breif overview of tm joint disorders

1. KIMS DENTAL DEPARTMENT
presents
CME PROGRAM
A brief insight into
ORPHAN JOINT

2. MODERATOR
DR. SRINIVAS SAKAMURI
MDS
HEAD OF THE DEPARTMENT
PRESENTER
DR G. GURU KARTHIK
MDS
ORAL AND MAXILLOFACIAL
SURGEON

3. List of contents
• Introduction
• Peculiarities of TM Joint.
• Applied anatomy.
• Normal movements.
• Evaluation of patient.
• Signs and symptoms
• Classification of TMJ disorders.
• A brief insight into
 MPDS.
 Internal derangements.
 Dislocations, subluxation.
 Ankylosis.

4. Treatment:
• Conservative management
• Surgical management
Minimally invasive
Invasive

5. Introduction
All the bones in the skull are attached with fibrous joint
and are immovable expect for temporomandibular joint.
• The temporomandibular joint( TMJ ) is a bilateral synovial
articulation between the mandible and temporal bone. The
name of the joint is derived from the two bones which
form the joint: the upper temporal bone which is part of
the cranium (skull), and the lower jawbone or mandible.
• The most important functions of the
temporomandibular joint (TMJ) are mastication and
speech.
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6. Anatomy

7. VASCULAR ANATOMY

8. MAXILLARY ARTERY

9. Arterial & Nerve supply

10. Arterial supply

11. INNERVATION OF TMJ
• Auriculotemporal nerve
• Masseteric nerve
• Deep temporal nerve
• Mechanoceptors
• Nociceptors

12. Peculiarities of TMJ
1. Bilateral diarthrosis – right & left function together
2. Articular surface covered by fibrocartilage instead of
hyaline cartilage.
3. Only joint in human body to have a rigid endpoint of
closure i.e. occlusal contact through teeth.

13. What is normal?

16. EVALUATION OF THE PATIENT
1. Case history
2. Physical examination
3. Radiographic evaluation
a. Transcranial views
b. OPG
c. Tomograms
d. Arthrography
e. CT scans
f. MRI
4. Psychologic evaluation

17. 1. History of trauma.
2. History of rheumatoid arthiritis.
3. History of osteoarthritis.
4. History of long standing otitis
media.
5. Long standing cervical spondylitis.
6. History of extraction of posterior
teeth.
7. Bruxism.
8. History of psychological issues.
9. History of unfinished orthodontic
treatment.

18. • Gait- associated with
osteo/rheumatoid arthiritis.
• Tmj examination.
• Masticatory muscles
examination.

19. Radiographic examination

22. CLASSIFICATION OF TMJ DISORDERS
1. Myofascial pain and dysfunction (MPD)
2. Disk displacement disorders
3. Degenerative joint disease
4. Systemic arthritic conditions
5. Chronic recurrent dislocation
6. Ankylosis
7. Neoplasia
8. Infections

23. MYOFASCIAL PAIN & DYSFUNCTON
•MPD is the most common cause of
masticatory pain and limited function for
which patients seek dental consultation
and treatment.
•The source of the pain and dysfunction is
muscular, with masticatory muscles
developing tenderness and pain as a
result of abnormal muscular function or
hyperactivity.

24. MYOFASCIAL PAIN & DYSFUNCTON
CAUSES :
• Daytime clenching
• Bruxism
• Malocclusion
• Disk displacement disorders
• Degenerative joint disease

25. Associated symptoms of MPDS
Neurologic
Tingling
Numbness
Blurred vision
Twitches
Lacrimation
Otologic
Tinnitus
Ear pain
Dizziness
Vertigo
Diminished hearing
Gastrointestinal tract
Nausea
Vomiting
Diarrhea
Constipation
Dry mouth
Musculoskeletal
Fatigue
Tension
Tiredness
Weakness
Joint pain

26. MYOFASCIAL PAIN & DYSFUNCTON
SIGNS :
• Diffuse tenderness of the masticatory muscles
• The range of the mandibular movements is
decreased
• Deviation of the mandible to the affected side
• The teeth frequently have wear facets
• Joint noises may be present
• Trismus.
• Radiographs of the TMJs are usually normal

27. 2. DISC DISPLACEMENT DISORDERS
Disk displacement with reduction Disk displacement without reduction

28. Treatment

29. Conservative management
Diet modifications.
Occlusal corrections if any
Muscle reprogramming
exercises.
Splints.
Orthodontic treatment
if required.
Muscle relaxants
Anti-anxiolytics.
PRILIMINARY TREATMENT

30. NON INVASIVE TREATMENT
THERMAL APPLICATION
THERAPAUTIC ULTRASOUND
BIOSTIMULATION

31. • Jaw restraining devices.
• Biofeedback mechanics.

32. PERMANENT OCCLUSAL MODIFICATION
• Occlusal equilibration
•Prosthetic restoration
• Orthodontics
• Orthognathic surgery

33. TMJ SURGERY
•Arthrocentesis
•Arthroscopy
•Disk-Repositioning Surgery
•Disk Repair or Removal
•Condylotomy
•Total Joint Replacement
•Arthroplasty for Ankylosis

34. ARTHROCENTESIS
• L.A. with intravenous sedation
• Needles into the superior joint space
• Ringer’s solution
• Steroids, L.A
• NSAIDs
• Very effective in anterior disk displacement without
reduction
• Stretching of capsule, decrease in pain mediators,
release of adhesions, elimination of negative
pressure

36. Arthroscopy

38. DISK REPOSITIONING SURGERY
• Indicated in anterior disk displacement with or
without reduction
• Removing a wedge of tissue from posterior
attachment
• Suturing the disk back to the correct anatomical
position
• May be combined with recontouring of the
disk,articular eminence,and condyle
• Jaw exercises

39. DISK REPAIR OR REMOVAL
• Disk repair with dermal grafts or fascial tissue
• Diskectomy without replacement
• Disk replacement with autogenous grafts or
alloplastic implants

40. MANAGEMENT OF RECURRENT
DISLOCATION
1. Capsule tightening procedures
(capsulorrhaphy,reinforcement of capsule)
2. Creating mechanical obstacle
(osteotomy of eminence,placement of
graft,silastic block,Dautry’s procedure,
use of pins or screws)
3. Direct restrain of condyle
4. Creation of new muscle balance
5. Removal of mechanical obstacles

41. Osseous Surgery of TMJ - Condyloplasty

42. TMJ dislocation

43. Eminoplasty - Eminectomy

44. Eminoplasty - Eminectomy

45. Autogenous or allogenous implants

46. Dautrey procedure

47. Condylectomy

48. Condylotomy

49. Subcondylar osteotomy

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59. OUR TEAM
Dr. Srinivas Sakamuri MDS Endodontist
Dr Sahana Mallineni MDS Periodeontist
Dr. Venkatesh Nettam MDS Orthodontist
Dr. Kalyani Ch. BDS EHS Coordinator
Dr. Chandana BDS Budding Dentist
Dr. G. Guru Karthik MDS Oral and Maxillofacial Surgeon