МETHODS OF ORTHOPEDICAL TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

Temporomandibular joint (TMJ) disorders take special place in orthopedic dentistry because of difficulties in diagnostic and treatment, sometimes multiplex clinical picture. There is no standard classification of diseases of the joint. Different forms of pathology of this organ often do not fit the traditional diagnosis of "arthritis" and "arthrosis” Temporomandibular joint (TMJ) disorders take special place in orthopedic dentistry because of difficulties in diagnostic and treatment, sometimes multiplex clinical picture. There is no standard classification of diseases of the joint. Different forms of pathology of this organ often do not fit the traditional diagnosis of "arthritis" and "arthrosis”

Petrosov Y.A. (1996) proposed classification, according to which functional disorders and diseases of TMJ are divided into 5 groups Petrosov Y.A. (1996) proposed classification, according to which functional disorders and diseases of TMJ are divided into 5 groups 1) TMJ dysfunctional state: a) neuromuscular dysfunctional syndrome; b) syndrome occlusal-articulation; c) regular sprains of TMJ (jaw, meniscus). 2) Arthritis: a) acute infectious (specific, nonspecific); b) acute traumatic; c) chronic rheumatism, rheumatic and infectious-allergic. 3) Arthrosis: a) post infectious (neoarthrosis); b) post-traumatic (deforming) arthrosis; c) myogenic arthrosis; d) exchange arthrosis; e) ankylosis (fibrous and bone). 4) Combinated forms. 5) Tumors (benign and malignant venous).

Methods of examination of the patient with TMJ disorders Subjective examination (Questioning) Subjective examination (Questioning) Objective examination Objective examination

Objective exanim Survey external oral itntraoral: itntraoral: 1. maximum of multiple dental contacts in the central, front and side occlusion; 1. maximum of multiple dental contacts in the central, front and side occlusion; 2. smooth sliding of dental rows during the transition from one occlusion to another, without horizontal pushes on the teeth; 2. smooth sliding of dental rows during the transition from one occlusion to another, without horizontal pushes on the teeth; 3. absence or reduction of height between alveolar bones; 3. absence or reduction of height between alveolar bones; 4. absence of lateral displacement of the mandible during its transition from physiological resting position to the central occlusion and minimal distal displacement during this; 4. absence of lateral displacement of the mandible during its transition from physiological resting position to the central occlusion and minimal distal displacement during this; 5. absence of injured soft tissues of oral cavity. 5. absence of injured soft tissues of oral cavity. Palpation of TMJ X-ray methods of examination Grafic methpds of examination

Palpation of TMJ Pic. 1. Palpation of the head of mandible. Pic. 1. Palpation of the head of mandible. Pic. 2.Palpation of TMJ in front of external auditory passage Pic. 2.Palpation of TMJ in front of external auditory passage

Treatment of TMJ disorders should be complex 1.physiotherapy 1.physiotherapy 2.massage 2.massage 3.myogymnastic 3.myogymnastic 4.medical treatment 4.medical treatment 5.orthopedic treatment of TMJ disorders 5.orthopedic treatment of TMJ disorders 6.orthodontic treatment before prosthesis 6.orthodontic treatment before prosthesis 7.surgical treatment 7.surgical treatment 8.medical physical training and mechanotherapy 8.medical physical training and mechanotherapy in case of contractures of TMJ in case of contractures of TMJ

Orthopedic treatment includes using medico- diagnostic aparatures, removable and irremovable prosthesis.

Medico-diagnostic aparatures includes: Dental burl, Dental burl, Biting plates, Biting plates, Different construction of palatinal plates that have different purpose. Different construction of palatinal plates that have different purpose.

Pecularities of using of removable and irremovable dentures Bugel prosthes with the cast occlusional plates on the premolars for the restoration of occlusional height and reduction of the depth of incisival contacts. Bugel prosthes with the cast occlusional plates on the premolars for the restoration of occlusional height and reduction of the depth of incisival contacts.

Varieties of deep bite (scheme)

Secondary partial adentia, distal shift of the mandible and the articular heads, arthrosis of TMJ

Bugel splin clasp denture for the treatment of I, II and III types of deep bite.

Bugel splin clasp denture for the treatment of IV type of deep bite.

TMJ dysfunctional state Treatment of patients with neuromusular syndrome is directed on the elimination of the causes, though it continues to operate. Special dental treatment is directed on the normalization of occlusion and articulation by partial preparation, prosthesis, and, if it is necessary, myogymnastic and physiotherapy. Treatment of patients with neuromusular syndrome is directed on the elimination of the causes, though it continues to operate. Special dental treatment is directed on the normalization of occlusion and articulation by partial preparation, prosthesis, and, if it is necessary, myogymnastic and physiotherapy.

Pecularities of orthopedic treatment of patients with parafunction of chewing muscles Elimination of the pain in the masticatory muscles and normalization of TMJ function; Elimination of the pain in the masticatory muscles and normalization of TMJ function; Elimination of violations of occlusion; Elimination of violations of occlusion; Prevention of tooth abrasion; Prevention of tooth abrasion; Early prosthesis of defects of dental rows; Early prosthesis of defects of dental rows; Splinting the teeth on the early stage of initial traumatic syndrome. Splinting the teeth on the early stage of initial traumatic syndrome.