Final Exam Flashcards
(223 cards)
1
Q
2 Types of TMD
A
Myogenous TMD
Arthrogenous TMD
2
Q
Mygoenous TMD
A
Muscle and ligament related
3
Q
Arthrogenous TMD
A
Joint and bone related
4
Q
TMD are
A
A common subgroup of orofacial pain disorders
There are 2 basic types of TMD
5
Q
Joint Disc
A
The disc is vascular innervated and elastic
6
Q
Lateral ptergyogid muscle is
A
Located in front of the disk and attached to the front of the disc
7
Q
Reasons you cant open your mouth
A
If you cannot open your mouth might be because the disc is locked in front and then you’re hitting on the retrodiscal tissues causing pain
8
Q
Retrodiscal tissue
A
Are innervated so if there is a load in the back it will be painful
9
Q
Can apply loads to front because
A
Cartilage at the front of the disc is a vascular so there wont be any pain
10
Q
Disc reduction
A
Bring the disc back into place
11
Q
A good history taking is the
A
Basis of accurate diagnosis
12
Q
Cardinal criteria to diangose TMD
A
Pain Limitation of function Limitation of movement Physical change Alternated jaw relationship Tempromandibular sounds that have increased in intensity and frequency
13
Q
TMD: Limitation of function
A
Cannot bite
14
Q
TMD: Limitation of movemnt
A
Cannot open or close mouth
15
Q
TMD: Altered jaw relationship
A
Deviation instead of biting in a straight line
16
Q
TMD: Sounds
A
CLicking can be normal what is very important is that the sounds are increasing in intensity and frequency
17
Q
Articulator eminence angle defines
A
Condylar Guidance
Around 30-40 degrees
18
Q
When trying to replicated TMD
A
You cannot Control Articulator eminence angles can only simulate in articulator
Cannot replicate joint only the teeth
19
Q
Mandible works in what plane
A
Circular plane so it drops more in the back than in the front
Articulator is only one plane so anterior teeth must be set a lower angle (20 degrees) Posterior teeth (30 degrees)
20
Q
Articulator is only one plane so anterior teeth vs posterior
A
Anterior teethmust be set a lower angle (20 degrees) Posterior teeth (30 degrees)
21
Q
Etiology TMD
A
Issues with Pulp Occlusal Perio Muscles of mastication Joint Ear infections Neck muscles
22
Q
Tolerance
A
The body will tolerate the problem for a narrow period of time. If you keep ignoring it then you end up with a problem
23
Q
TMJ innervated
A
CN V
CN VII
Can cause referred pain
24
Q
TMD is a disease that has
A
A multifactorial etiology
25
TMD etiologic factors may be classified into
Predisposing factors
Initiating factors
Perpetuating factors
26
TMD: Predisposing factors
Increase the risk of TMD
Systemic, occlusal, loss of posterior teeth
27
TMD: Initiating Factors
Cause TMD
Trauma, parafunctional habits
28
TMD: Perpetuating factors
Enhance progression of TMD
Behavioral, social, or emotional stress
29
Factors associated with TMD
```
Occlusal condition
Trauma
Emotional stress
Deep Pain input
Parafunctional activities
```
30
Problems in bringing teeth together into MI are reflected in the
Muscles
31
Once the teeth are in occlusion problems in loading the mastication structures are reflected in
The joints
32
Introduction of an acute condition——>
Presence of orthopedic instability
33
Orthopedic stability occurs when
The stable MI position of teeth is in harmony with the musculoskelatlyl stable position of the condyles in their fossa
34
Activities of the mastication system
Functional
| Parafunctional
35
Functional activities of masticatory system
Chewing eating and swallowing
36
Parafunctional activities of masticatory
Diurnal parafunctilal activity
Nocturnal parafunctional
37
Diurnal Parafunctional activity
Clenching eating swallowing
Cheek and tongue biting
Finger and thumb sucking
38
Nocturnal Parafunctional activity
Bruxing-clenching and grinding result in the same consequence as clenching and grinding
39
Prosthetic treatment in TMD should only be carried out
After reversible therapy (night guard) has resulted in relief of pain and function
40
Dentist must refrain from providing dental therapies if
Occlusal interferences are not related to symptoms
41
TMD Treatment Modalities
Conservative
| No conservative
42
Conservative modalities
Reversible non invasive
43
Nonconservative modalities
Irreviesrible
| Surgery
44
Definitive treatment
Intended to directly eliminate or alter the cause o the disorder and its consequences
45
Supportive therapy
Not treating the problem but helping ease the pain/discomfort
46
Supportive therapy is directed toward
Altering the patients symptoms and reducing pain and dysfunction
47
Supportive therapy has _____ on the cause of disorder
No effect
Pharmacological
Physical therapy
48
Analgesics
Aspirin
49
Anti-inflammatory
Ibuprofen
50
Muscle relaxants
Soma
51
Anxiolytics agents
Valium
52
Antidepressant
Prozac
53
Anticonvulsant
Lyrics
54
Occlusal appliance material
Hard acrylic
55
Positive Occlusal contact
With teeth in opposing arch
Teeth do not touch anymore
56
Uses of occlusal appliances
Temporarily provides a more ortho-pedically stable joint position
To introduce an optimum functional occlusion that reorganizes the neuromuscular reflex activity
To protect teeth and supportive structures from abnormal forces that may create breakdown or occlusal wear
57
Occlusal appliances reduce what activity
They reduce parafunctional muscle activity, hence reduce myogenous pain
58
Occlusal appliances also reduce forced placed on
The TMJs and other structures within the masticatory system
When these structures are unloaded the associated symptoms decrease
59
Common features to all occlusal appliances
Temporary alteration of occlusal condition
Alteration of the condylar position
Increase in vertical dimension
Cognitive awareness
Placebo effect
60
Types of occlusal appliances
Stabilization appliance
Anterior positioning appliance
Anterior bite plane
Posterior bite plane
Pivoting appliance
Soft appliance
61
Most common appliance
Stabilization appliance
Easiest
62
Soft appliances are not
Therapeutic but might relieve pain
Not manufactured by dentist
63
Stabilization appliance is generally fabricated for
The maxillary arch and provides optimum functional occlusion
64
When stabilization appliance is in place the condyles are
In there most musculoskelatly stable position at the time when the teeth are contacting evenly
65
Primary goal of stabilization appliance
Elimante any orthopedic instability
66
Static
Don’t move
67
Dynamic
Do move
68
Goal of prosthodontic treatment
PRESERVE what remain
Support reaming teeth and provide a substitute for missing teeth
69
Relationship between elements
Dental compositions (micro)
Dentofacial composition (mini)
Facial composition (macro)
70
Esthetic harmony
Harmony depends on equilibrium between distractive elements
71
Frame of Reference
Bridge of nose
Philtrum
Face midline
Dental midline
72
Philtrum
BEST reference to find midline of the face
Not nose
73
Face midline
Should match the midline of the maxillary and mandibular teeth midline
74
Dental Midline
Studies have shown that the mean threshold for acceptable dental midline deviations is 2.2+/-1.5 mm
75
Esthetics depends largely on
Proportion
76
Unattractive if
Top heavy
Squat
Out of proportion
77
Golden proportion
How much smaller each tooth is compared to the one adjacent to it
78
Pythagoras
1/1/618
79
Plato
1/1.733
80
Increased embrasure is seen in
Young dentition and a restoration with unnaturally reduced embrasures
81
Incisor angulation slight______ is acceptable but ______ should be avoided
Mesial
Distal
82
Lip Line
Upper Lip
High: Enitre length of the tooth
Moderate
Low: hides margins and defects
83
Smile Line
Has to do with the teeth
Imaginary line that curves with the lower lip
More pronounced in women
Hypoethical curved line drawn along the edges of maxillary anterior teeth that has to coincide or run parallel to the curve a true of the lower lip
84
Buccal Corridor
Dark triangle on the side of the lips-are a singe of beauty
85
No corridor —>
Mouth full of teeth
86
Dominance
Primarily refers to the two central incisors
largest tooth that shows the highest in value
Brightest and stands out more
87
Embrasures
Form
Symmetry
Progression
88
Dental morphology
Contact areas
Embrasures
Texture
89
Gingival Morphology
Gingival tissue and racial factor
Gingival health and contour
Gingival zenith
90
Diagnostic waxing is the process of
Developing intra and inter arch relationships to establish crown contours and occlusal schemes for diagnostic purposes
91
Diagnostic waxes allow
The practioner to establish the optimum contour and occlusion fo the eventual prosthesis
92
Natural teeth have a _____ emergence profile in the ______ _______
Straight
| Gingival third
93
Emergence Profile
Zone around the tooth below the crest of curvature
94
Emergence Profile
Zone around the tooth below the crest of curvature
95
All teeth have an emergence profile that is
A straight line
| Not concave or convex
96
Most important feature of anterior teeth
Mesiobuccal line angle
97
Macroesthetics
The face in all 3 planes
Excessive buccal corridor
Inappropriate gingival height
Excessive or inadequeate gingival display
98
Microesthetics
The teeth
Tooth proportion in height and width
Gingival shape and contour
99
Is the golden proportions always best option
No too strong for dental esthetics
100
Dentist perception of anterior esthetics
```
Embrasure size
Central angulation
Lateral angulation
Lateral length
Central width to heigh ration
```
101
Central incisors width height ration
.75-.78
102
Lateral is ___ of central
66%
103
Canine is ____ width of lateral
84%
104
3 elements of prosthetic rehabilitation
Occlusion
Esthetics
Phonetics
105
Harmony depends on equilibrium between
Distractive elements
106
Goals of Occlusal Equilibration
To improve functional and esthetic relationships between auxiliary and mandibular teeth
Eliminate TMD
107
Treatment planning for Occlusal therapy
Selective Grinding
Fixed prosthodontics
Orthodontic therapy
Orthographic Surgery
108
Selective Grinding
Select Sponts on occlusal surface and grind them away
Most conservative method
109
Fixed prosthodontics for TMD
Grind whole tooth away and make a crown
Can creat new contacts and delete the slide to make CO=MI
110
Orthographic surgery
Combination between orthodontic therapy and surgery can cut The jaw and move it around
111
Anterior contact is usually coronal to the ______ and _____ to the _____
Cingulum
Apical
Fossa
112
Tripod contact
Is best
If its only the cusp tip it may slide
113
Rule of thirds: Selective Grinding
Contact occurring at center of tooth
114
Rul Rule of thirds: Fixed
Cusp angles (middle third) hitting
115
Rule of thirds: Orthodontic
Cusp tips hitting
116
Factors influencing treatment planning
```
Symptoms
Condition of the dentition
Systemic Health
Esthetics
Finances
```
117
The shorter the slide the
More likely it is that selective grinding can be accomplished within the confines of enamel
118
When the slide has a great horizontal component (flat cusps)
It becomes difficult to elimante within the confines of the enamel
119
Never grind the
Functional cusp
You grind the fossa
120
Mandibular excursions
Locate tooth in. The arch
Determine if it moves (mandibular only teeth that move)
Identify movement (working non working protrusive etc.)
121
MUDL
Mesial upper
| Distal lower
122
BULL
Buccal upper
| Lingual lower
123
Deviation forward on closing
Grind MUDL
124
Deviation toward the cheek on closing
Grind BULL
125
Deviation toward tongue on closing
LUBL
126
LUBL
Lingual upper
| Buccal lower
127
Non working interferences (opening)
BULL
128
Working interferences (opening)
LUBL
129
Protrusive Interferecesn
DUML
Only anterior teeth should touch
130
Horizontal slide
That’s a problem if there is a slide is should go upward
131
Optimal joint relationships is achieved only when
The Articulator disks are properly interposed between the condyles and the Articulator fossae (CR)
132
When in optimal joint relationships the Articulator surfaces and tissues of the joints are aligned so
So that forces are applied by the masculine do not create any damage
Loaded evenly
133
Musculoskeltally stable joint position can only be maintained when
It is in harmony with a stable occlusal position
134
More teeth =
Better
More distribution of forces
More stabilization of the mandible
135
_____ and ______ contact of all teeth during mandible closure
Even and simultaneous
136
Osseous tissues do not
Tolerate pressure forces
137
The PDL is present between the roots and bone to
Controls pressure forecasts
138
When trauma occurs the PDL
Prevents tooth to bone contact
Acts like a net that supports tooth not really elastic
139
Class I lever
Fulcrum is in the middle
140
Class 2 lever
Load is in the middle
Wheelbarrow
141
Class 3 lever
Effort is in the middle
Fishing
142
In MI posterior teeth come into contact and act
As a stop to minimzal horizontal load on anterior teeth
143
Anterior teeth take ______ forces
Lateral
144
Posterior teeth take ______ forces
Vertical
145
Anterior guidance
Protects posterior teeth during protrusion
146
Effects of tooth loss
```
Supraeruption
Tilting
Loss of contact
Loss of posterior tooth support
Loss of vertical dimension
Flaring of anterior teeth
Non-working interferences
```
147
Occlusal forces treatment goals
Furnish a smooth protrusive path guided by anterior teeth without any interferences from occlusal contacts between posterior teeth
148
In MI positions all mandibular teeth should
Contact their maxillary opponents at the same time with same intensity
149
To direct occlusal forces along the
Long axes of teeth
150
Working contacts
Should not be prevented from cotanting by non. Working interferences
151
Ear bow should be parallel to
The eyes
152
Earbow transfer related maxillary cast to
Terminal hinge axis (mandibular condyles)
153
Ear bow transfer orients the maxillary cast correctly in space using
A third point of reference (occlusal plane)
154
Ear bow transfer is aligned parallel to
Interpupillay line
155
Ear bow transfer permits mounting of the maxillary cast
On a semi adjustable Articulator
156
The mandibular cast is mounted using ______ record
Centric relation
157
Centric Relation
Relationship in which the condyles articulate with the thinnest avasular portion of their respective disk with the complex in the anterior superior position against the shaped of the Articulator eminences
This position in independent of tooth contact
158
Centric Relation is of _______ of tooth contact
Independent
159
Methods of recording CR
Bilateral manipulation
‘
Chin point guidance
Anterior deprogrammed
160
When doing excurvisve movements you don’t want teeth
In black to touch
discussion
161
Increased VO
Allows longer cusps
162
Decreased VO
Required shorter cusps
163
Increased HO
Requires shorter cusps
164
Decreased HO a
Allows longer cusps
165
On the horizontal path the angle known as _________ is the angle between the protrusive and mesial or non working path
Bennetts angle
166
On the Sagittal plane the angle between the protrusive and mesial or non working path is I known as
Fischer’s angle
167
The essence of both an atomic and curtail harmony is the balance between
Elevator muscles and depressor muscles
168
In order for the jaw to protrude it must go
Down and then forward
169
Translation and rotation can happen
Simultaneously
170
THA
An imaginary line that joins the condyles
The mandible rotates along this line and the mandible can move downwards and forward
171
Protrusive movement
Forward and downward
Cannot go straight forward or straight downward
172
Right lateral movement
Working side non working side
The opposite condyle moves forward and downward mesially
173
Bennett’s movement
The non working ALWAYS only goes down and forward
The working condyle anywhere inside the cone of Bennett sticking out laterally
174
Bennett’s side shift
Mandibular lateral translation = The center moves
The mesial pole is a little backwards from the distal pole
The distal pole is more forward
175
Chewing movement
You close in a circle bite
176
The centric relation curve
Line or curve our rotational
When you open your moth only slightly
177
Curve of translation
the whole jaw translated
This is the maximum opening because the tendons and uncles will prevent you from opening more
178
Maximum protrusive limit
Can bite down in a protrusive fashion; a straight line
179
Centric occlusion
Initial point of contact
180
Usually the direction of the shift is
A little forward but can be sidweways or a little backward
181
Ulf posselts motion
It wil hit the initial point of contact then slide into the maximum intercupstaion
182
Anterior guidance
Slide the mandibular teeth forward until you reach end to end position
183
CO=
MI
| Is ideal only 10%
184
Any point at the CR curve is termed centric relation=
Only rotation
185
Functions of anterior teeth
```
Anterior guidance
Initial acts of mastication
Speech
Lip Support
Esthetics
```
186
VO
Vertical overlap
187
HO
Horizontal overlap
188
Posterior teeth are not designed to take
Lateral surfaces they will chip off gum recession perio
189
Anterior guidance is dictated by
Position of the incisal edge of the mandibular anterior teeth relative to the lingual surfaces of the maxillary teeth
Changes in morphology of the lingual surfaces of maxillary anterior teeth
Length of mandibular incisors or canines
190
The incisal guide on an Articulator has 3 functions
When anterior teeth are prepped the angulation of the custom guide provides anterior guidance In place of the anterior teeth
When only posterior teeth are to be replaced the angulation of the guide serves to estimate the buccolingula and mesiodistal cusp angles so as to avoid interferceesn in both protrusive and non working excursions
Reduce the amount of wear of the stone casts during excursive Muenster made not he articulator
191
The geomtetric school
Denied the existence of condylar axes and disregarded the condylar paths as influences on occlusion instead claiming that the articulation of teeth guides the mandible during mastication
192
The condylar school
Adjustable condylar guides
Average value instruments
193
Bonwill Triangle
The size of the mandible is equal to 10cm(4in) from condyle to condyle and from each condyle to the incisor point
194
Balkwill Angle
Is formed between the occlusal plane and the bonwill triangle
26 degrees
195
Curve of Spee
The molar masticatory surfaces lie on the same arc of a circle the posterior continuation of which touches the most anterior point of the condyle
196
The steeper the path of the condyle the more
Pronounced the tooth curve would be because both have the same radius
(Theory)
197
Christensen
The space that occurs between he maxilla and mandible during protrusion because of the curve of Spee
198
Monsons spherical theory
Center located in sella trucica
| Formed a pyramid using bonwill equilateral triangle (D)
199
Curve of Wilson
Upper convex
Lower concave
Curvature of cusps projected on the frontal plane expressed in both arches
200
Hall’s Conical Theory
The external occipital protuberance was considered as the anatomical rotation center of mandible
201
Horizontal Plane: Lateral Movement
Working Condyle: Slight lateral translation (forward or backwards)
Non-Working Condyle: Forward and Medial
202
Frontal Plane: Lateral Movements
Working: Rotate and move lateral and upward or lateral and downwards
Non-working: Downward and medial
203
Centric Relation Arc of Closure
When the mandible is guided to centric relation the arc traced between the two mandibular central incisors. At any point along this arc the mandible is in centric relation
204
Incisal guidance is measured in degrees from the horizontal plane. The amount the mandible must drop in the anterior region is determined by the
Incisal guidance
205
Incisal guidance is measured in degrees from the horizontal plane. The amount the mandible must drop in the posterior region is determined by
The angle of the Articular eminence
206
what serve to guid the disclusion of posterior teeth
Inclination of the articular eminence of the TMJ
The morphology of the lingual surfaces of anterior teeth
207
Determinants of Mandibular Movements: Posterior Determinants
Inclination of articular eminence
Medial wall of glenoid fossa
Intercondylar distance
208
Determinants of Mandibular Movements: Anterior determinants
Horizontal overlap of anterior teeth
Vertical overlap of anterior teeth
209
Determinants of Mandibular Movements: Other
Occlusal plane
Curve of spee
Neuromuscular response
210
Eliminating protrusive interferences
DUML
211
Working Side interferences on opening
(Anterior guidance) LUBL
212
Non-working interferences on opening
BULL
213
Interferences to line of Closure toward cheek
BULL
214
Interferences on line of Closure toward tongue
LUBL
215
Interference to the arc of Closure (CR) (Anterior slide)
MUDL
216
Medial Pterygoid
Ptergoid plate—-medial angle of mandible
V3
Elevates
Lateral movements
217
Lateral Pterygoid
Superior head- infratemporal fossa—anterior side of condyle
Inferior head- lateral ptergoid plate——Pterygoid fovea
V3
Depresses mandible
Lateral movements
218
Temporalis
Temporal bone——coronoid process
V3
Elevation
Retraction
219
Masseter
Zygomatic arch—-coronoid procees lateral ramps
V3
Close mouth
Protrusion of mandible
220
Appliance mainly used to reduce muscle pain
Stabilization appliance
221
Anterior Positioning Appliance goal is to
change positioning of the mandible in relation to the cranium
Interocclusal that has the mandible more anterior
Patients with joint sounds and to treat disc displacement
222
Anterior bite plane is suggested for treatment of
Muscle disorders related to orthopedic instability or an acute change in occlusal condition
223
Indications for posterior bite plane
Cases of severe loss of vertical dimension or when major changes need to be done to the anterior positioning of the mandible
