N e w definition for relating occlusion to varying conditions of

the temporomandibular joint

P e t e r E. D a w s o n , D D S a
Center For Advanced Dental Study, St. Petersburg, Fla.

Centric relation is the accepted term for defining the condylar axis position of intact,
completely seated, properly aligned condyle-disk assemblies. However, some structur-
ally deformed t e m p o r o m a n d i b u l a r joints m a y function comfortably, even though they
do not fulfill the requirements for centric relation. A w i d e range of temporomandibu-
lar disorders from partial to complete disk derangements w i t h or without reduction
m a y adapt to a conformation that permits the joints to comfortably accept m a x i m a l
compressive loading by the elevator muscles. There has been no accepted terminology
to define the condition or position of such joints. The purpose of this article is to
define a n e w term, adapted centric posture, and to explain its rationale and h o w it is
determined. Verification of successful adaptation is an important step in diagnosis,
because it rules out structural intracapsular disorders as a source of orofacial pain
and establishes responsible guidelines for initiation of occlusal treatment or prosthetic
dentistry. It also establishes a m u c h n e e d e d terminology for more specific description
o f t e m p o r o m a n d i b u l a r joint position and condition for clinical research on the
relationship b e t w e e n occlusion and the temporomandibular joints. (J PROSTHETDENT
1995;74:619-27.)

C o n f u s i o n about the relationship between dental
occlusion and the temporomandibular joints (TMJs) has
been evident in the literature for many years. Many
authors advocate that condyle position is critical to the
equilibrium of the masticatory system at maximal inter-
cuspationY TM Others have argued that little or no rela-
tionship exists between faulty occlusion and temporoman-
dibular disorders. 2~
In contrast to published information that occlusion is not
a factor in temporomandibular disorders (TMDs), a review
of the literature suggests that such a conclusion is not to-
tally supported, because the information is routinely
devoid of specific details about the position or the condition
of the temporomandibular joints in relation to occlusal
contacts.20-2t Further confusion results from the use of the
single term "TMD" to denote a whole constellation of signs
or symptoms with no specificity of the type of intracapsu-
lar deformation or whether any structural deformation has
even occurred.
It is important to determine the type of intracapsular
deformation or change in TMJ structures before attempt-
ing to determine the optimal relationship between the
temporomandibularjoints and maximal intercuspation of
the teeth. Because the position of the condylar axis can be
aDirector.
Copyright 9 1995 by The Editorial Council of THE JOU~AL OV
PROSTHETIC DENTISTRY.
0022-3913/95/$5.00 + 0. 10/1/67765
altered by these changes, this article attempts to clarify the
rationale for positioning healthy condyle-disk assemblies
in centric relation and suggests more definitive terminol-
ogy and rationale for positioning temporomandibularjoints
that have undergone intracapsular deformation and struc-
tural change.
This article suggests three categories for condyle-fossa
relationships: centric relation, adapted centric posture,
and treatment position. These categories will be defined,
explained, and related to maximal intercuspation of the
teeth.
CENTRIC RELATION
Centric relation is defined in this article as the precise
location of the horizontal condylar axis when properly
aligned condyle-disk assemblies are completely seated in
their respective bony sockets. Because the position of the
horizontal condylar axis determines the maxillo-mandib-
ular relationship during jaw closure, any variation in
condylar position will change the closing arc of the mandi-
ble and thus affect the initial contact of the mandibular
teeth against the maxillary teeth. If maximal intercuspal
tooth contact is not coincident with the completely seated
position of both condyles, the condyles must be displaced
to achieve complete jaw closure into maximal intercuspa-
tion. Numerous electromyographic studies reported that
occlusal interferences to centric relation disrupt the coor-
dination of masticatory muscle function. 25-3~
The most important criterion for centric relation is the

DECEMBER 1995 THE JOURNAL OF PROSTHETIC DENTISTRY 619

THE JOURNAL OF PROSTItETIC DENTISTRY
,:
.
Fig. 1. In coordinated muscle function, triad of strong el-
evator muscles pulls condyles up slippery posterior slopes
of eminentiae. Inferior lateral pterygoid muscles release
and stay released through complete closure if no occlusal
interferences to centric relation occur.
complete release of the lateral pterygoid muscles during
jaw closure. 2 During jaw closure in intact TMJs the
condyle-disk assemblies are pulled up the eminentiae by a
triad of strong elevator muscles (Fig. 1). To ensure a coor-
dinated neuromusculature function, the release of inferior
lateral pterygoid muscle contraction must allow the
condyles to slide up to the apex of force positions,n~ at which
point the medial pole of each condyle-disk assemble would
be stopped by bone. This buttressed bone stop occurs at
the height of concavity in the medial third of each fossa
(Fig. 2). This relationship would then be considered the
ideally aligned or completely seated condyle-disk assem-
bly.
The condyles must be free to move down and up the pos-
terior slope of the eminence during function. The function
of the masseter and internal pterygoid muscles should
keep the condyles loaded 2 against the eminentiae in all
excursive movements (Fig. 3) and in centric relation. Fol-
lowing this philosophy, it may be more descriptive to say
that centric relation is the most superior position that the
properly aligned condyle-disk assemblies can achieve
against the eminentiae. This position would appear to be
physiologic, because it results mechanically from coordi-
nated release function, which completely seats the condyle-
disk assemblies if no occlusal inclines interfere. The
significance of this uppermost position is that only at this
bone-braced relationship is the coordinated activity of the
inferior lateral pterygoid muscles achieved through com-
plete closure. Ligament bracing is not a factor, because the
condyles can be displaced down and back from centric re-
lation before the ligaments reach their functional limita-
620
DAWSON
tions. This "uppermost" position is a departure from the
concept of"most retruded." To equate centric relation with
the "retruded position" is still common in the literature,
which, although it may be confusing, is acceptable if
achieved by coordinated masticatory muscles. It should not
be considered centric relation if the condyles are forced
away from the eminentiae to a more retruded position than
the one achieved by the coordinated muscle function. Un-
fortunately, in patients undergoing dental procedures the
technique of pushing the jaw back to record centric relation
is still too prevalent.
The reason we advocate preciseness in l(~cating centric
relation is because of the common clinical observation that
even the most minute deflection from the bone-braced
condyle position may activate uncoordinated contraction of
the lateral pterygoid muscles in opposition to elevator
muscle contraction. Our observations of this uncoordi-
nated muscle activity suggests that it can result in myo-
fascial pain if disruptive occlusal contact is prolonged. It is
reasonably assumed that prolonged isometric contraction
of antagonistic muscles can result in myogenous pain,
particularly in the smaller lateral pterygoid muscles,
which are at a disadvantage.
The trigger that activates lateral pterygoid contraction
can be inconspicuous. The exquisite sensitivity of peri-
odontal and interdental proprioceptive sensors can trigger
painful reflex muscle patterns from deflective occlusal in-
terferences that are easily missed by clinicians who do not
recognize their importance or the importance of verifying
the accuracy ofcentric relation before starting any occlusal
correction procedures (Fig. 4).
In most, if not all, of the published studies that downplay
the role of occlusion, no attempt has been reported to pre-
cisely locate and verify an accurate centric relation. If this
verification is not done, any conclusions drawn regarding
the relationship between correct occlusion and properly
positioned temporomandibular joints are highly suspect.
The mandible is in centric relation if four criteria are
fulfilled:
1. The disk is properly aligned on both condyles.
2. The condyle-disk assemblies are at the highest point
possible against the posterior slopes of the eminentiae.
3. The medial pole of each condyle-disk assembly is braced
by bone.
4. The inferior lateral pterygoid muscles have released
their contraction and are passive.
If all four of these criteria are fulfilled, healthy temporo-
mandibular joints in centric relation can accept all of the
loading that the elevator muscles can apply, because all of
the force is directed through avascular, noninnervated
structures that were designed to be load-bearing. 3236If the
upward slide of the condyle-disk assemblies is stopped by
bone, no resistance should be required from the inferior
lateral pterygoid muscles once the condyles are completely
seated; therefore upward loading should not alter their
V O L U M E 74 NUMBER 6
DAWSON THE JOURNAL OF PROSTHETIC DENTISTRY

F i g . 2. The condyle-disk assemblies slide up convex posterior slopes of eminentiae until

medial poles (solid arrow) are stopped by buttressed bone at medial third of fossae. Circle
indicates uppermost position at which medial pole braces against bone (with disk inter-
posed). Lateral two thirds of roof of fossa is thin and not bearing area.

Fig. 3. No muscles are in a position to distract condyles. Whether occlusal contact is on

anterior teeth only or posterior teeth only, all elevator muscles combine to direct the
condyles antero-superiorly in centric relation (A) and also keep them loaded against em-
inentiae as they travel up and down the slopes in function (B).

passive state during closure or activate their contraction
even during strong clenching. So unless the muscles are
triggered by a disruptive occlusal contact that occurs
before maximal closure is complete, the coordinated re-
lease of the inferior lateral pterygoid muscle should remain
consistent with elevator muscle contraction during the re-
petitive clenching posture associated with swallowing.
When both condyle-disk assemblies are completely
seated in centric relation, their medial poles should be at
the highest point of concavity of that part of each fossa.
From where the medial poles are stopped by bone the fos-
sae walls curve downward on three sides so that from a
correct centric relation, the condyles cannot travel for-
ward, backward, or medially without moving downward
(Fig. 5). The understanding of this apex of force position is
extremely important to our concept of centric relation. It
means that failure to completely seat condyles when har-
monizing an occlusion invariably results in a muscle-

DECE~m~R xggs 621

THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 4. Load testing conducted at suspected centric rela-
tion hinge position with torquing action starting with gen-
tle loading first, then increasing pressure from light to very
firm. Any sign of tension or tenderness in either joint in-
dicates that centric relation has not been achieved. Fingers
must be placed on posterior half of mandible during
manipulation.
braced condyle instead of a bone-braced condyle. It also
means that whenever the condyles go to their more upward
centric relation position during function, the closing forces
are directed more on the most posterior teeth, which
become pivotal to the upward moving condyles (Fig. 6).
Contrary to some opinions that centric relation is not a
functional position, that observation has not been sup-
ported by extensive research at the University of Florida is
or in studies that show that the retruded position is used
frequently in swallowing. 37 If the idea that the condyles do
go repeatedly to centric relation is doubted, it would only
be necessary to observe the facets of wear on the teeth of
a number of patients. Casts mounted correctly in centric
relation routinely show that if wear facets are present, the
facets always extend to centric relation on tooth inclines
that interfere with centric relation.
A study of condyle/fossa anatomic condition makes it
evident that the medial wall of the fossa braces against the
medial pole of the condyle disk assembly when the condyles
are in centric relation. This fact is why centric relation is
the midmost position of the mandible (Fig. 7). Thus from
centric relation it is not possible for either condyle-disk as-
sembly to move horizontally toward the midline. If such a
movement occurs, it is an indication that the condyles were
not completely seated in centric relation at the start of
movement. From centric relation the orbiting condyle
must move downward as it moves medially.
622
DAWSON
ADAPTED CENTRIC POSTURE
Many TMJs function with complete comfort and appar-
ent normalcy, even though they have undergone deforma-
tion caused by disease, trauma, or remodeling and there-
fore automatically cannot fulfill all of our criteria for cen-
tric relation. Some TMJs click or exhibit other signs of
intracapsular disorder, but they do not prevent patients
from functioning in an acceptable and comfortable man-
ner. Determining whether a deformed TMJ can function
acceptably with comfort and with a reasonable degree of
stability is one of the most important decisions in the di-
agnostic process.
The author defines adapted centric posture as the rela-
tionship of the mandible to the maxilla that is achieved
when deformed temporomandibular joints have adapted to
the degree that they can comfortably accept firm loading
when completely seated at the most superior position
against the eminentiae.
Like centric relation, adapted centric posture is a hori-
zontal axial position of the condyles. It occurs irrespective
of vertical dimension or tooth contact. It is also a midmost
position, because even if the disk is totally displaced, the
medial pole of the condyle adapts to the concavity of the
fossa and maintains contact against its medial incline.
The mandible is in adapted centric posture if four crite-
ria are fulfilled:
1. The condyles are comfortably seated at the highest
point against the eminentiae.
2. The medial pole of each condyle is braced by bone. (The
disk may be partially interposed.)
3. The inferior lateral pterygoid muscles have released
contraction and are passive.
4. The condyle-to-fossa relationships occur at a manage-
able level of stability.
The consequences of adaptive changes in the temporo-
mandibular articulation may be positive or negative with
regard to symptoms. The same adaptive changes that re-
sult in reduction of symptoms may simultaneously produce
serious and progressive deformation ofintracapsular struc-
tures and damage to collateral structures eleswhere. Teeth
and supporting structures can be especially affected by
structural changes of the TMJs. We note that excessive
occlusal wear or hypermobility of teeth is routinely ob-
served as disharmony between the TMJs and the occlusion
progresses. 3s Our clinical observation is consistent: unsta-
ble TMJs result in unstable occlusions.
Adapted centric posture may be achieved in a variety of
intracapsular deformations. The progression from a
healthy, intact TMJ to one that is deformed and has
adapted may include stages that produce pain and dys-
function as the adaptation process takes place. The pro-
gression of deformation may occur with little or no intra-
capsular pain. Diagnosis made on the basis of symptoms
only is insufficient and may lead to false assumptions
about the source of pain in patients with TMD.
VOLUME 74 NUMBER6
DAWSON THE J O U R N A L OF PROSTHETIC DENTISTRY

Fig. 5. Medial pole of each condyle-disk assembly is braced against uppermost roof of
concavity at medial third of each fossa. From that seated position condyles cannot move
forward, backward, or medialward without traveling downward (circle represents medial
pole position). Because anterior face of each condyle disk assembly (line with three arrows)
is against eminence in centric relation, no forward translation is possible without down-
ward movement.

Proper diagnosis requires an orderly evaluation ofintra-
capsular structures, not just to see whether deformation is
present but to determine the specific stage of deformation
responsible for the discomfort. The clinical experience of
the author has shown that in most patients with so-called
TMD, the discomfort is far more likely to be myogenous
rather than intracapsular, even when some deformation
has occurred within the intracapsular structures. This di-
agnosis cannot be determined on the basis ofepidemiologic
percentages. It must be determined by specific testing of
each individual patient to determine whether any intrac-
apsular structures are disordered, and, if they are de-
formed, to determine whether they have adapted to a
manageable level of comfort and stability. A combination
of history, load testing, auscultation, and palpation can
usually lead to a diagnosis, but some type of imaging may
be needed for specificity.
Some of the most common intracapsular conditions that
may permit an adapted centric posture are (1) lateral pole
disk derangements, (2) complete disk derangements with
formation of a pseudo-disk, (3) complete disk displacement
with perforation, and (4) other partial disk derangements
and asymptomatic clicking TMJs.
Lateral pole disk d e r a n g e m e n t s
Piper's classification of intracapsular disorders distin-
gnishes between lateral pole disk derangements and
derangements in which the disk is displaced off both the
lateral and medial poles of the condyle. If the disk is not
displaced off the medial pole, it is possible to achieve com-
plete seating ofthe condyle with no discomfort. This is true
even when a lateral pole click has progressed to closed lock
of the lateral half of the disk. If the intracapsular defor-
mation is intercepted at these stages, it has been our clin-
ical experience that stability of the articulation can b e
achieved if harmony is established between the occlusion
and the completely seated condyle-disk assemblies.
The experience of the author also suggests that lateral
pole disk derangements can be treated as normal joints if
the medial pole disk alignment is acceptable and if adapted
centric posture can be verified by load testing. 39 In my ex-
perience the key to success is in maintaining coordinated
musculature function through elimination of all occlusal
interferences to a verified adapted centric posture.
Complete disk d e r a n g e m e n t s w i t h formation
o f a p s e u d o disk
In the early stages of a complete disk displacement it is
the experience of the author that a period exists during
which pain is a symptom. Considerable pain may result
from compression of the vascular and richly innervated
retrodiskal tissue by the condyle (Fig. 8). If this compres-
sion occurs, adapted centric posture cannot be achieved
because the TMJ will not accept loading without some de-
gree of discomfort. Although not predictable, the retrodis-
kal tissue is sometimes converted to a fibrous connective
tissue pseudo-disk. We have observed such pseudo-disk
formation in cadaver specimens, in open-joint microsur-

DECEMBER 1995 623

THE J O U R N A L OF PROSTHETIC DENTISTRY
, ~ l [t [i i[IIr
/[[ il
: ~ ~ ~ ~ relation. This midmost position is consistently s imulta-
' neous with uppermost position.
! ~ fill
Fig. 6. Because condyles must displace downward to ac-
commodate intercuspal position that is forward of centric
relation (A), most posterior tooth that interferes becomes
pivotal point when condyles are pulled up into centric re-
lation. B, Inferior lateral pterygoid must remain actively
contracted whenever teeth are intercuspated,
gery, and on magnetic resonance images. If this formation
occurs, it is possible that blood vessels and their accompa-
nying sensory nerves will evacuate the bearing area, and
the fibrous extension of the original disk will eventually be
able to accept loading with no discomfort. It may then be
possible to achieve an adapted centric posture that appears
to be as stable as an intact condyle-disk alignment.
Complete disk displacement with perforation
The most likely progression from a closed-lock, anterior
displacement of the disk is to proceed through a painful
stage of compression of the retrodiskal tissues, which be-
come less painful as the condyle perforates the sensitive
624
DAWSON
Fig. 7. Medial pole bracing in line with medial pterygoid
muscle contraction establishes midmost position at centric
~ x
Fig. 8. In early stages of complete disk derangement,
condyle loads onto vascular, retrodiskal tissue, which is
richly innervated. When this structural misalignment oc-
curs, TMJ cannot accept loading without pain.
vascular tissues and begins to load against bone. As the
soft-tissue perforation expands, a complete bone-to-bone
contact may result that permits loading with no impinge-
ment against innervated structures. At this stage it is pos-
sible to verify an adapted centric posture by the absence of
discomfort when the condyles are loaded.
The typical sequence of events that we have experienced
after the retrodiskal tissue is perforated is a progressive
flattening of both the condyle and eminence. The osteoar-
thritic deformation starts at the articular cartilage, caus-
ing a loss of height of the condyle. Because the perforation
VOLUME 74 NUMBER 6
DAWSON
and disk derangement disrupts the flow of synovial fluid,
nourishment to the articular surfaces is compromised.
Thus the osteoarthritic joint is not completely stable.
Although the condyle will continue to lose height as its
bearing surface breaks down, the deformation can usually
be slowed to a manageable condition by reestablishing co-
ordinated muscle function and reducing muscle hyperac-
tivity. Any discomfort in this type of problem is invariably
myogenous. It can be readily resolved by restoring har-
mony between the occlusion and the completely seated
TMJs, even though they have undergone deformation.
It is the author's contention that patients with slowly
progressing osteoarthritis can be made as comfortable as
patients with intact TMJs if occlusal harmony is estab-
lished with adapted centric posture. If both condyles can
accept loading with no discomfort, relief of myofascial pain
is highly predictable if all occlusal interferences to the
bone-braced condyle position are completely eliminated.
Typically, it is necessary to adjust the occlusion periodi-
cally as condylar height is lost, but it does not create a
management problem if patients are informed of this need
in advance. In my clinical experience minimal corrections
to the occlusion are all that is needed at 9- to 12-month in-
tervals to maintain comfort in the masticatory muscula-
ture.
Other partial disk derangements and
a s y m p t o m a t i c c l i c k i n g TMJs
Reciprocal clicking is a sign that some degree of defor-
mation has occurred in the diskal ligaments. The varia-
tions in deformation of the ligaments and the disk appear
unlimited. However, many clicking and deformed joints
have adapted sufficiently so that they can comfortably ac-
cept loading. If a structural analysis shows that the condi-
tion is reasonably stable, adapted centric posture may be
achieved, even though the disk is deranged and a click is
present. The key to successful treatment of adapted TMJs
is the complete seating of both condyles so that the inferior
lateral pterygoid muscles can release their contraction
during closure all the way to maximal intercuspation.
TREATMENT POSITION
Three general types ofintracapsular disorders result in
pain or discomfort when the temporomandibular joints are
loaded.
1. In complete displacement of the disk, disk displacement
is almost always anterior to the condyle, which results
in compression of the vascular, innervated, retrodiskal
structures. If the disk is not reducible and compression
ofretrodiskal tissue causes discomfort, it is necessary to
determine a treatment position for the condyle for the
purpose of developing an adapted centric posture that
can eventually accept loading.
2. Retrodiskal inflammation and edema usually occurs as
a result of trauma and may or may not be associated
DECEMBER1~5
T H E J O U R N A L OF P R O S T H E T I C D E N T I S T R Y
with disk displacement. When the retrodiskal tissues
are swollen and painful, the condyles cannot completely
seat to either centric relation or adapted centric posture
without compressing these structures. A treatment po-
sition that reduces the compressive force and allows the
inflammation to subside should be determined. Antiin-
flammatory medication and soft diet are recommended
in combination with the use of a treatment position that
is protruded enough to prevent compression of retro-
diskal tissue. The condyles should be permitted to
return to centric relation or adapted centric posture as
soon as the edema is reduced, which is usually a mat-
ter of a few days.
3. Pathologic conditions and structural or functional dis-
orders that affect the ability of the intracapsular struc-
tures to accept loading can result from a variety of
causes. The basic rule is, "If the TMJs cannot accept
loading with complete comfort...find out why."
Differential diagnosis must first confirm that the source
of pain is within the intracapsular structures and not iso-
lated in muscle. Load testing is the most effective way to
make that determination. Masticatory muscle pain is
common when intracapsular pathosis is present, because
the muscles tend to protect the painful joint from overload.
Attempting to treat masticatory muscle problems without
knowledge of the specific type of intracapsular problem is
inappropriate. Appropriate treatment combines an at-
tempt to resolve the intracapsular problem while simulta-
neously establishing equilibrium within the total mastica-
tory system. If this procedure requires harmonization of
the occlusion with a temporary treatment position for the
joints, that decision should be based on determining the
optimal treatment position first.
Not all pathologic deformation results in pain on loading.
It is sometimes possible to load condyles with advanced
bone disease, but the condition may be too unstable to
warrant treatment procedures that are irreversible. A
complete diagnosis including history, palpation, load test-
ing, Doppler auscultation, range and path of motion test-
ing, and appropriate imaging should be used to determine
a specific diagnosis. 2, 39Blood studies, surgical exploration,
or both may be needed in some cases. It is not the purpose
of this article to outline all the protocols for diagnosing the
wide range of diseases that may be encountered. Advance-
ments in diagnostic tests and imaging capabilities make it
difficult for structural disorders to hide from an astute di-
agnostician.
Determination of treatment position
The need for a treatment position can be determined af-
ter it has been verified that neither centric relation or
adapted centric posture can be achieved. Two objectives
exist in determining the most favorable treatment position
for the condyles: (1) relief of pain, and (2) eventual stabi-
lization of the condyles in either centric relation or adapted
centric posture.
625
THE J O U R N A L OF PROSTHETIC DENTISTRY
I t m a y b e d i f f i c u l t to d e t e r m i n e w h e t h e r a t r e a t m e n t po-
s i t i o n is n e c e s s a r y i f l a t e r a l p t e r y g o i d m u s c l e c o n t r a c t i o n
is n o t r e l e a s e d . T h e p a i n o f m u s c l e s p a s m or p r o l o n g e d h y -
p e r c o n t r a c t i o n m a y m a k e i t too difficult to a c h i e v e com-
f o r t a b l e s e a t i n g of t h e condyles, e v e n w h e n n o i n t r a c a p s u -
l a r d i s o r d e r is p r e s e n t . U n l e s s a n a c t i v e i n t r a c a p s u l a r dis-
o r d e r is obvious, a n a t t e m p t s h o u l d b e m a d e to d e p r o g r a m
lateral pterygoid contraction before assuming that the
T M J s a r e t h e p r i n c i p a l s o u r c e of t h e p a i n . I t is s u g g e s t e d
t h a t t h i s d e p r o g r a m m i n g is b e s t d o n e b y c o m p l e t e l y sep-
a r a t i n g all p o s t e r i o r t o o t h c o n t a c t b y u s i n g a s m o o t h , flat,
anterior bite plane. Such a permissive splint allows the
muscles to move the mandible in coordinated function that
is u n d i s t u r b e d b y d e f l e c t i v e t o o t h c o n t a c t s . I f t h e p e r m i s -
sive s p l i n t p e r m i t s r e l e a s e of l a t e r a l p t e r y g o i d m u s c l e con-
t r a c t i o n a n d a l l o w s t h e c o m p l e t e s e a t i n g of t h e c o n d y l e s to
c e n t r i c r e l a t i o n or a d a p t e d c e n t r i c p o s t u r e , u s e of a t r e a t -
m e n t p o s i t i o n will n o t b e n e c e s s a r y . T h e r e l i e f of occluso-
m u s c l e p a i n o c c u r s quickly, m o s t o f t e n w i t h i n h o u r s w h e n
all o c c l u s a l i n t e r f e r e n c e s a r e e l i m i n a t e d . I f t h e p e r m i s s i v e
s p l i n t does n o t r e s u l t i n r e l i e f of all d i s c o m f o r t w h e n t h e
c o n d y l e s a r e l o a d - t e s t e d , a n i n t r a c a p s u l a r d i s o r d e r is s u s -
p e c t e d , a n d f u r t h e r t e s t i n g is i n o r d e r to d e t e r m i n e w i t h
specificity t h e t y p e o f s t r u c t u r a l d i s o r d e r t h a t is p r e s e n t .
T h e t r e a t m e n t p o s i t i o n t h a t is s e l e c t e d s h o u l d b e specific
for t h e t y p e of d i s o r d e r t h a t is d i a g n o s e d .
SUMMARY
L a c k of d e f i n i t i v e t e r m i n o l o g y to c l a r i f y d i f f e r e n t posi-
t i o n s a n d c o n d i t i o n s of t h e t e m p o r o m a n d i b u l a r j o i n t s h a s
caused confusion in the literature and has complicated
scientific d i s c u s s i o n r e g a r d i n g t h e r e l a t i o n s h i p of t h e
T M J s to occlusion.
U s e of t h e n o n s p e c i f i c t e r m T M D is i n a d e q u a t e for
d e s c r i b i n g specific d i s o r d e r s of t h e m a s t i c a t o r y s y s t e m .
T h e t e r m T M D does n o t specify w h e t h e r a d i s o r d e r
i n v o l v e s d e f o r m a t i o n o f i n t r a c a p s u l a r s t r u c t u r e s , does n o t
specify w h e t h e r a d i s o r d e r is p r i m a r i l y a m a s t i c a t o r y
m u s c l e p r o b l e m w i t h or w i t h o u t i n t r a c a p s u l a r d e f o r m a -
tion, does n o t specify w h e t h e r a d e f o r m e d T M J h a s a d a p t e d
s u f f i c i e n t l y to a c c e p t l o a d i n g w i t h o u t d i s c o m f o r t , does n o t
specify w h e t h e r a n a d a p t e d T M J is s t a b l e or u n s t a b l e , a n d
does n o t specify t h e t y p e of d e f o r m a t i o n or p a t h o s i s w i t h
e n o u g h c l a r i t y to b e m e a n i n g f u l i n d e t e r m i n i n g a n o p t i m a l
t r e a t m e n t p o s i t i o n for T M J s t h a t c a n n o t a c c e p t l o a d i n g .
I t is t h e a u t h o r ' s b e l i e f t h a t u n c o o r d i n a t e d , h y p e r a c t i v e ,
m a s t i c a t o r y m u s c l e s a r e t h e p r i m a r y s o u r c e of r e p e t i t i v e ,
t e n s i v e , a n d c o m p r e s s i v e forces a g a i n s t t h e T M J s a n d t h e
t e e t h a n d o t h e r m a s t i c a t o r y s y s t e m s t r u c t u r e s . I t is t h e
a u t h o r ' s b e l i e f t h a t a n a l y s i s of t h e c a u s e s for m a s t i c a t o r y
m u s c l e p a i n or d y s f u n c t i o n m u s t i n c l u d e a c c u r a t e d e s c r i p -
t i o n of t h e r e l a t i o n s h i p o f t h e o c c l u s i o n to t h e p o s i t i o n a n d
c o n d i t i o n of t h e T M J s .
626
DAWSON
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