Temporomandibular Joint: Disorders, Treatments, and Biomechanics

Abstract

Temporomandibular joint (TMJ) is a complex, sensitive, and highly mobile joint. Millions of people suffer from temporomandibular disorders (TMD) in USA alone. The TMD treatment options need to be looked at more fully to assess possible improvement of the available options and introduction of novel techniques. As reconstruction with either partial or total joint prosthesis is the potential treatment option in certain TMD conditions, it is essential to study outcomes of the FDA approved TMJ implants in a controlled comparative manner. Evaluating the kinetics and kinematics of the TMJ enables the understanding of structure and function of normal and diseased TMJ to predict changes due to alterations, and to propose more efficient methods of treatment. Although many researchers have conducted biomechanical analysis of the TMJ, many of the methods have certain limitations. Therefore, a more comprehensive analysis is necessary for better understanding of different movements and resulting forces and stresses in the joint components. This article provides the results of a state-of-the-art investigation of the TMJ anatomy, TMD, treatment options, a review of the FDA approved TMJ prosthetic devices, and the TMJ biomechanics.

Biomechanics of the Temporomandibular Joint

“…Injury to the jaw, temporomandibular joint, or muscles of the head and neck can cause TMD. Other possible causes include grinding or clenching the teeth, which puts a lot of pressure on the TMJ; dislocation of the disc; presence of osteoarthritis or rheumatoid arthritis in the TMJ; stress, which can cause a person to tighten facial and jaw muscles or clench the teeth; aging, etc (Bakke et al, 2001;Detamore et al, 2007;Ingawalé and Goswami, 2009;Tanaka et al, 2000). The most common TMJ disorders are pain dysfunction syndrome, internal derangement, arthritis, and traumas (Detamore and Athanasiou, 2003;Detamore et al, 2007).…”

“…Usually the treatment begins with conservative, nonsurgical therapies first, with surgery left as the last option. The majority of TMD patients can be successfully treated by non-surgical therapies and surgical interventions may be required for only a small part of TMD population (Ingawalé and Goswami, 2009). The initial treatment does not always work and therefore more intense treatments such as joint replacement may be a future option (Ingawalé and Goswami, 2009).…”

“…TMDs are seen most commonly in people between the ages of 20 and 40 years, and occur more often in women than in men (Detamore and Athanasiou, 2003;Detamore et al, 2007;Tanaka et al, 2008a). Some surveys have reported that 20-25% of the population exhibit one or more symptoms of TMD (Detamore et al, 2007;Ingawalé and Goswami, 2009). With a large part of population suffering from TMDs, it is a problem that should be looked at more fully.…”

“…A large fraction of TMD causes are currently unexplained. There is a great need of better understanding of the etiology of TMDs to develop methods to prevent, diagnose, and cure joint disorders (Beek et al, 2003;Ingawalé and Goswami, 2009). This chapter provides a state-of-the-art review of TMJ anatomy, disorders, and biomechanics; and briefly discusses our approach toward threedimensional (3D) anatomical and finite element (FE) modeling to understand the interaction between structure and function of the TMJ.…”

Management of Extra-Capsular Temporo-Mandibular Joint Ankylosis: Does Conservative Approach to Treatment Have a Role?

“…This ankylosis is classified as intracapsular or extracapsular; fibrous, bony or fibro-osseous; complete or incomplete; and unilateral or bilateral [5][6][7]. The main stay of treatment has been surgery irrespective of the type of ankylosis, and this includes gap arthroplasty, interpositional arthroplasty and TMJ reconstruction with autogenous or alloplastic materials [4,8,9].…”