ropostura

Marian Vladimir Constantinescu

Born at Bucharest, Romania on January 1st 1949

Married: two children ( Luciana, Florin )

Head of Postgraduate Dental Department at "Carol Davila" University of Medicine and Pharmacy

General Manager of "Prof. Dr. Dan Theodorescu" Dental University Hospital , Bucharest

Graduated "Carol Davila" University of Medicine and Pharmacy, Bucharest , 1973

Internship at Bucharest Clinical Dentistry Hospital , 1972 - 1975

Specialist Doctor in General Stomatology, Bucharest Dental University Hospital , 1978

Senior Doctor in Stomatology, Bucharest Dental University Hospital , 1991

Associate Lecturer, Oral Rehabilitation, "Titu Maiorescu" University Bucharest , 1996

Doctoral degree in Stomatology, "The study of mandibular kinematics in occlusal physiology and pathology", 1998

Expert evaluator of the National Commission of the National Center for Professional Training Program "Leonardo da Vinci", Bucharest, 1998-1999

Scientific Secretary of the Professorial Council of the Faculty of Stomatology, "Titu Maiorescu" University Bucharest , 1998-2001

Docent in Gnathology, Lombard University , Milan , Italy , 1998

Member of the National Commission of Stomatology of Romanian Medical College , 1999

Member of the National Commission of Stomatology of the Ministry of Health, 2000

Head of the Certification Commission for dental materials and instruments of the Ministry of Health, 2000-2002

Founder of the Romanian Foundation of Stomatology, 2002

Founder of the Romanian Society of Periodontology, 2003

Professor at the Postgraduate Dental Department at "Carol Davila" University of Medicine and Pharmacy, 2004

Docent in Posturology at the University of Palermo , Sicily , Italy , 2004

President and founder of the Romanian Association of Oral Rehabilitation and Posturotherapy (ROPOSTURO), 2004

Lecturer for Oral Rehabilitation with Bicon Dental Implant system, 2005

PUBLICATIONS

Co-author of the following books:

1. Complete Denture. Clinical Aspects. Treatment. 1st Ed 1996, 2nd Ed 1998, 3rd Ed 1998

2. Stomatognathic System. Clinical Functional Morphology Data , 1997

3. Oral Implantology. Practical Guide, 1998

4. Current Techniques in Prosthetic Dentistry, 1999

5. TMJ Disorders. Diagnosis and Treatment , 1999

6. Complete Denture, 2000

in which he wrote the chapters regarding the mandibulo-cranial posture, the classification of positioning methods, the recording of mandibulo-cranial posture by self-guidance principles and functional principles of oral rehabilitation.

Posturology: Unity in Diversity, Transdisciplinarity

Recently, at the interface of several medical disciplines, a new branch has emerged, POSTUROLOGY, that studies the human balance in the vertical position . This transdisciplinary medical branch born after fundamental research initiated during the 1950 in Italy , Portugal and U.S.A. reached maturity in 1985, when The French Association of Posturology published the guidelines of the orthostatic balance.

The correct posture is that in which the head is centered on pelvis, the face is directed straight forward and the shoulder grille is situated about the same level with the pelvis. When the man is standing right, the weight of the body is equally distributed. A line drawn downward from the ear should cross through the center of the heel bone. It this line falls in front of this point, the muscles of the neck and backbone will be under strain in order to support the head. As the head is kept forward to the correct position, compensatory changes are produced of the normal curve of the backbone. This compensatory changes extended, permanent changes are mode which will have some effect on each phase of the body mechanize. Similar problems occur when the head is kept on side or if the pelvis is bent forward or backward. The problem is to know how to correct this changes of posture. The posture is a static attitude with strong limits of oscillation, white the balance is ,,dynamic " and can be kept under more ample oscillations that require a range of postural attitudes that keep the projection of the center on the ground, in the sustainable polygon.

The postural tonic activity, on activity different from the muscle state, represents the muscular activity that assures the vertical position. This activity is a motor activity that employs sensory tracks and it is regulated by a complex system of afferences and efferences.

The postural system, due to its complexity, requires a range of information that are continuously perceived by the receptors. They send information though nervous fibres directly to the central nervous system that directs the operating muscles.

Besides the receptors, the postural system also uses the information that come from its sensory organs that are represented by the eye, the vestibule of ear, foot vault and the stomatognatic system.

The eye and the internal ear maintain the body balance in space.

The foot vault represents the final part of the cynetic chain that keeps the equilibrium in walking, running, etc.

The lower jaw has a respiratory function, a support function for the hyoide bone-trachea and acts as a fixture of the skull position. The dental occlusion is part of this system and represents an important station for proprioceptors and exteroceptors maintaining a correct verticality.

The man, apparently immobile, in order to assure the steadiness of his vertical position, is constantly regulating his posture and "oscillates".

The postural imbalances occur when one or several receptors do not send correct information. After these receptors are reprogrammed, a postural regulation may be obtained and the lesions may be cured and prevented. Several times the postural reprogramming is achieved by eye drills, oral myofunctional therapy or by breathing drills and the use of postural orthodontists.

The posture of one person is determined by various structural factors; the most important being the metabolic and above all the psychological factor.

All these things demonstrates that among organs there is such an interrelation that the clinical physician cannot have other option but to consider the patient in its entity, no longer being able to cure the patient only in his therapeutically field. We should not understand that the physician has to know everything in order to cure his patient.

The knowledge of major clinical signs becomes indispensable that permits the therapeutic to direct the patient to other specialists with whom to be in touch, in the view of the optimization of the treatment he prescribed. The fine control of the orthostatic posture is the result of several biomechanics, sensor, neuropsychological factors integrated, in real time, into a matrix called ,,fine postural system" (FPS). Deregulations, sometimes very small, may explain the systems of the postural patients that crown the waiting rooms with vertiges, backaches, neck aches or unexplained oro-facial points. Multiple subjects are in view: ophthalmology, ETN, neurology, podology, orthopedic, and dental medicine.

As any feedback devise that allows the maintenance of homeostasis, the fine postural system (FPS) has entrances that are mode of its sense receptors that informs it of the variations between the body axis and the environment and its sense receptors that informs it about the variations in the position of various muscles, and also about the location of the organs and the blood circulation. These receptors called exteroceptors or endoreceptors according to the source of information they convey are constantly stimulated in the vertical position by the slow movements with reduced amplitude, following the internal or external changes. These minimal postural variations to the environment are perceived mainly by the retina, the otholitic system, foot arches and the muscles of the lover limbs and are conveyed to the central nervous system that organizes and maintains a continuous movement of stability. As an answer to the FPS trokbles a steady microdynamics that shows several entries and only one exit towards the muscular activity and the tonus, called ,,common final way".

A deregulation of one several receptors of this system determines the transmission of several erroneous data to the central nervous system. In this case abnormal pressures are put on the skeleton and the joints and a supplementary activity of the whole body in order to attempt the resettlement of the equilibrium, a fact that might cause various physiological troubles. That is called ,,the syndrome of Postural deficiency (SPD), described by the Portuguese Da Cunha in 1979. The Postural deficiency Syndrome (PDS) is characterized by on unilateral Para vertebral hypertonic frequently associated with rich symptomatology (ser the Table).

Functional Signs of the Postural Deficiency Syndrom (PDS) after Da Cunha, 1979

Main Signs	Clinical Manifestation

Pain	Headache, retroocular pain, thoracic, abdomen pains, artrologia pains in the backbone

Disequilibrium	Nausea, deafness, vertigo, unexplained falls

Ophthalmologic	Astenopy, visual troubles, diplopia, directional scotoma , metatopy

Proprioceptive sensitivity	Dismetry, somatoagnosy, errors in assessing the body scheme

Secondary Signs	Clinical Manifestations

Articulation	TMJ Syndrome, torticolis, lumbago, periartritis, entorsis

Neuromuscular	Paresis, deficiency of motor control of extremities

Neurovascular	Parenthesis of extremities, Raynaud syndrome,

Cardio circulation	Tachycardia, lipotimy

Respiratory	Dispnea, fatigue

ENT	Ear sounds, deafness

Psychological	Dyslexia, disgraphia, agoraphobia, direction deficiency, space location, left-right confusion
Psychological	Concentration deficiency, memory losses, asthenia, anxiety, depression

In order to objectively identify this syndrome, the specialists in posturology used a simple examination that is achieved with the platform of stabilometry. The data obtained are compared with the established benchmarks for a normal population, then various tests are made to check the optimum function of each of the receptor of the fine postural system. This a source of postural trouble is established, or it can even be prevented .When curing does not yield results or when it does not last long, some patterns may be employed; the first level that indicates PDS is the anamnesis, associated with the examination of the morphological troubles. If a global anamnesis well performed may often allow a PDS, especially when the symptoms are rich, with more than 10 signs (see the Table), located especially on the same side of the body, the patient complains of a pain on side. To the some degree, if a morphological analysis shows a bend a rotation of the head, a swing of the shoulders or the bum a knee, a foot directed to the inside or the outside are signs that can direct the diagnosis. Only the dynamic examination of the muscle force of the whole body with segment contractions or if the patient has a systematic dysfunction, a real PDS with hypertonic on one side or spread to the whole postural muscles.

The posturodynamic test analysis the answer the muscles of the backbone to their own stretch, that reveals the mechanics of the myotatic reflex and unilateral or bilateral Para vertebral hypertonies of the whole backbone that means PDS. Over one third of the patients who come for a postural assessments have a form of PDS. It is important to reveal the real PDS. The preconditions of these patients may sometimes be too rich and very old; their biomechanical and emotional reactions are often intensified. They are often worsened by invasive treatment (ortheses, correcting lens, stabilizers, etc) that is the correction cures with an intensive mechanical aim.

Before starting a postural reprogramming, the posturologist will have a postural deprogramming putting the body in a neutral position: than he will look for the areas that trouble the position of the patient at the visual podal, proprioceptive or visceroceptive oral level.

Posturology develops a simple clinic language that allows the specialists a real communication among themselves, suggesting a common grid of interpreting the postural dysfunctions adopted now by neurologists, ophtalmologists, ENT specialists, orthopedists, dentists, kinesiologists, osteopathologists and podologists that allows a global analysis of the individual by assessing the state of activity of the postural force by some simple validated means. According to his abilities, the posturologist will cure the area areas that trouble the posture or he will guide the patient to a specialist.