The Masticatory System

A dynamic biomechanical musculoskeletal system

by Widyawati Sutedjo

Skeletal Anatomy:
Masticatory System
Maxilla Mandible Condyle Ascending Ramus Coronoid Process Body of the mandible Temporal bone

Components of the Mastication

Dentitions Periodontal supporting tissues Maxilla and Mandible Temporomandibular Joint Mandibular musculature Muscles of lips, cheeks, and tongue Involving soft tissue Supplying innervation and vasculation
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Mastication
Mastication: Processes involved in food preparation, including moving unchewed food onto the grinding surface of the teeth, chewing, it, and mixing it with saliva in preparation for swallowing

Loss of Teeth Causes Occlusal Disharmony

Early loss of deciduous teeth without space retaining appliances
Loss of mandibular first molar
lingual and mesial tipping of mandibular 2nd and 3rd molar Loss vertical dimension

Changing in masticatory habit and muscle tonicity

Signs of occlusal disorders

Repeated fracture of teeth or restorations. Repeated loss of cementation of indirect restorations where retention and resistance in the preparation appear adequate.

Drifting or progressively increasing mobility of a tooth or groups of teeth.

Wear of the functional surfaces of the teeth, which is out of proportion to the patients age. Sign and symptoms from TMD or their associated muscles.

OCCLUSAL THERAPY
The purpose of occlusal therapy is to establish stable functional relationships favorable to the oral health of the patient, including the periodontium
Occlusal Adjustment Occlusal adjustment, or coronoplasty, is the selective reshaping of occlusal surfaces with the goal of establishing a stable, nontraumatic occlusion have been used extensively in the past for treating a variety of problems including occlusal trauma, TMD symptoms, bruxism, and headache

Kriteria fungsi oklusi yang baik

Pengunyahan bilateral yang seimbang dan bergantian. Kontak ringan pada posisi interkuspa ketika menelan Gerak mengunyah kedalam dan keluar, yang bebas dari kontak defleksi pada sisi kerja maupun non-kerja Tidak ada gerak adaptasi dagu atau bibir pada saat menelan Tidak ada gerak mengerot (clenching) dan bruxism Tidak ada bunyi sendi pada saat mastikasi maupun membuka mulut lebar-lebar Tidak ada deviasi mandibula waktu mulut dibuka lebar Tidak ada kontak gigi pada saat berbicara atau melakukan ekspresi wajah

Centric Relation
Centric Relation is an orthopedically stable muscular position where the condyle rests in a superior anterior position against the posterior wall of the articular eminence with the articular disk interposed. A purely rotational movement can occur for the first 20-25 mm of jaw opening.

Centric Occlusion vs. Maximum Intercuspation

Centric Occlusion is the tooth position when the TMJ is in CR and the teeth first touch on closing. Maximum intercuspation is the position of the teeth when there is maximum contact of teeth in occlusion.

Mandibular Movement
Mandibular movements occurs as a complex series of interrelated threedimensional rotational and translational activities. It is determined by the combined and simultaneous activities of temporomandibular joints (TMJs). There are two types of movement occurs in the TMJ: rotational and translational.

Types of Mandibular Movement

Rotational movement
Horizontal axis of rotation Frontal (vertical) axis of rotation Sagittal axis of rotation

Translational movement

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Rotational Movement
Around the horizontal axis (hinge axis)

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Rotational Movement
Around the frontal (vertical axis Occurs when one condyle moves anteriorly out of the terminal hinge position with the vertical axis of the opposite condyle remaining in the terminal hinge position

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Rotational Movement
Around the sagittal axis Occurs when one condyle moves inferiorly while the other remains in the terminal hinge position.
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Translational movement
Can be defined as a movement in which every point of the moving object has simultaneously the same velocity and direction.
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Anatomical Planes of Mandibular Movement

Frontal view
Front view of the jaws

Sagittal view
Lateral view of the jaws

Horizontal view
Superior view of the jaws

Border Movements
Mandibular movement is

limited by the ligaments, muscles of the TMJ, articular surfaces and morphology and alignment of teeth.

The outer limits of the

mandibles range of motion are called border movements.

Gothic Arch Tracing

BORDER AND FUNCTIONAL MOVEMENTS (SAGITTAL PLANE)

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1 4 2

**Movement is limited by ligaments

SAGITTAL PLANE (Gothic Arch Tracing)

Rotational movement of the mandibular with the condyles in the terminal hinge position.
This pure rotational opening can occur until the anterior teeth are 20-25 mm apart.

BORDER MOVEMENTS

Posterior opening stage one - early rotational movement around the horizontal axis.

 Second stage of rotational movement during opening. The condyle is translated down the articular eminence while the mouth rotates open to its maximum limit. Maximum opening is reached when the capsular ligament prevent further movement of the condyles.

Posterior opening stage twotranslational down the eminence.

 With the mandible maximally opened, closure accompanied by contraction of the inferior lateral pterygoids will generate the anterior opening border movements.
Anterior opening in sagittal plane

BORDER MOVEMENTS SAGITTAL PLANE

Common relationship of the teeth when the condyles are in the centric relation (CR) position.

Force applied to the teeth when the condyles are in centric relation (CR) will create a superoanterior shift of the mandible to the intercuspal position (ICP).

BORDER MOVEMENTS HORIZONTAL PLANE

A Gothic arch tracer is used to trace mandibular border movements in the horizontal plane While the mandible moves, the stylus attached to the mandibular teeth generates a pathway on the recording table attached to the maxillary teeth

When mandibular movements are viewed in the horizontal plane, a rhomboid-shaped pattern can be seen, as well as 4 distinct movement components.
1. Left lateral 2. Continued left lateral with protrusion 3. Right lateral 4. Continued Right lateral with protrusion

BORDER MOVEMENTS HORIZONTAL PLANE

FRONTAL (VERTICAL) BORDER

When mandibular motion is viewed in the frontal plane, a shield-shaped pattern can be seen that has functional component, as well as four distinct movement components: Left lateral superior border Left lateral opening border Right lateral superior border Right lateral opening border movements

FRONTAL PLANE BORDER MOVEMENTS

(Shield Shape)
** Note: The red Dot = Postural Position = Rest Position

TMJ Ligaments

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Ligaments Temporomandibular ligament

extend from base of zygomatic process of the temporal bone downward and oblique to the neck of the condyle

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Ligaments

Stylomandibular ligament
From styloid process and runs downward and forward to attach broadly on the inner aspect of the angle of mandible

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Ligaments Sphenomandibular ligament

arising from the angular spine of sphenoid bone and petrotympanic fissure, ending at lingula of mandible

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Functions of Ligaments

Accessory ligaments may limit border movements of the mandible

Fibrous capsule and TM ligament may limit of extreme lateral movements in wide opening of mandible
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