The intra-articular distance within the TMJ during free and loaded closing movements

Previous studies on free opening and closing movements of the mandible have demonstrated that the opening movement traces of the condylar kinematic center (i.e., the condylar point for which the protrusive and the opening movement traces coincide) lie closer to the articular eminence than the closing traces. This indicates the presence of an intra-articular distance within the joint during free closing. Since the mandible behaves like a class III biomechanical lever, a counteracting mechanical load on the mandible during closing will press the condyle-disc complex against the articular eminence. Therefore, in this study the hypothesis was tested that the difference between opening and closing movement traces of the kinematic center is reduced when the closing movements are counteracted by a mechanical load. From 10 healthy participants, 20-second movement recordings were obtained by a six-degrees-of-freedom opto-electronic jaw movement recording system (OKAS-3D) for three types of movements: (1) free opening and closing movements, (2) free opening and loaded closing movements (i.e., the participants closed against a small or high manually applied downward-directed force to the chin), and (3) gum chewing. Off-line, the opening and closing movement traces of the kinematic center were reconstructed, and the average difference between the traces (the intra-articular distance) was calculated. The average intraarticular distance was significantly smaller during loaded closing than during free closing, whereas no significant differences were found in the intra-articular distances between the loaded situations of low and high manual loading and contralateral chewing (ANOVA and post hoc Bonferroni multiple comparisons of means test, p<0.005). In conclusion, loading of the mandible during closing movements reduces the intra-articular distance within the temporomandibular joint.     

Associations between incisor and mandibular condylar movements during maximum mouth opening in humans

This study evaluated the common clinical assumption that condylar translation and mouth opening at the incisor are closely related. The sample studied comprised 27 adult females (23-35 years), selected for normal temporomandibular function, occlusion, and skeletal patterns. Condylar and mandibular central incisor movements (straight-line distances and curvilinear pathways) were recorded in three dimensions (3D) for 20 s with an optoelectric (Optotrak(R)) jaw-tracking system while each participant performed multiple maximum opening cycles. Masticatory analysis and multilevel statistical programs computed the 3D movements of the incisors and condylar hinge axis during opening and closing. The incisor point moved an average straight-line distance of 46.6 mm during opening and 45.9 mm during closing; the lengths of the opening and closing curvilinear pathways were 48.6 and 47.7 mm, respectively. The condyles moved average straight-line distances of 11.9 and 12.2 mm during opening and closing, respectively. The condyles' curvilinear pathways during opening and closing were 14 and 14.6 mm, respectively. Ranges of condylar movement varied widely between individuals. The straight-line distances and curvilinear pathways were highly correlated for the incisors (R=0.98) and the condyles (R=0.98). Neither the straight-line distances nor curvilinear pathways of the incisors were correlated with those of the condyles. Incisor straight-line distances and curvilinear pathways were moderately correlated with mandibular rotation (R(between subjects)=0.82 and R(between repeats)=0.88). During repeated openings, both condylar and incisor excursions increased, but during repeated closings only incisor excursions increased. It is concluded that (1) maximum incisor opening does not provide reliable information about condylar translation and its use as a diagnostic indicator of condylar movement should be limited, (2) healthy individuals may perform normal opening with highly variable amounts of condylar translation, (3) the straight-line distances of the incisor and condyles provide adequate information about the length of the curvilinear pathway, and (4) variation in maximum incisor opening is largely explained by variation in the amount of mandibular rotation.     

Dynamic stereometry of the temporomandibular joint

Studies on jaw kinematics have provided a good understanding of the motion of the mandible in space, but are of little biomechanical relevance because they could not relate the movements to anatomic structures. This is possible by the combination of three-dimensional reconstructions of the temporomandibular joint (TMJ) anatomy with jaw motion recordings. This technique allows us to analyze the variation of the relationship between the articular surfaces, providing indirect insight into disk deformation during function and parafunction as well as TMJ loading. As far as the variation of the condyle-fossa distance is concerned, data indicated that during chewing the distance was smaller 1) on closing than on opening; 2) on the balancing than on the working side; and 3) during chewing of hard than soft food. Moreover, during a forceful static biting, the condyle-fossa distance decreased more on the contralateral, i.e. on the balancing side than on the working side. The decrease was related to the degree of clenching force. These results support the content that both condyles are loaded during chewing and the balancing side joint more than the working one. Biomechanically, the development of osteoarthrosis is more likely related to the magnitude and frequency of stresses applied on the cartilage. Joint movements produce tractional forces that may cause shear stresses contributing to cartilage wear and fatigue. Tractional forces are the result of frictional forces caused by the cartilage surface rubbing and of plowing forces caused by the translation of a stress-field through the cartilage matrix, as the intra-articular space changes during motion. Translation of the stress-field in mediolateral direction seems to be particularly important for the integrity of the TMJ disk because of its anisotropic properties. Dynamic stereometry showed that stress-fields translate in mediolateral direction during opening/closing, protrusion and laterotrusion, and that their translatory velocity varies intraindividually and with the rate of the condylar movement. Furthermore, the results seem to indicate that the lateral area of the TMJ disk is more often exposed to shear stresses caused by stress-field translation than the medial one. In conclusion, dynamic stereometry provides a good visualization of the movement of the condyles in the respective fossae. This helps improving our understanding for the complexity of condylar movements. The technique may also contribute to ameliorate our knowledge of TMJ biomechanics and therefore of the etiology of degenerative joint diseases and possibly also of internal derangement.     

Motion of the human mandibular condyle during mastication

It has been reported that loading to the mandible during closing movement makes the condylar path move more in the superior direction than that during the free closing movement. In this study, the hypothesis was tested that the displacement of the condyle on the chewing side is greater in the direction of the mandibular fossa than that on the non-chewing side. Using a six-degrees-of-freedom jaw movement recording system, we recorded condylar motion in 12 healthy adults without TMD, during the chewing of a large hard gummy jelly. The maximum displacements at the condyle on the chewing side from the maximum intercuspation (CO) position were significantly larger in the superior and medial directions at the initial stage and in the posterior direction at all stages (0.5 mm, 0.5 mm, and 0.6 mm, respectively) than those on the non-chewing side (0.0 mm, 0.1 mm, and 0.1 mm, respectively). This suggests that, in healthy adults, the condyles at CO are located in a position such that excessive load is not applied to the temporomandibular joint when there are the aforementioned displacements.     

Incisor and mandibular condylar movements of young adult females during maximum protrusion and lateratrusion of the jaw

This study evaluated the correlations between condylar translation and incisor movements during maximum protrusion and lateratrusion. The sample was 27 adult females (23--35 years old), selected for normal temporomandibular function, occlusion, and skeletal patterns. Condylar and mandibular central incisor movements [linear distances (LD) and curvilinear pathways (CP)] were recorded in three dimensions for 20 s with an optoelectric (Optotrak) jaw-tracking system while each participant performed multiple maximum protrusive and lateratrusive cycles. Masticatory analysis and multilevel statistical programs computed the three-dimensional movements of the incisors and condylar hinge axis during protrusion and lateratrusion. CP of the incisor point averaged 12.0 mm (9.3 mm LD) during protrusion, 13.0 mm (11.5 mm LD) during right excursion and 12.3 mm (11.0 mm LD) during left excursion. CP of the condyles averaged 11.9--12.9 (9.2--9.5 LD) mm during protrusion. During lateratrusion the contralateral condyles moved anteroinferiorly 11.6--14.1 mm (9.5--10.2 mm LD); the ipsilateral condyles moved posterolaterally 5.8-6.8 mm (2.3--2.5 mm LD). The left condyles demonstrated more movement than the right condyles during protrusion and than the contralateral condyles during laterotrusion. Relative variation, as measured by the coefficient of variation, was greater for the movements of the ipsilateral than contralateral condyles. Incisor movements were only moderately related to condylar movements between individuals and between replicates; LDs showed stronger correlations than CPs; and correlations were stronger for lateratrusion than protrusion. While incisor and condylar movements were not affected by repeated protrusion, incisor CP (approx. 0.2 mm/cycle) and LD (approx. 0.1 mm/cycle) increased significantly with repeated excursive movements to the left and right. It was concluded that (1) incisor protrusion and lateratrusion provide moderately reliable measures of condylar translation; (2) the linear distances that the incisors move during lateratrusion provide the best measure of contralateral condylar translation; and (3) condylar movements are not affected by repeated protrusion or lateratrusion.     

Effects of positions of experimental premature contacts on jaw function

The effects of different positions of experimental premature contacts on the jaw function were investigated on 6 subjects. The metal castings of 100-microns thickness were fabricated to make experimental premature contacts on each of 4 mandibular posterior teeth (from the first premolar to the second molar on the preferable masticatory side). The EMG activity of the masseter, anterior and posterior temporal muscles during maximum clenching and gum chewing as well as the mandibular movement during gum chewing were evaluated. The experimental premature contacts reduced the muscle activity, especially on the contralateral side during maximum clenching. As the premature contact was moved more posteriorly, the following results were observed. 1. The activity of the posterior temporal muscle was decreased on the ipsilateral side while it increased on the contralateral side during maximum clenching in many subjects. 2. The duration of the occlusion phase during the ipsilateral chewing was shortened in many subjects. 3. During ipsilateral chewing, a larger muscle activity was produced during the closing phase and the muscle activity produced during the occlusion phase was the least on the first molar. 4. In any chewing side, the closing and opening paths tended to go toward the chewing side.     

Reduced joint distance during TMJ movement in the posterior condylar position

Biomechanical loading reduces joint distance and has a causative relationship with disc displacement in temporomandibular joint and/or osteoarthritis. Condylar movement and pathways during mouth opening and closing are different depending on the condylar position in the glenoid fossa. Therefore, physical loading on the articular disc or condylar head would also be different in different condylar positions. The aim of this study was to evaluate the 3-dimensional changes of joint distance in different anterior–posterior condylar positions. We divided 52 temporomandibular joints into anterior, concentric, and posterior condylar positions using transcranial radiographs. We traced the condylar movements by simulating mandibular movement with 3-dimensional computed tomography data and a position-tracking camera. The joint distance during temporomandibular joint movement was significantly narrower, and the length of condylar pathways with narrower joint distance was longer in the posterior condylar position than in the concentric (p < 0.05) or anterior condylar positions (p < 0.01). Our study suggests that the posterior condylar position experiences more physical loading than other positions. Therefore, the position may have an accelerating or worsening effect on biomechanical loading-related temporomandibular joint disorder in cases of harmful parafunctional activities such as excessive mouth opening, clenching, and bruxism.     

Subluxation of the temporomandibular joint.

The temporomandibular joint in actual function does not resemble other joints in the body in that the condyles leave their fossae with maximal opening and in some subjects with only a 35 mm. opening. The term subluxation, with its implication of abnormality, does not seem applicable to a normal movement. While significant problems, such as dislocation, locking, and loud clicking, can occur with such anterior-to-the-fossae movements, they are relatively rare. Most temporomandibular problems are associated with confinment of the condyles to their fossae with limited or no translatory condylar movement. A recognition of the normal range of condylar movement would lessen iatrogenic abuse of this area.     

The electromyographic activity of the inferior part of the human lateral pterygoid muscle during clenching and chewing

The nature of activity in the two parts of the muscle is controversial. A reliable technique was developed for recording activity in its inferior part by means of an indwelling needle electrode. This part was most active during anteriorly- or contralaterally-directed intercuspal clenching, vertically-directed clenching with the jaw positioned to the contralateral side or anteriorly, and during jaw opening and least active during vertically-, ipsilaterally- or posteriorly-directed intercuspal clenching, and during vertically-directed clenches with the jaw positioned to the ipsilateral side. During chewing, activity appeared in the late intercuspal phase irrespective of the side used. It commenced earlier when chewing strokes were ipsilateral to the muscle. Activity during both ipsilateral and contralateral chewing strokes continued until maximum opening, when it ceased for the duration of the closing and crushing phases of the cycle. Thus the inferior part, with other muscles, may participate in bracing the condylar head against the articular eminence during vertical-clenching efforts involving condylar displacement, but not in the compressive or crushing phases of the cycle.     

髁突运动中心大张口轨迹与关节窝形态的关系及临床应用探讨

目的　探讨髁突运动中心大张口轨迹与关节窝形态的关系 ,对TMD患者髁突运动中心轨迹特征进行初步研究。方法　利用自行开发的髁突运动中心轨迹显示分析系统 ,分别以运动中心、终末绞链轴点作为参考点 ,观察 10名健康人和 7例临床检查怀疑盘前移位的TMD患者大张口轨迹 ,与磁共振成像得到的相应关节窝形态及关节盘位置诊断结果进行比较。结果　健康人左右侧运动中心轨迹与关节窝形态曲线重合率分别为 80 % (8/ 10 )和 90 % (9/ 10 ) ;终末绞链轴点轨迹与关节窝形态重合率均为 0 (0 / 10 )。TMD患者中 ,11侧盘前移位关节 ,除 1侧可复性盘前移位关节外 ,髁突运动中心轨迹均与正常的轨迹明显不同 ,出现各种改变 ;3侧正常盘位关节 ,髁突运动中心轨迹均与健康人的轨迹相似。结论　运动中心轨迹较终末绞链轴点个体稳定 ,可认为是较理想的研究髁突运动轨迹的参考点     

Relationship between condylar and incisor point displacement during habitual maximum open-close movements

SUMMARY The relationship between condylar movements and incisor point movements during habitual maximum open-close movements were studied in 10 healthy male and 10 healthy female subjects. Jaw movements were recorded by means of an opto-electronic jaw movement recording system, OKAS-3D, capable of recording the six degrees of freedom at a sample frequency of 300 Hz. The lower jaw position of the lateral pole of the condyles was found by means of palpation. In order to analyse the movements, the opening and closing path of the incisor point were divided into ten equal intervals and the corresponding condylar displacement in each interval was calculated. A displacement index was obtained by normalizing the condylar displacement with respect to the maximum condylar displacement. Due to the normalization, the displacement index is not sensitive to possible errors in the location of the lateral condylar point. A clear condylar displacement was already recorded in the first movement interval, right at the start of opening (average displacement index in the first opening interval was significantly greater than zero, P < 0.0005). The condylar displacements in the start and the end interval of opening and closing were smaller than in the intermediate movement intervals ( P < 0.00005).     

Masticatory muscles. Part VI. Masticatory muscles and movement of the lower jaw

The movement paths of the kinematic center of the temporomandibular joint were recorded by means of a jaw movement recording system (OKAS-3D) under 3 conditions: 1. free open and close movements; 2. free opening and loaded closing movements (subjects closed against a small, manually applied, downward directed force on the chin); and 3. during chewing of chewing gum. During free jaw movements, the opening path of the kinematic center lies above the closing path. During loaded closing movements, the opening and closing paths coincide. This indicates that during opening and loaded closing, the condyle-disc complex is slightly pressed against the articular eminence. However, during free closing, there is more space between the articulating surfaces. During gum chewing, the opening and closing paths of the condyle coincide on the balancing side, on the working side they don't. Thus, the joint on the balancing side is loaded and the joint on the working side is not.     

The role of passive muscle tensions in a three-dimensional dynamic model of the human jaw.

The role of passive muscle tensions in human jaw function are largely unknown. It seems reasonable to assume that passive muscle-tension properties are optimized for the multiple physiological tasks the jaw performs in vivo. However, the inaccessibility of the jaw muscles is a major obstacle to measuring their passive tensions, and understanding their effects. Computer modelling offers an alternative method for doing this. Here, a three-dimensional, dynamic model was used to predict active and passive jaw-muscle tensions during simulated postural rest, jaw opening and chewing. The model included a rigid mandible, two temporomandibular joints, multiple dental bite points, and an artificial food bolus located between the right first molars. It was driven by 18 Hill-type actuators representing nine pairs of jaw muscles. All anatomical forms, positions and properties used in the model were based on previously published, average values. Two states were stimulated, one in which all optimal lengths for the length-tension curves in the closing muscles were defined as their fibre-component lengths when the incisor teeth were 2 mm apart (S2), and another in which the optimal lengths were set for a 12.0 mm interincisal separation (S12). At rest, the jaw attained 3.6 mm interincisal separation in S2, and 14.8 mm in S12. Activation of the inferior lateral pterygoid (ILP) and digastric (DG) muscles in various combinations always induced passive jaw-closer tensions, and compressive condylar loads. Maximum midline gape (from maximum bilateral co-activation of DG and ILP) was 16.2 mm in S2, and 32.0 mm in S12. When both model states were driven with muscle patterns typical for human mastication, recognizable unilateral and vertical "chopping" chewing cycles were produced. Both states revealed condylar loading in the opening and closing phases of mastication. During unilateral chewing, compressive force on the working-side condyle exceeded that on the balancing side. In contrast, during the "chopping" cycle, loading on the balancing side was greater than that on the working side. In S2, chewing was limited in both vertical and lateral directions. These results suggest that the assumptions used in S12 more closely approximated human behaviour than those in S2. Despite its limitations, modelling appears to provide a useful conceptual framework for developing hypotheses regarding the role of muscle tensions during human jaw function.     

Sex differences in mandibular movements during opening and closing.

This study evaluated the sex differences in maximum 3-dimensional opening and closing movements. The sample included 29 men (ages, 23-39 years) and 27 women (ages, 23-35 years), who were selected for normal Class I occlusion, temporomandibular function, and skeletal patterns. Condylar (hinge axis) translation and mandibular incisor movements, were recorded with an optoelectric jaw-tracking system; each participant performed 4 maximum opening/closing cycles. The results showed significant (P <.05) sex differences for incisor opening and closing movements, with most of the differences in the vertical component. Male incisor straight-line distances and curvilinear pathways averaged 52.1 mm and 54.8 mm, respectively. Female straight-line distances and curvilinear pathways averaged 46.0 mm and 48.1 mm, respectively. There were significant (P <.05) sex differences for condylar translation, with most of the differences in the anteroposterior component. Male condyles translated 15.4 to 17.6 mm (straight-line distances) and 20.5 to 20.7 mm (curvilinear pathways); female condyles translated 12.4 to 12.7 mm (straight-line distances) and 16.2 to 17.9 mm (curvilinear pathways). Mandibular length accounted for some of the sex difference in interincisal opening and for most of the sex differences in condylar translation. Closing movements showed the same pattern of sex differences as opening movements. Mandibular opening rotation was approximately 4 degrees larger in men than in women. The shapes of the condylar opening and closing pathways also differed significantly between men and women. For both sexes, condylar translation did not correlate with incisor opening or closing movements. It was concluded that (1) significant sex differences exist in incisor opening movements that are independent of mandibular size, (2) sex differences in condylar translation are dependent on mandibular size, (3) incisor opening movements should not be used as an indicator of condylar translation, and (4) sex differences in the shapes of the condylar pathways indicate sex differences in articular eminence morphologic features.     

Relationship Between Sagittal Condylar Path and the Degree of Mandibular Asymmetry in Unilateral Cross-Bite Patients

This study was conducted to investigate the relationship between sagittal condylar path and the degree of mandibular asymmetry during jaw opening movement in subjects (25 adults: 7 males, 18 females) with unilateral cross-bite. The degree of mandibular shift was measured with the axial projected head plate. Sagittal condylar path was obtained by CADIAX. The shifted side of the condyles had a steeper condylar path than that observed on the ipsilateral side. There was no correlation between the deviation of the forward component in the sagittal condylar path and the degree of mandibular asymmetry.     

Medial pterygoid muscle activity during chewing and clenching

Specific activity of the human medial pterygoid muscle in relation to jaw movements and occlusion during mastication and clenching tasks is unclear. EMG activity of the medial pterygoid, masseter, anterior, and posterior temporal muscles was recorded simultaneously with three dimensional incisor point movement of the mandible. Data were sampled and analyzed by an on-line computer system. Patterns of medial pterygoid muscle activity were consistent for ipsilateral chewing and demonstrated activity of the muscle on the chewing side that peaked near the onset of intercuspation. The muscle on the contralateral side was active at the onset of intercuspation for subjects with a chopping stroke and inactive for those with a more lateral stroke guided into intercuspation on cuspal inclines. Activity in the early part of the closing phase was associated with a marked jaw movement toward the chewing side. There was generally less activity in protrusive than intercuspal clenching when occlusion was normal but more activity if marked incisal wear was present or multiple tooth contacts could be attained on protrusion. Intercuspal clenching initiated less activity when force was directed posteriorly and more activity when directed anteriorly than vertical intercuspal clenching.     

Influence of changing the chewing region on mandibular movement

Background:  In the shortened dental arch condition, little is known of how patients adapt their jaw function during mastication to the new oral environment. This study aimed to investigate the changes in mandibular movements when the chewing region was changed from the first molar to the first premolar.
Methods:  Thirty clinical residents with natural dentitions were recruited. The subjects were asked to chew a piece of beef jerky using either the first molar or the first premolar on the preferred chewing side. Three-dimensional trajectories of lower incisors and both condyles were analysed using a jaw movement tracking device with six degrees of freedom during the period between the onset and offset of electromyographic bursts from the masseter and anterior temporal muscles.
Results:  The closing angle of the lower incisors for first premolar chewing was narrower in comparison with that for first molar chewing (p < 0.05). The lengths of the condylar trajectories and the maximum velocities of the condylar movement for first premolar chewing were smaller and slower, respectively, in comparison with those for first molar chewing (both sides; p < 0.01).
Conclusions:  The mandibular movement during mastication might be changed to adapt the premolar chewing because of a loss of posterior occlusal supports.     

Surgical orthodontics and the temporomandibular joint. I. Superior repositioning of the maxilla

Ten randomly selected adults who had undergone orthodontic treatment and isolated superior repositioning of the maxilla for vertical maxillary excess (VME) were evaluated clinically and radiographically (mean, 48.7 months postsurgery) for signs and symptoms of masticatory and temporomandibular joint dysfunction. The patients ranged from 18 years to 37 years of age (mean, 26.2 years) when evaluated. A three-part evaluation of the subjects was performed. This consisted of an anamnestic evaluation (previous medical history), a clinical examination, and a radiographic evaluation. The anamnestic evaluation revealed that, prior to surgery, facial pain was reported by one patient and was not present in any of the patients upon follow-up examination. We believed that the pain was not related to the masticatory musculature and/or the temporomandibular joint. No patients reported pain or sounds in their joints preoperatively, while 30 percent (3/10) of the patients related a history of temporomandibular joint sounds immediately after release of intermaxillary fixation, which subsequently was reported to have resolved in all instances without treatment. Clinical examination of the temporomandibular joints at the time of recall evaluated mandibular movements and the presence of pain or sounds during joint function. These examinations revealed that clinical measures of mandibular movements were somewhat reduced relative to normal. All patients were free of temporomandibular joint and masticatory muscle pain during function, upon contralateral masticatory loading, and upon palpation. Fifteen percent (3/20) of the joints examined demonstrated sounds (popping or crepitation) via auscultation. Masticatory loading in the contralateral premolar region did not induce noise in any of the joints examined. Cephalometric laminagraphic radiographs were obtained of each of the twenty temporomandibular joints with the mandible in three positions; maximum intercuspation, mandibular rest position, and maximal opening. Numerous anatomic relations were quantified from these radiographs. However, only three parameters (condylar position, movement, and evidence of arthrosis) were compared to normative data available in the literature. These comparative data suggested that persons who had undergone orthodontic treatment in conjunction with superior maxillary repositioning demonstrated (1) a relatively retropositional condyle within the fossa and (2) reduced condylar movement during maximal mandibular opening. Two of twenty temporomandibular joints demonstrated radiographic evidence of arthrosis; one condyle demonstrated articular surface erosions, and another exhibited articular surface sclerosis. The overall incidence of arthrosis was not much greater than normal, with 20 percent (4/20) of the joints demonstrating a reduced interarticular joint space. Overall, the clinical findings revealed a low incidence of pathologic masticatory muscle and temporomandibular joint symptoms and signs compared to normative data in the literature...     

A comparison and validation of amorphous sensor condylar movement analysis to MRI diagnosis of anterior disc displacement

This study compared temporomandibular joint condylar movements in a sample of six patients with clinically normal joints, with those of nine patients with joints diagnosed by magnetic resonance imaging (MRI) to have anterior disc displacement with reduction (ADD). The aim of this study was to compare and validate the use of the amorphous sensor to MRI diagnosis in condylar movement analysis. The measuring device consisted of an amorphous sensor and a small magnet. Condylar and jaw movements were recorded simultaneously over the course of 10 open-close cycles. Maximum velocity of condylar movement during the opening phase in the ADD joints was significantly higher than the normal joints. The degree of jaw opening at the turning point of condylar movement in the ADD joints was significantly larger than the normal joints. The diagnostic sensitivity and specificity of the maximum velocity of condylar movement during the opening phase was 75.0 and 75.0%, respectively, while those of the degree of jaw opening at the turning point of condylar movement were 91.7 and 91.7%, respectively. These results suggest that the analysis of condylar movement, employing the amorphous sensor may be a reliable method for diagnosis of ADD.     

Clinical study on the relationship between chewing movements and temporomandibular joint abnormalities

Chewing movements are accomplished by the harmonious function of the stomatognathic system. Therefore, TMJs play important roles in chewing movements. Recently, significant findings on TMJ abnormalities have been obtained from many studies. However, the relationship between chewing movements and TMJ abnormalities remains unclear. The purpose of this study was to examine how TMJ abnormalities were reflected in chewing movements. Incisor point movements during chewing (chewing pattern) were investigated in 150 abnormal and 25 normal subjects using Sirognathograph Analysing System. Abnormal subjects were composed of 45 patients with anterior disk displacement with reduction (reciprocal click), 20 patients with anterior disk displacement without reduction (closed lock), 50 patients with osteoarthrosis and 35 patients with MPD syndrome. Analysis of condylar movements during chewing were also performed in 9 normal and 20 abnormal subjects. The results were as follow; 1. Subjects with TMJ abnormalities tended to show abnormal chewing patterns when chewing at their non-abnormal sides. 2. TMJ abnormality of each different type tended to show its respective characteristic chewing pattern. 1) Subjects with osteoarthrosis and reciprocal click without condylar posterior dislocation tended to show deviation of the turning point to the non-chewing side, with a convex opening path in the frontal plane and a lack of anteroposterior width in the sagittal plane. This finding was associated with the limitation in movement of the abnormal-side condyle. 2) Subjects with reciprocal click with condylar posterior dislocation tended to show a concave opening path and reversed or cross-over patterns in the frontal and horizontal planes, respectively. This finding was associated with the movement of the abnormal-side condyle in the medio-anterior direction during the initial phase of opening. 3) Subjects with closed lock without condylar posterior dislocation tended to show deviation of the turning point to the non-chewing side, with a concave opening path in the frontal plane and a lack of anteroposterior width in the sagittal plane. This finding was associated with the severe limitation in movement of the abnormal-side condyle. 4) Subjects with closed lock with condylar posterior dislocation characteristically tended to show reversed or cross-over patterns in the horizontal plane. This finding was associated with the movement of the abnormal-side condyle in the medio-anterior direction during the initial phase of opening. However, this movement was smaller than that of the reciprocal click. 3. Subjects with MPD syndrome showed chewing patterns similar to those of normal subjects. From the results, close relationships were found between chewing movements and TMJ abnormalities.