Morphology of the periodontium, tongue, soft and hard palati. Muscles attaching

mandible; TMJ joint

Ivo Klepáček KK

Cavitas oris dutina ústní

Dental arches divide it into vestibulum oris and cavitas oris propria

boundaries:

ventrally: lips – labia štěrbina-rima oris laterally: buccal parts – buccae

cranially: roof – palatum

causdally: m. mylohyoideus + m. geniohyoideus - tongue - lingua

dorsally: isthmus faucium KK

Specialized mucosa: free endings (pain, temperature) , Paccini (vibration), Ruffini (traction), taste buds Lining (buccal) mucosa: free endings (pain, temperature) , Paccini (vibration), Meissner (pressure), Merkel (pressure)

Mucosa Masticatory mucosa: free endings (pain, temperature) , Paccini (vibration), Ruffini (traction), Meissner (pressure) KK

Parodontal functions Tooth fixation, elasticity, (hydroelastic cushion -pillow) nutrition, asistency during eruption

Parodontium Clinical unit involving gum,

periodontal ligaments, cementum and lamina dura

(cortical layer) of the alveolus KK

Arrangement of the periodontal ligaments. a - ligamenta marginalia, b - ligamenta dentalia superiora, c - ligamenta dentalia media, d - ligamenta dentalia inferiora (apicalia)

Interdental circumdental,

dentoalveolar and intraalveolar

ligaments

0.3-0.5mm

0.1-0.2mm

about 0.2mm

Periodontium Free endings - pain Ruffini bodies - traction Paccini bodies - pressure , vibration KK

formation of the suspensory systém before and after eruption (after Levy and Bernick 1968, modified). A – tooth primordium inside developing alveolus, B – eruption starts, C - alveolus is formed, stadium, D – fully erupted tooth

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Periodontium (Parodontium)

Cells Fibers Matrix Ligaments Plasma Vessels Nerves Interstitial plasma and blood in vessels -

“hydroelastic pillow“ KK

Ion exchange between inner (pulp) and outer (oral cavity) environment KK

Gingival sulcus (pocket) Sulcus

gingivae

Free gingival groove Paramarginal sulcus

Gingiva = tightly surrounds tooth neck – “cuff (collar-like) connection“

free: Interdental; circumdental adjacent: closely attached, fixing

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Alveolar mucosa (“loose gingiva“) = shiny red, nonkeratizing

Gingiva proper (attached) = pink, stippled, keratizing KK

Interdental, circumdental, dentoalveolar, interalveolar ligaments

Ligamentous slings and circles help to tight attachment between gingiva and tooth KK

Free gingival groove changes

into periodontal

pocket

True pocket (deeper 3.5 mm) appears, if the tooth attachment is lost

True pocket

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nipple compression

nipple compression

nipple sucking

bite combined

boxed-like

folding-like KK

Lingua, glossa

Mucous and muscularorgan;

Inside cavum oris and pharynx apex

corpus (body) dorsum facies inferior

radix (root) margo (margin) sulcus (groove)

terminalis medianus (midline)

foramen caecum tonsilla lingualis

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Week 6 - 7

Papillae filiformes fungiformes vallatae foliatae

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hořko

slano

kyselo

sladko KK

Inervace

motorická: n. XII

(x m.palatoglossus)

senzitivní

V/3

IX

X

senzorická

VII

vegetativní:

parasympatická

ggl. submandibulare

sympatická

plexus lingualis

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f – plica fimbriata e – frenulum linguae g – vena lingualis profunda b – caruncula sublingualis a – opening of the ductus gl.sublingualis on the plica sublingualis KK

Ankyloglossia – influence on oral cavity bottom formation

Tongue-tie – Ankyloglossia – fusion between

tongue and floor of the mouth,

Tongue frenulum

extends to the tongue top

Combined with (Pierre-Robin, Treacher Collinssyndroms)

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Styloglossus Palatoglossus

Hyoglossus

Genioglossus

Zevní svaly jazyka mění

polohu jazyka KK

Vnitřní svaly jazyka mění tvar jazyka

mm. Longitudinales superiores et inferiores, transversalis, verticalis KK

Mm. Genioglossal muscles are separated from each other with

septum linguae (linguale) Gap between m.

hyoglossus and m. genioglossus is for vessels and nerves

Septum linguae is made from sparse connective tissue; it can be socked by pus - abscessus KK

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Abscessus v septu KK

Lymph outflow from tongue KK

vestibulum

vestibule

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c - frenulum linguae sup.

b,a - plicae bucco-alveolares (buccales) KK

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Palatum durum Palatum molle

Hard palate Soft palate

Premaxilla Maxilla Os palatinum

Papilla, rugae (folds) pits (foveolae) Lines (crests)

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Palatum – relief

Lacey

Papilla incisiva

Rugae palatinae

Raphe mediana

Top of the interalveolar septum; At level of papilla incisiva

The most ventrally found rugae palatinae are at level of caninus alveoli

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Relief patra; rugae, foveolae a papilla incisiva

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podle Petrovického2002

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Palatum molle (soft)

– posterior view

– anterior view KK

Palate – relief

Lacey

Palatum durum

Palatum molle

Raphe mediana

Fat zone

Foveolae palatinae

A

H

Hauptmayer line – between soft and hard palatum

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Chrápání Snoring

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Masticatory muscles

Musculi masticatorii Muscles of mastication

V3 – MANDIBULARIS Derivates of the 1. branchial arch KK

Masticatory muscles n. mandibularis - 3rd branch of the n. V.

M. masseter From the outer surface of the zygomatic arch; deep part

of the muscle run from the internal bone surface, too Superficial part runs mandibular angle; deep to the

„fovea zygomaticomandibularis“

M. temporalis From inferior temporal line (+adjacent bone) Proc. coronoideus mandibulae (coronoid process)

Fascia temporalis and fascia parotideomasseterica KK

M. temporalis et fascia temporalis

Spatium interfasciale; Interfascial

space KK

M. masseter KK

Fascia parotideomasseterica, Parotideomasseteric fascia

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Jost , G, Levet, V.: Parotid fascia and Face lifting: A critical Evaluation of the SMAS concept. Plastic and Reconstructive Surg, 74:42-51, 1983

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Mm. pterygoidei Medialis

From the pterygoid fossa and from the tuber maxillae Tuberositas pterygoidea

Lateralis From the processus pterygoideus (lamina lateralis) and

from the infratemporal face of the greater wing of the sphenoid bone

below mandibular head, pterygoid fossa and onto the joint capsule KK

pterygomandibularis

pterygoideus proprius

pterygospinosus

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a – lig. pterygospinosum

b – n. alveolaris inferior

c, d – n. lingualis e – lig. pterygomandibulare

(raphe buccopharyngea)

f – sulcus mylohyoideus

g – angulus mandibulae et lig. stylomandibulare

h – lig. sphenomandibulare

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Main and ´assisting´ masticatory muscles

(orthodontic and prosthetic point of view)

anterior belly of digastric m., mylohyoid m.

Innervation: CN V3

Geniohyoid m. KK

JAW MUSCLES There is differentiation of the jaw-closing musculature.

In basal synapsids, the major jaw-closing muscle is the adductor mandibulae (externus). It originates from the back of the skull and inserts on the posterior end of the lower jaw.

In derived synapsids, the adductor mandibulae divides into two major sets of jaw-closing muscles, the temporalis and masseter. The temporalis originates from the skull roof near the sagittal crest and inserts on the coronoid process. The masseter in turn divides into two parts. The deep masseter originates on the zygomatic arch and inserts on the lower jaw; the superficial masseter part arises beneath the eye, passes across the deep masseter, to insert on the angle of the dentary.

Evolution of Synapsid jaw adductor muscles

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Paleontological evidence for mammalian middle ear evolution. (A) Diagrams of lateral views of jaw skeletal elements showing modifications leading to the mammalian condition (after Allin, ’75). The geological record and occurrence of each animal are indicated on the left. For clarity of comparison, no teeth are shown. Note that a set of postdentary elements (articular, surangular, and angular) and the upper jaw elements (quadrate and quadratojugal), indicated by gray, became separated from the dentary and reduced in size during the transition from pelycosaurs to mammals. The sequence of changes in the fossil record does not represent a true ancestor–descendent relationship, but only structural grades. (B) Changes in jaw articulation during mammalian evolution. In a pelycosaur, Dimetrodon (top), the quadrate and articular formed a functional jaw joint (black arrow). In an ‘‘advanced’’ cynodont, Diarthrognathus (middle), an additional jaw joint was observed between the squamosal and dentary (white arrow). In an extant marsupial, Didelphis (bottom), the functional jaw joint has been taken over only by the squamosal and dentary.

Takechi M, Kuratani S. 2010. History of studies on mammalian middle ear evolution: a comparative morphological and developmental biology perspective. J. Exp. Zool. (Mol. Dev. Evol.) 314B:[page range].

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Compound joint Similar to hinge joint type

Temporomandibular (craniomandibular) joint Articulatio

temporo- mandibularis

ATM lat.

TM , TMJ engl.

Morphological

findings:

• The great variability of all the

articular structures

• The absence of hyaline cartilage

•The two separate compartments,

allowing a wider range

of mandibular movements

• The mared weakness of the

articular ligaments, allowing

hypertranslation and dislocation

without tearing the capsule

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Late triassic early mammal Mesozoic early mammal 125 millions year ago

Water mole (duckbill)

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rovina okluze occlusal plane protetická rovina Camper plane

x vodorovná rovina horizontal plane

M.Doskočil: Chrupavka ve vývoji mandibuly. (cartilage in the development of the mandible) Cs.Stomatologie, 1:10-18, 1988

Meckelova chrupavka a chrupavčité deriváty v krčku dolní čelisti KK

END

bundle of cartilaginous cels – Meckel derivate ?

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Os tympanicum zvýrazníte dalším kliknutím Tuberc. pharyngicum Foramen lacerum Spina sphenoidalis Foramen spinosum Foramen ovale

Fossa mandibularis Tuberculum articulare

Arcus zygomaticus

Condylus occipitalis

Processus styloideus Foramen jugulare For. stylomastoideum Processus mastoideus Fissura tympanomastoidea Fis.tympanopetrosa Fis.petrosquamosa Fis.tympanosquamosa Porus acusticus ext.

Basis cranii externa – semiview on the tympanic bone

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Processus postglenoidalis Post-glenoid process

Trigonum suprameatum Suprameatal triangle

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Articular Capsule is a sac that encloses TMJ. Borders: Superior: Capsule is positioned underneath inferior side of Articular Eminence. Inferior: Capsule wraps around condyle's neck (Collum Mandibulae)

It is a fibro-cartilageus disc. It divides synovial cavity of TMJ into: 1. Superior synovial cavity 2. Inferior synovial cavity Both cavities are filled with synovial fluid, secreted by inner side of articular capsule (clear, viscous fluid). Attachments of articular disc:

1.Anterior: a. Anterio-Superior: indirectly to articular eminence through capsule

b.Anterio-inferior: to condyl's neck

2.Posterior: a.Posterio-superior: to post-glenoid process spina supra meatum ?

b. Posterio-inferior: to condyl's neck

Gray´s anatomy, The classic collector´s edition KK

Salentijn, L. Biology of Mineralized Tissues: Prenatal Skull Development, Columbia University College of Dental Medicine post-graduate dental lecture series, 2007 Moss, ML. The non-existent hinge axis, Am. Inst, Oral Biol. 1972, 59-66 Rodríguez-Vázquez JF, et al., JF; Mérida-Velasco, JR; Mérida-Velasco, JA; Jiménez-Collado, J (1998). "Anatomical considerations on the discomalleolar ligament". J Anat.. 192 (Pt 4): 617–621. PMC 1467815. PMID 9723988. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1467815/. Rodríguez-Vázquez JF, et al. (1993). "Relationships between the temporomandibular joint and the middle ear in human fetuses.". J Dent Res.. 72 (1): 62–66. T Rowicki, J Zakrzewska. (2006). "A study of the discomalleolar ligament in the adult human.". Folia Morphol. (Warsz).. 65 (2): 121–125. S Zhang, N Gersdorff, J Frahm (2011) Real-Time Magnetic Resonance Imaging of Temporomandibular Joint Dynamics. The Open Medical Imaging Journal, 2011, 5, 1-7, [1] Zadik, Yehuda; Aktaş Alper; Drucker Scott; Nitzan W Dorrit (2012). "Aneurysmal bone cyst of mandibular condyle: A case report and review of the literature". J Craniomaxillofac Surg 40.

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Joint surface is composed form the fourth layers: • Superficial layer: superficial articular layer = connective tissue character • Very cellular layer: • Proliferating layer: • Hypertrophic layer:

discus articularis is rich by vessels in early age

Loose of vascularization supports degenerative changes of the disc

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Upper space - cavitas discosquamosa – 581 mm2

Lower space - cavitas discocondylaris – 396 mm2 KK

Condylar atrophy follows age

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A) Fissura tympanosquamosa

B) Stratum superius C) genu vasculosum D) Stratum inferius E) Capsule F) Glandula parotis G) Discus articularis ( Dreger 1994 )

Discus napojen na fascia parotis, a podkožní struktury; pouzdro je slabé

Discus napojen přes pouzdro

Discus je napojen samostatně

Discus a pouzdro jsou pevně spojeny

Dreger H (1994) Untersuchungen zur posterioren Anheftung Des Diskus artikularis im menschlichen Kiefergelenk. Med Diss Kiel

Vasili Naroushvili: Wechselwirkungen zwischen Okklusionsarten und Anheftungsarten des Musculus pterygoideus lateralis bei der Entstehung von Diskus Dislokation des Kiefergelenkes Hamburg 2006 KK

Minarelli, AM, DelSanto, M, Liberti, EA: The structure of the human temporomandibular joint disc: A scanning electron microscopy study. J Orof Pain 11:95-98, 1997

Examined discs: 16-39 weeks of intrauterine life Up to 4 months of age 30-39 years 60-69 years KK

Superior head, inferior head, and ´third´head of the lateral pterygoid are shown (dissected) 1-Discus articularis, 2-M.pteryg.lat (superior head), 3-M.pteryg.lat (inferior head), 4- third head of the m. pteryg. lat (attached inferior head)

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2

3 4

Discus articularis (dissected) 1-Discus articularis, 2-insertion of the mm. masseter and temporalis, 3-insertion of the m. pteryg.lat (superior head), 4-insertion of the m. pteryg.lat (inferior head)

V. Naroushvili 2006

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•J. Chen, U. Akyuz, L. Xu, R.M.V. Pidaparti : Stress analysis of the human temporomandibular joint •Medical Engineering & Physics 20/8/: 565-572, October 1998

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Thin elastic lamina

fibroelastic lamina

Retroarticular hydroelastic cushion Zenker (contains vessels) KK

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Kondylová dráha Condyle path a Transverse b Longitudinal

Rest position

Central position

Ventral position

Habitual (high) End of the masticatory cycle

Ventral (low)

muscle tone is the smallest

central (zenit)

through swalloving

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N. facialis: • lateral surface of the joint capsule KK

N. auriculotemporalis nerve is branched into four nerves: • lateral branch •Medial branch • branch from the middle nerve segment • branch from the area where nerve crosses n. temporalis superficialis KK

n. massetericus send four branches:

• branch below oval foramen • branch from the first nervous segment closely below skull base • two branches from the first segment below zygomatic bone

m. temporalis profundus:

• supplies rostromedial part of the disc and capsule

Ganglion oticum (otic ganglion):

• supplies dorsal part (pars discosquamalis) of the joint capsule

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Literature R. Čihák: Anatomie 1, 2, 3 Grada Publishing 2003

M. Dykes : Anatomy 2th edition, Mosby 2002

S.Snell: Clinical anatomy for Medical Students 6th edition, Lippincott, Williams & Wilkins

I.Klepáček, J.Mazánek et al.: Klinická anatomie ve stomatologii Grada Publishing 2001

G.J.Tortora : Principles of Human Anatomy 4th edition, Williams & Wilkins

K.L.Moore, A.F.Dalley: Clinically Oriented Anatomy 4th edition, Williams & Wilkins

F.H.Netter: anatomický atlas člověka Vlastní archív

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