SlideShare a Scribd company logo
Temporomandibular
joint, anatomy
histology and
development
Introduction
Development
anatomy
Articular disc
Retrodiscal tissue
Histology
Clinical consideration
conclusion
References

The efforts of the prosthodontist to record the movements of
the TMJ and to produce them on the articulator have been
the chief stimulus for studies on the functional structure of
this joint.
The purpose of this seminar is to focus attention on those
anatomic features which might provide a further basis for the
clinical management of the TMJ in prosthetic dentistry.
Development of the human temporomandibular joint.
Mérida-Velasco JR1
, Rodríguez-Vázquez JF, Mérida-Velasco JA, Sánchez-Montesinos I, Espín-Ferra J, 
Jiménez-Collado J. Anat. Res1 999 May 1;255(1):20-33.
A great deal of research has been published on the
development of the human temporomandibular joint
(TMJ). However, there is some discordance about its
morphological timing.
The most controversial aspects concern the moment of
the initial organization of the condyle and the squamous
part of the temporal bone, the articular disc and capsule
and also the cavitation and onset of condylar
chondrogenesis
A great deal of research has been published on the
development of the human temporomandibular joint
(TMJ). However, there is some discordance about its
morphological timing.
The most controversial aspects concern the moment of
the initial organization of the condyle and the squamous
part of the temporal bone, the articular disc and capsule
and also the cavitation and onset of condylar
chondrogenesis
 In the last few decades a
considerable amount of
research has been published
on the development of the
temporomandibular joint
 (Harpman and Woollard,
1938; Symons, 1952;
Moffett, 1957; Van Dongen,
1968; Perry et al., 1985).
 Studies have focused on the
development of the articular
disc and its relation with the
 Yuodelis, 1966a; Wong et al., 1985;
Smeele, 1990; Me
´ridaVelascoetal.,1993;O ¨ gu¨tcen-
TollerandJuniper, 1993, 1994); the
development of bony articular
elements (Baume, 1962; Yuodelis,
1966b; Baume and Holz, 1970;
Bach-Petersen et al., 1993);
 Coleman, 1970; Smeele, 1988; Rodrı´guez Va´zquez et al.,
1992, 1993; O ¨ gu¨tcen-Toller,1995). However few of these
studies have attempted to systematize chronologically
the morphological changes taking place in the
temporomandibular joint during development.
 Van der Linden et al. (1987) studied 52 human
embryos and fetuses, establishing the critical period
of TMJ morphogenesis between weeks 7 and 11 of
development
 Moreover, MoMorimoto et al. (1987) describes a
number of phases in development
Development of the human temporomandibular joint.
Mérida-Velasco JR1
, Rodríguez-Vázquez JF, Mérida-Velasco JA, Sánchez-Montesinos I, Espín-Ferra J
, Jiménez-Collado J. Anat. Res1 999 May 1;255(1):20-33.
 Three phases in the development of the
TMJ were identified.
 The first is the blastematic stage
(weeks 7-8 of development), which
corresponds with the onset of the
organization of the condyle and the
articular disc and capsule.
 During week 8 intramembranous
ossification of the temporal squamous
bone begins..
 The second stage is the cavitation stage
(weeks 9-11 of development), corresponding
to the initial formation of the inferior joint
cavity (week 9) and the start condylar
chondrogenesis.
 Week 11 marks the initiation of organization
of the superior joint cavity.
 And the third stage is the maturation
stage (after week 12 of development). This
work establishes three phases in TMJ
development: 1) the blastematic stage (weeks
7-8 of development)
 2) the cavitation stage (weeks 9-11 of
development)
 3) the maturation stage (after week 12 of
development).
 This study identifies the critical period of TMJ
morphogenesis as occurring between weeks 7
and 11 of development.
 The TMJ also known as cranio mandibular
joint is one of the complex, delicate and
highly used joints in a human body.
 It is the area where mandible articulates
with cranium.
 It is described as a
 complex ,
 compound,
 multiaxial ,
 synovial ,
 Ginglimoarthroidal joint.
introduction
 The area where the mandible
articulates with the cranium,
the TMJ, is one of the complex
joint in the body.
 It provides hinging movement in
one plane and therefore can be
considered a ginglymoid joint.
 However, at the same time it
also provides for gliding
movements, which classifies it
as arthroidal joint. Thus, it has
been technically considered as
ginglymoarthroidal joint.
 TMJ is classified as a compound joint.
 By definition, a compound joint requires the
presence of at least three bones, yet the TMJ is
made of only two bones.
Functionally, the articular disc serves as a
nonossified bone that permits the complex
movements of the joint.
Because the articular disc functions as a third bone,
the craniomandibular articulation is considered a
Okeson, management of temporomandibular disorders and occlusion 6th
edition. Mosby
elsevier
Components of the
joint:
 Articular surface of
the temporal bone
 The Condyle
 Articular disc/
Meniscus
 Ligaments
It is in the Sqamous portion of temporal
bone.
Consists of 3 parts:
Mandibular or glenoid fossa.
Articular eminence
Preglenoid plane.
Okeson. Management of temporomandibular disorder and
occlusion. 6th
edition. Elsevier mosby publication
It is the concave portion of the temporal
bone.
Boundaries:
Posteriorly: Squamotympanic or
Petrotympanic fissure
Medially: Spine of sphenoid
Laterally: Root of zygomatic process of
temporal bone
Anteriorly : Articular eminence
The glenoid fossa is covered by a dense, avascular
fibrocartilage consisting largely of bundles of
collagen fibres with occasional elastic fibres.
Okeson. Management of temporomandibular disorder and occlusion. 6th
edition.
Elsevier mosby publication
It is a small prominence on the
zygomatic arch.
It is thick and serves as functional
component of TMJ
On its lateral aspect, articular
tubercle is present which serves as
the point of attachment for the
collateral ligaments.
It is a cylindrical bony projection and
covered with a thin layer of fibro
cartilage.
The mandible is a U shaped
bone that articulates with the
temporal bone by means of
the articular surface of its
condyle.
The head is covered with
fibrocartilage and articulates with
temporal bone to form TMJ.
Okeson. Management of temporomandibular disorder and
occlusion. 6th
edition. Elsevier mosby publication
In the normal joint, the articular
surface of the condyle is located
on the intermediate zone of the
disc.
The shape of the disc is
determined by the morphology
of the condyle and mandibular
fossa.
The disc is somewhat flexible
and can adapt to the functional
demands of the articular
surface.
Okeson. Management of temporomandibular disorder and
occlusion. 6th
edition. Elsevier mosby publication
Okeson 6th
edition. Elsevier mosby publication
 From anterior view it has
medial and lateral
projections called poles
 Medial pole is generally
more prominent then
lateral pole
 Mediolateral length is
between 18 and 23mm
 Anterioposterior width is
between 8 and 10 mm
The articular disc is composed of dense
fibrous connective tissue, for the most part
devoid of any blood vessels or nerve fibers.
The extreme periphery of the disc,
however, is slightly innervated.
In the sagittal plane, it can be divided into
three regions according to thickness :
intermediate, anterior, and posterior.
The central area is the thinnest and is
called the intermediate zone.
Wink CS, St Onge M, Zimny ML: Neural elements in the human temporomandibular articular disc, J Oral Maxillofac Surg 50:334-337, 1992.
In sagittal plane it is divided into 3 planes.
1. Anterior band
2. Intermediate band
3. Posterior band
 The disc becomes considerably thicker both
anterior and posterior to the intermediate
zone.
 The posterior border is generally slightly
thicker than the anterior border.
 In the normal joint the articular surface of
the condyle is located on the intermediate
zone of the disc, bordered by the thicker
anterior and posterior regions.
 Acts as cushion
 Isolates synovial fluid
 Divides joint cavity
 Determinant in mandibular movement
The articular disc is attached posteriorly to a region
of loose connective tissue that is highly vascularized
and innervated .
This is known as the retrodiscal tissue or posterior
attachment.
Superiorly, it is bordered by a lamina of connective
tissue that contains many elastic fibers, the superior
retrodiscal lamina.
RETRODISCAL TISSUE
The superior retrodiscal lamina attaches the articular
disc posteriorly to the tympanic plate.
At lower border of the retrodiscal tissues is the inferior
retrodiscal lamina, which attaches the inferior border of
the posterior edge of the disc( the posterior margin of
the articular surface the condyle.
Okeson. Management of temporomandibular disorder and occlusion. 6th
edition. Elsevier
mosby publication
The inferior retrodiscal lamina composed chiefly of
collagenous fibers, not elastic fibers like the
superior retrodiscal lamina.
The remaining body of the retrodiscal tissue is
attached posteriorly to a large venous plexus, which
fills with blood as the condyle moves forward.
The superior and inferior attachments of the
anterior region of the disc are to the capsular
ligament, which surrounds most of the joint. The
superior attachment is to the anterior margin of the
articular surface of the temporal bone.
The inferior attachment is to the anterior margin
of the articular surface of the condyle.
Both these anterior attachments are composed
of collagenous fibers. Anteriorly, between the
attachments of the capsular ligament, the disc is
also attached by tendinous fibers to the superior
lateral pterygoid muscle.
Ligaments associated with the TMJ are composed of
collagen, which do not stretch and act
predominantly as restraints to motion of the condyle
and the disc.
They play an important role in protecting the
structures of the joint.
The TMJ has support of 3 functional ligaments and 2
accessory ligaments.
• Functional ligaments- Serve as major anatomical
component for the joint.
a] Collateral/Discal ligament
b] Capsular ligament
c] Temporomandibular ligament
• Accessory ligaments-Serve as passive restraints to
mandibular motion.
a] Sphenomandibular ligament.
b] Stylomandibular ligament.
COLLATERAL/DISCAL
ATTACHMENTS
These ligaments attach the articular disc to
the medial and lateral poles of the
condyle.
These are called the discal ligaments.
These are composed of collagenous
connective tissue fibers and they do not
stretch.
They function to restrict the movement of
the disc away from the condyle and permit
the disc to rotate anteriorly and posteriorly
on the condyle.
• The capsule of TMJ is described as fibrous
non elastic membrane surrounding the
joint.
• The capsule seals the joint and provides
passive stability.
• The active stability is achieved by
proprioceptive nerve endings in the
capsule which resist medial, lateral and
inferior forces thereby holding the joint
together.
• It offers resistance to movement of joint
only in the extreme range of motion.
• Secondary function of the capsular
ligament is to contain the synovial fluid
within the superior and inferior joint
spaces.
• It is located on the lateral
aspect of each TMJ.
• This ligament runs
downwards and
backwards from the
lateral aspect of the
articular eminence to the
posterior aspect of the
neck.
Okeson 6th
edition, elsevier. Mosby publication
Its function is to
limit the posterior
movement of the
condyle during
pivoting
movements such as,
when the mandible
moves laterally in
chewing position.
It also protects the
inner lateral
pterygoid muscle
from over
lengthening or
extension.
• The sphenomandibular
ligament arises from the
spine of the sphenoid
and extends downwards to a
small bony prominence on
the medial aspect of the
mandible called the lingula.
• It does not have any limiting
function on TMJ.
• It is a remnant of Meckels
cartilage.
• It assists the lateral pterygoid
in translatory and rotatory
movement.
• It arises from the styloid
process and extends
downwards and forwards to
the angle and posterior
border of the ramus of the
mandible.
• It limits the protrusive
movement of the mandible.
• It is taut in protrusion of
the mandible and relaxed
when the mandible is wide
opened.
The muscles of mastication are directly concerned
with mandibular movements in mastication and
speech.
4 pairs of muscles make up a group called the
muscles of mastication.
1. Masseter
2. Temporalis Accessory muscles
3. Medial pterygoid 1. Buccinator
4. Lateral pterygoid 2. Digastricus.
These four pairs of muscles attached to mandible,
primarily responsible for
Elevating
Depressing
Protruding
Retruding
Lateral movement
It is a quadrilateral muscle.
The fibers are arranged in3 layers
Superficial layer:
Origin : anterior 2/3 of inferior
surface of zygomatic arch.
& maxillary process of
zygomatic arch.
Insertion: angle of mandible ,
posterior half of the lateral
surface of mandibular
ramus.
Orbans
Middle layer:
Origin: medial aspect of 2/3 of
zygomatic arch.
Insertion: middle part of ramus.
Deep layer:
Origin: deep surface of zygomatic
arch.
Insertion : upper part of ramus &
coronoid process.
Most powerful closing muscle of
jaw
Action :
Elevates the mandible
to close the mouth.
Retraction of mandible
& clenching of teeth.
Superficial fibers help
in protrusion of
mandible.
This is a fan
shaped muscle
and fills the
temporal fossa.
The temporal
fascia covers the
muscle.
Origin:
Temporal fossa &
deep surface of
temporal fascia
Insertion:
Fibers converge to
insert on tip &
medial surface of
coronoid process of
mandible and
anterior border of
ramus of mandible
Action:
Anterior and middle
fibers elevate
mandible.
Posterior fibers retract
the mandible.
It is a quadrilateral
muscle with 2 heads.
A small superficial
head & a large deep
head.
Origin:
Superficial head: from
maxillary tuberosity
and adjoining
pyramidal process of
palatine bone.
Deep head: larger,
arises from medial
surface of lateral
pterygoid.
Insertion:
The fibres run
downwards, backwards
& laterally to insert
into medial surface of
the angle and
adjoining part of
ramus of mandible.
Actions:
When both side muscle
contracts together it
elevates the mandible
When one side muscle
contracts jaw is pulled to
opposite side.
It also helps in protrusion
of the mandible and helps
in lateral movements of the
jaw.
It is a short and
thick muscle with 2
distinct heads.
Origin:
Upper head- small, arises
from infra temporal
surface of greater wing of
sphenoid.
Lower head – large, arises
from lateral surface of
lateral pterygoid plate.
Insertion:
Fibres run backwards,
laterally, converge to insert
into pterygoid fovea in the
anterior surface of neck of
mandible, adjoining
articular disc and capsule
of TMJ.
Actions:
Depresses the mandible.
Lateral and medial pterygoid
muscles of both sides act
together to protrude the
mandible.
Helps in side to side movements
of the jaw.
 Temporalis, masseter, medial pterygoid muscle elevates
the jaw and have great power in keeping the teeth
clenched.
 The mouth opens by relaxation of these muscle and by
weight of mandible coordinated with contraction of
suprahyoid and infrahyoid group of muscle, platysma
and lateral pterygoid muscle.
 Infrahyoid and suprahyoid muscle also helps in function
of degluttination, phonation and mastication.
Histology of the Articular Surfaces
The articular surfaces of the mandibular condyle and
fossa are composed of four distinct layers or zones
 (1) articular,
(2) proliferative,
(3) fibrocartilaginous and
(4) calcified cartilage
 Articular surfaces of condyle and mandibular fossa
composed of 4 layers or zones
 Most superficial layer is articular zone
 Outermost functional surface
 Made up of dense fibrous connective tissue
 Collagen fibers are arranged in bundles and tightly
packed and so can withstand forces
 Second zone is proliferative zone and is cellular
 Undifferentiated mesenchymal tissue
 Proliferation of articular cartilage is responsible to
functional demands
Third zone is fibrocartilaginous zone
Collagen fibrils arranged in bundles in crossing
pattern
Offers resistance against compressive and lateral
forces
Fourth and deepest zone is calcified
zone
Made up of chondrocytes and chondroblasts
Site for bone remodeling activity.
External pressure resulting from joint loading
is in equilibrium with internal pressure of
articular cartilage
synovial membrane  is the soft tissue found between 
the articular capsule (joint capsule) and the joint cavity 
of synovial joints.
The word "synovium" is related to the word "synovia" 
(synovial fluid), which is the clear, viscous, lubricating fluid 
secreted by synovial membranes.
 The word "synvovia" or "sinovia" was coined 
by Paracelsus, and may have been derived from the Greek 
word "syn" ("with") and the Latin word "ovum" ("egg") 
because the synovial fluid in joints that have a cavity between 
the bearing surfaces is similar to egg white.
Function –
Provides liquid environment
Lubricates by two mechanism –
Boundary lubrication 
Weeping lubrication 
Two mechanisms of the lubrication :
• Boundary lubrication
Prevents friction in the moving joint
• Weeping lubrication
Eliminates friction in the compressed but not moving
joint
Auriculotemporal nerve
Deep temporal nerve
Masseteric nerve
Four types of nerve endings –
• Ruffini endings
• Pacini corpuscles
• Golgi tendon organ
• Free nerve endings
 The Ruffini’s corpuscles, present in the
capsule are the proprioceptors and
sense the changes in the joint when the
joint is static.
 The pacinian corpuscles, also present
in the capsule, act as
mechanoreceptors to signal the rapidity
and slowness of the joint movement.
 The Golgi tendon, present in the TM
joint ligament, functions as a
mechanoreceptor to protect the joint
when joint movements become
excessive.
 The free nerve endings which are
nociceptors (receptors for pain), are the
most numerous and widely distributed;
protect the joint from excessive
movements by causing pain.
• Superficial temporal artery
• Middle meningeal artery
• Internal maxillary artery
OTHERS –
• Deep auricular artery
• Anterior tympanic artery
• Ascending pharyngeal arteries
Described by Tanasesco (1912)
lymph node is an oval-shaped organ of the lymphatic
system, distributed widely throughout the body.
Lymph nodes are major sites of B, T, and other immune
cells.
Lymph nodes are important for the proper functioning of the
immune system, acting as filters for foreign particles
The lymph from temporo mandibular joints is drained into:
• Superficial parotid nodes
• Deep parotid nodes
•Upper deep cervical nodes
 The thinness of the bone in the
articular fossa is responsible for
fractures if the mandibular head is
driven into the fossa by a heavy blow.
 In such cases injuries of the dura
mater and the brain have been
reported.
 The finer structure of the bone and its
fibrocartilaginous covering depends on mechanical
influences.
 A change in force or direction of stress, especially
after loss of posterior teeth, may cause structural
changes.
 These changes may include fibrillation (separation
between collagen bundles) of the fibrous covering of
the articulating surfaces and of the disk.
 Abnormal functional activity may also produce injury
to the articular bones
 In severe trauma the articular bone is
destroyed, and cartilage and new bone
develop in the marrow spaces and at
the periphery of the condyle.
 When this occurs, the function of the
joint is severely impaired
 The articular surface is capable of
remodeling due to functional demands.
 It shows changes due to loss of teeth or
due to attrition of teeth.
 It also gets remodeled due to
orthodontic treatment.
 Normally, in the open position of the
mandible the interincisal distance is
approximately 48 mm in males and
45.5 mm in females.
 In approximately 18% of the population
the mandible deviates on opening, and
in almost 86% of this group deviation is
to the left.
 In approximately 35% of the population
the TMJ produces sounds during
opening movements.
Gross A and Gale EN: A prevalence study of the clinical signs associated with
mandibular dysfunction. J Am Dent Assoc 107:932, 1983.
 The joint has palpable irregularities
and produces popping and clicking
noises.
 However, use of a stethoscope reveals
that approximately 65% of TMJs
produce some kind of sound.
 This feature by itself, especially if not a
sign of disease may not require
treatment.
 The term myofacial pain dysfunction
syndrome is used to indicate a
dysfunction of the TMJ.
It is characterized by:
 (1) masticatory muscle tenderness
(most frequently, the lateral pterygoid
and then, in order, the temporalis,
medial pterygoid, and masseter);
 (2) limited opening of the mandible (<
37 mm); and
 (3) joint sounds. This symptom complex
is seen more often in females than in
males.
 Its cause is usually spasm of the
masticatory muscles.
 Since the condition may be related to
stress, treatment should be as
conservative as possible.
 Dislocation of the TMJ may take place
without the impact of an external force.
 The dislocation of the jaw is usually
bilateral, and the displacement is
anterior.
 When the mouth is opened unusually
wide during yawning, the head of the
mandible may slip forward into the
infratemporal fossa, causing articular
dislocation of the joint.
 Recently diagnostic techniques such as
computerized tomography (CT) and
magnetic resonance imaging (MRI),
which permit the visualization of the
TMJ disks in patients, are being applied
increasingly in the diagnosis of internal
disk dislocation or derangement.
The disk, for reasons not yet
determined, becomes displaced
anteromedially and creates one or more
of the following signs and symptoms:
pain,
clicking,
limitation of jaw movement,
deviation of the jaw or opening,
and locking.
If the condition remains untreated, it
could lead to osteoarthrosis.
 Diagnosis of cases of the TMJ disk
perforation is also on the increase, partly
because of the use of arthroscope, MRI, and
arthrographic techniques in the investigation
of TMJ diseases.
 Recently research has shown that
experimentally produced disk perforation in
rhesus monkeys leads to secondary
osteoarthrosis.
 Consequently, treatment of human disk
perforation will require more serious
consideration than it receives at present
Toller PA: Opaque arthrography of the temporomandibular joint. Int J Oral Surg 3:17,
1974.
 A good prosthodontic treatment bears direct
relation with TM articulation since establishment of
occlusion is one of the main step in complete
denture, fixed partial & removal partial dentures.
 A thorough knowledge of TMJ & its relationship with
surrounding structures is essential to fully
comprehend normal anatomy & physiology,
adaptive processes, dysfunction & pathology of the
TMJ.
 Wink CS, St Onge M, Zimny ML: Neural elements in the human
temporomandibular articular disc, J Oral Maxillofac Surg
50:334-337, 1992.
 Development of the human temporomandibular
joint.Mérida-Velasco JR1
, Rodríguez-Vázquez
JF, Mérida-Velasco JA, Sánchez-Montesinos I, Espín-
Ferra J, Jiménez-Collado J. Anat. Res1 999 May
1;255(1):20-33.
 Okeson 6th
edition. Elseiver mosby publication.
 Orbans oral histology and embryology. 13th
edition.
Elsevier.
 Toller PA: Opaque arthrography of the temporomandibular joint.
Int J Oral Surg 3:17, 1974.
TMJ

More Related Content

What's hot

Growth & development of maxilla and mandible
Growth & development of maxilla and mandibleGrowth & development of maxilla and mandible
Growth & development of maxilla and mandible
Rajesh Bariker
 
Development of occlusion from childhood to adolescence
Development of occlusion from childhood to adolescenceDevelopment of occlusion from childhood to adolescence
Development of occlusion from childhood to adolescence
Dr. Surej Unnikrishnan
 
Dentine
Dentine Dentine
Dentine
dentistry
 
TEMPOROMANDIBULAR JOINT
TEMPOROMANDIBULAR JOINT TEMPOROMANDIBULAR JOINT
TEMPOROMANDIBULAR JOINT
Siddharth Tevatia
 
Prenatal and postnatal growth of mandible
Prenatal and postnatal growth of mandiblePrenatal and postnatal growth of mandible
Prenatal and postnatal growth of mandible
shayonisen2012
 
Anatomy and physiology of temporomandibular joint
Anatomy and physiology of temporomandibular joint Anatomy and physiology of temporomandibular joint
Anatomy and physiology of temporomandibular joint
Akshay Karve
 
Anatomical Landmarks of Mandible
Anatomical Landmarks of MandibleAnatomical Landmarks of Mandible
Anatomical Landmarks of Mandible
Sabnoor Aujla
 
Tmj
TmjTmj
Eruption & shedding
Eruption & sheddingEruption & shedding
Eruption & shedding
koilonychia
 
Dentin
DentinDentin
Dentin
Mpdodz
 
Temporomandibular joint development and applied aspects
Temporomandibular joint development and applied aspectsTemporomandibular joint development and applied aspects
Temporomandibular joint development and applied aspects
Ravi banavathu
 
Anatomy of TMJ
Anatomy of TMJAnatomy of TMJ
Anatomy of TMJ
Dr Laxman Khanal
 
Compensating Curves in Prosthodontics
Compensating Curves in ProsthodonticsCompensating Curves in Prosthodontics
Compensating Curves in Prosthodontics
Partha Sarathi Adhya
 
Development of Mandible
Development of MandibleDevelopment of Mandible
Development of Mandible
Menatalla Elhindawy
 
anatomy of TMJ
anatomy of TMJanatomy of TMJ
anatomy of TMJ
Dhaval Trivedi
 
Temporomandibular joint disorders I
Temporomandibular joint disorders ITemporomandibular joint disorders I
Temporomandibular joint disorders I
IAU Dent
 
Anatomy and clinical significance of denture bearing areas
Anatomy and clinical significance of denture bearing areasAnatomy and clinical significance of denture bearing areas
Anatomy and clinical significance of denture bearing areas
Ogundiran Temidayo
 
Mechanical Properties of Dental Materials
Mechanical Properties of Dental MaterialsMechanical Properties of Dental Materials
Mechanical Properties of Dental Materials
Dr. Nithin Mathew
 
Cephalometrics
CephalometricsCephalometrics
Cephalometrics
Piyush Verma
 
Temporomandibular Joint (TMJ )
Temporomandibular Joint  (TMJ )Temporomandibular Joint  (TMJ )
Temporomandibular Joint (TMJ )
Dr Monika Negi
 

What's hot (20)

Growth & development of maxilla and mandible
Growth & development of maxilla and mandibleGrowth & development of maxilla and mandible
Growth & development of maxilla and mandible
 
Development of occlusion from childhood to adolescence
Development of occlusion from childhood to adolescenceDevelopment of occlusion from childhood to adolescence
Development of occlusion from childhood to adolescence
 
Dentine
Dentine Dentine
Dentine
 
TEMPOROMANDIBULAR JOINT
TEMPOROMANDIBULAR JOINT TEMPOROMANDIBULAR JOINT
TEMPOROMANDIBULAR JOINT
 
Prenatal and postnatal growth of mandible
Prenatal and postnatal growth of mandiblePrenatal and postnatal growth of mandible
Prenatal and postnatal growth of mandible
 
Anatomy and physiology of temporomandibular joint
Anatomy and physiology of temporomandibular joint Anatomy and physiology of temporomandibular joint
Anatomy and physiology of temporomandibular joint
 
Anatomical Landmarks of Mandible
Anatomical Landmarks of MandibleAnatomical Landmarks of Mandible
Anatomical Landmarks of Mandible
 
Tmj
TmjTmj
Tmj
 
Eruption & shedding
Eruption & sheddingEruption & shedding
Eruption & shedding
 
Dentin
DentinDentin
Dentin
 
Temporomandibular joint development and applied aspects
Temporomandibular joint development and applied aspectsTemporomandibular joint development and applied aspects
Temporomandibular joint development and applied aspects
 
Anatomy of TMJ
Anatomy of TMJAnatomy of TMJ
Anatomy of TMJ
 
Compensating Curves in Prosthodontics
Compensating Curves in ProsthodonticsCompensating Curves in Prosthodontics
Compensating Curves in Prosthodontics
 
Development of Mandible
Development of MandibleDevelopment of Mandible
Development of Mandible
 
anatomy of TMJ
anatomy of TMJanatomy of TMJ
anatomy of TMJ
 
Temporomandibular joint disorders I
Temporomandibular joint disorders ITemporomandibular joint disorders I
Temporomandibular joint disorders I
 
Anatomy and clinical significance of denture bearing areas
Anatomy and clinical significance of denture bearing areasAnatomy and clinical significance of denture bearing areas
Anatomy and clinical significance of denture bearing areas
 
Mechanical Properties of Dental Materials
Mechanical Properties of Dental MaterialsMechanical Properties of Dental Materials
Mechanical Properties of Dental Materials
 
Cephalometrics
CephalometricsCephalometrics
Cephalometrics
 
Temporomandibular Joint (TMJ )
Temporomandibular Joint  (TMJ )Temporomandibular Joint  (TMJ )
Temporomandibular Joint (TMJ )
 

Viewers also liked

Temporo mandibular joint
Temporo mandibular jointTemporo mandibular joint
Temporo mandibular joint
Martin Bush
 
Tmj disorder
Tmj disorderTmj disorder
Tmj disorder
Praveena Veena
 
Tmj
TmjTmj
temporomandibular joint
temporomandibular jointtemporomandibular joint
temporomandibular joint
soujanyadonthula
 
The Physiology Of Pain
The Physiology Of PainThe Physiology Of Pain
The Physiology Of Pain
Hunyady
 
Temporomandibular disorders
Temporomandibular disordersTemporomandibular disorders
Temporomandibular disorders
Arsalan Wahid Malik
 
Temporomandibular joint
Temporomandibular jointTemporomandibular joint
Temporomandibular joint
Ahmed Adawy
 
Approach to hypophosphatemia atee new
Approach to hypophosphatemia atee newApproach to hypophosphatemia atee new
Approach to hypophosphatemia atee new
Karyatee Hafiz
 
TMJ and its relation to periodontics
TMJ and its relation to periodonticsTMJ and its relation to periodontics
TMJ and its relation to periodontics
Chittoor Deals
 
Diseases of nerves and muscles/ dental crown & bridge courses
Diseases of nerves and muscles/ dental crown & bridge coursesDiseases of nerves and muscles/ dental crown & bridge courses
Diseases of nerves and muscles/ dental crown & bridge courses
Indian dental academy
 
A VEIW ON TEMPOROMANDIBULAR JOINT
A VEIW ON TEMPOROMANDIBULAR JOINTA VEIW ON TEMPOROMANDIBULAR JOINT
A VEIW ON TEMPOROMANDIBULAR JOINT
Dr.Subrata Das
 
Surgical anatomy of the temporomandibular joint and surgical (nx power lite) ...
Surgical anatomy of the temporomandibular joint and surgical (nx power lite) ...Surgical anatomy of the temporomandibular joint and surgical (nx power lite) ...
Surgical anatomy of the temporomandibular joint and surgical (nx power lite) ...
Indian dental academy
 
4. strelization and infection control
4. strelization and infection control4. strelization and infection control
4. strelization and infection control
dr neetu singh
 
Temporomandibular joint /disorders /management / treatment
Temporomandibular joint /disorders /management / treatmentTemporomandibular joint /disorders /management / treatment
Temporomandibular joint /disorders /management / treatment
Cairo University
 
Temporomandibular Joint
Temporomandibular JointTemporomandibular Joint
Temporomandibular Joint
Amery Rose Batallones
 
Endodontic pain management
Endodontic pain managementEndodontic pain management
Endodontic pain management
Praveena Veena
 
Pain pathways
Pain pathwaysPain pathways
Pain pathways
Siddharth Tevatia
 
Mandibular Premolars
Mandibular PremolarsMandibular Premolars
Mandibular Premolars
syedsadatullah
 
Endodontic Pain
Endodontic PainEndodontic Pain
Endodontic Pain
IAU Dent
 
Introduction to pain control in dentistry
Introduction to pain control in dentistryIntroduction to pain control in dentistry
Introduction to pain control in dentistry
Umm Al-Qura University Faculty of Dentistry
 

Viewers also liked (20)

Temporo mandibular joint
Temporo mandibular jointTemporo mandibular joint
Temporo mandibular joint
 
Tmj disorder
Tmj disorderTmj disorder
Tmj disorder
 
Tmj
TmjTmj
Tmj
 
temporomandibular joint
temporomandibular jointtemporomandibular joint
temporomandibular joint
 
The Physiology Of Pain
The Physiology Of PainThe Physiology Of Pain
The Physiology Of Pain
 
Temporomandibular disorders
Temporomandibular disordersTemporomandibular disorders
Temporomandibular disorders
 
Temporomandibular joint
Temporomandibular jointTemporomandibular joint
Temporomandibular joint
 
Approach to hypophosphatemia atee new
Approach to hypophosphatemia atee newApproach to hypophosphatemia atee new
Approach to hypophosphatemia atee new
 
TMJ and its relation to periodontics
TMJ and its relation to periodonticsTMJ and its relation to periodontics
TMJ and its relation to periodontics
 
Diseases of nerves and muscles/ dental crown & bridge courses
Diseases of nerves and muscles/ dental crown & bridge coursesDiseases of nerves and muscles/ dental crown & bridge courses
Diseases of nerves and muscles/ dental crown & bridge courses
 
A VEIW ON TEMPOROMANDIBULAR JOINT
A VEIW ON TEMPOROMANDIBULAR JOINTA VEIW ON TEMPOROMANDIBULAR JOINT
A VEIW ON TEMPOROMANDIBULAR JOINT
 
Surgical anatomy of the temporomandibular joint and surgical (nx power lite) ...
Surgical anatomy of the temporomandibular joint and surgical (nx power lite) ...Surgical anatomy of the temporomandibular joint and surgical (nx power lite) ...
Surgical anatomy of the temporomandibular joint and surgical (nx power lite) ...
 
4. strelization and infection control
4. strelization and infection control4. strelization and infection control
4. strelization and infection control
 
Temporomandibular joint /disorders /management / treatment
Temporomandibular joint /disorders /management / treatmentTemporomandibular joint /disorders /management / treatment
Temporomandibular joint /disorders /management / treatment
 
Temporomandibular Joint
Temporomandibular JointTemporomandibular Joint
Temporomandibular Joint
 
Endodontic pain management
Endodontic pain managementEndodontic pain management
Endodontic pain management
 
Pain pathways
Pain pathwaysPain pathways
Pain pathways
 
Mandibular Premolars
Mandibular PremolarsMandibular Premolars
Mandibular Premolars
 
Endodontic Pain
Endodontic PainEndodontic Pain
Endodontic Pain
 
Introduction to pain control in dentistry
Introduction to pain control in dentistryIntroduction to pain control in dentistry
Introduction to pain control in dentistry
 

Similar to TMJ

TMJ and it’s Prosthodontic Implication
TMJ and it’s Prosthodontic Implication  TMJ and it’s Prosthodontic Implication
TMJ and it’s Prosthodontic Implication
drfarhana4
 
Temperomandibular joint
Temperomandibular jointTemperomandibular joint
Temperomandibular joint
Indian dental academy
 
TMJ written report
TMJ written reportTMJ written report
TMJ written report
Amery Rose Batallones
 
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINTARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
DR. SNEHA NAIR
 
Jaw relations/ online orthodontic courses
Jaw relations/ online orthodontic coursesJaw relations/ online orthodontic courses
Jaw relations/ online orthodontic courses
Indian dental academy
 
Temporomandibular joint
Temporomandibular jointTemporomandibular joint
Temporomandibular joint
Parikshit Kadam
 
Anatomy and physiology of TMJ /orthodontic courses by Indian dental academy
Anatomy and physiology of TMJ   /orthodontic courses by Indian dental academy Anatomy and physiology of TMJ   /orthodontic courses by Indian dental academy
Anatomy and physiology of TMJ /orthodontic courses by Indian dental academy
Indian dental academy
 
Temporomandibular joint 1
Temporomandibular joint 1Temporomandibular joint 1
Temporomandibular joint 1
ANIL KUMAR
 
Locomotor system
Locomotor systemLocomotor system
Locomotor system
Kamal Deen
 
seminar on temporomandibular joint and disorders.pptx
seminar on temporomandibular joint and disorders.pptxseminar on temporomandibular joint and disorders.pptx
seminar on temporomandibular joint and disorders.pptx
SannuSonal
 
Skeletalsystem
SkeletalsystemSkeletalsystem
Skeletalsystem
Andrew McCaskill
 
Human skeleton pptx. Punjab cuvas bhawalpur
Human skeleton pptx. Punjab cuvas bhawalpurHuman skeleton pptx. Punjab cuvas bhawalpur
Human skeleton pptx. Punjab cuvas bhawalpur
mudassarkhanoutlook
 
Human Anatomy.Skeletal and Muscular system.pdf
Human Anatomy.Skeletal and Muscular system.pdfHuman Anatomy.Skeletal and Muscular system.pdf
Human Anatomy.Skeletal and Muscular system.pdf
Jackson Achankunju
 
Temporomandibular joint anatomy and function
Temporomandibular joint anatomy and functionTemporomandibular joint anatomy and function
Temporomandibular joint anatomy and function
DR POOJA
 
Skeletal goes musical artifact 2
Skeletal goes musical artifact 2Skeletal goes musical artifact 2
Skeletal goes musical artifact 2
777notw777
 
temporomandibular joint.pptx
temporomandibular joint.pptxtemporomandibular joint.pptx
temporomandibular joint.pptx
SumedhaThosar
 
SWERNY SKELETAL 1.pdf
SWERNY SKELETAL 1.pdfSWERNY SKELETAL 1.pdf
SWERNY SKELETAL 1.pdf
SwernyMumba
 
Jaw relation / dental crown & bridge courses
Jaw relation / dental crown & bridge coursesJaw relation / dental crown & bridge courses
Jaw relation / dental crown & bridge courses
Indian dental academy
 
Jr biological and clinical considerations /orthodontic courses by Indian den...
Jr  biological and clinical considerations /orthodontic courses by Indian den...Jr  biological and clinical considerations /orthodontic courses by Indian den...
Jr biological and clinical considerations /orthodontic courses by Indian den...
Indian dental academy
 
Skeletal sysytem ppt
Skeletal sysytem pptSkeletal sysytem ppt
Skeletal sysytem ppt
sharanyapalanisshami
 

Similar to TMJ (20)

TMJ and it’s Prosthodontic Implication
TMJ and it’s Prosthodontic Implication  TMJ and it’s Prosthodontic Implication
TMJ and it’s Prosthodontic Implication
 
Temperomandibular joint
Temperomandibular jointTemperomandibular joint
Temperomandibular joint
 
TMJ written report
TMJ written reportTMJ written report
TMJ written report
 
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINTARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
 
Jaw relations/ online orthodontic courses
Jaw relations/ online orthodontic coursesJaw relations/ online orthodontic courses
Jaw relations/ online orthodontic courses
 
Temporomandibular joint
Temporomandibular jointTemporomandibular joint
Temporomandibular joint
 
Anatomy and physiology of TMJ /orthodontic courses by Indian dental academy
Anatomy and physiology of TMJ   /orthodontic courses by Indian dental academy Anatomy and physiology of TMJ   /orthodontic courses by Indian dental academy
Anatomy and physiology of TMJ /orthodontic courses by Indian dental academy
 
Temporomandibular joint 1
Temporomandibular joint 1Temporomandibular joint 1
Temporomandibular joint 1
 
Locomotor system
Locomotor systemLocomotor system
Locomotor system
 
seminar on temporomandibular joint and disorders.pptx
seminar on temporomandibular joint and disorders.pptxseminar on temporomandibular joint and disorders.pptx
seminar on temporomandibular joint and disorders.pptx
 
Skeletalsystem
SkeletalsystemSkeletalsystem
Skeletalsystem
 
Human skeleton pptx. Punjab cuvas bhawalpur
Human skeleton pptx. Punjab cuvas bhawalpurHuman skeleton pptx. Punjab cuvas bhawalpur
Human skeleton pptx. Punjab cuvas bhawalpur
 
Human Anatomy.Skeletal and Muscular system.pdf
Human Anatomy.Skeletal and Muscular system.pdfHuman Anatomy.Skeletal and Muscular system.pdf
Human Anatomy.Skeletal and Muscular system.pdf
 
Temporomandibular joint anatomy and function
Temporomandibular joint anatomy and functionTemporomandibular joint anatomy and function
Temporomandibular joint anatomy and function
 
Skeletal goes musical artifact 2
Skeletal goes musical artifact 2Skeletal goes musical artifact 2
Skeletal goes musical artifact 2
 
temporomandibular joint.pptx
temporomandibular joint.pptxtemporomandibular joint.pptx
temporomandibular joint.pptx
 
SWERNY SKELETAL 1.pdf
SWERNY SKELETAL 1.pdfSWERNY SKELETAL 1.pdf
SWERNY SKELETAL 1.pdf
 
Jaw relation / dental crown & bridge courses
Jaw relation / dental crown & bridge coursesJaw relation / dental crown & bridge courses
Jaw relation / dental crown & bridge courses
 
Jr biological and clinical considerations /orthodontic courses by Indian den...
Jr  biological and clinical considerations /orthodontic courses by Indian den...Jr  biological and clinical considerations /orthodontic courses by Indian den...
Jr biological and clinical considerations /orthodontic courses by Indian den...
 
Skeletal sysytem ppt
Skeletal sysytem pptSkeletal sysytem ppt
Skeletal sysytem ppt
 

Recently uploaded

Acute Gout Care & Urate Lowering Therapy .pdf
Acute Gout Care & Urate Lowering Therapy .pdfAcute Gout Care & Urate Lowering Therapy .pdf
Acute Gout Care & Urate Lowering Therapy .pdf
Jim Jacob Roy
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
rishi2789
 
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHYMERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
DRPREETHIJAMESP
 
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptxCLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
Government Dental College & Hospital Srinagar
 
DECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principlesDECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principles
anaghabharat01
 
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdfMedical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Jim Jacob Roy
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.GawadHemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
NephroTube - Dr.Gawad
 
vonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentationvonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentation
Dr.pavithra Anandan
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Tina Purnat
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
walterHu5
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
Josep Vidal-Alaball
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
Dr. Ahana Haroon
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
LaniyaNasrink
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
AksshayaRajanbabu
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
FFragrant
 
How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.
Gokuldas Hospital
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
Jim Jacob Roy
 

Recently uploaded (20)

Acute Gout Care & Urate Lowering Therapy .pdf
Acute Gout Care & Urate Lowering Therapy .pdfAcute Gout Care & Urate Lowering Therapy .pdf
Acute Gout Care & Urate Lowering Therapy .pdf
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
 
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHYMERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
 
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptxCLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
 
DECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principlesDECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principles
 
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdfMedical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.GawadHemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
 
vonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentationvonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentation
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
 
How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
 

TMJ

  • 3. The efforts of the prosthodontist to record the movements of the TMJ and to produce them on the articulator have been the chief stimulus for studies on the functional structure of this joint. The purpose of this seminar is to focus attention on those anatomic features which might provide a further basis for the clinical management of the TMJ in prosthetic dentistry.
  • 4.
  • 5. Development of the human temporomandibular joint. Mérida-Velasco JR1 , Rodríguez-Vázquez JF, Mérida-Velasco JA, Sánchez-Montesinos I, Espín-Ferra J,  Jiménez-Collado J. Anat. Res1 999 May 1;255(1):20-33. A great deal of research has been published on the development of the human temporomandibular joint (TMJ). However, there is some discordance about its morphological timing. The most controversial aspects concern the moment of the initial organization of the condyle and the squamous part of the temporal bone, the articular disc and capsule and also the cavitation and onset of condylar chondrogenesis A great deal of research has been published on the development of the human temporomandibular joint (TMJ). However, there is some discordance about its morphological timing. The most controversial aspects concern the moment of the initial organization of the condyle and the squamous part of the temporal bone, the articular disc and capsule and also the cavitation and onset of condylar chondrogenesis
  • 6.  In the last few decades a considerable amount of research has been published on the development of the temporomandibular joint  (Harpman and Woollard, 1938; Symons, 1952; Moffett, 1957; Van Dongen, 1968; Perry et al., 1985).  Studies have focused on the development of the articular disc and its relation with the
  • 7.  Yuodelis, 1966a; Wong et al., 1985; Smeele, 1990; Me ´ridaVelascoetal.,1993;O ¨ gu¨tcen- TollerandJuniper, 1993, 1994); the development of bony articular elements (Baume, 1962; Yuodelis, 1966b; Baume and Holz, 1970; Bach-Petersen et al., 1993);
  • 8.  Coleman, 1970; Smeele, 1988; Rodrı´guez Va´zquez et al., 1992, 1993; O ¨ gu¨tcen-Toller,1995). However few of these studies have attempted to systematize chronologically the morphological changes taking place in the temporomandibular joint during development.  Van der Linden et al. (1987) studied 52 human embryos and fetuses, establishing the critical period of TMJ morphogenesis between weeks 7 and 11 of development  Moreover, MoMorimoto et al. (1987) describes a number of phases in development Development of the human temporomandibular joint. Mérida-Velasco JR1 , Rodríguez-Vázquez JF, Mérida-Velasco JA, Sánchez-Montesinos I, Espín-Ferra J , Jiménez-Collado J. Anat. Res1 999 May 1;255(1):20-33.
  • 9.  Three phases in the development of the TMJ were identified.  The first is the blastematic stage (weeks 7-8 of development), which corresponds with the onset of the organization of the condyle and the articular disc and capsule.  During week 8 intramembranous ossification of the temporal squamous bone begins..
  • 10.  The second stage is the cavitation stage (weeks 9-11 of development), corresponding to the initial formation of the inferior joint cavity (week 9) and the start condylar chondrogenesis.  Week 11 marks the initiation of organization of the superior joint cavity.
  • 11.  And the third stage is the maturation stage (after week 12 of development). This work establishes three phases in TMJ development: 1) the blastematic stage (weeks 7-8 of development)  2) the cavitation stage (weeks 9-11 of development)  3) the maturation stage (after week 12 of development).  This study identifies the critical period of TMJ morphogenesis as occurring between weeks 7 and 11 of development.
  • 12.
  • 13.  The TMJ also known as cranio mandibular joint is one of the complex, delicate and highly used joints in a human body.  It is the area where mandible articulates with cranium.  It is described as a  complex ,  compound,  multiaxial ,  synovial ,  Ginglimoarthroidal joint. introduction
  • 14.  The area where the mandible articulates with the cranium, the TMJ, is one of the complex joint in the body.  It provides hinging movement in one plane and therefore can be considered a ginglymoid joint.  However, at the same time it also provides for gliding movements, which classifies it as arthroidal joint. Thus, it has been technically considered as ginglymoarthroidal joint.
  • 15.
  • 16.  TMJ is classified as a compound joint.  By definition, a compound joint requires the presence of at least three bones, yet the TMJ is made of only two bones. Functionally, the articular disc serves as a nonossified bone that permits the complex movements of the joint. Because the articular disc functions as a third bone, the craniomandibular articulation is considered a Okeson, management of temporomandibular disorders and occlusion 6th edition. Mosby elsevier
  • 17. Components of the joint:  Articular surface of the temporal bone  The Condyle  Articular disc/ Meniscus  Ligaments
  • 18.
  • 19. It is in the Sqamous portion of temporal bone. Consists of 3 parts: Mandibular or glenoid fossa. Articular eminence Preglenoid plane. Okeson. Management of temporomandibular disorder and occlusion. 6th edition. Elsevier mosby publication
  • 20. It is the concave portion of the temporal bone. Boundaries: Posteriorly: Squamotympanic or Petrotympanic fissure Medially: Spine of sphenoid Laterally: Root of zygomatic process of temporal bone Anteriorly : Articular eminence The glenoid fossa is covered by a dense, avascular fibrocartilage consisting largely of bundles of collagen fibres with occasional elastic fibres. Okeson. Management of temporomandibular disorder and occlusion. 6th edition. Elsevier mosby publication
  • 21. It is a small prominence on the zygomatic arch. It is thick and serves as functional component of TMJ On its lateral aspect, articular tubercle is present which serves as the point of attachment for the collateral ligaments. It is a cylindrical bony projection and covered with a thin layer of fibro cartilage.
  • 22.
  • 23. The mandible is a U shaped bone that articulates with the temporal bone by means of the articular surface of its condyle. The head is covered with fibrocartilage and articulates with temporal bone to form TMJ. Okeson. Management of temporomandibular disorder and occlusion. 6th edition. Elsevier mosby publication
  • 24. In the normal joint, the articular surface of the condyle is located on the intermediate zone of the disc. The shape of the disc is determined by the morphology of the condyle and mandibular fossa. The disc is somewhat flexible and can adapt to the functional demands of the articular surface. Okeson. Management of temporomandibular disorder and occlusion. 6th edition. Elsevier mosby publication
  • 25. Okeson 6th edition. Elsevier mosby publication  From anterior view it has medial and lateral projections called poles  Medial pole is generally more prominent then lateral pole  Mediolateral length is between 18 and 23mm  Anterioposterior width is between 8 and 10 mm
  • 26. The articular disc is composed of dense fibrous connective tissue, for the most part devoid of any blood vessels or nerve fibers. The extreme periphery of the disc, however, is slightly innervated. In the sagittal plane, it can be divided into three regions according to thickness : intermediate, anterior, and posterior. The central area is the thinnest and is called the intermediate zone. Wink CS, St Onge M, Zimny ML: Neural elements in the human temporomandibular articular disc, J Oral Maxillofac Surg 50:334-337, 1992.
  • 27. In sagittal plane it is divided into 3 planes. 1. Anterior band 2. Intermediate band 3. Posterior band
  • 28.
  • 29.  The disc becomes considerably thicker both anterior and posterior to the intermediate zone.  The posterior border is generally slightly thicker than the anterior border.  In the normal joint the articular surface of the condyle is located on the intermediate zone of the disc, bordered by the thicker anterior and posterior regions.
  • 30.
  • 31.  Acts as cushion  Isolates synovial fluid  Divides joint cavity  Determinant in mandibular movement
  • 32. The articular disc is attached posteriorly to a region of loose connective tissue that is highly vascularized and innervated . This is known as the retrodiscal tissue or posterior attachment. Superiorly, it is bordered by a lamina of connective tissue that contains many elastic fibers, the superior retrodiscal lamina. RETRODISCAL TISSUE
  • 33.
  • 34. The superior retrodiscal lamina attaches the articular disc posteriorly to the tympanic plate. At lower border of the retrodiscal tissues is the inferior retrodiscal lamina, which attaches the inferior border of the posterior edge of the disc( the posterior margin of the articular surface the condyle. Okeson. Management of temporomandibular disorder and occlusion. 6th edition. Elsevier mosby publication
  • 35. The inferior retrodiscal lamina composed chiefly of collagenous fibers, not elastic fibers like the superior retrodiscal lamina. The remaining body of the retrodiscal tissue is attached posteriorly to a large venous plexus, which fills with blood as the condyle moves forward. The superior and inferior attachments of the anterior region of the disc are to the capsular ligament, which surrounds most of the joint. The superior attachment is to the anterior margin of the articular surface of the temporal bone.
  • 36. The inferior attachment is to the anterior margin of the articular surface of the condyle. Both these anterior attachments are composed of collagenous fibers. Anteriorly, between the attachments of the capsular ligament, the disc is also attached by tendinous fibers to the superior lateral pterygoid muscle.
  • 37.
  • 38. Ligaments associated with the TMJ are composed of collagen, which do not stretch and act predominantly as restraints to motion of the condyle and the disc. They play an important role in protecting the structures of the joint. The TMJ has support of 3 functional ligaments and 2 accessory ligaments.
  • 39. • Functional ligaments- Serve as major anatomical component for the joint. a] Collateral/Discal ligament b] Capsular ligament c] Temporomandibular ligament • Accessory ligaments-Serve as passive restraints to mandibular motion. a] Sphenomandibular ligament. b] Stylomandibular ligament.
  • 40. COLLATERAL/DISCAL ATTACHMENTS These ligaments attach the articular disc to the medial and lateral poles of the condyle. These are called the discal ligaments. These are composed of collagenous connective tissue fibers and they do not stretch. They function to restrict the movement of the disc away from the condyle and permit the disc to rotate anteriorly and posteriorly on the condyle.
  • 41. • The capsule of TMJ is described as fibrous non elastic membrane surrounding the joint. • The capsule seals the joint and provides passive stability. • The active stability is achieved by proprioceptive nerve endings in the capsule which resist medial, lateral and inferior forces thereby holding the joint together. • It offers resistance to movement of joint only in the extreme range of motion. • Secondary function of the capsular ligament is to contain the synovial fluid within the superior and inferior joint spaces.
  • 42. • It is located on the lateral aspect of each TMJ. • This ligament runs downwards and backwards from the lateral aspect of the articular eminence to the posterior aspect of the neck. Okeson 6th edition, elsevier. Mosby publication
  • 43. Its function is to limit the posterior movement of the condyle during pivoting movements such as, when the mandible moves laterally in chewing position. It also protects the inner lateral pterygoid muscle from over lengthening or extension.
  • 44. • The sphenomandibular ligament arises from the spine of the sphenoid and extends downwards to a small bony prominence on the medial aspect of the mandible called the lingula. • It does not have any limiting function on TMJ. • It is a remnant of Meckels cartilage. • It assists the lateral pterygoid in translatory and rotatory movement.
  • 45. • It arises from the styloid process and extends downwards and forwards to the angle and posterior border of the ramus of the mandible. • It limits the protrusive movement of the mandible. • It is taut in protrusion of the mandible and relaxed when the mandible is wide opened.
  • 46.
  • 47. The muscles of mastication are directly concerned with mandibular movements in mastication and speech. 4 pairs of muscles make up a group called the muscles of mastication. 1. Masseter 2. Temporalis Accessory muscles 3. Medial pterygoid 1. Buccinator 4. Lateral pterygoid 2. Digastricus.
  • 48.
  • 49. These four pairs of muscles attached to mandible, primarily responsible for Elevating Depressing Protruding Retruding Lateral movement
  • 50.
  • 51. It is a quadrilateral muscle. The fibers are arranged in3 layers Superficial layer: Origin : anterior 2/3 of inferior surface of zygomatic arch. & maxillary process of zygomatic arch. Insertion: angle of mandible , posterior half of the lateral surface of mandibular ramus. Orbans
  • 52. Middle layer: Origin: medial aspect of 2/3 of zygomatic arch. Insertion: middle part of ramus. Deep layer: Origin: deep surface of zygomatic arch. Insertion : upper part of ramus & coronoid process. Most powerful closing muscle of jaw
  • 53.
  • 54. Action : Elevates the mandible to close the mouth. Retraction of mandible & clenching of teeth. Superficial fibers help in protrusion of mandible.
  • 55. This is a fan shaped muscle and fills the temporal fossa. The temporal fascia covers the muscle.
  • 56. Origin: Temporal fossa & deep surface of temporal fascia Insertion: Fibers converge to insert on tip & medial surface of coronoid process of mandible and anterior border of ramus of mandible
  • 57. Action: Anterior and middle fibers elevate mandible. Posterior fibers retract the mandible.
  • 58. It is a quadrilateral muscle with 2 heads. A small superficial head & a large deep head.
  • 59. Origin: Superficial head: from maxillary tuberosity and adjoining pyramidal process of palatine bone. Deep head: larger, arises from medial surface of lateral pterygoid. Insertion: The fibres run downwards, backwards & laterally to insert into medial surface of the angle and adjoining part of ramus of mandible.
  • 60.
  • 61. Actions: When both side muscle contracts together it elevates the mandible When one side muscle contracts jaw is pulled to opposite side. It also helps in protrusion of the mandible and helps in lateral movements of the jaw.
  • 62. It is a short and thick muscle with 2 distinct heads.
  • 63. Origin: Upper head- small, arises from infra temporal surface of greater wing of sphenoid. Lower head – large, arises from lateral surface of lateral pterygoid plate. Insertion: Fibres run backwards, laterally, converge to insert into pterygoid fovea in the anterior surface of neck of mandible, adjoining articular disc and capsule of TMJ.
  • 64. Actions: Depresses the mandible. Lateral and medial pterygoid muscles of both sides act together to protrude the mandible. Helps in side to side movements of the jaw.
  • 65.  Temporalis, masseter, medial pterygoid muscle elevates the jaw and have great power in keeping the teeth clenched.  The mouth opens by relaxation of these muscle and by weight of mandible coordinated with contraction of suprahyoid and infrahyoid group of muscle, platysma and lateral pterygoid muscle.  Infrahyoid and suprahyoid muscle also helps in function of degluttination, phonation and mastication.
  • 66.
  • 67.
  • 68. Histology of the Articular Surfaces The articular surfaces of the mandibular condyle and fossa are composed of four distinct layers or zones  (1) articular, (2) proliferative, (3) fibrocartilaginous and (4) calcified cartilage
  • 69.
  • 70.  Articular surfaces of condyle and mandibular fossa composed of 4 layers or zones  Most superficial layer is articular zone  Outermost functional surface  Made up of dense fibrous connective tissue  Collagen fibers are arranged in bundles and tightly packed and so can withstand forces  Second zone is proliferative zone and is cellular  Undifferentiated mesenchymal tissue  Proliferation of articular cartilage is responsible to functional demands
  • 71. Third zone is fibrocartilaginous zone Collagen fibrils arranged in bundles in crossing pattern Offers resistance against compressive and lateral forces Fourth and deepest zone is calcified zone Made up of chondrocytes and chondroblasts Site for bone remodeling activity. External pressure resulting from joint loading is in equilibrium with internal pressure of articular cartilage
  • 72.
  • 74.
  • 76. Two mechanisms of the lubrication : • Boundary lubrication Prevents friction in the moving joint • Weeping lubrication Eliminates friction in the compressed but not moving joint
  • 77. Auriculotemporal nerve Deep temporal nerve Masseteric nerve Four types of nerve endings – • Ruffini endings • Pacini corpuscles • Golgi tendon organ • Free nerve endings
  • 78.  The Ruffini’s corpuscles, present in the capsule are the proprioceptors and sense the changes in the joint when the joint is static.  The pacinian corpuscles, also present in the capsule, act as mechanoreceptors to signal the rapidity and slowness of the joint movement.
  • 79.  The Golgi tendon, present in the TM joint ligament, functions as a mechanoreceptor to protect the joint when joint movements become excessive.  The free nerve endings which are nociceptors (receptors for pain), are the most numerous and widely distributed; protect the joint from excessive movements by causing pain.
  • 80. • Superficial temporal artery • Middle meningeal artery • Internal maxillary artery OTHERS – • Deep auricular artery • Anterior tympanic artery • Ascending pharyngeal arteries
  • 81. Described by Tanasesco (1912) lymph node is an oval-shaped organ of the lymphatic system, distributed widely throughout the body. Lymph nodes are major sites of B, T, and other immune cells. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles The lymph from temporo mandibular joints is drained into: • Superficial parotid nodes • Deep parotid nodes •Upper deep cervical nodes
  • 82.
  • 83.
  • 84.
  • 85.  The thinness of the bone in the articular fossa is responsible for fractures if the mandibular head is driven into the fossa by a heavy blow.  In such cases injuries of the dura mater and the brain have been reported.
  • 86.  The finer structure of the bone and its fibrocartilaginous covering depends on mechanical influences.  A change in force or direction of stress, especially after loss of posterior teeth, may cause structural changes.  These changes may include fibrillation (separation between collagen bundles) of the fibrous covering of the articulating surfaces and of the disk.  Abnormal functional activity may also produce injury to the articular bones
  • 87.  In severe trauma the articular bone is destroyed, and cartilage and new bone develop in the marrow spaces and at the periphery of the condyle.  When this occurs, the function of the joint is severely impaired
  • 88.  The articular surface is capable of remodeling due to functional demands.  It shows changes due to loss of teeth or due to attrition of teeth.  It also gets remodeled due to orthodontic treatment.
  • 89.  Normally, in the open position of the mandible the interincisal distance is approximately 48 mm in males and 45.5 mm in females.  In approximately 18% of the population the mandible deviates on opening, and in almost 86% of this group deviation is to the left.  In approximately 35% of the population the TMJ produces sounds during opening movements. Gross A and Gale EN: A prevalence study of the clinical signs associated with mandibular dysfunction. J Am Dent Assoc 107:932, 1983.
  • 90.  The joint has palpable irregularities and produces popping and clicking noises.  However, use of a stethoscope reveals that approximately 65% of TMJs produce some kind of sound.  This feature by itself, especially if not a sign of disease may not require treatment.
  • 91.  The term myofacial pain dysfunction syndrome is used to indicate a dysfunction of the TMJ. It is characterized by:  (1) masticatory muscle tenderness (most frequently, the lateral pterygoid and then, in order, the temporalis, medial pterygoid, and masseter);  (2) limited opening of the mandible (< 37 mm); and
  • 92.  (3) joint sounds. This symptom complex is seen more often in females than in males.  Its cause is usually spasm of the masticatory muscles.  Since the condition may be related to stress, treatment should be as conservative as possible.
  • 93.
  • 94.  Dislocation of the TMJ may take place without the impact of an external force.  The dislocation of the jaw is usually bilateral, and the displacement is anterior.  When the mouth is opened unusually wide during yawning, the head of the mandible may slip forward into the infratemporal fossa, causing articular dislocation of the joint.
  • 95.  Recently diagnostic techniques such as computerized tomography (CT) and magnetic resonance imaging (MRI), which permit the visualization of the TMJ disks in patients, are being applied increasingly in the diagnosis of internal disk dislocation or derangement.
  • 96. The disk, for reasons not yet determined, becomes displaced anteromedially and creates one or more of the following signs and symptoms: pain, clicking, limitation of jaw movement, deviation of the jaw or opening, and locking. If the condition remains untreated, it could lead to osteoarthrosis.
  • 97.  Diagnosis of cases of the TMJ disk perforation is also on the increase, partly because of the use of arthroscope, MRI, and arthrographic techniques in the investigation of TMJ diseases.  Recently research has shown that experimentally produced disk perforation in rhesus monkeys leads to secondary osteoarthrosis.  Consequently, treatment of human disk perforation will require more serious consideration than it receives at present Toller PA: Opaque arthrography of the temporomandibular joint. Int J Oral Surg 3:17, 1974.
  • 98.  A good prosthodontic treatment bears direct relation with TM articulation since establishment of occlusion is one of the main step in complete denture, fixed partial & removal partial dentures.  A thorough knowledge of TMJ & its relationship with surrounding structures is essential to fully comprehend normal anatomy & physiology, adaptive processes, dysfunction & pathology of the TMJ.
  • 99.  Wink CS, St Onge M, Zimny ML: Neural elements in the human temporomandibular articular disc, J Oral Maxillofac Surg 50:334-337, 1992.  Development of the human temporomandibular joint.Mérida-Velasco JR1 , Rodríguez-Vázquez JF, Mérida-Velasco JA, Sánchez-Montesinos I, Espín- Ferra J, Jiménez-Collado J. Anat. Res1 999 May 1;255(1):20-33.  Okeson 6th edition. Elseiver mosby publication.  Orbans oral histology and embryology. 13th edition. Elsevier.  Toller PA: Opaque arthrography of the temporomandibular joint. Int J Oral Surg 3:17, 1974.