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The nature of temporomandibular joint disorders (TMDs)
the therapeutic system integrated with orthodontic approach
Kazuo Tanne, DDS, PhD
APOS President
Department of Orthodontics & Craniofacial Developmental Biology,
Hiroshima University Institute of Biomedical and Health Sciences
1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
Temporomandibular joint disorder (TMD) has become an important topic in
the field of dentistry and/or orthodontics. Under such background, various studies have
been conducted to elucidate the nature and causes of TMD in association with various
etiologic factors. Currently, TMD is well accepted as a multi-factorial disease, however,
occlusal discrepancy is speculated as a principal cause to have a certain association with
the onset of TMD.
In order to clarify the nature of TMD, the relevant factors were examined in
our research group in terms of the association with the onset of TMD. As a result, it was
confirmed that excessive mechanical loading resulted from a certain occlusal or skeletal
discrepancy is a significant cause of TMD. Based upon these results, a problem-oriented
therapeutic system integrated with orthodontic approach was established. In this system,
differential diagnosis is essential for treatment planning of TMD patients with various
joint pathologies. Then, an availability of the therapeutic system was demonstrated in
TMD cases with a special reference to the intra-articular pathology.
The content of this presentation is as follows.
1. Structure and function of temporomandibular joint (TMJ)
2. Prevalence and causes of temporomandibular joint disorders (TMDs)
1) Prevalence of TMDs
2) Causes of TMDs
3. Examination and differential diagnosis for TMDs
1) Clinical examination
2) Functional examination
3) Image examination
4) Biochemical examination
5) Differential diagnosis according to the criteria of Wilkes
4. Therapeutic system for TMD cases with various intra-articular pathologies
integrated with orthodontic approach
1) Treatment of TMD with masticatory and the related soft tissue disorders
2) Treatment of TMD with reducible disk displacement (ADDW)
3) Treatment of TMD with irreducible disk displacement (ADDWo) and
TMJ-osteoarthritis (TMJ-OA)
First, I would like to review the current concept or the nature of TMDs with a
special reference to previous reports in the literature and our research findings. Then,
clinical aspects of TMDs will be discussed in terms of the examination and differential
diagnosis for the intra-articular pathology. Finally, actual treatment cases will be
presented to introduce a problem-oriented therapeutic system integrated with splint
therapy and subsequent orthodontic approach. In addition, the availability of this system
will be verified in various TMD cases with different pathologies in the TMJs. After the
lecture, if time allows, I would like to demonstrate how to use and adjust various types
of splints for TMD patients.