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1. A technique is presented for making temporomandibular joint roentgenographs which can be duplicated. 2. The use of a long cone technique gives roentgenographs of superior diagnostic quality and with markedly reduced exposure of the patient to radiation. 3. The device for positioning the patient's head permits the head to be in the upright position, thus providing an accurate picture of the postural position of the condyle in the articular fossa.

The maintenance of healthy tone and contour of the gingival tissues around crowns is of the utmost importance, and the correct fit of the iridio-platinum casting to the tooth makes for the best possible result (Fig. 3). Porcelain is the material of choice when esthetics is of primary importance. Porcelain fused to iridio-platinum is a material which can be used to fulfill both the functional and esthetic requirements. The material, when properly used, lends itself to the ultimate in modern dentistry.

Certainly temporomandibular joint pain has a long history, for Ruffer 1 found evidences of temporomandibular joint pathology in the skulls of early modern man. In 3,000 B.C., the surgeon of the Old Kingdom in Egypt had a sound working knowledge of the anatomy of this joint. The earliest known surgical text, the Edwin Smith Papyrus, 2 reports a case of "dislocation of the mandible" with a diagnosis and method of reduction that is still used today. Bellinger 3 quotes Cooper, in 1842, as calling attention to snapping in the temporomandibular joint, and Annandale, in 1887, for opening into the joint, repositioning the articular disk, and suturing it with gut to the outer side of the joint. He names Lang as the surgeon who, in 1909, introduced disk extirpation. Costen, 4 in 1934, first described his syndrome and stirred the interest of modern medicine in the temporomandibular joint. For the purposes

Summary 1. The temporomandibular joint is a ginglymo-diarthrodial joint whose anatomy and actions are still not completely known or understood. 2. Degenerative joint disease of the temporomandibular joint is widespread in its occurrence, although it is often symptomless. 3. The etiology of this disease is complex. Microtrauma, overclosure of the mandible, mandibular muscle spasms, age, and possibly heredity all play their part. 4. Local and referred pain and clicking and snapping sounds are the outstanding symptoms. Loss of hearing, tinnitus aurium, vertigo, and neuralgias are accepted as connected with these joint disturbances, but only by some investigators. 5. Roentgenography of the temporomandibular joint has little to offer at this time, and it is of uncertain value in diagnosis. Cinefluorography with image intensification may be part of the answer, but this technique is too new to evaluate. 6. Treatment is aimed to remove the sources of trauma by correcting the occlusion and restoring the vertical dimension, where necessary, to its correct physiologic level. 7. The prognosis is good, and we can usually look forward to a good functional result.

A method for securing an impression for quick-curing temporary acrylic resin jacket crowns has been described. The impression is simple to obtain, needs no special care, has excellent dimensional stability, and has the accuracy of any typical hydrocolloid impression.

A means for obtaining an accurate functional impression of an unfavorable edentulous mandibular ridge has been described. The impression is developed in three stages, each of which has a specific objective.

A knowledge of pain reference patterns of the skeletal muscles permits the dentist to locate myofascial trigger areas. Temporomandibular joint disturbances can be either a primary source of pain or a refference zone, and can initiate both referred pain and muscle spasms. The ear is a common zone of reference for myofascial pain and the pain of temporomandibular joint disturbances.

Costen's syndrome is the term applied to a symptom-complex described by J. B. Costen in 1934. 1 The symptoms can be summarized as follows: Otological symptoms: loss of hearing, stuffiness in the ears, and tinnitus aurium. Head and neck pain: pain in and about the ears, headaches in the vertex and occipital regions, and pain typical of "sinus disease." Miscellaneous symptoms: vertigo, tenderness of the temporomandibular joint to palpation, burning sensations in the tongue and throat, and a metallic taste. Costen claimed 1-6 that the symptoms forming his syndrome were produced by overclosure of the mandible and that "opening the bite" would clear up these symptoms. Costen's syndrome has been debated as a single entity standing or falling by the correctness of every one of its symptoms, by the validity of the etiology given by Costen, and by the success of its treatment by "opening the bite."

History Pathological changes in the temporomandibular joint of early modern man have been reported.1The surgeon of the Old Kingdom of Egypt, 3000 B. C., knew the anatomy of this joint. The earliest known surgical text, the Edwin Smith Papyrus,2has one case, a "dislocation of the mandible," with the method of reduction that is still used today. In 1842, Cooper is said3to have reported snapping in the temporomandibular joint, and in 1887 Annandale3repositioned the articular disc and sutured it to the outer side of the joint. Lang has been named3as the surgeon who introduced disc extirpation (1909). The role of the dental apparatus in temporomandibular joint disturbances was first noted by Prentiss4and Summa5in 1918. Costen6-10and Goodfriend1113in the early 1930's called attention to the diversity of symptoms produced by pathology of the temporomandibular joint

A method for making occlusion rims that will fit with the accuracy of the final denture has been described. Because of the elasticity of the rubber base lining, these occlusion rims can be removed from the casts without damage or distortion, regardless of the severity of the undercuts existing in the casts.