TEMPOROMANDIBULAR JOINT-

ANATOMY AND FUNCTION

PRESENTED BY: GUIDED BY:

DR. RITIKA PATEL DR. RUPAL SHAH (HEAD OF THE DEPARTMENT
PG 1ST YEAR AND PROFESSOR)
DEPARTMENT OF PROSTHODONTICS DR. SANJAY LAGDIVE (PROFESSOR)
“FUNCTION MUST BE UNDERSTOOD
BEFORE DYSFUNCTION CAN HAVE
MEANING”
 CONTENTS
• Introduction
• Evolution of TMJ
• Development of TMJ
• Anatomy of TMJ-
          Bony components
          Articular disk and its attachments
• Ligaments
• Relations of TMJ
• Vascular and nerve supply
• Muscles around TMJ
• Movements of TMJ
• Coordinated and disharmony in muscle activity
• Classification of TMDs
• Age changes in TMJ
• Conclusion
• Questionnaire
• References
 TEMPOROMANDIBULAR JOINT

•The area where the mandible articulates with the temporal bone of
the cranium is called as temporomandibular joint. ( okeson 8 th

edition)

•It is also considered as ginglymoarthrodial joint.

•TMJ is classified as a compound joint,  by definition a compound

joint that requires presence of at least three bones yet TMJ is
formed of two bones, functionally the articular disc serves as a non-
ossified bone that permits the complex movements of the joint
 EVOLUTION OF TMJ

The joint is unique to the mammals

In other vertebrates the joint is of compound type

where number of bones were involved.

 EVOLUTION OF TMJ

With evolution the compound lower jaw was reduced to one bearing teeth that articulate to the
newly developed surface of temporal bone.

Thus in phylogenetic terms it is a secondary joint because it developed as a separate joint and not
as a modification of the primary joint.

• Ref : TMJ disorders & Orofacial pain by Busmann & Lotzmann

 DEVELOPMENT OF
TEMPOROMANDIBULAR
JOINT
• 6th WEEK:

Lateral mesenchymal condensation along the meckel’s cartilage at the division of inferior
alveolar nerve into incisive and mental branches.

• 8th WEEK:

The development of both the components of TMJ begins. The migration of  neural crest cells
initiates the process. The temporal component of the joint also condenses simultaneously.

• 10th WEEK:
Wedge shaped condylar cartilage sits on the mandible.
• 10-12th WEEK:
The condylar cartilage grows rapidly in pace with widening cranial base (interdependence) . Condensation of
mesenchyme occurs in between the two (the anterior part goes to form lateral pterygoid and superior part goes
to form malleus)

• 12th WEEK :
 The two blastema meet , cellular breakdown begins with cavity formation ( upper and lower )

•14th WEEK :
Basic morphology of joint cavity formed (matured)
Critical period for the appearance of
malformations in joint seen in between 7th
to 12th week
• Once the TMJ is formed it doesn’t differentiate more but only increase
in size with age

• The inclination and the protuberance of the occlusal plane varies with
age and function by 90% is determined by the age of 10yrs
 ANATOMY OF
TEMPOROMANDIBULAR
JOINT
COMPONENTS OF TMJ

OSSEOUS SOFT TISSUE

 OSSEOUS COMPONENT
It includes :

Mandibular fossa/Glenoid fossa

Mandibular condyle

Articular eminence
• the upper articular surfaces is formed by
the following parts of temporal
bone:-
1. Articular eminence
2. Anterior part of mandibular fossa•

• The articular eminence is made of dense

bone and covered by the dense compact
fibrous tissue (type I collagen) suitable to
bear the load.
•It is non articulating
 The Glenoid fossa is 15 to 20mm
long(medial to lateral) and 8 to 12mm thick•
Post-Glenoid & Entoglenoid process
                               

The inferior articular surface is formed by

the head of the mandibular condyle.
•
•
•
 ¨The condyles are elliptical in shape and if
long axis of the two condyle are extended
medially, they converge to meet at basion on
the anterior limit of Foramen Magnum
¨
¨The angle formed will be 150˚ to 170˚
                               
The condyle  mediolaterally  is 15-20mm
and anteroposteriorly  8-10mm

The rotation of condyle happens only at

the medial pole and translation at the
lateral pole 
 HISTOLOGY OF
ARTICULAR SURFACES
 The articular cartilage of the mandibular condyle and fossa are
composed of four distinct layers or zones

•The most superficial layer is called the articular zone. It is found adjacent
to the joint cavity and forms the outermost functional surface.

•Unlike most other synovial joints, this articular layer is made of dense
fibrous connective tissue rather than hyaline cartilage.

•Most of the collagen fibers are arranged in bundles and oriented nearly
parallel to the articular surface.

•The fibers are tightly packed and are able to withstand the forces of
movement.
•The second zone is called the proliferative zone and is mainly
cellular. It is in this area that undifferentiated mesenchymal tissue is found.

•The third zone is the fibrocartilaginous zone. Here the collagen

fibrils are arranged in bundles in a crossing pattern, although some of the collagen is
seen in a radial orientation.

•The fourth and deepest zone is the calcified cartilage zone. This
zone is made up of chondrocytes and chondroblasts distributed
throughout the articular cartilage
ANATOMY OF SOFT TISSUE
COMPONENTS
 JOINT CAPSULE
The superior and inferior synovial membrane lines the fibrous layer of capsule
superior and inferior to the disc respectively secreting synovial fluid collected
in marginal gutters/sulci
¨
• ¨Upper compartment 1.2ml
• ¨Lower compartment 0.9ml
                               
¨
¨
Synovial fluid contains nutrients like protein, mucin hyaluronic
acid and some electrolytes derived from blood and extra
cellular fluid

Thus it plays the role of lubricant as well as nutrient medium

for the non vascular areas 
 The fibrous membrane encloses the TMJ complex
& is attached to:-
• ­Above– ant. magrin of articular tubercle
• ­Laterally & medially—margins of articular fossa
• ­Posteriorly– tympanosquamous suture
• ­Below– upper part of neck of mandible
­The articular disc attaches around its periphery to
the inner aspect of the fibrous membrane
 ARTICULAR DISC

Flat approximately circular biconcave fibrous disc divides the joint in two compartment i.e.
Upper and Lower

The disc contains collagenous fiber in different directions to resist shearing effect

With progressive age more of chondroid cells are seen and so also degenerative changes
 Thickest posteriorly, thin in centre and somewhat thicker anteriorly.
• ­Anteriorly 2mm
• ­Intermediate 1mm
• ­Posteriorly 3mm

This prevents disc displacement in inferior or posterior direction

 It is attached to the articular capsule & is directly fused in all sides except posterior section
where it is connected by a thick layer of tissue. 

This thick layer of tissue is bilaminar & known as the Retrodiscal tissue

The superior lamina is attached to the tympanic plate posterosuperiorly

¨
¨
Contains high amount of elastic fibers and it retracts the disc when the condyle moves
forward as in wide opening of mouth e.g. yawning
 The inferior lamina is attached posterosuperiorly to the neck of condyle
¨
Being high in collagenous content, it is unable to stretch and prevents excessive rotation
of the disc over condyle
Blood vessels are absent in the fine centre area indicating pressure exist in the joint

The avascular areas are devoid of nerve innervations also…thus if the joint is seated
properly it can bear forces without any discomfort
Disc acts as:-
• Buffer and shock absorber
• Makes articulation more
harmonious
• Strengthens the joint

Joints with menisectomy can

function but soon show sign of
excessive wear
LIGAMENTS
Collateral discal ligaments attaches the  disc to poles of condyle
medially and laterally

This permits the anterior posterior rotation of the disc on the condyle.

Discomalleolar / Pinto’s /  malleomandibular ligament runs from the

malleus in middle ear to posterior aspect of the capsule and disc as well
as connecting on the sphenomandibular ligament (29% cases)
 Capsular ligament : Reinforces the lateral aspect of the capsular
ligament
Encompasses the joint retaining the synovial
fluid. Outer oblique and inner horizontal parts

Fibroelastic, well vascularised and well Restricts excessive rotation

innervated.
Protects posterior retrodiscal tissue
Provides proprioceptic feedback

Temporomandibular ligament :
 EXTRA CAPSULAR LIGAMENT
The lateral ligament is the closest to the joint, lateral & runs diagonally backwards from the margin
of the articular tubercle to the neck of the mandible and has an outer vertical and inner horizontal
portion

• Horizontal part:- limits retrusion and laterotrusion

• Vertical part:- limits jaw opening
                  

                                                  
 The sphenomandibular ligament is medial
to the TMJ ,runs form the spine of the
sphenoid bone to the lingula on the
medial side of the ramus
• Restricts protrusive and mediotrusive 
   movements as well as jaw opening

¨
The stylomandibular ligament passes from
the styloid process to the posterior
margin and the angle of the mandible.
• Restricts protrusive and mediotrusive 
   movements
• Also prevents excessive upward rotation
of mandible
 Tanaka’s Ligament:-
A chord like reinforcement of medial capsule wall,
similar to lateral ligament.
Lateral ligament

Capsule of TMJ

Sphenomandibular ligament
Stylomandibular ligament
The presence of the disc allows the ginglymus and
diarthroidal movements

The loose attachments between the capsule, skull

and disc allows the diarthroidal movements in the
upper compartment

The tight attachments between the disc, capsule and

the condyloid process limits the movement to
ginglymus in lower compartment .
 RELATIONS OF
TEMPOROMANDIBULAR
JOINT
 Laterally:-

• Skin and fascia

• Parotid gland
• Temporal branches of facial nerve
Medially:-

• Tympanic plate separates the joint

from the internal carotid artery.
• Spine of sphenoid
• The auriculotemporal and chorda
tympani nerves
• Middle meningeal artery
 Anterior:-

• Lateral pterygoid
• Masseteric nerve and vessels
Posterior :-

• The parotid gland separates

the joint from the external
auditory meatus
• Superficial temporal vessels
• Auriculotemporal nerve
 Superior :-

• Middle carnial fossa

• Middle meningeal vessels
Inferior:-
• Maxillary artery
• Maxillary vein
BLOOD AND NERVE
SUPPLY
• The veins of joint drain to superficial temporal
veins , pterygoid plexus and maxillary vein

• Lymphatic vessels from lateral and ant. surface

drain into pre-auricular & parotid nodes.
¨
• The post. & medial surface drains into the sub
mandibular group of lymph nodes.
 Nerve supply :

• Auriculotemporal nerve
• Messeteric nerve

TMJ contains mechanoreceptors namely:-

1. Ruffini corpuscles
2. Pacini corpuscles
3. Golgi tendon organ
4. Free nerve endings
• Ruffini endings present in superficial layer and signal static joint position,
changes in intraarticular pressure and the direction, amplitude & velocity of
joint movements

• Pacinni corpuscles are rapidly acting mechanoreceptors with a low threshhold

in deeper layers and signal joint acceleration and deacceleration.

• Golgi tendon organ are limited to the ligaments and become active in extreme
movements of joint.
 MUSCLES AROUND
TEMPOROMANDIBULAR
JOINT
• Compressive forces of jaw musculature is around 975 lbs/sq. inch
• The prosthesis should be in harmony
Positioner muscles:- responsible for the horizontal movements of mandible
from centric relation (includes depressors)

Elevator muscles:- positioned distal to the teeth so they elevate the condyles
and hold them firmly against the eminence while hinging the jaw
 The muscles that are involved in  movement of
mandible are:-

1. Lateral pterygoid
2. Medial pterygoid
3. Masseter
4. Temporalis
5. Anterior belly of digastric
6. Posterior belly of digastric
7. Geniohyoid
8. Mylohyoid
 MOVEMENTS OF
TEMPOROMANDIBULAR
JOINT
 DISC MOVEMENT

• The disc rotates on the condyle like a bucket handle attached to

collateral ligaments
• This disc is also threaded back with the posterior ligament
• Elastic fibers behind maintain constant tension
• The combination of this tension and muscle pulls causes movement of
the disc
 OPENING-

• In centric relation, the disk is positioned

at the most forward position (on top of
the condyle) that the posterior ligament
allows.

• As the inferior lateral pterygoid muscle

starts to pull the condyle forward,
the superior lateral pterygoid muscle
releases contraction to allow the elastic
fibers to start pulling the disk more to the
top of the condyle.
 Maximum opening

• When the condyle reaches the crest of

the eminence, the elastic fibers have
rotated the disk back because the
superior lateral pterygoid muscle is in a
controlled release.

• The posterior ligament (PL) (which is

not elastic) becomes more lax as the
disk moves back.
 Closing

• the condyle starts to move back and up the

steeper slope of the articular eminence, so
the disk must be pulled back to the front of
the condyle.

• To accomplish this, the superior lateral

pterygoid muscle starts its contraction as
the inferior lateral pterygoid muscle
releases the condyle to the elevator
muscles that pull it back.
 Closed

• When the condyle reaches centric relation,

the disk has been pulled as far forward as
the posterior ligament will allow.

• If the ligament is intact and has not been

stretched or torn, the disk is stopped in
perfect alignment with the direction of
loading through the condyle.
 BORDER MOVEMENTS
•Border refers to the boundary of a surface and may imply the limiting line.

•Border positions of the mandible can be defined as the extreme positions of the mandible in
any direction in which it moves. The border positions are limited by nerves, bones, muscles,
teeth when present, and ligaments.

•The limiting is not a simple mechanical stoppage but a physiologic control through the
neuromuscular system

•According to Possell,  the border movements of the mandible are reproducible,

and all other movements take place within the framework of the borders.
BORDER MOVEMENTS - DR. ULF POSSELT (1952)
SAGITTAL MOVEMENT
HORIZONTAL PLANE
FRONTAL PLANE
ROLE OF MASTICATORY
MUSCLES
 COORDINATED MUSCLE MOVEMENTS
Coordinated muscle function refers to the timely release of a muscle or
group of muscles as contraction of antagonistic muscles takes place.

• As the jaw opens, the depressor muscles contract while the

elevator muscles release their contraction.

• The inferior lateral pterygoid muscle contracts during opening.

 Coordinated muscle function during jaw
closure

• As the jaw closes, the elevator muscles

contract while the depressor muscles release
contraction.

• Inferior lateral pterygoid muscle releases its

contraction and is passive
 Coordinated muscle function at maximum
intercuspation

• Release of the inferior lateral pterygoid

muscle during elevator muscle contraction is
the goal of occlusal harmony.

• The superior belly of the lateral pterygoid

muscle is active to hold the disk in
alignment with contact against the posterior
slope of the eminentia
 DISHARMONY BETWEEN THE OCCLUSION AND TMJ
If the condyles must be displaced from Incoordinated muscle function
centric relation to maximum intercuspation, The effect of having to displace the condyles to
the inferior lateral pterygoid muscle must make the teeth fit always directed at muscle.
contract to move the mandible to the
position of maximum intercuspation.
Four movements of prime importance to complete denture service are-

(1) the hinge like movement used in opening and closing the mouth for the introduction of food and, to a
limited degree, for the crushing of certain types of brittle food,

(2) a protrusive movement used in the grasping and incision of food,

(3) right or left lateral movements for use in the reduction of fibrous as well as other types of food,

(4) Bennett movement - the bodily side shift of the mandible which, when it occurs, may be recorded in
the region of the rotating condyle on the working side.
 CONDYLE PATH
• The condyle path is a controlling factor in mandibular movement and is peculiar to each
individual patient.

• It is the path traveled by the condyles in the temporomandibular Joints during the various
mandibular movements.

• In completely edentulous patients condyle paths are determined by

(1) the bony fossae,

(2)The tone of the muscles responsible for mandibular movements and their nerve controls,
(3) the limitations imposed by the attached ligaments, and
(4) the shape and movements of the menisci.

The path cannot be altered by the prosthodontist.

 Prosthodontic consideration-

• Two controlling end factors that must be considered in complete denture occlusion-
1.Condylar inclination- only factor determined by patient
2.Incisal guide angle- determined by dentist within esthetic limits.

• Any lack of harmony between tooth inclines and condylar inclines can result in
disturbance in temporomandibular articulation and stability of denture.
TEMPOROMANDIBULAR
JOINT DISORDERS
Derangements of the Structural incompatibility Inflammatory disorders
condyle disc complex of the articular surfaces of the joint

Disc displacement with Synovitis

Deviation in form
reduction

Disc displacement with

Capsulitis
intermittent locking Adherences/adhesions

Disc displacement without

Retrodiscitis
reduction subluxation

Arthritides
Luxation
AGE CHANGES IN TMJ
CONDYLE :
Becomes flattened SYNOVIAL FOLD :
Fibrous capsule becomes thick Fibrotic with thick basement membrane
Osteoporosis
Thinning or absence of cartilaginous bone.
BLOOD VESSELS AND NERVES :
DISC : Vessels become thickened.
Becomes thinner Nerves decrease in number.
Shows hyalinization and chondroid changes .
 CONCLUSION-
• It is impossible to comprehend the fine points of occlusion without an in depth
awareness of the anatomy, physiology, and biomechanics of the temporomandibular
joint (TMJ).

• The first requirement for successful occlusal treatment is stable, comfortable TMJs.
The jaw joints must be able to accept maximum loading by the elevator muscles with
no sign of discomfort.

• This understanding of the TMJ is foundational to diagnosis and treatment of almost

everything a dentist does.
 QUESTIONNAIRE
1.Anatomy and structure of TMJ and its functioning with respect to mastication

2.Development of TMJ ?

3.What are the age changes in TMJ ?

4.Anatomy of TMJ with reference to movement in mandible influencing occlusion?

5.Effect of faulty occlusion on TMJ ?

 BIBLIOGRAPHY
1. Journal of Anatomic society of India ,Vol 49,Dec 2000
2. Gray’s Anatomy
3. Human Anatomy, Chaurasiya Vol III
4. Clinically Applied Anatomy, Moore & Dalley
5. Clinical Anatomy, Snell
6. Human Embryology, Inderbeer Singh
7. Human Histology, Inderbeer Singh
8. Human Anatomical Atlas, McCinn’s
9. Oral Histology, Ten Cate’s , 6 Edition
th

10.Oral radiology, Goaz and White

●
 BIBLIOGRAPHY

11)  Management of Temporomandibular Disorders and    

       Occlusion, Okeson, 5th Edition
12)  Functional Occlusion , Dawson, 5th edition
13)  TMJ Disorders & Orofacial pain , Bumann & Lotzmann
14)  Syllabus of Complete Denture , Heartwell , 4 edition
th

15)  Essentials of Complete Denture Prosthodontics , 

16) Winkler , 2nd edition
17) Dental Occlusion & TMJ , Gerber & Steinhardt
18)Contemprary Orthodontics, Proffit
19) Text book of oral & maxillofacial surgery, Neelima Malik
THANK YOU