Anatomy of Temporomandibular Joint: Presented by

ANATOMY OF TEMPOROMANDIBULAR JOINT
Presented By :
Dr. Abhishek Nagpal Date :
29th August, 2006

Department of Prosthodontics Including Crown & Bridge, Maxillofacial Prosthodontics & Oral Implantology.
DEFINITIONS
CENTRIC OCCLUSION The occlusion of the opposing teeth when the mandible is in centric relation. This may or may not coincide with the maximum intercuspal position GPT-8th ed.
DEFINITIONS
CENTRIC RELATION
The maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective discs with the complex in the anterior-superior position against the shapes of the articular eminencies. This position is independent of tooth contact. This position is clinically discernible when the mandible is directed superior & anteriorly. It is restricted to a purely rotatory movement about the transverse horizontal axis GPT-8th ed.
DEFINITIONS
MAXIMAL INTERCUSPAL POSITION
The complete intercuspation of the opposing teeth independent of condylar position, sometimes referred to as the best fit of teeth regardless of the condylar position GPT-8th ed.
TEMPOROMANDIBULAR JOINT
INTRODUCTION The area where craniomandibular articulation occurs is called the temporomandibular joint The TMJ is the most complex joint in the body It provides for hinging movement in one plane & therefore can be considered a ginglymoid joint
INTRODUCTION
At the same time it also provides for gliding movement, which classifies it as an arthroidial joint Thus it has been technically considered as a ginglymoarthroidal joint The TMJ is formed by the mandibular condyle fitting into the mandibular fossa of the temporal bone
INTRODUCTION Separating these two bones from direct articulation is the articular disc The TMJ is classified as a compound joint, a compound joint requires the presence of at least three bones, yet the TMJ is made up of 2 bones Functionally the articular disc serves as a nonossified bone that permits the complex movement of the joint
INTRODUCTION The articular disc is composed of dense fibrous connective tissue devoid of any blood vessels or nerve fibers The central zone is the thinnest & is called the intermediate zone In the normal joint the articular surface of the condyle is located on the intermediate zone of the disc, bordered by the thicker anterior & posterior zones
ARTICULAR DISC OF TMJ
TEMPOROMANDIBULAR JOINT (LATERAL VIEW)
INTRODUCTION The disc is attached posteriorly to an area of loose connective tissue that is highly vascularized & innervated, known as the retrodiscal tissue Superiorly it is bordered by a lamina of connective tissue that contains many elastic fibers, the superior discal lamina Since this region consists of two areas, it is referred to as the bilaminary zone
INTRODUCTION The superior retrodiscal lamina attaches the articular disc posteriorly to the tympanic plate At the lower border of the retrodiscal tissues is the inferior retrodiscal lamina, attaching the inferior border of the posterior edge of the disc to the posterior margin of the articular surface of the condyle
TMJ : ANTERIOR VIEW
INTRODUCTION
The remaining body of the retrodiscal tissue is attached posteriorly to a large ligament that surrounds the entire joint, the capsular ligament The superior & inferior attachments of the anterior region of the disc are also by the capsular ligament The superior attachment is to the anterior margin of the articular surface of the temporal bone The inferior attachment is to the anterior margin of the articular surface of the condyle
INTRODUCTION Anteriorly between the attachments of the capsular ligament the disc is also attached by tendinous fibers of the superior lateral pterygoid muscle Like the articular disc the articular surfaces of the of the mandibular fossa & the condyle are lined with dense fibrous connective tissue rather than hyaline cartilage in most other joints The fibrous connective tissue is generally less susceptible than hyaline cartilage to the effects of ageing & therefore less likely to breakdown over time
INTRODUCTION
Also it has a much greater ability to repair than the hyaline cartilage The articular disc is attached to the capsular ligament not only anteriorly & posteriorly but also medially & laterally, thus dividing the joint into 2 distinct cavities The internal surfaces of the cavities are surrounded by specialized endothelial cells that form a synovial lining
INTRODUCTION
This lining, along with a specialized synovial fringe located at the anterior border of the retrodiscal tissues, produces synovial fluid which fills both the joint cavities Thus the TMJ is referred to as a synovial joint
INTRODUCTION This synovial fluid serves following purposes 1. Provides metabolic requirements to the nonvascular articular surfaces of the joint 2. Provides free & rapid exchange between the vessels of the capsule, the synovial fluid & the articular tissues 3. Serves as a lubricant between articular surfaces during function 4. Minimizes the friction produced between the articular surface of the disc, condyle & the fossa
INTRODUCTION
The synovial fluid lubricates the articular surfaces by way of two mechanisms: Boundary Lubrication- Occurs when the joint is moved & the synovial fluid is forced from one area of the cavity into another. The synovial fluid is forced upon the articular surfaces thus providing lubrication. Boundary lubrication prevents friction in the moving joint
INTRODUCTION
The synovial lubricates the articular surfaces by way of two mechanisms: Weeping Lubrication- Ability of the articular surfaces to absorb a small amount of synovial fluid. Thus, when articular surfaces are placed under compressive forces this small amount of synovial fluid, is released, lubricating the tissues. Weeping lubrication helps eliminate friction in the compressed but not moving joint
DEVELOPMENT OF THE JOINT
The components of the joint show the first indication in the mesenchyme between the condylar cartilage of the mandible & the developing temporal bone at about 10 weeks of intrauterine life Two slit like joint cavities & an intervening disc appear in this region at about 12 weeks of intrauterine life The mesenchyme around the joint begins to form the fibrous capsule

HISTOLOGY: Bony structure The condyle of the mandible is composed of cancellous bone covered by a thin layer of compact bone
CANCELLOUS BONE
COMPACT BONE

HISTOLOGY: Bony structure The trabeculae radiate from the neck of the mandible & reach the cortex at right angles, thus giving maximum strength to the condyle The red marrow in the condyle is of the myeloid or cellular type & in older individuals it is sometimes replaced by the fatty marrow

HISTOLOGY: Bony structure During this period of growth a layer of hyaline cartilage lies underneath the fibrous covering of the condyle This cartilaginous plate grows by the apposition from the deepest layers of the covering connective tissue Its deepest surface is replaced by bone & the remnants of this cartilage may persist into old age

HISTOLOGY: Bony structure The roof of the mandibular fossa consists of a thin, compact layer of bone In rare cases islands of hyaline cartilage are found in the articular tubercle

HISTOLOGY: Articular Fibrous Covering The condyle as well as the articular tubercle is covered by a fairly even thickness of fibrous tissue containing a variable number of chondrocytes Its superficial layers consist of a network of strong collagenous fibers The deepest layer of the fibrocartilage is rich in chondroid cells as long as growing hyaline cartilage is present in the condyle

HISTOLOGY: Articular Fibrous Covering It contains only a few thin collagenious fibers & in this zone the appositional growth of the hyaline cartilage of the condyle takes place The fibrous layer covering the articular surface of the temporal bone is thin in the articular fossa & thickens rapidly on the posterior slope of the articular tubercle

HISTOLOGY: Articular Fibrous Covering The fibrous tissue in this region shows a definite arrangement in two layers, with a small transition zone between them & are characterized by the different course of the constituent fiber bundles In the inner zone the fibers are at right angles to the bony surface, & in the outer zone they run parallel to that surface

HISTOLOGY: Articular Fibrous Covering In the fibrous covering of the mandibular condyle, a variable number of chondrocytes are found in the tissue on the temporal surface. In adults the deepest layer shows a thin zone of calcification There is no continuous cellular lining on the free surface of the fibrocartilage, only isolated fibroblasts are situated on the surface itself They are characterized by the formation of long, flat cytoplasmic processes

HISTOLOGY: Articular Disc In young individuals the articular disc is composed of dense fibrous tissue The interlacing fibers are straight & tightly packed Elastic fibers are found in relatively small numbers

HISTOLOGY: Articular Disc The fibroblasts in the disc are elongated & send flat cytoplasmic wiglike processes into the interstices between the adjacent bundles With advancing age, some of the fibroblasts develop into chondroid cells, which later may differentiate into chondrocytes, sometimes small islands of chondrocytes may be found in discs of older persons

HISTOLOGY: Articular Disc Chondroid cells, true cartilage cells, & hyaline ground substance may develop in situ by differentiation of the fibroblasts The fibrous tissue covering the articular eminence & the mandibular condyle, as well as the large area of the disc, is devoid of blood vessels & nerves & has limited reparative power

HISTOLOGY: Articular Capsule The articular capsule consists of an outer fibrous layer that is strengthened on the lateral surface to form the temporomandibular ligament The articular capsule is lined with synovial membrane, which folds synovial villi, which project into the joint spaces The synovial membrane consists of internal cells, which do not form a continuous layer but show gaps between the cells, & the subintimal connective tissue layer, rich in blood capillaries

HISTOLOGY: Articular Capsule The internal cells are of three types: Rich in RER & is called the fibroblast-like or B-cell Rich in Golgi complex, contains little or no RER & is called macrophage like or A-cell Cellular morphology between cell types A & B

HISTOLOGY: Articular Capsule A small amount of a clear, straw-colored viscous fluid, synovial fluid is found in the articular spaces It is a lubricant & also a nutrient fluid for the avascular tissues covering the condyle & the articular tubercle & for the disc It is elaborated by diffusion from the rich capillary network of the synovial membrane, augmented by the synovial cells
ANATOMY OF THE JOINT

Articular Surface The upper articular surface is formed by the following parts of the temporal bone: The articular eminence Anterior part of the mandibular fossa The inferior articular surface is formed by the head of the mandible The articular surfaces are covered with fibrocartilage The joint cavity is divided into upper & lower parts by an intra-articular disc
ARTICULAR SURFACES OF THE TMJ

Articular Disc The articular disc is an oval fibrous plate that divides the joint into an upper & lower compartment The upper compartment permits the gliding movements & the lower compartment permits, rotatory as well as gliding movements
ARTICULAR SURFACES OF THE TMJ

Articular Disc The disc has a concavo-convex superior surface & a concave inferior surface The periphery of the disc is attached to the fibrous capsule The articular disc has been commonly referred to as a meniscus, however it is not a meniscus at all

Articular Disc A meniscus is a wedge shaped crescent of fibrocartilage attached on one side to the articular capsule & unattached on the other side, extending freely into the joint spaces A meniscus does not divide a joint cavity, isolating the synovial fluid, nor does it serve as a determinant of the joint movement It functions passively to facilitate the movement between the bony parts
STRUCTURE OF A SYNOVIAL JOINT

Articular Disc In the TMJ the disc functions as a true articular surface in both joint systems & therefore more accurately termed an articular disc

Ligaments: Ligaments are made up of collagenous connective tissue, they do not enter actively into joint function, rather, they act as passive restraining devices to limit & restrict border movements Three functional ligaments support the TMJ: The collateral ligament The capsular ligament The temporomandibular ligament

Ligaments: There are two accessory ligaments: The sphenomandibular ligament The Stylomandibular ligament

Ligaments: The Collateral (Discal) Ligaments:- The collateral ligaments attach the medial & lateral borders of the articular disc to the poles of the condyle They are commonly called the discal ligaments, & are two The medial discal ligament The lateral discal ligament

Ligaments: The medial discal ligament attaches the medial edge of the disc to the medial pole of the condyle The lateral discal ligament attaches the lateral edge of the disc to the lateral pole of the condyle These ligaments are responsible for dividing the joint mediolaterally into superior & inferior joint cavities

Ligaments: The discal ligaments are true ligaments, composed of collagenous connective tissue fibers, therefore they do not stretch Their function is to restrict the movement of the disc away from the condyle, i.e they allow the disc to move passively with the condyle as it glides anteriorly & posteriorly

Ligaments: Thus, these ligaments are responsible for the hinging movement of the TMJ, which occurs between the condyle & the articular disc The discal ligaments have a vascular supply & are innervated, which provide information regarding joint position & movement

Ligaments: The Capsular Ligament:- Is attached above to the articular tubercle, the circumference of the mandibular fossa & the squamotympanic fissure, & below to the neck of the mandible. The synovial membrane lines the fibrous capsule & the neck of the mandible

Ligaments: The capsular ligament acts to resist any medial, lateral or inferior forces that tend to separate or dislocate the articular surfaces A significant function of the capsular ligament is to encompass the joint, thus retaining the synovial fluid The capsular ligament is well innervated & provides the proprioceptive feedback regarding the position & movement of the joint

Ligaments: The Lateral (Temporomandibular) Ligament:- It reinforces & strengthens the lateral part of the capsular ligament. Its fibers are directed downwards & backwards. It is attached above to the auricular tubercle, & below to the posterolateral aspect of the neck of the mandible The oblique portion of the temporomandibular ligament resists excessive dropping of the condyle, therefore limiting the extent of mouth opening This portion of the ligament also influences the normal opening movement of the mandible

Ligaments: During the initial phase of opening, the condyle can rotate around a fixed point until the temporomandibular ligament becomes tight as its point of insertion is on the neck of the condyle that is rotated posteriorly When the ligament is taut, the neck of the condyle cannot rotate further If the mouth were to be opened wider, the condyle would need to move downward & forward across the articular eminence

Ligaments: This unique feature of the temporomandibular ligament, which limits the rotational opening, is found only in humans The inner horizontal portion of the temporomandibular ligament limits the posterior movement of the condyle & the disc When a displacing force is applied to the condyle posteriorly, this portion of the ligament becomes tight & prevents the condyle from moving into the posterior region of the mandibular fossa

Ligaments: The Sphenomandibular Ligament:- It is an accessory ligament, that lies on a deep plane away from the fibrous capsule. It is attached superiorly to the spine of the sphenoid, & inferiorly to the lingula of the mandibular foramen. It does not have any significant limiting effects on mandibular movement

Ligaments: The Stylomandibular ligament:- It is another accessory ligament of the joint. It represents the thickened part of the deep cervical fascia which separates the parotid & the submandibular salivary glands. It is attached above to the styloid process, & below to the angle & posterior border of the ramus of the mandible It becomes taut when the mandible is protruded, but is the most relaxed when the mandible is opened. Therefore the stylomandibular ligament limits excessive protrusive movements of the mandible
Relations Of The Temporomandibular Joint: Lateral: Skin & fasciae Parotid gland Temporal branches of the facial nerve
Relations Of The Temporomandibular Joint: Medial: The tympanic plate separates the joint from the internal carotid artery Spine of sphenoid, with the upper end of sphenomandibular ligament attached to it The auriculotemporal & chorda tympani nerves Middle meningeal artery
Relations Of The Temporomandibular Joint: Anterior: Lateral pterygoid Massetric nerve & vessels Posterior: The parotid gland separates the joint from the external auditory meatus Superficial temporal vessels Auriculotemporal nerve
Relations Of The Temporomandibular Joint: Superior: Middle cranial fossa Superior meningeal vessels Inferior: Maxillary artery Maxillary nerve
Nerve Supply: The nerve supply to the TMJ arises from the mandibular division of the trigeminal nerve specifically the: The auriculotemporal nerve which runs below & behind the joint The nerve to masseter also sends a twig to the joint
NERVE SUPPLY OF TMJ
Nerve Supply: The nerve supply to the TMJ arises from the mandibular division of the trigeminal nerve specifically the: The deep temporal branches
NERVE SUPPLY OF TMJ
Blood supply: The blood supply to the TMJ is from 4 arteries: Branches from the superficial temporal artery The deep auricular artery The anterior tympanic artery The ascending pharyngeal artery
ARTERIAL SUPPLY OF TMJ
Lymph Drainage: It is to the pre-auricular nodes The intraparotid nodes The upper deep cervical nodes
Muscles responsible for the movement of the jaw: Protrusion:- Both the lateral pterygoid muscles Retraction:- Posterior fibers of the temporalis muscle Lateral Excursion:Unilateral contraction of the lateral & medial pterygoid muscles
MUSCLES OF MASTICATION
Muscles responsible for the movement of the jaw: Opening:- Lateral pterygoid & the digastric muscles Closing:- Masseter, medial pterygoid & temporalis muscles
MUSCLES OF MASTICATION
FUNCTIONAL ANATOMY OF THE JOINT

MECHANISM OF MANDIBULAR MOVEMENTS Mandibular movements occur as a complex series of interrelated 3-dimensional rotational & transitional activities It is determined by the combined & simultaneous activities of both TMJs TMJs cannot function entirely independently of each other & rarely function with identical concurrent movements

MECHANISM OF MANDIBULAR MOVEMENTS To better understand the complexities mandibular movements, it is better to isolate the movements that occur within a single TMJ The types of movements that occur will first be discussed & then the 3-dimensional movements of the joint will be divided into movements within a single plane

ROTATIONAL MOVEMENT Dorlands Illustrated Medical Dictionary defines rotation as the process of turning round an axis: movement of a body about its axis. In the masticatory system, rotation occurs when the mouth opens & closes around a fixed point or axis within the condyles In the TMJ rotation can occur as movement within the inferior cavity of the joint
ROTATIONAL MOVEMENT AROUND A FIXED POINT IN THE CONDYLE

ROTATIONAL MOVEMENT Thus, rotation is the movement between the superior surface of the condyle & the inferior surface of the articular disc The rotational movement of the mandible can occur in all the 3 reference planes, around a point called the axis : Horizontal Frontal (vertical) Sagittal

HORIZONTAL AXIS OF ROTATION: Mandibular movement around the horizontal axis is an opening & closing motion It is referred to as a hinge movement The horizontal axis around which it occurs is there fore referred to as the hinge axis
ROTATIONAL MOVEMENT AROUND THE HORIZONTAL AXIS

HORIZONTAL AXIS OF ROTATION: This axis runs horizontally from the right side of the condyle to the left side Hinge movement is probably the only example of the mandibular activity in which pure rotational movement occurs In all other movements rotation around the axis is accompanied by translation of the axis

FRONTAL (VERTICAL) AXIS OF ROTATION: When the condyles are in their most superior position in the articular fossae & mouth is purely rotated open, the axis around which the movement occurs is called the terminal hinge axis The vertical axis runs through the condyle & the ramus of the mandible, & the mandible rotates around this vertical axis during lateral movements

FRONTAL (VERTICAL) AXIS OF ROTATION: Mandibular movement around the frontal axis occurs when one condyle moves out of the terminal hinge position with the vertical axis of the opposite condyle remaining in the terminal hinge position
ROTATIONAL MOVEMENT AROUND THE FRONTAL AXIS

SAGITTAL AXIS OF ROTATION: This anteroposterior axis is an imaginary axis running along the mid-sagittal plane The mandible shows slight rotation around this axis
ROTATIONAL MOVEMENT AROUND THE SAGITTAL AXIS

SAGITTAL AXIS OF ROTATION: During the movement the condyle of one side moves downward & medially along the slope of the entoglenoid process (medial slope of the glenoid fossa) & the condyle of the opposite side moves upwards & laterally This type of movement is usually seen in association with lateral movements

TRANSLATIONAL MOVEMENT Translation can be defined as a movement in which every point of the moving object has simultaneously the same velocity & direction In the masticatory system, translation occurs when the mandible moves forward, as in protrusion The teeth, condyles, & rami all move in the same direction & to the same degree

TRANSLATIONAL MOVEMENT Translation occurs within the superior cavity of the joint, between the superior surface of the articular disc & the inferior surface of the articular fossa During most normal movements of the mandible, both rotation & translation occur simultaneously, i.e while the mandible is rotating around one or more of the axes, each of the axes is translating (i.e changing its orientation in space)
TRANSLATIONAL MOVEMENT OF THE MANDIBLE

SINGLE PLANE BORDER MOVEMENT: Mandibular movement is limited by the ligaments & the articular surfaces of the TMJs as well as by the morphology & alignment of teeth When the mandible moves through the outer range of motion, reproducible discernable limits result, which are called border movements

The border & typical functional movements of the mandible for each reference plane: Sagittal plane border & functional movements Mandibular motion viewed in the sagittal plane can be seen to have 4 distinct movement components:1. Posterior opening border 2. Anterior opening border 3. Superior contact border 4. Functional
FUNCTIONAL & BORDER MOVEMENTS IN SAGITTAL PLANE
Sagittal plane border & functional movements The range of posterior & anterior opening border movements is determined, or limited by the ligaments & the morphology of the TMJs Superior contact border movements are determined by the occlusal & incisal surfaces of the teeth The functional movements are not considered border movements because they are not determined by an outer range of motion

Posterior opening border movements: Posterior opening border movements occur in the sagittal plane as two-stage hinging movements In the 1st stage the condyles are stabilized in their most superior positions in the articular fossae (i.e terminal hinge position) The most superior condylar position from which a hinge axis movement can occur is the centric relation (CR) position
ROTATIONAL MOVEMENT OF THE MANDIBLE WITH THE CONDYLES IN TERMINAL HINGE POSITION

Posterior opening border movements: The mandible can be lowered (i.e mouth opening) in a pure rotational movement without translation of the condyle Theoretically, a hinge movement (i.e pure rotation) can be generated from any mandibular position anterior to the centric relation For this to occur the condyles must be stabilized so that the translation of the horizontal axis does not occur

Posterior opening border movements: Since the stabilization of the condyles is difficult to establish, posterior opening border movements that use the terminal hinge axis are the only repeatable hinge axis movement of the mandible In centric relation the mandible can be rotated around the horizontal axis to a distance of only 20 to 25 mm, as measured between the incisal edges of the maxillary & mandibular incisors At this point of opening the temporomandibular ligaments tighten, after which continued opening results in an anterior & inferior translation of the condyles

Posterior opening border movements: As the condyles translate the axis of rotation of the mandible shifts into the bodies of the rami, resulting in the 2nd stage of the posterior opening border movements The exact location of the axis of rotation in the rami is likely to be the area of attachment of the sphenomandibular ligaments
2ND STAGE OF ROTATIONAL MOVEMENT DURING MOVEMENT

Posterior opening border movements: During this stage in which the mandible is rotating around a horizontal axis passing through the rami, the condyles are moving anteriorly & inferiorly & the anterior portion if the mandible is moving posteriorly & inferiorly Maximum opening is achieved when the capsular ligaments prevent the further movement of the condyles Maximum opening is in the range of 40 to 60 mm when measured between the incisal edges of maxillary & mandibular teeth

Anterior opening border movements: With the mandible maximally opened, closure accompanied by contraction of inferior lateral pterygoids, will generate the anterior opening border movement Theoretically, if the condyles were stabilized in this anterior position, a pure hinge movement could occur while the mandible was closing from the maximally opened to the maximally protruded position As the maximum protrusive movement is determined in part by the stylomandibular ligament, when closure occurs, tightening of the ligaments produces a posterior movement of the condyles

Anterior opening border movements: Condylar position is the most anterior in the maximally open but not the maximally protruded position The posterior movement of the condyle from the maximally open position to the maximally protruded position produces eccentricity in the anterior border movement, therefore it is not a pure hinge movement
ANTERIOR OPENING BORDER MOVEMENT IN THE SAGITTAL PLANE

Superior contact border movements: The superior contact border movements are determined by the characteristics of the occluding surfaces of the teeth Throughout this entire movement the tooth contact is present

Superior contact border movements: Its precise delineation depends on the following five factors The amount of variation between centric relation & maximum intercuspation The steepness of cuspal inclines of the posterior teeth The amount of vertical & horizontal overlap of the teeth The lingual morphology of the maxillary anterior teeth The general interarch relationship of the teeth

Superior contact border movements: As this border movement is totally tooth determined, changes in the teeth will result in changes in the nature of the border movement In the centric relation position the, the tooth contacts are normally found on one or more opposing pairs of posterior teeth The initial tooth contact is terminal hinge closure, or centric relation, occurs between the mesial inclines of a maxillary tooth & the distal inclines of a mandibular tooth
COMMON RELATIONSHIP OF TEETH WHEN THE CONDYLES ARE IN CENTRIC RELATION POSITION

Superior contact border movements: If a muscular force is applied to the mandible, a superoanterior movement or shift will result until the intercuspal position is reached This centric relation to the intercuspal slide may have a lateral component, & this slide is present in approximately 90% of the population, the average distance is 1.25+1 mm In the intercuspal position the opposing anterior teeth usually contact
INTERCUSPAL POSITION ATTAINED WHEN THE FORCE IS APPLIED ON THE MANDIBLE

Superior contact border movements: When the mandible is protruded from maximum intercuspation, contact between the incisal edges of the mandibular teeth & the lingual inclines of the maxillary teeth results in an anteroinferior movement of the mandible This continues until the maxillary & the mandibular teeth are in an edge to edge relationship, at which time a horizontal pathway is followed
ANTEROINFERIOR MOVEMENT OF THE MANDIBLE

Superior contact border movements: The horizontal movement continues until the incisal edges of the mandibular teeth pass beyond the incisal edges of the maxillary teeth At this point the mandible moves in a superior direction until the posterior teeth contact
SUPERIOR MOVEMENT OF THE MANDIBLE
The occlusal contacts of the posterior teeth then dictate the remaining pathway to the maximum protrusive movement, which joins with the most superior position of the anterior opening border movement
CONTINUED BORDER MOVEMENT OF THE MANDIBLE
CONTINUED BORDER MOVEMENT OF THE MANDIBLE

Superior contact border movements: When a person has a discrepancy between the centric relation & maximum intercuspation, the initial description of the superior contact border movement is altered From centric relation there is no superior slide to intercuspal position The beginning protrusive movement immediately engages the anterior teeth, & the mandible moves inferiorly, as detected by the lingual anatomy of the maxillary anterior teeth

Functional movements: Functional movements occur during the functional activity of the mandible They usually take place within the border movements & therefore are considered free movements Most functional activities require maximum intercuspation & therefore begin at & below the intercuspal position

Functional movements: When the mandible is at rest it is found to be 2 to 4 mm below the intercuspal position, which has been called the clinical rest position It has also been determined that the so called clinical rest position is not the position at which the muscles have their least amount of electromyographic activity The muscles of mastication are at their lowest level of activity when the mandible is positioned approximately 8 mm inferior & 3 mm anterior to the intercuspal position
POSTURAL POSITION OF THE MANDIBLE

Functional movements: At this point the force of gravity pulling the mandible down is in equilibrium with the elasticity & resistance to the stretching of the elevator muscles & other soft tissues supporting the mandible Thus, this position is best described as the clinical rest position As function cannot occur readily from this position, the myotactic reflex, which counteracts forces of gravity & maintains the jaw in a more functionally ready position 2 to 4 mm below the intercuspal position, is activated

Functional movements: In this position the teeth can be quickly & effectively brought together for immediate function The increased levels of electromyographic muscle activity in this position are indicative of the myotactic reflex As this is not a true resting position, the position in which the mandible is maintained is more appropriately termed the postural position

Functional movements: If the chewing stroke is examined in the sagittal plane, the movement will be seen to begin at the intercuspal position & drop downwards & slightly forward to the position of the desired opening It then returns in a straighter pathway, slightly posterior to the opening movement
CHEWING STROKE WITH BORDER MOVEMENT IN THE SAGITTAL PLANE

Functional movements: Postural effects of functional movement When the head is positioned erect & upright the postural position of the mandible is located 2 to 4 mm below the intercuspal position On contraction of the elevator muscles, the mandible will be elevated directly into the intercuspal position

Functional movements: Postural effects of functional movement If the face is directed approximately 45 degrees upward, the position of the mandible will be altered to a slightly retruded position If the elevator muscles contract in this position, the path of closure will be slightly posterior to the path of closure in the upright position

Functional movements: Postural effects of functional movement Tooth contact therefore will occur posterior to the intercuspal position As this position is usually unstable, a slide results, shiftinng the mandible to maximum intercuspation

Functional movements: Postural effects of functional movement The normal head position during eating is with the face directed downwards 30 degrees, this is referred to as alert feeding position In it the mandible shifts slightly anteriorly to the upright postural position

Functional movements: Postural effects of functional movement If the elevator muscles contract with the head in this position, the path of closure will be slightly anterior to that in the upright position Thus, the tooth contacts will occur anterior to the maximum intercuspal position Such an alteration in closure leads to heavy anterior tooth contacts

Functional movements: Postural effects of functional movement The 45-degree head position is the head posture assumed during drinking In this position the mandible is maintained more posterior to maximum intercuspation Thus, closure with the head back often results in tooth contacts posterior to the intercuspal position

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Gothic arch tracers have been used to record the mandibular movement in the horizontal plane It consists of a recording plate attached to the maxillary & mandibular teeth
GOTHIC ARCH TRACER

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Mandibular movements in the horizontal plane can be viewed as a rhomboid-shaped pattern that has a functional component, as well as 4 distinct movement components 1. Left lateral border 2. Continued left lateral border with protrusion 3. Right lateral border 4. Continued right lateral border with protrusion
MANDIBUALR BORDER MOVEMENTS IN THE HORIZONTAL PLANE

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Left lateral border movements: With the condyles in centric relation position, contraction of the right inferior lateral pterygoid will cause the right condyle to move anteriorly & medially (also inferiorly) Simultaneously if the left inferior lateral pterygoid remains relaxed, the left condyle will remain situated in centric relation & the result will be a left lateral border movement
LEFT LATERAL BORDER MOVEMENT IN HORIZONTAL PLANE

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Left lateral border movements: Therefore the left condyle is called the rotating condyle as the mandible is rotating around it, the left condyle is also called the working condyle as it is on the working side The right condyle is called the orbiting condyle as it is orbiting around the rotating condyle, the right condyle is also called the nonworking condyle as it is on the nonworking side

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Continued left lateral border movements: With the mandible in the left lateral border position, contraction of the left inferior lateral pterygoid along with continued contraction of the right lateral pterygoid muscle will cause the left condyle to move anteriorly & to the right As the right condyle is already in its maximal anterior position, the movement of the left condyle to its maximum anterior position will cause a shift in the mandibular midline back to coincide with the midline of the face
CONTINED LEFT LATERAL BORDER MOVEMENT

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Right lateral border movements: Contracting of the left inferior lateral pterygoid muscle will cause the left condyle to move anteriorly & medially (also inferiorly) If the right inferior lateral pterygoid muscle stays relaxed, the right condyle will remain situated in centric relation position The resultant mandibular movement will be a right lateral border movement (e.g., the left condyle rotating around the the frontal axis of the right condyle)
RIGHT LATERAL BORDER MOVEMENT

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Right lateral border movements: The right condyle in this movement is therefore called the rotating condyle, because the mandible is rotating around it The left condyle during this movement is called the orbiting condyle, because it is orbiting around the rotating condyle

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Continued right lateral border movements with protrusion: With the mandible in the right lateral border position, contraction of the right inferior lateral pterygoid muscle along with continued contraction of the left inferior lateral pterygoid will cause the right condyle to move anteriorly & to the left As the left condyle is already in its maximum anterior position, the movement of the right condyle to its maximum anterior position will cause a shift back in the mandibular midline to coincide with the midline of the face
CONTINUED RIGHT LATERAL BORDER MOVEMENT

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Continued right lateral border movements with protrusion: This completes the mandibular border movement in the horizontal plane Lateral movements can be generated by varying levels of mandibular opening The border movement generated with each increasing degree of opening will result in increasingly smaller tracing until, at the maximally opening position, little or no lateral movements can be made
MANDIBULAR BORDER MOVEMENTS AT VARIOUS DEGREES OF JAW SEPARATION

HORIZONTAL PLANE BORDER & FUNCTIONAL MOVEMENTS Functional movements: As in the sagittal plane, functional movements in the horizontal plane most often occur near the intercuspal position During chewing the range of jaw movements begin some distance from the maximum intercuspal position, however, as the food is broken down into smaller particle sizes jaw action moves closer & closer to the intercuspal position The exact position of the mandible during chewing is dictated by the existing occlusal configuration
FUNCTIONAL RANGE WITHIN THE HORIZONTAL BORDER MOVEMENTS

FRONTAL (VERTICAL) BORDER & FUNCTIONAL MOVEMENTS When the mandibular motion is viewed in the frontal plane, a shield-shaped pattern can be seen that has a functional component as well as 4 distinct movement components 1. Left lateral superior border 2. Left lateral opening border 3. Right lateral superior border 4. Right lateral opening border movements
MANDIBUALR BORDER MOVEMENTS IN THE FRONTAL PLANE

FRONTAL (VERTICAL) BORDER & FUNCTIONAL MOVEMENTS Left lateral superior border movements: With the mandible in maximum intercuspation, a lateral movement is made to the left An inferiorly concave path is generated, the precise nature of this path is determined by the morphology & interarch relationships of the maxillary & mandibular teeth that are in contact during this movement

FRONTAL (VERTICAL) BORDER & FUNCTIONAL MOVEMENTS Left lateral superior border movements: The condyle-disc-fossa relationship & morphology of the working or rotating side TMJ The maximum lateral extent of this movement is determine by the ligaments of the rotating joint
LEFT LATERAL SUPERIOR BORDER MOVEMENT

FRONTAL (VERTICAL) BORDER & FUNCTIONAL MOVEMENTS Left lateral opening border movements: From the left lateral superior border position, an opening movement of the mandible produces a laterally convex path As the maximum opening is approached the ligaments tighten & produce a medially directed movement that causes a shift back in the mandibular midline to coincide with the midline of the face
LEFT LATERAL OPENING BORDER MOVEMENTS

FRONTAL (VERTICAL) BORDER & FUNCTIONAL MOVEMENTS Right lateral superior border movements: From the maximum intercuspation position a lateral movement is made to the right that is similar to the left lateral superior border movement Slight differences may occur because of the tooth contacts involved
RIGHT LATERAL SUPERIOR BORDER MOVEMENTS

FRONTAL (VERTICAL) BORDER & FUNCTIONAL MOVEMENTS Right lateral opening border movements: From the maximum right lateral border position, an opening movement of the mandible produces a laterally convex path similar to that of the left opening movement As maximum opening is approached, ligaments tighten & produce a medially directed movement that causes a shift back in the mandibular midline of the face to end this left opening movement
RIGHT LATERAL OPENING BORDER MOVEMENT

FRONTAL (VERTICAL) BORDER & FUNCTIONAL MOVEMENTS Functional movements: As in the other planes, functional movements in the frontal plane begin & end at the intercuspal position During chewing the mandible drops directly inferiorly until the desired opening is achieved
FUNCTIONAL MOVEMENT WITHIN THE MANDIBULAR BORDER MOVEMENT IN FRONTAL PLANE

FRONTAL (VERTICAL) BORDER & FUNCTIONAL MOVEMENTS Functional movements: It then shifts to the side on which the bolus is placed rises up As it approaches maximum intercuspation, the bolus is broken down between the opposing teeth In the final millimeter the mandible quickly shifts back to the intercuspal position

ENVELOP OF MOTION When we combine the border movements of all the 3 planes (i.e sagittal, horizontal & frontal) a three- dimensional envelop of motion can be produced that represents the maximum rage of movements of the mandible It was 1st described by Posselt in 1952
MODEL OF ENVELOP OF MOTOIN

ENVELOP OF MOTION The envelop of motion is longest & widest superiorly & narrows down to a point near the maximum mouth opening position Hence, as the jaw separation increases, space for movement decreases to zero at the maximum mouth opening position
COMBINATION OF MOVEMENTS IN ALL THE THREE PLANES
REFRENCES
Okeson JP. Management of temporoandibular disorders & functions. 5th ed. Missouri. Mosby Inc 2003 Zarb AG, Bolender LC, Karlson GE. Prosthodontic treatment for edentulous patients. 11th ed. Missouri (CN). Mosby-1997. p.197219 Heartwell, Charles M. Syllabus of complete dentures. 4th ed. Philedelphia. Lea & Febiger - 1992. p.277-307. Profit WR. Contemporary orthodontics. 3rd ed. Missouri. Mosby Inc 2001 Arey LB. Develeopmental anatomy. 7th ed. Philedelphia. WB Saunders Co.-1965 Orban B. Oral histology & embryology. 7th ed. St. Louis. Mosby Inc 1972

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ANATOMY OF TEMPOROMANDIBULAR JOINT

29th August, 2006

ARTICULAR DISC OF TMJ

TEMPOROMANDIBULAR JOINT (LATERAL VIEW)

TMJ : ANTERIOR VIEW

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

DEVELOPMENT OF THE JOINT

ANATOMY OF THE JOINT

ARTICULAR SURFACES OF THE TMJ

ANATOMY OF THE JOINT

ARTICULAR SURFACES OF THE TMJ

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

STRUCTURE OF A SYNOVIAL JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

NERVE SUPPLY OF TMJ

ANATOMY OF THE JOINT

ARTERIAL SUPPLY OF TMJ

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

ANATOMY OF THE JOINT

FUNCTIONAL ANATOMY OF THE JOINT

FUNCTIONAL ANATOMY OF THE JOINT

FUNCTIONAL ANATOMY OF THE JOINT

ROTATIONAL MOVEMENT AROUND A FIXED POINT IN THE CONDYLE

FUNCTIONAL ANATOMY OF THE JOINT

FUNCTIONAL ANATOMY OF THE JOINT

ROTATIONAL MOVEMENT AROUND THE HORIZONTAL AXIS

FUNCTIONAL ANATOMY OF THE JOINT

FUNCTIONAL ANATOMY OF THE JOINT

FUNCTIONAL ANATOMY OF THE JOINT