TEMPOROMANDIBULARDISORDERS

AmericanDentalAssociation,1983definedTMDasagroupoforofacialdisorderscharacterizedby:Paininthepreauriculararea,TMJ,ormusclesofmasticationLimitations/deviationsinmandibularrangeofmotionTMJsoundsduringjawfunction1990YCraniomandibularDisorders(CMD)DefinitionEpidemiologyofTMDTMDpainhasbeenestimatedtoaffect10%(5-12%)ofthepopulationItisatleasttwiceascommoninwomenasinmenItoccursmorefrequentlyinpeople20-50yearsoldAnatomyofTMJMandibularcondyleJointsurfaceoftemporalboneArticulardiscTMJcapsuleTMJligamentMulti-axis&multi-direction

?MovementagilityAimportantpartinstomatognathicsystem?AremodelinginalllifetimejointAnatomyofTMJSagittalplaneview:Therelationshipamongdics&condyle&glenoidinCOPNormal:Oneplane:frontbevelofcondyle/middlepartofdisc/posteriorbevelofnodeOneline:crossridgeofcondyle/posteriorborderoflaterbeltofdisc/peakofglenoidAbnormal:1.Retrusionofcondyle2.HyperfunctionoflateralpterygoidmuscleAnatomyofTMJCoronalplaneview:therelationshipofdisc&condyle&nodeinCOPNormal:middlepositioncondyleanddiscinmiddlepositionAbnormal:Ingressionorout-shiftofcondyleanddiscAnatomyofTMJEtiologyofTMDPsychicfactorBadhabitsTraumaOthersOcclusalfactor:OcclusalinterfereProtrusiveocclusalinterfereLateralocclusalinterfereRetrusive

occlusalinterfereHighspot×occlusionEtiologyofTMDLateralocclusalinterfereOcclusalfactorPrematurecontact：interferehappenedinPPtoICPElongationofupper3rdmolarAnteriorsuperiordisplacementofcondyleElongationoflower3rdmolarPosteriordisplacementofcondyleEtiologyofTMDOcclusalfactorMalocclusion:MalocclusionofindividualtoothMalocclusionofdentitionEtiologyofTMDAnteriorteethlingualtippingdeepoverbiteOcclusalfactorMoreteethlosedLateralmolarsloss：unilateralmasticationBilateralmolarsloss：PosteriordisplacementofcondyleMaladjustmentofReversetensilereflectionEtiologyofTMDOcclusalfactorChangeofinterarchdistance:Morehigher:apertognathiaMorelower:excessivewearAnteriorinferiordisplacementofcondyleSustainedtensionofmasticationalmusclePosteriorsuperiordisplacementofcondyleMaladjustmentofreversetensilereflectionEtiologyofTMDMorehigherverticaldistance

withmoretensermusclesMorelowerininterarchdistance－－seriousteethwearOcclusalfactorsLatrogenicfactors:OralmadicineProsthodonticsOrthodonticsEtiologyofTMDPredisposingfactorsInitiationfactorsPerpetuatingfactorEtiologyofTMDPainTMJsoundsLimitationsinmandibularrangeOthersClinicalmanifestationofTMDMusclederivedpainArticularderivedpainprotectivemusclesplintinglocalmusclesorenessmyofascialpainmyospasmchronicmyosis

painhappenedindiscandligamentretrodiscitissynovitisorcapsulitisosteoarthritisClinicalmanifestationofTMDDisplacementofdiscRecoverablitydiscdislocationUnrecoverabilitydiscdislocationRecoverablitydiscdislocationUnrecoverabilitydiscdislocationClinicalmanifestationofTMDAntiorerdiplacementofdiscAntiorerdiplacementofdiscTMJsoundsTMJsoundsHyperosteogeny&discperforationSynoviumlesionsClinicalmanifestationofTMDOpeninglimitationAbnormalopeningClinicalmanifestationofTMDTensiontypeheadacheMigraineOthersClinicalmanifestationofTMDClinicalexaminationofTMDOpeningpatternsStraightDeviation(right&left)CorrecteddeviationOthersClinicalexaminationofTMDOpeningpattenStraightDeviation(right&left)CorrecteddeviationOthersClinicalexaminationofTMDClinicalexaminationofTMDClinicalexaminationofTMDClinicalexaminationofTMDClinicalexaminationofTMD患者自身?xiàng)l件評(píng)價(jià)（patientassessmentofcondition)：chiefcomplaints;treatmenthistory&expectation行為狀態(tài)評(píng)價(jià)(behavioralstatus)：jawdisability;parafunctionalbehaviors;generalhealthbehaviors心理評(píng)價(jià)(psychologicalstatus)：depression;anxiety;somatization（精神狀態(tài)的軀體表現(xiàn)）社會(huì)心理評(píng)價(jià)(psychosocialstatus)

：pain-relatedinterferencewithdailylife,painintensityandpersistence,socialsupportClinicalexaminationofTMDTreatmentofTMDRelaxationsplintTreatmentofTMDStabilizationsplintTreatmentofTMDRepositioningsplintTreatmentofTMDPivotsplintTreatmentofTMDTreatmentofTMDOcclusaladjustmentSurgeryOrthodonticsProsthodonticsThanks下頜運(yùn)動(dòng)軸心?