An overview on Mandibular Movements

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After fabricating the record bases and the occlusal rims, lets have a look at how to go about relating them in 3D space.

I have in store for you the following subtopics Definitions

Introduction Complexity of Maxillomandibular relations. Natural vs artificial dentition Mandibular movements Determinants of mandibular movements
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Anatomy of TMJ
Types of Mandibular Movements

Bennett Shift
Border Positions Condyle Path

Maxillomandibular or Intermaxillary Relations

Boucher classified maxillomandibular relations as:

Orientation jaw relation:

Use of a facebow. 1. 2. 1. 2. a) b) Vertical jaw relation: At rest. At occlusion. Horizontal jaw relation: Centric relation. Eccentric relations: Deviations from centric Protrusive relation. Right and left lateral relation.
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Definitions by the Glossary, Eighth edition

Maxillomandibular relationship : Any spatial relationship of the maxilla to the mandible; any one of the infinite relationships of the mandible to the maxillae Maxillomandibular relationship record : A registration of any positional relationship of the mandible relative to the maxillae. These records may be made at any vertical, horizontal, or lateral orientation maxillomandibular registration Mandibular movement : Any movement of the lower jaw

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Complexity of Maxillomandibular relationships

Maxillomandibular relations and occlusion create a lot of controversy.

Several factors in which there are differences in

1. Interpreting definitions.

2. Terminology. 3. Clinical results. 4. Mechanical instruments like articulators which reproduce living tissues. 5. Evaluating the Jaw relations and occlusion of natural teeth.
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Natural vs. Artificial

Natural Dentition

Teeth attached to PDL and surrounded by alveolar bone. Premature contact affects the involved tooth and adjacent tissues only.

Artificial Dentition

Bases rest on movable and displaceable tissues thus a premature contact affects the entire base in its relation to the supporting tissue.

Conclusion: Natural teeth have a greater influence in mandibular movements than do artificial teeth on their movable bases.
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Significance of the knowledge of mandibular function

Understanding the whole stomatognathic system is vital for any treatment plan.

To understand natural occlusion and develop complete denture occlusion

To develop occlusal morphology of artificial restorations ( Crowns, Inlays, etc.) To understand, select and design articulators Treatment of TMJ disorders.

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Mandibular Movements
Determinants of Mandibular Movements: The two posterior determinants are the TMJ and associated structures. The anterior determinant are the teeth- Cuspal inclines and other contacting areas of the teeth.

The fourth determinant is the neuromuscular component.

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The prosthodontist has a control over the anterior determinant as the two posterior determinants are fixed. The fourth component can be indirectly altered by modification procedures viz. occlusal equilibration, restorative procedures, orthodontic therapy and selective extraction of teeth.
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Anatomy of the TMJ

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The highlight of anatomy of the TMJ are the condyles which articulate with the temporal bones in the elliptical concavities called the glenoid fossae. Interarticular fibrocartilages, the menisci lie between the dome shaped concavities and the condyles dividing the joint into upper and lower compartments.

Movements in the joint compartments

Upper: Hinge like movement or Rotational Lower: Anteroposterior gliding or Translation
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Variety of Movements
Great variety of movements seen in mandible. It might appear to lack coordination unless carefully understood. Four important movements of the mandible are : Hinge like

Protrusive
Right or Left lateral while reduction of fibrous food Bennett movement on the rotating condyle

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Other movements
Natural or Characteristic movements like that occur during mastication, swallowing, speech and yawning;
Parafunctional movements like clenching, tapping or grinding together constitute the parafunctional mandibular movements.

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Planes and Axes of Mandibular Movements

Planes of the skull: 3

Planes
Horizontal,

Frontal and
Sagittal.

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Rotational Centers or Axes of rotation of the mandible: 3 Axes

Transverse, Sagittal and Vertical.

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Transverse Axis, movement occurs in a hinge fashion while opening and closing along the sagittal plane.

Vertical Axis, movement in lateral direction along the horizontal plane.

Sagittal Axis, one condyle moves inferiorly while the other is relatively fixed in Terminal hinge position

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A trained individual moves the mandible laterally along the vertical, opens and closes in hinge along the transverse and opens in a non hinge fashion along the sagittal axis.

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Bennett Shift contd.

Bennetts movement and Bennetts side shift [Sir Norman Godfrey Bennett, British dental surgeon, 1870-1947]: see LATEROTRUSION. Laterotrusion : Condylar movement on the working side in the horizontal plane. This term may be used in combination with terms describing condylar movement in other planes.

Bennett NG. A contribution to the study of the movements of the mandible. Proc Roy Soc Med (Lond) 1908;1:79-98 (Odont Section)
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Four different paths of lateral rotation/ Laterotrusion

Laterosurtrusion (laterally upwards).

Laterodetrusion (laterally downwards). Lateroprotrusion (laterally forward).

Lateroretrusion (laterally backward).

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The two condyles and the Bennett Shift

The rotating condyle shifts

laterally by about 1 to 4 mm with an

average of about 0.75 mm The orbiting condyle on the other hand makes one of the four possible types of pathways: 1 Just medially (with no lateral component) 2 Straight line path in case of Progressive shift 3 Lateral

shift occurring in the first 2-3 mm of

forward movement is termed as Precurrent shift and 4 Shift which occurs before any forward

movement of the orbiting condyle

is termed as Immediate shift
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Bennett Shift

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Terminal Hinge Axis

Terminal hinge axis: see TRANSVERSE HORIZONTAL AXIS (GPT) Transverse horizontal axis : An imaginary line around which the mandible may rotate within the sagittal plane. The Terminal Hinge Axis (THA) represents a border position that can be repeated and recorded consistently. The rotary component lasts only for 12mm after which the mandible is forced to move in translation as the condyles of the mandible slide along the articular eminences.

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Border Positions

Definition: Border positions can be defined as the extreme positions of the mandible in any direction in which it moves.(GPT 8)

Physiologic limitations to the movements are through the neuromuscular system which involve nerves, bones muscles, teeth when present and ligaments.

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Functional range

Functional Range refers to the full extent over which something is effective. The border positions of the mandible are the only consistently repeatable positions.

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Envelope
Envelope of motion in three planes- horizontal, frontal and sagittal.
1. It is variable since these movements are influenced by the Size and resistance of the bolus

2. Number and size of the teeth 3. Excess or lack of saliva

4. The musculature and the vigor of the stroke.

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Border Positions- Posselts envelope of motion

Mandibular Border movements
(I) Shows schematic drawings in A. Sagittal plane B. Horizontal movement area at a definite level of maxillomandibular separation C. Composite of average movement area in the sagittal plane at three different levels.
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Posselts envelope of motion

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Superior contact positions

Anterior border opening

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(II) Posterior border : Hinge movement and translation. Also relation condyle articular eminence
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the of to

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Condyle Path
It is the path travelled by the condyles in the TMJ during the various mandibular movements. Determined by:

1.

The bony fossae

2. The tone of the muscles 3. The limitations by the attached ligaments 4. Shape and the movements of the menisci

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Condyle Path cannot be altered by a prosthodontist It does not follow a straight line but follows the contour of the tissue lined bony surroundings.

It is of a dynamic nature and is not recorded by articulators in which condylar elements travel in a straight slot or on a flat surface. (Figure)

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Hanau Wide Vue

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Fully adjustable articulator

Hanau Kinoscope
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Articulators that have individually ground condyle paths refined to pantographic tracings record the path in the tracings.(Figure)
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Pantographic tracings

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Carl O Boucher It must be recognized that the person operating the instrument is more important than the instrument. If dentists understand articulators and their deficiencies, we can compensate for their inherent inadequacies.

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Conclusion
A sound knowledge of the TMJ Mandibular movements and Its influences on various maxillomandibular relations is important before we actually record them. Prosthodontic research has come a long way in its constant efforts to mimic natural mandibular movements and incoporate those details into new technology.
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References
1. Prosthodontic treatment for edentulous patients. Zarb-Bolender 12th ed, Elsevier.

2.
3. 4. 5. 6. 7.

Text book of complete Dentures, Rahn and Heartwell 5th ed. Elsevier.
Essentials of CD prosthetics, Sheldon Winkler, 2nd ed, Ishiyaku publications. Bennett NG. A contribution to the study of the movements of the mandible. Proc Roy Soc Med (Lond) 1908;1:79-98 (Odont Section) University of Michigan, school of Dentistry resources 2004 Hanau Spring bow user manual by Whip Mix corp. Christensen RL Rationale of the face bow in maxillary cast mounting. ;J Prosth Dent 9;338, 1960

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