TMD Suci

 TEMPOROMANDIBULAR  TEMPOROMANDIBULAR DISORDER Poerwati Soetji Rahajoe

OUTLINE • GAMBARAN UMUM • ETIOLOGI • PATHOFISIOLOGI • KLASIFIKASI KLASIFIKASI (DETAILED (DETAILED DISCRIPTION) •  TRAUMA  TRAUMA TM

 TEMPOROMANDIBULAR  TEMPOROMANDIBULAR DISORDER A !o""e!tio# o$ %e&i!a" a#& &e#ta" !o#&itio#' ae!ti# the TM a#&*or the %+'!"e' o$ %a'ti!atio# a' we"" a' !o#ti+o+' ti''+e !o%,o#e#t'

ETIOLOGI • M+"ti$a!toria" • Pre&i',o'i# Pre&i',o'i# $a!tor'  – M+'!+"o'-e"eta"

• Pre!i,itati# Pre!i,itati# $a!tor' $a !tor'  – Tra+%a.  Tra+%a. !"e#!hi#. ri#&i#

• Per,et+ati# $a!tor' $a !tor'  –  ,'/!hoe#i!

Aetiology • S-e"eta" jaw re"atio#'hi,' • O!!"+'a" &i'har%o#ie' • La!- o$ ,o'terior teeth • U#i"atera" teeth "o'' • Para$+#!tio#a" ha0it' • A#1iet/ a#& &e,re''io# •  Tra+%a

E,i&e%io"o/ • 234536 o$ e#era" ,o,+"atio# ha7e o#e 'i# • Pre7a"e#!e 0/ 'e"$ re,ort8 94:96 (o#e 'o+r!e e'ti%ate' :36 o$ wo%e#. 26 o$ %e#) • 96 or "e'' 'ee- treat%e#t • ;o%e#34=3) • Ma#/ TMD are 'e"$4"i%iti# or ?+!t+ate o7er ti%e witho+t ,rore''io# • 96 re@+ire '+rer/

 TEMPOROMANDIBULAR OINT DISORDER •  Mai# Cateorie'  – M/o$a'!ia" ,ai# &/'$+#!tio# '/&ro%(A; MUSCLES. #e!- %+'!"e'. 'ho+"&er %+'!"e')  – I#ter#a" &era#e%e#t o$ the joi#t (&i'"o!ate& joi#t. DISPLACED DISC. !o#&/"ar tra+%a)  – Dee#erati7e joi#t &i'ea'e (OSTEOARTHROSIS. RA)

SMPTOM (UMUM) TEMPOROMANDIBULAR DISORDER (Ta#&a Kar&i#a")

• • • •

Sa-it 'e#&i TM Pe%0ata'a# &a# &e7ia'i era- %a#&i0+"a S+ara 'e#&i Ra'a 'a-it otot %a'ti-a'i

PATHOFISIOLOGI TMD

Acute

Cronic Trauma TMJ (Responses)

Membran sinovial Musculus Condyle Recove ry

Ligament & capsul

Deformity of TMJ

Dislocation ypomobility Muscle! "acia! #$in contracture

ypermobility

Causes

Muscle imbalance 'diopatic

A%uired dislocation  Joint Adesio

Congenital TMJ

Mecanical bloc$ ('D!

RESPONSE TM TERHADAP  TRAUMA • CAPSUL DAN LIGAMENT LAIT KONTRAKTUR • SINOIAL MEMBRAN EFFUSI HIPERTROPI ADHESI (&# CARTILAGO)

• CARTILAGO DESTRUKSI DEGENERASI PROLIFERASI • MUSCLE ATROPI HIPERTROPI KONTRAKTUR

LA#'"'A#'

• M/o$a!ia" Pai# a#& D/'$+#!tio# (MPD) • I#ter#a" Dera#e%e#t.DISC DISPLACEMENT (ID) • Dee#eratio# oi#t De'ea'e (DD* ARTHROSIS)

: MOFACIAL PAIN DISFUNCTION

M/o$a'!ia" Pai# D/'$+#!tio# S/#&ro%e

•

•

Co%%o#e't !a+'e o$ !o%,"ai#t i#7o"7i#  TM

 !ar&i#a" '/%,to%'8 : Pai# a''o!iate& with  TM or it' %+'!+"at+re > C"i!-i# o$ the joi#t  Li%itatio# o$ joi#t %o7e%e#t

M/o$a'!ia" Pai# D/'$+#!tio# S/#&ro%e

•

•

S/%,to%' 7ar/ i# i#te#'it/ &+ri# the &a/ Mo't !o%%o# i# the %or#i#

•  Te#&er#e'' to ,a",atio# o$ orii#' a#& i#'ertio#' o$ %a'ti!ator/ %+'!"e' i' +'+a"

• More $re@+e#t i# wo%e# with a %ea# ae at ,re'e#tatio# o$ 3 /ear'

Cange in dental occlusion Modication of muscle activity Locali*ed yperactivity

#tress Daytime clencing /ru0ism Muscle yperactivity

Damage to regions of +ea$  And susceptible ,a+ muscles -ain.dysfunction ealing if rest acieved by treatment

#tress

Muscular yperactiv ity

Dental 'rritation

Muscular "ati%ue Muscular 2ver 34tention

M12#-A#M

Muscular 2ver Contractio n

M12"AC'A5 -A'56D1#"75CT'25 #15DR2M3 Contractur

2clusal disarmon y

'nternal derangeme nt

D38353RA T'93 Artritis

Altered ce+ing pattern (AMA 58 :=54:9. :2 cit  Sar#at  La'-i#. :>)

>INTERNAL DERANGEMENT

INTERNAL DERANGEMENT • AKIBAT POSISI DISC ANG TIDAK NORMAL*DISC DISPLACEMENT

Di'! Di',"a!e%e#t

• A0#or%a" ,o'itio#a" re"atio#'hi, 0etwee# the arti!+"ar &i'!. the hea& o$ the !o#&/"e. a#& the arti!+"ar $o''a o$ the te%,ora" 0o#e • It ha' 0ee# re,orte& i# >94296 o$ e"&er"/ ,atie#t'

Di'! Di',"a!e%e#t • It i' a"'o ,re7a"e#t i# ,atie#t' with %/o$a'!ia" ,ai#4 &/'$+#!tio# '/#&ro%e a#&*or o'teoarthriti! !ha#e' i# the joi#t • ;hether the &i',"a!e%e#t ,re!e&e' or $o""ow' '+!h !ha#e' i# +#!"ear • Not a"" ,atie#t' with &i',"a!e%e#t' ha7e or &e7e"o, 'i#' or

INTERNAL DERANGEMENT (ID) • KLASIFIKASI  – : TPE IA.CLICKING TANPA RASA SAKIT (936NORMAL SUBEK)  – >TPE IB.CLICKING .ADA RASA SAKIT .AKIBAT KRONIK STECTHING CAPSULAR LIGAMAENT. BILAMINAR ONE  – TPE II. J TPE IB TETAPI ADA RI;AAT LOCKING  – =TPE III.PERSISTEN LOCKING.SAKIT KRONIK

'nternal derangement • Disc displacement +it reduction •

Re,ro&+!i0"e !"i!-i# • Di'! &i',"a!e%e#t 'how# 0/ i%ai# a#& a0'e#!e o$ &ee#erati7e 0o#e &i'ea'e •  There %a/ 0e ,ai#. &e7iatio# o$ jaw %o7e%e#t' • No "i%itatio# o$ o,e#i# •

Sta0i"iatio# ',"i#t or

INERNAL DERANGEMENT • Disc displacement +itout reduction •

Di'! i' &i',"a!e& &+ri# o,e#i#  !"o'i#

•

Per'i'te#t "i%itatio# o$ %o+th o,e#i#

•

Di'! &i',"a!e%e#t 'how# 0/ i%ai# a#& a0'e#!e o$ &ee#erati7e 0o#e &i'ea'e

•

Pai#

•

No clicking

INTERNAL DERANGEMENT •  aw "o!-

LAT: -T3R12'D #-A#M

C2M-R3##'25.M' #7#3 ALT3R3D #7R"AC3 2" TMJ '5 C22RD'5AT'25

TRA7 MA

'5CR3A#3D "R'CT'25

ADR(A5T3R'2R D'#-LAC3D ;'T R3D7CT'25)

AD;R (A5T3R'2R D'#-LAC3D ;'T27T R3D7CT'25) (Etio"oi I#ter#a" Dera#e%e#t. Sar#at  La'-i#. :>)

I#ter#a" &era#e%e#t a#terior &i',"a!e%e#t o$ the &i'-

I#ter#a" &era#e%e#t (i#!oor&i#atio#)

ANTERIOR DERANGEMANT

ANTERIOR DERANGEMENT ;ITH REDUCTION

ANTERIOR DISPLAMENT ;ITHOUT REDUCTION

OSTEOARTHROSIS

AGE CHANGES OF TM :4 F"atte#e& !o#&/"e >4 o'teo,oro'i' o$ the !o#&/"e 0o#e 4 Thi!-#i# o$ the 0ro+' !o7eri# o$ the !o#&/"e =4 Thi##i# o$ the !arti"ae#o+' o#e o$ !o#&/"e 94 Thi##i# o$ the &i'! 24 Fi0roti! '/#o7ia" $o"&' 54 Thi!-e#i# o$ the 07 wa""' 4 De!rea'e the #+%0er o$ #er7e'

AGE CHANGES OF TM Tese age canges lead to< 4De!rea'e i# the '/#o7ia" ?+i& $or%atio# 4I%,air%e#t o$ %otio# &+e to &e!rea'e i# the &i'! a#& !a,'+"e e1te#'i0i"it/ 4De!rea'e the re'i"ie#!e &+ri# %a'ti!atio# &+e to !ho#&roi& !ha#e' i#to !o""ae#o+' e"e%e#t' 4D/'$+#!tio# i# o"&er ,eo,"e

Arthriti' o$ TM

• 'nfectious artritis • Reumatoid artritis • Degenerative artritis • Traumatic artritis

O'teoarthro'i' (O'teoarthriti') • A &ee#erati7e &i'ea'e whi!h %ai#"/ ae!t' weiht40eari# joi#t' • I# the TM it &ier' $ro% other joi#t' ,ro0a0"/ 0e!a+'e8 : It i' #ot a weiht40eari# joi#t > The arti!+"ar '+r$a!e i' !o7ere& with 0ro+' ti''+e rather tha# h/a"i#e !arti"ae •. It i' rare i# TM 0e$ore 9 th &e!a&e o$ "i$e. 0+t a$ter that it i#!rea'e' ,ro,ortio#ate"/ with ae

O'teoarthro'i' • C"i#i!a" $eat+re'8 

Pai#



Cre,it+'



Li%itatio# o$ jaw %o7e%e#t



De7iatio# o# o,e#i#



Ma#/ !a'e' are !"i#i!a""/ 'i"e#t

O'teoarthro'i' •

C"i#i!a" $eat+re'8



C"i#i!a" 't+&ie' '+e't a re"atio#'hi, i# 'o%e !a'e' 0etwee# "ater &e7e"o,%e#t o$ o'teoarthro'i' a#&8 a +#treate& %/o$a'!ia" ,ai#4&/'$+#!tio# '/#&ro%e. 0 "o'' o$ %o"ar '+,,ort. ! &i'! &i',"a!e%e#t .

S,o#ta#eo+' re'o"+tio# i' !o%%o#

o7er"oa&i # I#!rea'e& re%o&e"i# 

Neati7e a&a,tatio #

Di'! &i',"a!e%e#t

De7iatio# i# $or% o7er"oa&i #

ARTHROSIS Li#- o$ arthro'i' a#& Di' &i',"a!e%e#t.Sa#at

Di'! &i',"a!e% e#t

KESIMPULAN