Quiz: Friday March 30, South 1:15 p.m.
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1 Masticatory Anatomy
2 Quiz: Friday March 30, South 1:15 p.m. Material included: lecture material & Okeson readings Feb 23: Interocclusal Records, CR-Clinical Method and Arc of Closure March 2: Masticatory Anatomy & Biology of Centric Relation
3 Masticatory Anatomy
4 The Muscles of Mastication
5 A. Temporalis Muscle Origin: temporal fossa & temporal fascia Insertion: coronoid process & anterior of ramus
6 Function: Elevation and positioning of the mandible A. Temporalis Muscle
7 B. Masseter Muscle Origin: zygomatic arch Insertion: lateral surface of ramus, coronoid process & angle of mandible
8 Function: power with vertical elevation of the mandible; deep portion stabilizes the condyle in protrusive closure B. Masseter Muscle
9 C. Medial Pterygoid Muscle Origin: medial surface of lateral pterygoid plate, pyramidal process of palatine bone & Mx tuberosity Insertion: medial surface of ramus & angle of mandible
10 C. Medial Pterygoid Muscle Function: elevation of the mandible, protrusion of the mandible and lateral movement of the mandible with unilateral activation
11 Pterygomasseteric Sling
12 D. Inferior Lateral Pterygoid Muscle Origin: lateral surface of lateral pterygoid plate Insertion: pterygoid fovea of condyle
13 D. Inferior Lateral Pterygoid Muscle Function: protrusion, lateral movement and contributes to opening
14 E. Superior Lateral Pterygoid Muscle Origin: infratemporal surface greater wing of the sphenoid bone Insertion: pterygoid fovea of the condyle and variable to the disc
15 E. Superior Lateral Pterygoid Muscle Function: active with the muscles of closure, especially aiding stabilization of the condyle during the power stroke
16 Temporomandibular Joint Anatomy
17 Craniomandibular Joint : a diarthrodial or synovial lined joint
18 A compound joint: > 2 components Temporal Bone Mandibular Condyle Articular Disc
19 Cranial component Mandibular fossa Articular eminence Articular surface from superior fossa to the anterior aspect of the eminence, thickest bone. A. Temporal Bone
20 B. Mandibular Component: Condyle Condylar dimensions: A-P 8-10 mm M-L mm Articular surface: anterior superior aspect
21 B. Mandibular Condyle Variation side to side in size and shape is common. Response to loading Lateral pole anterior to medial pole.
22 C. Articular Tissue Origin: modified periosteum of intramembranous bone, NOT endochondral origin. A consequence of 2 embryonic tissue masses growing towards each other, NOT a single tissue mass cleft to form a joint articulation.
23 Function: 1) load distribution 2) synovial lubrication Character: NOT hyaline cartilage, but fibrous in nature 1) avascular 2) NOT innervated 3) resistant to shear, tension forces 4) increased remodeling potential C. Articular Tissue
24 D. Articular Disc Composition: avascular connective tissue, collagenous Shape: biconcave in cross section with posterior band, intermediate zone and anterior band Position: posterior band edge at 12:00
25 D. Articular Disc
26 E. TM Joint Capsule Function: 1) limit extreme ROM 2) synovial lining 3) confines synovial fluid 4) joint proprioception
27 F. Mandibular Ligaments Restrict and limit joint range of motion
28 A. Temporomandibular Ligament Lateral thickening of the TM jt capsule Limits: retrusion and inferior condylar distraction
29 B. Collateral Ligaments Medial and lateral Limit: medial and lateral movement of the disc relative to the condyle
30 C. Accessory Ligaments Sphenomandibular Ligament: nonfunctional vestige or remnant of Meckel s cartilage Stylomandibular Ligament: limits extreme jaw protrusion
31 TM Joint Stability NOT ligaments Muscles pulling across joints Articular Disc Geometry
32 TM Joint Anatomy: sagittal Lateral Pterygoid M Superior head insertioncondyle & sometimes disc Inferior head insertioncondyle Retrodiscal tissues 1) Superior- elastic 2) Inferior- check ligament 3) Loose C.T.- venous compartment and innervated Synovial tissues
33 TM Joint Retrodiscal Tissue
34 TM Joint Innervation: V3
35 TM Joint Functional Anatomy Read pages in Okeson, pp !
36
37 History of Centric Relation when both condyles are firmly seated in their most posterior positions in the glenoid fossae. McCollum BB, Stuart CE: A Research Report, 1955, pg 91
38 History of Centric Relation From all that we know, the character of the condylar movements remains the same from day to day, from age to age, as long as the individual lives McCollum BB, Stuart CE: A Research Report, 1955, pg 91
39 History of Centric Relation The most retruded relation of the mandible to the maxillae when the condyles are in the most unstrained position in the glenoid fossae from which lateral movement can be made, at any given degree of jaw separation. The Glossary of Prosthodontic Terms, 1 st Edition: The Academy of Denture Prosthetics. J Prosthet Dent 1956;6:11.
40 History of Centric Relation A maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective discs with the complex in the anterior-superior position against the slopes of the articular eminences. The Glossary of Prosthodontic Terms, 5 th Edition: The Academy of Denture Prosthetics. 1987
41 History of Centric Relation This position is independent of tooth contact. This position is clinically discernible when the mandible is directed superiorly and anteriorly and restricted to a purely rotary movement about a transverse horizontal axis The Glossary of Prosthodontic Terms, 5 th Edition: The Academy of Denture Prosthetics *Definition has remained essentially unchanged through the 8 th Edition, 2005.
42
43
44 Centric Relation (Okeson, 2003) Jaw position with the condyles in their most superoanterior postions in the articular fossae, resting against the posterior slopes of the articular eminences, with the articular discs properly interposed.
45 Biology of Centric Relation Muscloskeletal Stability: a stable position in which to load the joint, mm pull across jts seating condyle
46 Biology of Centric Relation Clinical Evidence: patients do well with IP coincidental with jaw position in CR (clinical experience)
47 Biology of Centric Relation Clinically repeatable: a reference position for restorative dental procedures but NOT immutable! (Celenza FV, JPD 1973) About 1 year? but highly variable
48
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