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1、TEMPOROMANDIBULAR DISORDERS,American Dental Association, 1983 defined TMD as a group of orofacial disorders characterized by: Pain in the preauricular area, TMJ, or muscles of mastication Limitations/deviations in mandibular range of motion TMJ sounds during jaw function 1990Y Craniomandibular Disor
2、ders(CMD),Definition,Epidemiology of TMD,TMD pain has been estimated to affect 10% (5-12%) of the population It is at least twice as common in women as in men It occurs more frequently in people 20-50 years old,Anatomy of TMJ,Mandibular condyle Joint surface of temporal bone Articular disc TMJ capsu
3、le TMJ ligament,Multi-axis & multi-direction ,Movement agility,A important part in stomatognathic system ,A remodeling in all lifetime joint,Anatomy of TMJ,Sagittal plane view: The relationship among dics & condyle & glenoid in COP,Normal: One plane: front bevel of condyle / middle part of disc / po
4、sterior bevel of node One line: cross ridge of condyle /posterior border of later belt of disc /peak of glenoid,Abnormal: 1.Retrusion of condyle 2.Hyperfunction of lateral pterygoid muscle,Anatomy of TMJ,Coronal plane view: the relationship of disc & condyle & node in COP,Normal: middle position con
5、dyle and disc in middle position Abnormal : Ingression or out-shift of condyle and disc,Anatomy of TMJ,Etiology of TMD,Psychic factor,Bad habits,Trauma,Others,Occlusal factor:,Occlusal interfere,Protrusive occlusal interfere Lateral occlusal interfere Retrusive occlusal interfere,High spot,occlusion
6、,Etiology of TMD,Lateral occlusal interfere,Occlusal factor,Premature contact：interfere happened in PP to ICP,Elongation of upper 3rd molar,Anterior superior displacement of condyle,Elongation of lower 3rd molar,Posterior displacement of condyle,Etiology of TMD,Occlusal factor,Malocclusion:,Malocclu
7、sion of individual tooth Malocclusion of dentition,Etiology of TMD,Anterior teeth lingual tipping deep overbite,Occlusal factor,More teeth losedLateral molars loss：unilateral mastication Bilateral molars loss：,Posterior displacement of condyle,Maladjustment of Reverse tensile reflection,Etiology of
8、TMD,Occlusal factor,Change of interarch distance:More higher: apertognathiaMore lower: excessive wear,Anterior inferior displacement of condyle,Sustained tension of masticational muscle,Posterior superior displacement of condyle,Maladjustment of reverse tensile reflection,Etiology of TMD,More higher
9、 vertical distance with more tenser muscles,More lower in interarch distanceserious teeth wear,Occlusal factors,Latrogenic factors: Oral madicine Prosthodontics Orthodontics,Etiology of TMD,Predisposing factorsInitiation factorsPerpetuating factor,Etiology of TMD,Pain TMJ sounds Limitations in mandi
10、bular range Others,Clinical manifestation of TMD,Muscle derived painArticular derived pain,protective muscle splinting local muscle soreness myofascial pain myospasm chronic myosis,pain happened in disc and ligamentretrodiscitissynovitis or capsulitisosteoarthritis,Clinical manifestation of TMD,Disp
11、lacement of disc Recoverablity disc dislocation Unrecoverability disc dislocation,Recoverablity disc dislocation,Unrecoverability disc dislocation,Clinical manifestation of TMD,Antiorer diplacement of disc,Antiorer diplacement of disc,TMJ sounds,TMJ sounds,Hyperosteogeny & disc perforation Synovium
12、lesions,Clinical manifestation of TMD,Opening limitationAbnormal opening,Clinical manifestation of TMD,Tension type headache Migraine Others,Clinical manifestation of TMD,Clinical examination of TMD,Opening patterns Straight Deviation (right & left) Corrected deviation Others,Clinical examination of
13、 TMD,Opening patten Straight Deviation (right & left) Corrected deviation Others,Clinical examination of TMD,Clinical examination of TMD,Clinical examination of TMD,Clinical examination of TMD,Clinical examination of TMD,患者自身条件评价（patient assessment of condition)：chief complaints; treatment history s
14、omatization（精神状态的躯体表现） 社会心理评价(psychosocial status) ：pain-related interference with daily life, pain intensity and persistence, social support,Clinical examination of TMD,Treatment of TMD,Relaxation splint,Treatment of TMD,Stabilization splint,Treatment of TMD,Repositioning splint,Treatment of TMD,Pivot splint,Treatment of TMD,Treatment of TMD,Occlusal adjustment Surgery Orthodontics Prosthodontics,Thanks,下颌运动轴心 , CNS muscle occlusion TMJ,Stomatognathic system,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,
