TMJ /certified fixed orthodontic courses by Indian dental academy

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TMJ /certified fixed orthodontic courses by Indian dental academy

  1. 1. TEMPOROMANDIBULAR JOINT www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS EVOLUTION DEVELOPMENT ANATOMY PHYSIOLOGY BIOMECHANICS www.indiandentalacademy.com
  4. 4. BICONDYLAR GINGLIMOARTHROIDAL COMPOUND JOINT www.indiandentalacademy.com
  5. 5. EVOLUTION OF TMJ www.indiandentalacademy.com
  6. 6. THE LIVING VERTEBRATES CLASS EXAMPLE Agnatha Lampreys Condrichthyes Sharks Osteichthyes Bony fishes Amphibia Frogs, toads Reptilia Snakes, turtles, lizards Aves Birds www.indiandentalacademy.com
  7. 7. MAMMALIA Protheria Platypus Metatheria Marsupials Eutheria Placental mammals www.indiandentalacademy.com
  8. 8. SCHOOLS OF THOUGHT Morphological concept Suspension and suction Support for ventilation Genetics www.indiandentalacademy.com
  9. 9. AGNATHA Vertebrates without jaws Gill slits- Filtering and feeding Epiceratobranchial joint in mordern sharks Oral opening www.indiandentalacademy.com filtering
  10. 10. GNATHOSOMES Ist & IInd gilled arches- Brain IIIrd & IVth gilled arches- Prehension CEPHALIZATION Skin over the edges- Teeth Simple hinge joint- Quadrate-Articular Eudiarthroidial joint- True bony fishes www.indiandentalacademy.com
  11. 11. JAW AND THE CRANIUM A. Gill Slits B. Autostyly D. Modified autostyly C. Amphistyly E & F. Hyostyly G. www.indiandentalacademy.com Holostyly
  12. 12. AMPHIBIA Jaws – cartilagenous core with blanket of dermal bones Joints- Quadrate-Articular eudiarthroidial www.indiandentalacademy.com
  13. 13. REPTILIA Increase in the dentary bone in backward direction Increase in muscle size and their mechanical advantage Dentary-Squamosal joint replaces Quadrate-Articular joint Temporalis- orgin & insertion Streptostylic suspension www.indiandentalacademy.com
  14. 14. www.indiandentalacademy.com
  15. 15. SEQUENCE OF CHANGES Availability of particular diet Variations in tooth form Replacement of the old joint Adaptation of the musculature Response of the bone Coordination activity of the joints www.indiandentalacademy.com
  16. 16. Why there was a need of formation of new joint Prey size Muscle force , mass and direction of muscle pull Complex pattern of muscle activity Rigid lower jaw Greater range of movements www.indiandentalacademy.com
  17. 17. MAMMALIA EUTHERIA CARNIVORE HERBIVORE RODENT www.indiandentalacademy.com HUMANS
  18. 18. FUNCTIONAL POWER STROKES PREHENSION COMMUNITION CRUSHING TEARING CARNIVORE HERBIVORE CUTTING GNAWING GRINDING SLICING www.indiandentalacademy.com
  19. 19. CARNIVORES Projecting jaws used for grabbing prey Long lower jaws with no ramus Large coronoid process and large temporalis Horizontally expanded temporal fossa Short zygomatic area www.indiandentalacademy.com
  20. 20. CONDYLE Firmly fitted joint www.indiandentalacademy.com
  21. 21. HERBIVORES Long jaws with long cheek teeth and no canines Cheek teeth are set well posterior Jaw joint is fitted for wide, gliding and horizontal movements Small coronoid process decreased temporal fossa Enormously lengthened masseter www.indiandentalacademy.com orgin
  22. 22. Lateral movements of the joint www.indiandentalacademy.com
  23. 23. RODENTS Large sharp edged chisel shaped incisor teeth Long gap between incisors and cheek teeth Antero-posteriorly directed glenoid groove Less lateral movements of joint www.indiandentalacademy.com
  24. 24. www.indiandentalacademy.com
  25. 25. HOMINIDS Upright posture Bipedal locomotion-Increased manual dexterity Shrinkage and retraction of jaws Change of diet- Omnivores Increase in brain size www.indiandentalacademy.com
  26. 26. TMJ IN PRIMATES Unspecialized Specialized Universal www.indiandentalacademy.com
  27. 27. D THE MUSCLES L M inspiratoy gills V expiratoy www.indiandentalacademy.com
  28. 28. III ORDER LEVER R F E www.indiandentalacademy.com
  29. 29. Reptile Early mammal Mammal www.indiandentalacademy.com
  30. 30. Shark Lobe finned fish Primitive amphibian www.indiandentalacademy.com
  31. 31. Primitive reptile Primitive marsupial www.indiandentalacademy.com
  32. 32. Primitive primate Man Chimpanzee www.indiandentalacademy.com
  33. 33. CONDYLAR CARTILAGE Membranous bone with periosteum Pressure on the condyle Localized ischemic changes Undifferentiated mesenchymal cells Chondroblasts proliferation Cartilage formation www.indiandentalacademy.com
  34. 34. INTERARTICULAR DISK No separate cartilage Enlargement of the dentary Muscle from the pterygoid region Attachment to the new joint www.indiandentalacademy.com
  35. 35. EVOLUTION & MOLECULAR BIOLOGY Homeobox genes (HOX) Neural crest cells – mid brain Hox-free default in mandibular arch Myosin heavy chain (MYH) www.indiandentalacademy.com Neural crest cells
  36. 36. DEVELOPMENT OF TMJ www.indiandentalacademy.com
  37. 37. MECKELS CARTILAGE Cartilage of the first arch Extent of the cartilage www.indiandentalacademy.com
  38. 38. www.indiandentalacademy.com
  39. 39. PRIMARY JOINT 6th week- formation 8th week- supports the mandible Dorsal end is continuous with the developing ear ossicles 16th week- Ossicles undergo endochondral ossification 10 WEEKS www.indiandentalacademy.com
  40. 40. CONDYLE 9th week- start 10-11 weeks- chondrifies 12th week- fuses with ramus 20 weeks- completion www.indiandentalacademy.com 9-10 WEEKS
  41. 41. 12 WEEKS ONWARDS 14 weeks 11 WEEKS 12 WEEKS www.indiandentalacademy.com
  42. 42. 22 WEEKS 16 WEEKS AT BIRTH www.indiandentalacademy.com
  43. 43. CARTILAGES PRIMARY SECONDARY www.indiandentalacademy.com
  44. 44. Differences ….koski et al 1968 CHARACTER CONDYLAR CARTILAGE EPIPHYSEAL CARTILAGE GROWTH APPOSITIONAL INTERSTITIAL INTERMIDIATE LAYER UNDIFFRENTIATED CARTILAGE CELLS ORGANIZATION OF CELLS RANDOM LINEAR MINERALIZATION HYPERTROPHIC ZONE DEGENERATIVE ZONE INTRINSIC GROWTH POTENTIAL ABSENT PRESENT RESPONSE TO MECH. MORE STIMULATION LESS SPONGIOSA PRESENT ABSENT www.indiandentalacademy.com
  45. 45. According to BAUME: Growth Center: Is a site of endochondral ossification with tissue separating force,contributing to the increase of skeletal mass. Growth Site: Regions of Periosteal or suture bone formation and modeling resorption adaptive to environmental influences. www.indiandentalacademy.com
  46. 46. GROWTH OF THE CONDYLE Articular surface Proliferative zone Cartilage Subchondral bone www.indiandentalacademy.com
  47. 47. ENDOCHONDRAL GROWTH OF CONDYLE Forces are compressive in nature Direction of growth Periosteum adapts itself mainly to tensile forces Cartilage Endochondral bone tissue cortices www.indiandentalacademy.com
  48. 48. CLINICAL CONSIDERATIONS 7-11 weeks morphogenesis- teratogens Regional adaptive growth Arrangement of the prechondroblast cells www.indiandentalacademy.com
  49. 49. HENCE Condylar cartilage is – SECONDARY IN EVOLUTION SECONDARY IN DEVELOPMENT SECONDARY IN GROWTH www.indiandentalacademy.com
  50. 50. GLENOID FOSSA 7-8 weeks - Develops earlier than the condyle 10th week- ossification 22 weeks- medial and lateral walls Shape of the fossa www.indiandentalacademy.com
  51. 51. ARTICULAR CAPSULE 9-11 Weeks- first appearance 17th Week- differentiation 26th Week- completion www.indiandentalacademy.com
  52. 52. ARTICULAR EMINENCE 7TH month- Formation of the trabeculae 8-9 months- Completion www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
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  55. 55. SUMMARY TMJ is one of the last synovial joints to develop Develops from two blastema It has an fibro cartilage covering Condyle is a primarily a growth site www.indiandentalacademy.com
  56. 56. TEMPOROMANDIBULAR JOINT www.indiandentalacademy.com
  57. 57. ANATOMY OF THE TMJ www.indiandentalacademy.com
  58. 58. JOINTS FIBROUS CARTILAGENOUS SYNOVIAL SYNARTHROSES SYMPHYSES SYNDESMOSES SYNCHONDROSES GOMPHOSES www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com
  60. 60. SYNOVIAL JOINT Gross anatomy Hyaline cartilage Low friction Weeping lubrication www.indiandentalacademy.com
  61. 61. THE CONDYLE Oval shaped structure 15-20 mm M-L & 8-10 mm A-P Poles of the condyle Long axis www.indiandentalacademy.com
  62. 62. www.indiandentalacademy.com
  63. 63. GLENOID FOSSA Squamous portion of the temporal bone 23 mm M-L & 15 mm A-P NOT a stress bearing portion RELATIONS www.indiandentalacademy.com
  64. 64. ARTICULAR EMINENTIA Anatomy Slopes- Anterior & Posterior Functional area www.indiandentalacademy.com
  65. 65. ARTICULAR DISK Zones of the disk Surfaces Relations & attachments Significance of fibro cartilage Functions www.indiandentalacademy.com
  66. 66. www.indiandentalacademy.com
  67. 67. RETRODISCAL TISSUE SUPERIOR INFERIOR www.indiandentalacademy.com
  68. 68. FIBROUS CAPSULE Attachments Layers of the capsule Functions capsule www.indiandentalacademy.com
  69. 69. CAPSULE fossa capsule condyle www.indiandentalacademy.com
  70. 70. LIGAMENTS EXTRINSIC INTRINSIC Temporomandibular lig Sphenomandibular lig Collateral lig Stylomandibular lig Pterygomandibular raphe www.indiandentalacademy.com Contra lateral TM lig
  71. 71. TEMPOROMANDIBULAR LIGAMENT Two layers Functions www.indiandentalacademy.com
  72. 72. FUNCTION OF TM LIGAMENT www.indiandentalacademy.com
  73. 73. COLLATERAL LIGAMENT SPHENOMANDIBULAR LIGAMENT ORGIN INSERTION RELATIONS FUNCTIONS STYLOMANDIBULAR LIGAMENT www.indiandentalacademy.com
  74. 74. BLOOD SUPPLY www.indiandentalacademy.com
  75. 75. NERVE SUPPLY www.indiandentalacademy.com
  76. 76. HISTOLOGY MACROSCOPIC www.indiandentalacademy.com
  77. 77. ARTICULAR EMINENCE GLENOID FOSSA MICROROSOPIC www.indiandentalacademy.com CONDYLE
  78. 78. SYNOVIAL MEMBRANE Vascular connective tissue Retrodiscal tissues Type A cells- macrophages Type-B cells- synovial fluid (80%) LUBRICATION NUTRITION www.indiandentalacademy.com
  79. 79. RADIOGRAPHIC ANATOMY TRANSCRANIAL PANORAMIC www.indiandentalacademy.com
  80. 80. ARTHROGRAPHY www.indiandentalacademy.com
  81. 81. CT IMAGING www.indiandentalacademy.com
  82. 82. MRI IMAGING www.indiandentalacademy.com
  83. 83. www.indiandentalacademy.com
  84. 84. PHYSIOLOGY OF TMJ www.indiandentalacademy.com
  85. 85. NEUROANATOMY REFLEXES OF THE JOINT PSYCHOLOGICAL ASPECTS www.indiandentalacademy.com
  86. 86. NEUROANATOMY SENSORY INERVATION Main nerve supply- Auriculotemporal nerve- Posterior & lateral parts of the capsule It has the richest innervations Massetric & Deep temporal – medial parts of the capsule Center of the disk and the articulating surfaces are not innervated www.indiandentalacademy.com
  87. 87. RECEPTOR INNERVATION OF TMJ FOUR TYPES RUFFINI GOLGI-TENDON VATER PACINI CORPUSCLES FREE NERVE ENDINGS www.indiandentalacademy.com
  88. 88. ANATOMICAL DESIGNATION FUNCTIONAL DESIGNATION REFLEX ROLE LOCATION RUFFINI ENDING Static mechanoreceptor Posture Post & posterioro -lateral aspects of capsule VATER-PACINI CORPUSCLE Dynamic mechanoreceptor Movement accelerator TM ligament GOLGI TENDON Static mechanoreceptor Protection of the ligament TM ligament FREE NERVE ENDING Pain receptor Protection of the joint Distributed throughout the capsule www.indiandentalacademy.com
  89. 89. www.indiandentalacademy.com
  90. 90. CENTRAL PROJECTION www.indiandentalacademy.com
  91. 91. MOTOR INNERVATION REFLEXES OF TMJ ORGIN Mandibular Inhibition in masserteric closing discharge TONUS facilitation Opening of mandible www.indiandentalacademy.com
  92. 92. JAW CLOSING REFLEX The stretch reflex of jaw closers When the jaw is tapped muscle spindles of elevators are excited The A.P generated travel to the mesencephalic nucleus Travels to motor nucleus Extra fusal fibers of the elevator muscle www.indiandentalacademy.com
  93. 93.  FUNCTION- Maintenance of the jaw against gravity and the inertial loading  MONOSYNAPTIC www.indiandentalacademy.com
  94. 94. JAW OPENING REFLEX The flexor reflex of the jaw closers Reflex is activated biting into hard objects A.P is carried to the spinal nucleus Interneurons synapse with motor nucleus Excitation of the depressors www.indiandentalacademy.com
  95. 95. FUNCTION- protection of the hard and soft tissues POLYSYNAPTIC www.indiandentalacademy.com
  96. 96. JAW UNLOADING REFLEX Sudden breakage of the food item Sudden closing of the jaw Spindles are unloaded Elevators are inhibited Occlusion is prevented www.indiandentalacademy.com
  97. 97. REFLEXES PROTECTING THE TMJ These reflexes ONLY operate to restrict EXTREME opening movements Maximal opening could be increased with anesthesia Attenuation of discharge on the contralateral muscles TMJ has no receptors that can monitor loading of the joint www.indiandentalacademy.com
  98. 98. REFLEXES PROTECTING THE TEETH Normal postion of the mandible Balancing interference Position of the mandible Position of the mandible Balancing interference Normal closing Mandibular deviation Mandibular deviation Mandibular deviation www.indiandentalacademy.com
  99. 99. TMJ AND THE TONGUE 0 DEG- no change in genioglossus muscle 21 < DEG- increased activity is seen Infiltration of the anesthetic abolished the reflex Associated with the receptors monitoring the adequeacy of the ventilation www.indiandentalacademy.com
  100. 100. PSYCHOLOGICAL ASPECTS OF THE INERVATIONS MANDIBULAR POSITION SENSE Duplication of the mandibular movement SIZE THRESHOLD- .01 MM of objects www.indiandentalacademy.com
  101. 101. SUMMARY Auriculotemporal nerve- lateral & posteriorly Jaw muscle activity probably affects the sensitivity of receptors Its sensitivity is increased by inflammation and elevated pressures Receptors cannot protect against excessive loading Crucial mass is more important than Crucial mix www.indiandentalacademy.com
  102. 102. BIOMECHANICS www.indiandentalacademy.com
  103. 103. MUSCLES Microscopic features Arrangement of the muscle fibers www.indiandentalacademy.com
  104. 104. TYPES OF MUSCLE FIBERS SLOW MUSCLE FIBERS- TYPE I MASSETER & MEDIAL PTERYGOID POST FIBERS OF THE TEMPORALIS LATERAL PTERYGOID FAST MUSCLE FIBERS- TYPE II POST FIBERS OF MASSETER AND MEDIAL PTERYGOID TEMPORALIS SUPERFICIAL 50% MUSCLES OF THE MASTICATION INTERMDIATE FIBERS TYPE II C www.indiandentalacademy.com
  105. 105. MUSCLES OF MASTICATION www.indiandentalacademy.com
  106. 106. MASSETER www.indiandentalacademy.com
  107. 107. FEATURES SUPERFICIAL DEEP ORGIN Zygomatic process Anterior two thirds of zygomatic arch INSERTION Angle and lower portion of mandible Upper portion of the lateral aspect of ramus ORIENTATION Oblique downwards Vertically downwards FUNCTIONS Protruding of mandible Stabilizing condyle against the articular eminence www.indiandentalacademy.com
  108. 108. TEMPORALIS Fan shaped muscle ORIGIN- Temporal fossa & the lateral surface of the skull INSERTION- Forms a tendon inserts into coronoid process and the anterior border of the ramus www.indiandentalacademy.com
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  110. 110. DIVISIONSANTERIOR MIDDLE POSTERIOR - Directed vertically Oblique orientation Horizontally More concerned with moving and stabilizing the mandible www.indiandentalacademy.com
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  113. 113. MEDIAL PTERYGOID ORIGIN- Medial portion of the lateral pterygoid plate - maxillary tuberosity INSERTION- medial portion of the angle of mandible FUNCTIONS- Elevating and protrusion of the mandible -Unilateral contraction mediotrusive movement www.indiandentalacademy.com
  114. 114. www.indiandentalacademy.com
  115. 115. LATERAL PTERYGOID Two divisions- INFERIOR LATERAL PTERYGOID SUPERIOR LATERAL PTERYGOID INFERIOR HEADORIGIN- outer surface of the lateral pterygoid plate INSERTION- neck of the condyle FUNCTIONS- Protrusion when contracts simultaneously - Mediotrusive motion when contracts unilaterally www.indiandentalacademy.com
  116. 116. www.indiandentalacademy.com
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  118. 118. SUPERIOR HEADORIGIN- Infratemporal surface of of the greater wing of the sphenoid INSERTION- FOUR TYPES www.indiandentalacademy.com
  119. 119. I Insertion into the condyle by merging into the central tendon II Insert directly into pterygoid fovea(60 – 70 %) III Blend with the fibers of the capsule IV Insert directly into the medial portion of the disk (30 %) FUNCTIONSActive during the closing especially during the power stroke www.indiandentalacademy.com
  120. 120. www.indiandentalacademy.com
  121. 121. DIGASTRICS POSTERIOR BELLY – Origin- Mastoid notch Fibers- Downwards forwards and inwards Attachment- Hyoid bone ANTERIOR BELLYOrigin- Fossa of the lingual surface of the mandible Fibers- Downward and backward FUNCTION – Depression of the mandible www.indiandentalacademy.com
  122. 122. www.indiandentalacademy.com
  123. 123. TYPES OF MOVEMENT ROTATIONAL MOVEMENT HORIZONTAL AXIS FRONTAL AXIS SAGITTAL AXIS TRANSLATIONAL MOVEMENT SINGLE PLANE BORDER MOVEMENTS www.indiandentalacademy.com
  124. 124. HORIZONTAL AXIS HINGE AXIS www.indiandentalacademy.com
  125. 125. FRONTAL AXIS www.indiandentalacademy.com
  126. 126. SAGITTAL AXIS www.indiandentalacademy.com
  127. 127. TRANSLATION MOVEMENT Definition Occurs in the superior joint cavity Both hinge and the translation occurs simultaneously www.indiandentalacademy.com
  128. 128. SAGITTAL PLANE BORDER MOVEMENTS FOUR COMPONENTS Posterior Anterior Superior Functional www.indiandentalacademy.com
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  132. 132. www.indiandentalacademy.com
  133. 133. HORIZONTAL BORDER MOVEMENTS L R www.indiandentalacademy.com
  134. 134. www.indiandentalacademy.com
  135. 135. FRONTAL BORDER MOVEMENTS www.indiandentalacademy.com
  136. 136. www.indiandentalacademy.com
  137. 137. www.indiandentalacademy.com
  138. 138. ENVELOPE OF MOTION www.indiandentalacademy.com
  139. 139. BENNETT MOVEMENT & ANGLE www.indiandentalacademy.com
  140. 140. ARTICULAR DISK www.indiandentalacademy.com
  141. 141. www.indiandentalacademy.com
  142. 142. ELEVATION SUMMARY TEMPORALIS RETRACTION MASSETER & MEDIAL PTERYGOID PROTRACTION DIAGASTRIC & GENIOHYOID LATERAL PTERYGOID DEPRESSION www.indiandentalacademy.com
  143. 143. ARTHROSCOPY OF TMJ Kenji Takagi Japan first introduced this technique Insertion of an rigid endoscope into the joint compartment for observation and therapeutic purpose Arthrography is mandatory before this procedure- Joint space www.indiandentalacademy.com
  144. 144. INSTRUMENTATION TV camera and video Scopes - 2.4, 1.9, 1.7 mm Sheath - 2.7, 2.4 , 2 mm Light source – xenon arc illuminator www.indiandentalacademy.com
  145. 145. TECHNIQUE www.indiandentalacademy.com
  146. 146. NORMAL JOINT www.indiandentalacademy.com
  147. 147. www.indiandentalacademy.com
  148. 148. REFERENCES LASKIN- Temporomandibular joint CARLSSON, SESSLE, MOHL,ZARB- Temporomandibular And masticatory muscle disorders BERKOVITZ- Oral anatomy J.P OKESON- Temporomandibular disorders www.indiandentalacademy.com
  149. 149. IDE NAKAZAWA –Anatomical atlas of TMJ TENCATE – Oral histogy Koski et al , 1968 AJO-DO MAJOR M ASH-Wheelers dental anatomy, Physiology and occlussion www.indiandentalacademy.com
  150. 150. T.M GRABER ,T RAKOSI, A G PETROVIC- Dentofacial orthopedics with functional appliances www.indiandentalacademy.com
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  156. 156.  Ct fig www.indiandentalacademy.com MRI fig
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  161. 161. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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