THE NECESSITY OF GNATHOSTATIC DIAGNOSES IN
ORTHODONTIC PRACTICE*
B y D R . P A U L W . S IM O N , Berlin, Germ any
T is not my intention to describe the
I technical details o f gnathostatic im ­
pressions and models, or o f photo­
static photos. I refer you to the
numerous lectures and demonstrations I
presented in this country in the spring
o f 1924, as a guest o f the Am erican
Society o f Orthodontists. T h e paper
presented in Kansas C ity, M o ., has been
published;1 and since the society has
decided to publish an English transla­
tion o f tw o o f my books, anyone
interested in this subject may gain the
necessary technical inform ation there­
from .
F or those w ho may wish a plastic
presentation, I shall give, a practical
demonstration, so that the instruments
employed can be inspected.
T h e aim o f this paper is to empha­
size the principles upon which the new
methods are based; to show some o f the
progress which they have engendered;
to discuss ultimate objections, and,
finally, to disprove the latter.
Nevertheless, it may be useful to
state briefly a fe w elementary rules o f
the gnathostatic system.
W e no longer consider the denture
as an isolated body, but as an anatomic
and physiologic part o f the head, and
*R ea d b e fo re the Section on O rth odon tia
at the Seventh International D en tal Congress,
P hilad elp hia, P a., A u g . 24, 1926.
1. Sim on, P . W . : Internat. J. O rth odon .
Jour. A . D . A ., January, 1928
we therefore study its exact connection
with the skull, by measuring the pro­
portions o f the denture in its relation
to three planes o f the head. These
three planes stand at right angles to
each other and are as fo llo w s : 1. T h e
F rankfort horizontal plane, which
passes through the eye points and the
ear points. 2. T h e orbital plane,
which interesects the eye points and
stands perpendicular to the ear-eye
plane. 3. T h e raphe-median plane,
which intersects tw o occipital points o f
the raphe-palati, perpendicular to the
ear-eye plane.
These planes are not natural ana­
tom ic planes (w h ich we have not at all
on the irregularly form ed sk u ll), but
artificial ones, which can be represented
by straight sections. Details as to why
just these planes have been chosen as
especially useful and how they can be
marked on the head cannot be given
here fo r lack o f time. I refer you to
my other papers.
W e study the dentofacial relations
by making tw o reproductions, one o f
the denture, i.e., the teeth, alveolar
process and palate, and one o f the facial
part o f the head. Both reproductions,
o f course, must be marked according to
the three planes.
W e get the first by the gnathostatic
m odel (F ig . 1 ). T h e upper model
base is identical with the ear-eye plane,
22
 Simon— Gnathostatic Diagnoses in Orthodontie Practice
the orbital plane is represented by the
perpendicular line, drawn around the
m odel, and the raphe-median plane is
also represented by such an outline.
(F ig . 2 .)
Figure 3 shows the gnathostat fas­
tened on the head o f the patient in order
to take the impression. T h e other nec­
essary instruments, and their use, are
illustrated as fo llo w s : at first, the orbital
marker (F ig . 4 ) , to project the orbital
F ig . 1.— Gnathostatic m odel.
plane on the palate o f the impression;
further on, the symmetrograph (F ig . 5 )
to draw at right angles the orbital and
raphe-median planes, together with the
sliding compass (F ig . 6 ) , to measure
the symmetry or asymmetry o f the den­
tal arch, and, finally, the diameter
(F igs. 7 and 8 ) to represent the upper
and low er occlusal lines and transverse
and sagittal sections o f the palate in the
fo rm o f curve diagrams.
Figures 9-11 shows such curves o f
several cases, projected one into the other
so that one can make comparisons.
W e see, further, the cast o f the
upper impression with the help o f a
23
plate, which is used instead o f the
pointer-bow (F ig . 1 2 ), and, on the
low er impression, a base is made par­
allel to the upper base, and at a distance
o f 8 cm . fro m it. W e use a little table
with three legs o f corresponding height
fo r this (F igs. 13 and 1 4 ).
T h e second reproduction is the pho­
tostatic photograph o f the patient
F ig . 2.— M o d e l sh ow in g planes.
(F ig . 1 5 ) taken exactly one quarter
life-size, and in such a way that the
photo plane corresponds to the sagittal
median plane. T h e tw o other planes
are represented as sections by connecting
lines through the ear-points and eye-
points, and by a perpendicular to the
eye-point. Further, the corpus and the
ramus ascendens o f the mandible are
represented by lines joining the point
on the chin (gn ath ion ) to the point on
the ja w angle (g o n io n ), and to the
earpoint (tra g io n ), so that one can
measure the distances (F ig . 1 6 ).
24 T he Journal o f the American Dental Association
T h e next pictures show the photo­
static apparatus (F igs. 17 and 1 8 ).
F or the diagnostic analysis o f each
case, we therefore use the gnathostatic
m odel, with the curve diagrams, and
the photostatic photo. T o explain how
the diagnosis is made with the help o f
this material, I must refer to the
norm al denture, or the dental norm.
I f we compare a number o f gnatho­
static models and photostatic photo-
F ig . 3.— Gnathostat in position.
graphs with each other, which, in a
scientific sense, is only possible on a
basis o f exact localization, we find
(measuring fro m each plane) a large
number o f variations. N o tw o cases
ever resemble each other in their en­
tirety, not even those o f brothers and
sisters, nor even those o f identical or
true twins, though with these nearest
possible relatives resemblances are often
very marked. I can best demonstrate
this fa ct o f individual variation by pre­
senting examples.
F or instance, let us consider sixteen
dentures which present anatomically
faultness conditions: all the teeth are
present and in correct occlusion. In a
superficial view , these dentures re­
semble each other very m uch; a layman
could scarcely detect any differences.
A n d i f we should make the customary
dental casts o f them, the differences
w ould be even less easily discernible.
But all this is changed the mom ent we
F ig . 4 .— O rbital m arker.
begin to measure the gnathostatic
models, because exact measurements
are possible. Nevertheless, one simple
measurement is possible even on the
customary models, that o f the width o f
the dental arches, which is very im por­
tant in orthodontic therapy. L et us
measure the transverse distances be­
tween the first molars, and between
the first bicuspids in the sixteen
cases. I have arranged these in two
curves, as shown in Figure 19. T h e
upper curve shows the distances between
 Simon— Gnathostatic Diagnoses in Orthodontie Practice
the molars, arranged according to size
or distance, fro m 45.5 to 53 m m . T h e
low er curve gives the distances between
the bicuspids not arranged according to
size, but in such a manner that each
measurement is placed under the meas­
urement o f the molars to which it be­
longs; that is, o f the same case. By
this very irregular curve, we note that
one cannot speak o f regularity, or great
resemblance o f the arches, even in these
so-called “ norm al” dentures.
F ig . 5.— S ym m etrograph.
N ow , as to the other symptoms o f
the denture, it goes without saying that
we find practically the same variations.
T h erefore, we must face the fa ct that,
even am ong the best and anatomically
most perfect dentures o f a number o f
individuals, there are extensive differ­
ences in form . It is not admissible to
call an anatomically correct denture a
“ norm al” denture, simply because a
particular denture shows this form a ­
tion, another one a variation, and that
therefore, it w ould be unsafe to attempt
to determine a norm.
25
T h e extraordinarily important conse­
quences emanating fr o m this statement,
especially fo r orthodontic practice, can
be demonstrated with the same simple
example o f arch breadth. In most
anomalous cases, we find arches that
are too narrow. T h e y must be w id ­
ened, but how much? A glimpse at
the curves just shown indicates that
nature, even with its quite faultless
dentures (w hich many mistakenly call
“ norm al” dentures), does not answer
our question differently: D o as you like,
just as I do. Indeed many practitioners
seem to acknowledge only this one solu­
tion o f the diagnostic problem, i.e., an
arbitrary attitude. But a distinction
must be made between the apparent ar­
bitrariness o f Nature, whose efficiency
our finite minds are not able to pene­
trate, and the arbitrariness o f the prac­
titioner, w ho does not fu lly understand
but w ho wishes to impel Nature.
By the gnathostatic system, we at­
tempt to find out, through extensive
and exact measurements, whether these
26 T he Journal o f the American Dental Association
differences in nature (just shown in
one single exam ple) are without plan
or system, or, whether, in some way, a
systematic purpose, a natural law, can
be discovered.
T h is problem is attacked in a strictly
scientific manner, avoiding all subjec­
tive opinions and dogmas. O u r pro­
cedure is as follow s.
W e are collecting as many individual
cases as possible in one population-
center, in persons w ho have grow n
up in a similar environment. T hey
must have faultless dentures, with
anatomically correct occlusion. T h e ir
gnathostatic models and photostatic
photographs are compared in such a
manner that the characteristics which
are most important fo r our judgm ent
in practice are ascertained and meas­
ured from the three planes, that is, in
three dimensions. W e thus find a great
many variations, corresponding to our
form er example o f arch breadth. T h e
orbital plane, fo r example, may pass
through the cusps o f the upper first
bicuspids, or through the mesial inclined
planes o f these cusps; through the cusps
o f the cuspids, or through the mesial,
or distal, inclined planes o f their cusps;
or through the incisors, etc. T h e tables
presenting the results o f these measure­
ments show that this characteristic also
varies considerably. But we find fe w
in which the orbital plane passes through
the incisors, and fe w in which it inter­
sects the bicuspids. T h e number in
F ig . -D ia m eter.
which the orbital plane lies within the
cuspids is much greater. In the great­
est number, it passes almost exactly
through the cusps o f the cuspids. It,
therefore, seems that we have no arbi­
trary and irregular arrangement but a
systematic one, which is particularly
impressive i f one arranges the results
in a graphic curve (F ig . 2 0 ). Y ou
w ill note the three teeth that must be
considered: the lateral incisor, the cus­
pid and the first bicuspid. T h e vertical
lines indicate the various possible inter­
secting lines o f the orbital plane in
 Simon— Gnathostatic Diagnoses in Orthodontie Practice
these three teeth, and the horizontal
lines, the distribution according to per­
centages o f the 137 individuals exam­
ined by H erzog. Y o u w ill note that,
in 45 per cent o f all these cases, the
orbital plane passes exactly through the
cusps o f the cuspids; in 3 2.4 per cent,
it passes between the cusp and the prox­
imal surfaces, 15 per cent mesially and
17.4 per cent distally, and in 5 per cent
through the bicuspid, in none through
the incisor. Considering the results as
F ig . 9.— Case curve.
a whole, in about on e-h a lf the cases,
the orbital plane passes exactly through
the cusps o f the cuspids, and, in one-
third, it passes nearby.
In biometrics, there is a law known
as the la w o f Quetelet, by which
somatic characteristics ( f o r example,
the stature o f the body, the girth o f the
chest and the weight o f the brain) o f
individuals are compared and are fou n d
to be markedly variable. Nevertheless,
their distribution is rather systematic,
and this we designate as the “ binomial
distribution o f the variants.” A great
many individuals were included in
27
Quetelet’s examinations fo r an average
o f the examined symptoms, and the
more the measure o f the examined
symptoms deviates fro m the average to
either side (the plus and the minus
sid e), that is, the more extreme the
variants are, the smaller is the number
o f their frequency.
It cannot be doubted that this aver­
age which must be reckoned fo r every
characteristic (inclu din g features o f
the denture) with the aid o f exact
F ig . 10.— Case C urve.
methods o f measurement, represents
what we have always designated by the
w ord “ ty p e ;” and this type is identical
with the norm . T h e law o f Quetelet
makes it evident that Nature, in spite
o f these multiple variations, aims to
produce in each population group again
and again a certain con form ity, to
maintain a norm al, or average, type.
W e can comprehend the origin o f this
normal type quite w ell, though not all
o f the com plicated paths o f nature have
been thoroughly examined, and possibly
never w ill be entirely. In all prob­
ability, the norm al type is a result o f
inheritance fo r thousands o f genera­
28 T he Journal o f the American Dental Association
tions, on a basis o f adaptation to the
conditions o f life . W e cannot enter
into fu ll particulars here, but a great
many facts gleaned fro m the sciences
that deal with inheritance and the con­
stitutional conditions support our
opinion in this regard.
Specialists often use the w ord “ nor­
m al” when speaking o f the size o f the
body, or o f the weight, etc. T h e y , o f
course, have a certain idea concerning
it, and it may be that each one o f us
has certain opinions regarding the nor­
mal in our race, our population, and
also our fam ily. It is natural fo r us
to have these opinions. T h e y exist in
the subconscious m ind; but they are
hazy and subjective; they are like a fo g
without definite contours, and their
definition evades you. Biom etric prog­
ress, based upon a statistical study o f
variation, consists o f an exact formula­
tion o f the normal type upon a scientific,
objective basis.
N ow , I have given a short sketch o f
the task o f the gnathostatic system—
which it has partly solved. W e must
calculate the normal denture type o f
a population center fro m the averages
o f its variation curves o f the most im ­
portant characteristics and qualities, on
the basis o f the three-plane system and
with the aid o f measuring instruments.
I f this “ n orm al” denture has been
actually determined (and I wish to
state that this has been done as regards
its more important characteristics), a
practical diagnosis o f its anomalies can
be made. In my books, I have described
rather extensively how this new gnatho­
static procedure is fo llo w e d , with the
aid o f gnathostatic models and photo­
static photographs and with the help o f
a logical classification o f dental anom ­
alies; hence, I need not enter into
minute details.
I wish here to speak o f the objections
that have been raised against the system,
and I shall try to disprove them.
It may perhaps be said by some that
the making o f the models, curves and
photographs requires much time and
 Simon— Gnathostatic Diagnoses in Orthodontic Practice
effort. T h is is not the case, as every­
one w h o has become intimately ac­
quainted with their use w ill testify.
But even i f it were true, every con­
scientious practitioner w ill wish to use
them when he is convinced o f their
value and necessity.
N ow , these procedures do not incon­
venience the patient, or, in any case,
the inconvenience is less than that ex­
perienced in a roentgen-ray examina­
tion. N or is the subsequent diagnosis
difficult. T o the contrary, the new
procedure is clearer, more comprehen­
sible and more extensive than the old
method. W e orthodontists, who have
always moved malposed teeth in the
three directions o f space, quickly com ­
prehend that it is useful and necessary
to make our diagnoses in three dimen­
sions.
Sometimes the criticism is made
against the cephalometric method that
the measure-points on the head can be
determined only inexactly. T h is is
partly true. I f one has practiced one
definite technic in marking these points,
the unavoidable inaccuracy is so small
that it has no significance as regards
29
the correctness o f the diagnosis. But
our critics who make this charge should
not be so inconsistent, because they, at
the same time, lay great stress on the
“ constancy” and “ fixity” o f position o f
the first permanent molars. It has been
definitely proved that they are very in­
constant, that they are not fixed, and so
one must not say that they are in cor­
rect position; they are in an organ
which perhaps goes through the most
complicated development o f all organs
o f the body, and which is exposed to
many external influences.
Another objection refers to the above
mentioned normal denture, which is
ascertained biometrically. It is said
that its form is adequate as to morpho­
logic relations, but that it does not take
“ normal function” into consideration.
It is claimed that, in a forw ard m ove­
ment o f the mandible, such a denture
w ould show apertures in the buccal
teeth, resulting in an im perfect com ­
minution o f fo o d . I have observed
that these objections emanate largely
fro m prosthodontists, not orthodontists;
fro m men who are primarily interested
in articulation, and w h o forget that
their problem does not concern itself
with natural dentures, which are co m ­
30 T he Journal o f the American Dental Association
posed o f fixed teeth, but with artificial
dentures, in which other conditions pre­
vail. W e need only examine an ana­
tom ically faultless denture ( o f an
individual, o f course, w h o belongs to a
civilized nation, not o f an Australian
negro or Papuan), and w e w ill practi­
cally always observe these apertures. A
study o f the physiologic process o f bit­
ing and chewing in natural dentures
and o f the fo o d o f a civilized nation
w ill disclose that the fo rm o f our bio­
metric “ norm al” denture is also very
useful and represents the optimum, and
F ig . 14.— T a b le used in casting im pression.
that every other fo rm w ould be per­
haps less effective.
C O N C L U S IO N
I wish to mention one more criticism
o f gnathostatics as a method o f meas­
uring, but which in reality is only an
objection to the biom etric norm , or
against the necessity fo r a norm at all.
These opponents demand an “ individual
therapy” instead o f the “ schematic
therapy” that the norm suggests. R e­
calling that one cannot have any plaus­
ible objections to gnathostatic models,
etc., I w ould remind those w ho pretend
to be able to measure a denture w ith­
out cephalometric measurements that
they must prove, first, that they are
endowed with supernatural ability.
Personally, I believe they have not suffi­
ciently recognized the difference be­
tween “ subjective” and “ objective”
confirmation.
T h e demand fo r an individual
therapy is not only an attack on
gnathostatics, but assails all our therapy
up to the present day. L et me first
explain what is meant by “ individual
therapy,” notwithstanding such ex­
planation is difficult. Apparently, one
must re-form the abnormal denture o f
F ig . 15.— Photostatic p h otograp h .
a patient in such a manner that it w ill
correspond with the particular individ­
ual nature. O n e is expected to believe
that, fo r each individual, there is only
one fitting, appropriate, “ individual
normal denture,” differing fro m all
others, but that it m erely has not de­
veloped, because certain disturbances,
or “ etiologic factors” exercised perni­
cious influences. T h e r e fo r e , it is neces­
sary, first o f all, to recognize these
factors and to remove them. In this
sense, an “ individual therapy” is con­
nected with the “ causal,” or “ etiologic.”
A nd here I must call your attention to
a fundamental error: the identification
o f anomaly with disease. A person who
 Simon— Gnathostatic Diagnoses in Orthodontie Practice
has no other infirmity than an abnormal
denture is enviably healthy, and his
denture (teeth, gums, jaws, muscles,
etc.) is by no means diseased. W ith a
sick patient, to find the cause o f his
suffering and to remove it is indispen­
sable ; otherwise, he w ill not get w ell.
W ith a dental anomaly, it is useful to
search fo r causes only fo r theoretical
reasons; it is absolutely useless fo r treat­
ment purposes; or, are there perhaps
special appliances fo r rachitic anomalies,
and others fo r inherited anomalies, and
F ig . 16.— Lines draw n to represent planes.
still others fo r those anomalies which
are due to finger sucking, etc.?
A causal therapy can exist only i f
we do not remove the anomaly by arti­
ficial, mechanical appliances, i.e., by a
s o ft force, but nevertheless by force,
but operate through internal and or­
ganic means, e.g., with an abnormal
system o f glands, and thus obtain an
internal spontaneous transformation o f
the jaws. T h is seems utopian to me,
at least fo r cases o f anomalies that are
marked and established. It is, o f
course, quite another matter in prophy­
laxis, or the prevention o f anomalies.
A n d n ow that we have established
that “ casual therapy” is an error, what
remains o f “ individual therapy” ? T h e
31
gnathostatic system suggests that we
transform an abnormal denture in such
a way that w ill correspond as nearly as
possible to the biometric norm. The
fo llo w in g train o f thought suggests it­
se lf : Since w e cannot possibly know
what fo rm a patient’s denture w ould
have assumed during an undisturbed
development, w e provide him with one
that is most suitable in every relation,
as i f this denture had developed all by
itself in an undisturbed manner.
A certain pattern is thus at hand, as
the real individual is thus neglected in
fa vor o f the general. A n d what is the
condition o f the individual? I f you
reflect on the genesis o f a denture, from
its very beginning— which means from
the germ -cell— and i f you take into
consideration all o f the infinitely com ­
plex influences and conditions o f inheri­
tance, o f intrauterine and extrauterine
existence, you w ill come to the fo llo w ­
ing conclusion: T h e particular denture
fou n d in an individual prior to ortho­
dontic treatment, regardless o f its
paricular kind o f deform ity, is the in­
dividual denture; it represents the last
effect o f endogenous and exogenous
influences to which this person has
reacted individually; and every ortho­
dontic alteration means, under all cir­
cumstances and even i f desirable and
corrective, an arbitrary reshaping o f the
32 T he Journal o f the American Dental Association
individual form . T his is only justi­
fiable i f it is patterned after a higher,
better m odel than the individual. A nd
this m odel is the biometric norm.
T h ere can be no individual therapy.
It is unknown, even in general thera-
peusis in disease. In every pharm ocol-
ogy, you w ill find a great many
remedies that are recomm ended quite
schematically fo r abstract diseases,
without any knowledge o f the condi­
tion in the individual. But there is an
individualizing therapy that depends on
certain changes in the general therapy
F ig . 18.— P hotostatic apparatus in use.
by taking certain peculiarities o f the
patient into consideration.
It goes without saying that this is
also true in gnathostatics. I need
merely mention the age o f the patient.
A total maxillary protraction, fo r ex­
ample, can be treated without extrac­
tion up to the tenth year by m oving the
buccal teeth distally. Later in life , one
must eventually extract the first bicus­
pids; or, i f one does not want to resort
to that method fo r “ individual” rea­
sons, then the protraction must remain,
or be le ft untreated. Every experi­
enced practitioner knows how to indi­
vidualize, but he must first acquaint
him self fu lly with the general, i.e., the
superindividual, method.
Recently, an author tried to define
individuality on the basis o f inheritance.
E very child is said to reflect in his
bodily structure the fo rm o f his parents,
but only these, not that o f other an­
cestors. T h e occurrence o f an anomaly
is then explained by assuming that the
structure o f the parents did not exactly
correspond each to the other. T h e
possibility is granted that exogenous
conditions may cause anomalies, but
their influence is minimized. T h is doc­
trine is a mixture o f subjective opinions.
T h e author tries to found it on scientific
material; and its preparation and utili­
zation is very im perfect. Nevertheless,
an “ individual therapy” is abstracted
from it, the ideal demand o f which is
as fo llo w s: T h e parts o f the jaws o f
a child that resemble the corresponding
part in the jaws o f one o f its parents
must not be changed during treatment,
since they form a quite original com ­
ponent o f the individual, and are
therefore “ individual norm al.” T h is de­
mand w ould only be justified i f the
parents were always o f ideal form ,
which, unluckily, is not the case. T h e
inventor o f this doctrine unfortunately
forgets that the dentures o f the parents
have fo r decades been exposed to the
form -changing influences o f function,
 Simon— Gnathostatic Diagnoses in Orthodontie Practice 33

life , etc.; that they do not in the least
show the real, inherited fo rm — the
genotype.
F or lack o f time, I shall not refer
to other objections. In any case, this
attempt at an etiologic foundation fo r
diagnosis and therapy possessed one
good, in that it clearly shows the utter
impossibility o f such a doctrine.
A gain, I believe it necessary fo r
every orthodontist to use cephalometric,
S3
ft
s/
jp
n
is
sable fo r etiologic and other similar in­
vestigations, because, in this domain, an
especially objective clarity and exacti­
tude are demanded.
T h e determination o f a dental norm
on a biometric foundation seems indis­
pensable to me and corresponds with
the methods employed fo r many years
in medicine. O n ly such a norm is free
o f hypotheses based on probability; fo r
it does not depend on future supposi-

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vt

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tf
Vr
39
38
3?
3i
3S

F ig . 20.— G raphic curve sh ow in g syste­

F ig . 19.— M easure o f transverse distances
m atic arrangem ent o f planes.
between first m olars and bicuspids.

tions but irrefutable figures. O n ly in

gnathostatic methods in his practice;
fo r , with the help o f these methods, it
is not only possible to judge the denture
in three dimensions, which is the only
right way, but the dentofacial relations
are also considered in an exact manner.
T h e personal, subjective conception is
now replaced by the striving fo r objec­
tivity. Orthodontics thus emerge from
a state o f unworked empiricism, o f
personal experiences and preferences,
into a truly scientific vocation.
I regard these methods as indispen­
this wise is it possible to define anom ­
alies, their degree and their localiza­
tion.
Gnathostatic diagnosis is not a
gnathostatic therapy. Every practitioner
is le ft free to determine the method
and aim o f treatment, and to draw on
his ow n experiences. Gnathostatics
merely tries to grasp in a scientific man­
ner that which it is possible to grasp
scientifically. Beyond it, there lies a
wide field fo r medical intuition and
orthodontic art. But the use o f the bio­
34 T he Journal o f the American Dental Association
metric dental norm, determined gnatho-
statically, is our safest and most
indispensable plan, an indispensable
model for our treatments. W e may
m odify and individualize, i f we have
good reasons fo r so doing; but, in most
cases, this will be unnecessary.
Above all, I regard these methods as
useful for putting orthodontics on a
broader basis. Our studies in anthro­
pology, biometrics and heredity, and
consideration o f the human structure
and other important matters no longer
remain a beautiful wish, about which
only a few are concerned, but a neces­
sity o f everyday practice for the exten­
sion o f our knowledge. Now we have
the means and they are not difficult to
apply.
I thus express the hope that many
new aspirants will join with old friends
to advance orthodontic proficiency, in
order to attract devoted students o f
science, and that our specialty may
progress steadfastly.
DISCUSSION
A lle n H olm a n S u g g ett, San F rancisco,
C a lif.: A ft e r listening to a paper on a subject
on w h ich the author has put in ten years o f
scientific research, it is presum ption on m y
p art to trespass on y o u r time. Y o u w h o have
read D r . S im on’s “ Fundam ental P rinciples o f
Systematic D iagn osis o f D e n to fa cia l A n o m ­
alies” and the N onn C oncept o f O rth odon ­
tics,” ex p la in in g his p h ilosop h y o f the norm ,
fu ll y realize the scientific, literary and p h il­
osop h ic ba ck grou n d he possessed in order to
ca rry o n such a piece o f research successfully.
T h is w o r k is fo u n d e d on an th ro p o lo g y and
an th ropom etry, both o f w hich must be dis­
credited in ord er to disprove him . W e have
done to o m uch guessing, and w e have, in the
past, laid great stress on the constancy o f the
m a x illa ry m olars, a fiction w ith about as
m uch scientific fo u n d a tio n as the theory that
the earth is flat. It was first advanced as an
hypothesis, but n o attem pt was ever m ade to
p rov e it. Sim on’s research p lain ly shows that
none o f the teeth are constant in their p osi­
tio n : variations are endless. So this theory
o f the constancy o f the m olars o r, f o r that
m atter, o f any o f the teeth is not an h y p o­
thesis but fiction , and must be used as such,
sim ply as an aid to reasoning. A w riter m ay
and does use the fo r m o f fiction , in ord er to
present truths that he co u ld present in no
other w a y , treating the subject as i f it
w ere true. T h e fiction o f the constancy o f
the m olars is useful, but w e must not fo r g e t
that it is a fiction . D r . Sim on’s w o rk treats
o f the subject o f diagnosis and not o f treat­
m ent. Bear in m ind that diagnosis is not
treatment. D r. Sim on has presented to us a
sim ple, practical m ethod o f taking impres­
sions and m ak in g m odels that show the rela­
tion o f the teeth to the head. W e can readily
F ig . 21.— L e ft, an ordin ary m odel and,
righ t, a gnathostatic m odel o f the same case.
see the im portance o f loca tin g these planes
fr o m w h ich he takes his measurements, out­
side the area effected by m alocclu sion. T h e y
are stable and ad m irably located and each one
bisects both arches. I f you w ere out in the
ocean in a storm , you w o u ld hardly select a
lig h t on another boat that was lost, too, by
w h ich to g u id e y o u r course, but w o u ld select
the north star o r the m agnetic p ole , because they
are outside the influence o f the storm . T h e y
are fixed. It is true that they have certain v a ri­
ations just as the planes o f the g r o w in g head
vary, but w e understand what that variation
is and plan a ccord in g ly . I have been dem on­
strating D r . Sim on’s m ethod o f gnathostatic
and photostatic diagnosis f o r tw o years and
it is interesting to hear some o f the objections
offered . “ Y o u can’ t measure the h e a d ;”
“ y ou can’ t measure the so ft tissues;” “ you
can ’t measure N a tu re ;” etc. W h y can’ t we
do a ll these things? D o n ’t w e measure the
 Simon—-Gnathostatic Diagnoses in Orthodontie Practice
stars and w eigh them? D o n ’ t we w eigh and
measure p eople? D id not anthropom etrists
measure every bone o f the bod y , years and
years a g o ? W e measure the strength o f the
different muscles, the fo c a l distance, brain
capacity and m entality. E very dentist is d o ­
in g a thousand things fa r m ore difficult than
taking an im pression and m aking a gnath o­
static m od el. T h e first step in treating a
disease is to d iscover w hat kind o f a disease
it is. T h e y used to say, “ Feed a fe v e r and
starve a c o ld .” I f that w ere sound treatment,
it was v ery im portant to first find out whether
it was a fe v e r o r a co ld . P eople in a ll ages
have recog n ized the im portance o f diagnosis;
otherw ise, they w o u ld not have resorted to
F ig . 22.— Case o f extrem e retraction, the
occlusal plane slo p in g d ow n w a rd 20 degrees.
such drastic m ethods to make one. In the
m iddle ages and later, they alm ost resorted
to cru elty in d iag n osin g C hristianity o r
w itch craft. T h e y used to “ diagnose” a witch
by d u ck in g her in a p on d , i f she drow n ed
that was scientific p r o o f o f g u ilt. If
she did not d ro w n , that was evidence
that she possessed a d evil and she was taken
out and burned. T h e diagnosis was generally
m ade a fte r the treatment instead o f b e fo re ,
w hich was rather hard on the patient, but
v ery c o m fo r t in g to the d octor. W hen we
exam ine a case o f m alocclu sion, w e g o
through the m ental process o f m ak in g a
diagnosis. T h e diagnosis m ay not be thor­
ou g h o r scientific, but it is a diagnosis never
the less. W e notice, perhaps v ery casually,
w hat is there presented. Instead o f m akin g
the diagnosis scientifically by fin d in g and
record in g in an o rd e rly m anner just what is
there, it is o fte n d on e in a very haphazard
35
w ay. W e notice that there is a distoclusion
and proceed to p lace an appliance f o r a Baker
an ch orage. A ft e r a f e w m onths, we notice
that there is a bicuspid lack in g , and w e
change the appliance to m ake room f o r the
biscuspid. A ft e r a fe w m ore m onths, w e no­
tice that there is a v ery deep bite and we
p ro v id e f o r that. B y and by, w e get w orried
because o f the nonappearance o f the bicuspid,
and we take a ra d iogra m and are m uch
chagrined to fin d that there is none, so w e
proceed to close up the space w e have m ade.
B y this tim e, we have the teeth in pretty fa ir
con d ition , but the parents com p lain that the
ch ild is “ a ll teeth,” and that w e have spoiled
his b ea u tifu l m outh.
F ig . 23.— Case o f extrem e protraction , the
occlusal plane slop in g up 3 degrees.
B y this tim e, b y trial and error, hit and
miss, do and un do, we have m ade a diagnosis,
a fa ilu re . W e k n ow n ot w hat w e have done
n o r h o w we did it. W e have a ll done it, so
I speak as on e h a v in g authority and n ot as
the scribes. D r . Sim on has cleverly pointed
out h o w to make a scientific diagnosis and
how to record it in o rd e rly fashion . The
gnathostatic m od el shows every p oin t that the
ord in ary m od el does, and fu rth erm ore shows
the three planes by w h ich w e can ascertain
the relation o f the teeth to the head. The
ord in ary m od el shows on ly the relation o f
one ja w to the other. T h e gnathostatic m od el
shows that and also the loca tion o f the raphe-
median plane, the eye-ear plane, the orbital
plane by w h ich w e can measure the teeth re­
lation to the head. In F igu re 21, the top
o f the m od el represents the eye-ear plane,
and y ou w ill notice where the orbital plane
36 T he Journal o f the American Dental Association
o f Sim on’s passes th rou g h the denture. It
also shows the inconstancy o f the m olars.
The orbital p lane passes through the
prosthion, just distal o f the centrals in this
m odel, and in this one on the righ t it passes
d ow n just m esial to the m olars. T hese
m olars are the distance o f tw o and o n e -h a lf
teeth to o f a r fo r w a r d , and in the other
m odel they are tw o teeth to o fa r distal.
F igu re 22 shows h o w a ll these points can
be measured and record ed. F igu re 23 shows
the photostatic picture and w here the orbital
plane passes. F o r years, w e a ll have heard
argum ents that sounded wise, at least, they
were positive and sure, about teeth bein g too
fa r fo r w a r d , to o fa r back, to o fa r d ow n and
too fa r up, w hether a g o th ic arch was
low e re d o r n ot a fte r expansion o f the arches;
but they w ere never settled. D r. Sim on, as
the result o f eight o r ten years o f scientific
research, presents to the orth o d o n tic p ro fe s­
sion a sim ple m ethod fo u n d e d on anthro­
p o lo g y and an th rop om etry b y w hich a ll these
measurements can be easily and qu ick ly made
in ou r every-da y practice, and record ed in
an o rd e rly and systematic m anner. I venture
to say that no orth od on tist w h o has once
m ade a diagnosis w ith the aid o f gnathostatic
m odels and photostatic pictures w ill ever again
be satisfied w ith the ord in ary m odels. A ft e r
using this m ethod f o r tw o years, I desire to
thank D r . Sim on f o r the great piece o f re­
search that he has carried on, resulting in the
greatest contribution to scientific diagnosis
that has ever been made.
C. A . H a w le y , W a sh in g ton , D . C .: D r.
Sim on was so kind as to send m e a set o f his
instruments im m ediately a fte r his return to
G erm any in 1924, and I have also been
k in d ly fa v o r e d by D r . Lischer w ith the ad­
vance typew ritten pages o f his translation o f
Sim on’ s b o o k , so that I have had the
op portu n ity o f using this m ethod f o r nearly
tw o years. F o r o v er a year it has been a
routine procedure in m y office. A l l m y im ­
pressions are taken gnath ostatically and all
m y p h otograp h s are photostatic photographs.
T h e extra time required f o r im pressions is
not o v er tw o minutes. M y m odel m aker in
the lab ora tory n o w p refers to m ake gnath o­
static m odels. T h e photostatic photograph s
take no lo n g e r than any other p h otograp h .
I have alw ays taken m y o w n photograp h s,
and I spend no m ore time than w ith m y old
m ethods. F ive minutes is sufficient to make
the exposures. T h e instruments and camera
w ith its attachments are m ade w ith accuracy
o f detail and are com plete. So I m ay say
that this m ethod is w ell adapted to the routine
o f a busy practice. T h e m ak in g o f the
graphs o r draw ings o f the curves take m ore
tim e, a h a lf hou r, perhaps, but it can easily
be done b y an assistant, and even i f I had
to do it m y self, it w o u ld be time w ell spent
and an econ om y o f time in the end. The
m ethod requires care and accuracy, o f course.
I m ade m any mistakes at first, but n o w I
think m y w o rk is accurate and u n iform .
O ne o f the first questions that arises in the
m ind when this m ethod is considered is “ Is
the la w o f the cuspids tru e?” I believe it is.
One o f the first questions raised when D r.
Sim on read his paper at Kansas C ity was
that, w h ile it m igh t be true in the German
p eop le on w h om these investigations were
first m ade, w o u ld it be true f o r the A m erican
p eop le, a m ixed race, o r the F rench, o r any
other race? I cannot see the fo r c e o f this
o b je ctio n . W e have, in a ll civ ilized races,
three types o f faces, the straight, the con v ex
and the concave. In the straight type, the
most adm ired type here in A m erica, I have
fo u n d , in variab ly, that the orbital line passes
th rou g h o r v ery near the p oin t o f the cuspid.
In the con v ex type o f fa ce , it is lik ely to
pass a little back o f the p oin t o f the cusp
o r between the cuspid and first bicuspid. I
have o n ly had a fe w cases o f the concave type,
not enou gh really to fo r m an op in ion , but I
think that, in this type, the orbital line may
be m esial to the cusp. I am speaking o f
cases in w h ich the teeth are in g o o d occlusion.
W e have in this a fundam ental and most
valuable m ethod f o r the study o f types o f
fa ces, a fa scin atin g diversion. T h e adoption
o f this m ethod has throw n so m uch lig h t on
the vexed p roblem s o f diagnosis that it has
been an elix ir that has renew ed m y p ro fe s ­
sional youth and brou g h t fresh interest and
enthusiasm in m y w ork . T h e days are not
lo n g enou gh and the years rem aining are too
fe w in w hich to pursue this fa scin atin g study.