Tmj (nx power lite) /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in

continuing dental education , training dentists

in all aspects of dentistry and offering a wide

range of dental certified courses in different

formats.

Indian dental academy provides dental crown &

Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit

www.indiandentalacademy.com ,or call
0091-9248678078

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Tmj (nx power lite) /certified fixed orthodontic courses by Indian dental academy

  1. 1. TEMPEROMANDIBULAR JOINT DISORDERS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com dr.godhi TMJ
  2. 2. CLASSIFICATION OF JOINTS CLASS -1 Synartrosis Synostosis Gomphosis Syndesmosis Symphysis Synchondrosis CLASS -2 Amphyartrosis CLASS -3 Diartrosis www.indiandentalacademy.com dr.godhi TMJ
  3. 3. CLASSIFICATION OF TMJ DISORDERS MUSCULAR DISODERS Myositis MPDS DISC-CONDYLE INCOORDINATION Internal derangement Subluxation Dislocation STRUCTURAL Capsulitis FRACTURE OF TMJ NEOPLASIA ARTHRITIS OF TMJ Non inflammatory Inflammatory Rheumatoid Infectious Metabolic-gout DOVELOPMENTAL Condylar hyperplasia Condylar hypoplasia Condylar aplasia ANKYLOSIS OF TMJ Fibrous Bony www.indiandentalacademy.com dr.godhi TMJ
  4. 4. SUBLUXATION It is a triad of Ligamentous & capsular laxity Eminential erosion & flattening Trauma. MANAGEMENT •IMF With elastics •Sclerosing agents Sodium psylliate Sodium morrhuate Sodium tetradecyl sulfate www.indiandentalacademy.com •Capsulorrhapy dr.godhi TMJ
  5. 5. DISLOCATION OF TM JOINT ACUTE, CHRONIC RECURRENT, LONG STANDING--Uni/Bi Dislocation is a displacement of the condylar head completely out of glenoid fossa, which usually can not be reduced by the patient. Subluxation is a displacement of condylar head, which patient can reduce himself CAUSES: Extrinsic forces Trauma GA Extraction Intrinsic forces Excessive yawning, Vomiting, Blowing, Hysterical fits www.indiandentalacademy.com dr.godhi TMJ
  6. 6. UNILATERAL DISLOCATION: •Difficulty in mastication , swallowing & speaking •Deviation of chin to opposite side •Cross bite & open bite on opposite side •Depression in pre auricular area BILATERAL DISLOCATION: •Pain & inability to close the mouth •Excessive salivation •Protrusion of chin •Gagging of molar teeth with anterior open bite •“Halllowness” in preauricular area www.indiandentalacademy.com dr.godhi TMJ
  7. 7. MANAGEMENT •Reassuring patient •Tranquilizers/sedatives •Pressure &massage to the area •Manipulation -Manual reduction -Indirect reduction •Direct reduction - Condylotomy,condylectomy - Eminectomy - Augmentation of eminence - Dautery’s procedure - Osteotomy - Chemical capsulorrhaphy www.indiandentalacademy.com dr.godhi TMJ
  8. 8. LIMITED MANDIBULAR MOBILITY: •TRISMUS •MECHANICAL INTERFERENCE •EXTRA CAPSULAR CAUSE •ANKYLOSIS www.indiandentalacademy.com dr.godhi TMJ
  9. 9. TRISMUS: •Odontogenic --- MPDS, Malocclusion •Infective •Traumatic •Neoplastic •Pharmacological --- Phenothiazene •Neurotoxic --- Tetanus •Neurological --- Central & peripheral lesion •Psychological --- Historical trismus www.indiandentalacademy.com dr.godhi TMJ
  10. 10. Significance ? • Still common in Asia • Disabling condition • Affects growth www.indiandentalacademy.com dr.godhi TMJ
  11. 11. Union between the two articulating surfaces of the joint www.indiandentalacademy.com dr.godhi TMJ
  12. 12. ANKYLOSIS OF TMJ VICTIM INTERFERENCE WITH MASTICATION & DIGESTn OF FOOD DECREASED BALANCE DIET--MALNUTRITION UNABLE TO PARTICIPATE IN PUBLIC FUNCTION CHILDHOOD > FACIAL DEFORMITY PSYCHOLOGICAL STRESS PHYSICAL HANDICAP EMOTIONAL DISTARBANCES www.indiandentalacademy.com dr.godhi TMJ
  13. 13. CHILD CONDYLAR NECK IS BROAD SUBARTICULAR LAYER INTERCONNECTING PLEXES OF BLOOD VS PENETRATE BONE & EXTENDS TO CAPSULE INJURY TO TMJ HAEMARTHROSIS HIGH OSTEOGENIC PARTICLES FIBRO-OSSEOUS MASS ANKYLOSIS www.indiandentalacademy.com dr.godhi TMJ
  14. 14. CAPSULE ADULT EXTRA CAPSULAR # CHILD Thin cortex periosteum in Active Osteogenic www.indiandentalacademy.com Phase Intra capsular # Vascular Bone Haemathrosis dr.godhi TMJ
  15. 15. Types ? Fibrous / Unilateral / Bony Bilateral www.indiandentalacademy.com dr.godhi TMJ
  16. 16. ETIOLOGY OF ANKYLOSIS TRAUMA Intra capsular # Penetrating wounds Forceps delivery INFECTION Otitis media Osteomyelitis of the jaw Haematogenous SYSTEMIC ARTHROPATHY Still’s disease Osteo arthritis Rheumatoid arthritis NEOPLASIA Chondroma/Osteo chondroma Sarcoma/ Fibro sarcoma Metastasis to condyle www.indiandentalacademy.com dr.godhi TMJ
  17. 17. • Birth trauma • Forceps delivery • Condylar fractures www.indiandentalacademy.com dr.godhi TMJ
  18. 18. Sequelae ? Direct Unable to open the mouth Indirect Poor oral hygiene Abnormal feeding habits Prone for snoring Effect on growth www.indiandentalacademy.com dr.godhi TMJ
  19. 19. CLINICAL FEATURES: UNILATERAL ANKYLOSIS •Chin deviated towards affected side •Affected side being foreshortened •Lack of contour on unaffected side •Ramus & body on ankylosed side are underdeveloped •Presence of ANTIGONIAL NOTCH •Malocclusion & tilting of lower incisors & posterior crossbite www.indiandentalacademy.com dr.godhi TMJ
  20. 20. Unilateral Ankylosis Effects on Growth • Fullness of affected side • Flat normal side • Deviation of mandible to affected side www.indiandentalacademy.com dr.godhi TMJ
  21. 21. CLINICAL FEATURES BILATERAL ANKYLOSIS •Age at the time of injury •Degree of unilateral/bilateral involvement •Failure of development of lower jaw •Deficiency of ramus height •Downward inclination of mandible •Double chin effect “Bird face” deformity •“Ande-gump” profile •Effect upon growth & development www.indiandentalacademy.com dr.godhi TMJ
  22. 22. Bird face deformity Retruded chin &double chin effect www.indiandentalacademy.com dr.godhi TMJ
  23. 23. • Retruded chin • Bird face appearance www.indiandentalacademy.com dr.godhi TMJ
  24. 24. Diagnosis - Clinical www.indiandentalacademy.com dr.godhi TMJ
  25. 25. Diagnosis - Imaging www.indiandentalacademy.com dr.godhi TMJ
  26. 26. Diagnosis - Imaging www.indiandentalacademy.com dr.godhi TMJ
  27. 27. SURGICAL MANAGEMENT Objectives: to 1. Establish joint movt & jaw function 2. Prevent relapse 3. Restore appearance & occlusion 4. Achieve normal growth & occlusion in child by interceptive surgery & orthodontics APPROACHES TO TMJ 1. Pre auricular 2. Pre auricular with temporal extension 3. Endaural 4. Sub mandibular 5. Al-kayat bramley 6. Hemicoronal 7. Bi coronal www.indiandentalacademy.com dr.godhi TMJ
  28. 28. Surgical Approaches End-aural Al-Kayat Bramley www.indiandentalacademy.com dr.godhi TMJ
  29. 29. OPERATIVE TECHNIQUE OSTEO ARTHROTOMY OSTEO ARTHRECTOMY •Condylectomy •Gap arthroplasty •Inter-positional arthroplasty www.indiandentalacademy.com dr.godhi TMJ
  30. 30. Condylectomy Condyle is removed by sectioning at the neck • Fibrous ankylosis • Bony ankylosis where configuration of condyle is seen www.indiandentalacademy.com dr.godhi TMJ
  31. 31. Gap Arthroplasty Bony Ankylosis A piece of bone from the ankylosed mass is removed to create the gap www.indiandentalacademy.com dr.godhi TMJ
  32. 32. Gap Arthroplasty www.indiandentalacademy.com dr.godhi TMJ
  33. 33. Inter Positional Arthroplasty Materials interposed to prevent bony contact • Temporal fascia • Temporalis muscle • Costochondral grafts www.indiandentalacademy.com dr.godhi TMJ
  34. 34. Inter Positional Arthroplasty Temporalis muscle & fascia www.indiandentalacademy.com dr.godhi TMJ
  35. 35. Costochondral Grafts Indicated In Children • Maintains height of ramus • Further growth of condyle? www.indiandentalacademy.com dr.godhi TMJ
  36. 36. Surgeons Perspective Total Rehabilitation • Release • Reconstruction www.indiandentalacademy.com dr.godhi TMJ
  37. 37. www.indiandentalacademy.com dr.godhi TMJ
  38. 38. www.indiandentalacademy.com dr.godhi TMJ
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  45. 45. www.indiandentalacademy.com dr.godhi TMJ
  46. 46. www.indiandentalacademy.com dr.godhi TMJ
  47. 47. Thank You www.indiandentalacademy.com dr.godhi TMJ

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