Introduction

Review of Masticatory System

and

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From DOCC 381

Concept Instruments and technique Morphology of occlusion Anatomy of mastication system Mandibular movement Neurophysiology of mastication Sign and symptom of TMD Occlusal splint
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Introduction to DOCC 582

Aetiology and Epidermiology of TMD Clinical assessment of masticatory system Diagnosis and Classification of TMD Oral parafunction Trauma from occlusion Management of TMD problem

Interocclusal appliances
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Occlusion also Includes Biological evolution Development Histology Anatomy Biomechanics Physiology (Neurophysiology) Adaptation Pathology Behaviour sciences Clinical diagnosis Therapy

Definition

(Jablonski, 1982)

The relationship between all the components of the masticatory system in normal function, dysfunction, and parafunction, including the morphological and functional features of contacting surfaces of opposing teeth and restorations, occlusal trauma and dysfunction, neuromuscular physiology, the TMJ and muscle function, swallowing and mastication, psychological status, and the diagnosis, prevention, and treatment of functional disorders of the masticatory system
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Objectives and Goals The subject of occlusion serves as a natural interface between certain of the biologic and behavioural sciences and the clinical sciences. The subject of occlusion is, in the view of many, the medium that brings all branches of dentistry together (Ricketts, 1969)

The Masticatory System

A dynamic biomechanical musculoskeletal system

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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Primary Dentition

Maxillary teeth
12 4 2 4 3 3 5 27 29 5

Mandibular teeth 1

Months

8 10 13 16 19

Permanent Dentition

Maxillary teeth Mandibular teeth Years

6
6

6 1

1 2

53 7

8 8

3 4 5 7

10

12

20

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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

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Periodontal Supporting Tissues

Cementum Periodontal ligament Supporting bone Usually, periodontium is protected against injury by neuromuscular reflexes

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Problems to Periodontium
Periodontal trauma pattern of mastication Loss of teeth loss of periodontal support

Faulty restoration
Abnormal occlusal force; bruxism, clenching

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Temporomandibular Joint (TMJ)

A complex giniglymoarthrodial (hinge and glide) articulation with limited capability of diarthrosis (free movement)

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Histology of TMJ Area

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Temporomandibular Joint (TMJ) Composed of

Condyle
Mandibular fossa Articular capsule

Synovial tissue
Articular disc Ligaments

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Mandibular Condyle
Modified barrel shape approx. 20 x 10 mm (ML x AP) Perpendicular to the ascending ramus of mandible Dense cortical bone covered with dense fibrous connective tissue with irregular cartilage like cell

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Mandibular Fossa
Dense cortical bony surface of temporal bone Posterior to articular eminence Posterior nonarticular fossa is formed by tempanic plate Thin at the roof of the fossa and tympanic plate

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Articular Capsule and Disk

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Articular Capsule
Ligamentous capsule surrounds the joint Attached to the neck of the condyle and around the border of the articular surface of the temporal bone anterolateral aspect of the capsule may thicken form the Temporomandibular ligament function as stabilising structure

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Articular Capsule
Consist of
internal synovial layer outer fibrous layer containing veins, nerves, and collagen fibres.

Innervation of capsule disk arises from CN V; auriculotemporal and masseteric nerves

Venous plexus at posterior aspect
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Synovial tissue
Synovial cell and connective tissue covering the lower and upper-joint spaces Synovial fluid, a proteoglycan-hyaluronic acid complex acts as a lubricant and may participated in nutritional and metabolic interchange for central part.

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Articular Disk (Meniscus)

Biconcave oval structure interposed between the condyle and the temporal bone 1 mm in the middle and 2-3 mm at periphery

Dense collagenous connective tissue

Centre area is a vascular, hyaine and devoid of nerve

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Articular Disk (Meniscus)

Fuse to a strong ligament at lateral side connect to the neck of the condyle The other borders are attached to capsule ligaments or synovial membranes separate between two joint spaces.

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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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Masticatory Muscles Masseter muscle

Temporalis muscle
Medial pterygoid muscle Lateral pterygoid muscle

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Masster muscle Superficial layer

O : lower border of malar bone, Zygomatic arch & zygomatic process of maxilla
R : Downward and Backward I : Angle of mandible and inferior half of the lateral side of mandible
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Masster muscle Deep layer

O : Internal surface of zygomatic arch R : Downward (vertical) I : Ramus of mandible and base of coronoid process 50 degree between 2 layers

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Temporalis muscle 3 bundles

Anterior bundle (vertical fibre)
Action: Mandible elevator (Close jaws), crushing and chewing at C.O. Inaction: Mandible depression (except Max. Opening and Opening against resistance)
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Temporalis muscle
Posterior bundle (Horizontal bundle) Action: Mand. retraction and positioner Inaction: Mand. depression and protrusion Intermediate bundle Action: Protrisive movement
Nerve supply

Ant. and Post. deep temporal nerve

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Med. Pterygoid muscle

Rectangular shape at medial surface of ramus, synergistic with masseter muscle
O : Pterygoid fossa and medial surf. of the lateral pterygoid plate

I : Inf. + Post. border of ramus and angle of mand.

R : Downward and Backward

N : Medial Pterygoid nerve

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Lat. Pterygoid muscle Superior head

O: Wing of sphenoid and infratemporal crest
R: Downward and Backward

Inferior head
O: Lateral surf. of lateral pterygoid plate R: Upward and backward

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Lat. Pterygoid muscle

Insertion of superior and inferior heads Ant. portion of the condylar neck (pterygoid fovea) Ant. surface of the articular capsule Ant. Border of the disk Function

Open the jaws, protrude and lateral movement with moving disk forward
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Lat. Pterygoid muscle Superior head

Synergistic with elevator group of muscle for closing and clenching

Inferior head
Synergistic with suprahyoid group of muscle for opening jaw

Nerve supply
Lateral pterygoid nerve
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Non Masticatory Muscle Digastric muscle

Mylohyoid muscle
Geniohyoid muscle Orbicularis Oris

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Non Masticatory Muscle

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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

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Rotational Movement
Around the sagittal axis

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Translational movement

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Sagittal Plane Border Movement

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Sagittal Plane Border Movement

Posterior open border Anterior open border Superior contact border Functional movements

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Horizontal Plane Border Movement

Left lateral border Continued left lateral border with protrusion Right lateral border Continued right lateral border with protrusion Functional movements
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Horizontal Plane Border Movement

Continued right lateral border with protrusion

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Horizontal Plane Border Movement

Functional movements

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Frontal (Vertical) Border and Functional Movement

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Frontal (Vertical) Border and Functional Movement

Left lateral superior border

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Frontal (Vertical) Border and Functional Movement

Right lateral opening border

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Frontal (Vertical) Border and Functional Movement

Functional movements

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References
Ash and Ramfjord. Occlusion 4th edition. W.B. Saunders Company, 1995 Mohl, Zarb, Carlsson and Rugh. A textbook of Occlusion. Quintessence Publishing Co., 1998 Sicher and DuBrul. Oral Anatomy 6th edition. The C.V. Mosby company, 1975 Kraus, Jordan and Abrams. Dental anatomy and Occlusion. The Williams and Wilkins company, 1969

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Thank you

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