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TMD > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Anterior Guidance

A

Influence of the contacting surfaces of anterior teeth on tooth limiting mandibular movements. The steepness of the lingual surfaces of max anterior teeth determines the amount of vertical movement of the mandible.

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2
Q

Condylar guidance

A

Mandibular guidance generated by the condyle and articular disc traversing the contour of the glenoid fossa. It depends on the steepness of the articular eminence.

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3
Q

Working side contacts

A

Contacts of teeth made on the side of the articulation toward which the mandible is moved during working movements.

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4
Q

Non working or balancing side interference

A

Undesirable contacts of the opposing occlusal surfaces on the non working side (which interferes with the working side occlusal contacts.) one of the features of ideal occlusion is ABSENCES of posterior interferences.

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5
Q

Occlusal equilibration

A

The modification of the occlusal form of the teeth with the intent of the equalizing occlusal stress, producing simultaneous occlusal contacts or harmonizing cuspal relations.

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6
Q

When do we do occlusal equilibration?

A

When managing certain TMD after the occlusal appliance therapy has eliminated TMD symptoms and to compliment treatment associated with major occlusal changes like Orthodontics and Prosthodontics

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7
Q

Primary goals of equilibration or selective grinding

A
  1. With the condyles in CR (musculoskeletal stable position) and the articular discs properly interposed, all possible posterior teeth contact evenly and simultaneously between centric cusp tips and opposing flat surfaces.
  2. When excursive movements happen, laterotrusive contacts on the anterior teeth disocclude the posterior teeth.
  3. When the mandible is protruded, contacts on the anterior teeth disocclude the posterior teeth
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8
Q

Posselts envelope of motion

A

Term that refers to the range of motion of the mandible. The shape of the envelope carries depending on the plane, but it generally resembles a beak, a shield, or a diamond

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9
Q

What is the envelope of motion useful for?

A

Studying the anatomy and function of the TMJ and understand the relationship between the position of the teeth and the movement of the jaw

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10
Q

3 planes of movement

A

Sagittal, frontal, horizontal

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11
Q

Mandibular movements in sagittal plane

A

ICP= MIP
RCP = Retruded contact position
R = rotation
T= translation
Pr= maximum protrusion
E = Edge to edge

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12
Q

Mandibular movement frontal plane

A

Shield shape
1 = jaw movement to the right
2= depression of mandible to maximum opening
3= jaw movement to the left
4 = depression of mandible to max opening

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13
Q

Mandibular movement in horizontal plane

A

Diamond shape
RCP= retruded
ICP = intercuspal position
R= maximum lateral movement

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14
Q

2 movements for mouth opening

A

Rotation
Translation

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15
Q

Rotation

A

Occurs in the inferior joint cavity
Opening of 20 -25 mm

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16
Q

Translation

A

Occurs in the superior joint cavity
Opening of 25-35 mm

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17
Q

Maximum opening

A

45-55 mm

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18
Q

Lateral movement

A

10-12 mm

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19
Q

Protrusive movement

A

8-10 mm

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20
Q

Articulator

A

Mechanical instrument that represents the TMJ and jaws, to which maxillary and mandibular casts may be attached to stimulant some or all mandibular movements

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21
Q

Facebow

A

Instruments used to record the spatial relationship of the maxillary arch to some anatomical reference point or points (Condyles horizontal axis and one other selected anterior point) and then transfer the relationship to an articulator

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22
Q

Class I

A

Only vertical motion is possible
Accepts a single static registration

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23
Q

Class II

A

Permits horizontal and vertical motion but does not orient the motion to the TMJs

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24
Q

Class III

A

Instruments that stimulates condylar pathways by using averages of mechanical equivalents for all or part of the motion.
Semi-adjustable

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25
Q

Class Iv

A

Instrument that will accept 3D dynamic registrations, allow for orientation of the casts to the TMJs and simulation of mandibular movements.
Fully adjustable.

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26
Q

Components of the articulator

A

Condylar guidance
Anterior guide pin
Anterior guide table
Member
Mounting plate

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27
Q

Condylar guidance

A

Lateral and horizontal condylar inclination - represents the posterior determinants

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28
Q

Anterior guide pin

A

Rigid rod attached to one member contacting the anterior guide table of the opposing member. Maintains vertical separation

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29
Q

Anterior guide table

A

Where the anterior guide pin rests to maintain VDO and influence articulator movements. It influences the degree of separation of the casts in all relationships

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30
Q

Member

A

Upper member holds maxillary cast and lower member holds mandibular casts

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31
Q

Mounting plate

A

Removable metal or resin devices that attaches to the superior and inferior members of the articulator which are used to attach casts to articulator

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32
Q

Functional mandibular movements

A

All normal, proper or characteristic movements of the mandible made during speech, mastication, yawning, swallowing, and other associated movements

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33
Q

Occlusal trauma

A

Trauma to the periodontium from functional or parafunctional forces causing damages to its attachment by exceeding its adaptive and reparative capacities.
Primary and secondary

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34
Q

Primary occlusal trauma

A

Forces acting on teeth with normal periodontal support

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35
Q

Secondary occlusal trauma

A

Forces acting on teeth with decreased periodontal support

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36
Q

Parafunction

A

Disordered function like clenching and grinding of the teeth

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37
Q

Bruxism

A

Parafunctional grinding of teeth. It is an oral habit consisting of involuntary rhythmic or spasmodic nonfunctional gnashing, grinding or clenching of teeth. It may lead to occlusal trauma

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38
Q

3 main skeletal components

A

Maxilla
Mandible
Temporal bone

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39
Q

Maxilla

A

-upper facial skeleton
-2 maxillary bones fused at midpalatal suture
-dentoalveolar support
-bony attachment to skull

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40
Q

Mandible

A

-body and ramus
-lower facial skeleton
-dentoalveolar support
-no bony attachment to skull (muscle and ligament suspension, mobile)
-processes of the ramus (coronoid and condylar process)

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41
Q

Temporal bone

A

Supports the mandible at articulation with cranium

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42
Q

Mandibular condyles

A

-Portion of the mandible that articulates with cranium bilaterally
-condylar process in made of condyle and condylar neck
-condyle has medial and lateral poles
- medio-lateral (18-23mm)
- anteroposterior (8-10mm)

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43
Q

Glenoid fossa

A

-site of mandibular condyle articulation
-oval depression on inferior aspect of temporal bone
-located anterior to external auditory meatus

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44
Q

Articular eminence

A

-forms anterior limit of the mandibular fossa
-convex prominence of thick dense bone
-variable degree of convexity (dictates protrusive path of mandibular condyle)

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45
Q

Gross anatomy of TMJ

A

-Complex diarthrodial joint with 2 functional movements
-rotatory and sliding

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46
Q

Rotatory movement

A

Inferior compartment between mandibular condyle and articular disc

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47
Q

Sliding (translation)

A

In superior compartment between disc and temporal component

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48
Q

Articular disc

A

-Divides joint space into superior and inferior compartments
-Avascular dense fibrous CT
-biconcave, oval in shape
-ant and post bands with an intermediate zone in between
-medial and lateral attachments

49
Q

Superior compartment

A

Between disc and mandibular fossa

50
Q

Inferior compartment

A

Between disc and condyle

51
Q

Retrodiscal tissue

A

-post attachment
-bilaminar zone
-loose neurovascular tissue bordered by 2 lamina - superior and inferior

52
Q

Superior lamina

A

Temporal posterior attachment

53
Q

Inferior lamina

A

Condylar posterior attachment

54
Q

TMJ capsule

A

-Fibrous and no elastic membrane surrounding the TMJ
-function is to create a seal for joint space
-stability
-limits separation and range of movement of articular components- prevents tissue damage and lateral and medial dislocation of joint

55
Q

TMJ ligaments

A

-Thick fibrous tissue limiting joint movement
-sphenomandibular ligament
-stylomandibular ligament

56
Q

Masticatory muscles

A

-masseter
-temporalis
-medial pterygoid
-lateral pterygoid

57
Q

Clinical importance of masticatory muscles

A

-muscles of mastication maintain postural position of mandible at rest against gravity
- TMJ disorders frequently involve pain

58
Q

Accessory muscles of mastication

A

-Suprahyoid muscles
-infrahyoid muscles
-platsyma
-orbicularis oris
-buccinator

59
Q

Suprahyoid muscles

A

Digastric, stylohyoid, mylohyoid, geniohyoid

60
Q

Infrahyoid muscles

A

Omohyoid, sternohyoid, sternothyroid, thyrohyoid

61
Q

Masseter

A

Quadrilateral, covers lateral aspect of ramus
Superficial part, deep head

62
Q

Masseter superficial part = origin

A

Inferior border of the ant 2/3 of zygomatic arch

63
Q

Masseter Superficial part= insertion

A

Angel of the mandible

64
Q

Masseter Superficial part action

A

Elevation, bilateral
Ipsilateral, excursion
Protrusion, bilateral

65
Q

Masseter Deep head origin

A

Inf border of post 1/3 and internal aspect of zygomatic arch

66
Q

Masseter Deep head insertion

A

Lateral superior ramus

67
Q

Masseter Deep head action

A

Elevation, bilateral
Ipsilateral excursion
Retrusion, bilateral

68
Q

Temporalis

A

Fan shaped

69
Q

Temporalis origin

A

Inf temporal line of skull, temporal fossa

70
Q

Temporalis insertion

A

Coronoid process

71
Q

Temporalis action

A

Elevation, bilateral
Retrusion (post fibers)

72
Q

Disc

A

Dense fibrous CT, slightly innervated
Articular surface of condyle located on the line intermediate zone of the disc
Maintains morphology unless destructive forces or structural changes in joint. If that happens = morph of disc can be irreversibly altered —> biomechanical changes
Acts as non-ossified bone contributing to both joint systems
Functions as true articular surface in both joint systems

73
Q

Synovial fluid

A

Both join cavities are filled with synovial fluid
2 purposes

74
Q

2 purposes of synovial fluid

A

Articular surfaces are nonvascular, synovial fluid acts as a medium for providing metabolic requirements to these tissues.
Serves as a lubricant between the articular surfaces during function

75
Q

Retrodiscal tissue

A

Loose CT attaches to posterior part of disc.
Highly vascularized and innervated.

76
Q

Innervation of TMJ

A

Trigeminal nerve (V3) mandibular nerve - auriculotemproal nerve

77
Q

Biomechanics of TMJ

A

Extremely complete joint system.
Two TMJs connected to the same bone (mandible), cant act without influencing the other.
Structure and function has 2 systems
Interarticular pressure happens

78
Q

One joint system TMJ

A

Tissue that surround the inferior synovial cavity (condyle and articular disc). The disc and its attachment to the condyle is called the condyle-disc complex and is the responsible for the rotational movement in the TMJ

79
Q

Second system TMJ

A

Made up of the condyle-disc complex functioning against the surface of the mandibular fossa. Translation occurs in this superior joint cavity between the disc and the mandibular fossa

80
Q

Do the articular surfaces of the joint have any structural attachment or union?

A

No, but contact must be maintained for join stability

81
Q

How is Stability of the joint maintained?

A

Constant activity of the muscles

82
Q

3 important principles of the biomechanics of the TMJ

A
  1. Ligaments do not actively participate in the normal function of the TMJ
  2. Ligaments do not stretch, they ELONGATE
  3. Articular surfaces of the TMJ must maintain constant contact (produced by muscles of mastication (elevator))
83
Q

Mechanics of mandibular movement

A

Rotation
Translation

84
Q

Rotation

A

Occurs as movement within the inferior cavity of the joint. Between the superior surface of the condyle and the interior surfaces of the articular disc.
Can occur in all 3 planes, 20-25 mm

85
Q

Translation

A

Occurs when the mandible moves forward. Happens within the superior cavity of the joint between the superior surface of the articular disc and the inferior surface of the articular fossa.
40-60 mm max opening

86
Q

Temporomandibular disorders

A

Several clinical problems that involve the masticatory musculature, the TMJ and associated structures or both, identified as a major cause of nondental pain

87
Q

Most common symptoms of disorders

A

Pain, limited or asymmetric mandibular movements, TMJ sounds, headaches, earaches, jaw pain, facial pain, coexist with other cranial mandibular and Orofacial pain conditions

88
Q

Epidemiology of TMD

A

40-75% at least one sign of joint dysfunction
~33% at least one symptom
50% joint sounds
5% mouth opening limitation
Children less than adults
More women (they seek treatment more)
Only 3.6% to 7% need treatment

89
Q

Etiology of TMD

A

Predisposing factors (increase risk of TMD), initiating factors (onset of TMD), perpetuating factors (factors that interfere with healing or enhance progression of TMD), long term successful management

90
Q

Trauma

A

Any force applied to the mastication structures that exceeds the normal function load
Direct, indirect, micro

91
Q

Direct trauma

A

Direct blow to structures, produces injury via impact, inflammation, structural failure, loss of function, onset occurs within 24-72 hours of the trauma

92
Q

Indirect trauma

A

Sudden blow without direct contact to affected structures, whiplash injury, pathways of pain from cervical area to the trigeminal area, not uncommon to see symptoms of TMD following injury to neck without direct trauma to face or jaw

93
Q

Microtrauma

A

Sustained and repetitious adverse loading of the masticatory system through postural imbalance or from parafunctional habits, postural habits, intensity and frequency of parafunctional jaw activity may be exacerbated by stress and anxiety, sleep disorders and medications, intense and persistent parafunctional can also occur in patients with neurological disorders = cerebral palsy, orofacial dyskinesia and epilepsy

94
Q

Anatomic factors

A

Skeletal relationship, occlusal relationships

Must of the association noted were judged to be secondary to joint alteration and not etiologic

95
Q

Skeletal relationship

A

Skeletal malformations, arch discrepancies, post injuries to teeth.
Steepness of the articular eminence

96
Q

Occlusal relationships does literature support the role of etiology in TMD?

A

Literature does not support the role of occlusion in etiology of TMD
Overbite, anterior open bite, over jet, unilateral posterior crossbite, missing posterior teeth

97
Q

Overbite

A

Associated with more joint sounds and muscle tenderness

98
Q

Anterior open bite

A

Associated with condylar changed and rheumatoid arthritis

99
Q

Overjet

A

TMD symptoms and osteoarthritis changes

100
Q

Unilateral posterior crossbite

A

More common in TMD patients

101
Q

Missing posterior teeth

A

Internal derangement and osteoarthritic changes

102
Q

Pathophysiologic factors

A

Systemic - managed in cooperation with physician
Degenerative, endocrine, infectious, metabolic, neurological, rheumatologist, vascular disorders

103
Q

Psychosocial factors

A

Anxiety and depression
Alcohol, tranquilizers, narcotics, contributes to the chronic its of many TMD patients

104
Q

Medial pterygoid origin deep head

A

Pterygoid fossa between lateral and medial pterygoid plates

105
Q

Medial pterygoid origin superficial head

A

Pyramidal process of palatine bone, maxillary tuberosity

106
Q

Medial pterygoid insertion

A

Angle of the mandible medial ramus

107
Q

Medial pterygoid action

A

Elevation, bilateral
Protrusion, bilateral
Contralateral excursion, unilateral

108
Q

Lateral pterygoid superior head origin

A

Greater wing of sphenoid bone, inferior aspect

109
Q

Lateral pterygoid superior head insertion

A

TMJ capsule, disc, anterior condylar neck

110
Q

Lateral pterygoid superior head action

A

Stabilization of disc position

111
Q

Lateral pterygoid inferior head origin

A

Lateral pterygoid plate of sphenoid bone

112
Q

Lateral pterygoid inferior head insertion

A

Condylar neck

113
Q

Lateral pterygoid inferior head action

A

Protrusion, bilateral
Depression, bilateral
Contralateral excursion, unilateral

114
Q

What is the only structure capable of retracting the disc posteriorly on the condyle?

A

The superior Retrodiscal lamina

115
Q

What is attached to the anterior border of the disc and what happens when it is active?

A

Superior lateral pterygoid, the fibers will pull anterior and medially

116
Q

What also attached to the neck of the condyle?

A

Lateral pteryoid, dual attachment does not allow the muscles to pull the disc forward

117
Q

What happens when the inferior lateral pterygoid is protracting the condyle forward?

A

The superior lateral pterygoid is inactive. It activates during mandibular closure

118
Q

What is the mechanism by which the disc is maintained with the translating condyle dependent on?

A

The morphology of the disc and interarticular pressure

TMD (2 decks)

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