Introduction and Review of Masticatory System โดย ผศ.ทพ.ดร.สิ ทธิ ชัย วนจันทรรั กษ์ 1 From DOCC 381 • • • • • • • • Concept Instruments and technique Morphology of occlusion Anatomy of mastication system Mandibular movement Neurophysiology of mastication Sign and symptom of TMD Occlusal splint 2 Introduction to DOCC 582 • Aetiology and Epidermiology of TMD • Clinical assessment of masticatory system • Diagnosis and Classification of TMD • Oral parafunction • Trauma from occlusion • Management of TMD problem • Interocclusal appliances 3 Occlusion also Includes • • • • • • Biological evolution Development Histology Anatomy Biomechanics Physiology (Neurophysiology) • Adaptation • Pathology • Behaviour sciences • Clinical diagnosis • Therapy 4 Definition (Jablonski, 1982) The relationship between all the components of the masticatory system in normal function, dysfunction, and parafunction, including the morphological and functional features of contacting surfaces of opposing teeth and restorations, occlusal trauma and dysfunction, neuromuscular physiology, the TMJ and muscle function, swallowing and mastication, psychological status, and the diagnosis, prevention, and treatment of functional disorders of the masticatory system 5 Objectives and Goals • The subject of occlusion serves as a natural interface between certain of the biologic and behavioural sciences and the clinical sciences. • The subject of occlusion is, in the view of many, the medium that brings all branches of dentistry together (Ricketts, 1969) 6 The Masticatory System A dynamic biomechanical musculoskeletal system 7 Components of the Mastication • • • • • • • • Dentitions Periodontal supporting tissues Maxilla and Mandible Temporomandibular Joint Mandibular musculature Muscles of lips, cheeks, and tongue Involving soft tissue Supplying innervation and vasculation 8 Primary Dentition Maxillary teeth 12 Mandibular teeth 1 Months 4 2 4 3 5 3 8 10 13 16 19 5 27 29 9 Permanent Dentition Maxillary teeth 6 Mandibular teeth 6 Years 6 1 1 2 2 8 4 53 7 3 4 5 7 10 12 8 8 20 10 Loss of Teeth Causes Occlusal Disharmony • Early loss of deciduous teeth without space retaining appliances • Loss of mandibular first molar – lingual and mesial tipping of mandibular 2nd and 3rd molar – Loss vertical dimension – Changing in masticatory habit and muscle tonicity 11 Periodontal Supporting Tissues • Cementum • Periodontal ligament • Supporting bone Usually, periodontium is protected against injury by neuromuscular reflexes 12 Problems to Periodontium • Periodontal trauma • pattern of mastication • Loss of teeth • loss of periodontal support • Faulty restoration • Abnormal occlusal force; bruxism, clenching 13 Temporomandibular Joint (TMJ) A complex giniglymoarthrodial (hinge and glide) articulation with limited capability of diarthrosis (free movement) 14 Histology of TMJ Area 15 Temporomandibular Joint (TMJ) • Composed of – Condyle – Mandibular fossa – Articular capsule – Synovial tissue – Articular disc – Ligaments 16 Mandibular Condyle • Modified barrel shape approx. 20 x 10 mm (ML x AP) • Perpendicular to the ascending ramus of mandible • Dense cortical bone covered with dense fibrous connective tissue with irregular cartilage like cell 17 Mandibular Fossa • Dense cortical bony surface of temporal bone • Posterior to articular eminence • Posterior nonarticular fossa is formed by tempanic plate • Thin at the roof of the fossa and tympanic plate 18 Articular Capsule and Disk 19 Articular Capsule • Ligamentous capsule surrounds the joint • Attached to the neck of the condyle and around the border of the articular surface of the temporal bone • anterolateral aspect of the capsule may thicken form the Temporomandibular ligament function as stabilising structure 20 Articular Capsule • Consist of – internal synovial layer – outer fibrous layer containing veins, nerves, and collagen fibres. • Innervation of capsule disk arises from CN V; auriculotemporal and masseteric nerves • Venous plexus at posterior aspect 21 Synovial tissue • Synovial cell and connective tissue covering the lower and upper-joint spaces • Synovial fluid, a proteoglycan-hyaluronic acid complex acts as a lubricant and may participated in nutritional and metabolic interchange for central part. 22 Articular Disk (Meniscus) • Biconcave oval structure interposed between the condyle and the temporal bone • 1 mm in the middle and 2-3 mm at periphery • Dense collagenous connective tissue • Centre area is a vascular, hyaine and devoid of nerve 23 Articular Disk (Meniscus) • Fuse to a strong ligament at lateral side connect to the neck of the condyle • The other borders are attached to capsule ligaments or synovial membranes separate between two joint spaces. 24 TMJ Ligaments 25 Ligaments • Temporomandibular ligament – extend from base of zygomatic process of the temporal bone downward and oblique to the neck of the condyle 26 Ligaments • Stylomandibular ligament – From styloid process and runs downward and forward to attach broadly on the inner aspect of the angle of mandible 27 Ligaments • Sphenomandibular ligament – arising from the angular spine of sphenoid bone and petrotympanic fissure, ending at lingula of mandible 28 Functions of Ligaments • Accessory ligaments may limit border movements of the mandible • Fibrous capsule and TM ligament may limit of extreme lateral movements in wide opening of mandible 29 Masticatory Muscles • Masseter muscle • Temporalis muscle • Medial pterygoid muscle • Lateral pterygoid muscle 30 Masster muscle • Superficial layer – O : lower border of malar bone, Zygomatic arch & zygomatic process of maxilla – R : Downward and Backward – I : Angle of mandible and inferior half of the lateral side of mandible 31 Masster muscle • Deep layer – O : Internal surface of zygomatic arch – R : Downward (vertical) – I : Ramus of mandible and base of coronoid process – 50 degree between 2 layers 32 Temporalis muscle • 3 bundles – Anterior bundle (vertical fibre) –Action: Mandible elevator (Close jaws), crushing and chewing at C.O. –Inaction: Mandible depression (except Max. Opening and Opening against resistance) 33 Temporalis muscle – Posterior bundle (Horizontal bundle) Action: Mand. retraction and positioner Inaction: Mand. depression and protrusion – Intermediate bundle Action: Protrisive movement – Nerve supply Ant. and Post. deep temporal nerve 34 Med. Pterygoid muscle Rectangular shape at medial surface of ramus, synergistic with masseter muscle O : Pterygoid fossa and medial surf. of the lateral pterygoid plate I : Inf. + Post. border of ramus and angle of mand. R : Downward and Backward N : Medial Pterygoid nerve 35 Lat. Pterygoid muscle • Superior head O: Wing of sphenoid and infratemporal crest R: Downward and Backward • Inferior head O: Lateral surf. of lateral pterygoid plate R: Upward and backward 36 Lat. Pterygoid muscle Insertion of superior and inferior heads – Ant. portion of the condylar neck (pterygoid fovea) – Ant. surface of the articular capsule – Ant. Border of the disk Function – Open the jaws, protrude and lateral movement with moving disk forward 37 Lat. Pterygoid muscle • Superior head Synergistic with elevator group of muscle for closing and clenching • Inferior head Synergistic with suprahyoid group of muscle for opening jaw • Nerve supply Lateral pterygoid nerve 38 Non Masticatory Muscle • Digastric muscle • Mylohyoid muscle • Geniohyoid muscle • Orbicularis Oris 39 Non Masticatory Muscle 40 Types of Mandibular Movement • Rotational movement – Horizontal axis of rotation – Frontal (vertical) axis of rotation – Sagittal axis of rotation • Translational movement 41 Rotational Movement • Around the horizontal axis (hinge axis) 42 Rotational Movement • Around the frontal (vertical) axis 43 Rotational Movement • Around the sagittal axis 44 Translational movement 45 Sagittal Plane Border Movement 46 Sagittal Plane Border Movement • Posterior open border • Anterior open border • Superior contact border • Functional movements 47 Horizontal Plane Border Movement • Left lateral border • Continued left lateral border with protrusion • Right lateral border • Continued right lateral border with protrusion • Functional movements 48 Horizontal Plane Border Movement • Continued right lateral border with protrusion 49 Horizontal Plane Border Movement • Functional movements 50 Frontal (Vertical) Border and Functional Movement 51 Frontal (Vertical) Border and Functional Movement • Left lateral superior border 52 Frontal (Vertical) Border and Functional Movement • Right lateral opening border 53 Frontal (Vertical) Border and Functional Movement • Functional movements 54 References • Ash and Ramfjord. Occlusion 4th edition. W.B. Saunders Company, 1995 • Mohl, Zarb, Carlsson and Rugh. A textbook of Occlusion. Quintessence Publishing Co., 1998 • Sicher and DuBrul. Oral Anatomy 6th edition. The C.V. Mosby company, 1975 • Kraus, Jordan and Abrams. Dental anatomy and Occlusion. The Williams and Wilkins company, 1969 55 Thank you 56