Outlines:

Occlusion definition
Stomatognathic system definitions and functions
Muscles of mastication
TMJ anatomy
Pathology related to muscles of mastication

Occlusion definition – planes & curves

Occlusion is defined as the contact relationship of the teeth in function or

parafunction .

There is 2 types of occlusion ( normal occlusion / malocclusion )

Normal occlusion means simply the contact between teeth . More

technically, it is the relationship between the maxillary ( upper ) and
mandibular ( lower ) teeth when they approach each other , as occurs during
chewing or at rest .

Malocclusion is defined as the misalignment of teeth and jaws , or more

simply, a “ bad bite “ . Malocclusion can cause a number of health and dental
problems .

Curve of spee : it refers to the antero-posterior

curvature of the occlusal Surfaces beginning at the tip
of lower cuspids & following the cuspid tip of the
bicuspids and molars continuing as an arc through the
condyle . If the curve is extended , it would form a
circle of about 4 inch diameter
  Note : teeth + TMJ + muscles = OCCLUSION

Centric occlusion is the occlusion of opposing teeth when the mandible is

in centric relation . Centric occlusion is the first tooth contact and may or may
not coincide with maxiimum intercuspation. It is also referred to as a person’s
habitual bite , bite of convenience , or intercuspation position (ICP) .

MAXIMUM INTERCUSPATION = CENTRIC OCCLUSION

Centric relation , not to be confused with centric occlusion , is a

relationship between the maxilla and mandibule .

Conformative approach VS reorganize approach

Conformative approach  you won’t motify the occlusion of the pt.

You have intercuspation.
Not indicated :
 for edentulous pt. because you don’t have the
relation between the upper and lower teeth
 for partial denture pt with multiple
missing teeth
 with traumatic occlusion which is
harmful either to TMJ or muscles .

Reorganized approach  you don’t need the existing occlusion, all the
relation between the maxilla and the mandible is
going to be replaced .
so .. you need to find something that never change
even the pt lost his teeth which is called
(CENTRIC RELATION ) / retroduded contact position

indicated
:  when you don’t have enough teeth to
hold centric occlusion
 you have enough teeth but the occlusion is very
harmful
 STOMATOGNATHIC SYSTEM:

The stomatognathic system (SS) is a functional body unit

responsible for mastication, speech and deglutition. It is
composed of bones, joints, ligaments, teeth, muscles, and a
detailed nerve control, which regulates and coordinates all its
structures and compounds. The SS is a complex and refined unit.
A deep comprehension of the functioning of this system is
essential in dental practice. As it is a basic area in dentistry, the
complete understanding of dental occlusion

STOMA = MOUTH
GANTHION = JAW

Anatomical components

 The TMJ
 The muscle of mastication

The TMJ

Cartilage ( articular disc) : is located

between the condyle and articulating fossa of
the maxill

 The mandible is the only bone of the whole body

that has 2 joints and each joint moves
independantely ( Rt & Lt)
Articular eminence is the bone that controll
the mandible from moving forward

Mandidular fossa is the rest position of the

condyle

Movements of mandible

Rotation is when the condyle moves in its place without sliding , very early
movement

Translation which means after rotation movement the mandible during

opening, the condyle moves along the articular eminence to make sliding

 This 2 movements can be seen when the both side of the mandible
moves

What if one side only moves and the other side moves differentely like the
right makes rotation movement and the left make translation movements or
vice versa , this is called SLIDING SHIFT that the mandible moves to the right
or to the left  Lateral movement .

Note : 90% of problems of TMJ are totally corrected by occlusion

Articular capsule : that covers and protects the joints , any problems in the
function will refer to pt either by pain/ clicking or crepitus .
 Functional muscles of mastication

Four major muscles are :

 Masseter muscle
 Temporalis muscle
 Lateral pterygoid muscle
 Medial pterygoid muscle

Masseter muscle ( it will close the mandible in Centric occlusion )

 Superficial layer

Origin : lower border of malar bone , zygomatic arch &zygomatic process of

Maxilla

Insertion : angle of mandible & inferior half of the lateral side of the madible

Relaxation : downward and backward

 Deep layer

Origin : internal surface of zygomatic arch

Insertion : ramus of mandible and base of coronoid process

Relaxation : downward ( vertical )

Nerves : Masseteric nerve , a branch of the anterior division of the mandibular

nerve .

Action : the muscle elevates the mandible to close the mouth ; and clenches
the teeth

Note : masseter muscle is the most exposed to hypertrophy

with pt used to clench a lot .
Temporalis muscle ( 3 bundles )
 Anterior bundle ( vertical fiber )

Action : mandible elevator ( close jaws ) , crushing and chewing at C.O.

 centric occlusion

Inaction : mandible depression ( opening and opening against resistance)

 Intermediate bundle
 Action : protrusive movement

 Posterior bundle ( horizontal bundle )

Action : mandibular retraction and positioner

Inaction : mandibular depression and protrusion

 Note the posterior bundle is the only muscle fiber that is responsible of
the centric relation of the mandible, so it is very difficult to instruct
the pt to put the mandible in centric relation .

Medial pterygoid muscle

Rectangular shape at the medial surface of ramus , synergistic with masseter

muscle

Origin :pterygoid fossa and medial surface of the lateral pterygoid plate

Insertion : inferior + posterior border of ramus and angle of mandible

Relaxation : downward and backward  action : upward & forward

Nerve : pterygoid nerve

Lateral pterygoid muscle

 Superficial layer

Origin : wing of sphenoid infratemporal crest

Relaxation : downward & backward

 Inferior layer

Origin : lateral pterygoid of lateral pterygoid plate

Relaxation: upward and backward

 Note : from the 4 major muscles , the only one that occludes in
CENTRIC RELATION is the Posterior bundle of temporalis muscle
Non masticatory muscles are :
 Digastric muscle

 Mylohyoid muscle

 Geniohyoid muscle

 Orbicularis oris muscle

 ROLE OF MUSCLES IN
VARIOUS MANDIBULAR
MOVEMENTS
a) ELEVATION:

Right & left Temporalis muscles (anterior fibres  Right & left Masseter
muscles

Right & left Medial pterygoid muscle

b) DEPRESSION:

Right & left Inferior heads of Lateral pterygoids  Right & left Suprahyoid
and Infrahyoid muscles  Anterior belly of Digastric & Mylohyoid

c) PROTRUSION:

Right & left Inferior heads of Lateral pterygoid  Right & left Medial
pterygoids

Right & left Superior heads of Masseter

d) RETRUSION:

Right & left Posterior fibres of Temporalis  Right & left Deep heads of
Masseter

PATHOLOGY RELATED TO MUSCLES OF MASTICATION

1. MYOFASCIAL PAIN DYSFUNCTION

 Clinical Features
- Affects muscles only: neck, scalp, masticatory

- Predominantly in young

- Affects women more than men

- Pain
 - Muscles painful during use, often painful in morning

- Specific tender spots on muscle

- Masticatory muscles may be tender to palpation

- Clicking

- Jaw locking

- Limitation of mouth opening/jaw movements

Etiology :

Several contributing factors

 Parafunctional activity e.g. clenching, grinding

 Stress, psychological disturbance or psychiatric illness
 Occlusal disturbance
 Wide opening of mouth
 True joint disease in TMJ
Treatment :

 Watch and control daytime parafunction

 Anti-inflammatory analgesic (e.g.ibuprofen 400 mg three times a day)
 Occlusal splint therapy esp. at night
 Local physiotherapy
 Consider referral to psychologist/psychiatrist (if suspect severe
anxiety/depression, psychiatric disturbance)

MYOFASCIAL PAIN: Most commonly reported type of masticatory

muscle disorder. It is characterized by a dull regional ache that
increases during function. Palpation reveals tenderness of these
muscles.

MYOSITIS: It is primary inflammation of muscle resulting from

infection / trauma. It is characterized by constant acute pain in one or
more of the masticatory muscles usually accompanied by swelling,
redness of overlying skin & increase in temperature over the affected
area. It results in jaw dysfunction & limited range of movement.
\MYOSPASM / MUSCLE CRAMP: Acute condition resulting from a
sudden, involuntary & continuous tonic contraction of muscle. It is
characterized by localized acute pain& severely limited range of
motion of the mandible. These characteristics coupled with their
sudden onset at rest allow the clinician to differentiate myospasm
from other masticatory muscle disorders.

Reference
Essentials of human anatomy- A K DATTA

Wheeler’s Dental anatomy, Physiology, Occlusion

William f ganong,Review of Medical Physiology,eighteen

edition

Essentials of Complete Denture Prosthodontics SHELDON

WINKLER (2nd edition)

Scully,C. and D. H. Felix, D.H. (2006) , Oral Medicine — Update for the
dental practitioner Orofacial pain, British Dental Journal Vol. 200 (2):75-8

BY MUSTAFA FAYEZ MOHAMED