GROWTH AND DEVELOPMENT

OF TEMPOROMANDIBULAR
JOINT

By :-
Dr. Abhijeet Kumar Sadhu
MDS First Year
Department of Orthodontics and Dentofacial Orthopedics
New Horizon Dental College And Research Institute
 INDEX
1. Introduction
2. Evoutionary development
3. Anatomy
 Articular Surface
 Articular Disc
 Synovium
 Temporomandibular Ligaments
 Retrodiscal Tissue

4. Relations of TMJ
5. Muscles Producing Movements
6. Stages of Temporomandibular Development
7. Embryonic Development
8. Posnatal Growth
9. Developmental TMJ Anomalies
10. References
 INTRODUCTION
1. Diarthrotic joint

2. Ginglymoarthrodial joint

3. Distinct from other synovial joints

EVOLUTIONARY DEVELOPMENT
ANATOMY
Articular Surfaces :-

1. Upper articular surface

2. Inferior articular surface

3. Covering
Articular Disc :-
1. Structure

2. Fibre orientation

3. Attachments to capsule and

condyle
Articular Disc Cont. :-

1. Surfaces

2. Attachments
 Anterior
 Posterior

3. Parts

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 Synovium :-

1. Vascular connective tissue

2. Synovial fluid

3. Joint Lubrication
 Weeping Lubrication
 Boundary Lubrication
 Temporomandibular Ligaments :-
• Capsular Ligament

1. Tissue composition

2. Attachments
• Lateral Temporomandibular Ligament
Accessory Ligaments
 Retrodiscal Tissue :-

1. Posterior attachment

2. Tissue Composition

3. Lamina attachments
 Relations of TMJ

1. Lateral

2. Meidal

3. Anterior

4. Posterior

5. Superior

6. Inferior
Muscles Producing Movements
1. Depression

2. Elevation

3. Protrusion

4. Retraction

5. Lateral or side to side moaements

Stages of temporomandibular
Development
 Embryonic Development
1. First Pharyngeal Arch

2. 8 week post conception

3. Mandibular growth center

condyle
1. 10th Week

2. Mutual Approximation of Blastema

3. Upper and Lower Joint Cavities

 Articular spaces
1. 9th Week – Starts formation

2. 10th Week – Lower Join Space

11th Week – Upper Joint Space

3. 12th to 16th Week - Growth

 Articular Disk
1. 7th Week – Mesenchymal Thickening

2. 10th Week – Mildly pronounced contours

3. 12 th Week – Assc. With Lateral Pterygoid Muscle

4. 15th to 20th week – Cartilagenous thickening

 Temporal bone

1. 7 to 7.5 weeks – Temporal Blastema

2. 12th week – Articular Fossa

3. 8th to 11th Week - Articular capsule

4. 14th Week – TMJ Fully Developed

 Postnatal growth

1. Second Decade of Life

2.Hypertrophic zone
DEVELOPMENTAL TMJ ANOMALIES
Developmental Hypoplasia

Treatment - Reconstructive surgery, hearing aids, speech therapy

 Developmental Hyperplasia

Treatment -1.Orthognathic surgery,  

2.Condylectomy with articular disk repositioning
and orthognathic surgery 
Developmental Dysplasia :-

Treatment :- distraction osteogenesis, or costochondral graft

 Developmental Dysmorphias :-

Treatment - Vibrotactile hearing devices,  Cochlear implantsdone in children above the age of
12 months having severe or profound hearing loss
Pierre Robin sequence

Pierre Robin sequence

Other names Pierre Robin syndrome, Pierre
Robin malformation, Pierre
Robin anomaly, Pierre Robin
anomalad[1]
Specialty Medical genetics
Symptoms Micrognathia, glossoptosis,
obstruction of the 
upper airway, sometimes 
cleft palate
Usual onset During gestation, present at
birth
Causes intrauterine compression of
fetal mandible or de-
novo mutations (on
chromosomes 2, 4, 11, or 17)
Diagnostic method Physical examination
Treatment Craniofacial surgery, 
oral and maxillofacial surgery
Frequency 1 in 8,500 to 14,000 people
 TMJ Ankylosis as a complication of
iatrogenis error in forces delivery

Temporomandibular joint ankylosis is a condition in which condylar

movement is limited by a mechanical problem in the joint
(“ true ankylosis”) or by a mechanical cause not related to joint
components (“false ankylosis”).
 True ankylosis may be bony or fibrous.
In bony ankylosis, the condyle or ramus is attached to the
temporal or zygomatic bone by an osseous bridge.
Trauma due to forceps delivery causes bilateral TMJ ankylosis.
The most common cause for both unilateral and bilateral ankylosis is
trauma.
It can cause local or systemic infections.
 TMD's and occlusal splint therapy

Signs & Symptoms of TMD :-

- Pain in the chewing muscles and / or jaw joint. - Radiating pain in the face, jaw, or neck
-Jaw muscle stiffness
- Limited Jaw Movement or "Locking
- Painful Clicking, Popping or Grating Sounds in the joint when opening or closing the mou
--A Sudden Change in the Bite "Acute Malocclusion". - Ear Pain, Dizziness, Hear Problems
Occlusal Splint Therapy
A Non-invasive and Reversible Biomechanical Method of Managing Pain and
Dysfunction of the TMJ and its Associated Musculatures.
Stabilization Splint
- Removable interocclusal device
- Usually made of hard acrylic resin - Fits over the
teeth in one arch
Purpose of Occlusal Splint Therapy :-
>Stabilize or improve the function of the TMJs.

>Improve the function of the Masticatory Muscles &

Reduce abnormal muscle activity.

>Protect Teeth from attrition and adverse traumatic

loading.
Occlusal Splints 2 Main Types
1-Permissive Splints
→ Designed To Unlock the Occlusion & Allow the
Condyles
to Return to their Correct Seated Position in CR
2- Directive Splints
→ Designed To Position the Mandible in a Specific
Relationship to the Maxilla that Enhance the
Alignment of the Condyle - Disc Complex.
 Anterior Repositioning Splint

Indication :
❖ Anterior Disc
Displacement
With Reduction
Types of Permissive occlusal Splints
The Stabilization Splint
❖ Synonyms
- Muscle Relaxation S. - Centric Relation S. -Michigan
S.
- Bruxism Appliance
The most commonly used appliance, which is a hard
acrylic splint that provides a temporary & ideal
occlusion.
Rationale for Occlusal splint therapy
- Establish a new occlusal scheme
-Decrease muscle hyperactivity Unloading the joint
structures
- Improve disc - condyle relationship - "Cognitive
Awareness"
- Placebo effect
 REFERENCES
 Sperber, G.H. (2001) Craniofacial Development. Hamilton, Ont.: B.C. Decker.
 Chaurasia, B.D. (2004) B D Chaurasia's human anatomy regional and applied,
Dissection and clinical volume 3: Head, Neck and brain. New Delhi: CBS
Publishers.
 Premkumar, S. (2011) Textbook of craniofacial growth. New Delhi: Jaypee
Brothers Medical Publishers.
 Keith, D.A. (1982) “Development of the human temporomandibular joint,” British
Journal of Oral Surgery, 20(3), pp. 217–224. Available at:
https://doi.org/10.1016/s0007-117x(82)80042-5.
 Bender, M.E., Lipin, R.B. and Goudy, S.L. (2018) “Development of the pediatric
temporomandibular joint,” Oral and Maxillofacial Surgery Clinics of North
America, 30(1), pp. 1–9. Available at: https://doi.org/10.1016/j.coms.2017.09.002 .
 Tomislav B. , Ivana S. , Dijana Z. , Miljenko M., Ivan K. and Durdica G.
Temporomandibular joint development and functional disorders related to clinical
otologic symptomatology, Acta Clin Croat 2011; 50:51-60.