Introduction

and

Review of Masticatory System

...

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

Definition

(Jablonski, 1982)

The
allall
thethe
components
of the
Therelationship
relationshipbetween
between
components
of
masticatory
system in
normalinfunction,
dysfunction,
the masticatory
system
normal function,
and
parafunction,
including
the morphological
and
dysfunction,
and
parafunction,
including the
functional
features
contactingfeatures
surfacesof
of
morphological
andoffunctional
opposing
teethsurfaces
and restorations,
occlusal
contacting
of opposing
teethtrauma
and
and dysfunction,
neuromuscular
physiology,
the
restorations,
occlusal
trauma and
dysfunction,
TMJ and muscle function, swallowing and
neuromuscular physiology, the TMJ and muscle
mastication, psychological status, and the
function, swallowing and mastication,
diagnosis, prevention, and treatment of functional
psychological status, and the diagnosis,
disorders of the masticatory system

prevention, and treatment of functional

disorders of the masticatory system

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)

The Masticatory System

A dynamic biomechanical musculoskeletal system

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
1 2

Mandibular teeth 1
Months

4
2

5
3

8 10 13 16 19

5
27 29

Permanent Dentition

Maxillary teeth

Mandibular teeth

Years

1
1

2
2
8

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