Okeson Review Chapter 1 Mandible suspended by muscles, ligaments Condyle medial pole > lateral pole (Fig 1-8)

8) Temporal bone Condyle articulates with squamous part of temporal bone (articular/glenoid fossa) TMJ Ginglymoarthrodial joint - hinge + gliding Compound joint mandibular condyle, temporal bone (articular fossa), and articular disc (non-ossified third bone) Articular disc Dense fibrous CT Sagittal plane = posterior border > anterior border > intermediate zone (this is where articular surface of condyle is) (Fig 1-12) Anteriorly = disc thicker medial > lateral Retrodiscal tissue (aka Posterior Attachment) LCT that attaches disc posteriorly; highly vascularized/innervated Superior retrodiscal lamina attaches to tympanic plate (elastic) Inferior retrodiscal lamina attaches to posterior margin of articular surface of condyle (collagen) Synovial Joint Endothelial lining inside cavities make synovial fluid 1. metabolic requirements (weeping) 2. lubricant a. boundary joint moved, fluid forced to move b. weeping articular surfaces absorb synovial fluid i. (metabolic exchange) Ligaments Limit and restrict border movements 1. Collateral (discal) Attach disc to poles of condyle Medial and lateral discal ligaments divide into superior/inferior joint cavities HINGE 2. Capsular Entire TMJ surrounded by capsular; retains synovial fluid 3. TM (lateral) ligament Outer oblique limits mouth opening (rotational) Inner horizontal limits posterior movement of condyle/disc

Muscles Masseter Zygomatic arch -> lower ramus Elevates Mandible, chewing, protrusion Medial (Internal) Pterygoid Pterygoid fossa -> angle Elevates mandible, protrusion Unilateral contraction mediotrusive *SLING masseter and medial pterygoid Lateral (External) Pterygoid Superior Infratemporal greater wing of sphenoid -> capsule, disc, condyle Power Stroke chewing, clenching Inferior Lateral pterygoid plate -> condyle Protrusion Digastric (secondary) Posterior belly mastoid notch -> hyoid Anterior belly Depress mandible

Biomechanics (p. 22-26) know these for FINAL He said at least (2) questions! Condyle-disc complex (inferior synovial cavity) = ROTATION Condyle-disc complex against mandibular fossa (superior cavity) TRANSLATION superior articular disc and fossa Contact = Joint Stability (muscles -> condyle -> disc -> fossa) = Interarticular pressure (dislocation in absence of) Width disc space inversely related with pressure Mandibular opening Superior retrodiscal lamina stretched Maximum opening = maximum retractive forces holds disc most posteriorly on the condyle as possible *superior retrodiscal lamina ONLY posterior disc retractor on condyle* Rest position Superior lateral pterygoid mild tonus anteromedial force on disc exceeds posterior retractive force disc occupies most anterior rotary position on condyle (i.e. intermediate zone and posterior border of disc) Joint stability Power stroke of Superior lateral pterygoid Three clinical concepts 1. ligaments = guidewires restrict/permit certain joint movements 2. ligaments do NOT stretch 3. articular surfaces must have constant contact

Chapter 3 Dempster Study Lateral View Mandibular Arch teeth are mesially inclined Maxillary Arch Anteriors mesially inclined, get more distal as you move posteriorly Curve of Spee line thru buccal cusp tips Frontal View Mandicular Posterior teeth are lingually inclined Maxillary Posterior teeth are buccally inclined Curve of Wilson line thru buccal and lingual cusp tips of posteriors Interarch Tooth Alignment Mandibular buccal cusps in to CF of Maxillary Maxillary lingual cusps in to CF of Mandibular Supporting/centric cusps mandibular buccal, maxillary lingual Broad, rounded Guiding cusps/non-centric cusps mandibular lingual, maxillary buccal Sharp stabilize mandible in to MIP Class I normal, Class II maxillary bigger, Class III mandibular bigger Anterior Occlusion Mandibular Incisal edges contact Maxillary Marginal Ridges Anterior Guidance Guide mandible thru lateral excursive movements Overjet horizontal overlap Overbite vertical overlap Class II deep bite Class III end to end Anterior Open bite Negative vertical overlap!

Chapter 4 Rotation movement between superior condylar surface and inferior articular disc Horizontal, frontal (vertical), sagittal Horizontal Axis = Hinge (opening/closing movement) pure Terminal hinge axis condyle most superior in articular fossa, mouth opened Frontal (Vertical) Axis = One condyle moves anteriorly out of terminal hinge while opposite condyle remains Sagittal Axis = One condyle moves inferiorly while other remains in terminal hinge Occurs in conjunction with other movements Translation Superior cavity of TMJ between superior articular disc (disc-condyle complex) and inferior of articular fossa *Usually rotation and translation occur together Postural position position mandible is maintained, teeth can be quickly and effectively brought together for immediate function Alert feeding position 30 degrees downward Drinking position 45 degrees upward See Wheeler CD and Okeson text for detailed descriptions on border movements, etc.

MIP RCP

transition

Primary Teeth AB C D E F G H I J TSRQP O N M L K Permanent Teeth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 25 24

LEFT

LEFT

Right Lateral Excursion

A. Working Side (Right Side)

Max Mand

Right 1 st Molar MLC Lingual Groove

1st Molar

1st Molar

Lingual Groove DLC

Buccal Groove DBC

Buccal Embrasure MBC

DLC Lingual Embrasure

B. Non-Working Side( Left Side) Left 1st Molar Max Mand MLC DB Groove Left 2nd Molar MLC Buccal Groove

Muscles 1. Superior Lateral Pterygoid Power stroke During forceful unilateral contraction on a hard object, pulls articular disc forward, stabilizing the disc in fossa. 2. Inferior Lateral Pterygoid Pulls condyles down articular eminences and mandible is protruded Unilateral contraction creates mediotrusive movement of that condyle 3. Medial Pterygoid During contraction, mandible is elevated and teeth brought closer together Protrusion Unilateral contraction causes mediotrusive movement of the mandible. 4. Temporalis A positioning muscle (creates multi-directional pull on the mandible 5. Digastric Opens mouth 6. Infrahyoid * stabilizes hyoid

Ligaments 1. Collateral true ligaments allows rotation of the condyle while still keeping it firmly attached to fossa Lateral Discal=prevents the articular disc from rotating over the head of the condyle in a medial direction. Attached to lateral edge Medial Discal= prevents the articualr disc from rotating over the head of the condyle ina lateral direction. attached to medial edge 2. Capsular encompasses joint, retaining synovial fluid 3. TM outer part=limit mouth opening inner part=limits posterior movements of the condyle 4. sphenomandibular No limiting effects on mandibular movements 5. stylomandibular active during protrusion relaxed during mouth opening limits protrusive movements of the mandible

TMJ Structures 1. Superior retrodisca lamina creates greatest retractive forces on the disc during Maximum jaw opening and Maximum Protrusion

Biomechanics 1. Condyle/disc complex 2. condyle/disc complex with the articulating surface of the temporal bone

Ligaments act as guide wires and do not actively participate in normal joint movements Ligaments can elongate but do not stretch The articular surface of the TMJ must be maintained in constant contact.

Horizontal Determinant Trends (on ridge and groove direction) 1. The greater the lateral translation, the greater the angle formed by laterotrusive and mediotrusive movements. 2. The greater the distance from rotating condyle, the greater the angle 3. The greater the distance from midsaggital plane, the greater the angle 4. The greater the Intercondylar distance, the smaller the angle

Vertical Determinants (on cusp height and fossa depth) 1. Condylar Guidance= As angle gets steeper, taller post. cusps 2. Anterior Guidance= As vertical overlap increases, taller posterior cusps As horizontal overlab increases, shorter post. cusps 3. Plane of occlusion 4. Lateral translation= the greater the movement, the shorter the post. Cusps. The more superior the movement of rotating condyle, the shorter the post. Cusps The greater the immediate side shift, the shorter the post. Cusps 5. Curve of Spee= the more acute the curve, the shorter the most post. Cusps

** An increase condylar guidance=increase anterior guidance=increase vertical overlap