1、TEMPOROMANDIBULAR DISORDERSTEMPOROMANDIBULAR DISORDERS American Dental Association,1983 defined TMD as a group of orofacial disorders characterized by:lPain in the preauricular area,TMJ,or muscles of masticationlLimitations/deviations in mandibular range of motionlTMJ sounds during jaw function 1990
2、Y Craniomandibular Disorders(CMD)DefinitionEpidemiology of TMDlTMD pain has been estimated to affect 10%(5-12%)of the populationlIt is at least twice as common in women as in menlIt occurs more frequently in people 20-50 years oldAnatomy of TMJlMandibular condylelJoint surface of temporal bonelArtic
3、ular disclTMJ capsulelTMJ ligamentlMulti-axis&multi-direction lMovement agilitylA important part in stomatognathic system lA remodeling in all lifetime jointAnatomy of TMJlSagittal plane view:The relationship among dics&condyle&glenoid in COPNormal:One plane:front bevel of condyle/middle part of dis
4、c/posterior bevel of nodeOne line:cross ridge of condyle/posterior border of later belt of disc/peak of glenoidAbnormal:1.Retrusion of condyle2.Hyperfunction of lateral pterygoid muscleAnatomy of TMJlCoronal plane view:the relationship of disc&condyle&node in COPNormal:middle position condyle and di
5、sc in middle positionAbnormal:Ingression or out-shift of condyle and discAnatomy of TMJEtiology of TMDlPsychic factorlBad habitslTraumalOthersOcclusal factor:Occlusal interfere1.Protrusive occlusal interfere2.Lateral occlusal interfere3.Retrusive occlusal interfereHigh spotocclusionEtiology of TMDLa
6、teral occlusal interferelOcclusal factorPremature contact：interfere happened in PP to ICPElongation of upper 3rd molarAnterior superior displacement of condyleElongation of lower 3rd molarPosterior displacement of condyleEtiology of TMDlOcclusal factorMalocclusion:Malocclusion of individual toothMal
7、occlusion of dentition Etiology of TMDAnterior teeth lingual tipping deep overbitelOcclusal factorMore teeth losed1.Lateral molars loss：unilateral mastication2.Bilateral molars loss：Posterior displacement of condyleMaladjustment of Reverse tensile reflectionEtiology of TMDlOcclusal factorChange of i
8、nterarch distance:1.More higher:apertognathia2.More lower:excessive wearAnterior inferior displacement of condyleSustained tension of masticational musclePosterior superior displacement of condyleMaladjustment of reverse tensile reflectionEtiology of TMDMore higher vertical distance with more tenser
9、 musclesMore lower in interarch distanceserious teeth wearlOcclusal factorsLatrogenic factors:1.Oral madicine2.Prosthodontics3.OrthodonticsEtiology of TMDlPredisposing factorslInitiation factorslPerpetuating factorEtiology of TMDlPainlTMJ soundslLimitations in mandibular rangelOthersClinical manifes
10、tation of TMDMuscle derivedpainArticular derivedpainprotective muscle splintinglocal muscle sorenessmyofascial painmyospasmchronic myosis pain happened in disc and ligament retrodiscitis synovitis or capsulitis osteoarthritisClinical manifestation of TMDlDisplacement of disclRecoverablity disc dislo
11、cationlUnrecoverability disc dislocationRecoverablity disc dislocationUnrecoverability disc dislocationClinical manifestation of TMDAntiorer diplacement of discAntiorer diplacement of discTMJ soundsTMJ soundslHyperosteogeny&disc perforationlSynovium lesionsClinical manifestation of TMDlOpening limit
12、ationlAbnormal openingClinical manifestation of TMDlTension type headachelMigrainelOthersClinical manifestation of TMDClinical examination of TMDOpening patterns1.Straight2.Deviation(right&left)3.Corrected deviation4.OthersClinical examination of TMDOpening patten1.Straight2.Deviation(right&left)3.C
13、orrected deviation4.OthersClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDClinical examination of TMDl患者自身条件评价（患者自身条件评价（patient assessment of condition)：chief complaints;treatment history&expectationl行为状态评价行为状态评价(behavioral status)：jaw disa
14、bility;parafunctional behaviors;general health behaviorsl心理评价心理评价(psychological status)：depression;anxiety;somatization（精神状态的躯体表现）（精神状态的躯体表现）l社会心理评价社会心理评价(psychosocial status)：pain-related interference with daily life,pain intensity and persistence,social supportClinical examination of TMDTreatment
15、of TMDlRelaxation splintTreatment of TMDlStabilization splintTreatment of TMDlRepositioning splintTreatment of TMDlPivot splintTreatment of TMDTreatment of TMDOcclusal adjustmentSurgeryOrthodonticsProsthodonticsThanks下颌运动轴心下颌运动轴心 CNS muscle occlusion TMJStomatognathic system 咀嚼运动中肌肉和关节的协调运动咀嚼运动中肌肉和关节的协调运动咀嚼运动中肌肉的左右协调运动咀嚼运动中肌肉的左右协调运动
