The Morpho-Functional Cranio-Facial Rehabilitation 2 (MFCFR) The « NORMAL »

Posted on: 22 mars 2017 by in Non classé
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It’s not until a few years ago that we developed a 3D animation project, the (CFU), destined for teaching and dental research, in collaboration with Lille II faculty. The CFU is also a conceptualization project. In fact, the fundamental data (the genetics and the acquired), and the analyses and clinical findings concerning the essentiality of the mandible led us to the Three-dimensional Mandibular Concept and then to the Morpho-Functional Mandibular Rehabilitation. But since we have to consider the whole cranio-facial entity to accomplish rehabilitation, this new concept of global Rehabilitation was given a new name: Morpho-Functional Cranio-Facial Rehabilitation (RCFMF). This recovery process is physiological, skeleto-muscular, gnathological and functional. The RCFMF consists of « the morpho-functional model »: the FIVE entities that constitute the masticatory apparatus (fig. 2.1), and that, when harmonious, led us to the identification of the FOUR conditions of the act of manducating (fig 2.2): Functional Centric Relation (1st condition), straight Opening and Closing movement (2nd condition), Physiological Occlusion (3rd condition) and Functional Chewing. These conditions constitute the normal functioning of the masticatory apparatus (FAM). According to this and when one or more entity is disordered, the mastication is not normal. This is the definition of the Disorders of the Manducatory Apparatus (DAM) of the RCFMF, also called « the morpho-Dysfuncional model », which gives us a new classification based on the etiopathogenesis of the different minor or major adaptive or pathological syndromes (fig. 2.3). The temporary or permanent treatments (Dentofacial orthopedics, occlusal balancing via a mandibular guide, prosthetics, posturology,…) should aim for the preservation or the reproduction of the five entities and the four conditions. This is the Morpho-Functional Cranio-Facial Rehabilitation. Note : the  figures are appointed 2.1, 2.2 … (2. expresses article 2).



Figure 2.1 the five harmonious entities of the Manducatory Apparatus : 1- Cranio-facial morphology, 2- Dento-dental articulation, 3- Disco-ligamental system, 4- Neuro-muscular system, oro-facial functions, 5- General physiological posture.


Figure 2.2  New notions: the four conditions of a balanced manducation that represent the (physiological) functioning of the Manducatory Apparatus or FAM

1) RCF, ERCP- reciprocity-2) Prehension: straight Opening and Closing 3) Physiological occlusion 4) Functional mastication. Swallowing: pharyngeal first phase (reflex)-Oro-facial functions.

Functioning of the four conditions: cycle opening, cycle closing.




Figure 2.3 DAM classification: etiology, clinical symptoms according to the RCFMF (Unbalanced entities and manducation)


MINOR ADAPTIVE DAMs (1, 2, 3, 4) via:

  • Isolated basal dysmorphoses
  • Morphological occlusal dysharmonies
  • Oro-facial functions disorders

Articular centering and settling, mandibular guidance disorder:

Straight Opening and Closing, compensating occlusion, dysfunctional mastication

Absence of: pain, popping, clicking, deviation, limitation


MAJOR ADAPTIVE DAMs (1, 2, 3, 4) via:

  • Cranio-facial dysmorphoses
  • Functional occlusal dysharmonies
  • Pathological general posture

Centering, settling and guidance disorders:

Condyles shifting, Deviated and limited Opening and Closing, compensating occlusion, dysfunctional mastication

Absence of: pain, popping, clicking

Presence of a shift


Pathological DAMs (1, 2, 3, 4) :

  •  Articular DAMs, condyle/disc uncoordinated (after a trauma), affected TMJ structures (chronic disease or general syndrome)
  • Muscular DAMs: spasms, bruxism, grinding (caused by stress, hyper/para-functions)

Centering, settling and guidance disorders: releasing of the condyles, Deviated and limited Opening and Closing, popping, clicking, pain, dysfunctional occlusion and mastication

Acute cases: pain, heat, redness, headache

Chronic cases: pain, popping/clicking, shifting, limitation

Other etiologies: iatrogenic treatments

In a previous article, we presented the morpho-functional model with the functioning of the manducatory  apparatus, or the Normal. The following describe the details of the four conditions of the FAM (Figures 2.4 to 2.7).





Figure 2.4 First condition: the condyles are in a Functional « Centric » Relation in the physiological condylar rotation space ERCP (grey grid space). This is not an anatomical position, it is a skeleto-muscular position related to the five entities and to the straightest opening-closing movement (second condition) and reciprocally.


Figure 2.5 Second condition: the straight opening-closing movement is composed of:

  1. The Mac Collum hinge axes that pass through the medial poles of the condyles (original axes in green, movement axes in blue): the pure condylar rotation in the profile and facial views happens in the 20 mm from the opening start till the closing end.
  2. The pure rotation is followed by a rotation-translation movement from the OIM, to the relaxed occlusion to the maximal opening position.


Figure 2.6 third condition: physiological occlusion close to the natural denture:

  1. The six keys of Andrews, slight curve of Spee
  2. Positive torque of the lateral sectors (curve of Wilson)… connected directly to the functional mastication (fourth condition) and reciprocally.


Figure 2.7 fourth condition: functional mastication described by Le Gall and Lauret.


  1. At the cycle opening, there is the intervention of the jaw elevators, and not the jaw depressors solicited in the canine protected occlusion, and there is the dental contacts from the lateral incisor till the second molar
  2. At the cycle closing, on the palatal cusp surfaces, related directly to the criteria of the physiological occlusion (figure 2.6)

Our diagnosis and treatment should preserve or reproduce the five entities and the four conditions of the manducation.

In the next article, we are going to discuss the morpho-dysfunctional model with the detailed classification of the DAMs or the Abnormal of the RCFMF.



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