DEPT.

OF ORTHODONTICS
AND
DENTOFACIAL ORTHOPEDICS
SRI AUROBINDO COLLEGE OF DENTISTRY
AND P.G. INSTITUTE

SEMINAR -2
DEVELOPMENT OF TMJ

BY:CHAITREE DE
PG 1ST YEAR
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 Contents
1. Introduction
2. Development of TMJ
3. Components of TMJ
4. Vascular supply
5. Nerve supply
6. Functional movements
7. Age changes
8. TMJ and orthodontics
9. Conclusion
10. References

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 Introduction
• The TMJ (temporomandibular joint) is a
ginglymodiarthrodial joint, where ginglymus,
means a hinge joint, allowing motion only
backward and forward in one plane, and
arthrodia, meaning a joint which permits a gliding
motion of the surfaces.

• It is the articulation between the squamous part of

the temporal bone and the head of the mandibular
condyle.

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• Important functions :-
1. Speech
2. Mastication

• Synonyms for TMJ:-

1. Craniomandibular joint /articulation
2. Bicondylar joint
3. Mandibular joint
4. Modified Ball & Socket
5. Compound joint

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• Special features of TMJ:-

1. Bilateral diarthrosis right & left function together

2. Articular surface covered by fibrocartilage instead

of hyaline cartilage.

3. Only joint in human body to have a rigid endpoint

of closure that of the teeth making occlusal contact.

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 Development Of TMJ
8th-9th week IU life

1. Meckel’s cartilage provides the skeletal support for

the development of the mandible and extends from
the midline backwards and dorsally.

2. The articulation of malleus and incus (ear ossicles)

functions as the primary TMJ.

3. These structures are derived from 1st pharyngeal

arch/ mandibular arch.
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 10th week IU life
1. Two distinct regions of mesenchymal condensation
between the condylar cartilage of mandible
(temporal blastema) and the developing temporal
bone (condylar blastema).

2. At the same time lateral pterygoid muscle attaches

to condyle.

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12th weeks IU life
1. Two slit like joint cavities & an intervening disc
appear .

2. 1st cleft appears immediately above condylar blastema

becomes inferior joint cavity. The condylar blastema
then differentiates into condylar cartilage.

3. 2nd cleft appears in relation to the temporal

ossification that becomes the superior joint cavity.

4. With the appearance of this cleft, the primitive

articular disk is formed.
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16th week IU life
1. Malleus & Incus begin Transformation into
middle ear bones .
2. Disappearance of primary joint starts.

18th -20th week IU life

3. Secondary joint becomes functional &
Meckel’s Cartilage.
4. Loses its function & dissapears.

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 Components of TMJ
BONY COMPONENTS :-
1. Condylar head
2. Glenoid fossa
3. Articular eminence

SOFT TISSUE COMPONENTS :-

4. Articular disc
5. Fibrous capsule
6. ligaments
7. Synovial fluid
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CONDYLE
• An ovoid process seated atop a
narrow mandibular neck forms the
articulating surface .

• It is convex in all directions.

• Wider latero-medially (15 to 20

mm) and less convex than antero-
posteriorly (8 to 10mm).

• Medial & lateral projections termed

poles.
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• The medial pole is directed more
posteriorly.

• The long axis of the two poles

deviate posteriorly , meeting at
the anterior border of the foramen
magnum.

• The articular surface lies on

anterosuperior aspect, continuing
downwards medially facing the
entoglenoid process.

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GLENOID FOSSA

• Anteriorly – Articular eminence.

• Posteriorly - Squamotympanic &

petrotympanic fissure.

• Medially – Spine of sphenoid.

• Laterally – Root of the zygomatic

process of temporal bone.

• Superiorly – Thin plate of temporal

bone.
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 ARTICULAR EMINENCE

• Forms posterior root of zygomatic

arch and anterior wall of glenoid
fossa.

• Present on the inferior aspect of

the zygomatic process of temporal
bone.
•

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OTHER BONY LANDMARKS

• Articular tubercle is a small, raised, rough, bony

knob on the outer end of the articular eminence.

• It projects below the level of the articular surface and

serves to attach the lateral collateral ligament of
the joint.

• Preglenoid plane, is the slightly hollowed, almost

horizontal, articular surface continuing anteriorly
from the height of the articular eminence.

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• The posterior part of the mandibular fossa is anterior
margin of the petrosquamous suture and is elevated to
form a ridge known as the posterior articular ridge or
lip.

• This ridge increases in height laterally to form a

thickened cone-shaped prominence called the post
glenoid process immediately anterior to the external
acoustic meatus.

• Lateral border of the mandibular fossa usually rises to

form a slight crest joining the articular tubercle in front,
with the postglenoid process behind.
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• Medially the fossa narrows considerably and is
bounded by a bony wall that is the entoglenoid
process, which passes slightly medially as the medial
glenoid plane.

• The roof of the mandibular fossa, which separates it

from the middle cranial fossa, is always thin and
translucent.

• This demonstrates that, although the articular fossa

contains the posterior rim of the disk and the condyle,
it is not a functionally stress-bearing part of the
craniomandibular articulation.
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ARTICULAR DISC

• Most important anatomic

structure of the TMJ.

• It is a biconcave
fibrocartilaginous structure
located between the condyle and
the glenoid fossa.

• Its accommodates hinging

action as well as the gliding
action of the TMJ.
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• The articular disc is oval, firm and
fibrous plate.

• Anterior part = 2 mm thick,

posterior part = 3 mm thick and
intermediate part is 1 mm thick.

• More posteriorly there is a bilaminar

or retrodiscal region.

• It is shaped like a peaked cap that

divides the joint into larger upper
compartment and a smaller lower
compartment.
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• Hinging movements take place
in the lower compartment and
gliding movements take place
in the upper compartment.

• The superior surface is

saddle-shaped to fit into the
glenoid fossa contour ,
whereas the inferior surface is
concave to fit against the
mandibular condyle.

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• The disc is attached all around the joint capsule except
for the strong straps that fix the disc directly to the
medial and lateral condylar poles, which ensure that the
disc and condyle move together in protraction and
retraction.

• The anterior extension of the disc is attached to a fibrous

capsule superiorly and inferiorly.

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• In between it gives insertion to the lateral pterygoid
muscle where the fibrous capsule is lacking and the
synovial membrane is supported only by loose areolar
tissue.

• Posteriorly, the bilaminar region consists of two

layers of fibers separated by loose connective tissue.

• The upper layer or temporal lamina is attached to the

postglenoid process, medially extended ridge. It
prevents slipping of the disc while yawning.

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• The inferior layer of the fibers or
inferior lamina curve down behind
the condyle to fuse with the capsule
and back of the condylar neck at the
lowest limit of the joint space. It
prevents excessive rotation of the
disc over the condyle.

• In between the two layers, an

expansile, soft pad of blood vessels
and nerves are sandwiched and
wrapped in elastic fibers that aid in
contracting vessels and retracting
disc in recoil of closing movements.
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• In between the two layers, an expansile, soft pad of
blood vessels and nerves are sandwiched and
wrapped in elastic fibers that aid in contracting
vessels and retracting disc in recoil of closing
movements.

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FIBROUS CAPSULE

• Tissue completely surrounding the

TMJ.

• Functionally limits the forward

translation of the condyle.

• It is reinforced by an external TMJ

ligament, which also limits the
distraction and the posterior
movement of the condyle.

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• Anteriorly, the capsule has an orifice through which
the lateral pterygoid tendon passes.

• This area is relatively weak in the capsular lining, it

can be the site of possible herniation of intraarticular
tissues and may allow forward displacement of the
disk.

• The synovial membrane lining the capsule covers all

the intra-articular surfaces except the pressure-
bearing fibrocartilage.

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The outline :–

1. Anterolaterally to the articular tubercle

2. Laterally to the lateral rim of the mandibular fossa
3. Posterolaterally to the postglenoid process
4. Posteriorly to the posterior articular ridge
5. Medially to the medial margin of the temporal
6. Anteriorly it is attached to the preglenoid plane
7. Laterally( on mandible) - the lateral condylar
pole
8. Medially ( on mandible) - dips below the medial
pole.
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TMJ Ligaments
1. Lateral Ligament / temporomandibular ligament:
• Arranged in two distinct layers.

• Wide outer or superficial layer is fan-shaped and arises

from the outer surface of the articular tubercle and most
of the posterior part of the zygomatic arch runs obliquely
downward and backward to be inserted on the back,
below the mandibular neck.

• medial to superficial layer, the narrow ligamentous band

arises from the crest of the articular tubercle runs
horizontally back as a flap strap to the lateral pole of the
condyle.
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• upper part of this band continues on to attach to the
back of the disk, lateral to the condylar pole.

• The outer oblique band becomes taut in the

protraction of the condyle, which accompanies the
opening of the jaw, thereby limiting the inferior
distraction of the condyle in forward gliding and
rotational movements

• The inner horizontal band tightens in retraction of the

head of the mandible, thereby limiting posterior
movement of the condyle.

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2. Collateral Ligament

• Also called discal ligament.

• Attaches the medial and lateral

borders of disc to to poles of
condyle.

• Prevents the movement of disc

away from condyle as it glides
forward and downward.

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3. Capsular Ligament
• Surrounds entire TMJ

• Superiorly attaches to the temporal

bone along the borders of articular
surface of glenoid fossa and articular
eminence.Inferiorly attaches to neck
of condyle.

• Resists any medial, lateral or

inferior forces.

• Retains the synovial fluid.

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3. Sphenomandibular Ligament:

• Arises from the angular spine of the

sphenoid and petrotympanic fissure,
runs downward and outward to insert on
the lingula of the mandible.

• The ligament is pierced by the

myelohyoid nerve and vessels.

• This ligament is passive during jaw

movements, maintaining relatively the
same degree of tension during both
opening and closing of the mouth.
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4. Stylomandibular ligament:

• Extends from the apex of the styloid

process to the angle of mandible and
posterior border of mandible.

• It is a local concentration of deep

cervical fascia.

• It is lax when the jaws are closed and

slackens when the mouth is opened.

• This ligament becomes tense only in

extreme protrusive movements.
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SYNOVIAL FLUID
• It is clear, straw-colored viscous fluid, which diffuses out
from the rich capillary network of the synovial membrane.

• CONTENTS:
1. Hyaluronic acid
2. Free cells like macrophages

• FUNCTIONS:
1. Lubrication of articulating surfaces.
2. Transport of nutrients to avascular regions of the joint.
3. Clearing tissue debris produced by normal wear and tear
of the surfaces.
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• The synovial fluid comes from two sources:
1. plasma
2. secretion from type A and B synoviocytes with a
volume of no more than 0.05 ml.

• However, contrast radiography studies have

estimated that the upper compartment could hold
approximately 1.2 ml of fluid without undue pressure
being created, while the lower has a capacity of
approximately 0.5 ml.

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 Vascular Supply of TMJ
• The Blood supply to TMJ is only Superficial, i.e. there is
no blood supply inside the capsule, its nourished by
Synovial fluid.

• It receives superficial supply from the branches of

external carotid artery-
1. Superficial temporal artery
2. Deep auricular artery

• Venous drainage by superficial temporal vein.

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 Nerve Supply
• It receives nervous supply from the branches of
mandibular division of trigeminal nerve, namely-
1. Auriculotemporal
2. deep temporal
3. masseteric

• 4 types of nerve endings can be seen here-

1. Ruffini’s corpuscles (limited to capsule)
2. Pacinian corpuscles (limited to capsule)
3. Golgi tendon organs (confined to ligament)
4. Free nerve endings (most abundant)
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• Ruffini Endings- Position the mandible
• Pacinian Receptors- Accelerate movement during
Reflexes
• Golgi tendon Organs- Protection of ligaments Around
TMJ
• Free Nerve Endings- Pain receptors

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 Functional Movements
• Rotational / hinge movement in first 20-25mm of mouth
opening, translatory movement after that when the
mouth is excessively opened.

• Translatory movement – seen in the superior part of the

joint as the disc and the condyle traverse anteriorly along
the inclines of the articular eminence to provide forward
and downward movement of the mandible.

• Hinge movement – seen in the inferior portion of the

joint between the head of the condyle and the lower
surface of the disc.
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• Depression Of Mandible
– Lateral pterygoid
– Digastric
– Geniohyoid
– Mylohyoid

• Elevation of Mandible
- Temporalis
- Masseter
- Medial Pterygoid

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• Protrusion of Mandible
– Lateral Pterygoid
– Medial Pterygoid

• Retraction of Mandible
- Posterior fibres of Temporalis

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 Age Changes in TMJ
• Condyle:
– Becomes more flattened
– Fibrous capsule becomes thicker.
– Osteoporosis of underlying bone.
– Thinning or absence of cartilaginous zone.

• Disk:
– Becomes thinner.
– Shows hyalinization and chondroid changes.

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• Synovial fold:
– Become fibrotic with thick basement membrane.

• Blood vessels and nerves:

– Walls of blood vessels thickened.
– Nerves decrease in number

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Thus these structural changes bring about complications
Like:-

-Decrease in the synovial fluid formation

-Impairment of motion due to decrease in the disc and

capsule extensibility

-Decrease the resilience during mastication due to

chondroid changes into collagenous elements

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 TMJ in Orthodontics
• No orthodontic procedure can be performed in
isolation without considering its possible effect on the
temporomandibular joint.

• Etiologic factors that might cause upward and backward

pressures on the mandible should be reduced as much
as possible.

• Mechanotherapy that may cause upward and backward

pressures on the condyles is not recommended.

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• Retention procedures should be planned to provide a
proper path of closure to minimize or prevent
possible retrogressive post-treatment changes.

• The orthodontic treatment does not appear to be a

valuable resource for treating or preventing the onset
of signs and symptoms of TMD.

• The application of forces during certain orthodontic

mechanics, especially orthopedic situations, can
cause alterations in condylar growth and bone
structures of the TMJ.

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 Conclusion
• The temporomandibular joint is one of the most
complicated working assemblies in the human body.

• The correct occlusal relationship as a result of

orthodontic treatment is not obtained at the expense of
nonphysiological positioning of both the condyle and
the articular disc.

• Thus, the mechanics application should be performed

properly and the professional must have knowledge of
these impacts.
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 References

• BD Chaurasia’s, Human anatomy 2nd edition.

• Gray’s Anatomy-39th Edition
• Jeffrey P.Okeson Management of TMJ Disorders and
Occlusion
• Snell’s Anatomy

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