The temporomandibular joint (TMJ) connects the mandibular condyle to the articular fossa of the temporal bone. It is a diarthrodial joint that allows for translational and rotational movement and contains an articular disc that separates its upper and lower compartments. The TMJ is important for functions like chewing and speaking. Disorders can occur when there are derangements of the condyle-disc complex or inflammatory conditions of the joint. Treatment involves conservative therapies like exercises and splint therapy or more invasive options like arthrocentesis or disc repositioning surgery.

5. The articulation of the condylar process of the mandible
and the intra-articular disc with the mandibular fossa of the
squamous portion of the temporal bone; a diarthrodial,
sliding hinge (ginglymus) joint; movement in the upper
joint compartment is mostly translational, whereas that in
the lower joint compartment is mostly rotational; the joint
connects the mandibular condyle to the articular fossa of
the temporal bone with the TEMPOROMANDIBULAR
JOINT ARTICULAR DISC interposed
According to GPT :-9

8. Presence of dense avascular fibrocartilaginous instead of hyline cartilage.
Temporomandibular joint is in fact a double joint consisting of 2 synovial joint
cavities separated by an articular- disc, each performing different functions.
2 Temporomandibular joint does not function independently, one joint is
dependent on the other.
Functional movement of the joint are guided by the nature of the occlusal
surface of the teeth
Walia MS, Arora S, Arora N, Rathee M. Temporomandibular Joint (TMJ): A Weight Bearing Joint?. Indian Journal of
Stomatology. 2014 Jan 1;5(1).

9. Weeks
Gestation
TMJ Development
7-8 weeks Blastemic stage: formation glenoid fossa
and condylar blastemas
9 weeks Cavitation stage: formation inferior joint
space
11 weeks Cavitation stage: formation superior joint
space
17 weeks Joint capsule develops
19-20 weeks Cartilage develops within the joint
26 weeks until birth Further maturarion of joint structure
Bender et al. Oral Maxillofacial Surg Clin N Am 30 (2018) 1-9

11. Chaurasia BD. Human Anatomy (Head, Neck and Brain part) volume-3 osteology of head and neck.

12. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

13. Squamous tympanic fissure extend mediolaterally from
posterior part of the glenoid fossa.
The roof is mostly thin and translucent, which shows that the
articular fossa is not a stress bearing part of functional TMJ.
Anterior portion of mandibular fossa , which extend from the
roof to anterior eminence is the true articulating surface /
articulating surface.
Steepness of the articular eminence surface indicates the
pathway of the condyle( condylar guidance ).
Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

14. • Bony apophysis of mandibular ramus.
• Slim neck & ellipsoid shaped head
• Mediolateral width > anterioposterior width
(15-20 mm) ( 8-10 mm)
• Condyle is covered by a thin layer of fibrocartilage
that is thickest superiorly and anteriorly, which are
the areas loaded under function and parafunction.
Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

15. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

16. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

17. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

19. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

20. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

21. Shock absorption thus protecting the articular surfaces.
Prevents undue forward gliding.
Allowing a combination of different movements in the joint by dividing the joint into
compartments and allowing the bony elements to move independently on the disc.
Distribution of weight across the joint, by increasing the area of contact which may
prevent wear.
Aid lubrication of the joint by storing fluid squeezed out from loaded area

22. Chaurasia BD. Human Anatomy (Head, Neck and Brain part) volume-3 osteology of head and neck.

23. To resist any lateral or downward forces that tends to separate or
dislocate the articular surface .
To retain the synovial fluid
Chaurasia BD. Human Anatomy (Head, Neck and Brain part) volume-3 osteology of head and neck.

24. Resists excessive
dropping of the condyle
so limits the extent of
mouth opening
Chaurasia BD. Human Anatomy (Head, Neck and Brain part) volume-3 osteology of head and neck.

25. Superiorly:- spine of the sphenoid
Inferiorly :- lingula of the mandibular
foramen
Laterally :
a. Lateral pterygoid muscle
b. Auriculotemporal nerve
c. Maxillary artery
Medially :
a. Chorda tympani nerve
b. Wall of the pharynx
Chaurasia BD. Human Anatomy (Head, Neck and Brain part) volume-3 osteology of head and neck.

26.  It is also an accessory ligament of the joint.
 Represents a thickened part of the deep
cervical fascia which separates the parotid
and submandibular salivary glands.
 It is attached above to the lateral surface of
the styloid process, and below to the angle
and adjacent part of posterior border of the
ramus of the mandible
It limits excessive
protrusive
movements of the
mandible
Chaurasia BD. Human Anatomy (Head, Neck and Brain part) volume-3 osteology of head and neck.

27. Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

28. Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

29. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

30. SYNOVIAL FLUID
Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

31. Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

32. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, Salvador A. Anatomy of the
temporomandibular joint. Semin Ultrasound CT MR. 2007 Jun;28(3):170-83

34. Horizontal axis Vertical axis Sagittal axis
Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

35. Rotational Movement of the Mandible With
the Condyles in the Terminal Hinge Position.
This pure rotational opening can occur until
the anterior teeth are some 20 to 25 mm
apart.
Second Stage of Rotational Movement
During Opening. Note that the condyle is
translated down the articular eminence as
the mouth rotates open to its maximum
limit.

36. Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

37. Lateral pterygoid
Digastric,
Geniohyoid
Mylohyoid muscles
1. Masseter,
2. Anterior vertical, middle oblique
fibres of temporalis
3. Medial pterygoid muscles
Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

38. • Lateral and medial pterygoid
• superficial oblique fibres of
masseter
• Posterior horizontal fibres of the
temporalis
• Deep vertical fibres of masseter.
Okeson JP. Management of temporomandibular disorders and occlusion. Elsevier Health Sciences; 2019 Feb 1.

39. INSPECTION PALPATION
AUSCULTATION

41. Panoramic
radiography
Transcranial
radiography
Tomography
Arthrotomography
Arthrography
Magnetic
resonance
imaging (MRI)
Computed
tomography
(CT)
Karjodkar FR. Textbook of Dental and Maxillofacial Radiology by Karjodkar. Jaypee Brothers Publishers; 2006.

42. Karjodkar FR. Textbook of Dental and Maxillofacial Radiology by Karjodkar. Jaypee Brothers Publishers; 2006.
INDICATIONS:
TMJ pain dysfunction syndrome- pain , clicking
and limitation in opening.
Fractures of the condylar heads or necks
Condylar hypo/hyperplasia

43. Transmaxillary view Submentovertex view
A. Open position
B. Close position
Karjodkar FR. Textbook of Dental and Maxillofacial Radiology by Karjodkar. Jaypee Brothers Publishers; 2006.

44. Arthrography
Karjodkar FR. Textbook of Dental and Maxillofacial Radiology by Karjodkar. Jaypee Brothers Publishers; 2006.

45. A. Normal B. Flattening C. Erosion D. Osteophyte
Karjodkar FR. Textbook of Dental and Maxillofacial Radiology by Karjodkar. Jaypee Brothers Publishers; 2006.

46. Karjodkar FR. Textbook of Dental and Maxillofacial Radiology by Karjodkar. Jaypee Brothers Publishers; 2006.

48. GLOSSARY OF PROSTHODONTIC TERMS:-9

50. I. MASTICATORY MUSCLE DISORDERS
A. Muscle splinting
B. Myospasm
C. Myositis
D. Myofascial trigger point pain
Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

51. A. Derangements of the condyle-disc
COMPLEX
1. Disc displacement
i) single clicks
ii) reciprocal clicks
2. Disc displacement with reduction
( Loud pop or catching )
3. Disc displacement without reduction
(closed lock)
B. Structural incompatibility of the
articular surface
1. Alteration in form:
a. Disc
b. Condyle
c. Fossa
2. Adhesions
a. Disc to condyle
b. Disc to fossa
3. Subluxation (hypermobility)
4 spontaneous dislocation ( open lock)
II. DISC- INTERFERENCE DISORDERS
Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences; 2019 Feb 1.

52. 1. Synovitis/capsulitis
a. Traumatic
b. Secondary inflammatory
2. Retrodiscitis
a. From extrinsic trauma
b. From intrinsic trauma
3. Degenerative joint disease
III INFLAMMATORY DISORDERS OF THE TEMPOROMANDIBULAR JOINT
4. Inflammatory arthritis
a. Traumatic
b. Infectious
c. Rheumatoid
d. Hyperuricemia
5. Inflammatory disorders of associated structures:
a. Temporal tendonitis
b. Stylomandibular ligament inflammation
Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences; 2019 Feb 1.

53. IV. CHRONIC MANDIBULAR HYPOMOBILITY
1. Contracture of elevator muscles
2. Capsular fibrosis
3. Coronoid impedance
4. Ankylosis
a. Fibrous
b. Osseous
V. GROWTH DISORDER OF THE JOINT
1. Hypoplasia
2. Hyperplasia
3. Neoplasia
Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences; 2019 Feb 1.

54. ETIOLOGY
1)Occlusal factors
2) Trauma
3) Emotional stress
4)Deep pain input
5) Parafunctional activities.
Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences; 2019 Feb 1.

56. TMD Treatment divided into
• Conservative Therapy
• TMJ Surgery

57. Phase 1: Include Education, anxiety
Control, behavioral modifications,
physiotherapy, medication therapy and
splint therapy.
Phase 2: Dental rehabilitation, occlusion
correction, fixed prosthesis, restorative
treatments, orthodontic treatments and
orthognathic surgery.

58. Arthrocentosis
Arthroscopy.
Disc-Repositioning Surgery.
Condylotomy.
Arthroplasty.
Total Joint Displacement

59. TMJ pain relieving exercises

60. Relaxed Jaw Exercise
Gold fish exercise
(partial opening)

61. Chin tuck Exercise
Gold Fish Exercise
(Full Opening)

62. Resisted Opening of the mouth
Resisted Closing of the mouth

63. Tongue Up Exercise
Side to Side Movement

64. Forward Jaw Movement

71. • Until the positions of TMJ’s are precisely determined an accurate maxillomandibular
relationship cannot be verified and correct occlusal analysis is not possible.
• Bilateral relaxation of external pterygoid muscle is essential to obtain true centric.
1 ) Chin point guidance Guichet (1970): Thumb and forefinger— positions the condyle in RUM position

72. 2) Bimanual method Peter Dawson (1974): Guides the mandible in most superoanterior
position.
3. Three finger method—Peter Thomas (1980): Thumb, forefinger, middle finger—
positions condyle in anterior superior position

73. Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

74. TMJ works as class III lever
Walia MS, Arora S, Arora N, Rathee M. Temporomandibular Joint (TMJ): A Weight Bearing Joint?. Indian Journal of
Stomatology. 2014 Jan 1;5(1).

75. • The way the teeth fit together may affect the TMJ
complex.
• A stable occlusion with good tooth contact and
interdigirior belly is responsible for proper disk
movement in coordination with movement of the lower
jaw, especially when closing the mouth, just the
opposite of the inferior belly.
• It then exerts forward pressure on both the condyle and
the disk, stabilizing their relationship to each other and
assuring the most effective position possible when the
strong forces of chewing move the condyle backward
and forward

76. VERTICAL DIMENSION
• In normal or structurally intact TM joints, the soft tissue and hard
tissue maintain a vertical dimension at the TM joint level.
• If there any joint alteration, initial tissue deformation typically occur
at soft tissue level, resulting in a loss of ligament attachment between
the disk and the condyle.
• Loss of attachment result in anteriorly displacement of disk resulting
in decrease in vertical dimension .
• Vertical dimension can increase in a situation where the condyle
functions against the thickened posterior band of the disk
Silverman, M. Vertical dimension must not be increased. J Pros Dent; 1952;2,2:188-97

77. • As the mandible is protruded, the condyle descends along
the articular eminence.
• Horizontal reference plane is determined by the steepness
of the eminence.
• The steeper the eminence the more the condyle is forced
to move inferiorly as it shifts anteriorly.
• Results in greater vertical movement of the condyle,
mandible, and mandibular teeth.
• Steeper angle of the eminence (condylar guidance) steeper
posterior cusps.
Okeson JP. Management of temporomandibular disorders and occlusion-E-book. Elsevier Health Sciences;
2019 Feb 1.

78. Occlusal dysharmony
High points/defective
tooth inclines
Muscle hyperactivity
Pain

79. El-Zawahry MM, El-Ragi AA, El-Anwar MI, Ibraheem EM. The Biomechanical Effect of Different Denture Base Materials on the Articular Disc in Complete Denture Wearers: A Finite
Element Analysis. Open Access Maced J Med Sci. 2015 Sep 15;3(3):455-61