The position of the TemporoMandibular Ligament is designed to limit the pure ______ axis _______ movement of the mandible.
HINGE…Rotational
The full length of the TemporoMandibular Ligament occurs at no more than ___-___mm of opening, measured by the maxillary and mandibular _______.
15-20 mm….incisiors
The TemporoMandibular Ligament has a _______ at the 15-20mm of opening, the _______ movement then commences.
Pivot Point….Translation
In a Saggital View of the Articular Disc & Fossa: The ______ border of the articular disc is ______ than the anterior border.
posterior….THICKER
In a Saggital View of the Articular Disc & Fossa: most of the mandibular movement occurs in the ________ zone and the ______ region.
intermediate zone…anterior
The retrodiscal tissue: elastic or distended?
elastic
The retrodiscal tissue: is it innervated? is it vascular?
YES! Highly innervated AND vascular!!
The retrodiscal tissue: painful if placing significant force, aka “______”
“load”
The retrodiscal tissue: ______ can cause inflammation surrounding the articular disc, ESPECIALLY in our retrodiscl tissues.
Trauma
MAXIMUM INTERCUSPATION, from a force perspective…what’s ideal?: For Angle Class I occlusion, the relations of what 2 teeth are most important?
the first molars and the canines!
MAXIMUM INTERCUSPATION, from a force perspective…what’s ideal?: there must be adequate ______ of the maxillary over the mandibular teeth.
overlap
MAXIMUM INTERCUSPATION, from a force perspective…what’s ideal?: Occlusial forces should be exerted down the _______ of _______ teeth.
long axis…posterior
MAXIMUM INTERCUSPATION, from a force perspective…what’s ideal?: There MUST BE _______ contact of all the maxillary and mandibular teeth!
SIMULTANEOUS
MAXIMUM INTERCUSPATION, from a force perspective…what’s ideal?: 50 SHADES!!! Posterior tooth occlusial contacts should _______ over the anterior teeth.
DOMINATE
MAXIMUM INTERCUSPATION, from a force perspective…what’s ideal?: Anterior teeth should display “_____” occlusal contact or ______ occlusal contact with each other.
“passive”…minimal
MAXIMUM INTERCUSPATION, from a force perspective…what’s ideal?: _______ occlusial contacts for even _______ of forces on all teeth.
MULTIPLE….distribution
The Temporalis: this action is considered NORMAL fxn and helps seat the CONDYLES into the mandibular FOSSA….
RETRACTION/RETRUSION of the mandible
The Temporalis: it positions the mandible to obtain this VERY important relationship….
CENTRIC RELATION
The Medial Pterygoid: it is the PRIMARY muscle to produce ________ movement.
mediotrusive
Lateral Pterygoid, Superior Head: it is ________ active during CLOSING of the mandible, which is considered normal function.
PROGRESSIVELY
Lateral Pterygoid, Superior Head: frequently displays a _____ as a result of some types of occlusial dysfunction.
SPASM!!
Lateral Pterygoid, Superior Head: a SPASM here will result in the articular disc being pulled ______ out of the glenoid fossa..it is considered ________ activity.
ANTERIORLY…parafunctional
Normal Closure of the Mandible: the condyle will be located primarily in the _______.
glenoid fossa
Normal Closure of the Mandible: the ______ fibers of the TEMPORALIS will contract.
ANTERIOR
Normal Closure of the Mandible: the ______ pterygoid muscle will contract.
medial
Normal Closure of the Mandible: the entire ______ muscle will contract.
Masseter
Normal Closure of the Mandible: the suprahyoids and infrahyoids will ______.
relax
Normal Closure of the Mandible: the _______ neck musculature will minimally contract to hold the cranium in place.
posterior
Arch Alignment factors: Max and Mand arch ____
size
Arch Alignment factors: Occlusal _______ relationships
contacting
Arch Alignment factors: the _______ is in a facial-lingual equilibrium.
musculature
Arch Alignment factors: These PROBLEMS can also influence the arch: _____functional activity, ______ teeth, _______ cusps, severely ______ teeth, and lastly ______ or _______-positioned teeth!
Parafunctional, missing, fractured, carious, rotated or ectopically
What two teeth does the maxillary 2nd molar contact in occlusion?
Mandibular 2nd molar, Mandibular 3rd molar
Ideal force application: Forces placed on the _______ teeth are intended to go up and down the long axis of the roots.
Posterior
What is the PREFERRED name for the maxillary LINGUAL cusps and mandibular FACIAL cusps as they relate to each other?
CENTRIC (making max-facial and mand-lingual cusps to be “non-centric”
Static/Stationary Occlusion: In ideal tooth positions- _________ will and _______ are coincident. (PLEASE don’t get this wrong)
Centric Relation and Maximum Intercuspation
Static/Stationary Occlusion: each tooth has _______ locations of where contacts should be at complete closure.
PRECISE
Static/Stationary Occlusion: tooth contact should be precise, _______, and short-lasting.
minimal
Static/Stationary Occlusion: the arches should receive contact THEN ________/_______ from each other, when movement commences.
release/disengage
Static/Stationary Occlusion: many contacts are _______ driven (strategic locations for optimal stationary occlusal contact)
anatomically
Non-Centric Cusp location: where does the ML cusp of the second mandibular molar rest in normal occlusion?
lingual embrasure between the max 1st and second molars
Non-centric cusp location: where does the DF cusp of the Max 1st molar rest during normal occlusion? (2)
1.DF groove of the mand 1st molar OR the facial embrasure between the mand 1st and 2nd molars
Which pathway of mandibular cusps positioned over maxillary teeth is a 45 degree angle between protrusion and working movements?
Lateral Protrusive pathway
The lateral protrusive pathway is a 45 degree angle between the ______ and the _____ pathways.
working and protrusion pathways
In a non-working movement where does the left mandibular 1st molar’s DL cusp start before making mediotrusive movement?
the LINGUAL GROOVE of the max 1st molar
In a moving diagram, with view of the mandibular left teeth which movement is being made with and arrow pointing in the lingual direction from the central fossa of the 1st molar?
working (laterotrusive)
In a moving diagram, with a view of the mandibuar right teeth, what type of movement is shown with an arrow pointing from the central fossa of the 1st molar to the facial?
non-fxnal…(can’t go perfectly facial, going facial AND posterior would be non-working side)
What is the most anterior position in the border movements of a sagittal plane view?
Maximum protrusion
What position is most superior in the border movements in a frontal plane?
Maximum intercuspation (NOT Centric Relation)
When tracing mandibular movement at the condyler level and looking at a sagittal view, what pathway yields the most superior condyle position?
the Working Pathway
As Horizontal Overlap increases, the anterior guidance angle ______.
decreases
An increase in Horizontal Overlap (with the anterior guidance angle diminished) results in less vertical displacement of the mandible and _______ posterior cusps.
FLATTER
If our anterior controlling factors have an angle of 57 degrees and the posterior controlling factors have an able of 45 degrees, what teeth are affected the most: the mand 1st molar or the mand 1st PM?
the closer to the anterior the more affected, so the mand 1st PM
The longer the radius of the imaginary circle, the ______ the Curve of Spee.
FLATTER
What do we call it when the initial mandibular lateral translation occurs BEFORE the condyle translates in the fossa?
Immediate Sideshift
The greater the immediate side shift, the _______ the cusps MUST be and the ______ are the OPPOSING fossae and grooves.
shorter…wider
The greater the distance of the tooth from the axis of rotation (the ______ condyle) the ______ the angle formed by latero and mediotrusive pathways.
working condyle…wider
Factor: Distance from working condyle—–>Condition: Greater the Distance—–>Effect: ______ the angle between laterotrusive and mediotrusive pathways.
Wider
SemiAdjustable Articulator: A significant advantage over the nonadjustable in replicating the patients specific ______ movement.
condylar
SemiAdjustable Articulator: Excellent for _______ dental treatment.
routine
SemiAdjustable Articulator: more _____ consuming because info must be passed from patient to _______.
time…articulator
SemiAdjustable Articulator: more ______ than the non-adjustable, but pales in comparison to the fully adjustable.
EXPENSIVE
What are the 3 things necessary to go with the use of a fully adjustable articulator? Do you use a cast to mount?
1.Exact hinge location of the condyles (special facebow) 2.Pantograph 3.CR occlusal record (NOT M.I.!!)…….NO cast mount!
Working Side Occlusial Interferences are potentially observed on the following surfaces: Lingual inclines of the maxillary posterior ____ cusps (due to “__” type of contacts)
posterior facial cusps…“A” contacts
Working Side Occlusial Interferences are potentially observed on the following surfaces: Facial inclines of the mandibular posterior _____ cusps….(a type “___” contact)
facial…“A” contact
Working Side Occlusial Interferences are potentially observed on the following surfaces: Lingual inclines of the maxillary posterior _____ cusps…Type “C” contacts.
lingual
Working Side Occlusial Interferences are potentially observed on the following surfaces: Facial inclines of the mandibular posterior _____ cusps…Type “C” contacts.
lingual
Working Side Occlusial Interferences are potentially observed on the following surfaces: ARE ONLY DUE TO type “__” and type “__” contacts.
A and C!
Locations of NON-working interferences on the mandible are on the lingual inclines of the Mandibular posterior _____ cusps. (remember working BULL???!!)
Facial= non-working on lower posteriors (lower lingual=working)
“A” & “C” contacts will display the condyle on the _______ side deviating laterally, while the condyle on the SAME side of the interference is ______ to centric relation.
OPPOSITE side….anterior to centric relation
Myofacial Pain Syndrome is pain of a regional nature beginning with a ______ within muscle/facia.
trigger point
In Myofacial Pain Syndrome, pain can _____ to other areas of the body.
refer
What is associated with blanching, coldness, sweating, erythema, hyperesthesia, and hyperalgesa?
Myofacial Pain Syndrome
In the dreaded TRISMUS: the pain is ______
variable
In the dreaded TRISMUS: the incisal-interocclusial distance is less than __mm!
18mm
In the dreaded TRISMUS: has a ____ end-feel (articular disc is ______ to the head of the condyle and when the Pt opens the condyle stops at the A.D.)
HARD…anterior
In the dreaded TRISMUS: the process IS _______!! (GOOD!)
reversible
In the dreaded TRISMUS, it is secondary to these 3 things:
1.Infection 2.Hematoma 3. Trauma
Where does pain refer to with a trigger point in the ANTERIOR Temporalis?
Maxillary Incisors!
_____ Articular Disc click: happens in the articular disc regaining its position.
opening
______ Articular Disc click: pops out of the position to the anterior, very near close.
Closing
INTRAcapsular Disorders: can INCREASE pain with increased intraarticular ______ and mandibular movement.
pressure
INTRAcapsular Disorders: any movement provoked by manipulation of the mandible will elicit pain if it increases ______ on the TMJ.
pressure (yet again!)
INTRAcapsular Disorders: If Pt has pain from biting on the TONGUE BLADE the _________ muscle will exhibit pain!
Inferior Lateral Pterygoid!
INTRAcapsular Disorders: Having the Pt _______ the mandible against resistance as they bite will NOT increase pain if the problem is indeed intracapsular.
protrude
INTRAcapsular Disorders: biting on the opposite side of the affected joint will ______ pain (because of the ______ effect)
increase…fulcrum
What are the 2 main pain sources NOT TO CONFUSE with TMJ pain??
- Necrotic Pulp Pain 2. Cervical Spine Pain (reflex to Trigeminal/M of M pain)
Spontaneuos Subluxation/Dislocation of the condyle from the eminence (YIKES): the Articular Disc has become _____ OR ______ placed in reference to the condyle. Now the condyle is anterior to the _______. Don’t worry though, the condyle can be replaced with _______.
anteriorly OR posteriorly…..articular eminence….manipulation of the mandible by the clinician!