ММETHODS OF ETHODS OF ORTHOPEDICAL ORTHOPEDICAL TREATMENT OF TREATMENT OF TEMPOROMANDIBULAR TEMPOROMANDIBULAR JOINT DISORDERSJOINT DISORDERS

Temporomandibular joint (TMJ) Temporomandibular joint (TMJ) disorders take special place in disorders take special place in orthopedic dentistry because of orthopedic dentistry because of difficulties in diagnostic and treatment,difficulties in diagnostic and treatment, sometimes multiplex clinical picture. sometimes multiplex clinical picture. There is no standard classification of There is no standard classification of diseases of the joint. Different forms of diseases of the joint. Different forms of pathology of this organ often do not fit pathology of this organ often do not fit the traditional diagnosis of "arthritis" the traditional diagnosis of "arthritis" and "arthrosis”and "arthrosis”

Petrosov Y.A. (1996) proposed Petrosov Y.A. (1996) proposed classification, according to which classification, according to which functional disorders and diseases of TMJ functional disorders and diseases of TMJ are divided into 5 groupsare divided into 5 groups

1) TMJ dysfunctional state:             a) neuromuscular dysfunctional syndrome;             b) syndrome occlusal-articulation;             c) regular sprains of TMJ (jaw, meniscus).

2) Arthritis:             a) acute infectious (specific, nonspecific);             b) acute traumatic;             c) chronic rheumatism, rheumatic and infectious-allergic.

3) Arthrosis:             a) post infectious (neoarthrosis);             b) post-traumatic (deforming) arthrosis;             c) myogenic arthrosis;             d) exchange arthrosis;             e) ankylosis (fibrous and bone).

4) Combinated forms.

5) Tumors (benign and malignant venous).

Methods of examination of Methods of examination of the patient with TMJ the patient with TMJ disordersdisorders

Subjective examination Subjective examination ((QuestioningQuestioning))

Objective examinationObjective examination

Objective exanimObjective exanim

SurveySurvey external oralexternal oral itntraoralitntraoral:: 1. maximum of multiple dental contacts in the central, front and side 1. maximum of multiple dental contacts in the central, front and side

occlusion;occlusion; 2. smooth sliding of dental rows during the transition from one occlusion to 2. smooth sliding of dental rows during the transition from one occlusion to

another, without horizontal pushes on the teeth;another, without horizontal pushes on the teeth; 3. absence or reduction of height between alveolar bones;3. absence or reduction of height between alveolar bones; 4. absence of lateral displacement of the mandible during its transition from 4. absence of lateral displacement of the mandible during its transition from

physiological resting position to the central occlusion and minimal distal physiological resting position to the central occlusion and minimal distal displacement during this;displacement during this;

5. absence of injured soft tissues of oral cavity5. absence of injured soft tissues of oral cavity..

Palpation of TMJPalpation of TMJX-ray methods of examinationX-ray methods of examinationGrafic methpds of examinationGrafic methpds of examination

Palpation of TMJPalpation of TMJ

Pic. Pic. 1.1. Palpation of the head of mandible Palpation of the head of mandible.. Pic. Pic. 2.2.Palpation of TMJPalpation of TMJ in front of external auditory passagein front of external auditory passage

Treatment of TMJ disorders Treatment of TMJ disorders

should be complexshould be complex

1.1. physiotherapyphysiotherapy 2.2. massagemassage 3.3. myogymnasticmyogymnastic 4.4. medical treatmentmedical treatment 5.5. orthopedic treatment of TMJ disordersorthopedic treatment of TMJ disorders 6.6. orthodontic treatment before prosthesisorthodontic treatment before prosthesis 7.7. surgical treatmentsurgical treatment 8.8. medical physical training and medical physical training and

mechanotherapy mechanotherapy

in case of contractures of TMJin case of contractures of TMJ

Orthopedic treatment Orthopedic treatment includes using medico-includes using medico-diagnostic aparaturesdiagnostic aparatures,, removable and removable and irremovable prosthesis.irremovable prosthesis.

Medico-diagnostic Medico-diagnostic aparatures includesaparatures includes::

Dental burlDental burl, , Biting platesBiting plates, , Different construction of palatinal Different construction of palatinal

plates that have different purpose.plates that have different purpose.

Pecularities of using of Pecularities of using of removable and irremovable removable and irremovable

denturesdentures Bugel prosthes with the cast occlusional plates on the Bugel prosthes with the cast occlusional plates on the

premolars for the restoration of occlusional height and premolars for the restoration of occlusional height and reduction of the depth of incisival contactsreduction of the depth of incisival contacts..

Varieties of deep bite Varieties of deep bite (scheme)(scheme)

Secondary partial adentia, distal shift of Secondary partial adentia, distal shift of the mandible and the articular heads, the mandible and the articular heads, arthrosis of TMJarthrosis of TMJ

Bugel splin clasp denture for the Bugel splin clasp denture for the treatment of I, II and III types of deep treatment of I, II and III types of deep bite.bite.

Bugel splin clasp denture for the Bugel splin clasp denture for the treatment of IV type of deep bite.treatment of IV type of deep bite.

TMJ dysfunctional state

Treatment of patients with neuromusular Treatment of patients with neuromusular syndrome is directed on the elimination of syndrome is directed on the elimination of the causes, though it continues to the causes, though it continues to operate. Special dental treatment is operate. Special dental treatment is directed on the normalization of directed on the normalization of occlusion and articulation by partial occlusion and articulation by partial preparation, prosthesis, and, if it is preparation, prosthesis, and, if it is necessary, myogymnastic and necessary, myogymnastic and physiotherapy.physiotherapy.

Pecularities of orthopedic Pecularities of orthopedic treatment of patients with treatment of patients with parafunction of chewing parafunction of chewing musclesmuscles

Elimination of the pain in the Elimination of the pain in the masticatory muscles and masticatory muscles and normalization of TMJ function;normalization of TMJ function;

Elimination of violations of occlusion;Elimination of violations of occlusion; Prevention of tooth abrasion;Prevention of tooth abrasion; Early prosthesis of defects of dental Early prosthesis of defects of dental

rows;rows; Splinting the teeth on the early stage Splinting the teeth on the early stage

of initial traumatic syndrome.of initial traumatic syndrome.