FULL Episode:

www.protrusive.co.uk/080

And Its Relevance to Restorative Dentistry

Spear Education and Protrusive Dental Podcast Collaboration
Inspired by Dr Jim McKee and Dr Mark Piper

I No Stuctural Damage
Ligament attachment to Lateral Pole and Medial
Medial
Pole

Pole intact
Intact Ligament Lateral
Restorative Significance: Pole
Healthy joint,
Good Prognosis Disc
Low Risk Condyle
Retrodiscal
Tissue

II Structural Damage to Lateral Collateral Ligament

(Minor)
Less stable fit of disc on the lateral pole

Restorative Significance: Structural damage

Occasional clicking of joint to ligament
Good Prognosis
Low Risk
Usually asymptomatic

III III-A
Lateral Collateral Ligament is torn
Medial Pole Ligament attachment is still intact
Disc is shaped so that it can still jump back on to the condyle
at the lateral pole (this is the 'click') therefore WITH reduction
Restorative Significance:
As long as the disc is attached on the Medial Pole,
the prognosis for long-term stability will be good.
Occasional click at the Lateral pole
Low to Moderate RIsk

III-B
Lateral Collateral Ligament is torn
Medial Pole Ligament attachment is still intact
Disc has structurally altered so that it does not fit
back on to the lateral pole of the condyle (no more click)
therefore WITHOUT reduction
Restorative Significance:
As long as the disc is attached on the Medial Pole,
the prognosis for long-term stability will be good.
Moderate Risk

IV
Consider Referral / proceed with caution
**As the Disc displaces, it may do so in different directions.
This can be confirmed by MRI
IV-A
Now the Medial Collateral Ligament is also torn
The condyle is displaced and unable to return to a normal
position on the lateral pole
At the medial pole the Disc can still
jump back on to the condyle
therefore WITH reduction

IV-B
Now the Medial Collateral Ligament is also torn
The condyle is displaced and unable to return to a normal position on the
lateral pole
The disc at the Medial pole remains in a forward position on opening
(no more click) therefore WITHOUT reduction
Disc completely displaced, soft tissue fills the space vacated.
Restorative Significance for Stage IV:
Click at the Medial Pole Increased risk of locking,
Patients may experience pain reduced opening and pain
Occlusal Instability Higher Risk and Instability
Guarded prognosis
High Restorative Risk

The disc gets its nutrition from lubrication fluid. If the disc is not in the
correct position to have lubrication fluid compressed into it, that disc
can start to change shape. And those are the cases where the condyle
can't get back underneath it.

V V-A
Now the condyle has perforated the
soft tissue completely resulting in
direct contact between the condyle
and the glenoid fossa
In this adapting/acute stage, there
is pain
V-B
Now the condyle has perforated the
soft tissue completely resulting in
direct contact between the condyle
and the glenoid fossa
The situation has reached
adapted/chronic stage

Restorative Significance for Stage V:

Unstable bite
High Risk

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