all what you need to know as a general dentist concerning TMJ

1. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
JMJ Disorders
All What You Need To Know
(A Lecture 4 GPs)

2. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Drug therapy
Splint
therapy
Physiotherap
y
Occlusal
adjustment
Arthroscopy
Arthrocentes
is
Disk
plication
Disk removal
Condyle
surgeries
Eminectomy
TMJDisorders
Dislocation MPDs Arthritis Internal Derangement
Examination
History Clinical Ex Diagnostic Modalities
Introduction
Features Anatomy Blood Supply Nerve Supply Arrangement Physiology Occlusion & TMJ

3. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
INTRODUCTION

4. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://boxedge.org/body-measuring-yoga-anatomy

5. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

6. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

7. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Features of TMJ
• Coordinated movements are complex
• Teeth; shape and position affect the movements
• Articulating surface of the TMJ is not formed of
Hyaline cartilage but of a sturdy avascular fibrous
layer
• Only synovial joint in the human body with an
articulating disc

8. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
TMJ
• Synovial joint
– the bones have a synovial cavity
• Complex joint
– Two or more articulation surfaces and an articular disc
or meniscus
• Diarthrosis
– freely movable

9. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
ANATOMY

10. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles

11. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
GLENOID FOSSA
LIMITS:
• ANTERIORLY: ARTICULAR EMINENCE
• POSTERIORLY: POST GLENOID TUBERCLE
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles
CRANIAL COMPONENT

12. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
GLENOID FOSSA
LIMITS:
• ANTERIORLY: ARTICULAR EMINENCE
• POSTERIORLY: POST GLENOID TUBERCLE
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles
CRANIAL COMPONENT

13. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://dentallecnotes.blogspot.com/2012/03/note-on-pterygopalatine-fossa.html
• LATERALY : LATERAL BORDER OF THE FOSSA
• MEDIALY: ENTOGOLENOID PROCESS
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles
CRANIAL COMPONENT

14. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Mandibular condyle
•SHAPE: OVOID, MAY BE FLAT, ROUND AND ANGULAR.
•POLES: MEDIAL AND LATERAL.
•MEDIAL IS MORE PROMINENT.
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles
Lateral view

15. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Mandibular condyle
•SHAPE: OVOID, MAY BE FLAT, ROUND AND ANGULAR.
•POLES: MEDIAL AND LATERAL.
•MEDIAL IS MORE PROMINENT.
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles
Lateral view

16. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Mandibular condyle
• OVOID, MAY BE FLAT, ROUND AND ANGULAR
• POLES: MEDIAL AND LATERAL
• MEDIAL IS MORE PROMINENT
Anterior view Posterior view
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles

17. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Mandibular condyle
• OVOID, MAY BE FLAT, ROUND AND ANGULAR
• POLES: MEDIAL AND LATERAL
• MEDIAL IS MORE PROMINENT
Anterior view Posterior view
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles

18. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://pocketdentistry.com/1-functional-anatomy-and-biomechanics-of-the-
masticatory-system/
http://www.doereport.com/generateexhibit.php?ID=1983
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles
• IT IS A THIN FUNNEL SHAPED, SLEEVE FIBROUS TISSUE
INVESTING JOINT COMPLETELY
• INSIDE FIBROUS TISSUE CAPSULE, A SILKY SYNOVIAL
MEMBRANE IS THERE

19. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://pocketdentistry.com/1-functional-anatomy-and-biomechanics-of-the-masticatory-system/
• IT IS A THIN FUNNEL SHAPED, SLEEVE FIBROUS TISSUE
INVESTING JOINT COMPLETELY
• INSIDE FIBROUS TISSUE CAPSULE, A SILKY SYNOVIAL
MEMBRANE IS THERE
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles

20. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://pocketdentistry.com/1-functional-anatomy-and-biomechanics-of-
the-masticatory-system/Collateral ligaments
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
LIGAMENTS
ARTICULAR DISC
Muscles Attach the disc sides to the capsule

21. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
ARTICULAR DISC
LIGAMENTS
Muscles
MENISCUS:
Divide the joint into 2 compartments
Superior compartment (large) – TRANSLATION MOVEMENT
Inferior Compartment (small) – ROTATION MOVEMENT

22. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
ARTICULAR DISC
LIGAMENTS
Muscles PARTS OF MENISCUS:
ANTERIOR , INTERMEDIATE AND POSTERIOR ZONE

23. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
 ANTERIORLY
 ATTACHED WITH ARTICULAR EMINENCE
 ATTACHED TO THE LATERAL PTERYGOID MUSCLE
 POSTERIORLY IT IS DIVIDED INTO TWO LAMINA
• SUPERIOR RETRODISCAL LAMINA
• INFERIOR RETRODISCAL LAMINA
WITHIN THESE LAMINA THERE IS RETRODISCAL TISSUE SPACE
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
ARTICULAR DISC
LIGAMENTS
Muscles

24. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
 ANTERIORLY
 ATTACHED WITH ARTICULAR EMINENCE
 ATTACHED TO THE LATERAL PTERYGOID MUSCLE
 POSTERIORLY IT IS DIVIDED INTO TWO LAMINA
• SUPERIOR RETRODISCAL LAMINA
• INFERIOR RETRODISCAL LAMINA
WITHIN THESE LAMINA THERE IS RETRODISCAL TISSUE SPACE
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE
ARTICULAR DISC
LIGAMENTS
Muscles

25. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
True Capsular ligament
Temporomandibular ligament
http://what-when-how.com/dental-anatomy-physiology-and-occlusion/the-temporomandibular-
joints-teeth-and-muscles-and-their-functions-dental-anatomy-physiology-and-occlusion-part-1/
LIGAMENTS
ARTICULAR DISC
Muscles
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE

26. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
True
False
Capsular ligament
Temporomandibular ligament
Sphenomandibular ligament
Stylomandibular ligament
http://what-when-how.com/dental-anatomy-physiology-and-occlusion/the-temporomandibular-
joints-teeth-and-muscles-and-their-functions-dental-anatomy-physiology-and-occlusion-part-1/
LIGAMENTS
ARTICULAR DISC
Muscles
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE

27. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
LIGAMENTS
Muscles
ARTICULAR DISC
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE

28. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
LIGAMENTS
Muscles
ARTICULAR DISC
CRANIAL COMPONENT
MANDIBULAR
COMPONENT
TMJ CAPSULE

29. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Sagittal section

30. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Frontal section

31. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Keep In Mind
Occlusion & TMJ
• Maximum support to the muscles
and joint
Stable
Occlusiion
• Malfunction damage to the joint
Poor
Occlusion
• Increases the pressure on the joint,
causing damage and degeneration
Instable
Occlusion

32. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
BLOOD SUPPLY

33. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• Branches of External Carotid Artery
• The Blood supply to TMJ is only Superficial
• There is no blood supply inside the capsule
• TMJ takes its nourishment from Synovial fluid
• IA shares in the blood supply of the condyles

34. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
NERVE SUPPLY

35. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
 MANDIBULAR NERVE
• AURICULOTEMPORAL FOR POSTERIOR
• MASSETERIC for MEDIAL AND LATERAL ASPECTS
• DEEP TEMPORAL NERVE

36. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://dentallecnotes.blogspot.com/2011/08/anatomy-of-temporomandibular-jointwith.html
Masseteric
Auriculotemporal
Auriculotemporal
Temporal

37. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
NORMAL ARRANGEMENT

38. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

39. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

40. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• The condyle is present in the middle of the glenoid fossa
• The posterior portion of the disc is considered normal between 12 and 1
o'clock

41. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://www.claytonchandds.com/anatomyofthetmj.html

42. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://www.claytonchandds.com/anatomyofthetmj.html

43. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://www.claytonchandds.com/anatomyofthetmj.html

44. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
TMJ Syndrome - Morphopedics.html

45. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
PHYSIOLOGY - MOVEMENTS

46. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• It opens and closes like a hinge
• It slides forward and backward
• Side to side during its function
• Hinge
• Translation
• Lateral
• protrusive
http://www.georgia-clinic.com/blog/2014/06/treatment-with-a-tmj-specialist-in-augusta-ga/

47. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Axis of Movements
• Hinge – transverse movement
– Movement
• Opening & Closure
– Place
• Superior compartment
– Fulcrum
• Condyle twists
– Center of rotation
• It takes place in sagital plane
– Action
• Condyle twists vertically
https://www.slideshare.net/pramodchahar9/tmj-and-
prosthodontic-implications

48. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Axis of Movements
• Vertical Axis
– Movement
• Lateral movements
– Place
• In inferior disc space
– Fulcrum
• Condyle twists laterally and
backward
– Center of rotation
• In horizontal plane
– Action
• Condyle twists https://www.slideshare.net/pramodchahar9/tmj-and-
prosthodontic-implications

49. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Axis of Movements
• Sagital (antroposterior) Axis
– Movement
• Lateral movements
– Place
• In inferior disc space
– Fulcrum
• Condyle twists
– Center of rotation
• Frontal plane
– Action
• Condyle twists
https://www.slideshare.net/pramodchahar9/tmj-and-
prosthodontic-implications

50. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• Hinge movement
– Slight opening
– IIO 20-25mm
• Translational movement
– Superior joint space
– after that when the mouth is excessively opened
• Rotation movement
– Inferior joint space
– Mouth excessively opened

51. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

52. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

53. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

54. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• Depression Of Mandible
– Gravity
– Lateral pterygoid
– Digrastric
– Geniohyoid
– Mylohyoid
• Elevation of Mandible
– Temporalis
– Masseter
– Medial Pterygoids
• Protrusion of Mandible
– Lateral Pterygoids
– Medial Pterygoids
• Retraction of Mandible
– Posterior fibers of Temporalis

55. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
EXAMINATION

56. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Examination
History
Clinical
examination
Diagnostic
Modalities

57. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Examination
History
Family history
Medical history
Chief Compain
Habits
Clinical
examination
Diagnostic
Modalities

58. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Examination
History
Clinical
examination
Inspection
Palpation
Auscultation
Diagnostic
Modalities

59. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Examination
History
Clinical
examination
Inspection
Mouth
opening
IIO
MIO
Shift
Teeth &
occlusion
Bite
Palpation
Auscultation
Diagnostic
Modalities

60. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Examination
History
Clinical
examination
Inspection
Palpation
Muscles of
mastication
Auscultation
Diagnostic
Modalities

61. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Temporalis Muscle

62. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Superficial Masseter

63. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Deep Massetter

64. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Mylohyoid Muscle

65. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Examination
History
Clinical
examination
Inspection
Palpation
Auscultation
Diagnostic
Modalities

66. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Doppler

67. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

68. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Examination
History
Clinical
examination
Diagnostic
Modalities
Plain radiography
Tomograms
Plain/ tomograms + contrast
CT scans / CBCT
MRI
Ultrasonography
EMG

69. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Panoramic View

70. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Double TMJ View

71. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
CT Scans

72. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

73. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
CBCT Scans

74. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
https://www.sciencedirect.com/science/article/pii/S1073874615000158
MRI

75. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

76. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

77. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

78. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

79. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

80. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

81. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

82. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

83. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
DISORDERS

84. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
TMJ Disorders
Extracapsular
Myofascial pain
dysfunction
Referred pain
Intracapsular
Inflammation
Internal
Derangement
Dislocation
Arthritis

85. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
TMJDisorders
Muscles Related
Myofascial Pain Syndrome
Dislocation
Internal derangement
Anterior disc displacement
with reduction
Anterior disc displacement
without reduction
Disc perforation
Bone Related
Arthritis
Dislocation

86. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Dislocation

87. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• Displacement of the condyle out of the glenoid fossa but
within the capsule of the joint
• Etiology:
1. Extreme trauma specially to the chin when the mouth
is open
2. Sudden wide mandibular opening e.g. yawing
3. Prolonged wide opening
4. injudicious use of mouth gag during GA
5. forceful luxation of mandibular teeth during extraction
6. Capsular laxity as in chronic subluxation

88. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

89. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Classifications of Dislocation of
the mandible
I. According to the direction of the
dislocated condyle:
1. Anterior dislocation
2. Posterior dislocation
3. Medially
4. Laterally
5. upwards
II. According to the site:
1. Unilateral
2. Bilateral

90. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Classifications of Dislocation of
the mandible Cont.
III. According to the choronicity:
1. Acute Dislocation
Occurs after sudden stretching of the
masticatory muscles
2. Recurrent dislocation
Dislocation occurs several times with inability of
the patient to reduce it by himself
3. Subluxation
Self reducible dislocation

91. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

92. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

93. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

94. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

95. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

96. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

97. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

98. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Recurrentdislocation
Conservative
Minimally invasive
Surgical treatment

99. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Recurrentdislocation Conservative
IMF
Decrease mouth
activity
Minimally invasive
Surgical treatment

100. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

101. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Recurrentdislocation Conservative
Minimally invasive
Injection of scleroting agent
Injection of Botox
Injection of autologous blood
intracapsular
Surgical treatment

102. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

103. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

104. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Recurrentdislocation Conservative
Minimally invasive
Surgical treatment
(eminence surgeries)
Decrease the
eminence
Increase the
eminence

105. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Recurrentdislocation
Conservative
Minimally
invasive
Surgical
treatment
Decrease the
eminence
Eminectomy
Increase the
eminence

106. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

107. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

108. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

109. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Recurrentdislocation
Conservative
Minimally invasive
Surgical treatment
Decrease the
eminence
Increase the
eminence
Onlay grafting
Screw fixation
Down Fracturing of
the zygomatic arch

110. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

111. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

112. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

113. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

114. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

115. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Myofascial pain Syndrome
TMDs

116. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• TMD is a collective term representing a broad
spectrum of clinical joint and muscle problems in the
oro-facial area
• It characterized by
– Pain
– Joint sounds
– Irregular or limited jaw function

117. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• MPS is a common painful condition associated with tender
points in muscle
• It can affects any skeletal muscles in the body involving
mostly the masticatory muscles and muscles of the neck and
shoulders
• It is responsible for many cases of chronic musculoskeletal
pain

118. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• The cardinal clinical manifestations of MPS include
– Pain
• Dull aching
• Aggravated by chewing and other jaw functions
• Localized or radiated
– Tenderness over the masticatory muscles
– Limitation or deviation of mandibular movement
– Joint sounds
– headache
– Development of TrP

119. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

120. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Causes
1. Trauma
2. Malocclusion
3. Arthritis
4. Developmental abnormalities
5. Hypermobility
6. Internal joint derangement
7. Psychogenic causes

121. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
1. Acute trauma (macrotrauma)
a. Punch to the jaw
b. Fist blow
c. Accident
2. Chronic trauma (microtrauma)
a. Bruxism
b. Clinching
c. Grinding
3. Iatrogenic
a. Extraction molar teeth specially impacted ones
b. Tonsillectomy
c. Endoscopy
d. Opening the jaw too widely during laughing ,yawning or biting into a thick something e.g.
sandwich
Trauma

122. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• The effect of this factor varies from mild to
severe
• It results from missing of various teeth
pushing to abnormal habits in chewing and
putting strain on the jaw muscles
Malocclusion

123. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
1. Hypoplastic condyles
2. Hyperplastic condyles
Developmental abnormalities

124. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• Results when the ligaments that hold the joint
together become stretched
• It usually occur by trying to open the mouth
too wide
Hypermobility

125. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT
Minimally invasive
Splint therapy
Combination

126. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT
Occlusal
adjustment
Drug therapy
Splint therapy
Physiotherapy
Minimally invasive
Splint therapy
Combination

127. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT
Occlusal
adjustment
Minimally invasive
Splint therapy
Combination

128. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT
Occlusal
adjustment
Minimally invasive
Splint therapy
Combination

129. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Drug therapy
Minimally invasive
Splint therapy
Combination
Muscle relaxants
NSAIDs
Tricyclic drugs

130. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Splint therapy
Minimally invasive
Splint therapy
Combination
• Habit breaking devices
• Soft night guard
• Hard night guard
• Muscle deprograming splints
Other splints Used for ID

131. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Splint therapy
Minimally invasive
Splint therapy
Combination
• Habit breaking devices
• Soft night guard
• Hard night guard
• Muscle deprograming splints

132. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Physiotherapy
Minimally invasive
Splint therapy
Combination
• Exercise
• Hydrotherapy
• Short wave and Ultrasound
• TENS

133. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Physiotherapy
Minimally invasive
Splint therapy
Combination
• Exercise
• Hydrotherapy
• Short wave and Ultrasound
• TENS

134. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Physiotherapy
Minimally invasive
Splint therapy
Combination
• Exercise
• Hydrotherapy
• Short wave and Ultrasound
• TENS

135. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Physiotherapy
Minimally invasive
Splint therapy
Combination
• Exercise
• Hydrotherapy
• Short wave and Ultrasound
• TENS

136. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Physiotherapy
Minimally invasive
Splint therapy
Combination
• Exercise
• Hydrotherapy
• Short wave and Ultrasound
• TENS

137. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Physiotherapy
Minimally invasive
Splint therapy
Combination
• Exercise
• Hydrotherapy
• Short wave and Ultrasound
• TENS

138. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Physiotherapy
Minimally invasive
Splint therapy
Combination
• Exercise
• Hydrotherapy
• Short wave and Ultrasound
• TENS

139. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT Physiotherapy
Minimally invasive
Splint therapy
Combination
• Exercise
• Hydrotherapy
• Short wave and Ultrasound
• TENS

140. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment Removal of the
cause
Conservative TTT
Minimally
invasive
TP injection
LA anesthesia
Saline
Distilled water
Acupuncture
Soft Laser
Therapy
Splint therapy
Combination

141. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://collegevilledentistry.com/

142. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://collegevilledentistry.com/

143. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://collegevilledentistry.com/

144. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

145. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

146. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT
Minimally invasive
TP injection
Soft Laser Therapy
Splint therapy
Combination

147. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

148. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Removal of the
cause
Conservative TTT
Minimally invasive
Splint therapy
Muscle
deprograming splint
Habit breaking
device
Combination

149. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
http://www.is.wayne.edu/MNISSANI/BRUXNET/advice.htm

150. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

151. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

152. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

153. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Arthritis

154. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
1. Osteoarthritis
– Occurs with missing or perforated disc
2. Rheumatoid arthritis
– Bilateral affecting the two joints
– Usually affects other joints of the body

155. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatmentaccordingtothecause
Disc perforation
Disc plication
Minesectomy
Interpositional
grafting
Joint replacement
Total joint
replacement
Patrial joint
replacement

156. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

157. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

158. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Internal Derangement

159. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Internalderangement
Anterior disc displacement with
reduction
Anterior disc displacement without
reduction
Disc perforations

160. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Anterior disc displacement
with reduction

161. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• Anterior disk displacement with reduction
– Presented by clicking or popping sound in the joint
when the mouth opens wide or the jaw shifts
from side to side
– This is usually the only symptom

162. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

163. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

164. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
ANTERIOR DISC DISPLACEMENT
WITHOUT REDUCTION

165. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• Anterior displacement without reduction
– pain is a common symptom
– with some limitation of jaw opening
– No clicking

166. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

167. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

168. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
DISC PERFORATIONS

169. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
• Disk perforation
• This is the most serious condition
• Pain is usually persistent and increase with any
joint movement
• Crepitus

170. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

171. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

172. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
TREATMENT

173. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Treatment
Conservative
TTT
Drug therapy
Splint therapy
Physiotherapy
Occlusal adjustment
Minimally
invasive
Arthroscopy
Arthrocentesis
Surgical TTT
Disk plication
Disk removal (menisectomy)
Condyle surgeries
Eminence surgeries
Orthognathic surgery

174. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Splints
• Superior repositioning splint SRS
• Anterior repositioning splint ARS

175. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

176. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

177. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

178. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

179. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Arthrocentesis
• Two point entry
• Lysis and lavage
• Installation of drugs
– Steriods
– Hyaluronates

180. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

181. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

182. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
arthroscopy
• Two points joint entry
• Inflow canula and lens
• Outflow canula
• Mainly diagnostic
• Limited surgical intervention

183. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

184. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Open Arthrotomy
• Last resort
• Only 5% of cases would need surgery
• disadvantages
– Recurrence of the symptoms
– External scar
– Facial nerve affection
– Adhesions
– Major occlusal changes in some procedures

185. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Disk Plication (repositioning)

186. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

187. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

188. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary

189. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Menisectomy (disk removal)

190. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
condylotomy

191. TMJ Disorders; What You Need To Know (A Lecture 4 GPs) Dr.ElHawary
Thank you