TM Joint Treatment

DR. SANJAY VASANT BHAWSAR Dr. Sanjay Bhawsar is the pioneer in the field of TMJ- neuromuscular dentistry Sciences in INDIA. He has completed his Diplomate level programme in T M joint – Neuromuscular Dentistry science from INTERNATIONAL COLLEGE OF NEUROMUSCULAR ORTHODONTICS & GNATHOLOGY- ITALY. He is a Prosthodontist & was the Dean of the Dental College. He was also a Honorary Consultant & faculty for the MSc programme of UNIVERSITY OF JAUME I, SPAIN He has a vast clinical experience of 42 years in this field. He has a team of various consultant of Dental & Medical fraternity related to TMJ Dysfunction treatment protocol. The unique features of our TMD treatment centers are - Highly specialized & experienced Consultants Pioneer center in India with High-tech – Computerized Equipments Highly qualified lab for fabrication of appliances Non invasive painless treatment protocol Treatment planning based on whole body evaluation like posture, shoulder, neck etc Standard sterilization protocol as per covid guidelines

Skull (Head) is placed on the 1st Vertebra of the vertebral column like a ball, which can move forward, backward and sideways. The upper jaw is positioned at the base of the skull. Upper Jaw- Maxilla never moves during opening –closing movements of jaw. It’s the lower jaw which only moves during jaw movements.. The lower jaw is attached to the skull by a ball & socket type joint – TM Joint, in-front of the ear. The Muscles of the face & Neck region Holds the Lower jaw and these muscles are responsible for various movements of the lower jaw. The various movements of the lower jaw are- forward & backward, opening & closing & side to side. The upper & lower teeth meets each other on one plane, it is called as an occlusal Plane- biting platform. The height of the upper & lower teeth maintains the height of the Face. During Forward – Backward, Side-side movements the lower jaw moves as per the guidance of the biting surface of all the teeth. The group of muscles which open & closes the lower jaw is also associated with some function of stabilizing the skull & cervical vertebrae. Thus skull- spine – Lower jaw- Teeth- T M Joint all are interrelated.

TM Joint is present on both side of the face Infront of Ear. In the skull, Infront of the ear there is a hollow cavity, called as Glenoid Fossa in the TEMPORAL bone. The lower jaw (Mandible) has a rounded structure at one end called as a HEAD. The Head of lower jaw forms a Ball & Socket like Hinge joint with the skull. The joint between Temporal & Mandible bone is called TM Joint. A disc is present between the Head of the lower jaw & cavity (Glenoid fossa) of skull. The DISC is made up of soft Fibrocartilage Tissue. During various movements of the lower jaw the Disc moves along with the Head of the Mandible. The TM Joint has a lubricating mechanism for smooth movements.

TM. Joint Problems – Clicking Sound, Crepitus Sound, Popping Sound during jaw opening & Closing in the joint Infront of ear. Joint pain, Deviation / Shifting of jaw while opening & closing, limited mouth opening etc. It has Signs like Mouth, Face, Body, Ear, Head, Teeth, Eye, Neck, Shoulder, Back related and Posture related – Forward Head positioning, Difference at Shoulder level, Selective positioning of neck on one side, Bending on one side Improper standing posture etc.
HOW T N JOINT DYSFUNCTION PATIENT IS TREATED—
In RUTUDENT clinic the evaluation & treatment is as follows
1)- General Examination of patient
2)-Detailed History of patients complaint-
3)-Examination of the Face, Head, Neck, Back < Body Posture etc.
4)- Clinical examination of T m Joint
5)- Intraoral examination of teeth, gums, occlusion
6)- Radiographic examination- OPG xay
7)- CBCT scan of the joint
8)- MRI scan of the disc –if required
9)- Impression of both Jaws are made for Study Models

COMPUTERIZED JAW TRACKING EQUIPMENTS The computerized instrumentation, are used after the clinical examination. They provides hard data, actual precise measurements of the various jaw movements , the muscle function, TMJ function and joint sounds. Measurements are made at various stages of treatment. It records the opening, closing and sideway movements of the mandible. A Magnet is placed on the lower front tooth in midline. A K7 equipment has a Frame & this Frame with sensor Array is placed surrounding the lower jaw. The whole assembly is attached to the computer. Pt. is asked to perform various movements of the jaw in all 3 planes. The sensor array captures the movement of the mandible. The various movements are represented Graphically as a Scan on the computer.

Utilizes a kineograph to measure intracapsular TMJoint sounds against normalized data. Duration of these sounds, exact location of the occurrence of these sounds during jaw movements etc are helpful data for Diagnosis of Joint capsule pathology. The joint sounds are analyzed by the computer in terms of amplitude and frequencies of the pathology.

It is the most objective and reliable method available for imaging muscle function and efficiency, which is done by identifying their electrical potentials. In global surface electromyography (sEMG), surface electrodes are located of the surface of the skin, and it detects the activity of the tensed painful muscle.

A therapy that uses low voltage electrical current to produce low frequency waves to provide pain relief. It delivers electrical impulses through electrodes placed on the surface of skin of the affected muscle. The electric current stimulates nerve cells that block the transmission of pain signals, by modifying perception of pain. The pain is relieved & then these relaxed muscles place the jaw at the muscle balanced neutral position. At this neutral position occlusal Rehabilitation is performed.

The pattern the upper & Lower Teeth meets each other is called as OCCLUSION. Occlusion analysis is important to analyze any disharmony in occlusion of teeth. The Biting force, the time & duration of teeth contacts, teeth interfering during closure of teeth etc are measured & detected with the help of Occlusal sensors.

Dr. Sanjay Bhawsar is one of the pioneer in the field of TMJ- neuromuscular dentistry Sciences. He is a Prosthodontist & was the Dean of the Dental College. He is also a Honorary Consultant & faculty for the MSc programme of UNIVERSITY OF JAUME I, SPAIN. He has a vast clinical experience of 40 years in this field. He has a team of various consultant of Dental & Medical fraternity related to NMD treatment protocol. The unique features of our TMD treatment centers are -