MANDIBULAR MOVEMENTS

Dr Rohan Bhoil
Introduction
CONTENTS
Methods of studying mandibular movements

Importance

Factors which regulate jaw motion

Mandibular positions

The clinical understanding

Conclusion
INTRODUCTION

Mandibular
movements are
complex.
 METHODS OF STUDYING
MANDIBULAR MOVEMENTS

Direct Clinical Observation

Sophisticated Electronic
Instrumentation :
Facial Clinometers , Roentgen
Fluoroscopy , Radionucleotide
Tracking; Optical Pantography;
Gnathic Replicator etc
SIGNIFICANCE OF UNDERSTANDING
MANDIBULAR MOVEMENTS
Developing Tooth Forms For Dental
Restorations,
Understanding Occlusion,
Arranging Artificial Teeth,
Treating TMJ Disturbances,
Preserving Periodontal Health
And the designing, selection and adjustment
of articulators.
FACTORS WHICH REGULATE JAW
MOTION
The Neuromuscular Role

Contacts Of Opposing Teeth

Anatomy And Physiology Of TMJ's

The Action Of Muscles /Ligaments

 NEUROMUSCULAR ROLE

Mastication is a
programmed event
residing in a
chewing centre
located within the
brain stem, probably
in reticular
formation of pons.
The cerebellum
ensures a
coordinated response
from muscles during
mandibular
movements, by
acting as a feedback
control mechanism..
Loss of propioceptors,
located principally in
periodontal
ligaments, eliminates
an important source
of control in
positioning of
mandible; for the
edentulous patients.
INFLUENCE OF OPPOSING TOOTH
CONTACTS

Opposing tooth surface

contacts are related to
occlusal surfaces of teeth
muscles
TMJs
and neurophysiological
components.
 INFLUENCE OF THE TEMPOROMANDIBULAR JOINTS

Mandibular
movements except
opening and
closing movements
at the terminal
hinge position, are
combinations of
rotation and
translation.
 ROTATION:

The movement of a rigid body in which the parts move in

circular paths with their centers on a fixed line called the axis
of rotation. The plane of the circle in which the body moves is
perpendicular to the axis of rotation.

TRANSLATION

The motion of a body at any instant when all points within the
body are moving at the same velocity and in the same
direction.
 TMJ

Rotation - in the
lower
compartment of
the TMJ.
The translatory or
gliding movements
- in the upper
compartment.
 A complex joint.

GINGLYMOARTHRODIAL JOINT.

TMJ consists of 4 main structures:-

Condyle
Temporal bone (Squamous part)
Articular disc
Ligaments
 THE TEMPORO MANDIBULAR JOINT

Articulating part of TMJ

includes convex head of
mandibular condyle and the
convexoconcave part of the
temporal bone i.e. mandibular
fossa and articular tubercle.

An intrarticular disc made of

fibrous tissue divides joint
cavity into upper and lower
compartments.
ARTICULAR DISC

SAGITTAL PLANE ANTERIOR VIEW

 LIGAMENTS OF TMJ

1. Fibrous capsule

2. Lateral temporomandibular ligament

3. and two accessory ligaments i.e.

sphenomandibular and the stylomandibular
ligaments.
TMJ LIGAMENTS
 ACCESSORY LIGAMENTS

Stylomandibular ligament limits excessive protrusive

movement of mandible.
MUSCULAR INVOLVEMENT IN JAW
MOTION
 ROLE OF MUSCLES

There are four main

muscles of mastication
Masseter, Temporalis and
the Medial and Lateral
Pterygoids.
All these except the lateral
pterygoids act as
ELEVATORS.
MASSETER

Functions:-
Elevation
Superficial portion: protrusion
Deep portion : stabilization against articular eminence
TEMPORALIS:-

It is a significant positioning
muscle of the mandible

It has 3 types of fibres

Anterior fibers or vertical.

Middle fibers run obliquely.

Posterior fibers consists of fibers that are aligned almost

horizontally.
 MEDIAL PTERYGOID

FUNCTION:
Elevation and protrusion.
Unilateral contraction mediotrusive movement
LATERAL PTERYGOID
 Function
Inferior Lateral Pterygoid:-
Simultaneous contraction:
depression and protrusion
Unilateral contraction:
mediotrusion & movement
to opposite side.
Superior Lateral Pterygoid
During opening: remains
inactive.
Becomes active only in
conjunction with elevator
muscles.
Active during power stroke
& when teeth held together
 THE SUPRAHYOID MUSCLES

These depress the

Mandible, if the hyoid
bone remains fixed.
Thus help when the
mouth is opened
wide or against
resistance.
MOVEMENTS
OPENING &
CLOSING

Lateral Pterygoid is the main

muscle responsible for opening.

Opening of mouth is limited by

the superior lamina of the
articular disc.
 PROTRUSION AND RETRACTION

Protrusion is brought about

by simultaneous
contraction of the lateral
and medial pterygoids of
both sides
While
Retraction is mainly due to
contraction of the posterior
horizontal fibres of
temporalis muscle
 CHEWING

Chewing or
side to side
movements
occur due to
alternate
contraction of
muscles of
both sides.
CERTAIN BASICS : JAW MOTION
 MANDIBULAR ROTATION

In opening and
closing and
lateral
movements.
AXES OF MANDIBULAR ROTATION

Rotation occurs around three

axes: transverse, vertical and
sagittal, that move constantly
during normal jaw function.
MOVEMENT ABOUT A
HORIZONTAL AXIS, AS SEEN IN A
HINGE AXIS OPENING.
MOVEMENT OCCURS AROUND
A VERTICAL AXIS DURING A
LATERAL EXCURSION.
THE MANDIBLE ALSO ROTATES
AROUND A SAGITTAL AXIS
WHEN ONE SIDE DROPS DOWN
DURING A LATERAL EXCURSION
 BASIC JAW POSITIONS

Centric Occlusion
it is defined as maximum intercuspation of teeth.

Centric Relation
the most posterior relation of the upper to the lower
jaw from which lateral movements can be made at a
given vertical dimension. {Boucher}
 CENTRIC RELATION (GPT-8) :
the maxillomandibular relationship in which the condyles
articulate with the thinnest avascular portion of their
respective disks with the complex in the antero-superior
position against the slopes of articular eminences. This
position is independent of tooth contact. This position is
clinically discernible when the mandible is directed superiorly
and anteriorly.
BASIC JAW POSITIONS.

Centric relation is used to transfer position

of mandible in relation to maxilla, to an
articulator.

The centric occlusion is a tooth determined

position, whereas the centric relation is a
jaw to jaw relation determined by the
condyles in the fossae.
 TERMINAL HINGE AXIS

When the condyles are in their most superior position in the

articular fossae and the mouth is purely rotated open, the axis
around which movement occurs is called the Terminal Hinge
Axis.
Condylar guidance Mandibular guidance
generated by the condyle and articular disc
traversing the contour of the glenoid fossa

Incisal guidance The influence of the contacting

surfaces of the mandibular and maxillary anterior
teeth during mandibular movements
Retruded Contact
Position
- guided occlusal
relationship occurring at
the most retruded
position of the condyles
in the joint cavity.
MANDIBULAR MOVEMENTS
Mandible performs
habitual and border movements
opening and closing movements
protrusive and lateral movements

And stopping positions along these movements

centric occlusion,
centric relation,
protrusive border position,
right and left lateral border positions
and a rest position.
 THE CLINICAL UNDERSTANDING OF
MANDIBULAR MOVEMENT
PARALLELOGRAM OF FORCES.

Factor of muscle pull related to positioning of

mandible after loss of teeth.

Direction of forces is affected by occlusal vertical

dimension.

Mainly two parallelograms.

In edentulous, occlusal plane is made parallel to

ala-tragus line.
 THE ENVELOPE OF MOTION.

Defining the limits of

possible mandibular motion
and certain mandibular
reference positions.

Records made in sagittal and

frontal planes.
 Envelope of motion in
the sagittal plane.
CO, Centric occlusion;

CR, centric relation;

MHO, maximum hinge-opening

position

MO, point of maximum

opening of the jaws

P, most protruded position of

the mandible with the teeth in
contact

Rest, postural rest position

 SAGITTAL PLANE BORDER &
1. FUNCTIONAL
Posterior opening border.MOVEMENTS:-
2. Anterior opening border.
3. Superior contact border.
4. Functional.
 Posterior Opening Border Movements:-
1st STAGE 2ND STAGE

Condyles: terminal hinge Axis of rotation shifts to bodies of

position rami.
Pure rotational movement
 1st STAGE 2ND STAGE

Opening range: 20-25mm Condyles: anteriorly &

inferiorly.
The movements are the Mandible: posteriorly &
only repeatable hinge axis inferiorly.
movement of mandible. Max opening: 40-60mm.
 Anterior Opening Border Movements:-

Generated when closure

accompanied by contraction
of inferior lateral pterygoid.

Not a pure hinge movement

due to eccentricity.
 Superior Contact Border Movements
Throughout this entire border movement tooth contact
is present.
It depends on:-
Amount of variation between centric relation and
maximum intercuspation.
The steepness of the cuspal inclines of the
posterior teeth.
Amount of vertical and horizontal overlap of
anterior teeth
Lingual morphology of maxillary anterior teeth.
General inter arch relationships of the teeth.
Envelope of
motion in the
frontal plane
CO, Centric
occlusion

MO, point of
maximum opening
of the jaws

Rest, postural
rest position.
Left lateral superior movement
Left lateral opening movement
Right lateral superior border movement
Right lateral opening border movement
 Maximum movements-

Opening : 50-60 mm
Lateral : 10 to 12 mm
Protrusive : 8 to 11 mm
And retrusive range is
about 1 mm.
 Functional Movements:-

Occur during functional activity of mandible.

Free movements: take place within border movements.
Occur chiefly around centric.
 Functional Movements:-
During chewing, the mandible
drops directly inferiorly until the
desired opening is achieved.

It then shifts to the side on which

bolus is placed and rises up.

As it approaches maximum
intercuspation, bolus is broken down
between the opposing teeth.

In the final closure, the

mandible quickly shifts back to
the intercuspal position.
EFFECT OF POSTURE
 Envelope of Motion
Gives reference positions from where fundamental movements of
mandible occur-
Helps in making vertical & horizontal jaw relation records

CR MHO :represents Posterior terminal hinge movement, which

is used to locate transverse hinge axis for mounting of casts on
articulator.

The rest position is a guide to

re-establishing the proper vertical
dimension of occlusion.
 Envelope of Motion

Multiple restorations and

complete dentures are so
constructed that their occlusion is in harmony with centric
relation, because mastication in dentulous occurs at CO
but in edentulous at CR.

Except at the occlusal contact position, where envelope of

movement is controlled by teeth, all other contours are
controlled by muscles, joints and soft tissue forces.
 The gothic arch or arrow point tracing.
It is a graphic registration of lateral
border movements on a horizontal
plane, which results in an angular
tracing.

The direction of lateral movements is

actively determined by the lateral
pterygoid muscle on nonworking side
and by the deep capsular ligaments of
condyle on working side.
 WORKING & NONWORKING SIDE

The side toward which the

mandible moves in a lateral
excursion is called Working side

And

The Nonworking side is that side of

mandible that moves toward
median line in a lateral excursion
Left lateral border movement
Continued left lateral border movement with
protrusion
 Right lateral border movements
Condyles in CR
Contraction of left inferior
lateral pterygoid

Left condyle moves

anteriorly,medially and
Inferiorly
 Continued right lateral movement with
protrusion

Contraction of rt. lateral pterygoid

& continued contraction left
inferior pterygoid

Right condyles moves anteriorly

and to left

Mandibular midline coincides with

midline of face
 BENNETT SHIFT
Described by Dr. Norman Bennett in 1908 , it is the
direct lateral side shift that occurs simultaneously
with a lateral excursion
The primary cause :is the contraction of lateral pterygoid
muscle because its origin is located medially to its insertion.

When mandible shifts to the side, its movement occurs in two

segments-
an immediate side shift in which the major direction of
movement is mediolateral

and a progressive side shift, which begins thereafter and

continues with the major direction of movement being anterior.
 Physiological rest position
Established by muscles and gravity.
Is actively determined.
It is a range of posture
Usually 2-4mm below maximum intercuspation
position, but can be upto 10 mm.
Remains relatively stable for reasonable periods of
time.
Affected by short and long term intra oral and
general health factors and by position of head.
 Conclusion
Knowledge of Jaw Movements is Essential for
Successful Treatment of Patients. It is imperative
to learn as much possible about jaw movement,
in order to reproduce those aspects of its
motion, considered necessary for proper
functioning of the occlusion, either natural or
artificial.
 References
Complete denture prosthodontics 3rd
edition, by John J Sharry

Prosthodontic Treatment for Edentulous

Patients by Zarb and Bolender, 12th edition.
An evaluation of mandibular border
movements: Their character and significance -
Harry C. Lundeen
Thank you !!!