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Tore L. Hansson

~ Temporomandibular joint dysfunction or craniomandibular disorders from a clinical and practical point of view, focusing on TMJ condylar asymmetry when present.

Tore L. Hansson

Category Archives: Temporomandibular Joint Sounds

TMD 2015, Condylar Asymmetry?

10 Tuesday Feb 2015

Posted by torelhansson in Arthrogeneous origin of pain, Asymmetry Index TMJ, Bruxism, Condylar asymmetry, Function & dysfunction of the stomatognathic system, Functional pain, Mandibular position, Retruded Position of the Mandible, Temporomandibular Joint Clicking and Popping, Temporomandibular Joint Disk Displacement, Temporomandibular Joint Sounds, Treatment planning, Uncategorized

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Arthrogeneous origin of TMJ pain, Asymmetry, Asymmetry Index, Bruxism, condylar asymmetry recognition, Dentistry, Occlusal device, Retruded Position of the Mandible, Temporomandibular joint diagnostics, Temporomandibular joint disorder, Temporomandibular joint pain, TMJ rehabilitation, Treatment planning

Reflecting back on the interesting information given by eighteen well known international speakers at the Quintessence International Symposium on TMD & FACIAL PAIN and HEADACHE, Bridging the Gap Between Current Research and Clinical Practice in Scottsdale Arizona ( February 6-7,2015, Co-Chaired by Drs Daniel M.Laskin and Charles S.Greene ) I once again would like to stress the importance to recognize a temporomandibular joint condylar asymmetry when present. Several speakers stressed the overloaded temporomandibular joint as the cause of TMD and advised to pay less attention  to the masticatory muscles initially at  the examination of TMD pain. Lack of synovial liquid and mini ruptures or even nano ruptures of the joint tissues are to be looked upon as causes for cartilage degeneration with osteoarthritis / osteoarthrosis as the end result.

It is my opinion that in combination with bruxism a temporomandibular joint condylar asymmetry needs to be acknowledged and addressed. The shorter condyle side joint is in its morphology unstable and easily develops internal derangement of its articulating parts.  The well known phenomenon of disk displacement is thereby a fact and the first step in joint break down with the diagnosis Arthritis microtraumatica art.temp.mand. In this perspective occlusion becomes extremely important . The shorter condyle side joint needs to be supported with the correct vertical dimension of occlusion. What is missing in vertical dimension inside that joint needs to be compensated for at the level of the teeth of the ipsilateral side. In my mind this is the only possibility to create a stable occlusion with the maintenance of improved joint function after the initially reversible approach with an orthotic device.

Finally a statement/question that might need some thoughts: How much longer are we as a profession going to talk about occlusion without considering the vertical dimension of the two temporomandibular joints!?

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TMJ Clicking Sound

10 Monday Feb 2014

Posted by torelhansson in Arthrogeneous origin of pain, Bruxism, Condylar asymmetry, dentistry, Function & dysfunction of the stomatognathic system, Functional pain, Mandibular position, Myogeneous origin of pain, Occlusion, Retruded Position of the Mandible, Reversible treatment, Temporomandibular joint (a)symmetry, Temporomandibular Joint Sounds, Uncategorized

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Tags

Arthrogeneous origin of TMJ pain, Asymmetry, Centric relation, condylar asymmetry recognition, Dentistry, Myogeneous origin of TMJ pain, Retruded Position of the Mandible, Temporomandibular joint, Temporomandibular Joint Clicking, Temporomandibular joint diagnostics, Temporomandibular Joint Disk Displacement, Temporomandibular joint pain, Temporomandibular Joint Sounds

TMJ clicking sound has been reported, discussed, investigated and even visualized in thousands of articles during the past thirty and more years with a peak of interest in 1980-s. Common knowledge is that the sound is either due to deviations in form of the articulating surfaces of the condyle and / or the temporal component ( increase of cartilage in specifically overloaded areas of the articulating surface ) or to a displacement of the disk. Disk displacement often comes and goes and it is therefore not a surprise that it is more common among patients with a mainly myogeneous origin of pain. Since the result of comprehensive epidemiological  studies in the 1970-s it is also common knowledge that  the phenomena occurs in about 40% of the adult population.

Hopefully in not contributing to the too often clinically existing confusion of how to handle the sound I would rather suggest the following: Check the panoramic x-ray i.e. check specifically the temporomandibular joint condylar heights before you take any further steps in your attempt to help your patient!

Most probably you will find a shorter condyle of the joint with the registered clicking sound. Try to guide a mandibular rotation movement around the higher condyle and most likely the clicking sound disappears or at least gets a reduced  magnitude, when it is due to a latent disk displacement. If there is no discomfort or pain to be registered there is no real indication for intervention. However, if discomfort or a mainly myogeneous origin of pain is reported by the patient there is a need for an initially reversible treatment in form of a stabilization splint that compensates for the difference in vertical dimensions between the two condyles. The splint is to be worn part time . The patient is supposed to find a seemingly fast relief.  When the clicking sound is found in combination with a mainly arthrogeneous origin of pain the splint needs to be worn as much as possible for at least 6 months before additional permanent treatment is considered.

In addition , even if the clicking sound is due to a deviation in form ( of the condyle and / or of the temporal component )  the clicking sound may over time get reduced as a smoothening out of the articulating surfaces can be expected at a consequent long term  wearing of the correctly designed splint. Therefore I once again would suggest the use of the Maaxloc instrument in producing the index  which will be used in mounting the models into the articulator before the construction of the stabilization splint. The splint absolutely must compensate for the registered difference in vertical condylar height between the two joints in providing a symmetrical oral stability in order to eliminate the  painful and bothersome  tmj clicking.

Recent Posts

  • House of Gnathology part II
  • Splint (Oral Orthosis) Adjustment, A Necessity?
  • Too many adjustments on the dental work?
  • Prefabricated occlusal devices,mouth guards or splints
  • Splint adjustments

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Categories

  • Abused protrusion
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Recent Posts

  • House of Gnathology part II
  • Splint (Oral Orthosis) Adjustment, A Necessity?
  • Too many adjustments on the dental work?
  • Prefabricated occlusal devices,mouth guards or splints
  • Splint adjustments

Recent Comments

torelhansson on House of Gnathology part …
Paul C. Riley, DDS on House of Gnathology part …
torelhansson on Asymmetry Index ( AI ) for tem…
R on Asymmetry Index ( AI ) for tem…
marjan on TMJ Condylar Asymmetry

Archives

  • December 2016
  • January 2016
  • December 2015
  • September 2015
  • August 2015
  • July 2015
  • March 2015
  • February 2015
  • December 2014
  • October 2014
  • June 2014
  • May 2014
  • April 2014
  • March 2014
  • February 2014
  • January 2014
  • December 2013

Categories

  • Abused protrusion
  • Arthrogeneous origin of pain
  • Asymmetry Index TMJ
  • Bruxism
  • Condylar asymmetry
  • dentistry
  • Function & dysfunction of the stomatognathic system
  • Functional pain
  • Gnathology
  • Implantology
  • Mandibular position
  • Myogeneous origin of pain
  • Occlusal adjustment
  • Occlusal device
  • Occlusal splints
  • Occlusion
  • Occlusion
  • Orthodontics
  • Orthopantomogram OPG
  • Orthosis
  • Prosthodontics
  • Retruded Position of the Mandible
  • Reversible treatment
  • Temporomandibular joint (a)symmetry
  • Temporomandibular Joint Clicking and Popping
  • Temporomandibular Joint Disk Displacement
  • Temporomandibular joint morphology
  • Temporomandibular Joint Sounds
  • Tension headache
  • TMD
  • TMJ radiology
  • tooth clenching
  • tooth grinding
  • Treatment planning
  • Uncategorized

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