2 Anatomy of TMJ

TMJ AND ITS APPLIED
ASPECTS IN
PROSTHODONTICS
PRESENTED BY:
Dr. H.KOTESWARA RAO,
PG STUDENT,
DEPT. OF PROSTHODONTICS &
CROWN AND BRIDGE INCLUDING
IMPLANTOLOGY,
SIBAR INSTITUTE OF DENTAL SCIENCES,
GUNTUR.
Previously Asked Questions
 Describe the functional anatomy & biomechanics of

the TMJ.
-NTRUHS, 1999, 2001 & 2012 (25 Marks)
 Give description on the development & anatomy of
TMJ. Discuss the functions in application of
mastication.
-NTRUHS, 2012 (20 Marks)
 Prosthodontic considerations of TMJ.
-NTRUHS, 2000 (10 Marks)

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 2

CONTENTS
 INTRODUCTION
 DEFINITION & SYNONYMS
 DEVLOPMENT
 FUNCTIONAL ANATOMY OF TMJ
 HISTOLOGY OF THE JOINT
 AGE CHANGES IN TMJ
 BIOMECHANICS OF TMJ
 EXAMINATION OF TMJ
 DIAGNOSTIC IMAGING OF TMJ

CONTENTS
 CLASSIFICATION OF TEMPOROMANDIBULAR
DISORDERS
 FACTORS AFFECTED BY TMJ IN PROSTHODONTIC
REHABILITATION
 CONCLUSION
 BIBLIOGRAPHY & REFERENCES

INTRODUCTION
 TMJ is the unique and most complex joint in

the body and is the area in which the
mandible articulates with the cranium .
 The TMJ’s are one of the only synovial joints
in the human body with an articular disc.

 The name is derived from the two bones
which form the joint : the upper temporal

bone which is part of the cranium and the
lower jaw bone called the mandible.

DEFINITION
“The articulation between the temporal bone & the mandible.
It is a bilateral diarthroidal, bilateral ginglymoid joint.”
“The articulation of the condylar process of the

mandible & the intra-articular disk with the mandibular
fossa of the squamous portion of the temporal bone; a
diarthroidal , a sliding hinge
( ginglymus) joint. Movement in the upper joint
compartment is mostly transitional, whereas that in the
lower joint copartment is mostly rotational. The joint
connects the mandibular condyle to the articular fossa of the
temporal bone with the temporomandibular disk
interposed.”
-GPT-
9,
SYNONYMS
 Ginglymoarthroidal joint
 Craniomandibular joint
 Diarthoidal joint
 Synovial joint
 Compound joint

DEVELOPMENT OF TMJ
7th week IU: Meckel’s cartilage grows backwards
towards base of skull; terminates as malleus; articulates
with incal cartilage and acts as primary joint. By 10 th
week malleus and incus ossify and become
incorporated into middle ear.
10th week IU: two distinct mesenchymal condensation –

temporal and condylar blastemata; grows towards each
other to form TMJ.

 12th week IU: cleft appears above the condylar blastemata
and later another appears below the temporal blastemata
to give lower and upper joint cavity; primitive articular
disc formed.
13th week IU: condyle grow towards glenoid fossa;

compress the articular disc into a bi-concave disc.
22nd week IU: fibrous capsule forms around joint;

contain synovial fluid. Its development continues till
12years.

FUNCTIONAL ANATOMY
This is a synovial joint of condylar variety.
Articular surfaces-
A. Upper surface:
a) Articular eminence
b) Anterior part of
mandibular fossa.
B. Inferior surface :
a) Mandibular Condyle

COMPONENTS OF TMJ
 There are six main
components of the TMJ.
1. Mandibular condyles
2. Articular surface of
the temporal bone
3. Articular disc
4. Joint Capsule
5. Ligaments
6. Lateral pterygoid

1)CONDYLES
The condyle is the portion of mandible
that
articulates with the cranium around which the
movement occurs.
 Bulbous semicylindrical extremity of the
mandibular ramus.
◦ The posterior articular surface of is greater than
the anterior surface.
◦ Consists of medial and lateral poles.
◦ Convex mesio-distally and anterior-posteriorly.

 Dimensions:
 Mediolateral length: 18-23 mm
 Anteroposterior width: 8-10 mm
 Intercondylar distance: 100 mm
 Angle with frontal plane: 13˚ (0-30 ˚)
 Lateral tip lies about 13 mm beneath the skin & is
palpable.
ANTERIOR VIEW POSTERIOR VIEW

TMJ AND ITS APPLIED ASPECTS-86
05/15/2023 13
2)ARTICULAR SURFACE OF TEMPORAL
BONE
 The mandibular condyle articulates
at the base of the cranium with the
sqamous portion of the temporal
bone.
 This portion is called articular fossa
or glenoid fossa or mandibular

fossa.
 Divided by tympanosqamosal
fissure.
 Anterior portion forms the TMJ.
 Part of sqamous temporal bone.

 Modified to facilitate movement of
disc condyle complex.

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TMJ AND ITS APPLIED ASPECTS-86 14
ARTICULAR EMINENCE
 Immediately anterior to the fossa is a convex

bony prominence called articular eminence.
 Lies at inferior base of zygomatic process of
temporal bone.
 Antero-posterior convexity and transverse
concavity of the eminence is highly variable.
Covered by dense fibrous tissue.
 It dictates the path of condyle when mandible
is positioned anteriorly.

3)ARTICULAR DISC
 TMJ contains fibrous disc
interposed between the
articular surfaces
 It functions as a shock
absorber
 It is biconcave with a thin

intermediate zone ,thick
anterior and posterior bands.

 Anterior band - is
continuous into loose fibro
elastic connective tissue also
known as anterior foot
extension or anterior
ligament.
 Posterior band- is continuous

with lose connective tissue
rich in elastic fibers called
retrodiscal tissue or posterior
attachachment.

 It is loosely organized system of collagen fibers ,
branching elastic fibers , fat , blood,lymph vessels and
nerves .
 Superior retrodiscal lamina:
a)attaches to squamotympanic
fissure consists primarily of
elastin.
 Inferior retrodiscal lamina:
a) attaches to posterior articular slope
of condyle.
b)consists primarily of collagen
fibers.

4) JOINT CAPSULE
 Joint capsule is fibro elastic sac.
 BOUNDARIES:
Anteriorly Ascending slope of articular eminence
Posteriorly Lips of squamotympanic fissure
Superiorly Glenoid fossa

Inferiorly Neck of the condyle
 Inner surface of the capsule is smooth and
glistening.
 It is lined by synovial membrane.

SYNOVIAL MEMBRANE AND SYNOVIAL FLUID
 Synonyms: Synovial lining or synovial fringe
 Specialized endothelial cells.
 Anterior border of retrodiscal tissue forms
synovial fluid.
 Main constituent of synovial fluid is Hyaluronic
acid.
 Functions : Lubrication & providing metabolic
requirements.
 Mechanism of Lubrication:
 Boundary lubrication
 Weeping lubrication

JOINT SPACE
The disc divides the space into two compartments
1. Condylodiskal 2. temporodiskal
(hinge movement) (translatory movement)
Passive volume -0.9mL Passive volume -1.2mL

5)LIGAMENTS

 Made of collagenous connective tissue of particular
length .
 They do not stretch ,act as passive restraining
devices to limit and restrict border movements .
 3 Functional ligaments
Collateral ligament
Capsular ligament
Temporomandibular ligament
 2 Accessory ligaments
Sphenomandibular ligament
Stylomandibular ligament
Collateral or discal ligaments
 Two discal ligaments– Medial & lateral.
 Divides the joint.
 Functions:
◦ Restrict movement of disc

away from condyle.
◦ Hinge movement.
 Innervation of ligaments
determine:
◦ Joint position.
◦ Movement.
◦ Strain produces pain.

Capsular ligament
It surrounds and
encompasses the entire
TMJ.
Thus it retains synovial
fluid.
Well innervated and
provides proprioceptive
feedback regarding
position and movement of
joint.
Action : resists medial,
lateral, or inferior forces
that tend to separate or
dislocate articular surfaces.
05/15/2023 25
Temporomandibular
ligament
 Lateral aspect of capsular ligament is reinforced
by strong tight fibers that makeup
temporomandibular ligament
Limits extent of
outer oblique mouth opening
portion
Temporomandibula Resists excessive

r ligament dropping of
condyle
Limits posterior
Inner horizontal movement of
portion condyle and
disc

Temporomandibular
ligament

Accessory ligaments
05/15/2023 28
SPHENOMANDIBULAR LIGAMENT
Arises from spine of sphenoid bone and
extend downward to the lingula .
It does not have any significant limiting effect
on mandibular movements.

STYLOMANDIBULAR LIGAMENT
Arises from styloid
process and extends
downward & forward
to the angle and
posterior border of
the ramus.
Limits excessive
protrusive
movement of the
mandible.

Understanding the condyle disk
alignment
 Collateral ligaments allow
disk to rotate from top of
condyle to front and
back.
 Posterior ligament
prevents disk from
rotating too far forward.
 It also prevents the disk
from being displaced
anteriorly.
05/15/2023 31
 Superior elastic
stratum maintain
constant tension on
the disk toward the
distal.
 Superior lateral
pterygoid the only
forward pulling force.

HISTOLOGY OF THE JOINT
ᵜ A – Articular zone
ᵜ B - Reserve zone
ᵜ C - Proliferative zone
ᵜ D - Hypertrophic zone
ᵜ E - Calcifying zone
ᵜ F - Bone

Articular zone
 Most superficial.
 Utmost functional surface.
 Made of dense fibrous

connective tissue.
 Collagen fibers are parallel

to articular surface and
tightly packed to with
stand forces.

Proliferative zone
 Mainly cellular.
 Undifferentiated
mesenchymal tissue is
found .
 Responsible for
proliferation of
articular cartilage in
response to functional
demands .

Fibrocartilage zone
 Collagen fibers are
arranged in bundles in a
crossing pattern.
 Offers resistance against
compressive forces and

lateral forces.
Calcified zone
 Deepest zone.
 Made up of chondrocytes
and chondroblasts
distributed throughout the
articular cartilage.

Histology of articular cartilage
 Composed of chondrocytes and inter

cellular matrix.
 Chodrocytes produce collagen,

proteoglycons , glycoprotiens and
enzymes that form matrix.

Innervations of TMJ
 Except articular disc the joint tissues are
innervated by
• Auriculotemporal nerve(sensory)
• Massetric nerve and Deep temporal
branches(motor).
 Lymphatic drainage:
• Lateral surface : Preauricular & parotid

nodes
• Posterior surface : Submandibular nodes
• Medial surface : Parotid nodes

Blood supply of TMJ
 Arterial supply:
Posteriorly : Superficial temporal artery
Anteriorly : Middle meningeal artery
Inferiorly : Internal maxillary artery
 Venous supply:
Drain into: Superficial temporal,

Pterygoid plexus &
Maxillary veins.

MUSCLE PRODUCING MOVEMENTS
 Depression- Lateral pterygoid with
suprahyoid muscle
 Elevation/Biting- Masseter, temporalis,

medial petygoid of both sides
 Protrusion- Lateral and medial pterygoid.
 Retraction- Posterior fibres of temporalis
 Lateral or side to side movement ex. Turning

chin to left side- left lateral pterygoid and
right medial pterygoid.
05/15/2023
AGE CHANGES IN TMJ
 The condyle appears flattened in outline and
sometimes remnants of condylar cartilage can be
found in aged joints.
 The fibrous covering of the condyle becomes
thicker.
 Osteoporosis of the underlying bone of the
condyle is a common feature.

 The articular disk becomes thinner and exhibits
hyalinization. Chondroid changes are apparent.

 Tears can be seen in small acellular areas of
disk.

Age changes
 The synovial folds appear fibrotic with thick
basement membrane.
 Walls of blood vessels become thick, and
nerves decreased in number.

 These age changes in turn could lead to
dysfunction, impairment of motion, affect the

degree of resiliency during masticatory
function, decrease in the formation of
synovial fluid.

BIOMECHANICS OF TMJ
The movements of the mandible, combining
rotation and translation include:
1. Opening and closing.
2. Protrusion and retrusion.
3. Lateral shifts of the mandible.

Opening
◦ Initial step = relaxation of Masseter and
Temporalis (closing muscles).
◦ Intermediate = Inferior head of Pterygoid
pulls disc & condyle down.
◦ End = Digastric muscle pulls mandible
down & back.

Closing
◦ Superior head of Pterygoid stabilizes disc
& condyle.
◦ Masseter & Temporalis pull jaw up.
◦ Posterior movement limited by TML.

According to Okesonc
Rotatory Protrusive Anterior

Movement in TMJ
Extent of movement
Type of Movement
& Retrusive &
Translatory & Posterior
Lateral Border
Movements movements

Based on type of movement occuring
in TMJ
 Rotation:
“The process of turning
around an axis:
movement of a body
around its own axis”.
It occurs when the mouth

opens & closes around a
fixed point or axis with
in the condyles.

Transverse Axis
 The transverse axis runs horizontally from one side of
the mandible to the other side.

 When the condyles are in their most superior position
in the articular fossa, the axis around which pure
rotational movement occurs is called the “terminal
hinge axis”.
 Terminal hinge axis was proposed by Mc.Collum &
verified by Kohno.
 This pure rotational movement of the joint
takes place around the horizontal axis till the

patient opens his mouth about 20 to 25 mm.

Vertical axis
 The vertical axis runs through
the condyle and the posterior
border of the ramus of the
mandible.
 The mandible rotates around
this vertical axis during the
lateral movements.

Sagittal Axis
 The anteroposterior axis is an imaginary axis running along
the mid Sagittal plane. When one condyle moves inferiorly ,
the other remains in the terminal hinge position.
 This type of isolated movement
does not occur naturally because

the ligaments & musculature of
TMJ prevents inferior displacement
of condyle.
 The mandible shows slight
rotation around the axis.

Translational Movements
 “Movement in which every point of the
moving object has simultaneously the same
velocity & direction”.
 The mandible moves forward as in

protrusion, the teeth, rami, condyles- all
move in same direction & same degree.

 Translation occurs simultaneously around
one or more of the 3 axis resulting in
extremely complex movements.

Based on extent of movement
 Mandibular movement is limited by the
ligaments & the articular surfaces of the TMJ
as well as the morphology & alignment of the
teeth.
 When the mandible moves through the outer

range of motion reproducible describable
limits results, which are called border
movements.

 Border movements is defined as, “Mandibular
movement at the limits dictated by anatomic
structures, as viewed in a given plane”.
-GPT8,2005.
 Extreme border movements occur in three
different planes:
 Horizontal/ Transverse plane
 Sagittal plane
 Coronal/Vertical plane

Extreme movements in
horizontal plane
 Border movements recorded

in horizontal plane produced
characteristic “Diamond
tracing”.
TMJ AND ITS APPLIED ASPECTS-8605/15/2023 56

Extreme movements in the Sagittal
plane
A characteristic “ Beak Tracing” is

formed while recording border
movements in the Sagittal plane.

Extreme movements in the coronal
plane
Border movements produced in

this plane produced
characteristic “Shield tracing”.

Posselt’s Envelope of motion
 By combining mandibular
border movements in
3 planes, a 3 dimensional
envelope of motion
can be produced.
 This represents maximum

range of movement of
mandible.

Based on type of movement
Protrusive movement:
 This type of movement occurs when the mandible
moves forward from intercuspation.

Ex : while incising and grasping the food.
 This movement is presumed to occur after the condyle

rotates more than 13˚in the temporomandibular joint.

Retrusive movements
 Occurs when the mandible moves posteriorly
from intercuspation.
 This movement is restricted by the
ligamentous structures.
05/15/2023 61
Lateral Movements

`
 Bennett movement or laterotrusion is defined as
“The bodily lateral movement or lateral shift of the
mandible resulting from the movements of the
condyle along the lateral inclines along the
mandibular fossae in lateral jaw movements.”
“Condylar movement on the working side in
horizontal plane. This term may be used in
combination with terms describing condylar
movement in other planes, for example,
laterodetrusion , lateroprotrusion, lateroretrusion, and
laterosurtrusion”.
-GPT -9 ,
05/15/2023
Bennett Angle
Definition: “Angle formed by the sagittal plane & the
path of
the advancing condyle during
lateral mandibular movements
as viewed in the horizontal
plane”.
 Bennett Angle: 7.5 to 12.8º.

 This angle is used in
articulators with immediate
lateral translation capability.
Bennett Angle(L)=H/8+12

Factors affecting Bennett Shift
Looseness of the
Shape of the Glenoid
capsularFossa
ligaments
Contraction of the lateral pterygoids
Horizontal condylar
Guidance settings

Examination of TMJ

Diagnostic imaging of TMJ
 Hard tissue imaging  Soft tissue imaging
 Panoramic  Arthrography
 Transcranial  MRI
 Transpharyngeal
 Transorbital
 CT

Classification of
Temporomandibular disorders:
 Occluso-muscular disorders
 Intracapsular disorders
 Disorders that mimic TMD

GUidlines From American Society Of
Temporomandibular Joint Surgeons For
TemporOmandibular Joint And Related
Musculoskeletal Disorders
 Intra-articular(intra capsular) pathology
◦ Articular disk
◦ Disk attachments
 Displacement
 Inflammation
 Deformity
 Injury
 Adhesions
 Perforation
 Degeneration
 Fibrosis
 Injury
 Adhesions
 Perforation

◦ Synovium ◦ Articular Fibrocartilage
 Inflammation/effusion  Hypertrophy/
 Injury hyperplasia
 Adhesions  Degeneration
 Synovial (chondromalacia)
hypertrophy/hyperplasia  Fissuring
 Granulomatous  Fibrillation
inflammation  Blistering
 Infection  Erosion
 Arthritides(rheumatoid,
degenerative)
 Synovial chondromatosis
 Neoplasia

◦ Mandibular condyle and glenoid fossa
 Osteoarthritis(osteoarthritis,
degenerative joint disease)
 Avascular necrosis(osteonecrosis)
 Resorption
 Hypertrophy
 Fibrous and bony ankylosis
 Implant arthropathy
 Fractures/dislocations

 Extra-articular(extracapsular
pathology)  Masticatory muscles and tendons
 Anamolous development
◦ Musculoskeletal  Injury
 Bone(temporal,mandibular  Inflammation
,styloid)  Hypertrophy
 Anamolous  Atrophy
development(hypoplasia,hyper  Fibrosis, contracture
trophy,  Metabolic disease
malformation, ankylosis)  Infection
 Fracture
 Dyspalsisa
 Metabolic disease
 Neoplasia
 Systemic
 Fibromyalgia
inflammatorydisease(connectiv
e tissue/ arthritides) ◦ Central nervous system/peripheral
 Infection nervous system
 Reflex sympathetic dystrophy
 Dysplasias
 Neoplasia

TMJ INTERNEL DEARRAGMENT
DISC DISPLEACEMRNT
 A disorder characterized by abnormal
relatonship between the articular

disc ,mandibular condyle and articular
eminence
 The disc displacement most offen displace

anteriorly or anterio-medially
 Most common in patient with sign and
symtoms of TMDs

Classification of TMJ disc displacements
 Antomical calssification
o Anterior
o Antero-medial
o Antero-distal
o Lateral
o Medial
o Posterior(very rare)

Functional classification
 Disc displacement with reduction

 Disc dispalcement with out reduction-acute phase
 Disc dispalcement with out reduction –chronic phase

Disc dispalcement with reduction
 The displaced disc recaptured its normal
relationship with mandibular condyle during
mouth opening
Disc displacement with out
reduction
 Displacement of articular disc on closing and
failure to reduce or recapture the normal
relationship with condyle up on opening

Tmj Ankylosis and Management
 Ankylosis is a pathological fusion of parts of
joints resulting in restricted movement across
the joint.
 Classification –
Bilateral/unilateral ankylosis
Fibrous /bony ankylosis
Interarticular/Extraarticular ankylosis
Complete/Partial Ankylosis
True/False ankylosis

Etiology of Ankylosis
 Trauma
At the birth
Condylar fractures
 Infection and Inflammation
Rheumatoid arthritis
Osteo arthritis
Parotitis
Mastioditis

 Systemic Diseses
Small pox
Ankylosing spondilitis
Thyphoid fever
Scarlet fever
 Others
Malignancies
Post surgery

Clinical Features
 Facial Deformitiy-The chin is deviated to the
affected side.
 Inability to open the jaws.
 In unilateral ankylosis the lower jaw shifts
toward the affected side.

 Flatness of the affected side.
 Cross bite on ipsilateral side
 Class-II mal occlusion on the affected side

Management
 Surgical
 Non surgical

 Surgical procedures
Gap arthroplasty
Condylectomy
Interpositional arthroplasty

Condylectomy
 In fibrous ankylosis ,the preauricular incision
is made.
 The cut is made at the level of the condylar
neck.
 The head should be seperated from the
superior attachement carefully.Then is it

sutured in layers.
Complications
 Ipsilateral deviation to the affected side
 Bilateral procedure causes anterior Open bite.

Gap arthroplasty
 Indicated in extensive bone ankylosis
 It consists of two osteotomy cuts.
 Removal of the bony wedge for creation of
the gap between glenoid fossa and ramus of

the mandible.
 Gap should be 1cm to avoid the re-ankylosis.

Inter positional arthroplasty
 This is actually an improvement /modification
on gap arthroplasty.
 Currently the surgical protocol of choice
 Materials are used to interpose between the
ramus of the mandible and the base of the
skull to avoid reankylois.
 The procedure involves the creation of gap,but
in addition a barrier is inserted between the
two surfaces to avoid reoccurence and too
maintain the vertical height of the ramus.

Subluxation and Discolation of TMJ
 Sulaxation is defined as the self reducing
partial dislocation of tmj during which the
condyle passes anteriorly to the condylar
eminence.
 Dislocation is defined as the long lasting
inability to close the mouth due to the

complete translation of the condyle anterior
to the articular eminence.

Causes of Subluxation
 Subluxation also called as hyper mobility.
 Usually as a result of anatomic form of the fossa.

 Patients having a steep short posterior slope of
articular eminence followed by longer flat

angular slope seem to display greater tendency
towards subluxation.
 The last movement of condyle becomes a sudden
quick jump forward leaving a clinically noticeable

pre auricular depression.

Treatment
Definitive treatment-
 The only definitive treatment for subluxation is
surgical alteration of joint itself by eminectomy.

Supportive Therapy-
 Supportive therapy starts with educating the
patient regarding the cause.

 Patients must learn to restrict opening so as not
to reach the point of translation that initiates

interference.
 An intra oral device can be used for 2months
when the interference is not voluntarily resovled.

Dislocation
Condition commonly referred as open lock.
Cause-
 When mouth extends to fullest extent
condyle is translated to its anterior limit.

 In this position the disc is rotated to its most
posterior extent on the condyle.

 If the condyle moves beyond this limit the
disc can be forced through the disc space and

trapped in its anterior position as disc space
collapses.

Treatment
 Definitive Treatment-it is directed towards
increasing the disc space which allows the
superior retrodiscal lamina to retract the disc.
 As the mandible is locked open,the patient can
be quiet distressed and will generally tend to

contract the elevators.This aggrevates the
spontaneous dislocation.
 The patient must open widely as if yawning.This
will activate mandibular depressors and inhibit

elevators.This will sometimes reduces
spontaneous dislocation.

 If this not successful the clinicians thumbs
are placed on the mandibular molars and
downward pressure is exerted usually this
will provide enough space to recapture
normal disposition.
 It is advisable to wrap gauze around clinicians
thumb to protect from sudden closure.

Supportive Therapy
 Patient is taught the reduction technique as
in sub luxation.
 Surgery is considered only after supportive
therapy has failed.

Inflammatory Disorders
Osteoarthritis-
 It is the most common arthritides
affectingTmj.
 It is also referred to as degenerative joint
disease.
 Most common factor is overloading of
articular structures of the joint.

 This may occur when the disc is dislocated or
retro discitits.

 When bony changes are active ,the condition
is often painful and referred to as osteo
arthritis.
 When precise cause of arthritis is known it is
referred to as secondary osteoarthritis. when

cause is known it is referred as primary
osteoarthritis.

Clinical Features
 Limited mandibular opening because of joint
pain.
 Crepitation can be typically felt.lateral
palpation of the condyle increases pain.

Rheumatoid Arthritis
 Rheumatoid arthritis is a heterogenous group
of systemic disorders with general synovial
membrane inflammation in several joints.
Clinical Features-
More in females,increases with age.
It affects small jont of hands,wrists,kneesand
feet,bilateralsymmetric.
Pain,swelling,stifness of jaw opening bilateral
involvement.

Treatment
Definitive treatment
Because the cause of the rheumatoid arthritis
is unknown the,no definitive treatment exists
Supportive treatment
-It is directed towards the pain reduction by
giving the stabilisation appliance
-athrocentesis,and arthroscopic procedures are
helpful with accute symptoms associated with
rheumatoid arthritis
-

0cclusal splint therapy
 A non invasive and revesible biomechanical
methods of managing pain and dysfuntion of
tmj and its associated musculatures
 The joint stabilization splint

 Main purpose :
To stabilize the tmj by decreasing pressure

on joint structure and reduce parafunctonal
activity such as buxism

0
The stabilization splint
-covers the entire dental arch
-occlude with all oppising teeth
-The occlusal surface is flat with slight
indentation for opposing cups tip

1
The anterior positioning applience
 Anterior bite plane

2
 Posterior bite plane

3
 Soft or resilent appliances

4
Factors affected by TMJ in
prosthodontic rehabilitation
Hinge axis
 It is an imaginary line passing through the centre of
the condyle when the mandible rotates in the
sagittal plane.
 This rotation is within 5-12 degrees.
 There can be multiple axes of rotation for a single
patient.
 The one which coincides with centric relation is
called true hinge axis.
 This should be accurately determined during full
mouth rehabilitation done with either removable or
fixed partial denture.
05/15/2023 10
Rest position
 It is defined as “the postural position of the

mandible when opening and closing muscles are in
minimal tonic contraction”.
 When mandible is not functionally active it adopts a
rest position.
Significane: In healthy TMJ this record is fairly
constant
This varies for number of reasons like
condyle head position and levels of muscle activity

7
Centric Relation
 “Most posterior relation of the

mandible to the maxilla with
the head of condyle in
unstrained & most retruded
position in the glenoid fossa”.
 Significance:
 Retention & stability will be
lost if CO & CR are not

coinciding.
 Maintains health of TMJ
 Improves masticatory
efficiency

8
 Helpful in adjusting condylar guidance to the
articulator to produce balanced occlusion.
 It is the basic point of teeth setting &
adjustment in articulator.
 It is learnable, repeatable & recordable position
which remains constant throughout life.

 Acts as centre from which all the eccentric
movements can be made.

 Helps to mount maxillary cast onto the
articulator.
05/15/2023 10
Vertical Dimension
Increased Decreased

0
Range Of Mandibular Movement
 The position of widest mouth opening is

associated with the condyle moving to the
crest of the articular eminence or beyond.
 A wide variation in mandibular movement

exists
 Incisor displacement remains the most
common diagnostic indicator

1
Occlusion
 Reduced number of contacting teeth in

intercuspal position and loss of posterior
teeth are the risk factors for development of
TMDs.

2
Condylar Guidance
 Mandibular guidance generated by the
condyle and the articular disc traversing the
contour of the glenoid fossa.

3
Conclusion
 As the temporomandibular joint is the most

complex and unique joint of the body which
is responsible for all the functional
movements of the mandible there is all the
need to know its anatomy and function in
order to establish a healthy occlusion in
prosthodontic rehabilitation.

4
BIBLIOGRAPHY & REFERENCES
 Okeson JP.Functional Anatomy & Biomechanics of
TMJ .In Management of TMJ disorders and
occlusion;6th edition 2008 : 1-38.
 Dawson PE. The TMJ. In Functional occlusion from
TMJ to smile design 2007,33-45.
 White SC & Pharoah MS. Imaging Principles &
Techniques. In Oral Radiology Principles &
Interpretation.6th edition 2004: 175- 225.
 Greenberg MS,Glick M.Temperomandibular
Disorders. In. Burkit’s Oral medicine diagnosis and
treatment .10th edition :271-300.
 Chaurasia BD. Temporal & Infratemporal Regions. In
Human anatomy:Head & Neck. 4th edition:161-163.

5
 Ash MM, Nelson SJ .TMJ’s muscles,teeth & their function. In
Wheeler’s Dental Anatomy Physiology & Occlusion.8th
edition,2005: 411-429.
 Bolender CL, Zarb GA.Biological & Clinical Considerations in
making Jaw Relation Records. In Prosthodontic treatment for
edentulous Patients.12th edition 2005:268-303.
 Roberson TM. Clinical signifance of Dental Anatomy,
Histology, Physiology & Occlusion. In Sturdevant’s Art &
Science of Operative Dentistry 5th edition 2009:48-64.
 Lundeen HC, Shryock EF, Gibbs CH. An evaluation of
mandibular border movements: their character and
significance .J Prosthet Dent. 1978;40:442-452

6
 Landa JS. A critical analysis of the bennett movement Part I. J
Prosthet Dent 1958;8(4):709-26.
 Landa JS. A critical analysis of the bennett movement Part II. J
Prosthet Dent 1958;8(5):865-79.

 Bennett NG. A contribution to the study of the movements of
the mandible. J Prosthet dent 1958;8(1):41-54.

An evaluation of mandibular border movements: their
character & significance. J Prosthet Dent 1978;40:442-452.
Gibbs CH. Functional movements of the mandible. J Prosthet
Dent 1971;26:604-19.

7

2 Anatomy of TMJ

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2 Anatomy of TMJ

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TMJ AND ITS APPLIED

 Describe the functional anatomy & biomechanics of

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 2

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 3

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 4

 TMJ is the unique and most complex joint in

in the human body with an articular disc.

which form the joint : the upper temporal

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 5

“The articulation of the condylar process of the

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 7

10th week IU: two distinct mesenchymal condensation –

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 8

13th week IU: condyle grow towards glenoid fossa;

22nd week IU: fibrous capsule forms around joint;

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 9

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 10

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 11

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 12

ANTERIOR VIEW POSTERIOR VIEW

or glenoid fossa or mandibular

 Part of sqamous temporal bone.

disc condyle complex.

 Immediately anterior to the fossa is a convex

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 15

 It is biconcave with a thin

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 16

 Posterior band- is continuous

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 17

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 18

Superiorly Glenoid fossa

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 19

 Anterior border of retrodiscal tissue forms

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 20

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 21

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 22

devices to limit and restrict border movements .

◦ Restrict movement of disc

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 24

Temporomandibula Resists excessive

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 26

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 27

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 29

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 30

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 32

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 33

 Utmost functional surface.

 Made of dense fibrous

 Collagen fibers are parallel

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 34

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 35

compressive forces and

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 36

 Composed of chondrocytes and inter

 Chodrocytes produce collagen,

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 37

• Lateral surface : Preauricular & parotid

• Medial surface : Parotid nodes

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 38

Drain into: Superficial temporal,

TMJ AND ITS APPLIED ASPECTS-86 05/15/2023 39

 Elevation/Biting- Masseter, temporalis,