyramidal corticogeniculate fascia of the secondary orality. The frontal cortex is the 2nd
brain of orality. But it’s not only breathing and respiratory modalities that impose brutal changes for the
infant, it is all the other unpleasant stimuli received from all the different sensory portals, as stated by
Magistretti and Ansermet, that, in particular, establish the ability to fight gravity and develop mobility, thus
allowing for autonomy.
And the progressive establishment of occlusion and mastication, that is, all the functions of the mouth,
including mouth closure, can no longer be separated from the other stages of sensorimotor
development.
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Espace utérin -> espace de la pesanteur -> tonus pneumatique
développement -> posture -> denture…
2014-2015 : C.A.S. Certificate of Advanced Studies UNIL (Lausanne) = Bilan sensorimoteur précoce de Bullinger…

We must incorporate into our teaching the results of Bullinger’s study on early sensorimotor outcomes.
As a result of this new information, we are better able to look more in depth into the narrow connections
of the cranio-cervico-facial neuromuscular connections, in utero, during each step of the overall
sensoritonic balance.
If we look at the diagrams at the top of the slide, from Roger Vasseur, at first there is a prenatal period of
neuromuscular training in the inter-uterine space, which becomes more and more intense as we approach
the end of gestation, between the anterior and posterior chains, under the control through contraction and
relaxation of he . But this occurs in an aquatic environment, without the influence of gravity.
Bullinger had the genius to define the gravitational space following birth, in which the newborn must
develop a neuromuscular means to support its own weight, and must develop mobility with the aid, firstly,
of its pneumatic tonus (by blocking respiration) during the first horizontal stage (2nd diagram). This is the
onset of structuring and balancing between the anterior and posterior chains, according to the tonic
capacity of the baby to pass from one position or activity to another. And there are significant differences
depending on the random journey of each individual (photo 1 = the “moon baby” sleeping position)
Diagrams 3 & 4: this is followed by uprighting into a sitting position using all the tonus and postural control
all the way down to the pelvis. This represents the most delicate and decisive phase of our study.
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Summary : development – posture – dentition… out of our control… as seen in
Bullinger’s early sensorimotor outcome theory.
Progressive structurisation of the anterior chain (sub-
and supra-hyoid), in coordination with the pneumatic
tonus and the cervical tonus of the posterior chain
(superficial and deep planes)
two left plans : it's during the transition from the sitting position towards the vertical position that the
baby, struggling against the gravity constraints (black arrows), connects with new neuromotor ways in order
to find and build his/her muscular tone, with the aim to ensure the way he/she holds the head (red arrow
in A) prior to going down to the pelvis.
It's clearly stated in the sensor-motor assessment and since the beginning of our observations since two
years which are daily confirmed, that in order for the tongue to change its position and dynamics, the
flexibility of the cervical vertebrae is required in order to allow changes in baby's senso-tonique balance
(Bullinger 2015, p.30).
And what are the tongue's support to go vertical? It is not going vertical towards the palate thanks to the
pressure of the intrinsic muscle elevator, in particular the styloglossus, as we all assumed until now ...

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Résumé : développement - posture - denture… les incontournables: …
… venant du bilan sensorimoteur précoce de Bullinger…
There must be more force than that in order to alter, in such widely varying pattern, the form of the
palatal vault, the lower facial height, and the angle of mandible… in balance with an effectively
equivalent force for the posterior chain, in order to be able to hold the head upright…
And genetics fall short of explaining such variability, thus epigenetics and randomness must play a role in
the stages of sensorimotor development…
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Conclusion : développement - posture - denture
Progressive structurisation of the anterior chain (sub-
and supra-hyoid), in coordination with the pneumatic
tonus and the cervical tonus of the posterior chain
(superficial and deep planes)
In conclusion, in this theoretical portion, we postulate that the first changes or challenges to the entire
glossopharyngeal, down to the level of the sternum and clavicle, are going to prove to be more effective
and crucial. This is in coordination with pneumatic tonus (the power of the thoracic cage) and in
permanent balance with the superficial cervical chain, followed by the deeper chain. This allows the first
postural elements to be put into place. The process begins with the antero-posterior fibers, followed by
those located laterally. Thus at the end of growth the body arrives at good balance between the 5
postural chains, depicted in the diagram on the right (courtesy of the osteopath Michel Clauzade).
To reiterate once again, from about 6 months, when the baby first sits, until he begins to walk, around 12
months, is the time interval that corresponds precisely to the eruption of opposing incisors, first lower then
upper, which will modify the sensory and motor perception of the tongue. Normally, this aids in a change

in posture and movement, assuming the conditions of balance and of the anteriorly constructed
neuromotor network allow for it. This also assumes there is not a limit in neuronal plasticity.
There is yet another important notion of early sensorimotor function: the infant first experiments with the
existing tools, imperfectly, in the early stages. Then the teeth come and the imbalance is more or less
compensated for. Thus the justification of our title: Dentition follows posture.
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développement -> posture -> denture… études cliniques
Anamnèse : Tableau de développement… Etudes cliniques (40 cas)
objectif 2017 = 100 cas en 3 groupes
Aim: to find radiographic norms taking into account pre, neo or post natal
contingencies, as well as sensory-motor development.
In order to check these assumptions and to look for connections between sensory development according
to Bullinger, and the development of dento-facial dysfunctions and dysmorphoses, we started last year a
clinical study by building a survey about peri and post-natal anamnesis.
We collected data and compared all cases of patients aged seven or less year old, in treatment or examined
for treatment ... meaning more than 40 cases. I expect having examined more than a hundred cases by May
next year, prior to the AIOF Congress in Canada.
Dr. Michael Lacroix
Pediatric Orthodontics
Orthoglobal
Rue du Simplon, 5
1020 RENENS – CH
(www.orthoglobal.ch)

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