TEMPOROMANDIBULAR DISORDER

2018
 DEFINISI TMDS
 The glossary of prosthodontic :
1: conditions producing abnormal, incomplete, or impaired
function of the temporomandibular joint(s)

2: (obs) a collection of symptoms frequently observed in

various combinations first described by Costen (1934, 1937),
due to irritation of the auriculotemporal and/or chorda
tympanic nerves
 American dental association, 1983
a group of orofacial disorders characterized by:
1. Pain in the preauricular area, TMJ, or muscles
of mastication
2. Limitations/deviations in mandibular range of
motion
3. TMJ sounds during jaw function
 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
 ETIOLOGY OF TMD

 Psychic factor

 Bad habits
Bruxism

 Trauma
Occlusal factor

 Others
Congenital
Etiology of TMD

Occlusal factor:
Occlusal interfere
×

High spot occlusion

1. Protrusive occlusal interfere

2. Lateral occlusal interfere
3. Retrusive occlusal interfere
LATERAL OCCLUSAL INTERFERE
Etiology of TMD

 Occlusal factor

Premature contact：

Elongation of Anterior superior displacement of

upper 3rd molar condyle

Elongation of Posterior displacement of condyle

lower 3rd molar
Etiology of TMD

 Occlusal factor

Malocclusion:

• Malocclusion of individual tooth

• Malocclusion of dentition
Etiology of TMD

 Occlusal factor

More teeth losed

1. Lateral molars loss：unilateral mastication

2. Bilateral molars loss：

Posterior displacement of condyle

Maladjustment of Reverse tensile reflection

MORE HIGHER VERTICAL DISTANCE
WITH MORE TENSER MUSCLES
MORE LOWER IN INTERARCH DISTANCE
－－SERIOUS TEETH WEAR
Etiology of TMD

 Occlusal factors

Latrogenic factors:

1. Prosthodontics

2. Orthodontics
Clinical manifestation of TMD

 Pain
 TMJ sounds

 Limitations in mandibular range

 Others
 Clinical manifestation of TMD
 Displacement of disc
 Recoverablity disc dislocation
 Unrecoverability disc dislocation

Recoverablity disc
dislocation

Unrecoverability disc
dislocation
 KLASIFIKASI

1. American Academy of Orofacial Pain (AAOP)

2. Research Diagnostic Criteria for

Temporomandibular Disorder (RDC/TMD)
Klasifikasi TMDs berdasarkan American Academy of Orofacial Pain (AAOP)
II.TMJ DISORDER
 Derarangement of condyle disc complex
1. disc displacement
2. disc dislocation with reduction
3. disc dislocation without reduction
 Structural incompatibility of articular surface
1. deviation in form
2. spontaneus dislocation (open lock)
 Inflammatory disorder of TMJ
1. Osteoartritis
 1. DISC DISPLACEMENT

 Abnormal positional
relationship between the
articular disc, the head of
the condyle, and the
articular fossa of the
temporal bone.

 It has been reported in 25-

65% of elderly patients.
DISC DISPLACEMENT

 It is also prevalent in
patients with myofascial
pain-dysfunction syndrome
and/or osteoarthritic
changes in the joint.

 Not all patients with

displacements have or
develop signs or
symptoms.
2. DISC DISLOCATION WITH REDUCTION

 Reproducible clicking
 Disc displacement shown by
imaging and absence of
degenerative bone disease
 There may be pain, deviation
of jaw movements
 No limitation of opening
 Stabilization splint or anterior
repositioning splint
3. DISC DISLOCATION WITHOUT REDUCTION

 Disc is displaced during opening

& closing
 Persistent limitation of mouth
opening
 Disc displacement shown by
imaging and absence of
degenerative bone disease
 Pain
INTERNAL DERANGEMENT

 Jaw lock
STRUCTURAL INCOMPATIBILITY OF ARTICULAR
SURFACE
1. deviation in form

deviasi
2. spontaneus dislocation (open lock)
DISK PERFORATION
1.OSTEOARTHROSIS
AGE CHANGES OF TMJ

1- Flattened condyle
2- osteoporosis of the condyle bone.
3- Thickning of the fibrous covering of the condyle.
4- Thinning of the cartilagenous zone of condyle.
5- Thinning of the disc
6- Fibrotic synovial folds
7- Decrease the number of nerves
AGE CHANGES OF TMJ

These age changes lead to:

-Decrease in the synovial fluid formation
-Impairment of motion due to decrease in the
disc and capsule extensibility
-Decrease the resilience during mastication due
to chondroid changes into collagenous
elements
-Dysfunction in older people
ARTHRITIS OF TMJ

Infectiousarthritis
Rheumatoid arthritis

Degenerative arthritis

Traumatic arthritis
OSTEOARTHROSIS (OSTEOARTHRITIS)
 A degenerative disease which mainly affects weight-bearing
joints.

 In the TMJ it differs from other joints probably because:

1. It is not a “weight-bearing” joint.
2. The articular surface is covered with fibrous tissue rather than
hyaline cartilage.

 It is rare in TMJ before 5th decade of life, but after that it

increases proportionately with age.
OSTEOARTHROSIS
 Clinical features:

 Pain.

 Crepitus.

 Limitation of jaw movement.

 Deviation on opening.

 Many cases are clinically silent.

 Disc
overloading
displacement

Increased
remodeling

Negative Disc
Deviation in form
adaptation displacement

overloading

ARTHROSIS

Link of arthrosis and Dis

displacement,Sanat 1992