TMJ Study and Investigation Page. Three years of publication.

Dear friends,

At December 2014 I started the project TMJ Study and Investigation Page. At first, all its content was offered in three languages: Portuguese, English and Spanish. Due to the analysis of the webpage access statistics, at March 2015 I decided to offer the content solely in Portuguese and English.

Anyway, access to the contents of the page is still available to other researchers, professionals in the field and to those interested in the research that I develop.

Three years of publication

Nowadays, the medicine based on evidence is hierarchically stratified from top to bottom, where in the base of the pyramid we find the clinic cases, which are rarely seen as evidence.

The TMJ Study and Investigation Page had in its conception, the purpose of posting the clinic cases, which were carefully published with the documentation related to each of the patients treated at Clinica MY with pain complaints, dysfunction and TMJ pathology.

The proposition was of presenting these clinic cases and concepts in order share them, offering free access to the content along images, surface electromyographies, computerized kinesiography, scanned before and after the therapeutic process. Cases of tridimentional orthodontics and neuromuscular phisiologic reabilitation of the second phase of treatment, after the TMJ treatment, were also included.


The TMJ Study and Investigation Page completed in the month of December, three years of life.

I remembered to celebrate on the first anniversary of the Page.

In the middle of the work with patients, teaching and publications I did not remember to celebrate the second year.

I want to celebrate these three years with you.

With this project, we have a place in the Internet that presents a line of work known as neuromuscular physiologic dentistry, which takes into account the whole body system. It is an area which acts on posture, mandibular functioning and considers the entire body system.

In order to do that, the neuromuscular physiologic dentistry aims to establish, in the patient, a position that is based on a harmonious relation between the muscles, the teeth, and the temporomandibular joints.


In the publication of this year’s end I have chosen the most significant images of all these years of publications, with direct links to each of the original publications.

At the end of this publication I placed the links of the publications of the first year of this page.


The TMJ Study and Investigation Page  has grown tremendously and continues to receive visitors from all over the world.

Thank you!

Lidia Yavich

Temporomandibular Joint Pathology in a Patient with Congenital Fusion of two Cervical Vertebrae. First and Second Phase. Case Report.


Postural Improvement in a Patient after Neuromuscular Physiological Mandible Repositioning Treatment. Patient with Scoliosis Surgery and Craniomandibular Symptomatology.


TMJ Pathologies Treatment: Patient with Severe Headaches and Temporomandibular Joint Pain with Significant Contour Irregularities in the Mandibular Condyle and Mouth Opening Limitation.


Reestablishment of the Bone Marrow Signal in a case of Avascular Necrosis of the Mandibular Head. Monitoring two years after treatment.


Neuromuscular Physiological Treatment in a Patient with Headache and Pain in the Temporomandibular Joints. Case report without possibility of Disc Recapture: first and second phase.

10 abre e fecha inicial


TMJ Pathologies Treatment: Patient with Pain in the Back of the Head, Bilateral Tinnitus and Constant Teeth and Prosthesis Fracture. First and second phase. Case Report.


TMJ Pathologies Treatment: Patient with headache for 30 years. Neuromuscular Physiological Rehabilitation. First and second phase. Case Report.


TMJ Pathology in Professional Musicians: A look beyond the risk factors. Physiological Neuromuscular Rehabilitation. First and second phase. Case Report.


TMJ Study and Investigation Page. One year of publication



The TMJ Study and Investigation Page  has grown tremendously and continues to receive visitors from all over the world.

Thank you!

Lidia Yavich

Osteonecrosis of the Mandibular Head: recovery of condylar bone marrow alteration

I had been showing clinical cases in the page  and in several groups. Some of them with rehabilitation and with tridimensional orthodontics, always after treating the TMJ.

In this post I’m not going to show all the sequence of the patient. I have  the intention to show the improvement of the signal of the MEDULLAR OF THE CONDYLE that had presented osteonecrosis.

Anamnesis and clinical inspection are a fundamental part in the  diagnosis of the patient that presents TMJ pathology.

Images are primordial when we study any sinovial joint, unfortunately I see patients with valuable information in their images that were told that those are just occasional findings.

MRI (magnetic resonance imaging) can give a lot of information and not only the disk position information. Logically is necessary to know what to do with that information.

Osteonecrosis of the mandibular head corresponds to a death of the osseous tissue, also called avascular necrosis.

 Alteration in the bone marrow of the mandibular condyle is a possible cause of TMJ pain.


MRI: T 1 closed sagittal rightTMJ before treatment.

Avascular necrosis in the acute phase can be diagnosed only through MRI imaging or biopsy.

The differential diagnosis of altered signal intensity in the mandibular condyle starts with an awareness of its normal signal characteristics.

This condyle has also a severe irregularity on the superior pole, with loss of substance, but in this post I want to analyze the bone marrow signal. Of course, in a diagnosis we need to consider all the information.


MRI: T1 closed sagittal rightTMJ before treatment.

Avascular necrosis occurs when blood flow to a bone is interrupted or reduced, which may be caused by several conditions, like joint or bone injury, pressure inside the bone, medical conditions, among others.

A condyle affected by avascular necrosis displays low signal intensity on T1 weighted images as a result of edematous changes in the cancellous bone.


MRI: T2 closed sagital rightTMJ before treatment.

The differential diagnosis of effusions in the TMJ has a broad-spectrum as of joint effusions in other skeletal regions.

A MRI (magnetic resonance imaging) can give a lot of information and not only the disk position. In this case THE PATIENT HAS NO DISK.


The same sagittal slice of the condyle in T1 and T2. Image A shows osteonecrosis of the head of the mandible and image C shows the articular effusion.

The patient complained from severe pain in the TMJ, headache, and pain on the back of the neck.

The patient had a major trauma history in the jaw in adolescence. She had rheumatic fever in childhood.

 We referred her to a rheumatologist, and in that moment she did not present positive results for inflammatory systemic disease.

Her muscles were electronically deprogrammed and a DIO (Intraoral Device) was constructed in a neurophysiological position. In other publications we mentioned the computarized kinesiographic used methods.


Comparing T1  images: A (before the treatment) and B (after the treatment): we can see the improvement and recovery of the the medullar signal. Improvement of the superior cortical of the mandibular head. 

The differential diagnosis and the systemic condition of the patient must be taken in account for the prognosis of the case.

2B Comparing T2  images: C (before the treatment) and D (after the treatment).It is clear in the first one (C) the inflammatory signal and in the other (D) the remission of the effusion.

Sem Título-1

Comparing T1 images (A and B) we can see the improvement and recovery of the  medullar signal and the superior cortical of the mandibular head. In T2 weightened images (C and D) it  is clear (in C) the inflammatory signal and in the other (in D) the remission of the effusion.

Sem Título-6

One year after the second image, a new control was solicited, and the results were even better.

In this case  I decided  NOT TO GO forward to a second phase.  Diagnosis is essential for each case.  Dentistry need to understand like Medicine do, that we have limitations and if a patient needs to live with an orthotic  it is not the end of the world.

We have patients that are going to live with insulin all their life, or with other medicines that are saving their lives or just improving their life quality.
Therefore, diagnosis is essential and for that all the tools that can help to get there are welcome.