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.
Diagnosing TMJ /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The temporomandibular joint is the joint of the jaw and is frequently referred to as TMJ. The TMJ is a bilateral synovial articulation between the mandible and temporal bone. The name of the joint is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium (skull), and the lower jawbone or mandible.
There are six main components of the TMJ.
Mandibular condyles
Articular surface of the temporal bone
Capsule
Articular disc
Ligaments
Lateral pterygoid
Diagnosing TMJ /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The temporomandibular joint is the joint of the jaw and is frequently referred to as TMJ. The TMJ is a bilateral synovial articulation between the mandible and temporal bone. The name of the joint is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium (skull), and the lower jawbone or mandible.
There are six main components of the TMJ.
Mandibular condyles
Articular surface of the temporal bone
Capsule
Articular disc
Ligaments
Lateral pterygoid
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
A Brief description of the causes and clinical manifestations of the internal derangement of the temporomandibular joint , with particular emphasis on Disc Displacements .
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.for more details please visit
www.indiandentalacademy.com
This seminar explains about the development, relations, ligaments, various attachments, vascular and nervous supply and various surgical approaches and its modifications to TMJ
Muscle function in orthodontics /certified fixed orthodontic courses by Indi...Indian dental academy
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
Extra oral examination /certified fixed orthodontic courses by Indian dental ...Indian dental academy
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.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
A Brief description of the causes and clinical manifestations of the internal derangement of the temporomandibular joint , with particular emphasis on Disc Displacements .
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.for more details please visit
www.indiandentalacademy.com
This seminar explains about the development, relations, ligaments, various attachments, vascular and nervous supply and various surgical approaches and its modifications to TMJ
Muscle function in orthodontics /certified fixed orthodontic courses by Indi...Indian dental academy
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
Extra oral examination /certified fixed orthodontic courses by Indian dental ...Indian dental academy
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.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
TMJ is very important joint in head and neck anatomy, this seminar describes normal anatomy of tmj, pathological conditions associated with tmj, mandibular movements and tmj disorders.
Condylar fractures /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
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
Temporo mandibular joint /certified fixed orthodontic courses by Indian denta...Indian dental academy
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
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TMJ is formed by the mandibular condyle and the mandibular fossa of the temporal bone. The articular disc separates these two bones from direct articulation .
The main components of TMJ
Mandibular condyles
Articular surface of temporal bone
Articular disc
LigamentsSPHENOMANDIBULAR LIGAMENT
morphologically, it is remnant of cephalic end of meckel’s cartilage is attached
superiorly to: spine of sphenoid bone
inferiorly to: lingula of mandibular foramen
laterally related to: lateral pterygoid muscle, auriculotemporal nerve, maxillary artery.
medially related to: chorda tympani nerve.
near its lower end it is pierced by: mylohyoid nerves and vessels
STYLOMANDIBULAR LIGAMENT:
It is thickened part of deep cervical fascia.
Above: lateral surface of styloid process.
Below: angle and adjacent part of posterior part of ramus.
AGE CHANGES
CONDYLE:
Becomes more flattened
Fibrous capsule becomes thicker.
Osteoporosis of underlying bone.
Thinning or absence of cartilaginous zone.
ARTICULAR DISK:
Becomes thinner.
Shows hyalinization and chondroid changes.
BLOOD VESSELS AND NERVES:
Walls of blood vessels thickened.
These age changes lead to:
-Decrease in the synovial fluid formation
-Impairment of motion due to decrease in the disc and capsule extensibility
-Decrease the resilience during mastication due to chondroid changes into collagenous elements
-Dysfunction in older people
TMJ EXAMINATION
Examined both clinically and radiographically.
PALPATION OF TMJ is determined by digital palpation..
CREPITATION This is a grating or scalping noise that occurs on jaw movements. may be an early sign of degenerative joint disease. AUSCULTATION OF THE TMJ can be examined with a stethoscope. Also the timing of clicking during opening and closure can be noted.
CLICKING It occurs due to the uncoordinated movement of condylar head and TMJ disc. Joint clicking is differentiated as:
Initial clicking: it is a sign of retruded condyle.
Intermediate clicking: it is a sign of uneven condyle surfaces and articular disc.
Terminal clicking: it is an effect of the condyle being moved too far anteriorly in relation to the disc on maximum jaw opening. TMJ ARTHROGRAPHY
Norgaard (1940)
Indications:
Position and function of disk -pain and dysfunction-long standing
History of locking-persistent
Perforations of the disk and retrodiskal tissue.
Therapeutic :
To delineate loose bodies in the joint spaces
Diagnostic aspiration of joint fluid.
Intraarticular injections of steroids
Contraindications:
Infections in the preauricular region.
Patients allergic to contrast media.
Patients with bleeding disorders and on anticoagulant therapy
TMJ ARTHROGRAPHY
Norgaard (1940)
Indications:
Position and function of disk -pain and dysfunction-long standing
History of locking-persistent
Perforations of the disk and retrodiskal tissue.
Therapeutic :
To delineate loose bodies in the joint sp
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.for more details please visit
www.indiandentalacademy.com
Temporomandibular disorders/certified fixed orthodontic courses by Indian den...Indian dental academy
Description :
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.for more details please visit
www.indiandentalacademy.com
Temperomandibular joint /certified fixed orthodontic courses by Indian dent...Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
Similar to Temparo mandibular joint disorders /certified fixed orthodontic courses by Indian dental academy (20)
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Indian Dental Academy
Leader in continuing dental education
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skype:indiandentalacademy
+919248678078
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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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.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
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In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
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It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
3. Embrylogy – TMJ
• TMJ develops between 7th & 12th week of
gestation from two separate
blastemas.(Temporal, Condyle)
• Superior to condylar blastema, a band of
mesenchymal cells defferentiate to form
articular disk.
• Temporal & Condylar blastemas
→Osteoblasts
→Membranous bone
www.indiandentalacademy.com
4. Embrylogy – TMJ…
• In the centre of the condyle, Cartilage
develops → Secondary Cartilage
Endochondral Ossification
Subchondral Bone Formation
Enlargement of the condyle in
adulthood in adaptation to
overloading
www.indiandentalacademy.com
5. Embrylogy – TMJ…
• The developing disk is highly cellular & vascular
• It continues anteriorly with Lat.pterygoid muscle &
posteriorly by a ligament with superior end of Meckel’s
cartilage that develops in to malleus of middle ear. –
Discomalleolar ligament / Pinto’s ligament *
• In post natal life pinto’s lig. Inserts most of its fibers into
squamo tympanic fissure & loses its attachment to the
malleus.
*- Viva Question
www.indiandentalacademy.com
6. Embrylogy – TMJ…
• Pinto’s ligament: / Discomalloelar ligament
• Described by Pinto -1962
• “Fibrous link between the poasteromedial aspect of articular
disk & anterior process of malleus of middle ear seen in
fetal tm joints”
• In adults the ligament is present, but looses its attachment to
malleus
• Loughner et al -1989: dissection 14 cadaveric heads, showed
that only one had anatomic continuity to malleus
www.indiandentalacademy.com
7. Anatomy - TMJ
• “Uniqueness” of the TMJ- Stegenga B, DeBont
LGM et al, JOMS 47:249-256 1989
• Bilateral articulation with the cranium
• Occlusion and articulation of teeth affect joint
movement and condylar positions
• Articular surfaces are fibrocartilage rather
than hyaline cartilage
• TMJ contains an articular disc
www.indiandentalacademy.com
12. Anatomy – TMJ…
CAPSULE:
TMJ is enclosed in a thick
fibrous capsule.
Capsule attachments:
• superiorly: articular
eminence & the
circumference of the
mandibular fossa.
• Inferiorly: neck of the
condyle.
• Laterally - thickened temporo-mandibular
ligament.
www.indiandentalacademy.com
15. Anatomy – TMJ…
•
•
•
•
•
Articular Disk – Functions:
Shock absorber of Joint
Prevents bone- bone contact
Viscoelastic property?
Keratan sulfate,
Glycosaminoglycans - -Chondroitin 4 sulfate,
-GAG
Hyaluronic acid & Link proteins
• GAG are distributed in load bearing areas
• GAG-absorb water-allows disk to absorb stresses by deforming &
leaking water.
• On relief from stress, water content restored & loaded tissue returns
to original shape
www.indiandentalacademy.com
26. Biomechanics of normal TMJ
• The condyle functions in both a hinge and a sliding
fashion. During full opening the condyle not only
rotates on a hinge axis but also translates forward to
a position near the most inferior portion of the
articular eminence.
• During function the biconcave disk remains
interpositioned between the condyle and fossa, with
the condyle remaining against the thin intermediate
zone during all phases of opening and closing.
www.indiandentalacademy.com
27. Biomechanics of normal TMJ
• Normal tmj – Postion
of disk
Posterior band --12 o’
clock
Intermediate zone—
1 o’clock
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28. Biomechanics of normal TMJ
Stretching of bilaminar zone & retrodiskal tissues
→ forward movement of disk
→ condylar translation
www.indiandentalacademy.com
29. But..
• Prolonged overloading of Joint
• Chronic Macro & Micro trauma – joint
• Dental &/ skeletal malocclusions
• Oromandibular dyskinesias… etc
↓
• Overstretching/laxity of retrodiskal tissues
↓ +/• Hyperactivity of Lateral pterygoid muscle
↓
• Malrelationship/ in-co-ordination of condyle-disc movement
↓
•
Internal derangement of TMJ
www.indiandentalacademy.com
30. Internal derangement of TMJ
• Hey & Davies (1814) – ― a localized
mechanical fault interfering with smooth
action of a joint‖
• Laskin (1994) -- ― A disturbance in the
normal antatomic relationship between the
disc & the condyle that interferes with
smooth movement of the joint & causes
momentary catching, clicking,popping or
locking ‖
www.indiandentalacademy.com
31. Internal derangements of TMJ…
Staging of internal derangement – Wilkes system:
Stage-I: Early reducing disk displacement
Stage-II: Late reducing disk displacement
Stage-III: Non reducing disk displacementAcute/subacute
Stage-IV: Chronic Non reducing disk
displacementStage-V: Stage-IV + Osteoarthrosis
**Wilkes CH,
Arch Otolaryngol Head Neck Surg 115:469-457 1989
www.indiandentalacademy.com
32. Internal derangement of TMJ…
• Clinical features & physical examination:
• Opening & reciprocal click(Stage-I or II)
• Joint Pain & tenderness to palpation, on
function
• Deviation to affected side until clicking
occurs
• Limitation of mouth opening /Deviation of
opening with lack of palpable translation
( stage-III – V)
www.indiandentalacademy.com
33. Internal derangement of TMJ…
• Clinical features & physical
examination:contd.
• Crepitus – Chronic disk displacement with
perforation, degenerative changes (StageV)
www.indiandentalacademy.com
35. Internal derangement of TMJ…
Disk displacement with reduction – (Wilkes stage-I/II)
www.indiandentalacademy.com
36. Internal derangement of TMJ…
Disk displacement with reduction – (Wilkes stage-I/II)
www.indiandentalacademy.com
37. Staging Criteria for Internal Derangements of
the TMJ with Respect to Clinical, Radiologic
and Surgical Findings
• Stage- I
• Clincal:-no mechanical symptoms,
Reciprocal click +, no pain or limitation of ROM
• Imaging:normal tomograms, good disc contours
• Surgical: normal anatomic form, slight anterior
displacement, passive clicking
www.indiandentalacademy.com
38. Staging Criteria for Internal Derangements of
the TMJ with Respect to Clinical, Radiologic
and Surgical Findings
Stage-II
• Clinical: Few episodes of pain
•
•
Imaging: Normal tomogram, slight forward
displacement & slight thickening of posterior
edge of disc
Surgical: Anterior displacement, early anatomic deformity
www.indiandentalacademy.com
39. Internal derangement of TMJ…
No Clicking
Disk displacement without reduction – (Wilkes stage-III/IV)
www.indiandentalacademy.com
40. Internal derangement of TMJ…
Disk displacement without reduction – (Wilkes stage-III/IV/V)
www.indiandentalacademy.com
41. • ―A clicking joint doesn’t lock & a locking
joint doesn’t click‖ - Farrar et al
Current advances in Oral Surgery Vol.III- William Irby
www.indiandentalacademy.com
42. Staging Criteria for Internal Derangements of
the TMJ with Respect to Clinical, Radiologic
and Surgical Findings
• Stage-III:
• Clinical: Multiple episodes of pain, joint
tenderness, catching and locking, restriction of
motion, pain with function
• Imaging: Anterior displacement with moderate
to marked thickening of the posterior edge,
normal tomogram
• Surgical: Marked anatomic deformity,
displacement, adhesions, no hard tissue changes
www.indiandentalacademy.com
44. Staging Criteria for Internal Derangements of
the TMJ with Respect to Clinical, Radiologic
and Surgical Findings
• Stage-IV:
• Clincal: Chronicity with variable and episodic pain
• Imaging:abnormal tomograms, early to moderate
degenerative changes
• Surgical: Hard tissue degenerative remodeling
changing of both bearing surfaces with
osteophytes, no perforation
www.indiandentalacademy.com
45. Staging Criteria for Internal Derangements of
the TMJ with Respect to Clinical, Radiologic
and Surgical Findings
• Stage-V:
• Clinical: Crepitus, variable and episodic pain,
restriction of motion, functional impairment
•
Imaging: Anterior displacement with
perforation, degerative arthritic changes
•
Surgical: Gross degenerative changes of hard
and soft tissue, perforation of posterior attachments,
osteophytes
www.indiandentalacademy.com
46. Pathophysiology Of Disk
displacements
• Disk displacements– Adaptive response
Pseudo disk Formation,
Remodelling of condyle..
• Chronic disk displacements
→DEGENERATIVE JOINT DISORDER
www.indiandentalacademy.com
47. Pathophysiology Of degenerative
joint disorders
• Mechanisms of Injury:
• 1.DIRECT MECHANICAL TRAUMA:
• Trauma (mechanical overloading) → generation of free
radicals →intracellular damage & reduction in the reparative
capacity
• 2.HYPOXIA - REPERFUSION INJURY
• Increased intracapsular hydrostatic pressure (clenching &
bruxing) ----- → hypoxia.
• When the pressure in the joint is decreased and perfusion is
reestablished, free radicals are formed leading to intracellular
damage.
www.indiandentalacademy.com
48. Pathophysiology Of degenerative
joint disorders
• 3.NEUROGENIC INFLAMMATION
• In cases of disk displacement the compression or
stretching of the nerve - rich retrodiscal tissue may
result in release of pro-inflammatory neuropeptides.
• The release of cytokines results in release and
activation of prostaglandins, leukotrienes, and
matrix-degrading enzymes.
www.indiandentalacademy.com
54. Evaluation of the patient with disc
displacement & investigations
•
•
•
•
•
•
•
•
•
•
•
1. Case history
2. Physical examination
3. Radiographic evaluation
a. Transcranial views
b. OPG
c. Tomograms
d. Arthrography
e. CT scans
f. MRI
g. Nuclear imaging
4. Psychologic evaluation
www.indiandentalacademy.com
55. Treatment – Internal
derangement
Treatment for all pts with disc displacement ???
Disc displacement ---35 % asymptomatic volunteers.
• 1. Katzberg RW, Westesson PL et al “ Anatomic disorders of
the temporomandibular joint disc in asymptomatic subjects.”
J Oral Maxillofac Surg 1996; 54:147-53.
• 2. Ribeiro RF, Tallents RH et al “ The prevalence of disc
displacement in symptomatic and asymptomatic volunteers
aged 6 to 25 years. ” J Orofac Pain 1997; 11:37-47.
www.indiandentalacademy.com
56. • Self remission of internal derangements??
www.indiandentalacademy.com
57. Treatment – disk displacement
disorders
• Sato S, Takahashi K, et al “The natural course of nonreducing
disc displacement of the TMJ : changes in condylar mobility
and radiographic alterations at one-year follow-up.”
Int J Oral Maxillofac Surg 1998; 27:173-7.
• 44 subjects who agreed to observation without treatment
• Successful resolution - 68% @ 18 months
• Mouth opening increased from 29.7 mm to 38 mm
• Conclusion: Self reduction of displaced disc-unlikely
• Stretching & remodelling of the retrodiscal tissues, enabling the
disc to be displaced more anteriorly by the translating condyle.
www.indiandentalacademy.com
58. Treatment – Disk displacement
disorders
•
•
•
•
•
Conservative Treatment:
AIMS:
Reducing pain and discomfort
Decreasing inflammation in muscles and joints
Improving jaw function
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METHODS OF CONSERVATIVE TREATMENT:
1. Patient education
2. Medication
3. Physical therapy
4. Splints
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59. Treatment – Disk displacement
disorders
1. PATIENT EDUCATION
• Awareness about the pathology
• Discontinuation of parafunctional habits
• Biofeedback devices
• Psychologic counseling
• Modification of diet and home exercises
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61. Treatment – Disk displacement
disorders
• “Treatment of severe TMJ clicking with botulinum
toxin in the lateral pterygoid muscle in two cases of
anterior disc displacement .”
Merette Bakke, Eigild Moller et al
OOOE 2005;100:693-700
• EMG guided injection BTX-A & after 6
months.
• Assessment: clinical ex.,EMG, MRI
• Results:Permanent elimination of clicking
Small improvement in condyle - disc
relationship
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62. Treatment – Disk displacement
disorders
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3.PHYSICAL THERAPY
1. Isometric jaw exercises
2. Ultrasound ( 0.7 to 1.0 watts per cm 2)
3. Spray and stretch
4. Pressure massage
5. Transcutaneous Electrical Nerve
Stimulation
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63. 4.Splint therapy – TMJ disk
displacement disorders
• RATIONALE FOR THE USE OF SPLINT
THERAPY
• “Unloading the joint” / ↑Joint space
• Reduce inflammation, increases free jaw
movement
• Decreases muscular activity
• Provides stable dental occlusion
• Possible effect in bruxism
• Placebo effect
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66. • “Orthodontic treatment of TMJ disc
displacement with pain: an 18 year
follow-up”
Ugo Capurso, Ida Marini
Progress in orthodontics 2007; 8(2):240-250
68 pts with wilkes II,III– splints– orthodontic Rx
Tmj pain & Function – 1,5,10,18 yrs post Rx
Significant % of pts.-- improvement of symptoms
(73 %)
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67. • “Temporomandibular joint dysfunction and
orthognathic surgery: a retrospective study”
Jean-Pascal Dujoncquoy, Joël Ferri et al
Head & Face Medicine 2010, 6:27
• High prevalence of TMJ disorders in dysgnathic patients.
• Patients with preoperative TMJ signs and symptoms can
improve TMJ dysfunction and pain levels be reduced by 80 %
• A percentage of dysgnathic patients who were preoperatively
asymptomatic developed TMJ disorders after surgery ---3.6 %
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74. ARTHROSCOPY
• Placement of cannula into superior joint
space
• Arthroscope with light source is inserted
• Video camera and monitor are connected
• Instrumentation forceps, scissors,
sutures, medication needles, cautery
probes, burs, shavers, and laser fibers
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78. Fridrich KL et al . “Prospective comparison of arthroscopy and
arthrocentesis for temporomandibular joint disorders.”
J Oral Maxillofac Surg 1996; 54:816-20.
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19 patients
GroupI: Arthroscopic lysis and lavage under general
anesthesia,
GroupII: Aarthrocentesis, hydraulic distention and
lavage under intravenous sedation.
Subjective & Objective assesment of TMJ --- 26
months
Success rates : 82% - arthroscopy
75%Arthrocentesis.
Conclusion: Both modalities - decreasing TMJ pain
Increasing mandibular range of motion
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79. Murakami K, et al. “Short-term treatment outcome study for
the management of temporomandibular joint closed lock. A
comparison of arthrocentesis to nonsurgical therapy and
arthroscopic lysis and lavage.”
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;
80:253-7.
• 108 patients- Results of arthrocentesis, arthroscopic
surgery were comparable.
• Conclusion: Arthrocentesis was indicated for the
patient with acute TMJ closed lock who was
refractory to medication and mandibular
manipulation.
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82. 3. Arthrotomy + Disc Repair:
PLICATION:
• Chronic non reducing disc displacements
• A wedge of retrodiscal tissue is removed
• Disc is repositioned a posterior & lateral
plane
• The remaining retrodiscal tissue sutured
directly to posterior ligament
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83. 3. Arthrotomy + Disc Repair:
• DISK PLICATION:
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84. 4.Arthrotomy+ Disk repositioning
• Condylar Diskopexy:
• In Wilke’s stage –III,IV disk displacements
• Displaced disk freed in both joint spacesadhesions released
• Small hole drilled in Lat.pole of condyle
• A 2.0/3.0 non resorbable suture passed
through the hole & disk @ junction of ant.
& intermediate bands
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86. Arthrotomy+ Disk repositioning
• Temporal diskopexy:
• In Wilke’s stage IV cases with too
deformed disks
• Bur holes drilled in postero-lateral lip of
glenoid fossa
• Disk secured to roof of fossa
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87. Diskopexy- bone anchors
―Temporomandibular joint disc
repositioning using
bone anchors: an immediate
post surgical evaluation by
MRI‖
ShanYong Zhang, XiuMing Liu
et al
BMC Musculoskeletal
Disorders 2010, 11:262
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88. 5.Arthrotomy+diskectomy
• Wilkes stage IV & V , disks with
perforations & severe degenerative
changes
• Cases with relapse of symptoms after disk
repair surgeries
• Fibrocartilagenous disk removed totally
• Condylar / fossa irregularities smoothened
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89. 6.Arthrotomy+diskectomy+autogenous
graft
• ―There is little evidence to suggest that
autogenous graft disk raplacement is
superior to no replacement at all‖
• But hypothesized rationale favouring
grafting:
a)graft provides scaffold for ingrowth of
tissue from synovium
b)May prevent degeneration that follows
diskectomy.
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92. 7.Condylotomy
• Popularized by Ward1952
• Creation of a
displaced condylar
neck #
• Condyle repositons
antero-inferiorly
• Unloads the posterior
attachment of disc
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93. Hall’s Modified Condylotomy
• Vertical subcondylar
osteotomy
• Open osteotomy
procedure
• More controlled
approach to condylar
repositioning
• Less risk of total
dislocation of
condylar head
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94. Recent advances – Rx of Internal
Recent articles on Mgmt of TMJ
Internal derangementRRecent
derangement
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95. • “Pterygoid Plate Disjunction: Minimally Invasive
Treatment for Internal Derangement of the
Temporomandibular Joint”
Varghese Mani, Antony George et al
Asian J Oral Maxillofac Surg. 2005;17:247-255
• Patients - internal derangement of TMJ, with pain and/or trismus
and/or joint noise, underwent pterygoid plate disjunction on the
affected side.
• Subjective & Objective Assesment Pre & 18 months post-op
• Results: Pain symptoms resolved in 26 of 29 joints and diminished in the
remaining 3 joints. Trismus resolved in 22 of 24 patients and diminished in the
remaining 2 patients. Joint noise disappeared in 23 of 30 joints
• Conclusion: : Pterygomaxillary disjunction appears to be an
effective treatment for painful internal derangement of the
temporomandibular joint that is worthy of further investigation
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96. “Pterygoid disjunction for internal derangement of
Temporomandibular joint”
Rohit Sharma.
J.Maxillofac.Oral surg.Apr-Jun2011;10(2):142-147
• As a 1* Rx modality in Wilkes I & II in 33 pts.
• Pts evaluated –Helkimo anamnestic, &
clinical dysfuntion indices, pre & post
opearively
• All the patients had improvement in Pre
operative pain & dysfunction
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97. Randomized Effectiveness Study of Four Therapeutic
Strategies for TMJ Closed Lock
E.L. Schiffman, J.O. Look et al
J Dent Res. 2007 January ; 86(1): 58–63.
Comaprison of medical, rehabilitative, arthroscopy, arthroplaty.
Assessment of TMJ pain & funtion @ 3,6,12,18,24,60 months
• Within-group improvement for all groups
• Conlusion: Primary treatment for individuals
with TMJ closed lock should consist of medical
management or rehabilitation.
• This approach will avoid unnecessary surgical
procedures.
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98. Chronic Recurrent dislocation of
Condyle
• Recurrent dislocation of
condyle out of the fossa
& anterior to eminece.
• Predisposing factors:
• Laxity of the ligaments
• Degenerative joint
disease
• Morphologic condition
of condyle & eminence
• Non synchronised
muscle function
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99. Chronic Recurrent dislocation of
Condyle- TREATMENT
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•
•
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•
•
Miller & Murphy (1976)*:
1.Capsular tightening procedures
2.Creation of a mechanical obstacle
3.Direct restraint of condyle
4. Creation of new muscle balance
5.Removal of mechanical obstacle
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*-Viva Q / Short Q/ Essay Q
100. Chronic Recurrent dislocation of
Condyle- TREATMENT contd…
• 1.Capsular tightening procedures:
• Chemical sclerosants: Sod.teradecyl
sulfate,etc
• Capsulorrhaphy:
• Placement of horizontal mattress sutures
• Placement of vertical incision, overlapping
edges & suturing
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107. Recent articles – TMJ
dislocation
―Evaluation of the mechanism and principles of
management of temporomandibular
jointdislocation. Systematic review of literature and
a proposed new classification of
temporomandibular joint dislocation‖
--- Babatunde O Akinbami
-Head & Face Medicine 2011, 7:10
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108. Key to success ---PG Exams
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A
B
C
D
E
F
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Articles / Authors
Books
Charts/flowcharts/algorithms..
Diagrams
Estimate time
Format Your answers
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109. Suggested Reading:
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Peter.D.Quinn: Atlas of TMJ surgery
Irby:Volume -3 TMJ Disorders
Norman & Bramley- TMJ Disorders
Fonseca, Vol-4 of seven volume series: TMJ
disorders
• OMS clin. North america. –Modern surgical
management of the TMJ –Vol.18,No.3,aug.2006
• Okeson: Orofacial Pain
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