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Tmj disorders 1 /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 disorders 1 /certified fixed orthodontic courses by Indian dental academy

  1. 1. Temperomandibular Joint {TMJ} INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. • SURGICAL ANATOMY • TRISMUS • DISLOCATION • INTERNAL DERANGEMENT • ANKYLOSIS • MYOFACIAL PAIN DYSFUNCTION www.indiandentalacademy.com
  3. 3. T.M.J = GINGLYMOARTHRODIAL JOINT • GINGLYMUS – A HINGE (ROTATION) • ARTHRODIAL – SLIDING MOVEMENT CHARACTERISTIC FEATURES: • DIARTHROIDAL, NONWEIGHT-BEARING JOINT • BOTH THE JOINTS ARE INTERDEPENDENT • BOTH ARE INTERDEPENDENT ON DENTITION www.indiandentalacademy.com
  4. 4. TMJ BONY COMPONENTS 1. Glenoid fossa 2. Condylar head 3. Articular eminence  MUSCLES 1. 2. 3. 4. Muscles of mastication Muscles attached to the joint Muscles of facial expression Muscles of the neck www.indiandentalacademy.com SOFT-TISSUE COMPONENTS 1. Articular disk 2. Joint capsule 3. Ligaments
  5. 5. SURGICAL ANATOMY BONY COMPONENTS: • GLENOID FOSSA • MANDIBULAR CONDYLE • ARTICULAR EMINENCE www.indiandentalacademy.com
  6. 6. GLENOID FOSSA  Single layer of cortical bone separates fossa from  middle cranial fossa – Temporal lobe of brain   Covered by thin fibrous layer www.indiandentalacademy.com
  7. 7. CONDYLAR HEAD  Oval – mediolaterally – ‘Rugby ball’, ‘Date-stone’  15-20 mm long (M-L); 8-10 mm wide (A-P);  Medial pole > lateral pole  Posterior surface > anterior surface  Articulating surface – Fibrous tissue www.indiandentalacademy.com
  8. 8. ARTICULAR EMINENCE Sigmoid shape, Anterior & posterior slopes  Saddle – shaped in coronal section – concave mediolaterally   With disc, guides mandibular movement during jaw opening www.indiandentalacademy.com
  9. 9. SOFT TISSUE COMPONENTS: 1. DISC – • FIBROCARTILAGENOUS, AVASCULAR • SEPARATES JOINT INTO TWO COMPARTMENTS • 3 REGIONS:- CENTRAL ZONE- 1 MM THICK, ANTERIOR ZONE- 2MM THICK, POSTERIOR ZONE-3MM THICK AND BILAMINAR • • INNERVATED BY AURICULOTEMPORAL NERVE SUPERIOR SURFACE IS CONCAVO-CONVEX & INFERIOR IS CONCAVE • ATTACHED TO THE MEDIAL AND LATERAL POLES OF THE CONDYLE www.indiandentalacademy.com
  10. 10. ARTICULAR DISK www.indiandentalacademy.com
  11. 11.  Position of articular disk www.indiandentalacademy.com
  12. 12. 2. CAPSULE ATTACHED TO THE ARTICULAR MARGINS OF THE HEAD OF THE CONDYLE & TO THE MARGINS OF THE GLENOID FOSSA AND ARTICULAR EMINENCE   Fibrous, non-elastic membrane surrounding the TMJ Attachments Post – squamotympanic fissure Lat – glenoid fossa Ant – articular eminence www.indiandentalacademy.com
  13. 13.  Thin structure – reinforced by ligaments  Inner surface lined by syanovial membrane Functions:  Seals joint space  Provides passive stability  Active stability - proprioceptive nerve-endings in capsule www.indiandentalacademy.com
  14. 14.  3. LIGAMENTS – TEMPOROMANDIBULAR LIGAMENT {lateral} – STYLOMANDIBULAR LIGAMENT – SPHENOMANDIBULAR LIGAMENT www.indiandentalacademy.com
  15. 15. TMJ LIGAMENTS www.indiandentalacademy.com
  16. 16. FUNCTIONAL LIGAMENT Fan-shaped reinforcement of lateral wall of capsule Obliquely from outer surface of articular eminence & zygomatic process 2 parts Outer oblique – outer surface of condylar neck Inner horizontal – lateral pole of condyle & lateral margin of disk www.indiandentalacademy.com
  17. 17. Functions: 1. Prevents lateral (same side) & medial (contralateral) dislocation 2. 3 Oblique part – resists excessive dropping of condyle - limits extent of mouth –opening/rotational opening – unique to humans - prevents impingement on vital submandibular & retromandibular structures Horizontal part – limits posterior movement of condyle & disc - protects RDT from trauma - protects lateral pterygoid from overlengthening or extension www.indiandentalacademy.com
  18. 18.  SPENOMANDIBULAR LIGAMENT – no role  STYLOMANDIBULAR LIGAMENT – limits excessive protrusive movements www.indiandentalacademy.com
  19. 19.  SYNOVIAL MEMBRANE LINES BOTH THE CAVITIES & FILLED WITH SYNOVIAL FLUID Functions: Medium for metabolic exchange to avascular articulating surfaces Lubricant – minimizes www.indiandentalacademy.com friction
  20. 20.  LATERAL PTERYGOID MUSCLE – 2 HEADS; – UPPER HEAD ATTACHED TO THE DISC, – LOWER TO THE CONDYLE www.indiandentalacademy.com
  21. 21. INFERIOR LATERAL PTERYGOID Both –protrusion Unilateral – mediotrusive on same side With depressors – lowers mandible - condyles glide downward & forward on articular eminence SUPERIOR LATERAL PTERYGOID Does not act with inferior head Protractor of disk Power stroke with elevators www.indiandentalacademy.com
  22. 22. NERVE AND BLOOD SUPPLY   SENSORY – AURICULOTEMPORAL NERVE VASCULAR – SUPERFICIAL TEMPORAL ARTERY www.indiandentalacademy.com
  23. 23. TMJ MOVEMENTS www.indiandentalacademy.com
  24. 24. CLASSIFICATION OF TMJ DISORDERS MUSCULAR DISORDERS • 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 DEVELOPMENTAL • Condylar hyperplasia • Condylar hypoplasia • Condylar aplasia ANKYLOSIS OF TMJ • Fibrous • Bony www.indiandentalacademy.com
  25. 25. HYPOMOBILITY (TRISMUS) • SYSTEMIC FACTORS: • TETANUS • TETANY • INTRACRANIAL CAUSES  EXTRAPYRAMIDAL LESIONS  EPILEPSY • DRUG INDUCED – STRYCHNINE POISONING • PSYCHOGENIC – HYSTERIA www.indiandentalacademy.com
  26. 26. • LOCAL FACTORS: • INFECTION  INTRA-ARTICULAR – ARTHRITIS  EXTRA-ARTICULAR - PERICORONITIS • TRAUMA  FRACTURE OF MANDIBLE  IMPROPER IAN BLOCK • TMJ DYSFUNCTION SYNDROME • TMJ ANKYLOSIS • ORAL SUBMUCOUS FIBROSIS • POST RADIATION FIBROSIS • NEOPLASMS INVOLVING MUSCLES www.indiandentalacademy.com
  27. 27. TMJ DISLOCATION • INCIDENCE – 3 %, HIGHER IN FEMALES • MOST COMMONLY IN ANTERIOR DIRECTION • SUBLUXATION – INCOMPLETE DISLOCATION • LUXATION = DISLOCATION • RECURRENT DISLOCATIONS - REPEATED DISLOCATIONS WITH NO STRONG PSYCHOLOGICAL COMPONENT • HABITUAL DISLOCATIONS – AT THE WILL OF THE PATIENT • UNILATERAL OR BILATERAL; ACUTE OR CHRONIC • HYPERMOBILITY – PREDISPOSING FACTOR www.indiandentalacademy.com
  28. 28. ETIOLOGY   INTRINSIC TRAUMA: • OVER EXTENSION INJURY • YAWNING, VOMITING • WIDE BITING, SEIZURE DISORDER EXTRINSIC TRAUMA: TRAUMA • FLEXION- EXTENSION INJURY TO THE MANDIBLE • INTUBATION • ENDOSCOPY • DENTAL EXTRACTIONS • FORCEFUL HYPEREXTENSIONS www.indiandentalacademy.com
  29. 29. CONNECTIVE TISSUE DISORDERS: • HYPERMOBILITY SYNDROME • EHLER’S DANLOS SYNDROME • MARFAN SYNDROME MISCELLANEOUS CAUSES: • INTERNAL DERANGEMENT • LOST VERTICAL DIMENSIONS • OCCLUSAL DISCREPANCIES PSYCHOGENIC: • HORIZONTAL DISLOCATION • TARDIVE OROFACIAL DYSKENESIA DRUG INDUCED: • PHENOTHIAZINES www.indiandentalacademy.com
  30. 30. DIAGNOSIS • GOOD HISTORY • ASCERTAIN TYPE & DETERMINE CAUSE • CLINICAL SIGNS AND SYMPTOMS • PALPATION OF MUSCLES • INVESTIGATIONS www.indiandentalacademy.com
  31. 31. www.indiandentalacademy.com
  32. 32. BILATERAL: • PAIN – TEMPORAL FOSSA • INABILITY TO CLOSE THE MOUTH • TENSE MASTICATORY MUSCLES • DIFFICULTY IN SPEECH • EXCESSIVE SALIVATION • PROTRUDED CHIN • OPEN BITE • DISTINCT HOLLOW IN FRONT OF THE TRAGUS • PROTUBERANCE ANTERIOR AND BELOW THE ARTICULAR EMINENCE www.indiandentalacademy.com
  33. 33. UNILATERAL: • MANDIBLE SWUNG AWAY FROM SIDE OF DL • CROSS & OPEN BITE - CONTRALATERALLY • PROTRUSIVE OCCLUSION • HOLLOW IN FRONT OF TRAGUS – INVOLVED SIDE • SEVERE PAIN IN THE INVOLVED SIDE www.indiandentalacademy.com
  34. 34. RADIOGRAPHS • ORTHOPANTOMOGRAPH • TRANSCRANIAL VIEW & LAT. TOMOGRAMS • ARTHROGRAPHY • CT SCANS • ELECTROMYOGRAPHY www.indiandentalacademy.com
  35. 35. NON SURGICAL TREATMENT ACUTE DISLOCATIONS: GOAL – RELIEF OF PAIN, ANXIETY, REDUCTION & IMMOBILIZATION • REASSURANCE OF THE PATIENT • TRANQUILIZER / SEDATIVE • MASSAGE OVER THE CORONOID PROCESS • INJECTION OF L.A. INTO THE DEPRESSION • MANIPULATION & REDUCTION • IMMOBILIZATION FOR 4 WEEKS • RESTRICTED www.indiandentalacademy.com MOUTH OPENING
  36. 36. MANIPULATION TECHNIQUES • HIPPOCRATES METHOD • COMMON METHOD • ROTH’S METHOD • YURINO’S METHOD www.indiandentalacademy.com
  37. 37. COMMON METHOD www.indiandentalacademy.com
  38. 38. www.indiandentalacademy.com
  39. 39. LONG STANDING DISLOCATIONS: • MUSCLE SPASM & FIBROSIS • MANIPULATION UNDER G.A. • IMMOBILIZATION FOR 4 WEEKS • MUSCLE RELAXANTS • CLASS III ELASTICS  AIDS IN COMPLETE REDUCTION www.indiandentalacademy.com
  40. 40. RECURRENT DISLOCATIONS: • SIMPLER THAN ACUTE DL • UNSTABLE AFTER REDUCTION - LAXITY • PHYSICAL THERAPY – ISOMETRIC EXERCISES • NSAIDS, MUSCLE RELAXANTS • OCCLUSAL TREATMENT • CHEMICAL CAPSULORRAPHY (SCLEROSANTS)  SODIUM TETRADECYL SULPHATE  SODIUM PSYLLIATE  HOMOGENOUS BLOOD www.indiandentalacademy.com
  41. 41. SURGICAL TREATMENT INDICATIONS:  LONG STANDING DL  DISABLING RECURRENT DL 3 CATEGORIES: • PROCEDURES TO LIMIT TRANSLATION • ELIMINATION OF BLOCKING FACTORS • COMBINATION PROCEDURES www.indiandentalacademy.com
  42. 42. PROCEDURES TO LIMIT TRANSLATION ANCHORING PROCEDURES: • CAPSULORRAPHY • CAPSULAR PLICATION • LIGAMENTOPEXY • FLAPS SECURED TO CAPSULE • SLINGS BETWEEN CONDYLE & ZYGOMATIC PROCESS • SECURING DISC TO CAPSULE • ANCHORING CORONOID PROCESS TO ZYGOMA www.indiandentalacademy.com
  43. 43. PROCEDURES TO LIMIT TRANSLATION LATERAL PTERYGOID MYOTOMY: • SUPERIOR BELLY IS CUT • ELIMINATES FORCE RESPONSIBLE BLOCKING PROCEDURES: • CREATES AN OBSTACLE FOR THE CONDYLE • SOFT TISSUE PROCEDURES • BONY PROCEDURES www.indiandentalacademy.com
  44. 44. KONJETZNY PRODECURE CREATES A CLOSED LOCK www.indiandentalacademy.com
  45. 45. DAUTERY PROCEDURE INCREASES HEIGHT OF THE EMINENCE www.indiandentalacademy.com
  46. 46. ELIMINATING BLOCKING FACTORS DISKECTOMY www.indiandentalacademy.com
  47. 47. ELIMINATING BLOCKING FACTORS EMINECTOMY www.indiandentalacademy.com
  48. 48. COMBINATION PROCEDURES • LATERAL PTERYGOID MYOTOMY WITH DISKECTOMY • CONDYLOTOMY • CONDYLECTOMY www.indiandentalacademy.com
  49. 49. CONDYLECTOMY www.indiandentalacademy.com
  50. 50. INTERNAL DERANGEMENT OF TMJ AN ABNORMAL RELATIONSHIP OF THE ARTICULAR DISK TO THE MANDIBULAR CONDYLE, FOSSA & ARTICULAR EMINENCE • MENISCUS ASSUMES ABNORMAL POSITION • ASSOCIATED WITH CLICKING www.indiandentalacademy.com
  51. 51. www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. ETIOLOGY • LATERAL PTERYGOID MUSCLE SPASM • TRAUMA • CHRONIC FUNCTIONAL OVERLOAD (CLENCHING) • DEGENERATIVE JOINT DISEASES www.indiandentalacademy.com
  55. 55. www.indiandentalacademy.com
  56. 56. CLINICAL DIAGNOSIS HISTORY• PAIN • CLICKS • OCCLUSAL DISHARMONY • HISTORY OF PREVIOUS TREATMENT • PSYCHOLOGICAL EVALUATION • ANY OTHER RELEVANT INFORMATION www.indiandentalacademy.com
  57. 57. CLINICAL EXAMINATION• OCCLUSAL DISHARMONIES • INTER-INCISAL DISTANCE DURING MO • RANGE OF MANDIBULAR MOVEMENTS • MIDLINE DEVIATION • CORRELATION OF CLICKING WITH PAIN & MO • PALPATION OF JOINT & MUSCLES www.indiandentalacademy.com
  58. 58. PALPATION www.indiandentalacademy.com
  59. 59. SPECIAL INVESTIGATIONS• PLAIN RADIOGRAPHS – OPEN & CLOSED • ARTHROGRAPHY – INJ. OF CONTRAST MEDIA • CT SCANS • MRI • TMJ ARTHROSCOPY • ACOUSTIC EVALUATION www.indiandentalacademy.com
  60. 60. CLINICALLY, 3 STAGES: A) INITIAL STAGE – • ANT. DISPLACEMENT WITH REDUCTION B) INTERMEDIATE STAGE – • ANT. DISPLACEMENT WITHOUT REDUCTION C) TERMINAL STAGE – • ANT. DISPLACEMENT WITH PERFORATION www.indiandentalacademy.com
  61. 61. MANAGEMENT 1. INITIAL TREATMENT• AIM - NORMAL JOINT – SYMPTOMATIC • EXPLAIN THE NATURE AND PROGNOSIS • RELIEVE THE JOINT FROM TRAUMA –  SOFT DIET, AVOID BRUXISM, ETC. • MEDICATIONS – NSAID’S • MUSCLE RELAXANTS – DIAZEPAM; • LIMIT MOUTH OPENING • APPLICATION OF HEAT, COLD • INTRA-ARTICULAR INJECTIONS  TRIAMCINALONE / HYDROCORTISONE www.indiandentalacademy.com
  62. 62. 2. SUPPORTIVE THERAPYA) APPLIANCES (SPLINTS) • STABILIZATION SPLINTS • REPOSITIONING SPLINTS   B) PHYSIOTHERAPY • JOINT MOBILIZATION • MOVEMENT EDUCATION   C) OCCLUSAL REHABILITATION • SELECTIVE GRINDING • ORTHODONTICS www.indiandentalacademy.com
  63. 63. SURGICAL MANAGEMENT • EMPLOYED FOR END STAGE DISORDERS • INTRACTABLE PAIN - UNRESPONSIVE • CHRONIC CLOSED LOCK • DISC PERFORATIONS  ARTHROCENTESIS  ARTHROSCOPY www.indiandentalacademy.com
  64. 64. 1. MENISECTOMY 2. HIGH CONDYLECTOMY 3. CONDYLECTOMY 4. CONDYLOTOMY • BASED ON FINDING OF CONDYLAR # - ELIMINATION OF JOINT SOUND • WARD (1961)- CLOSED CONDYLOTOMY – CONDYLE ASSUMES NEW POSITION 5. EMINECTOMY• REMOVAL OF ARTICULAR EMINENCE      www.indiandentalacademy.com
  65. 65. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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