Comprehensive Approach to TMJ Pathology Diagnosis and Orthopedic Treatment

Diagnosis and orthopedic

treatment of patients with TMJ

pathology

.

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Articular disorders - 19%

Muscle disorders - 23%

A combination of muscle

and joint disorders - 31%

Have no signs of

dysfunction - 31%

The frequency of violations

increases from 15 to 45

years.

Ratio of men and women

from 1/3 to 1/9.

The structure of the

temporomandibular joint

 Ligaments of the temporomandibular

joint

View from the medial side.

1- lateral ligament (temporomandibular

joint);

2- capsule of the temporomandibular joint;

3- wedge-mandibular ligament;

4 - awl-mandibular ligament;

5- aperture of lower jaw;

6- zygomatic arch;

7-wedge sinus;

8 - pituitary fossa (Turkish saddle).

DIAGNOSTICS OF TISSUE DISEASES

Anamnesis

1.

Symptoms at the moment:

•

Pain, stiffness and tension in the muscles

and joints;

•

Impaired mobility of joints;

•

Sensitivity or pain in the teeth, the intensity

of pain reactions;

•

The onset and duration of symptoms;

2. Previous Symptoms

3. Previous dental history.

4. Data on grinding or squeezing teeth

Classification.

Articular problems:

1.

Disc offset:

•

With the restoration of position;

•

Without restoring the situation.

2. Disk compression:

•

The problem of the ligamentous apparatus of

the joint;

•

Muscular problems.

3. Combination of displacement and

compression.

Etiology of disc displacement:

•

Injury of the joint, leading to a sharp

displacement of the joint head back;Loss of

incisive path;

•

Prosthetics without the principle of "freedom

in centric" (when modeling a prosthesis, a

dental technician should give 1 mm of freedom

of the incisal and fang path);

•

Anomalies of occlusion with forced position of

the lower jaw (offset to the side).

2 types of displacement of

the joint disc:

•

With the restoration of

position

•

Without restoring the

situation

 The clinical picture of the

displacement of the articular disc

with the restoration of the position:

•

Clicking when opening and closing the mouth at the same

stage (reciprocal click may not be heard without a

stethoscope);

•

Shift of the lower jaw to the sore side, after clicking, the lower

jaw is centered;

•

Pain syndrome is not characteristic;

•

Limitation of the volume of movements is not observed;

•

Deformation of the disc in 31% of cases.

Without restoring the situation

•

Acute stage:

•

Severe pain with lower jaw movement

•

Noticeable restriction of mouth opening

•

There are no noises in the joint, but they can be in the anamnesis

•

Straight line of deflection of the mandible to the sore side

•

Limiting the movements of the lower jaw in a healthy way

•

Chronic stage

•

No noise, but they can be.

•

Anamnesis

•

Easy restriction of opening the mouth with a shift of the lower jaw to the sore

side

•

Limiting the movements of the lower jaw in a healthy way

•

Deformation of the disc in 77% of cases

Treatment:

•

Pain relief - diclofenac, ibuprofen (50 mg 2 r./d. After

eating 5-10 days);

•

Nimesulite, nise, nimelite (100 mg 2 r./d. After eating)

•

Manufacturing of a reponning tire (when the disc is

displaced with position restoration). Wear 10-15 days

24 hours a day (do not take off food for a while); Brush

your teeth with your mouth open. Helps in 20-30% of

cases.

•

If for two weeks the kappa did not help (two reasons:

clicking away from occlusion, shifting the disc without

restoring the position), then plastics of the ligaments or

removal of the disc are necessary.

Classification of TMJ diseases in children and

adolescents (MMSI; NN Kasparov):

1.

Primary-bone injuries and joint diseases.

1.1. Congenital pathology of the TMJ.

1.2. Inflammatory diseases of articular ends of bones and their outcomes.

Osteoarthritis;

Secondary deforming osteoarthritis;

Bone ankylosis;

• neoarthritis.

2. Functional-distension diseases of the TMJ and their outcomes.

2.1. Youthful dysfunction of the TMJ

Habitual dislocation;

Painful dysfunction syndrome.

2.2. Inflammatory and inflammatory-degenerative primary cartilaginous diseases of the

TMJ, developed as a consequence of joint dysfunction

Arthritis (acute, chronic);

Deforming juvenile arthrosis.

Dysfunction of the temporomandibular joint 

is a violation of joint

mobility, in the form of restriction or increase in motion,

lateral displacement, clicks in the joint, pain in the muscles

and nerves of the face. If the dysfunction continues for a long

time, the articular cartilage prematurely wears out, and in these

cases we often see arthrosis or arthritis. Often this disorder is

considered a trigeminal neuralgia, and treated for a long time

and ineffectively.

Osteoarthritis of the temporomandibular joint 

develops usually as

a result of prolonged dysfunction, trauma or inflammation.

The articular disc, cartilage becomes thinned and tearing,

hence the pain and limitation of mobility in the joint. The

diagnosis is not difficult to establish during examination and x-

ray photographs. A full-scale treatment, as a rule, helps to

relieve pain and improve mobility.

Inflammation of the temporomandibular joint (arthritis)

occurs with arthrosis, after trauma and with such serious

rheumatic diseases as rheumatoid arthritis, Bechterew's

disease, gout, articular psoriasis, reactive arthritis, systemic

lupus erythematosus. For proper treatment, it is necessary to

find the cause of inflammation accurately, and we do this

with the help of modern laboratory studies.

Immobilization (contracture) of the temporomandibular joint

after trauma or inflammation.

Trism - 

a spasm of the muscles of the jaws, with difficulty

opening the mouth. This is a consequence of pain in the area

of ​​the teeth or the temporomandibular joint, against the

background of the depleted state of the nervous system.

Etiology of primary-bone inflammatory diseases

of the TMJ

•

Hematogenous osteomyelitis of the condylar process of the lower

jaw;·

•

 Birth trauma of the TMJ;

•

Intra- and extra-articular fractures of the condylar process of the

lower jaw;

•

Acute traumatic arthritis of the TMJ;

•

Odontogenic osteomyelitis of the lower jaw with transition to

condylar process;

•

Acute purulent otitis media;

•

Osteomyelitis of the temporal bone (otogenous), mastoiditis.

Articular Symptoms

1. 

Crunch, clicks, pain while moving the jaw;

2. With a slow wide opening of the mouth, the jaw

performs C- or S-shaped movements;

3. Failure to open your mouth smoothly;

4. Swelling and pain in the joint region (between the

cheek and the auricle;

5. Insufficient or asymmetrical opening of the mouth;

6. Noise in the ear;

7. Increased wear of teeth.

Muscle Symptoms

1.

Pain points in the muscles of the face (they are

often taken for pain of the trigeminal nerve);

2. Fatigue when chewing;

3. Chewing on one side with a full set of teeth;

4. Pain when chewing;

5. Insufficient or asymmetrical opening of the

mouth;

6. Increased wear of teeth.

What can be expressed dysfunction of the TMJ?

Inside the joints there are no nerve endings, so if their work is

disturbed, the pain rarely appears in the joint region, they irradiate to

other areas. In addition to pain, the development of dysfunction of

the 

TMJ 

is a strain in the muscles of the head and neck, the

appearance of seals, the so-called "trigger points", painful when

pressed.

These muscles include:

Chewing muscles

Temporalis muscle

Hyoid muscle

Neck muscles

Pterygoid muscle

Sternum-subclavian-mastoid muscle

Trapezius muscle of back

Possible causes of arthritis

1.

Aggression of one's own immunity with respect to

joint tissues. This is possible with autoimmune

rheumatic diseases such as

Reactive arthritis,

Rheumatoid arthritis,

Bechterew's disease (ankylosing spondylitis),

Psoriatic arthritis (articular psoriasis),

Systemic lupus erythematosus (SLE),

Rheumatism.

•

2. 

Exchange violations.

•

 Of the inflammatory diseases of the joints most often

gout, when the body produces an excess of uric acid

and its crystals are deposited in the joints.

•

Overload of the joint with its prolonged mechanical

damage, microfractures of the meniscus, cartilage and

ligaments. The reasons for a long load (walking,

running, sports) with flat feet, arthrosis.

•

Infectious inflammation. Often inflammation in the

joint is associated with venereal infections

, 

for

example, chlamydia, ureaplasma, mycoplasma,

gonorrhea.

Inflammation of the joints can be acute, then the

joint swells, it can become hot to the touch,

possibly redness of the skin around the joint. A

pain arises necessarily. Body temperature may

increase.

Chronic, flaccid inflammation of the joints may not

be accompanied by swelling, it is rare to see

redness of the skin. An important symptom of

inflammation is the combination of pain and

stiffness, especially after a long stay of the joint in

immobility, for example, in the morning, after a

night's sleep, or after a long sitting.

•

Often inflammation in the joint is

associated with venereal, urological and

gynecological infections, for example,

chlamydia, ureaplasma, mycoplasma,

gonorrhea.

Osteoarthritis - 

inflammation of the joint, which

developed as a result of damage or inflammation of

the articular ends of bones and the spread of the

inflammatory focus to the elements of the joint.

Displacement of the joints

•

The displacement of the

articular heads upwards or

distally may also occur with

the maximum interlacey

closure of the teeth.

Clicks in the joints

•

The clicking sounds at the opening and closing

movements of the lower jaw, as well as with its

lateral movements, are characteristic

symptoms of the mandibular dysfunction.

Pathological changes in the joint (change in shape and degeneration)

•

Osteoarthritis of the joint

•

Leads to flattening, erasure and erosion of the

joint, perforation of the disc, as well as to wear

and erosion of the articular surfaces of the

temporal bone. Prolonged existence of occlusal

disharmony, displacement of joints and non-

functional loads can lead to injury of joint tissues,

changes in their shape or development of

arthrosis.

The crepitation

•

Crepitation is a "crunchy" sound that

sometimes appears in the joint with the

opening, closing and eccentric movements of

the lower jaw. These sounds testify to intra-

articular pathology.

Dislocation (subluxation) of

joints

•

Dislocation or subluxation may occur if the

opening of the lower jaw is too strong, for

example during yawning.

Chronic arthritis on the background of habitual dislocation:

Clinical symptoms:

Dull pain in the joint area,

A symptom of a crunch,

Dysfunction of chewing muscles (pain, stiffness),

Painful dysfunction syndrome.

Diagnostic X-ray signs:

Increasing narrowing of the joint space,

Thinning and destruction of the subchondral bone closure

plate,

Foci of destruction in the subchondral bone of the head

.

Primary-bone injuries and diseases of the

TMJ.

The congenital pathology of the TMJ is one of the symptoms of

congenital syndromes (Robin syndrome, Franceschetti syndrome, Gill arches

syndrome 1 and 2, Goldenhar syndrome), accompanied by a violation of the

growth of the lower jaw. There is underdevelopment of the head n / h,

condylar process, mandibular fossa of the temporal bone, articular tubercle.

Clinical symptoms:

Is revealed at the birth of a child,

Underdevelopment of longitudinal dimensions of 

lower jaw 

on the side of

developmental defect

Movements are free,

Concomitant malformations of the mouth slit, ear, neck.

Diagnostic X-ray signs:

A wide articular cleft up to the complete absence of articulation of the surfaces,

Hypoplasia of the condylar process, articular tubercle and fossa of the temporal

bone.

Ankylosis of the TMJ. 

There are two forms of ankylosis of the TMJ: bone

and fibrous. However, it can be two stages of the same pathological process. Very

often secondary deforming osteoarthritis precedes bone ankylosis. The clinical

picture of bone ankylosis of the TMJ resembles the clinic of secondary deforming

osteoarthritis. However, with bone ankylosis, the lower jaw is immovable and the

patient can not open his mouth at all.

Radiologically, the TMJ elements are virtually absent, as the bony growths occupy the

entire articular gap (it is not visible), the articular cavity, sometimes even the

semilunar incision, etc. There is complete or partial fusion of the condylar process

of the lower jaw with the temporal bone. The most common cause of bone

ankylosis is hematogenous osteomyelitis of the lower jaw, which occurs most often

in young children.

 Moving the incisal point

when opening the mouth in

patients with arthrosis

 Changing the shape of the head

of the lower jaw with arthrosis of

the TMJ

Neoarthrosis 

is a pathological articulation that arises from the

displacement of the head of the n / h into a new position e

under the influence of some pathological process; Leads to a

slower growth of

lower jaw .

Clinical symptoms:

The disease is detected at the age of 5-15 years,

Underdevelopment of longitudinal dimensions of lower jaw on

the side of the patient joint is absent or weakly expressed,

Free or slightly limited movements of the jaw.

Diagnostic X-ray signs:

Unevenly deformed joint joint,

The condylar process is shortened,

The head is n / h flat, the bone is sclerotized.

Neoarthrosis or a false joint 

is a pathological joint in the immediate

vicinity of the TMJ or instead of it, due to the displacement of the condylar

process of the lower jaw or the lysis of its head. This is the most favorable

outcome of osteoarthritis.

Clinically, neoarthritis is characterized by asymmetry of the face, due to

underdevelopment of the lower jaw on the "sick" side, malocclusion

(oblique or cross), limited (but often normal) opening of the mouth. X-ray

in this case there are all signs of neoarthrosis (closure of the cortical plate

of the bone, etc.). Often the head of the condylar process is absent due to its

lysis.

•

One of the outcomes of osteoarthritis in children is a secondary 

deforming

osteoarthritis

 of the TMJ. This is a chronic joint disease, characterized by a

combination of inflammatory, destructive and hyperplastic processes occurring at

the articular ends of bones, cartilaginous tissue, ligamentous apparatus, etc. The

disease develops again mainly in young children. Since the condylar process of the

lower jaw is a zone of longitudinal growth of the lower jaw, as a result of this

disease the longitudinal growth of the lower jaw from the "sick" side slows down

or completely stops. At the same time, excessive bone formation occurs in the

neck of the condylar overgrowth, due to chronic irritation of the periosteum.

Locally, in addition to delaying the growth of the lower jaw and shifting the chin

to the sore side, there is limited opening of the mouth, oblique (cross) bite, etc.X-

ray joint joint is viewed as a straight line. The head of the condylar process is flat,

the cervix is ​​short, thick, sclerotized, the articular tubercle and fovea are weakly

expressed. With the duration of the disease for several years, the shortening of the

mandibular branch, the reflected deformation of the maxilla, and the like are

determined.

Youthful dysfunction of the TMJ

Etiology:

-Parified infectious diseases;

-Destruction of bite;

-Orthodontic hardware treatment associated with n / h movement or overbiting.

Clinical symptoms:

-

When you open your mouth - a click symptom;

-

Deviation of the jaw towards the joint with a smaller amplitude of movements;

-

Palpation - when the mouth is open, exit the head from the fossa with the

formation of a westernization in front of the tragus of the ear.

-

A syndrome of painful dysfunction is possible;

-

As a result of asynchronous "work" of both TMJ, S-shaped movements of the

lower jaw are possible with maximum opening of the mouth (deviation of the

lower jaw).

Diagnostic X-ray signs:

-Radiologically, with adolescent dysfunction of the TMJ, as a rule, pathological

changes are not detected. When the mouth is open, exit the head from the fossa

beyond the articular tubercle.

Load on the TMJ

Treatment of arthritis:

Restriction of opening the mouth,

Anti-inflammatory and medicament

Treatment of arthritis:

treatment,

Physiotherapy treatment,

with contraindications to physiotherapy -

phytotherapy (compresses from the ointment

"Bagulnik" or "Rus", having a strong anti-

inflammatory effect, as well as metal-

medetherapy).

Treatment of 

bone ankylosis 

begins with

surgical intervention (regardless of the age of

the child), whose goal is to create a false joint as

close as possible to the natural joint.

To do this,

use an osteotomy of the lower jaw with elastic

stretching or osseous plastic of the lower jaw

(arthroplasty). Later, after immobilization,

mechanotherapy and orthodontic treatment

are performed until 15-16 years, after which the

question of the need for surgery for aesthetic or

functional indications (contour or bone plastic)

is decided.

Treatment of adolescent dysfunction should begin

with activities that create rest in the joint. To do this, you

can not take solid food, open your mouth wide, you

should avoid traumatizing the lower jaw (sport), you can

use a sling dressing, etc. In some cases, for the same

purpose, you should use orthodontic devices that limit the

opening of the mouth, especially with the habitual

dislocation (Yadrovoy , The apparatus of Petrosov).

In the presence of pain syndrome, it is possible to

immobilize the lower jaw for 10-14 days with the help of

ligature binding of teeth. At the same time, physiotherapy

is carried out: UHF therapy, paraffin therapy, Novocain

electrophoresis, potassium iodide; Phonophoresis of

hydrocortisone, etc. Taking into account the pathogenesis

of the disease, timely treatment can promote recovery by

the time the organism grows to an end.

 Treatment of 

arthrosis-arthritis

 of the TMJ

is similar, like juvenile dysfunction. In

addition, the mandatory component of

treatment is the use of non-hormonal anti-

inflammatory drugs (salicylates). In adults,

hormone therapy is possible. Surgical

treatment aimed at the prevention of habitual

dislocation is not used in children.

Secondary deforming osteoarthritis 

is a chronic

inflammatory bone disease that develops after

osteoarthritis and causes bone deformation of the articular

ends of the bones: the condylar process and the articular

surface of the temporal bone.

Clinical symptoms:

The underdevelopment of all lower jaw

departments on the side

of the affected joint,

Limited mobility of the jaw.

Diagnostic X-ray signs:

Unevenly narrowed and deformed articular fissure,

The condylar process is shortened, thickened,

Compaction of the articular tubercle and fossa of the temporal

bone.

Evolution of secondary deforming osteoarthrosis of

the TMJ:

A-after birth trauma,

Б

 - after the fracture of the condylar process,

В

-after hematogenous osteomyelitis.

Kind of condylar process with secondary deforming

osteoarthrosis:

Bony ankylosis 

is a pathological bone fusion of the condylar

process with a temporal bone, which developed as a result of

the death of the articular cartilage and the growth of bone

tissue.

Clinical symptoms:

The disease is detected more often at the age of 2-3 years,

The underdevelopment of all lower jaw departments on the side

of the affected joint,Full immobility of the jaw.

Diagnostic X-ray signs:

The joint gap is absent,

The bone of the condylar process without borders passes into the

bone of the temporal bone.

Contracture is the restriction of mobility in the joint

Common reasons:

Joint destruction due to inflammation or trauma;

Deformation of articular ends of bones (arthrosis, arthritis, trauma);

Loss of elasticity of the joint capsule and ligaments (arthrosis, arthritis, periarthritis, trauma);

Shortening of the muscles providing movement in the joint (paralysis, neuromuscular disease,

trauma, surgery, post-burn scars, etc.).

With contracture, the volume of possible movement in the joint is limited, up to its complete

immobility (ankylosis).

With complete ankylosis, only surgical treatment is possible, so we begin the development of

contracture as early as possible.

Surgical and non-surgical methods of treating contractures have been developed.

We will offer you a course of non-surgical restorative treatment:

Electrophoresis of caripazim (caripain);

Degradative local treatment (compresses and ointments);

Joint development and gymnastics;

Special types of massage and self-massage.

Electrophoresis of caripazim (caripain)

Treatment of secondary deforming osteoarthritis

and ankylosis of the TMJ:

Tasks:

1.

Restoration of movement lower jaw

surgically with fixation

of the jaw of the jaw along the middle line of the face;

2.

Orthodontic correction of deformities of the alveolar process

of the upper and alveolar part of the lower jaw and

correction of the occlusion;

3.

Prevention of the development of secondary deformities of

the upper jaw;

4.

Physical development of masticatory and mimic muscles by

myogymnia.

Orthopedic treatment:

•

Normalization of occlusal contacts (selective

polishing);Normalization of the form of dental rows (artificial

crowns, bridges, clasp prostheses);

•

Restoration of interalveolar height;

•

Normalization of the position of the joints in the articular

pits(Plastic kappa on the dentition, stamping plate on the entire

dentition or on the lateral teeth, palatal plate with an inclined

plane, mouth opening limiters);

•

X-ray control;

•

Prosthetics are carried out in 2-3 months from the beginning of

using the device to restore the interalveolar height.

Surgery:

Secondary deforming osteoarthritis after osteoarthritis (before and after

surgery)

Deforming arthrosis:

Clinical symptoms:

•

Periodic acute pain in the joint,

•

Restriction of joint mobility,

•

Noise symptoms,Painful dysfunction syndrome.

Diagnostic X-ray signs:

•

Unevenly narrowed and deformed articular fissure,

•

Thickening of the occluding bone plate,

•

Bone compaction and deformation of the contour of

the head.

Treatment of functional diseases of the TMJ:

1.

Anti-inflammatory measures (medicamental and physical);

2.

Electrophoresis of potassium iodide;

3.

Gentle diet;

4.

Restriction of opening the mouth;

5.

The use of edged orthopedic devices restricting movement

lower jaw (apparatus Petrosova);

6.

Surgical treatment (aged 18-20 years).

Stalk plate for treatment of TMJ

Changing the cartilage with joint arthrosis

Doctor Kosten

Compression of the disk (in Russia

known as Costa's syndrome):

•

Пусковой механизм – снижение

высоты прикуса (в результате удаления

или множественных реставраций),

протезирование без соблюдения

принципа «

freedom in centric

». Часто

сочетается с мышечными проблемами.

Clinical picture:

•

Pain syndrome

•

Headache

•

Noise in ears

•

As a rule, the patient associates deterioration

of a condition with the certain moment (for

example, after prosthetics)

•

On the tomogram - the narrowing of the

articular space with the mouth closed.

Treatment:

•

Withdrawal of pain syndrome

•

Decompression bus manufacture

•

After it became clear that the compression of

the disk led to a decrease in bite - increased

bite

 Kosten's syndrome (JV Costen, born in 1896, an

American otorhinolaryngologist) is a combination of

pathological changes in the temporomandibular joint (snap,

crunch, stiffness), hearing loss, ear congestion, dull ear pain

radiating to the parietal And occipital area, pain and burning in

the tongue, dry mouth, dizziness and trigeminal neuralgia; It is

observed with deep bite and absence of many teeth, with

pathological abrasion of hard tooth tissues, with deforming

arthrosis of the temporomandibular joint.

•

The decompression tire is an

ordinary Osamu retarder for 2

weeks.

Costen syndrome

Synonyms

-

Arthralgia mandibularis

-

Costen syndrome

-

Joint of temporomandibular syndrome

Characteristic

The combination of pathological changes in the temporomandibular

joint (snap, crunch, stiffness) with neurological manifestations: a

decrease in hearing, a sense of ear congestion, blunt pain in the

ear, radiating to the parietal and occipital areas;

 Pain in the tongue, throat, nose;

Dry mouth, dizziness, trigeminal neuralgia.

It is observed with deep bite and absence of many teeth, with

pathological abrasion of hard tooth tissues, with deforming

arthrosis of the temporomandibular joint.

Radiological picture 

 X-ray picture of the deforming arthrosis of the

temporomandibular joint, both with expansion and with

narrowing of the joint gap.

Treatment of the TMJ

•

Dissipative topical treatment (compresses and ointments)Local

remedies are used that improve the blood supply to the joint and

promote the elasticity of the joint capsule. These are gels, ointments,

compositions for compresses containing bee venom, medical bile,

plant extracts, vasodilating and anti-inflammatory components.

•

Local treatment works well when its basic principles are fulfilled:

•

It is necessary to maintain a constant concentration of the drug in the

tissues of the joint. Therefore, apply the medication regularly, as

indicated by the instructions or by the doctor, usually 2-3 times a

day.

•

The amount of ointment applied should be sufficient, according to

the instructions, usually a strip of ointment about 5 cm.

•

Local treatment should be combined with physiotherapy, massage

and gymnastics.

Diseases of the TMJ are currently quite high among dental

patients. There are following methods of treatment of TMJ

diseases:

orthopedic,

Orthodontic,

Physiotherapeutic

Reflexotherapy (most often performed at the end of orthopedic

treatment to consolidate the results),

surgical,

phytotherapy,

Metal therapy (to relieve pain in the joint with

contraindications to physiotherapy),

Detensor therapy for muscle relaxation.

Treatment of musculo-articular dysfunction. It

consists in the elimination of pain and dysfunction

(relaxation tires, TMJ trainer, physiotherapy

treatment, RT, phytotherapy, detensor therapy,

antidepressants).Subsequent orthopedic treatment

with permanent structures of dental prostheses: in

the anterior occlusion it is necessary to create

symmetrical contacts of incisors, chewing teeth

are separated, in lateral occlusions - to create a

closing of teeth on the working side and smooth

lateral occlusal movements, to achieve the

absence of balancing and hyperbalancing

supercontacts

The soft TMJ-trainer (joint tire) is designed to eliminate the

myofascial pain syndrome with TMJ dysfunction, and can also be

used for rapid diagnosis. Thanks to the patented "pterygoid" form

of the tire base, the effect of soft decompression and muscle

relaxation of the maxillofacial and cervical region is created.

TMJ-trainer has the form of an ideal dental arch and fixes the

relative position of jaws in the first class, correcting the position

of the lower jaw and lateral parafunction. The trainer easily

adapts to the individual features of the dental system of each

patient, without causing discomfort in the patient.

TMJ-Trainer allows:

•

-

To remove the excessive load on the TMJ

-

Eliminate the pain syndrome

-

Immediately begin treatment

-

Limit the effect of bruxism

-

- Diagnose conditions accompanied by head and neck pain

Causes of TMJ dysfunction- violations of the occlusal surfaces of the dentition

-

Reversal swallowing (with a displacement of the lower jaw)

-

Bruxism

-

mouth breathing

- decreasing bite with abnormal abrasion of teeth

- acute and chronic stress

- overload in the exercise of athletic sports

•

With orthodontic treatment, as well as any restorations, whether "direct restorations",

crowns, bridges or seals on the chewing surface of the teeth, two factors should be taken

into account: AESTHETICS and FUNCTION.

•

FUNCTION - correct functioning of the dentoalveolar system. The key functional factors are

the occlusion and interposition of the temporomandibular joints.

•

OKCLUSION - bite, full clenching of teeth

•

CENTRAL OCCLUSION (CO) - position of the lower jaw with a dense, deepest and most

comfortable closure of teeth

•

CENTRAL RELATION (CR) - the position of the lower jaw, in which the TMJ heads are

located in the articular bags in the most anteriorly-appropriate position, the articular disk

is correctly located between them (Stanley D. Crawford, DDS, Angle Orthod 1999; 69 (2):

103- 116).

•

Okeson describes this position as the most muscular-skeletal stable position of the

mandible (Okeson JP, Management of temporomandibular disorders and occlusion, 3rd

ed., StLouis: Mosby, 1993).Numerous studies confirm the relationship between symptoms

and symptoms of temporomandibular dysfunction and differences in positions in the

Central Relation (CR) and Central Occlusion (CO). In orthodontics, this approach is an

integral part of the "philosophy of Dr. Ronald Roth," the founder of one of the modern

American schools of orthodontics.

Orthopedic method of treatment

-begins with s elective grinding of teeth.

Its objectives are:

Elimination of the traumatic situation in the periodontium by distributing the

functional load to as many teeth as possible;

-

removal of trauma of hard tissues of teeth and pulp;

-

load distribution along the axis of teeth;

-

removal of pathological activity of masticatory muscles;

-

elimination of balancing and hyperbalancing supercontacts;

-

creation of stable, stable central occlusion;

-

elimination of the violation of occlusion before orthopedic treatment;

-

restoration of functional occlusion after the performed orthodontic

treatment;

- prevention and treatment of periodontal pathology, chewing muscles and

TMJ.

•

Treatment of arthrosis. Complex, includes all

kinds of occlusive correction, medical and

surgical treatment, orthopedic treatment of

defects of dentition with restoration of

functional occlusion. The physiotherapy is

performed once a year

Ligament apparatus problems:

•

Hyperplasticity of the joint (extreme form -

complete dislocation). Often combined with

the displacement of the disk.

•

Etiology

: occurs during the period of active

skeletal growth in adolescents in the puberty

period: sharp wide opening of the mouth -

yawning, laughter, dental intervention,

intubation anesthesia.

Clinical picture:

•

Excessive amount of movement in the joint

•

Clicks, noises in the joint, deviation n.ch. (These

symptoms are of a non-permanent nature, arise

with sharp movements of the lower jaw)

•

Deviations of the lower jaw and noise disappear

when applying a load on the lower jaw (resistance

to movement)

•

The pain is absent

•

With complete dislocation it is impossible to shut

your mouth

Treatment:

•

Sparing diet

•

Restriction of mouth opening

•

Isotonic exercises to improve muscle

coordination and reduce pain syndrome

•

Isotonic exercises:

•

Pressure on the chin with his fist, resisting the

displacement of the jaw. Right, then left.

•

Maintain the chin with your hand while trying to open

your mouth

•

If you try to close your mouth, resist with your hand,

placing your fingers on your lower teeth.

•

Rest during exercises: hold the forehead with your

hands (elbows on the table), the lower jaw is relaxed.

•

Rules of implementation: tension 5-6 seconds,

relaxation 5-6 seconds, perform each exercise 5-6 times

2-3 times a day; Rest between exercises 20-30 seconds.

Muscular problems

•

Dysfunction of the masticatory muscles: muscle

trismus, discoordination during function, pain

syndrome.

•

Etiology. As a rule, against the background of stress +

morphological factors: a decrease in the height of the

occlusion, a one-stage change in occlusion, occlusive

interference (premature contacts).

•

Clinical picture. Pain in muscles at rest and during

function; Muscle spasm; bruxism; Discoordination in

movements. Complaints in 90% of cases - "I do not

know where to put the lower jaw."

Treatment.

•

Pain relief; Sparing diet; Antidepressants (for example,

Novopassit), isotonic muscle exercises; Manufacture of the

occlusal tire.

•

Occlusal tire. Objectives:

•

Definition - whether occlusive disorders are the cause of

muscle disorders;

•

Relaxation of muscles for the purpose of occlusal polishing or

prosthetics;

•

Long-term use with frequent exacerbations.

•

Diagnostic occlusal tire - plate with bite pad. Separates the

occlusion in the lateral sections by 1-2 mm. You can use no

more than 1 week.

•

An occlusive tire for long-term use is the Michigan tire.

•

After muscle relaxation:

•

 occlusal resurfacing;

•

Physiotherapy for additional relaxation.

Thank you for attention!