MANDIBULAR MOVEMENTS

INTRODUCTION:
The masticatory, or stomatognathic system is extremely complex. It is made up of a three linked chain. The first link is the maxilla and mandible supporting the teeth. The second is the TMJ and the third link is the muscles and ligaments with its nerve and vascular supply. The first two are considered to be passive links while the third one is an active link. During the performance of various function, such as mastication, deglutition, speech and respiration there is a delicate balance between the various components of the stomatognathic system which is carefully monitored by the neuromuscular control. It thus becomes essential to study mandibular movements in relation to complete denture as it enables us to plan the arrangement of teeth, development of occlusion and selection of suitable articulators for complete denture fabrication so that the artificial prosthesis is in harmony with the functions of the stomatognathic system. I) Anatomy of the TMJ: The area where cranio-mandibular articulation occurs is called the temporo-mandibular joint. Ginglymo-arthroidal compound synovial joint:

Ginglymoid joint hinging movement in one plane. Arthroidal joint hinge + gliding movements.

Compound Presence of three bones (articular disc is considered as non-ossified bone). The TMJ consists of 4 main structures: a) Condyle. b) Squamous part of the temporal bone. c) The articular disc. d) Ligaments. a) Condyle: The portion of the mandible which articulates with the

cranium around which movement occurs. From the anterior view, it has medial and lateral projections

called poles. Medial pole is more prominent than the lateral pole.
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Medio Lateral length 15-20mm.

Antero-posterior width 8-10mm. The actual articulating surface of the condyle extends both

anteriorly and posteriorly to the most superior aspect of the condyle. The posterior articulating surface is greater than the anterior articulating surface. A given point on each condyle has a free but relatively

limited mobility along its cranial joint surface. This is called as contact movement surface of the condylar point. It is about 1012mm long and 2-3mm broad.

Contact movement surface of the incisal point is slightly

over 11mm deep (sagittal direction) and 20mm broad (frontal direction). The tooth bearing part of the mandible therefore has a

complete freedom of movement inside a relatively narrow but long space. b) Squamous part of the temporal bone: Mandibular condyle articulates at the base of the cranium

with the squamous portion of the temporal bone. it is referred to as the articular/glenoid fossa. Posterior to this fossa is the squamo-tympanic fissure which

runs medio-laterally. Immediately anterior to the fossa is a convex bony

prominence called the articular eminence. Steepness of this surface dictates the pathway of the condyle when the mandible is positioned anteriorly. The posterior roof of the mandibular fossa is quite thin,

indicating that this area of temporal bone is not designed to sustain heavy loads. The articular eminences however is composed of thick dense bone and is more likely to tolerate such heavy forces. c) The articular disc: Composed of dense fibrous connective tissue devoid of any

blood vessels or nerves.

In the sagittal plane, it can be divided into 3 regions

according to thickness. The central area is the thinnest, called the intermediate zone. The disc becomes thicker anteriorly and posteriorly with the posterior zone, slightly thicker than the anterior zone. From an anterior view, the disc is more thicker medially that

laterally, which results in increased space between the condyle and the fossa towards the medial aspect of the joint. The articular disc is attached posteriorly to a region of loose

connective tissue which is highly vascularised and innervated called the retrodiscal tissue. Superiorly Superior retrodiscal lamina (elastic fibers) attaches the disc to tympanic plate Bilaminary zone. Inferiorly Inferior retrodiscal lamina (collagenous fibres) attaches the inferior border of the disc to the posterior margin of the articulate surface of the condyle. Anteriorly, the articular disc is attached to the capsular ligaments. Superior attachment anterior margin of the articular surface of the temporal bone. Inferior attachment anterior margin of the articular surface of the condyle. Articular disc divides the joint into 2 distinct cavities: i. Superior cavity bordered by the mandibular fossa and the superior surface of the disc.
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ii.

Inferior cavity bordered by the mandibular condyle and the inferior surface of the disc.

d) Ligaments: Classified as: i. Functional ligaments: Collateral ligaments. Capsular ligaments. Temporomandibular ligament. ii. Accessory ligament - Sphenomandibular ligaments. Stylo-mandibular ligaments. i. Collateral-ligament (discal ligaments): Attach the medial and lateral borders of the articular disc to the poles of the condyle. They function to restrict the movements of the disc away from the condyle. ii. They are responsible for the hinging movement of the TMJ. Capsular ligament: The entire TMJ is surrounded and encompassed by the capsular ligament. It is attached superiorly to the temporal bone along the borders of the articular surfaces of the mandibular fossa and articular eminence. Inferiorly it attaches to the neck of the condyle.

It resists any medial, lateral or inferior forces that tend to separate or dislocate the articular surfaces.

A significant function is to encompass the joint and retain the synovial fluid.

iii. i)

Temporomandibular ligament (lateral ligament) 2 parts: Outer oblique portion it extends from the

outer surface of the articular tubercle and zygomatic process postero-inferiorly to the outer surface of the condylar neck. It resists the excessive dropping of the condyle, limiting the extent of mouth opening. If the mouth was to open wider, the condyle would need to move downward and forward across the eminence. This change in opening movement is brought about by the tightening of the TM ligament. ii) Inner horizontal portion: extends from outer

surface of articular tubercle and zygomatic process and attaches to the lateral pole of condyle and posterior part of articular disc. It limits the posterior movement of the condyle and disc. iii) Sphenomandibular ligaments: Arises from

spine of sphenoid and attaches to lingual. Does not have significant limiting effects on the mandible. iv) Stylomandibular ligament:Runs across the

styloid process and attaches to angle and posterior border of ramus of the mandible limits excessive protrusive movement of mandible.
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Neuromuscular aspect of the masticatory system: The energy required to move the mandible and allow function of the masticatory system is provided by the muscles. The most important of these are the muscles of mastication each of which has a different function but all act in a cooperative way to effect jaw movement. However to produce adequate mandibular function, they must collaborate with other muscle groups namely the suprahyoids, infrahyoids and the post vertebral muscle groups. I] Masticatory Muscles: 1. 2. 3. 4. the mandible. II] Suprahyoid muscles: 1. Mylohyoid. 2. Geniohyoid. 3. Stylohyoid. 4. Digastric. Their function is two fold: If the muscles of mastication, close the jaws and fix the mandible in its position, the suprahyoid muscles will elevate
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Masseter. Temporalis. Medial pterygoid. Lateral pterygoid Protrusion and stabilization of - Elevators.

the hyoid bone and larynx which is attached to it by a membrane, which is necessary for swallowing. If however the infrahyoids are contracted, the hyoid bone is made stable and immovable. If the suprahyoids then contract, against the secured hyoid bone the mandible will be retracted and depressed. Its movement will be down and back. III] Infrahyoid muscles: 1. 2. 3. Sternohyoid. Omohyoid. Thyrohyoid.

They mainly function to depress the hyoid bone and along with the suprahyoid muscles stabilize the hyoid bone during function. IV] The post vertebral muscles are also important in chewing and maintaining functional balance. They form a continuous chain from the base of the skull to the base of the spine. They are anti-gravity muscles which sustain functional posture in relation to chewing. Masseter Elevation Protraction Extreme lateral movements Temporalis Principal positioner. Elevator Unilateral contraction leads to lateral movement on same side

Medial pterygoid

Elevation Lateral positioning of mandible Simple protraction Sub activity dividing protraction and opening

Lateral pterygoid

Protrusion Lateral movement (LP + MP + M + T)

Neurologic Structures: The masticatory system consists of the following receptors which monitor the status of its components. a) Muscle spindles found in muscle tissue. b) Golgi tendon organs located in tendons. c) Pacinian corpuscles which are widely distributed in the various joint structures. d) Nociceptors Distributed throughout the masticatory system. a) Muscle spindles: Skeletal muscles consist of two types of muscle fibres: i. ii. Extra-fusal fibres (contractile). Intra-fusal fibres (minutely contractile).

A bundle of infra-fusal fibres bound by connective tissue sheath is called a muscle spindle. The nuclei of the intrafusal fibres within each

spindle are arranged in two distinct fashions i.e. nuclear chain type and nuclear bag type. There are two types of afferent nerves that supply the intrafusal fibres. They are: Primary endings or annulospiral endings which end in the central region of the intrafusal fibres and have a larger diameter. Secondary endings or flower spray endings which end at the poles of the intrafusal fibres and have a smaller diameter.
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Efferent supply of intrafusal fibres Fusimotor nerve fibres ( efferent) Therefore when muscle is stretched.Intrafusal + Extrafusal fibres are stretched. Annulospiral and flower spray endings are activated.

Afferent neurons carry information to trigeminal mesencephalic nucleus and trigeminal motor nuclei. The CNS then sends back impulses via two different pathways: Fusimotor nerve fibres or gamma efferents (for intrafusal fibres) efferent motor neurons (for the extrafusal fibres)

Muscle contraction

Thus, the muscle spindles primarily monitor muscle length.

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b) Golgi tendon organs: They are located in the muscle tendon between the muscle fibres and their attachment to bone. they are primarily concerned with monitoring muscle tension and are active in reflex regulation during normal function. c) Pacinian Corpuscles: These are widely distributed and serve principally for the perception of movement and firm pressure. d) Nociceptors: Located throughout most of the tissues in the masticatory system. Transmit injury information. They primarily function to monitor the condition, position and movement of tissues of the masticatory system. Reflex action: A reflex action is a response resulting from a stimulus that passes as an impulse along an afferent neuron to a posterior nerve root or its cranial equivalent, where it is then transmitted to an efferent neuron leading back to the skeletal muscle.

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Two general reflex actions are important in the masticatory system: (i) Myotactic (stretch) reflex:

It is the only monosynaptic jaw reflex. Sudden stretch of the skeletal muscle. Afferent nerve activity from the spindles. Trigeminal mesencephalic nucleus. Afferent fibres in the trigeminal mesencephalic nucleus synapse with the different motor neurons in the trigeminal motor nucleus. Efferent fibres carry the response to the extrafusal fibres. Muscle contraction. The myotactic reflex is an important determinant of the rest position of the jaw. It is a principal determinant of the muscle tonus in elevator muscle. (ii) Nociceptive (flexor) reflex Lost in CD patients concerned with tooth and PDL. Polysynaptic reflex to noxious stimuli and therefore is considered protective. Sudden biting on hard object Noxious stimuli Afferent nerves carry impulse to trigeminal and spinal tract nucleus where they synapse with interneurons.

Inhibitory interneurons

Excitatory interneurons

Synapse with efferent neurons in trigeminal motor nucleus

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Inhibitory interneurons which synapse with the efferent neurons result in jaw relaxation. Excitatory interneurons which synapse with the efferent neurons cause contraction of the jaw depressing muscles jaw opens. This process is called Antagonistic inhibition.

-Influence from higher centers. Although the cortex is the main determiner of function, the brainstem is in charge of maintaining homeostasis and controlling subconscious body function. Within the brainstem is a pool of neurons that controls rhythmic muscle activity such a breathing walking and chewing. This pool of neurons is called Central Pattern Generation (CRG). This CRG is responsible for precise timing of activity between the antagonistic muscles so that specific functions can be carried out. The brainstem also consists of other areas which have a influence on function. (i) (ii) (iii) Reticular system. Limbic system. Hypothalamus.

Classification of mandibular movements: According to Sharry According to direction:

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(i)

Opening and closing. Protrusion and retrusion. Lateral grading. According to tooth contact

Movements with tooth contact. Movements without tooth contact (ii) joint structure Border movements. - Intra border movements. (iii) (iv) Function of masticatory system: Mastication. Deglutition. Speech. Respiration. CNS : Innate movements. Learned movements. 1) According to type of movement. i) ii) Rotational. Translation. According to limitation by

2) According to the planes of border movement. i. ii. iii. Sagittal plane border movements. Horizontal plane border movements. Frontal plane border movements.
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Mechanics of mandibular movements: Mandibular movements occur as a complex series of inter related 3dimensional rotational and translational activities. It is determined by combined and simultaneous activities of both TMJs. Two types of movements occur in the TMJ: (i) (ii) I) Rotational. Translational.

Rotational movements: Rotation is the movement of a body about its axis. Rotation occurs

when the mouth opens and closes around a fixed point or axis within the condyles. Rotation occurs in the inferior cavity of the joint between the superior surface of the condyle and inferior surface of the articular disc. Rotation of the mandible can occur in 3 reference planes around a point called the axis. They are: a) Horizontal axis of rotation: Mandibular movement around a horizontal axis of rotation is an opening and closing motion. It is referred to as hinge movement and the horizontal axis around which it occurs is referred to as hinge axis. The hinge movement is the only example of mandibular activity in which a pure rotational movement occurs.

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When the condyles are in the most superior position in the articular fossa, and the mouth is purely rotated open, axis around which movement occurs is the terminal hinge axis

b) Frontal (vertical axis of rotation): Mandibular movement around the frontal axis occurs when one condyle moves anteriorly out of the terminal hinge position with the vertical axis of the opposite condyle remaining in the terminal hinge position. c) Sagittal axis: Mandibular movement around the sagittal axis occurs when one condyle moves inferiorly while other remains in the terminal hinge position. II) Translational movements: It can be defined as a movement in which every point of the growing defect has simultaneously the same velocity and direction. Translation occurs within the superior joint cavity between the superior surface of the articular disc and inferior surface of the articular fossa. Border movements: When the mandible moves through the outer range of motion, reproducible desirable limits result, which are called as border movements.

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Border movements can be described in 3 reference planes: (i) (ii) (iii) (i) Sagittal. Horizontal. Frontal. Sagittal plane border and functional movements:

In the sagittal plane, it has 4 distinct components: a) Posterior opening border. b) Anterior opening border.
Determined by ligaments and morphology of T.M.J.

c) Superior contact border. Occlusal and incisal surfaces d) Functional neuromuscular system

a)

Posterior opening border movements: Occurs as two stage hinging movements. In the first stage, the

condyles are stabilized in their most superior positions in the articular fossae. The most superior condyle position from which hinge axis movement occur is called centric relation. (Retruded contact position, terminal hinge axis or ligamentous position). In anterior relation, mandible can be rotated around the horizontal axis to a distance of only 20-25mm as measured between the incisal edges of the maxillary and mandibular teeth. At this point of opening, the TMJ ligament tightens, after which, continued opening results in an anterior and inferior translation of the condyles.

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This is the 2nd stage of the posterior opening border movements. As the condyles translate, axis of rotation of the mandible shifts into the bodies of the rami, most likely in the area of attachment of the sphenomandibular ligament. Maximum opening is reached when the capsular ligament will prevent further movement of the condyles. This opening is in the range of 40-60mm measured between the incisal edges of the Mx and Md teeth. b) Anterior opening border movement: When the mandible is maximally opened, closure accompanied by contraction of the inferior lateral pterygoids (which keep the condyles positioned anteriorly) will generate the anterior opening border movement. Since the maximum protrusive position is determined in part by the stylomandibular ligaments, as closure occurs, tightening of the ligament produces a posterior movement of the condyles. Condylar position is most anterior in the maximally open but not in the maximally protruded position. c) Superior contact border movements: Throughout this entire movement, tooth contact is present. It depends on: Amount of variation between centric relation and maximum intercuspation positions. Steepness of cuspal inclines of posterior teeth. Amount of vertical and horizontal overlap of anterior teeth.
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Lingual morphology of maxillary anterior teeth. The general inter arch relationships of the teeth. The initial contact in terminal hinge closure (centric relation occurs between the mesial inclines of a maxillary tooth and the distal inclines of the mandibular tooth.

When muscular force is applied to the mandible, a superoanterior movement or shift will occur until the intercuspal position is reached. This slide is present in 10% of the population and is approx 1.25mm 1mm.

When

the

mandible

is

protruded

from

maximum

intercuspation contact between the incisal edges of the mandibular anterior tooth and lingual inclines of the maxillary anterior teeth results in an antero-inferior movement of the mandible. This continues until the maxillary and the mandibular teeth are in an edge to edge relationship, at which time a horizontal pathway is followed. As the incisal edges of the mandibular teeth pass beyond the incisal edges of the maxillary teeth, the mandible moves in a superior direction, until the posterior teeth contact. The occlusal surfaces of the posterior teeth, then dictate the remaining pathway of the maximum protrusive movement which joins with the most superior position of the anterior opening border movement. d) Functional movements:

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They usually take place between the border movement and therefore considered as free movements.

Most functional activities require maximum intercuspation and therefore typically begin at and below the intercuspal position.

When the mandible is at rest it is found to be located approx2-4mm below the intercuspal position. This position has been called cliniical rest position. This position is variable.

The myotactic reflex is active at this position, and the teeth can be quickly and effectively brought together for immediate function.

Postural effects on functional movements:

a)

Head

position

is

erect:

Postural position of the mandible is 2-4mm below the intercuspal position (elevator muscles contract mandible goes directly to ICP). b) Head positioned 45 upward:

postural position of the mandible will be altered to a slightly retruded position. This change is related to the stretching and elongation of various tissues that are attached to and support the jaws (elevator muscles contract path of closure is slightly posterior to path of closure in erect position). c) Head positioned 30

downward (alert feeding position). If the elevator muscles contract with the head in this position, the path of closure will be slightly anterior to that in upright position. (Elevator muscles contract
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path of closure is slightly anterior to path of closure in erect position). Horizontal plane border movements: Gothic arch tracer is used to record mandibular movements in the horizontal plane. Consists of recording plate attached to the maxillary teeth and a recording stylus attached to the mandibular teeth. As the mandible moves, stylus generates a line on the recording plate that coincides with this movement. The mandibular movements when viewed in a horizontal plane are rhomboid-shaped and has 4 distinct component movements plus a functional movement. a) b) with protrusion. c) d) border with protrusion. a) Left lateral border: With the condyles in CR position, contraction of the right inferior lateral pterygoid, will cause the right condyle to move anteriorly and medially. If the left inferior lateral pterygoid stays relaxed the left condyle will remain situated in CR and the result will be a left lateral border movements. Right lateral border. Continued right lateral Left lateral border. Continued left lateral border

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b) Continued left lateral border movements with protrusion With the mandible in the left lateral border position contraction of the left inferior lateral pterygoid muscle along with continued contraction of the right inferior lateral pterygoid muscle will cause the left condyle to move anteriorly and to the right. This causes a shift in the mandibular midline back to coincide with the midline of the face. c) Right lateral border movement: Once the left border movements have been recorded the mandible is returned to CR and the right lateral border movements are recorded. Contraction of the left inferior lateral pterygoid muscle will cause the left condyle to move anteriorly and medially. If the right inferior lateral pterygoid muscle stays relaxed, the right condyle will remain situated in the CR position. The resultant movement will be right lateral border movement. d) Continued right lateral border movement with protrusion

Contraction of the right inferior lateral pterygoid muscle along with the continued contraction of the left inferior lateral pterygoid muscle will cause the right condyle to move anteriorly and to the left. Since the left condyle is already in its maximum anterior position, the movement of the right condyle to its maximum anterior position will cause the shift in the mandibular midline back to co-incide with the midline of the face.

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e) Functional movements: As in the sagittal plane, functional movements in the horizontal plane most often near the intercuspal position. During chewing, range of jaw movements begins same distance away from MICP but as food is broken down into smaller particles, jaw action moves closer and closer to ICP. III) functional movements: When mandibular motion is viewed in the frontal plane, a shield like pattern can be seen that has 4 distinct movement components: a) b) c) d) Left lateral superior border. Left lateral opening border. Right lateral superior border. Right lateral opening border. Frontal (vertical) border and

The movement in the plane has not been traditionally traced, an understanding of them is useful in visualizing mandibular activity 3dimensionally. a) Left lateral superior movement: With the mandible in maximum intercuspation a lateral movement is made to the left. A recording device will disclose an inferiorly concave path being generated. The precise mixture of this path is primarily determined by the morphology and inter arch relationships of the maxillary and mandibular teeth that are in contact during this movement.
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Of secondary influence are the condyle-disc-fossa relationships and morphology of the working or rotating side TMJ. b) Left lateral opening border: From the maximum left lateral superior border position an opening movement produces a laterally convex path. As maximum opening is approached, the ligaments tighten and produce a medially directed movement that causes a shift in the mandibular midline to coincide with the midline of the face. c) Right lateral superior border movements: Once the left frontal border movements are recorded the mandible is returned to maximum intercuspation. From this position a lateral movement is made to the right that is similar to left lateral superior border movements. d) Right lateral opening border movements: From the right lateral superior border position an opening movement produces a laterally convex path similar to that of the left lateral opening border movements. e) Functional movements: As in other planes, functional movements in the frontal plane begin and end and the intercuspal position. During chewing, the mandible drops directly inferiorly until the desired opening, is achieved. It then shifts to the side the bolus is placed and rises up. As it approaches maximum intercuspation, the bolus is broken down between the opposing teeth. It the final mm of closure the mandible quickly shifts back to the ICP.
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Envelope of motion (given by Posselt): By combining mandibular border movements in all 3 planes a 3-D envelope of motion is produced. This represents maximum range of movement of the mandible. The superior surface of the envelope is determined by tooth contacts. Other borders are primarily determined by ligaments and joint anatomy. Eccentric mandibular movements: Eccentric mandibular movements can be divided into protrusive and lateral movements and consist mainly of condylar translation instead of rotation. 1) a) Sagittal protrusive condylar path: Mandible translates in a forward and downward direction during protrusive movement. The right and left condyle disc assemblies also slide downward and forward, a total movement of only 10mm. The orbit produced by the centres of right and left condyles during protrusive movement is referred to as protrusive condylar path. When the protrusive condylar path is projected in the sagittal plane, it is called sagittal protrusive condylar path, an Sshaped curve. Protrusive movement:

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The curve is more obvious in dentulous arches. The shape varies from a shallow curve to a straight line.

The angle formed by the protrusive condylar path and the horizontal reference plane is called Sagittal inclination of protrusive condylar path. The average angle is 33 when Campers plane used as horizontal reference plane and 35.6 when Frankfurt horizontal plane is used.

Sagittal protrusive incisal path: During protrusive movement the mandibular anterior teeth protrude downward and forward along the lingual concavities of the maxillary anterior teeth discluding the posterior teeth. The orbit of the incisal point from maximum intercuspation to edge to edge occlusion is referred to as protrusive incisal path. Mean length is 5mm and is variable for different individuals. Angle formed between the protrusive incisal path and the horizontal reference plane is called sagittal inclination of protrusive incisal path (incisal guidance angle) with a range of 50-70degrees. Usually sagittal inclination of protrusive incisal path is greater than sagittal inclination of protrusive condylar path (Hobo 1978).

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Lateral movement: Lateral mandibular movement occurs when one condyle rotates within the TM fossa and the other condyle translates forward, inward and downward. When the orbit of the center of the non working condyle is traced on the sagittal plane it is called sagittal lateral condylar path (mediotrusive path). It is longer and steeper than the Sagittal protrusive condylar path. Fisher angle Angle formed between sagittal protrusive condylar path and sagittal lateral condylar path varies from 3-10 mean of 5. Angle form between sagittal lateral condylar path and horizontal reference plane is called sagittal inclination of lateral condylar path. FHP is approx. 45-50.. The sagittal inclination of the lateral condylar path on the non-working side has 5 different patterns: i) ii) iii) iv) v) Unique concave curve type. Concave curve type. Straight type. Convex curve type. Unique convex curve type.

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Bennett movement: Bennett in 1908, studied the working condylar path and called it Bennett movement, now referred to as laterotrusion. Bennett movements refers to condylar movements on the working side and Bennetts shift is the bodily side shift of the mandible on the working side generally in the horizontal direction. The glossary of Occlusal terms, International Academy of Gnathology 1979 defines Bennett movement as The bodily side thrust or shift of the mandible regulated by the anatomical configurations of the glenoid fossa or capsular ligaments. The degree of inward movement of the orbiting condyle is determined by 2 factors: i) ii) Morphology of medial wall of mandibular fossa. Inner horizontal part of the TM ligaments, which attaches to the lateral pole of the rotating condyle. If the TM ligament of the rotating condyle is very tight and the medial wall is close to the orbiting condyle, there is no bodily side shift of the mandible and therefore no Bennett movement. This rarely occurs. Bennett movement has 3 components: a) Amount. b) Timing. c) Direction.

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a) Amount: More medial the wall of the mandibular fossa from the medial pole of the orbiting condyle, looser the TM ligament of the rotating condyle, greater the Bennett movement. When the Bennett movement occurs, a shift is seen before the condyle begins to translate from the fossa. This is called Immediate side shift. Beyond this the condyle moves forward, downward and inward. This is called progressive side shift.
b) Timing: Depends upon amount of ISS and PSS i..e. the rate or amount of

descent of the orbiting condyle and rotation and lateral shift of working condyle. a. Immediate side shift : It is the first movement, the mandible makes when initiating lateral excursions. The non-working condyle moves from centric position medially against the medial and superior walls of the articular fossa to a distance of approx 1mm (range 0.2-2.5mm). it is not an exact 90 or right angled medial movement in the horizontal plane. b. Progressive side shift: Beyond the ISS, the condyles more

forward, downward and inward. This movement is called PSS. Lundeen and Wirth ISS varies with individual PSS is constant 7.5/ c. Bennett angle Angle formed by lateral horizontal condylar path and the sagittal plane. Mean value of 16 degrees.
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c) Direction: The direction of the Bennett movement depends primarily on

the direction taken by the rotating condyle during bodily movement. The direction of the shift of the rotating condyle during Bennett movement is determined by the TMJ undergoing rotation. Clinical significance of mandibular movements: Importance of mandibular movements: (i) [I] Condylar guidance and anterior guidance: These are the two end controlling factors of mandibular movements. When movement of a solid body is governed by contacting surfaces at either ends of the body, the direction of movement of any point within the body is determined by its location in relation to the two guiding surfaces.
a)

Construction and use of articulators. Arranging of artificial teeth. Development of occlusal scheme. Treating TMJ disorders. Protrusive movements:

2nd molar is closer to the

condylar guidance than the lateral incisor, condylar guidance has a greater effect on direction of movement of lower 2nd molar than it does on the lower lateral incisor.
b)

Anterior guidance has a greater

effect on the direction of movement of the lower canine than it does on the 2nd molar. Anterior guidance has a greater effect on direction of

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tooth movement during mandibular movement as all the teeth are closer to anterior guidance than the condylar guidance. Effect of condylar and anterior guidance on cusp height and fossa depth. a. condylar guidance angle, shorter the cusp heights. b. condylar guidance angle, greater the cusp height. c. vertical overlap, shorter the cusp of the posterior teeth. d. vertical overlap, longer the posterior cusps may be: [II] Bennetts movement It is necessary that the teeth must be in harmony with this side shift. a) The more Bennett movement, more mesial are the working and balancing cusp paths on the mandibular teeth and the more distal they are on the maxillary teeth. The less the side shift, the reverse occurs dentures. b) Effect of timing of side shift: The greater the side shift initially the more mesial is the cusp path on the mandibular teeth and more distal it is on the maxillary teeth. Effect on cusp height and fossa: Greater the side shift, shorter the cusps. Lesser the side shift, longer the cusps. Greater the Lesser the Greater the Lesser the

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[III] It helps to determine the terminal hinge axis position which is stable and repeatable. It is the starting point of all lateral movements. The CR record is made in the terminal hinge axis position, it helps to orient the casts to the articulator. [IV] Centric relation is the posterior limit of the envelope of motion. It is a repeatable and recordable position. In CD, CR coincides with CO. It is a comfortable position for the patient and is satisfactory for speech and mastication. Major functions of the masticatory system: a) Mastication. b) Deglutition. c) Speech. a) Mastication: It is the act of chewing food. Mastication is made up of rhythmic and well controlled seperation and closure of the maxillary and mandibular teeth. In the frontal plane, it has a tear shaped pattern. It has: a. Opening phase. b. Closing phase: It is divided into: a.

Crushing phase. Grinding phase.

Opening phase: In the opening phase the mandible drops downward from the intercuspal position to a point where the incisal edges are

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approx 16-18 mm apart. It then moves laterally 5-6mm from the midline as the closing movement begins.
b.

Closing phase: The first phase is the crushing phase in which the food is trapped between the teeth. As the teeth approach each other, the lateral displacement is lessened so that when the teeth are only 3mm apart, the jaw occupies a position only 3-4mm lateral to the starting point of the chewing motion. At this point, the teeth are so positioned that the buccal cusps of the mandibular teeth are almost directly under the buccal cusps of the maxillary teeth on the side to which the mandible has been shifted. As the mandible, continues to close, the grinding phase begins. During the grinding phase, the mandible is guided by the occlusal surfaces of the teeth back to the intercuspal position, which causes the cuspal inclines of the teeth to pass over each other permitting shearing and grinding of the bolus of food. If movement of the mandibular incisor is followed in the sagittal plane, it will be seen that during the opening phase, the mandible moves slightly anteriorly. During the closing phase, it follows a slightly posterior pathway, ending in an anterior movement back to the maximum intercuspal position.

Tooth contact during mastication: When food is initially introduced in the mouth, few contacts occur. As the bolus is broken down, tooth contact increases. 2 types of contacts have been identified.

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(i) phases of mastication. (ii) maximum intercuspal position. -

Gliding which occurs as the

cuspal inclines pass by each other during the opening and grinding

Single

which

occurs

at

Initial stages of chewing greater lateral movement. Harder the food greater lateral movement. Tall cusp and deep fossae vertical chewing pattern. Flat worn out teeth broader chewing stroke. Malocclusion Irregular and less repeatable chewing stroke. Normal persons with good occlusion chewing strokes well rounded with definite border and less repeated.

Average tooth contact during mastication 194 ms.

Maxmium biting force Males 118-142lb. Females 79-19lb. b) Swallowing (deglutition): It is a series of coordinated muscular contractions that moves a bolus of food from the oral cavity through the oesophagus to the stomach. Stabilization of the mandible is important part of swallowing. The mandible must be fixed so contraction of suprahyoid and infrahyoid muscles can control proper movement of the hyoid bone needed for swallowing. Somatic swallow teeth used for stabilizing mandible, in adults.
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Visceral swallow In infants, mandible is braced by placing the tongue forward between the dental arches and gum pads. Average tooth contact during swallowing 683ms When the teeth contact evenly and simultaneously in the retruded closing position, the muscles of mastication appears to function at lower levels of activity and more harmoniously during mastication.

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CONCLUSION:
It is necessary to understand the physiologic activities of the masticatory system before we attempt in providing the patient with a prosthesis. Various daily activities such as mastication, swallowing speech etc require a complex interplay of various factors. Disharmony in any one factor can effect the entire working of the masticatory system and be a source of discomfort to the patient.

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