Why is Understanding the Anatomy of the TMJ Important?
The TMJ is one of the most important joints in your body. It gives you the ability to open your mouth to speak and eat. But we don’t always think about the jaw joint the same way we think about the knee or the hip.
Did you know that the TMJ is just like the knee, hip, or elbow?
Yes, there are some differences between them. But at the end of the day, the TMJ is a joint. The anatomy of the jaw joint is like the anatomy of the knee or the hip.
There are ligaments. There are tendons. There are muscle attachments.
The anatomy of the jaw joint should affect how we deal with TMJ disorders. We need to take care of it like we take care of our knees and hips. When we understand the anatomy of the jaw joint, we can take a more orthopedic approach to TMJ disorders. Knowing the structure of the TMJ allows us to offer a more accurate diagnosis. A more accurate diagnosis means more effective treatment options.
Let’s look at the Anatomy of the TMJ.
The TMJ is made up of two bones joined together which allows for the movement between those bones. Inside the joint, there are ligaments that hold it in place. Cartilage and tendons are also important parts of the jaw joint.
There is also a synovial disc. The synovial disc contains fluid that lubricates and provides nutrition to the joint. The synovial disc allows for better movement and keeps the joint healthy.
What Problems Can Occur Within the Joint?
Whenever your bite changes or you lose a tooth it can affect your jaw joint. In these situations, there is extra pressure on the TMJ. This pressure causes damage. It’s like putting extra pressure on the knee or the hip. If you spend a long period of time on your knees, for example, damage will occur. The TMJ is no different. If we put too much pressure on the jaw joint, we can cause damage, resulting in TMJ disorders.
The synovial disc often plays a role in TMJ disorders. A lack of synovial fluid can cause cartilage cells to thin. Thin cartilage cells can become damaged. Damaged cartilage is difficult to repair when there is no synovial fluid. The result is a breakdown of the jaw joint. The bones begin to wear down and become damaged, leading to TMJ disorders.
How Do We Take Care of the TMJ?
Understanding the anatomy of the jaw joint helps us take care of it better. We treat the TMJ like we treat the knee or hip. If you injure your knee, what will your doctor say?
Take some pain medication.
Maybe ice it.
Well, it’s the same thing for the TMJ. If you are experiencing pain in your jaw the first thing we need to do is rest it. Eat softer foods. Don’t chew gum for a while. Give it a chance to repair itself. We may prescribe anti-inflammatories and recommend icing the joint to help with the pain.
In some cases, when you injure your knee your doctor may prescribe a knee brace to help support it. We can support the jaw joint in a similar way. For some patients, a mouthguard or bite brace can help. Mouthguards are especially helpful for patients who grind or clench their teeth. Grinding and clenching can not only cause damage to the teeth. They can also put unnecessary pressure on the jaw joint. Mouthguards keep that damage from happening.
And like in the hip or knee, there are certain cases where conservative methods won’t work. There are times where surgery is the only permanent solution to TMJ disorders. Again, this is where anatomy can help us determine whether or not surgery is necessary. In the same way, a doctor would evaluate the knee or hip, we should be looking at the jaw joint carefully. We need to make sure we account for any damage that has taken place. We want to use conservative treatments as much as possible, but it’s also important to know when surgery is the best solution for our patients.
How the Anatomy of the Jaw Joint Helps US Determine Treatment Options
In order to determine what treatments are best for each individual patient, we need to be able to examine the joint well. This involves not only feeling it but also getting scans so we can see what’s going on more clearly. A doctor evaluating your knee will take several scans of the knee before recommending treatment. This is because they want to see everything that is going on inside the knee so they can address those issues. We want to do the same thing with the jaw joint.
We need to be able to see inside the joint. So, we’ll take X-Rays and even an MRI so we can see the whole picture. When we understand the anatomy of the jaw joint we can detect where damage has occurred. And we can figure out the cause of that damage. Once we understand what’s going on, we can offer treatment options that actually work for you.
Taking an Orthopedic Approach to TMJ Disorders
PRECiDENT believes that understanding the anatomy of the jaw joint is crucial for treating TMJ disorders. When we understand how the jaw joint works, we can take a more effective orthopedic approach to issues within the jaw joint. This allows us to see exactly what is going on within the TMJ, so we can give our patients the treatment options they really need. Some patients will be just fine with rest, pain medication, and ice. Others will need a mouthguard. And there will be some situations where the only real solution is TMJ surgery. But the only way we can know which treatment option is best for our patients is to understand the anatomy of the jaw joint.
“Use a mouthguard when you sleep. Take some pain medication. Just try to relax. Do what you can to minimize the stress in your life…” These are words that many people who suffer fromTMJ disorders have heard before. Many patients go to their physician complaining about jaw pain, earaches, and frequent headaches, all common symptoms of a problem in the jaw joint. And many of these patients are told that their TMJ disorder is simply due to stress or anxiety. They try a mouthguard at night, some pain medication, and stress reduction techniques.
For some patients, this works, at least temporarily. For so many other TMJ patients, however, reducing stress and using a mouthguard just doesn’t work. They’re still in pain. Their jaw still clicks. It gets harder and harder to simply open their mouths to eat. When they look for answers, they’re told the same thing over and over again: it’s just stress.
Reducing stress can be, of course, an important step to relieving TMJ pain, but there are many other factors that may be at work and need to be examined, in order to ensure that patients find lasting relief.
The Relationship Between Stress and TMJ
Stress and anxiety are normal parts of life. Most of us have experienced stress at some point. Stress is simply our body’s natural reaction to certain situations. But feeling stress or anxiety for long periods of time is unhealthy and can have negative effects on our bodies. Too much stress over time can trigger headaches, insomnia, a weakened immune system, high blood pressure, and increase your chances of having a heart attack.
Your body’s response to stress and anxiety can also lead to issues in the jaw joint. In response to stress, you may start clenching your jaw during the day or grinding your teeth while you sleep (known as bruxism). Keeping your jaw tight or grinding your teeth overworks your TMJ and can wear down the disc inside your jaw joint. Bruxism can also alter the alignment of your bite, which puts extra stress on the jaw joint and surrounding muscles. Over time, the jaw joint begins to break down, leading to a TMJ disorder.
A Vicious Cycle
Stress-related TMJ disorders can create a vicious cycle. In many cases, our body’s response to stress leads to the breakdown of the jaw joint. However, the pain and discomfort that comes with TMJ disorders can be extremely frustrating.
Patients who have been living with TMJ pain for a long time are prone to even more stress and anxiety, especially when they can’t find a solution to their problem. As these patients continue dealing with the jaw pain and earaches, their body responds to that continued stress. Jaws keep clenching, teeth keep grinding, and as a result, these patients have increased TMJ pain.
TMJ Disorders Are Not Always Stress-Related
To be fair to the practitioners who diagnose stress as a cause of TMJ pain, it should be said that it is true that some TMJ disorders have their roots in stress and anxiety. Some patients find relief, simply by finding ways to relax and by using mouthguards to reduce the effects of teeth grinding. Unfortunately, however, many patients do not experience relief in stress reduction, alone. Because there are often other underlying issues that lead to TMJ disorders, it is important to consider all factors, not just stress, before making any definitive diagnosis and comprehensive treatment plan to alleviate TMJ symptoms and potentially
Other causes of TMJ disorders include:
Poor alignment of the jaw
Even previous dental or orthodontic work that changed the alignment of the jaw or bite can have a negative effect on the jaw joint.
TMJ Disorders Require a Thorough Diagnosis
While stress is a factor to consider, it’s not the only factor. When it comes todiagnosing TMJ disorders, thoroughly evaluating the jaw joint is crucial to providing treatment options that actually fix the problem. Even in cases where the TMJ pain is caused by stress, a thorough examination of the jaw joint is necessary. We need to examine the TMJ area to determine the extent of the damage that has been done to the joint and to prevent further damage.
A thorough diagnosis is essential to providing patients with treatment options that actually work. The jaw joint is a complex system, but it is still a joint just like the other joints in the body. When patients come to us complaining about TMJ pain, we need to take the same orthopedic approach that we would take to evaluate knee or hip pain.
When a patient comes to us with jaw pain and other symptoms of a TMJ disorder, we \get a report of your medical history. We need to feel and listen to the joint. Finally, we will need to get scans so we can see the entire joint and look for t any damage.
We ask questions like:
What do the ligaments look like?
What about the muscles around the joint?
How does the disc look?
What does the alignment of the jaw look like?
Is osteoarthritis a possibility?
Taking this comprehensive, orthopedic approach to TMJ disorders gives us the opportunity to truly help patients find relief. If we do determine that stress is the root cause of your jaw pain, we still need to make sure the treatment we offer will actually solve the problem. Our goal is not limited to just pain management, but rather to alleviate the underlying causes of that pain.
With PRECiDENT as your partner in health, NOW you can relax.
If you are experiencing jaw pain, earaches, and frequent headaches, you may be one of the millions of Americans who suffer fromTMJ disorders. TMJ disorders happen when your jaw joint, otherwise known as the temporomandibular joint, is damaged or misaligned. TMJ disorders can happen for a number of reasons including injury, arthritis, stress, and even poor posture. Thesymptoms that come with TMJ disorders can be frustrating and make it hard to enjoy life. If you’ve already spoken to your doctor, they possibly have prescribed pain killers and a bite brace. They may have told you to try to avoid any sources of stress. And even though you’ve followed their instructions exactly, you’re still in pain. In fact, your symptoms are getting worse. But, you keep on trying to manage the pain in the hope that you’ll find relief.
Unfortunately, many TMJ patients are stuck simply managing their pain with pain killers and bite braces due to an inability to reach a complete diagnosis. Diagnosing TMJ disorders can be challenging. The jaw joint is a very complex system. Taking a comprehensive, orthopedic approach to diagnosing TMJ disorders gives us the opportunity to get a full understanding of what is going on in the joint. When we know what’s going on in the joint, we can offer effective treatment options that actually help you find relief.
An Orthopedic Approach to Diagnosing TMJ Disorders
An orthopedic approach involves fully evaluating every aspect of the jaw joint area in order to get the most accurate diagnosis possible. This is the same way problems with other joints are managed. If you were experiencing knee pain, for example, your doctor would not only feel your knee, they would also take several scans so they would be able to see exactly what is going on. Only then would they offer treatments based on their diagnosis.
We need to approach TMJ disorders the same way. Even though the jaw joint may have some differences from other joints in the body, it is still a joint. It’s susceptible to the same diseases and damage as other joints in the body.
The Anatomy of the TMJ Effects How We Diagnose TMJ Disorders
An important part of an orthopedic approach is understanding the anatomy of the joint. Having a thorough understanding of the anatomy of the TMJ allows us to find the cause of pain more easily. When we know how the joint is built and how it works we can deliver a more accurate diagnosis.
The TMJ is a synovial joint, joining your lower jaw to your skull. The joint is covered by cartilage and joined together by a fibrous tissue capsule that encloses the joint cavity. Within the joint, between the jaw and skull, is a cushion called a disc. The disc contains synovial fluid which lubricates and supplies nutrients to the joint, allowing for a greater degree of movement and health of the bone.
The jaw joint is also made up of ligaments, tendons, and muscles, just like other joints in the body, which help provide necessary stability to the movable joint. TMJ disorders may be a result of damage to the disc, the ligaments, and tendons, or even the bone of the jaw, where it attaches to the skull (condyle). Your TMJ specialist at PRECiDENT will be able to see, through a thorough examination, just which part of your TMJ is causing your issues.
How We Diagnose TMJ Disorders
Patients that come to see us for TMJ disorders will go through a full, comprehensive evaluation. We examine every aspect of the jaw joint area. When we’re evaluating you for TMJ disorders we’re not just looking at the joint itself. We want to look at the whole system. We’re asking questions like:
What do the ligaments look like?
What do the muscles look like?
How is your joint moving?
Is your bite being affected?
How does the airway work?
How is all of this affecting the neck?
When you come to PRECiDENT to treat TMJ disorders, you’ll spend 3-4 hours just getting the diagnostic work done. Our goal is to uncover every issue that is going on inside your jaw joint. We don’t just want to examine one aspect of your jaw and treat symptoms immediately with pain medication or a mouthguard. We need to examine everything in order for you to find true relief from your TMJ disorder, so we don’t miss an underlying cause of your pain, allowing it to linger unnecessarily.
Our Diagnostic Process
We’ll start by getting your full medical history. Medical conditions such as arthritis or past injuries can help us understand more about what is going on with your jaw. Any information on orthodontic or previous dental work will be helpful as well. If your bite has been adjusted by orthodontic work your jaw joint can be impacted, for example. Upon scheduling with us, we will provide you a full, health history packet, so we can get all of your health information. Sometimes, things that may seem unrelated can help us tailor your treatment plan for the best outcome.
After reviewing your medical history, we will start the physical exam. We will feel your jaw as you open and close it. We will also listen for any clicking and popping sounds. The goal of the physical exam is to feel for any kind of misalignment in the jaw joint. While we’re feeling your jaw, we’re also keeping the anatomy of your jaw joint in mind.
Finally, we will need to get a better look at what is going on in your jaw joint with CT scans, MRIs, or X-Rays. These images will help us see exactly what is going on with your joint. We will take scans from multiple angles in order to determine the extent and nature of the damage to your joint. In most cases, we’ll help you schedule an MRI prior to your consultation with us. This allows us to see all of your soft tissues surrounding your joint and make a more complete diagnosis at your very first visit.
From Pain Management to a Pain-Free Life
So many patients continue to deal with symptoms of TMJ simply because they haven’t had a thorough diagnosis. The TMJ is a complex system, and our specialists belong to a very elite group of professionals who have dedicated themselves to both the repair and management of this intricate joint. With over 30 years of experience and training specific to TMJ, you are in the best possible hands with our clinicians and surgeons.
At PRECiDENT, our goal is to move you past simply managing your pain. For some of you with mild symptoms of TMJ, bite braces and pain medications may be all you need. But for others of you, a more focused treatment plan may be necessary. That’s why taking a comprehensive, orthopedic approach to diagnose TMJ disorders is so important. It helps us design treatment options that actually work for you, so you can finally live a pain-free life. If you are tired of managing your TMJ symptoms and want to experience treatments that truly solve your TMJ problems,schedule a consultation with our TMJ specialists today.
TMJ stands for temporomandibular joint. The TMJ is the joint that connects your jawbone to your skull. You have one on both sides of your face. Your jaw joint acts as a hinge that allows you to open and close your mouth and move your jaw side to side. The TMJ is just like every other joint in your body. It has ligaments, muscles, and tendons. The TMJ also has a disc that contains synovial fluid, which is crucial for the proper function of the jaw joint.
You may not always think about your jaw joint, but when it’s not working properly it can cause a lot of pain. When your jaw joint is damaged or misaligned, it is known as aTMJ disorder. Pain in your TMJ can happen for a number of different reasons, including arthritis, injuries, and even stress. Poor jaw alignment and teeth grinding can also cause issues with your jaw joint.
Symptoms of TMJ Disorders
TMJ disorders can often go undiagnosed or misdiagnosed for years because many of the symptoms associated with the TMJ are seen in other conditions. It’s important to have a thorough diagnosis to make sure you get the proper treatment. If you have one or more of the following symptoms, you may want to talk to your doctor about TMJ disorders:
Clicking and popping in the jaw
Difficulty chewing and opening your mouth
Ear pain is anothercommon symptom of TMJ disorders. A lot of our TMJ patients are referred to us from the ENT after they thought they had an ear infection. The nerves that surround the TMJ are many of the same sensory nerves that supply the ear with sensation as well. So, when there is an injury or damage to the TMJ it can feel like an ear infection. Many physicians assume that the ear is hurting because of pressure in the ear when really it’s because of issues in the jaw. Of course, if you have ear pain an infection is a possibility. But if you have been treated for ear infections without any relief, it may be time to consider taking a look at your jaw joint.
How We Diagnose TMJ Disorders
Your jaw joint is a very complex system. This complexity can make it difficult to diagnose properly. When you come to PRECiDENT with jaw pain we will thoroughly evaluate your jaw. We want to look at every part of your jaw. When we’re evaluating you for TMJ disorders we’re not just looking at the joint itself. We want to look at the whole system. We’re asking questions like:
What do the ligaments look like?
What do the muscles look like?
How is your joint moving?
We take a comprehensive, orthopedic approach todiagnosing TMJ disorders. The TMJ is similar to other joints in the body like the knee or the hip, and it’s important to keep that in mind when evaluating patients with jaw pain. A thorough diagnosis is crucial for offering the best treatment possible. It’s not enough to simply provide pain management for TMJ pain. We want to find solutions for you that last long term.
The Diagnostic Process
We’ll start by getting some information about your medical history. Medical conditions such as arthritis or past injuries can help us understand more about what is going on with your jaw. We also want to know about things like mouth breathing while you sleep or a bad bite so we can address those issues while we’re evaluating your TMJ. Any information on orthodontic or previous dental work will be helpful as well. Sometimes adjustments to your bite or other dental procedures can have an effect on your jaw joint. The more information you can provide about your symptoms and medical history, the easier it will be for us to understand the underlying problem.
The next step in the diagnosis process is the physical exam. We’ll look for any sign of misalignment by feeling your jaw while you open and close it. We’ll also listen for any popping or clicking sounds.
After reviewing your medical history and examining your jaw joint, we may need to get a better look at what’s going on in the jaw joint. So, we may need to get an X-Ray, CT scan, or MRI. These scans will give us a better picture of what is actually happening with your jaw joint.
Treatment Options for TMJ Disorders
Thetreatment for a TMJ disorder depends on what is causing it. That’s why we take so much time evaluating your jaw joint before offering treatment options. When the diagnostic process is rushed, physicians end up prescribing treatments that don’t help the patient. They manage the pain and symptoms instead of treating the underlying cause.
For mild cases of TMJ disorders, symptom management may be a viable, non-surgical treatment option. In those cases, we recommend various combinations of the following:
Keep in mind, your jaw joint is similar to the other joints in the body. When you hurt your knee or your hip your doctor will usually tell you to stay off of it for a while to let it heal. Your TMJ is no different. If your TMJ is damaged in any way it’s important to rest it. We usually recommend going on a soft diet for a while to see if that helps your pain at all.
Ever wear a knee wrap or brace? Depending on the case, your surgeon may prescribe a bite splint that acts in a similar way, by supporting your jaw in its correct position relative to the joint. This can reduce pain and further damage. Some patients respond well to this mouthpiece, relieved from pain and symptoms for months or years, before needing to take additional measures.
Anti-inflammatory medications, such as ibuprofen, can also be very helpful in the management of pain in the joint. Heat and/or ice are another option to help reduce inflammation and stress on the jaw.
Treatment for More Severe TMJ Disorders
In more severe cases, the only lasting treatment for a TMJ disorder is surgery. Of course, all surgery has risks, so your surgeon at PRECiDENT will carefully consider all other options, first. If surgery is necessary for optimal health, then your surgeon will review all of your health history and risk factors to minimize any risks for your best outcome. Again, at PRECiDENT, we take an orthopedic approach to these surgeries, since the TMJ is a ball-and-socket joint, like a knee, hip, or shoulder. Depending on your particular case, your surgeon may recommend one or a combination of the following:
If your disc is malpositioned or “slipped” from the top of your jaw, inside the joint, it will not provide the proper cushioning and lubrication to the joint and bone. In that instance, your surgeon may perform an “arthroplasty.” This is a technique in which the surgeon makes a small incision just behind your jaw joint and repositions your disc.
If your surgeon finds that you have ligament damage, this can be repaired as well. At PRECiDENT, our surgeons’ approach is to use MITEK anchors, which will give stability back to the joint while allowing for optimal flexibility for eating, chewing, and talking (without that pain you may be experiencing now!) after healing.
In some of the most severe cases where the disc and ligaments have been damaged beyond repair and the bone in the joint has started to degenerate (such as with arthritis, for example), or has been broken or crushed (such as after a trauma to the facial bones), it may be necessary to have your joint replaced. Advancements in this type of surgery have allowed for a customized joint replacement that has superior and lasting results.
Our TMJ Specialists Are Here for You
Our goal at PRECiDENT is always to make sure we find solutions that really work for our patients. We know that living with the pain of TMJ disorders can be frustrating and painful and can get in the way of your life. That’s why we take so much time working with you to understand what is going on with your jaw joint. If you are tired of dealing with the pain of a damaged jaw joint, our TMJ specialists are here to help you find relief.Schedule a consultation today and we will help you get started on the path to a pain-free life.
Preliminary Results of a Prospective Multi-Center Clinical Study
Digital workflows have improved dental implant placement accuracy and precision in fully edentulous patients with a goal of predictable restorations. Despite the introduction of CBCT-based planning software and fabricated surgical guides, challenges remain in efficiently and accurately transferring the plans at surgery. Limitations inherent in the static guide workflow include treatment delays related to guide fabrication, the risk of poorly fitting guides, and the physical bulk of the guide impeding surgical site access and visualization. Robotic guidance using haptic boundaries has been well-documented to enhance accuracy, precision, and flexibility across surgical fields.1 Recently, robotic haptic guidance with the novel Yomi platform (Neocis Inc., Miami, FL) has shown promise in partially edentulous patients.2 This study aimed to evaluate the platform in fully edentulous patients. In a preliminary subset of a prospective single-arm clinical study, 8 patients who qualified for and elected to have dental implants to restore full-arch dentition were treated using Yomi robotic guidance. A virtual preoperative restorative and surgical plan was created on Yomi Plan software (Neocis Inc., Miami, FL) prior to surgery. On the day of surgery, the Yomi edentulous patient splint was affixed to the anterior maxilla or mandible using self-tapping bone screws. A patient CBCT scan with a splint-mounted fiducial array was obtained and merged with the previously created virtual plan. The fiducial array was replaced with a patient tracker end effector allowing Yomi to track patient motion. Intraoperatively, the surgeons maneuvered a handpiece attached to the Yomi robotic guidance arm, which haptically constrained osteotomies and implant placement to the virtual plan. Splint affixation proceeded under local anesthesia and the implant procedure under either local or general anesthesia. Intraoperative outcomes captured included safety, efficacy, surgical time, and a Likert scale evaluation of user experience. A total of 58 implants were placed in 11 arches in 8 patients. Thirty-five implants were placed in the mandible and 23 in the maxilla, including 3 dual-arch cases. Eight patients were edentulated during surgery. Bone quality ranged from poor to very dense. Yomi edentulous patient splint affixation and removal times averaged 6.5 ± 3.9 and 1.1 ± 0.3 minutes, respectively. Surgical time per arch averaged 20.5 ± 10.3 minutes for osteotomies and 9.9 ± 7.9 minutes for implant placement. Three arches were considered candidates for and were treated using a flapless approach, and conservative tissue flaps were performed in all other cases. Two patients had been considered candidates for and were successfully provided with immediately loaded full-arch prostheses. No adverse events were reported, and user experience was rated highly with respect to the standard of care. First cases using Yomi robotic guidance in fully edentulous patients were notable for brief procedural times, compatibility with minimally invasive soft tissue management and access to immediate loading of restorations for candidate patients. These results may attest to quick integration of the Yomi edentulous protocol into the digital practitioner’s clinical workflow and the ease of employing robotic guidance to enhance edentulous patient treatment. Additionally, there was no wait for surgical guide fabrication and no physical guide impeding access or visualization. Robotic haptic guidance securely constrained the handpiece to the virtual restorative plan. Given the accuracy, precision, and intraoperative flexibility of robotic surgical platforms, these preliminary data support the promise of Yomi robotic guidance to augment dental implant therapy for fully edentulous arches. This study was approved by WIRB and the FDA as G190282 Edentulous Patient Splint.
Figure thumbnail fx1
The Yomi edentulous patient splint was affixed anterior to the maxilla or mandible using self-tapping bone screws and intraoperatively connected to a patient tracker end effector, allowing the robotic system to track patient motion.
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The surgeons maneuvered a handpiece attached to the Yomi robotic guidance arm, which haptically constrained motion to the virtual plan. Full-arch osteotomies and dental implant placement proceeded under haptic guidance.
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Two patients had been considered candidates for and were successfully provided with immediately loaded full-arch prostheses. Successful early incorporation of immediately loaded prostheses indicates the ease with which robotic guidance may be employed to enhance restorative-driven protocols.