CNO Foundations

What is TMJ, TMD, and Occlusion?

*Included with $695 CNO annual membership*

Course Author

Length: Approx. 3 hours of self study
Credit Hours: 3 hours

Certification Overview

Professionals who have demonstrated an understanding of how neurologic, orthopedic, and timing issues within the human bite can profoundly influence a TMD patients condition. These individuals will be better armed to help diagnose occlusal (bite) and TMD related conditions such as headaches, nonspecific orofacial pains, and TMD-related neck and shoulder pains in ways that are not taught in any other mainstream curriculum in existence. CNO Foundations (CNO-F) is highly recommended for all health care professionals, including any dentist, physician, naturopath, dental laboratory technician, chiropractor, or dental student who wishes to learn more about DTR therapy and 3D imaging, and how this knowledge base in particular pertains to occlusal and TMD pathology.

ANNUAL MEMBERSHIP FEE OF $695 GRANTS ACCESS TO CNO FOUNDATIONS STUDY MATERIALS, AN ATTORNEY REVIEWED DTR CONSENT FORM, THE ADVANCED PLACEMENT OF THE C-D LINE TO INTERPRET DTR THERAPY, AND A DTR POST-OPERATIVE CARE FORM. All of the study material needed to complete the optional CNO-F exam is provided within the slideshow (be sure to also study the online video references included in CNO-F slideshow). Optional C.E. credits and database listing as a CNO Foundational provider will be granted once the practitioner pays for and passes the optional CNO Foundations exam. The member must maintain their annual membership dues to remain listed within the CNO database.

Level Requirements
  • 100 multiple choice questions/$200 for CNO Foundations exam (optional)/80% required to pass

  • Completion of the optional CNO Foundations examination is only necessary if you wish to be listed in the CNO database as a Foundation-level practitioner, (F).

What You Will Learn:
  • Answers: What is TMJ, TMD, & Occlusion?
  • How the TIMING of the human bite can readily correlate with headaches, clenching, grinding, hypersensitive teeth, sore neck and shoulder muscles, and more.
  • How hyperactive muscles of chewing/mastication due to a misaligned bite can cause chronic pain problems such as temporal headaches and much more.
  • How force, timing and resultant muscular activity are interrelated, and how these parameters can all be objectively measured.
  • How dental work can actually cause TMD issues, and how to identify if this is the case.
  • How and why muscular TMD issues are the cause of most common TMD pains.
  • How and why muscular TMD issues are epidemic and underdiagnosed throughout the world.
  • How hyperfunctioning muscles of mastication/chewing can cause pain primarily due to muscular ischemia.
  • Why typical dental procedures may actually cause or exacerbate muscular TMD issues.

Level 1

Understanding A Timed Anterior Guidance & DTR Therapy


Course Author

Length: Approx. 2 days on Avg.
Credit Hours: 16 hours

Certification Overview

Understanding how an objectively and digitally Measured Anterior Guidance (MAG) relates to occlusion and Temporomandibular Dysfunction, including Disclusion Time Reduction (DTR) theory and practice; a didactic curriculum. An introduction to how the joints relate to the occlusion, and how objective metrics can be used to study and potentially improve the occlusion.  Includes advanced instruction on usage of the T-Scan®, BioEMG®, and JVA, and a basic introduction to MRI and CBCT imaging technologies.

Annual membership fee of $695 allows for Level 1 Certification listing once the practitioner passes the level 1 exam.

Level Requirements
  • Required reading: Handbook, CNO Foundations slideshow series (included with CNO membership), & various papers (see “Download Curriculum Packet” button on level 1 section directly below for required paper reading/bibliography as well as the textbook and link to IGI Global publishers located on the side of this page)
  • 200 question multiple choice written exam/$400 exam fee/80% to pass
  • Examination covers concepts presented via live lecture and the required reading lists. Additionally, studying CNO Foundations material (included with CNO membership), helps one better prepare for both the level 1 lecture and the level 1 examination.
  • The Rogers CNO Level 1 curriculum spends a great deal of time discussing the orthopedic TMJ’s role re directly altering the occlusion, and introduces the attendee to objective 3D MRI and CBCT imaging of the TMJ’s.
  • Doctors who have passed Level 1 and are current with CNO membership will be listed in the CNO database for patients to find them
  • Listing within the CNO database requires that the doctor or dental laboratory technician be current with CNO annual membership
What You Will Learn:
  • Use and interpretation of the T-Scan and Bio-EMG objective measurement tools.
  • Use and interpretation of the Tscan/EMG technologies slaved together in 3/1000 second increments.
  • An introduction to Joint Vibration Analysis TMJ cartilagenous screening of the TMJ's.
  • Efficacy of Disclusion Time Reduction occlusal therapy and the Immediate Complete Anterior Guidance Development protocols.
  • An introduction to Frictional Dental Hypersensitivity (FDH) theory and it’s relationship to muscular TMD.
  • Why a MEASURED, TIMED, and IMMEDIATE anterior guidance development is essential for physiologically efficient muscular activity of the muscles of mastication.
  • The vast importance of midcourse corrections upon the muscles of mastication.
  • An introduction as to how TMJ anatomy and pathology relates to changes in the occlusion.
  • What dental occlusion really is, and how to measure and control treatment outcomes.
  • The distinction between TMJ and TMD defined.
  • How the static bite is less important than the dynamic bite in regards to a Measured Anterior Guidance Development.
  • The importance of stable and adapted TMJ’s for DTR therapy.
  • The pitfalls of traditional occlusal indicators such as bite/articulating ribbon, shimstock and waxes, straight from the scientific literature.
  • Sample video re CNO Level 1: https://youtu.be/JaJ47xwWNts
Certification Overview

A practical clinical performance examination leading to DTR certification for dental practitioners who wish to demonstrate clinical proficiency to the CNO regarding DTR therapy on appropriate patients. DTR therapy has been shown repeatedly in the scientific literature to help TMD patients with stable and adapted joints most every time, and is typically a wonderful way to set up an occlusion relative to orthodontic and restorative dentistry treatment. Patients should aspire to find a CNO level 2 trained and certified dentist before undergoing DTR therapy, since these individuals have been calibrated by the very doctors who brought DTR therapy to the forefront of dental medicine.

Annual membership fee of $695 allows for Level 2 Certification listing once the practitioner passes both the level 1 didactic exam (through the CNO) and the level 2 clinical proficiency practical exam conducted by Dr. Robert Kerstein or Dr. Scott Green (or another certified level 2+ CNO doctor who is an active member of the CNO Board of Advisors).

Testimonials for level 2 training:


To schedule a CNO2 training session, contact info@cnotmj.com.

Level Requirements
  • 1 on 1 Practical Exam
  • A CNO instructor travels to the dental practitioners office and watches the practitioner perform proper DTR therapy on at least 3 appropriate TMD patients.

The dental practitioner must have direct access and be fully adept in the usage of the following three pieces of equipment and associated softwares:

  • T-Scan (Tekscan Inc., Boston, MA, USA)
  • BioEMG III (Bioresearch Associates, Deer Borne, WI, USA)
  • Joint Vibration Analysis/JVA (Bioresearch Associates, Deer Borne, WI, USA)

Listing within the CNO database requires that the doctor be current with CNO annual membership.

What You Will Learn:
  • Proper selection of the TMD patient by the practitioner is part of the clinical testing process.
  • Proper operation of the biometric tools and softwares used to accomplish DTR therapy as demonstrated to the CNO instructor (T-Scan, EMG, JVA).
  • Proficiency and FCNO Level II certification is presented to the clinician who satisfactorily performs the ICAGD/Measured Anterior Guidance occlusal adjustment protocols to accomplish DTR therapy on 3+ appropriate patients in front of the CNO instructor (after having passed the CNO1 didactic exam).
Certification Overview

Dentists who aspire to integrate 3D imaging including CT and MRI scans into their occlusal and/or TMD diagnostic and treatment protocols. The highest and most challenging level of the CNO organization, patients are encouraged to find a CNO level 3 doctor whenever possible since difficult orthopedic, inflammatory, and growth and development problems within the TMJ’s themselves are best identified with this sort of imaging. These otherwise unknown variables not only potentially relate to changes in the bite/occlusion, but can add numerous other layers to a TMD patients’ problems. After completing this level, the practitioner is practicing at the highest diagnostic and treatment level within the CNO, and is thereafter granted Mastership in the CNO (MCNO), and will rightfully enjoy top placement for searching patients in the CNO database. Level 3 doctors must first pass both level 1 and level 2.

A current annual membership fee of $695 allows for Level 3 Certification listing once the practitioner passes the level 3 written and oral examinations.

Level Requirements
  • Completion of Levels 1 and 2 are prerequisites.
  • 2-3 days of lecture, observation, and participation in Rogers, AR at CNO headquarters.
  • A serious introduction into reading TMJ CBCT and MRI scans, and how they relate to TMD treatment.
  • 200 question written multiple choice online examination/$400 exam fee/80% to pass/must be taken within 12 months of CNO level 3 attendance.
  • 2 hour oral examination regarding 3D imaging and its relevance to TMD diagnosis and therapy by CNO instructors at CNO headquarters in Rogers, Arkansas. This oral examination must be taken within 12 months of CNO level 3 attendance. Topics covered will be similar to those studied in the bibliography disseminated for the level 3 examination/oral exam cost is $800/pass-fail
  • Verified attendance at the Piper Education and Research Centers coursework entitled “Utilizing Imaging Skills in Foundational Occlusion” with Dr. Mark Piper in St. Petersburg, Florida. See the following for information regarding the imaging course: http://www.pipererc.com/courses-facility.asp
  • Level 3/MCNO listing within the CNO database requires that the doctor be current with CNO annual membership
What You Will Learn:
  • How to determine CNO patient Type A, B, or C.
  • Deciding if a patient possesses “stable and adapted” joints based upon objective metrics.
  • How the TMJ’s affect the bite, and vice versa.
  • The basics of how to order, read, and interpret CBCT and MRI scans of the TMJ’s.
  • What to do with the knowledge that the 3D imaging provides.
  • How to combine 3D imaging data with occlusal treatment decisions in a reproducible and objective manner.
  • How 3D imaging of the TMJ’s relates to the occlusion.
  • When occlusal adjustment corrections are not indicated based upon 3D scans.
  • When TMJ surgery is likely the best option for the patient.
  • How to decide if MIP is a good restorative treatment position or not, based upon 3D scans.
  • How to decide if downwards and forwards may be a good restorative treatment position or not, based upon 3D scans.
  • Understanding the relevance of lateral and medial pole cartilagenous tears.
  • Basics behind TMJ surgery.
  • An introduction to cervical sympathetic inputs for a TMD patient with intractable pain.
  • Understanding TMJ anatomy and dynamic function.
  • How to “read a bite” to elucidate when TMJ foundational joint issues are present and require 3D imaging for diagnosis.
  • When occlusal splints or orthotics are biomechanically indicated, and why they are not much of the time.
  • How to objectively and reliably ascertain if a patient possesses stable and adapted TMJ’s based upon clinical exam and 3D imaging.
  • How to use Anomalous Medical software to create a virtual representation of your patients condition.
  • An introduction to Dr. Mark Pipers foundational occlusion concepts.
  • How to objectively decide when NOT to perform DTR occlusal adjustment therapy on a patient based upon not only the occlusal measurement tools, but on 3D scans of the “backside” TMJ’s as well.
  • The efficacy of using in office CADCAM digital imaging to perpetuate the exact shape of restorative additive alterations the same day, to help ensure proper perpetuation of additive occlusal changes.

Continuing Education Partners

Big Sky Seminars is an ADA CERP Recognized Provider. These continuing education activities have been planned and implemented in accordance with the standards of the ADA CERP through joint sponsorship between Big Sky Seminars and The Center for Neural Occlusion. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by Boards of Dentistry.


Required Reading Level 1

Required Equipment

Required Equipment

The CNO Recommends