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TEMPOROMANDIBULAR DISORDERS

TEMPOROMANDIBULAR DISORDERS. Definition. American Dental Association, 1983 defined TMD as a group of orofacial disorders characterized by: Pain in the preauricular area, TMJ, or muscles of mastication Limitations /deviations in mandibular range of motion TMJ sounds during jaw function

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TEMPOROMANDIBULAR DISORDERS

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  1. TEMPOROMANDIBULAR DISORDERS

  2. Definition American Dental Association, 1983 defined TMD as a group of orofacial disorders characterized by: • Pain in the preauricular area, TMJ, or muscles of mastication • Limitations/deviations in mandibular range of motion • TMJ sounds during jaw function 1990Y Craniomandibular Disorders(CMD)

  3. Epidemiology of TMD • TMD pain has been estimated to affect 10% (5-12%) of the population • It is at least twice as common in women as in men • It occurs more frequently in people 20-50 years old

  4. Anatomy of TMJ • Mandibular condyle • Joint surface of temporal bone • Articular disc • TMJ capsule • TMJ ligament

  5. Anatomy of TMJ • Multi-axis & multi-direction► • Movement agility • A important part in stomatognathic system ► • A remodeling in all lifetime joint

  6. Anatomy of TMJ • Sagittal plane view: The relationship among dics & condyle & glenoid in COP Normal: One plane: front bevel of condyle / middle part of disc / posterior bevel of node One line: cross ridge of condyle /posterior border of later belt of disc /peak of glenoid Abnormal: 1.Retrusion of condyle 2.Hyperfunction of lateral pterygoid muscle

  7. Anatomy of TMJ • Coronal plane view: the relationship of disc & condyle & node in COP Normal: middle position condyle and disc in middle position Abnormal : Ingression or out-shift of condyle and disc

  8. Etiology of TMD • Psychic factor • Bad habits • Trauma • Others

  9. Etiology of TMD Occlusal factor: Occlusal interfere × occlusion High spot • Protrusive occlusal interfere • Lateral occlusal interfere • Retrusive occlusal interfere

  10. Lateral occlusal interfere

  11. Etiology of TMD • Occlusal factor Premature contact：interfere happened in PP to ICP Elongation of upper 3rd molar Anterior superior displacement of condyle Elongation of lower 3rd molar Posterior displacement of condyle

  12. Etiology of TMD • Occlusal factor Malocclusion: • Malocclusion of individual tooth • Malocclusion of dentition

  13. Anterior teeth lingual tipping deep overbite

  14. Etiology of TMD • Occlusal factor • More teeth losed • Lateral molars loss：unilateral mastication • Bilateral molars loss： Posterior displacement of condyle Maladjustment of Reverse tensile reflection

  15. Etiology of TMD • Occlusal factor • Change of interarch distance: • More higher: apertognathia • More lower: excessive wear Sustained tension of masticational muscle Anterior inferior displacement of condyle Posterior superior displacement of condyle Maladjustment of reverse tensile reflection

  16. More higher vertical distance with more tenser muscles

  17. More lower in interarch distance－－serious teeth wear

  18. Etiology of TMD • Occlusal factors • Latrogenic factors: • Oral madicine • Prosthodontics • Orthodontics

  19. Etiology of TMD • Predisposing factors • Initiation factors • Perpetuating factor

  20. Clinical manifestation of TMD • Pain • TMJ sounds • Limitations in mandibular range • Others

  21. Clinical manifestation of TMD Muscle derived pain Articular derived pain protective muscle splinting local muscle soreness myofascial pain myospasm chronic myosis pain happened in disc and ligament retrodiscitis synovitis or capsulitis osteoarthritis

  22. Clinical manifestation of TMD • Displacement of disc • Recoverablity disc dislocation • Unrecoverability disc dislocation Recoverablity disc dislocation Unrecoverability disc dislocation

  23. Antiorer diplacement of disc

  24. Antiorer diplacement of disc

  25. TMJ sounds

  26. TMJ sounds

  27. Clinical manifestation of TMD • Hyperosteogeny & disc perforation • Synovium lesions

  28. Clinical manifestation of TMD • Opening limitation • Abnormal opening

  29. Clinical manifestation of TMD • Tension type headache • Migraine • Others

  30. Clinical examination of TMD

  31. Clinical examination of TMD • Opening patterns • Straight • Deviation (right & left) • Corrected deviation • Others

  32. Clinical examination of TMD • Opening patten • Straight • Deviation (right & left) • Corrected deviation • Others

  33. Clinical examination of TMD

  34. Clinical examination of TMD

  35. Clinical examination of TMD

  36. Clinical examination of TMD

  37. Clinical examination of TMD • 患者自身条件评价（patient assessment of condition)：chief complaints; treatment history & expectation • 行为状态评价(behavioral status)：jaw disability; parafunctional behaviors; general health behaviors • 心理评价(psychological status)：depression; anxiety; somatization（精神状态的躯体表现） • 社会心理评价(psychosocial status)：pain-related interference with daily life, pain intensity and persistence, social support

  38. Treatment of TMD

  39. Treatment of TMD • Relaxation splint

  40. Treatment of TMD • Stabilization splint

  41. Treatment of TMD • Repositioning splint

  42. Treatment of TMD • Pivot splint

  43. Treatment of TMD • Occlusal adjustment • Surgery • Orthodontics • Prosthodontics

  44. Thanks

  45. 下颌运动轴心 ►

  46. Stomatognathic system ┌─→ CNS ←─┐ │ │ │ muscle │ │ │ occlusion ←─→ TMJ

  47. 咀嚼运动中肌肉和关节的协调运动

  48. 咀嚼运动中肌肉的左右协调运动 ►

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