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Table of Contents

Forewords

Acknowledgments

Table of Contents

Introduction

The Masticatory System as a Biological System

Progressive/Regressive Adaptation and Compensation/Decompensation

Functional Diagnostic Examination Procedures...

...and their Therapeutic Consequences

The Role of Dentistry in Craniofacial Pain

Primary Dental Evaluation

Findings in the Teeth and Mucous Membrane

Overview of Dental Examination Techniques

Anatomy of the Masticatory System

Embryology of the Temporomandibular Joint and the Muscles of Mastication

Development of the Upper and Lower Joint Spaces

Glenoid Fossa and Articular Protuberance

Mandibular Condyle

Positional Relationships of the Bony Structures

Articular Disk

Anatomical Disk Position

Bilaminar Zone

Joint Capsule

Ligaments of the Masticatory System

Arterial Supply and Sensory Innervation of the Temporomandibular Joint

Sympathetic Innervation of the Temporomandibular joint

Muscles of Mastication

Temporal Muscle

Masseter Muscle

Medial Pterygoid Muscle

Suprahyoid Musculature

Lateral Pterygoid Muscle

Macroscopical-Anatomical and Histological Studies of the Masticatory Muscle Insertions

Force Vectors of the Muscles of Mastication

Tongue Musculature

Muscle of Expression

Temporomandibular Joint and the Musculoskeletal System

Peripheral and Central Control of Muscle Tonus

Physiology of the Jaw-Opening Movement

Physiology of the Jaw-Closing Movement

Physiology of Movements in the Horizontal Plane

The Teeth and Periodontal Receptors

Condylar Positions

Static Occlusion

Dynamic Occlusion

Manual Functional Analysis

The Masticatory System as a Biological System

Specific and Nonspecific Loading Vectors

Examination Form for Manual Functional Analysis

Patient History

Positioning the Patient

Manual Fixation of the Head

Active Movements and Passive Jaw Opening with Evaluation of the Endfeel

Differential Diagnosis of Restricted Movement

Examination of the Joint Surfaces

Manifestations of Joint Surface Changes

Conducting the Clinical Joint Surface Tests

Examination of the Joint Capsule and Ligaments

Clinical Significance of Compressions in the Superior Direction

Examination of the Muscles of Mastication

Palpation of the Muscles of Mastication with Painful Isometric Contractions

Areas of Pain Referred from the Muscles of Mastication

Length of the Suprahyoid Structures

Investigation of Clicking Sounds

Active Movements and Dynamic Compression

Manual Translations

Dynamic Compression during Retrusive Movement

Differentiation among the Groups

Differentiation within Group 1

Differentiation within Group 2

Differentiation among Unstable, Indifferent, and Stable Repositioning

Differentiation within Group 3

Differentiation within Group 4

Unified Diagnostic Concept and...

...Treatment Plan for Anterior Disk Displacement

Tissue-Specific Diagnosis

–Principles of Manual Functional Analysis

–Protocol for Cases with Pain

–Protocol for Clicking Sounds

–Routine Protocol

–Protocol for Limitations of Movement

–Primary and Secondary Diagnoses

Investigation of the Etiological Factors (Stressors)

Neuromuscular Deprogramming

Mandibular and Condylar Positions

Static Occlusion

Dynamic Occlusion

Bruxism Vector or Parafunction Vector

Dysfunctional Movements

Influence of Orthopedic Disorders on the Masticatory System

Supplemental Diagnostic Procedures

–Mounted Casts, Axiography

–Panoramic Radiograph

–Lateral Jaw Radiograph

–Joint Vibration Analysis (JVA)

Musculoskeletal Impediments in the Direction of Treatment

Manual Functional Analysis for Patients with no History of Symptoms

Imaging Procedures

Panoramic Radiographs

Portraying the Temporomandibular Joint with Panoramic Radiograph Machines

Asymmetry Index

Distortion Phenomena

Eccentric Transcranial Radiograph (Schüller Projection)

Axial Cranial Radiograph According to Hirtz and Conventional Tomography

Posterior-Anterior Cranial Radiograph according to Clementschitsch

Lateral Transcranial Radiograph

Computed Tomography of the Temporomandibular Joint

Computed Tomography of the Temporomandibular Joint and its Anatomical Correlation

Three Dimensional Images of the Temporomandibular Joint...

...with the Aid of Computed Tomography Data

Three-Dimensional Reconstruction for Hypoplastic Syndromes

Three-Dimensional Models of Polyurethane Foam and Synthetic Resin

Magnetic Resonance Imaging

T1-and T2-Weighting

Selecting the Slice Orientation

Practical Application of MRI Sections

Reproduction of Anatomical Detail in MRI

Visual (Qualitative) Evaluation of an MR Image

Classification of the Stages of Bony Changes

Disk Position in the Sagittal Plane

Disk Position in the Frontal Plane

Misinterpretation of the Disk Position in the Sagittal Plane

Morphology of the Pars Posterior

Progressive Adaptation of the Bilaminar Zone

Progressive Adaptation in T1 - and T2-Weighted MRI

Disk Adhesions in MRI

Disk Hypermobility

Partial Disk Displacement

Total Disk Displacement

Types of Disk Repositioning

Disk Displacement without Repositioning

Partial Disk Displacement with Total Repositioning

Partial Disk Displacement with Partial Repositioning

Total Disk Displacement with Total Repositioning

Total Disk Displacement with Partial Repositioning

Condylar Hypermobility

Posterior Disk Displacement

Disk Displacement during Excursive Movements

Regressive Adaptation of Bony Joint Structures

Progressive Adaptation of Bony Joint Structures

Evaluation of Adaptive Changes: MRI Versus CT

Avascular Necrosis Versus Osteoarthrosis

Metric (Quantitative) MRI Analysis

Examples of Bumann’s MRI Analysis

MRI for Orthodontic Questions

Three-Dimensional Imaging with MRI Data

Dynamic MRI

–Cine MRI

–Movie MRI

MR Microscopy and MR Spectroscopy

Indications for Imaging Procedures as Part of Functional Diagnostics

Prospects for the Future of Imaging Procedures

Mounting of Casts and Occlusal Analysis

Making of Impressions and Stone Casts

Fabrication of Segmented Casts

Registration of Centric Relation

Techniques for Recording the Centric Condylar Position

Transcutaneous Nerve Stimulation for Muscle Relaxation–“Myocentric”

Interocclusal Registration Materials

Centric Registration for Intact Dentitions

Occlusal Splints used as Record Bases

Centric Registration for Posteriorly Shortened Dental Arches

Jaw Relation Determination for Edentulous Patients

Mounting the Cast in the Correct Relationship to the Cranium and Temporomandibular Joints

Attaching the Anatomical Transfer Bow

Mounting the Maxillary Cast using the Anatomical Transfer Bow

Mounting the Maxillary Cast using a Transfer Stand

Mounting the Maxillary Cast following Axiography

Mounting the Mandibular Cast

Axiosplit System

Split-Cast Control of the Cast Mounting

Check-Bite for Setting the Articulator Joints

Effect of Hinge Axis Position and Thickness of the Occlusal Record on the Occlusion

Occlusal Analysis on the Casts

Occlusal Analysis using Sectioned Casts

Diagnostic Occlusal Reshaping of the Occlusion on the Casts

Diagnostic Tooth Setup

Diagnostic Waxup

Condylar Position Analysis Using Mounted Casts

Instrumented Analysis of Jaw Movements

Mechanical Registration of the Hinge Axis Movements (Axiography)

Evaluating the Axiograms and Programming the Articulator

Hinge Axis Tracings (Axiograms) as Projection Phenomena

Effect of an Incorrectly Located Hinge Axis on the Axiograms

Electronic Paraocclusal Axiography

Diagnoses and Classifications

Classification of Primary Joint Diseases

Classification of Secondary Joint Diseases

Hyperplasia, Hypoplasia, and Aplasia of the Condylar Process

Hyperplasia of the Coronoid Process

Congenital Malformations and Syndromes

Acute Arthritis

Rheumatoid Arthritis

Juvenile Chronic Arthritis

Free Bodies within the Joints

Styloid or Eagle Syndrome

Fractures of the Neck and Head of the Condyle

Disk Displacement with Condylar Neck Fractures

Fibrosis and Bony Ankylosis

Tumors in the Temporomandibular Joint Region

Joint Disorders–Articular Surfaces

Joint Disorders–Articular Disk

Joint Disorders–Bilaminar Zone and Joint Capsule

Joint Disorders–Ligaments

Muscle Disorders

Principles of Treatment

Specific or Nonspecific Treatment?

Nonspecific Treatment

Elimination of Musculoskeletal Impediments

Occlusal Splints

Splint Adjustment for Vertical Disocclusion and Posterior Protection

Relationship between Joint Surface Loading and the Occlusal Scheme

Relaxation Splint

Stabilization Splint

Decompression Splint

Repositioning Splint

Verticalization Splint

Definitive Modification of the Dynamic Occlusion

Definitive Alteration of the Static Occlusion

Examination Methods and Their Therapeutic Relevance

Illustration Credits

References

Index

TMJ Disorders and Orofacial Pain

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