Abstract

Measurements of condylar positions and movements indicate that reciprocal clicking and locking are caused by derangement of the TMJ disc and condyle. This is described as posterior displacement of the condyle associated with anterior displacement of the disc when the teeth are closed into the intercuspal position. The locking phenomena is usually preceded by clicking. Comparison of the condylar paths indicate that reciprocal clicking and locking are simply variations of the same dysfunction. In reciprocal clicking the click during opening is an unlocking of the joint. The click during closing is a displacement of the disc and condyle. As reciprocal clicking and lacking become more chronic the disc remains dislocated anteriorly throughout the normal range of mandibular movement. Clinical and radiographic observations extending over a decade have revealed that degenerative arthritis of the TMJ is a natural consequence of derangement of the disc and condyle. The first signs of reduced joint space are followed by a progression of events that include condylar flattening, irregularity of the articular surfaces with peripheral exostoses, and ultimately sclerosis of the condyle and the neck of the mandible. Therefore internal derangement of the disc and condyle characterized by reciprocal clicking and/or locking is a pathogenic condition which frequently is the direct cause of TMJ pain, dysfunction, and disease. Consequently, contemporary concepts of the nature and causes of TMJ problems should be expanded to include these phenomena associated with displacement of the disc and condyle.

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