TMD and Orthodontics A clinical guide for the orthodontist

Visit the link below to download the full version of this book:

https://medipdf.com/product/tmd-and-orthodontics-a-clinical-guide-for-the-orthod
ontist/

Click Download Now

Sanjivan Kandasamy • Charles S. Greene
Donald J. Rinchuse • John W. Stockstill
Editors

TMD and Orthodontics

A Clinical Guide for the Orthodontist
Editors
Sanjivan Kandasamy
Department of Orthodontics
School of Dentistry
University of Western Australia
Nedlands, WA
Australia

Centre for Advanced Dental Education

Saint Louis University
Saint Louis, MO
USA

Charles S. Greene
University of Illinois
College of Dentistry
Chicago, Illinois
USA

Donald J. Rinchuse
Greensburg, Pennsylvania
USA

John W. Stockstill
Seton Hill University
Greensburg, PA
USA

ISBN 978-3-319-19781-4 ISBN 978-3-319-19782-1 (eBook)

DOI 10.1007/978-3-319-19782-1

Library of Congress Control Number: 2015945966

Springer Cham Heidelberg New York Dordrecht London

© Springer International Publishing Switzerland 2015
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made.

Printed on acid-free paper

Springer International Publishing AG Switzerland is part of Springer Science+Business Media

(www.springer.com)
This book is dedicated to our troops who sacrifice their lives
to provide us with the freedom to study, teach and live freely.
They set the foundation and example for clinicians around
the world who strive on a daily basis to provide essential
evidence-based care to their patients. We hope our book will
enable them to accomplish these important goals as they
deal with patients in pain.
Foreword

The writing of forewords is something of a cottage industry for retired aca-

demics. Regardless of the subject, a few laudatory, largely honest paragraphs
are usually easy to craft. A book on TMD for orthodontists, however, has to
be approached with caution. My concern about this invitation involves more
than an aversion to books for dentists who seek some sort of complex
mechanical perfection, seemingly to compensate for childhood difficulties
with toilet training. Unfortunately, temporomandibular dysfunction is the
red-headed stepchild of many healing arts. Everything seems to work, at least
for a while. No wonder so many professions, specialties, and splinter groups
claim to be keepers of the flame.
As I write these words, chances are that someone, somewhere is crafting a
book on TMD for homeopaths or cranial manipulators or chiropractors or
naturopaths, world without end. When challenged with inconvenient evi-
dence (an irritating distraction from their mission of “helping people”), true-
believers take refuge in the fact that people are said also to have laughed at
Pasteur or Freud or Einstein. True, but most often people laughed at Bozo the
Clown.
Given the murky nature of the field, involvement with a TMD book must
be approached with care. Does it have a strong evidentiary basis? Is it written
by recognized authorities? Are its recommendations consistent with treat-
ments for other types of chronic pain? In the present instance, the answer to
these questions is a resounding, reassuring yes! The editors have recruited
respected authorities to provide a thorough, evidence-based survey of the
various interactions between orthodontics and TMD. Indeed, the authors and
editors of this concise but thorough book are the people to whom I look for
rational guidance. For example, I once heard Chuck Greene put the problem
into perspective with a single short sentence: “TMD is reported; it isn’t dis-
covered.” Suffice it to say, I am honored to participate in the publication of
this meticulous compilation. It is both an antidote for the thought-crime of the
past and a rational, evidence-based survey for the present and the foreseeable
future of our specialty. Well done!

Lysle E. Johnston Jr., DDS, MS, PhD, FDS RCS, FACD, FICD
Eastport, Michigan, USA

vii
Preface

The orthodontic profession has had long-standing interests in the temporo-

mandibular joint (TMJ). Beginning with the need to understand how the mas-
ticatory system develops, all orthodontists can expect to encounter a variety
of clinical issues in their practices involving this important joint and the many
issues that have evolved related to the TMJs. It is therefore essential that
orthodontists should keep up to date on the most current scientific evidence
related to these topics.
One major issue that is of concern is the patient who has a temporoman-
dibular disorder (TMD). That patient may present to the orthodontist as a
referral from a colleague, with the request for orthodontic treatment as a way
to resolve this problem. Alternatively, an orthodontic patient may suddenly
develop TMD symptoms during treatment or may return with such com-
plaints following treatment. All of these scenarios demand an appropriate
response from the orthodontist, and the nature of that response has changed
as new research and data have emerged in the TMD field in the past 25 years.
It is the purpose of this book to bring together a group of experts who are
internationally recognized leaders in their field. These experts have come
from within and outside the orthodontic profession to address all of the salient
topics about orthodontics and the TMDs. We have been extremely fortunate
to have several outstanding colleagues join us on this project. This is the first
book of its kind to focus exclusively on orthodontics, the TMJs and TMDs,
and it is organized to deliver the latest evidence-based information in the
ever-changing controversial world of temporomandibular disorders and oro-
facial pain. Rather than burdening the reader with highly specific detail and
basic sciences that can be obtained elsewhere, each chapter is written with a
clinical perspective and ends with a large number of useful references.
Clinicians, orthodontic residents and faculty will all find this book to be an
extremely useful resource providing much needed clarity in an area filled
with a great deal of misinformation and confusion.

Sanjivan Kandasamy
Charles S. Greene
Donald J. Rinchuse
John W. Stockstill

ix
Contents

1 Static and Functional Anatomy of the Human

Masticatory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
John W. Stockstill and Norman D. Mohl
2 Temporomandibular Disorders: Etiology
and Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Jeffrey P. Okeson
3 Screening Orthodontic Patients for Temporomandibular
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Charles S. Greene and Gary D. Klasser
4 Psychological Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Richard Ohrbach and Ambra Michelotti
5 Sleep Bruxism: What Orthodontists Need to Know? . . . . . . . . 63
Gary D. Klasser and Ramesh Balasubramaniam
6 Orthodontics and TMD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Sanjivan Kandasamy and Donald J. Rinchuse
7 Idiopathic/Progressive Condylar Resorption:
An Orthodontic Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Chester S. Handelman and Louis Mercuri
8 Management of TMD Signs and Symptoms
in the Orthodontic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Charles S. Greene, Donald J. Rinchuse,
Sanjivan Kandasamy, and John W. Stockstill
9 Surgical Management of Temporomandibular
Joint Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
D.M. Laskin
10 TMD and Its Medicolegal Considerations
in Contemporary Orthodontic Practice . . . . . . . . . . . . . . . . . . . 133
L. Jerrold, Sanjivan Kandasamy, and D. Manfredini

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

xi
Contributors

Ramesh Balasubramaniam, BDSc, MS, FOMAA School of Dentistry,

University of Western Australia, Crawley, WA, Australia
Private Practice, West Leederville, WA, Australia
Charles S. Greene, BS, DDS Department of Orthodontics, University of
Illinois at Chicago, College of Dentistry, Chicago, IL, USA
Chester S. Handelman, DMD Department of Orthodontics, University of
Illinois at Chicago, College of Dentistry, Chicago, IL, USA
L. Jerrold, DDS, JD NYU-Lutheran Medical Center, Department of
Dental Medicine, Division of Orthodontics, Brooklyn, NY, USA
Sanjivan Kandasamy, BDSc, DClinDent, MOrthRCS, FRACDS
Department of Orthodontics, School of Dentistry, University of Western
Australia, Nedlands, WA, Australia
Centre for Advanced Dental Education, Saint Louis University,
Saint Louis, MO, USA
Private Practice, Midland, WA, Australia
Gary D. Klasser, DMD, Cert Orofacial Pain Department of Diagnostic
Sciences, Louisiana State University Health Sciences Center,
School of Dentistry, New Orleans, LA, USA
D.M. Laskin, DDS, MS Department of Oral and Maxillofacial Surgery,
Virginia Commonwealth University, School of Dentistry,
Richmond, VA, USA
D. Manfredini, DDS, MSc, PhD Italian Minister of University
and Instruction, Padova, Italy
Department of Maxillofacial Surgery, University of Padova, Padova, Italy
Louis G. Mercuri, DDS, MS Department of Orthopedic Surgery,
Rush University Medical Center, Chicago, IL, USA
Ambra Michelotti, DDS, BSc, Orthod. Section of Orthodontics,
Department of Neuroscience, University of Naples Federico II, Naples, Italy

xiii
xiv Contributors

Norman D. Mohl, DDS, MA, PhD SUNY Distinguished Service,

Department of Oral Diagnostic Sciences, University at Buffalo School of
Dental Medicine, Buffalo, NY, USA
Richard Ohrbach, DDS, MS, PhD Department of Oral Diagnostic
Sciences, University at Buffalo School of Dental Medicine, Buffalo, NY,
USA
Jeffrey P. Okeson, DMD Department of Oral Health Science, Orofacial
Pain Program, College of Dentistry, University of Kentucky,
Lexington, KY, USA
Donald J. Rinchuse, DMD, MS, MDS, PhD Private Practice, Greensburg,
PA, USA
John W. Stockstill, DDS, MS Department of Orthodontics,
Temporomandibular Disorders/Orofacial Pain, Seton Hill University,
Center for Orthodontics, Greensburg, PA, USA
Center for Orthodontics, Graduate Orthodontics Residency Program,
Seton Hill University, Greensburg, PA, USA
 Static and Functional Anatomy
of the Human Masticatory System
1
John W. Stockstill and Norman D. Mohl

1.1 Occlusal Concepts belief systems. Evidence-based explanations and

and Terminology definitions will be offered rather than teleological
explanations, and the emphasis will be on physiol-
1.1.1 Review of Occlusion Concepts ogy rather than philosophy.
and Definitions According to the Textbook of Occlusion (Mohl
et al. 1988), the scope of the subject of occlusion
In accordance with the primary intent of this book, relative to dentistry includes “the relationship
part one of this chapter will address the basic and between all the components of the masticatory
common occlusal concepts and terminology used system in normal function, dysfunction, and
in dental practice in general, and orthodontic prac- parafunction, including the morphological and
tice in particular. Because so much of the contro- functional features of contacting surfaces of
versy about temporomandibular disorders (TMDs) opposing teeth and restorations, occlusal trauma
revolves around these occlusal concepts, the and dysfunction, neuromuscular physiology, the
authors will address those relationships wherever temporomandibular joints and muscle function,
appropriate. This also will set up the framework swallowing and mastication, psychophysiologi-
for similar discussions in other chapters through- cal status, and the diagnosis, prevention, and
out this book. Due to the many controversies and treatment of functional disorders of the mastica-
“philosophical” explanations reported in the litera- tory system” [1, 2]. Thirty-seven variations of the
ture regarding occlusal concepts, our intent will be term “dental occlusion” are found in Dorland’s
to enlighten the reader rather than to argue about Illustrated Medical Dictionary, 32nd edition
(2012), and most or all represent commonly used
(often incorrectly) terms for the relationship of
J.W. Stockstill, DDS, MS (*)
the teeth to their environment and to one another
Department of Orthodontics, Temporomandibular specifically [3]. The intent of this section is to
Disorders/Orofacial Pain, Seton Hill University, Center offer standardized terminology that satisfies “…
for Orthodontics, 2900 Seminary Drive, Building E, the school of thought that is promulgated (as)
Greensburg, PA 15601, USA
e-mail: [email protected]
one that has some basis in objective scientific
inquiry or is at least within the mainstream of
N.D. Mohl, DDS, MA, PhD
Department of Oral Diagnostic Sciences, SUNY
current thought within dentistry” [2]. It does not
Distinguished Service, University at Buffalo-School represent any particular point of view; instead,
of Dental Medicine, Buffalo, NY, USA it has been framed within the boundaries of

© Springer International Publishing Switzerland 2015 1

S. Kandasamy et al. (eds.), TMD and Orthodontics: A Clinical Guide for the Orthodontist,
DOI 10.1007/978-3-319-19782-1_1
2 J.W. Stockstill and N.D. Mohl

evidence-based scientific thinking and clinical and considered “gold standards” when discuss-
application. Controversies regarding the subject ing, diagnosing, and managing the human denti-
of dental occlusion are numerous, and it is not the tion and occlusion, and also when discussing the
interest or responsibility of this publication to act static and functional anatomy and biomechanics
as the “decider” for any one of these “schools” of the masticatory system [2, 5–8].
or “beliefs.”
In a recent publication entitled “Understanding
Occlusion” [4], the concepts of occlusion and 1.1.2 Terms and Concepts
functional movement of the mandible were
described as being confusing and resulting in
frustration to the dental profession, but the three Centric Occlusion (Maximum Intercuspation,
“experts” who were interviewed for this article Habitual Occlusion, Intercuspal Position) The
seemed to agree that common ground was avail- position of the mandible when the relationship of
able for discussing the three most common occlu- opposing occlusal surfaces provides for maxi-
sal philosophies. These occlusal philosophies mum planned contact and/or intercuspation. This
include (1) conformational occlusion, (2) is a tooth-determined position.
neuromuscular-based occlusion, and (3) joint-
based occlusion. Briefly, the concept of confor- Centric Relation Occlusion (Retruded Contact
mational occlusion holds that one should allow Position, RCP) Is defined as the occlusion of
the patient’s mandible to function in whatever the teeth when the mandible is in centric relation.
occlusal scheme they have and with which they This is a tooth-joint determined position.
are comfortable. The neuromuscular-based
occlusion concept theorizes that there is an ideal Centric Relation (CR) The relationship of the
occlusal position that is determined using elec- mandible to the maxillae when the mandibular
tromyography and muscle stimulation devices in condyles are in their most superior position, with
order to achieve “muscular physiologic har- the central bearing area of the articular discs in
mony.” The third occlusal concept, often referred contact with the articular surface of the condyles
to as gnathology, implies that the condyle-fossa and with the articular eminentia. Importantly, the
relationships must be ideal and that occlusal con- condyles may or may not be in their most retruded
tacts during excursions of the mandible should be position, depending on the degree of restraint
in harmony with condylar movements. The ideal provided by the TM ligament. This position is
temporomandibular joint (TMJ) relationship is independent of tooth contact and is determined
generally described as “centric relation (CR),” by the structural features of the temporomandib-
but it should be noted that this position has been ular joint and not the dentition.
redefined several times over the years.
In any case, these authors agree that there are Malocclusion Any occlusion in which the struc-
no clear criteria for deciding which philosophy tural characteristics are beyond those established
one must use to “build a healthy masticatory sys- for a theoretically ideal occlusion. The term does
tem.” But it is interesting to note that, in spite of not necessarily imply that such an occlusion is
there being “philosophical differences” between nonphysiologic or that therapy is indicated. The
these pronounced theories, “Without scientific presence of a malocclusion, particularly in adults,
evidence, it has not been proved definitely that does not mean that therapy is necessary, and the
treatment planning with any one philosophy is malocclusion may be physiologic.
better than using the patient’s own occlusion”
[4]. Therefore, it may be said that the “physiolog- Physiologic Occlusion Usually in adults, it is an
ical evidence trumps the philosophical belief” in occlusion that deviates in one or more ways from
every instance. Theories aside, the terms and the theoretically ideal, yet is well adapted to that
concepts which follow are universally accepted particular environment, is esthetically pleasing to
1 Static and Functional Anatomy of the Human Masticatory System 3

the patient, and has no pathological manifesta- A minimal amount of elevator muscle activity
tions or dysfunctional problems. It does not is needed to maintain the mandible in this
require intervention. position.

Nonphysiologic Occlusion An occlusion which Rest Vertical Dimension The vertical dimen-
presents with signs or symptoms of pathology, sion of the face when the mandible is in postural
dysfunction, or inadequate adaptation of one or rest position.
more components of the masticatory system that
can be attributed to faulty structural relationships Interocclusal Distance The distance (com-
or mandibular functional activity. Therapy to monly 2–4 mm) between the occluding surfaces
improve the malocclusion may be indicated. of the maxillary and mandibular teeth when the
mandible is in postural rest position. It is also
Therapeutic Occlusion An occlusion that has referred to as freeway space and is routinely con-
been modified by appropriate therapeutic modal- sidered to be a space that is “best fit” or averaged
ities in order to change a nonphysiologic occlu- throughout the occlusal plane.
sion to one that falls within the parameters of a
physiologic occlusion, if not a theoretically ideal
occlusion. This occlusion optimizes the health 1.1.3 Mandibular Movement
and adaptive potential of the masticatory Terminology
system.

Theoretically Ideal Occlusion A preconceived Disclusion The loss of occlusion (nonocclu-

theoretical concept of occlusal structural and sion) between opposing teeth during tooth-guided
functional relationships that includes idealized movements of the mandible. For example, when
principles and characteristics that an occlusion the anterior teeth are in an edge-to-edge position,
should have. It does not represent the “norm” and the posterior teeth are said to be in disclusion.
is used as a series of idealized parameters against The term is appropriate only when some degree
which variations may be compared. of dental contact is occurring.

Muscular Contact Position (MCP) The posi- Hinge Movement Movement in space charac-
tion of the mandible when it has been raised by terized by two divergent points moving around a
voluntary muscular effort to initial occlusal con- central axis of rotation.
tact with the head erect. This position is consis-
tent with the intercuspal position (CO) in Hinge Axis An imaginary line between the
asymptomatic individuals. mandibular condyles around which the mandible
can rotate without translatory movement. This is
Occlusal Vertical Dimension The vertical also referred to as transverse hinge axis.
dimension of the face as determined by a midline
vertical measurement of the face between two Translatory Movement Movement in space
arbitrary points above and below the mouth when characterized by linear motion with no axis of
the mandible is in centric occlusion. By conven- rotation. This movement may follow a straight
tion, vertical dimension is interchangeable with path (rectilinear translation) or a curved path
occlusal vertical dimension. (curvilinear translation).

Postural Rest Position The “resting” position Protrusion Movement of the mandible forward
of the mandible when an individual is sitting or or in an anterior direction from centric occlusion
standing in an upright position. This position is with an anterior translation of both condyles,
determined by muscles and other structures. either with or without occlusal contacts.
4 J.W. Stockstill and N.D. Mohl

Retrusion Retraction or posterior movement of Anterior Guidance The influence on mandibu-

the mandible from any given point. lar movements by the relative overlap of the ante-
rior teeth as determined by the lingual surfaces of
Lateral Excursion Sideward movement of the the maxillary anterior teeth and the incisal edges
mandible from a median occlusal position, and or labial surfaces of the mandibular anterior
characterized by a forward, inward, and down- teeth. This movement is influenced by the hori-
ward translation of the contralateral condyle. Left zontal overlap (overjet) and vertical overlap
lateral excursion results in the left condyle rotat- (overbite) of the anterior teeth. An anterior open
ing about an axis and the right condyle translat- bite or negative overlap will reduce or eliminate
ing forward, inward, and downward as it tracks the downward movement of the mandible during
the medial wall of the glenoid fossa. protrusive movement.

Working Side The lateral segment of the den- Incisal Guidance That part of the anterior guid-
tition toward which the mandible moves during ance that occurs during protrusive movements of
lateral excursion (functional or ipsilateral or lat- the mandible and is influenced by the relative
erotrusive side). Left lateral movement of the overlap, position, and anatomy of the maxillary
mandible results in the left side dentition being and mandibular incisors.
designated as the working side and the right side
dentition being designated as the nonworking Canine Guidance That part of the anterior
side. guidance that occurs during lateral excursion of
the mandible and is influenced by the relative
Nonworking Side The side opposite the working overlap, position, and anatomy of the maxillary
side during lateral excursive movement of the and mandibular canines on the working side.
mandible (nonfunctioning or contralateral or bal-
ancing or mediotrusive side). Left lateral move-
ment of the mandible results in the right side 1.1.4 Dental Definitions
dentition being designated as the nonworking side. and Concepts

Condylar Guidance The influence on mandib-

ular movements by the direction of condylar Plane of Occlusion An imaginary surface that
movement during translation of the condyles as is related anatomically to the cranium and that
determined by the anatomical features of the theoretically touches the incisal edges of the inci-
temporomandibular joint. For example, the sors and the tips of the occluding surfaces of the
height and amount of convexity of the articular posterior teeth. It is NOT a plane in the true sense
eminences will dictate the degree of downward of the word and represents the mean or best fit of
movement of the condyles during forward trans- the curvature surface.
lation (protrusive movement).
Compensating Curve The curvature of the
Condylar Inclination That part of the condylar alignment of the occlusal surfaces of the teeth
guidance formed by the inclination of the con- that is present to compensate for the curved
dyle path as it translates forward and downward movement patterns of the mandible (Monson
on the articular eminence. curve). When viewed laterally, it is referred to as
the curve of Spee, and when viewed in the frontal
Condylar Angulation That part of the condylar plane, as the curve of Wilson.
guidance formed by the angulation of the non-
working side condyle path as it translates forward Overbite The extension of the maxillary teeth
and inward during lateral excursion and tracks over the mandibular teeth in a vertical direc-
the medial wall of the glenoid fossa. tion when the opposing posterior teeth are in