Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document provides information on headgear, including its components, principles of use, types, and applications in orthodontic treatment. Headgear delivers extraoral force from a cranial support to intraoral appliances. It consists of a facebow, force element, and head cap. Forces from headgear can distalize teeth and maxilla through different anchorage points. Types include cervical, occipital, and high pull headgear. Headgear is useful for orthopedic effects, anchorage reinforcement, molar distalization, and space maintenance.
This document provides an overview of mixed dentition and orthodontic appliances used during this period. Mixed dentition refers to the stage when primary teeth are being replaced by permanent teeth, between ages 6-13 years. Common orthodontic problems in mixed dentition include increased overjet and open bite. Functional appliances discussed include oral screens, lip bumpers, activators, and Frankel's regulator. Other appliances mentioned are space maintainers, tongue blades for crossbite correction, and space regainers. The document outlines the principles, advantages, limitations and indications for different appliances used in intercepting and correcting malocclusions during mixed dentition.
The document discusses different methods of maxillary arch expansion in orthodontics, including slow expansion and rapid maxillary expansion. Slow expansion uses lighter forces over a longer period and can involve dental or skeletal changes. Rapid expansion applies greater force to separate the mid-palatal suture more quickly, but risks relapse. A variety of fixed and removable appliances are described for delivering expansion forces, including quad helix, W-arch, nickel-titanium wires, and expansion screws. The effects, indications, contraindications, and risks of both rapid and slow expansion techniques are compared.
This document discusses removable orthodontic appliances used for tooth movement. It defines key terminology like removable appliance and classifications active and passive appliances. It describes how removable appliances can be used to expand arches, reposition teeth, and intrude or extrude teeth. Specific active plate designs are outlined for anterior expansion, transverse expansion, and simultaneous anterior and posterior expansion. Removable appliances can also be used to position individual teeth using springs or screws. The document discusses various retentive components like Adams clasps and ways to improve retention. It concludes by noting other uses of removable appliances like as bite planes, to treat habits, as space maintainers, or to retain treatment results.
RAPID MAXILLARY EXPANSION VS SLOW MAXILLARY EXPANSIONShehnaz Jahangir
This document provides an overview of rapid maxillary expansion (RME) vs slow maxillary expansion (SME). It discusses the historical perspective of maxillary expansion, articulation and ossification of the midpalatal suture, indications and contraindications for expansion, classifications based on activation and support, examples of RME and SME appliances, activation protocols, and the biomechanical aspects and effects of RME on skeletal and dental structures. Key differences between RME and SME include the rate of activation (rapid vs slow) and appliances used (tooth-borne vs tissue-borne).
This document discusses the correction of Class 3 skeletal problems using reverse pull headgear or facemasks. It begins by describing Class 3 malocclusions that are due to maxillary deficiency or mandibular excess. It then discusses the types and etiology of Class 3 malocclusions. Reasons for treating Class 3 issues are provided. The document focuses on describing reverse pull headgear and facemasks, including their definition, indications, components, types, force parameters, biomechanics, treatment completion indications, advantages, and effects.
The document discusses different types of anchorage used in orthodontics. It defines anchorage as the resistance used to overcome the reaction to an applied force. There are different factors that affect a tooth's resistance to force, as well as different types of anchorage including extra-oral anchorage like headgear and intra-oral anchorage that can be intra-maxillary or inter-maxillary. Examples of each type are provided. Temporary orthodontic micro anchorage systems are also discussed as a modern method to reinforce anchorage.
Biologic tissue response to tooth movementCing Sian Dal
1. Orthodontic tooth movement occurs through the biological response of tissues to mechanical forces. When force is applied, pressure and tension zones develop in the periodontal ligament on either side of the tooth root.
2. Light, continuous forces cause frontal bone resorption, facilitating tooth movement. Heavy forces lead to hyalinization and undermining bone resorption, impeding movement.
3. In the pressure zones, force distorts periodontal ligament cells and matrices, altering blood flow and releasing biochemical signals like prostaglandins that stimulate bone-resorbing osteoclasts. This allows the tooth to move through bone remodeling.
This document provides information on headgear, including its components, principles of use, types, and applications in orthodontic treatment. Headgear delivers extraoral force from a cranial support to intraoral appliances. It consists of a facebow, force element, and head cap. Forces from headgear can distalize teeth and maxilla through different anchorage points. Types include cervical, occipital, and high pull headgear. Headgear is useful for orthopedic effects, anchorage reinforcement, molar distalization, and space maintenance.
This document provides an overview of mixed dentition and orthodontic appliances used during this period. Mixed dentition refers to the stage when primary teeth are being replaced by permanent teeth, between ages 6-13 years. Common orthodontic problems in mixed dentition include increased overjet and open bite. Functional appliances discussed include oral screens, lip bumpers, activators, and Frankel's regulator. Other appliances mentioned are space maintainers, tongue blades for crossbite correction, and space regainers. The document outlines the principles, advantages, limitations and indications for different appliances used in intercepting and correcting malocclusions during mixed dentition.
The document discusses different methods of maxillary arch expansion in orthodontics, including slow expansion and rapid maxillary expansion. Slow expansion uses lighter forces over a longer period and can involve dental or skeletal changes. Rapid expansion applies greater force to separate the mid-palatal suture more quickly, but risks relapse. A variety of fixed and removable appliances are described for delivering expansion forces, including quad helix, W-arch, nickel-titanium wires, and expansion screws. The effects, indications, contraindications, and risks of both rapid and slow expansion techniques are compared.
This document discusses removable orthodontic appliances used for tooth movement. It defines key terminology like removable appliance and classifications active and passive appliances. It describes how removable appliances can be used to expand arches, reposition teeth, and intrude or extrude teeth. Specific active plate designs are outlined for anterior expansion, transverse expansion, and simultaneous anterior and posterior expansion. Removable appliances can also be used to position individual teeth using springs or screws. The document discusses various retentive components like Adams clasps and ways to improve retention. It concludes by noting other uses of removable appliances like as bite planes, to treat habits, as space maintainers, or to retain treatment results.
RAPID MAXILLARY EXPANSION VS SLOW MAXILLARY EXPANSIONShehnaz Jahangir
This document provides an overview of rapid maxillary expansion (RME) vs slow maxillary expansion (SME). It discusses the historical perspective of maxillary expansion, articulation and ossification of the midpalatal suture, indications and contraindications for expansion, classifications based on activation and support, examples of RME and SME appliances, activation protocols, and the biomechanical aspects and effects of RME on skeletal and dental structures. Key differences between RME and SME include the rate of activation (rapid vs slow) and appliances used (tooth-borne vs tissue-borne).
This document discusses the correction of Class 3 skeletal problems using reverse pull headgear or facemasks. It begins by describing Class 3 malocclusions that are due to maxillary deficiency or mandibular excess. It then discusses the types and etiology of Class 3 malocclusions. Reasons for treating Class 3 issues are provided. The document focuses on describing reverse pull headgear and facemasks, including their definition, indications, components, types, force parameters, biomechanics, treatment completion indications, advantages, and effects.
The document discusses different types of anchorage used in orthodontics. It defines anchorage as the resistance used to overcome the reaction to an applied force. There are different factors that affect a tooth's resistance to force, as well as different types of anchorage including extra-oral anchorage like headgear and intra-oral anchorage that can be intra-maxillary or inter-maxillary. Examples of each type are provided. Temporary orthodontic micro anchorage systems are also discussed as a modern method to reinforce anchorage.
Biologic tissue response to tooth movementCing Sian Dal
1. Orthodontic tooth movement occurs through the biological response of tissues to mechanical forces. When force is applied, pressure and tension zones develop in the periodontal ligament on either side of the tooth root.
2. Light, continuous forces cause frontal bone resorption, facilitating tooth movement. Heavy forces lead to hyalinization and undermining bone resorption, impeding movement.
3. In the pressure zones, force distorts periodontal ligament cells and matrices, altering blood flow and releasing biochemical signals like prostaglandins that stimulate bone-resorbing osteoclasts. This allows the tooth to move through bone remodeling.
The document discusses various modifications that have been made to the original Herren activator appliance. It describes appliances that have one rigid acrylic mass but with reduced bulk, as well as appliances consisting of two parts joined by wire bows to reinforce muscle impulses. Some modifications discussed include the Eschler modification from 1952, Herren's activator from 1953, the LSU activator, elastic open activator, bow activator, Harvold Woodside activator, Karwetzky appliance, propulsor, cutout activator, and magnetic activator device. The document provides details on the design and intended use of several of these modified activator appliances.
Optimal orthodontic force /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
This document provides an overview of functional appliances used in orthodontic treatment. It begins with definitions of functional appliances and a brief history of their development. It then discusses the basis, classification, forces, treatment principles, indications, actions, case selection, and common appliances like the activator, frankel regulator, bionator, twin block, and Herbst appliance. It provides details on their design, indications, mode of action, and advantages. In summary, the document serves as a comprehensive guide to functional appliances, their development and use in orthodontic treatment.
This document provides information on performing a functional examination as part of an orthodontic diagnosis. It discusses examining the postural rest position and maximum intercuspation, as well as the temporomandibular joint, orofacial dysfunction, and various functional movements. Methods for determining and registering the postural rest position are described. Examination of swallowing, tongue posture, speech, lips, respiration, and craniofacial skeletal relationships are also covered to evaluate orofacial dysfunction. The document emphasizes that a functional examination is important for a complete orthodontic diagnosis beyond just a static evaluation of dental relationships.
This document provides an overview of twin block therapy. It discusses the history, philosophy, design, construction, and stages of treatment using twin blocks. Twin blocks are functional appliances composed of separate upper and lower bite blocks. They are worn 24 hours a day to achieve rapid correction of malocclusions through forces transmitted to inclined planes covering the posterior teeth. Treatment typically involves an initial active phase followed by a support phase to stabilize results.
This document discusses the management of vertical maxillary excess. It begins by outlining treatment approaches for mixed and permanent dentition, including habit breaking appliances, myotherapy, functional appliances, and orthodontic appliances. It then discusses specific treatment options in more detail, such as altering breathing mode, myotherapy exercises and appliances, habit breaking appliances like tongue cribs and vestibular screens, and functional appliances like activators. The document emphasizes the importance of proper diagnosis and treatment planning for managing vertical malocclusions.
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 presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
The document discusses temporary anchorage devices (TADs) used in orthodontic treatment. It defines TADs as devices that are temporarily fixed to bone to enhance orthodontic anchorage and are later removed. The document covers the history of TADs, classifications based on materials and design, indications for use, surgical procedures for placement, and factors involved in success and failure. It provides examples of different TAD systems and discusses considerations for biomechanics, long-term stability and failure of implants.
This document presents an overview of the activator appliance. It defines the activator, discusses its history and evolution. It outlines the indications and contraindications for activator use. The advantages and disadvantages are described. The components, mode of action, and modifications of different types of activators are explained. Case reports and references are also listed at the end. The document provides a comprehensive review of the activator appliance.
TMA is an archwire material that is intermediate in stiffness between stainless steel and nickel titanium. It has good flexibility and springback along with predictable moderate forces that provide consistent tooth movement. TMA can be used in all stages of treatment but is especially useful as a main working archwire due to its properties. It is formable, weldable, and delivers approximately half the force of stainless steel.
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 document provides an overview of cephalometrics including:
- Definitions of cephalometrics as the scientific measurement of the bones of the cranium and face using lateral radiographs.
- The goals of cephalometrics which are to evaluate relationships between the five major facial components.
- Types of cephalometric landmarks including anatomical, derived, hard tissue, and soft tissue landmarks.
- Examples of important cephalometric landmarks such as nasion, orbitale, pogonion, sella, point A, and point B.
- Classification of cephalometric lines and planes as horizontal or vertical including planes such as the SN plane, Frankfort horizontal, and mandibular plane.
The document discusses Wolff's law which states that bone remodels in response to stresses placed upon it. It then discusses different types of functional appliances used in orthodontics including myotonic appliances which rely on muscle mass/resting pressure and myodynamic appliances which make use of muscle activity/movement. The controversy around the degree of bite opening with appliances like activators is also summarized. The document argues that light bite opening may stimulate muscles and growth, while more opening relies on soft tissue stretching.
Orthodontic study models are three-dimensional plaster reproductions of a patient's teeth and surrounding tissues that are used to accurately diagnose and monitor orthodontic treatment. The document outlines the requirements, uses, and proper procedures for fabricating and trimming study models. Key steps include accurately reproducing the dental anatomy, trimming bases and backs at specific angles, and using wax bites and articulators to achieve proper occlusion. Study models provide a permanent record for treatment planning, evaluation, and legal documentation of a patient's orthodontic condition and progress.
The document provides information on Twin Block appliances. It begins with describing the history, design, and mechanism of Twin Block appliances. Twin Blocks consist of separate upper and lower bite blocks with inclined planes. They were developed in 1977 to treat a class II malocclusion. The inclined planes guide the mandible forward into a class I occlusion. The document further describes the skeletal and dental changes caused by Twin Block therapy, as well as the standard construction and stages of treatment. It covers indications, contraindications and modifications of Twin Block appliances.
This document provides an overview of rapid maxillary expansion (RME) in orthodontics. It discusses the history of RME dating back to 1860. It also covers anatomy related to RME, including the midpalatal suture. Key topics covered include indications and contraindications for RME, types of expansion screws used, jackscrew turn schedules, and different types of RME appliances such as the Haas expander and Hyrax expander. The document is an educational resource on the clinical use and mechanics of RME.
This article reviews different methods of maxillary expansion including rapid maxillary expansion (RME), slow maxillary expansion (SME), and surgically-assisted maxillary expansion. RME uses appliances like Haas or Hyrax expanders to apply heavy forces and separate the midpalatal suture quickly in 2-3 weeks. SME uses appliances like quad helix or coils to apply lighter, continuous forces over months. Surgically-assisted expansion is used when expansion is needed in older patients after suture closure. Maxillary expansion treats transverse deficiencies, crossbites, and improves nasal breathing. Complications can include discomfort, relapse, and tooth tipping.
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 document discusses the etiology of temporomandibular disorders (TMDs). It covers the history and terminology of TMDs and various theories that have been proposed to explain their etiology, including the mechanical displacement theory, trauma theory, biomedical theory, osteoarthritic theory, muscle theory, neuromuscular theory, psychophysiological theory, multifactorial theory, and biopsychosocial model. It also discusses predisposing factors, initiating factors, perpetuating factors, and contributing factors to TMDs. Specific etiologic considerations covered include occlusal factors, trauma, emotional stress, deep pain input, and parafunctional habits.
The document discusses various modifications that have been made to the original Herren activator appliance. It describes appliances that have one rigid acrylic mass but with reduced bulk, as well as appliances consisting of two parts joined by wire bows to reinforce muscle impulses. Some modifications discussed include the Eschler modification from 1952, Herren's activator from 1953, the LSU activator, elastic open activator, bow activator, Harvold Woodside activator, Karwetzky appliance, propulsor, cutout activator, and magnetic activator device. The document provides details on the design and intended use of several of these modified activator appliances.
Optimal orthodontic force /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
This document provides an overview of functional appliances used in orthodontic treatment. It begins with definitions of functional appliances and a brief history of their development. It then discusses the basis, classification, forces, treatment principles, indications, actions, case selection, and common appliances like the activator, frankel regulator, bionator, twin block, and Herbst appliance. It provides details on their design, indications, mode of action, and advantages. In summary, the document serves as a comprehensive guide to functional appliances, their development and use in orthodontic treatment.
This document provides information on performing a functional examination as part of an orthodontic diagnosis. It discusses examining the postural rest position and maximum intercuspation, as well as the temporomandibular joint, orofacial dysfunction, and various functional movements. Methods for determining and registering the postural rest position are described. Examination of swallowing, tongue posture, speech, lips, respiration, and craniofacial skeletal relationships are also covered to evaluate orofacial dysfunction. The document emphasizes that a functional examination is important for a complete orthodontic diagnosis beyond just a static evaluation of dental relationships.
This document provides an overview of twin block therapy. It discusses the history, philosophy, design, construction, and stages of treatment using twin blocks. Twin blocks are functional appliances composed of separate upper and lower bite blocks. They are worn 24 hours a day to achieve rapid correction of malocclusions through forces transmitted to inclined planes covering the posterior teeth. Treatment typically involves an initial active phase followed by a support phase to stabilize results.
This document discusses the management of vertical maxillary excess. It begins by outlining treatment approaches for mixed and permanent dentition, including habit breaking appliances, myotherapy, functional appliances, and orthodontic appliances. It then discusses specific treatment options in more detail, such as altering breathing mode, myotherapy exercises and appliances, habit breaking appliances like tongue cribs and vestibular screens, and functional appliances like activators. The document emphasizes the importance of proper diagnosis and treatment planning for managing vertical malocclusions.
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 presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
The document discusses temporary anchorage devices (TADs) used in orthodontic treatment. It defines TADs as devices that are temporarily fixed to bone to enhance orthodontic anchorage and are later removed. The document covers the history of TADs, classifications based on materials and design, indications for use, surgical procedures for placement, and factors involved in success and failure. It provides examples of different TAD systems and discusses considerations for biomechanics, long-term stability and failure of implants.
This document presents an overview of the activator appliance. It defines the activator, discusses its history and evolution. It outlines the indications and contraindications for activator use. The advantages and disadvantages are described. The components, mode of action, and modifications of different types of activators are explained. Case reports and references are also listed at the end. The document provides a comprehensive review of the activator appliance.
TMA is an archwire material that is intermediate in stiffness between stainless steel and nickel titanium. It has good flexibility and springback along with predictable moderate forces that provide consistent tooth movement. TMA can be used in all stages of treatment but is especially useful as a main working archwire due to its properties. It is formable, weldable, and delivers approximately half the force of stainless steel.
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 document provides an overview of cephalometrics including:
- Definitions of cephalometrics as the scientific measurement of the bones of the cranium and face using lateral radiographs.
- The goals of cephalometrics which are to evaluate relationships between the five major facial components.
- Types of cephalometric landmarks including anatomical, derived, hard tissue, and soft tissue landmarks.
- Examples of important cephalometric landmarks such as nasion, orbitale, pogonion, sella, point A, and point B.
- Classification of cephalometric lines and planes as horizontal or vertical including planes such as the SN plane, Frankfort horizontal, and mandibular plane.
The document discusses Wolff's law which states that bone remodels in response to stresses placed upon it. It then discusses different types of functional appliances used in orthodontics including myotonic appliances which rely on muscle mass/resting pressure and myodynamic appliances which make use of muscle activity/movement. The controversy around the degree of bite opening with appliances like activators is also summarized. The document argues that light bite opening may stimulate muscles and growth, while more opening relies on soft tissue stretching.
Orthodontic study models are three-dimensional plaster reproductions of a patient's teeth and surrounding tissues that are used to accurately diagnose and monitor orthodontic treatment. The document outlines the requirements, uses, and proper procedures for fabricating and trimming study models. Key steps include accurately reproducing the dental anatomy, trimming bases and backs at specific angles, and using wax bites and articulators to achieve proper occlusion. Study models provide a permanent record for treatment planning, evaluation, and legal documentation of a patient's orthodontic condition and progress.
The document provides information on Twin Block appliances. It begins with describing the history, design, and mechanism of Twin Block appliances. Twin Blocks consist of separate upper and lower bite blocks with inclined planes. They were developed in 1977 to treat a class II malocclusion. The inclined planes guide the mandible forward into a class I occlusion. The document further describes the skeletal and dental changes caused by Twin Block therapy, as well as the standard construction and stages of treatment. It covers indications, contraindications and modifications of Twin Block appliances.
This document provides an overview of rapid maxillary expansion (RME) in orthodontics. It discusses the history of RME dating back to 1860. It also covers anatomy related to RME, including the midpalatal suture. Key topics covered include indications and contraindications for RME, types of expansion screws used, jackscrew turn schedules, and different types of RME appliances such as the Haas expander and Hyrax expander. The document is an educational resource on the clinical use and mechanics of RME.
This article reviews different methods of maxillary expansion including rapid maxillary expansion (RME), slow maxillary expansion (SME), and surgically-assisted maxillary expansion. RME uses appliances like Haas or Hyrax expanders to apply heavy forces and separate the midpalatal suture quickly in 2-3 weeks. SME uses appliances like quad helix or coils to apply lighter, continuous forces over months. Surgically-assisted expansion is used when expansion is needed in older patients after suture closure. Maxillary expansion treats transverse deficiencies, crossbites, and improves nasal breathing. Complications can include discomfort, relapse, and tooth tipping.
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 document discusses the etiology of temporomandibular disorders (TMDs). It covers the history and terminology of TMDs and various theories that have been proposed to explain their etiology, including the mechanical displacement theory, trauma theory, biomedical theory, osteoarthritic theory, muscle theory, neuromuscular theory, psychophysiological theory, multifactorial theory, and biopsychosocial model. It also discusses predisposing factors, initiating factors, perpetuating factors, and contributing factors to TMDs. Specific etiologic considerations covered include occlusal factors, trauma, emotional stress, deep pain input, and parafunctional habits.
This document discusses periodontal response to external forces on teeth. It defines trauma from occlusion as injury to tissues from forces exceeding their adaptive capacity. Trauma can be acute or chronic, and primary (normal support) or secondary (reduced support). It discusses classifications and concepts around how gingival inflammation spreads to bone. Glickman's concept describes zones of irritation and co-destruction that are differentially affected. Waerhaug's concept is that bone loss is due exclusively to plaque inflammation. The stages of tissue response to increased forces are injury, repair, and adaptive remodeling.
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
0091-9248678078
This document provides a classification system and overview of various temporomandibular joint (TMJ) disorders. It discusses masticatory muscle disorders including protective co-contraction, local muscle soreness, myospasm, and myofascial pain. It also covers TMJ disorders such as derangement of the condyle-disc complex, structural incompatibilities, and various inflammatory disorders of the TMJ. Chronic mandibular hypomobility disorders and growth disorders are also summarized. The document provides details on causes, symptoms, clinical features and treatment for each condition.
Facial symmetry is an important factor in physical attractiveness and is influenced by traits like averageness and youthfulness. The document discusses methods for evaluating normal facial symmetry, including determining facial height and width by dividing the face into vertical fifths with the eye width as a measurement point. Common causes of facial asymmetry are also outlined, such as congenital defects, trauma, infections, and tumors. Treatment options depend on the severity and include growth modification, orthodontic camouflage, and orthognathic surgery to correct skeletal asymmetries.
1. Temporomandibular disorders (TMD) are a broad group of clinical problems involving the masticatory musculature, temporomandibular joint, and surrounding tissues.
2. Common causes of TMD include trauma, microtrauma from bruxism or malocclusion, and emotional or sleep disturbances.
3. Classification systems organize TMD into categories such as joint disorders, muscle disorders, and associated problems to guide diagnosis and treatment.
The periodontal pocket is a pathologically deepened sulcus that is a key feature of periodontal disease. It develops as plaque causes gingival inflammation that leads to migration of the junctional epithelium and destruction of supporting tissues. Pockets are classified by morphology as gingival pockets from enlarged gingiva or periodontal pockets from true tissue loss, and by number of tooth surfaces involved. Periodontal pockets contain bacteria and experience cycles of activity and quiescence that further deepen the pocket and destroy bone and connective tissue.
1. The document discusses key concepts related to occlusion and articulation including centric relation, centric occlusion, and maximal intercuspal position.
2. It provides guidelines for making wax rims and records for edentulous patients including determining the occlusal vertical dimension and freeway space.
3. The process of making a centric relation record is described which involves using bimanual manipulation to guide the mandible into the centric position while soft tissue is registered.
This document defines and discusses trauma from occlusion (TFO). It describes the physiologic capacity of the periodontium to adapt to occlusal forces. Factors that can increase traumatic forces include magnitude, direction, and duration of forces. TFO is classified as acute, chronic, primary, secondary, or combined. Clinical features may include mobility, pain, fremitus, and radiographic findings like increased periodontal ligament space. Treatment aims to maintain the periodontium in comfort and function through approaches like occlusal adjustment, parafunctional habit management, stabilization, orthodontics, reconstruction, or extractions.
In prosthodontics, replacing the missing, without affecting the other components of the masticatory system has two main reference the maximum intercupation and the centric relation.
In this lecture discussion of centric relation as reference is exposed.
Natural head position /certified fixed orthodontic courses by Indian dental a...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
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Temporomandibular disorders (TMD) can affect edentulous patients. While edentulous patients generally present with fewer TMD symptoms than dentate patients, the prevalence of TMD in complete denture wearers is estimated to be 15-25%. Tooth loss is considered a predisposing factor for TMD as it reduces occlusal support and proprioceptive feedback. Several factors can contribute to the development and progression of TMD in edentulous patients, including loss of vertical dimension, parafunctions like bruxism, trauma, psychosocial stress, and hormone levels. Classification systems for TMD in edentulous patients consider the degree of TMJ changes and associated symptoms.
The document discusses the relationship between occlusion and temporomandibular disorders (TMDs). It notes that while occlusion is not the sole cause of TMDs, it can be a contributing factor through its effects on orthopedic stability. Orthopedic stability exists when the stable intercuspal position (ICP) of the teeth is aligned with the musculoskeletal stable position of the condyles. Misalignment between ICP and the condylar position can lead to orthopedic instability over time if heavy forces are placed on the system. The degree of orthopedic instability and the loading forces are factors that influence the risk of developing intracapsular TMD disorders.
The document discusses various theories regarding the etiology of temporomandibular disorders (TMDs). It covers early theories that emphasized occlusal factors or trauma, as well as more modern theories that consider TMDs to have a multifactorial etiology influenced by predisposing, initiating, and perpetuating factors. These factors include occlusal condition, trauma, emotional stress, deep pain input, and parafunctional habits. The document also discusses how functional and parafunctional muscle activities can be affected by the occlusal condition.
This case appears to involve myofascial pain originating from a whiplash injury rather than a TMJ disorder. Conservative treatments like physical therapy, massage, injections and occlusal splint may help relieve symptoms.
The role of orthodontics in temporomandibular disordersArdalan Azad
Temporomandibular disorder (TMD) is a common cause of facial pain that affects the jaw joint and muscles. The cause of TMD is poorly understood but factors like trauma, stress, genetics, and parafunctional behaviors are thought to play a role. While malocclusion was once thought to be a major cause of TMD, most studies now refute or reduce the role of occlusion in causing TMD. Orthodontic treatment is also generally not associated with increased risk of developing TMD. It is still advised to screen patients for TMD before orthodontic treatment and manage any existing TMD symptoms conservatively.
Temporomandibular Joint And Its Homeopathic Treatment.pptxMahavratPatel
The temporomandibular joints (TMJ) are the 2 joints that connect your lower jaw to your skull. More specifically, they are the joints that slide and rotate in front of each ear, and consist of the mandible (the lower jaw) and the temporal bone (the side and base of the skull). The TMJs are among the most complex joints in the body. This joint is unique in that it is a bilateral joint that functions as one unit. Since the TMJ is connected to the mandible, the right and left joints must function together and therefore are not independent of each other.
This document provides a narrative review of the relationship between temporomandibular disorders (TMDs) and dental occlusion. It discusses two scenarios: 1) TMD as an etiological factor in dental occlusal changes, and 2) the role of dental occlusion as a causative factor in the genesis of TMDs. The review found that various TMDs can lead to secondary changes in dental occlusion, such as posterior open bite, anterior open bite, and crossbites. However, the role of occlusion as a primary causative factor in TMDs is considered low to very low based on systematic reviews. The distinction between occlusion changes caused by TMDs versus other factors is important for successful treatment management.
tempromandibuler disorder and ortho treatment ppt.pptxDelkhaz Ameide
This document discusses temporomandibular disorders (TMD) and their relationship to orthodontic treatment. It begins by introducing TMD as a common orofacial pain condition involving the TMJ and surrounding muscles. The objectives are to determine if orthodontic treatment causes or cures TMD, and to establish if evidence shows active orthodontic intervention leads to TMD. It then reviews the epidemiology of TMD according to numerous studies, finding high prevalence of symptoms and signs. Causes of TMD are discussed, including occlusion, trauma, stress, and parafunctional habits. Signs and symptoms of TMD are outlined. The document concludes by describing classifications of TMD including muscle disorders, internal derange
Tmd in orthodontics /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The document discusses temporomandibular disorders (TMD) in orthodontics. It covers definitions of TMD, the historical background and classifications. The relationship between TMD and orthodontic treatment is examined. Etiology is multifactorial and can include anatomical, psychological and neuromuscular factors. Symptoms commonly seen in TMD include pain in the jaw joints or muscles, joint sounds like clicking or crepitus, and limited jaw movement. Epidemiological studies find a high prevalence of TMD signs and symptoms.
This document provides an overview of temporomandibular disorders (TMDs), including:
- TMDs have multiple potential etiologies like parafunctional habits, trauma, and joint laxity.
- Symptoms affect 65-85% of people at some point and include jaw and ear pain.
- Diagnosis involves history, exam, and imaging like MRI to assess the disc position.
- Common types are myofascial pain, anterior disc displacement, and degenerative joint disease.
- Treatment depends on the disorder but may include exercises, appliances, medications, and surgery for issues like ankylosis.
Millions of people suffer from TMJ disorders in the US. Learn more about TMJ disorders, pain. In addition, learn more about a holistic and noninvasive approach to relieving pain associated with TMJ disorders.
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.
TMD in Relation to Malocclusion and Orthodontic Treatment BY Mohlin et.al pptDr. Yahya Alogaibi
This systematic review examines the relationship between temporomandibular disorders (TMD) and malocclusions. The review identified 9 studies that provided moderately strong evidence. These studies found that large overjets were associated with higher prevalence of TMD symptoms, though specific malocclusions could not be definitively linked to TMD. Longitudinal studies observing subjects from teenage years to age 30 showed reduction in most TMD signs over time. Psychological health and muscle strength may be as associated with TMD as malocclusion. More research is still needed, especially longitudinal studies observing subjects before and after treatment.
Identifying And Recovering From Tmj Injuries (Shorter Version)Dr. Steve Gamerman
1. Trauma is a main cause of temporomandibular joint (TMJ) disorders according to the National Institutes of Health. Whiplash injuries in particular put people at risk of developing delayed TMJ symptoms like pain and dysfunction.
2. Screening patients with headaches, neck pain, or facial pain for TMJ issues is important as undiagnosed TMJ disorders are a frequent cause of doctor visits. A questionnaire can help identify those who may need a TMJ evaluation.
3. Conservative treatments like physical therapy, appliances, and medications are recommended first for TMJ disorders before more invasive options. Headaches are a main symptom and may indicate muscle tension originating from the jaw, neck
1. Trauma is a main cause of temporomandibular joint (TMJ) disorders according to the National Institutes of Health. Whiplash injuries in particular put people at risk of developing delayed TMJ symptoms like pain and dysfunction.
2. Screening patients with headaches, neck pain, or facial pain for TMJ issues is important as undiagnosed TMJ disorders are a frequent cause of doctor visits. A questionnaire can help identify those who may need a TMJ evaluation.
3. Conservative treatments like physical therapy, jaw appliances, and medications are recommended first for TMJ disorders before more invasive options. Headaches are a main symptom and may indicate temporalis muscle damage from trauma.
This document discusses temporomandibular disorders (TMD) and their relationship to orthodontics. It begins by defining TMD as a cluster of joint and muscle disorders involving the temporomandibular joint and associated structures. The classification, etiology, epidemiology, symptoms, and signs of TMD are described. It notes that TMD has a multifactorial etiology involving anatomical, psychological, and neuromuscular factors. The document then discusses the examination, diagnostic imaging, and management of TMD, including two-phase therapy and different treatment modes. It emphasizes that the goal of orthodontic therapy is to develop a functional masticatory system while avoiding exacerbating TMD issues.
IS TEMPOROMANDIB ULAR JOINT (TMJ) A SIGNIFICANT AFFLICTION?anshifdr
The abbreviation TMJ, denoting the temporomandibular joint, frequently invokes visions of jaw anguish and discomfort. Yet, is TMJ indeed a grave
concern, or is it a predicament amenable to adept management and relief
through an appropriate strategy? In this article, we will delve into TMJ maladies, their potential gravity, and what recourse is available for individuals
grappling with TMJ-related tribulations
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
1.whiteboard lecture presentations
2.Case Discussions
3.with hundreds of pictures.
4.Demo on Models
5.Demo on Patients
6. subtitles in your own language
12 months unlimited access and support @350 USD only.
For Demo please visit :www.idalectures.com/preview/
For more details visit: www.idalectures.com
Please contact us for any clarifications:
idalectures@gmail.com
indiandentalacademy@gmail.com
Thanks & Regards
Indian Dental Academy
--
Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
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
Cytotoxicity of silicone materials used in maxillofacial prosthesis / 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.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian 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.for more details please visit
www.indiandentalacademy.com
Properties of Denture base materials /rotary endodontic coursesIndian 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.for more details please visit
www.indiandentalacademy.com
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
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
This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
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
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
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
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
5. Occlusal conditions
Parafunctional habits
Trauma
Emotional stress
Deep pain output
Signs and symptoms of TMDS
Functional disorders of muscles
Functional disorders of TMJ
Functional disorders of teeth
Other signs and symptoms
Summary
Conclusion
References
5www.indiandentalacademy.com
6. Introduction:
The masticatory apparatus is specialized unit that
performs multiple functions including those of speaking,
cutting & grinding food & swallowing.
TMJ disorder (TMD) are among the most misdiagnosed &
mistreated maladies in medicine.
Multifactorial origin
The term TMD are collective term embracing a member
of clinical problems that involve the masticatory
musculatures, the TMJ & associated structure or both
6www.indiandentalacademy.com
7. This disorders are characterized by
Facial pain in the region of the TMJ & for the muscle of
mastication.
Limitation or deviation in the mandibular range of
motion.
TMJ sounds during jaw movements & function.
History:
348 BC: Hippocrates described a condition of TMJ
dislocation.
1814: Hey had described internal derangement for a
localized mechanical fault interfering with smooth
articular function.
7www.indiandentalacademy.com
8. 1842: Cooper reported on subluxation of the TMJ as a
distinct entity. He observed patients with snapping jaw &
registered this symptom as an “ internal derangement of
the jaws”
1887: Surgical correction was described by Annandale.
1918: Pringle explained clicking & popping of the TMJ as a
sign of anterior displacement of the meniscus.
1934: Costen was first to indicate an occlusal etiology in
TMJ pain. He reported association of the bite over closure
with symptoms like ear pain, sinus pain, decreased
hearing, tinnitus, dizziness, burning & vertigo & occipital
headache.
8www.indiandentalacademy.com
9. 1947: Norgaard used orthographic techniques to
radiographically demonstrate anterior disc displacement
in clicking or popping TMJ.
1950-60: muscular cause not directly related to occlusion
was proposed
Schwartz coined the term Temporomandibular pain
syndrome.
1970: advances in diagnostic imaging have resulted a
better understanding of the intracapsular problem
associated with TMD.
Farrar & McCarthy rejuvenated the concept of internal
derangement with meniscus displacement.
9www.indiandentalacademy.com
10. Definition of TMD
Acc to Schiffman, Haley, Shapiro (1990)
the TMD encompasses many disorders of the masticatory
musculature (i.e. myositis, muscle spasm, muscle
contracture, & myofascial pain syndrome)
and TMJ ( internal derangements with or without
reduction and degenerative joint disease)
The AAOP ( in 1993 & 1996) refined TMD as a
collective term embracing a number of clinical problems
that involve the masticatory musculature, the
temporomandibular joint and associated structures or
both.
10www.indiandentalacademy.com
11. GPT - 8
Conditions producing abnormal , incomplete or impaired
function of the temporomandibular joint.
A collection of symptoms frequently observed in various
combinations first described by Costen (1934) which he
claimed to be reflexes due to irritation of the
auriculotemporal nerve and / or corda tympanic nerve as
they emerged from tympanic plate.
11www.indiandentalacademy.com
12. It is caused by altered anatomic relations and
derangements of the TMJ associated with loss of
occlusal vertical dimension, loss of posterior tooth
support, and / or other malocclusions. The symptoms
can include headache about the vertex and occiput,
tannitus, pain about the ear, impaired hearing and
pain about the tongue.
12www.indiandentalacademy.com
13. Classification of diseases of Temporomandibular
joint
Bell in 1960
3 subgroups:
Intracapsular conditions
Capsular conditions
Extracapsular conditions
In 1982, 5 subcategories
Masticatory muscle disorder
Disk interference disorder
Inflammatory disorder
Chronic hypomobilities
Growth disorders
13www.indiandentalacademy.com
14. Acc. to American Academy of Orofacial Pain
Diagnostic category Diagnosis
Cranial bones Congenital & developmental disorders
Aplasia
Hypoplasia
Dysplasia(1st
& 2nd
brachial arch
anomalies, hemifacial microsomia,
Pierre syndrome, Treacher Collin
syndrome)
Condylar hyperplasia
Prognathism, fibrous dysplasia.
Acquired disorders
Neoplasia
Fracture
14www.indiandentalacademy.com
15. Temporomandibular joint
disorders
Deviation in form
Disk displacement
(with reduction; without reduction)
Dislocation
Inflammatory conditions (synovitis,
capsulitis)
Arthritides (osteoarthritis,
osteoarthrosis polyarthritides)
Ankylosis (fibrous, bony)
Neoplasia
Masticatory muscle
disorders
Myofascial pain
Myositis
Spasm
Protective splinting
Contracture 15www.indiandentalacademy.com
17. Epidemiology
Between 65 and 85% of people experience some symptoms
of TMD during their lives, and approximately 12% experience
prolonged pain or disability that results in chronic
symptoms.
Only about 5 to 7% have symptoms severe enough to need
treatment.
TMD patients are similar to headache and back pain patients
with respect to disability, psychosocial profile, and pain
intensity, chronicity, and frequency.
17www.indiandentalacademy.com
18. The lower prevalence of TMD signs and symptoms in
older age groups supports the probability that most TMD
are self-limiting.
TMD are most prevalent between the ages of 20 and 40
years and predominantly affect women.
The reason why women make up the majority of patients
presenting for treatment is still unclear.
In a community-based study, a greater likelihood of
developing TMD was found if oral contraceptives were
used and, in women over 40 years of age, if estrogen
replacement was used.
18www.indiandentalacademy.com
19. While the prevalence of TMD is highest in the 20-
to 40-year age range, signs and symptoms of masticatory-
muscle and joint dysfunction are commonly observed in
children.
The cause may be acute reactive depression, disk
displacement, with or without reduction, internal
derangement due to previous injury.
19www.indiandentalacademy.com
21. Development of functional
disturbances in the masticatory
system
TMD symptoms
Normal
function
+
event
>physiologic tolerance
=
21www.indiandentalacademy.com
23. Events
During normal function of the masticatory system,
events can occure that may influence function.
Local events
systemic events.
23www.indiandentalacademy.com
24. Local events
Any change in sensory or proprioceptive input.
Placement of improperly occluding crown
or it may be secondary to trauma involving local
tissues e.g. post injection response of L.A.
trauma due to wide opening (i.e. strain) or
unaccustomed use (i.e. bruxisum).
24www.indiandentalacademy.com
25. systemic events
The entire body and CNS are involved.
E.g. emotional stress.
25www.indiandentalacademy.com
26. Physiologic tolerence
All individuals do not respond in the same manner to
the same event.
Each patient has the ability to tolerate certain events
without any adverse effect this is called physiologic
tolerance which can be influenced by both local and
systemic factors.
26www.indiandentalacademy.com
27. Local factors
Lack of occlusal stability- genetic, developmental, or
iatrogenic causes.
TMJ instability- alteration in normal anatomic form
e.g.- disc displacement, arthritic conditions, lack of
harmony between stable intercuspal position (ICP)
and musculoskeletally stable (MS) position of the
joint.
27www.indiandentalacademy.com
28. Systemic factors
Systemic factors which influence the patient’s
physiologic tolerance are, genetic, gender, diet, acute
and chronic diseases, overall physical condition of the
patient.
28www.indiandentalacademy.com
29. Structural tolerance and
development of symptoms.
When functional change exceeds a critical level,
alteration of tissues begins this level is called
structural tolerance level.
The initial breakdown is seen in the structures with
the lowest structural tolerance.
Therefore the breakdown sites varies from individual
to individual.
29www.indiandentalacademy.com
31. The etiology of TMD remains mired in
controversy. It is generally agreed that the
etiology of symptoms of TMD is
multifactorial. That is several different
factors acting alone, or in varying
combinations may be responsible.
31www.indiandentalacademy.com
32. Predisposing factor – factors that increase the risk
of TMD or orofacial pain developing.
Initiating factors – factors that cause the onset of
disorder.
Perpetuating factors – factors that interfere with
healing and complicate management .
32www.indiandentalacademy.com
33. Predisposing factors can be subdivided into :
Systematic factors – medical conditions such as
rheumatic infections, nutritional and metabolic
disorders can influence masticatory system to an
extent that TMD may emerge.
Psychologic factors - Personality, behaviour can
affect masticatory system.
33www.indiandentalacademy.com
34. Structural factors – All types of occlusal
discrepancies, improper dental treatment,
postural abnormalities ,skeletal deformation, past
injuries etc.
Genetic factors.
34www.indiandentalacademy.com
35. Direct precipitating or initiating
component:
Trauma from hyperextension (e.g. dental procedure,
oral intubation for G. A., yawning, hyperextension
associated with cervical trauma)
Micro & macro trauma
Adverse or overloading of joint structures
Parafunctional habits (nocturnal bruxing, tooth
clenching, lip or cheek biting)
35www.indiandentalacademy.com
36. Perpetuating factors or sustaining factors:
Mechanical & muscular stress
Metabolic problems
Mainly behavioral, social & emotional
difficulties
36www.indiandentalacademy.com
37. Five major factors associated with TMD
1) Occlusal condition
2) Trauma
3) Emotional stress
4) Deep pain input
5) Parafunctional activities.
37www.indiandentalacademy.com
38. occlusal condition.
Pullinger et al. (j prosthet dent 2000,83:66-75),
studied 11 possible occlusal factors.
Concluded that,
No single occlusal factor was able to differentiate
patient from healthy subjects.
Four factors, however occurred mainly in TMD
patients and were rare in normal subjects
38www.indiandentalacademy.com
39. 1) The presence of a skeletal anterior open bite.
2) Retruded contact position (RCP) and ICP slides of
greater than 2mm.
3) Overjets of greater than 4mm.
4) Five or more missing and unreplaced posterior
teeth.
39www.indiandentalacademy.com
40. Dynamic relationship between
occlusion and TMD
Occlusal conditions affects TMD by one of the two
ways
1) Occlusal conditions affects the orthopedic stability
of the mandible.
2) Acute changes in occlusion .
40www.indiandentalacademy.com
43. Degree of orthopedic instability- discrepancy more
than 1-2 mm
Amount of loading- bruxers are affected more than
non- bruxers
43www.indiandentalacademy.com
44. Acute changes in occlusion and
TMD
Mainly affects the activities of masticatory muscles.
Muscle activities are basically divided in to
1) Functional (chewing, speaking, swallowing)
2) Parafunctional (clinching and bruxism)
44www.indiandentalacademy.com
46. Occlusal contacts and muscle
hyperactivity
Precise effect of the occlusal condition on muscle
hyperactivity has not been clearly established.
Williamson and Landquist demonstrated that
certain posterior contacts can increase activity of
the elevator muscles.
But Rugh et al. Shown that premature occlusal
contacts do not increase bruxing activity (no
correlation between occlusal contacts and muscle
activities).
46www.indiandentalacademy.com
47. The difference between first and second study:- first
study assesed the effects of occlusal contacts on
conscious and controlled, voluntary mandibular
movements (controlled by peripheral nervous system)
while the second study assessed subconscious and
uncontrolled, involuntary muscle activity (bruxisum)
(controlled by CNS).
47www.indiandentalacademy.com
48. Thus sudden changes that disrupts the ICP can lead
to a protective response of the elevator muscles (i.e.
protective co-contraction) in conscious state which
may lead to pain.
But this increased tonus or change in ICP do not
cause any increase in bruxing activity which is
controlled by CNS.
48www.indiandentalacademy.com
49. Chronic occlusal interferences
1) Most common way is to alter muscle engrams so as
to avoid the potentially damaging contacts and get on
with the task of function.
2) Tooth movement to accommodate heavy loading.
Bruxism never occurs or accentuates because of
occlusal problems.
49www.indiandentalacademy.com
50. Problems with bringing the teeth into occlusion are
answered by muscles. However, once the teeth are in
occlusion, problem with loading the masticatory
structures are answered in the joints.
Therefore if one of these conditions exists, dental
therapy is likely indicated.
50www.indiandentalacademy.com
51. Trauma
Trauma seems to have greater influence on
intracapsular disorders than muscular disorders.
Two types
1) Macrotrauma- any sudden force that can result
in structural alteration e.g. blow on the face.
2) Microtrauma:- any small force that is repeatedly
applied to the structures over a long period of time
e.g. bruxism, clinching.
51www.indiandentalacademy.com
52. Macro trauma
Sudden force on the condyle.
It can be direct or indirect.
The direct macro trauma can be open mouth trauma
or closed mouth trauma.
52www.indiandentalacademy.com
53. Open mouth direct macro
trauma
Blow to the chin, when the teeth are separated (i.e.,
open-mouth trauma)- the condyle can be suddenly
displaced from the fossa - ligaments resist this sudden
displacement.
If the force is great, the ligaments can become
elongated - resulting increased looseness can lead to
discal displacement and to the symptoms of clicking
and catching.
Unexpected macrotrauma to the jaw (as might be
sustained during a fall or in a motor vehicle accident)
may lead to discal displacement, dislocation, or both.
53www.indiandentalacademy.com
54. Closed mouth direct macro trauma
Macrotrauma can also occur when the teeth
are together (i.e., closed-mouth trauma) - the
intercuspation of the teeth maintains the jaw
position, resisting joint displacement.
Closed-mouth trauma is therefore less injurious to
the condyle-disc complex.
Athletes who wear soft, protective mouth
appliances have significantly fewer jaw-related
injuries than those who do not.
54www.indiandentalacademy.com
55. Although ligaments may not be elongated,
articular surfaces can certainly receive sudden
traumatic loading. This type of impact loading may
disrupt the articular surface of the condyle, fossa
or disc, which may lead to alterations in the
smooth sliding surfaces of the joint, causing
roughness and even sticking during movement.
Therefore this type of trauma may result in
adhesions.
55www.indiandentalacademy.com
56. Indirect macro trauma
Indirect trauma refers to injury that may occur to the
TMJ secondary to a sudden force, but not one that
occurs directly to the mandible. The most common
type of indirect trauma reported is associated with a
cervical flexion-extension injury (i.e., whip-lash
injury).
56www.indiandentalacademy.com
58. Microtrauma
Microtrauma refers to any small force that is
repeatedly applied to the joint structures over a long
period of time loading exceeds the function-al limit of
the tissue, irreversible changes or dam-age can result.
When the functional limitation has been exceeded,
the collagen fibrils fragmented, resulting in a
decrease iness of the collagen network. This allows
proteoglycan-water gel to swell and flow out the joint
space, leading to a softening of articular surface. This
softening is called chondromalacia.
58www.indiandentalacademy.com
59. Regions of fibrillation can begin to develop, resulting
in focal roughening of the articular surfaces. This
alters the frictional characteristics of the surface and
may lead to sticking of the articular surfaces, causing
changes in the mechanics of condyle-disc movement.
Continued sticking, roughening, or both leads to
strains on the discal ligaments during movements
and eventually to disc displacements.
Another way in which micro trauma affects is the
hypoxia-reperfusion theory.
59www.indiandentalacademy.com
61. Another type of microtrauma results from
mandibular orthopedic instability. As previously
described, orthopedic stability exists when the stable
ICP of the teeth is in harmony with the
musculoskeletally stable (MS) position of the
condyles
Bruxing patients with orthopedic instability are more
likely to create problems than nonbruxers with the
same occlusion.
61www.indiandentalacademy.com
62. Emotional stress
The emotional centers of the brain have an influence
on muscle function
Stress - activates hypothalamus - increase the activity
of the gamma efferents - the intrafusal fibers of the
muscle spindles contract.
Stress releasing mechanisms:- external and internal
62www.indiandentalacademy.com
63. Deep pain input
Deep pain input- centrally excites the brain stem-
produces muscle response (protective co-contraction)
It is normal body response to pain.
Intraoral pains like tooth pain, sinus pain, ear pain or
even remote facial pains like cervical pain input may
restrict the mouth opening.
63www.indiandentalacademy.com
64. Parafunctional activities
Two types
1) Diurnal- occurs during day.
2) Nocturnal - occures during night.
DIURNAL ACTIVITIES - clinching and grinding,
cheek and tongue biting, finger and thumb
sucking, unusual postural habits, occupation
related habits e.g. holding nails, pen in mouth,
holding objects like telephone, violin under the
chin.
64www.indiandentalacademy.com
65. Nocturnal activities
Clinching (single episode of muscular contraction)
Bruxing (rhythmic contractions)
causes of bruxing activities
emotional stress, certain medications, genetic
predisposition, CNS disturbances, occlusal
interferences ???
65www.indiandentalacademy.com
68. A sign is an objective clinical finding that the
clinician uncovers during a clinical examination.
A symptom is a description or complaint reported by
the patient
patients are acutely aware of their symptoms yet may
not be aware of their clinical signs.
68www.indiandentalacademy.com
69. Clinical signs and symptoms of TMDs can be grouped
according to the structures affected
1) the Muscles.
2) the TMJs
3) the Dentition
69www.indiandentalacademy.com
70. Functional disorders of the
muscles
Two major symptoms
1) Pain
2) Dysfunction.
70www.indiandentalacademy.com
71. Pain
Pain felt in musculature is called myalgia.
Often associated with fatigue and tightness.
It is related to vasoconstriction of the relevant
nutrient arteries and accumulation of metabolic waste
products. Within the ischemic area of the muscle,
certain algogenic substances (e.g. bradykinin,
prostaglandins) are released, causing muscle pain
71www.indiandentalacademy.com
72. The severity of muscle pain is directly related to the
functional activity of the muscle involved. Therefore
patients often report that the pain affects their
functional activity.
When a patient reports pain during chewing or
speaking, these functional activities are not usually
the cause of the disorder.
72www.indiandentalacademy.com
73. Myogenous pain is a type of deep pain and, if it
becomes constant, can produce central excitatory
effects. These effects may present as sensory effects
(i.e.referred pain or secondary hyperalgesia) or
efferent effects (i.e. muscle effects), or they may even
present as autonomic effects.
Muscle pain can reinitiate more muscle pain (i.e., the
cyclic effect).
Another very common symptom associated with
masticatory muscle pain is headache.
73www.indiandentalacademy.com
74. Dysfunction
A decrease in the range of mandibular movement.
When muscle tissues have been compromised by
overuse, any contraction or stretching increases the
pain. Therefore to maintain comfort, the patient
restricts movement within a range that does not
increase pain levels. Clinically this is seen as an
inability to open widely.
74www.indiandentalacademy.com
75. An acute malocclusion may result from a sudden
change in the resting length of a muscle that controls
jaw position. When this occurs the patient describes
a change in the occlusal contact of the teeth.
The mandibular position and resultant alteration in
occlusal relationships depend on the muscles involved.
For example, slight functional shortening of the
inferior lateral pterygoid will cause disocclusion of the
posterior teeth on the ipsilateral side and premature
contact of the anterior teeth (especially the canines)
on the contralateral side.
75www.indiandentalacademy.com
76. With functional shortening of the elevator
muscles (clinically a less detectable acute
malocclusion), the patient will generally complain
of an inability to occlude normally. It is important
to remember that an acute malocclusion is the
result of the muscle disorder and not the cause
76www.indiandentalacademy.com
78. Events
Various types of events can interrupt normal muscle
function. These events can arise from either local or
systemic factors
Local events that acutely alter sensory or pro-
prioceptive input in the masticatory structures .
Systemic factors may also represent events that can
interrupt normal muscle function.
78www.indiandentalacademy.com
79. Local events
1) Fracture of tooth
2) Restoration in supraocclusion
3) Trauma to local tissues e.g. L.A. inj
4) Chewing hard food
5) Chewing for long period
6) Opening mouth too widely e.g. yawning, dental
treatments
79www.indiandentalacademy.com
81. Protective co-contraction
Protective co-contraction is a CNS response to injury or
threat of injury. This response has also been called
protective muscle splinting.
In the presence of an injury or threat of injury, normal
sequencing of muscle activity seems to be altered to
protect the threatened part from further injury.
This coactivation of antagonistic muscles is thought to be
a normal protective or guarding mechanism . If protective
co-contraction continues for several hours or days, the
muscle tissue can become compromised and a local
muscle problem may develop.
81www.indiandentalacademy.com
82. Local muscle soreness
Local muscle soreness is a primary, noninflammatory,
myogenous pain disorder (i.e., noninflammatory myalgia).
It is often the first response of the muscle tissue to
prolonged co-contraction.
Although co-contraction represents a CNS-induced
muscle response, local muscle soreness represents a
condition characterized by changes in the local
environment of the muscle tissues.
These changes are characterized by the release of certain
algogenic sub-stances (i.e., bradykinin, substance P, and
even histamine) that produce pain.
82www.indiandentalacademy.com
83. Along with protracted co-contraction, other causes of
local muscle soreness are local trauma or excessive use
of the muscle.
When excessive use is the cause, a delay in the onset
of muscle soreness can occur
Local muscle soreness presents clinically with muscles
that are tender to palpation and reveal increased pain
with function. Structural dysfunction is common, and
limited mouth opening results when the elevator
muscles are involved.
83www.indiandentalacademy.com
84. CNS EFFECTS ON MUSCLE PAIN
Activities within CNS either influence or
originates muscle pains
The CNS responds in this manner secondary to
one of three factors:
(1) the presence of ongoing deep pain input,
(2) increased levels of emotional stress (i.e., up-
regulation of the autonomic nervous system), or
(3) changes in the descending inhibitory system that
lead to a decrease in the ability to counter the
afferent input.
84www.indiandentalacademy.com
89. They generally fall into three broad categories:
(1)derangements of the condyle-disc complex,
(2)structural incompatibility of the articular surfaces,
and
(3)inflammatory joint disorders
89www.indiandentalacademy.com
90. The two major symptoms of functional TMJ problems
are pain and dysfunction.
PAIN
Pain in any joint structure (including the TMJs) is
called arthralgia .
Three periarticular tissues contain such nociceptors:
(1) the discal ligaments, (2) the capsular ligaments,
and (3) the retrodiscal tissues.
90www.indiandentalacademy.com
91. Stimulation of the nociceptors creates inhibitory
action in the muscles that move the mandible.
Therefore when pain is suddenly and unexpectedly
felt mandibular movement immediately ceases (i.e.,
nociceptive reflex).
When chronic pain is felt, movement becomes
limited and very deliberate (i.e., protective co-
contraction).
91www.indiandentalacademy.com
92. Arthralgia from normal healthy structures of the joint
is a sharp, sudden, and intense pain that is closely
associated with joint movement. When the joint is
rested, the pain resolves quickly.
92www.indiandentalacademy.com
93. DYSFUNCTION
It presents as a disruption of the normal condyle-disc
movement, with the production of joint sounds .
The joint sounds may be a single event of short
duration, known as a click.
If this is loud it may be referred to as a pop.
93www.indiandentalacademy.com
94. Crepitation is a multiple, rough, gravel-like sound
described as grating and complicated.
Dysfunction of the TMJ may also present as catching
sensations when the patient opens the mouth.
Sometimes the jaw can actually lock.
94www.indiandentalacademy.com
96. CONTINUUM OF FUNCTIONAL
DISORDERS OF THE TMJ
Disorders of the TMJs may follow a path of pro-
gressive events, a continuum, from the initial signs of
dysfunction to osteoarthritis
96www.indiandentalacademy.com
97. 1. Normal healthy joint
2. Loss of normal condyle-disc function the result of
either:
a. Macrotrauma that resulted in elongation of the
discal ligaments
b. Microtrauma that created changes in the articular
surface, reducing the frictionless movement between
the articular surfaces
3. Significant translatory movement begins between disc
and condyle (resulting in displacement of disc)
4. Posterior border of disc becomes thinned
5. Further elongation of discal and inferior
retrodiscal ligaments
97www.indiandentalacademy.com
98. 6. Disc becomes functionally displaced
a. Single click
b. Reciprocal click
7. Disc becomes functionally dislocation
a. Dislocation with reduction (i.e. catching)
b. Dislocation without reduction (i.e. closed lock)
8. Retrodiscitis
9. Osteoarthritis
98www.indiandentalacademy.com
100. Derangements of the Condyle-Disc
Complex
If the morphology of the disc is altered and the discal
ligaments become elongated, the disc is then
permitted to slide (i.e., translate) across the articular
surface of the condyle.
100www.indiandentalacademy.com
102. Alteration in the morphology of the disc accompanied by
elongation of the discal ligaments can change this normal
functioning relationship. In the resting closed joint position
the interarticular pressure is very low. If the discal ligaments
become elongated, the disc is free to move on the articular
surface of the condyle. Because in the closed joint position
the superior retrodiscal lamina does not provide much
influence on disc position, tonicity of the superior lateral
pterygoid muscle will encourage the disc to assume a more
forward position on the condyle.
The length of the discal ligaments and the thickness of the
posterior border of the disc will limit forward movement of
the disc.
102www.indiandentalacademy.com
103. If the pull of this muscle is protracted, over time
the posterior border of the disc can become more
thinned
This is called as functional disc displacement.
103www.indiandentalacademy.com
106. 1)During mandibular opening a sound is heard that
represents the condyle moving across the posterior
border of the disc to its normal position on the
intermediate zone. The normal disc-condyle
relationship is maintained through the remaining
opening movement.
2)During closing the normal disc position
is maintained until the condyle returns
to very near the closed joint position.
Characteristics of reciprocal click
106www.indiandentalacademy.com
107. 3)As the closed joint position is approached, the
posterior pull of the superior retrodiscal lamina is
decreased.
4)The combination of disc morphology and pull of the
superior lateral pterygoid allows the disc to slip back
into the more anterior position, where movement
began. This final movement of the condyle across the
posterior border of the disc creates a second clicking
sound and thus the reciprocal click.
107www.indiandentalacademy.com
108. As the disc becomes more flat, it further loses its
ability to self-position on the condyle, allowing more
translatory movement between condyle and disc.
The more freedom of the disc to move, the more
positional influence from the attachment of the
superior lateral pterygoid muscle.
Eventually the disc can be forced through the discal
space, collapsing the joint space behind.
108www.indiandentalacademy.com
109. When this occurs, interarticular pressure will
collapse the discal space, trapping the disc in the
forward position.
Then the next full translation of the condyle is
inhibited by the anterior and Medial position of
the disc.
The person feels the joint being locked in a limited
closed position because the articular surfaces have
actually been separated, this condition is referred
to as a functional dislocation of the disc
109www.indiandentalacademy.com
110. Functional dislocation Vs functional displacement
As previously described, a functionally displaced disc
can create joint sounds as the condyle skids across the
disc during normal translation of the mandible .If the
disc becomes functionally dislocated, the joint sounds
are eliminated because no skidding can occur.
110www.indiandentalacademy.com
111. Some persons with a functional dislocation of the
disc are able to move the mandible in various
lateral or protrusive directions to accommodate
the movement of the condyle over the posterior
border of the disc, and the locked condition is
resolved. If the lock occurs only occasionally and
the person can resolve it with no assistance, it is
referred to as a functional dislocation with
reduction. The patient will often report that the
jaw "catches" when opening wide.
111www.indiandentalacademy.com
113. when person is unable to return the dislocated disc to its
normal position on the condyle. The mouth cannot
be opened maximally because the position of the disc
does not allow full translation of the condyle .
Typically the initial opening will be only 25 to 30 mm
interincisally, which represents the maximum rotation of
the joint.
The person usually is aware of which joint is involved
and can remember the occasion that led to the locked
feeling. Because only one joint usually becomes locked,
a distinct pattern of mandibular movement is
observed clinically.
113www.indiandentalacademy.com
114. The joint with the functionally dislocated disc
without reduction does not allow complete
translation of its condyle, whereas the other joint
functions normally. Therefore when the patient opens
wide, the midline of the mandible is deflected to the
affected side. The dislocation without reduction has
also been termed a closed lock.
114www.indiandentalacademy.com
115. Closed lock / functional dislocation without reduction
115www.indiandentalacademy.com
116. Structural Incompatibility of the
Articular Surfaces
Smooth articulation of the TMJ is ensured by two
mechanisms: (1) boundary lubrication and (2) weeping
lubrication.
If static loading continues for a prolonged time, however,
weeping lubrication can become exhausted and sticking of
the articular surfaces can result. When the static loading is
finally discontinued and movement begins, a sense of
stiffness is felt in the joint until enough energy is exerted
to break apart the adhering surfaces.
This breaking apart of adherences can be felt as a click,
and it denotes the instant return to normal range of
mandibular movement
116www.indiandentalacademy.com
118. If however, the adherence remains for a significant
period of time, fibrous tissue can develop between the
articular structures ,and a true adhesion can develop.
This condition represents a mechanical connection
that limits normal condyle-disc-fossa function.
Another cause of adhesions is hemarthrosis (i.e.,
bleeding within the joint). The presence of blood by-
products seems to provide a matrix for the fibrous
unions found within adhesions.
Hemarthrosis can occur when the retrodiscal
tissues are disrupted by either external jaw trauma or
surgical intervention.
118www.indiandentalacademy.com
119. The morphologic characteristics of the surfaces
usually conform to each other closely. If the
morphology of the disc, condyle, or fossa is altered,
joint function can be impaired. For example, a bony
protuberance on the condyle or fossa may catch the
disc at certain degrees of opening, causing alterations
in function.
The disc itself may become thinned (as with disc
displacement) or even perforated, causing significant
changes in function.
These alterations in form can create click-ing and
catching of the jaw similar to that seen with
functional disc displacements.
119www.indiandentalacademy.com
121. Subluxation (hypermobility)
Some joint reveal that as the mouth opens to its
fullest extent, a momentary pause occurs, followed by
asudden jump or leap to the maximally open position.
This jump does not produce a clicking sound but
instead is accompanied by more of a THUD.
The examiner can readily see it by watching the side
of the patient's face. During maximum opening the
lateral poles of the condyles jump forward (i.e.,
subluxation), causing a noticeable preauricular
depression.
121www.indiandentalacademy.com
122. The cause of subluxation is usually not pathologic.
Subluxation is more likely to occur in a TMJ with an
articular eminence that has a short, steep posterior
slope followed by a longer, flatter anterior slope. The
anterior slope is often more superior than the crest of
the eminence
122www.indiandentalacademy.com
123. Spontaneous dislocation.
On occasion the mouth is opened beyond its normal
limit and the mandible locks. This is called
spontaneous dislocation or an open lock
With spontaneous dislocation the patient cannot
close the mouth. Wide opening (e.g., from an
extended yawn or a long dental procedure) almost
always produces this condition.
Spontaneous dislocation typically occurs in a patient
who has the fossa anatomy that permits subluxation.
123www.indiandentalacademy.com
126. Synovitis
Synovial tissues that lines the recess area of the joint
become inflamed.
Characterised by constant intracapsular pain that
enhances with joint movements.
130www.indiandentalacademy.com
127. Capsulities
Capsular ligament becomes inflamed.
Tenderness when the lateral pole of the condyle is
palpated.
Pain even in static position but joint movement
generally increase the pain.
131www.indiandentalacademy.com
128. Retrodiscities
Inflammation of retrodiscal tissues.
Constant dull aching pain that often increased by
clinching.
swelling may occur and force the condyle slightly
forward, down the Posterior slope of the articular
eminence.
This sum can cause an acute malocclusion. Clinically
such an acute malocclusion is seen as disengagement
of the ipsilateral posterior teeth and heavy contact of
the contralateral canines
132www.indiandentalacademy.com
129. As the disc is thinned and the ligaments become
elongated, the condyle begins to encroach on the
retrodiscal tissues. The first area of break-down is
the inferior retrodiscal lamina,which allows even
more discal displacement. With continued
breakdown, disc dislocation occurs and forces the
entire condyle to articulate on the retrodiscal tissues.
If the loading is too great for the retrodiscal tissue,
breakdown continues and perforation can occur.
With perforation of the retrodiscal tissues, the
condyle may eventually move through these tissues
and articulate with the fossa.
133www.indiandentalacademy.com
130. Arthritides.
Joint arthritides represent a group of disorders in
which destructive bony changes are seen.
Osteoarthritis: most common types of TMJ
arthritides represents a destructive process by which
the bony articular surfaces of the condyle and fossa
become altered. It is generally considered to be the
body's response to increased loading of a joints.
surface becomes softened (i.e., chondromalacia) and
the subarticular bone begins to resorb. Progressive
degeneration eventually results in loss of the
subchondral cortical layer, bone erosion, and
subsequent radiographic evidence of osteoarthritis.
134www.indiandentalacademy.com
131. Osteoarthritis is often painful, and jaw movement
accentuates the symptoms.
Crepitation (i.e., grating joint sounds) is a common
finding with this disorder. Osteoarthritis can occur
any time the joint is overloaded, but it is most
commonly associated with disc dislocation or
perforation
Although osteoarthritis is in the category of
inflammatory disorders, it is not a true inflammatory
condition. Often once loading is decreased, the
arthritic condition can become adaptive. The adaptive
stage has been referred to as osteoarthrosis
135www.indiandentalacademy.com
142. Management of TMDs and Occlusion. Jeffrey Okeson 5th
edt.
Functional occlusion from TMJ to smile design.
Dawson- 3rd
ed.
Color atlas of TMJ surgeries. Peter Quinn.
DCNA 2007, Jan, vol 51, no. 1 -TMDs and orofacial pain
Temperomandibular disorders – Weldon Bell
TMDs an evidence based approach to diagnosis and
treatment – Danial Laskin
146www.indiandentalacademy.com