Condylar replacement alone is not sufficient for prosthetic reconstruction of the temporomandibular joint

doi:10.1016/j.ijom.2006.01.022

International Journal of Oral and Maxillofacial Surgery

Volume 35, Issue 6, June 2006, Pages 488-492

https://doi.org/10.1016/j.ijom.2006.01.022 Get rights and content

Abstract

Prosthetic reconstruction of the temporomandibular joint (TMJ) is a controversial method of treatment. This paper presents 2 cases that illustrate the problem with prosthetic reconstruction of the condylar head with no fossa reconstruction. In both cases, severe erosion and heterotopic bone formation occurred, and the patients underwent installation of total TMJ prostheses to replace the previous, partial ones.

Section snippets

Case 1

A 64-year-old woman was admitted to the Regional Maxillofacial Unit, Glasgow, UK in April 2004, for a planned right TMJ prosthesis replacement. The patient had suffered from severe TMJ pain for the previous 10 years. Despite an initial conservative approach to the management of her symptoms including adequate denture provision, intra-articular steroids and the use of Dothieprin, the patient required insertion of her first TMJ prosthesis in 1998 (no information on type or origin available).

Case 2

A 61-year-old woman was referred to the Department of Maxillofacial Surgery at Kantonsspital Aarau (Switzerland) in August 1997 for evaluation and treatment of bilateral TMJ pain that she had suffered from for a long period. The pain was getting worse, especially on the right side. Her maximum inter-incisal opening was measured at 48 mm. CT scan demonstrated bilateral deformations and erosions, most severe on the right side, corresponding to arthritis in the TMJ. A conservative treatment was

Discussion

In the past, prosthetic reconstruction of the TMJ resulted in some poor treatment outcomes. To some extent, such failures were the result of sub-optimal design, engineering or function of the devices. Other failures resulted from treating conditions that should not have been treated with prosthetic TMJ reconstruction at all. These previous poor or unpredictable results continue to give prosthetic TMJ reconstruction a bad reputation¹. There is still bitterness over the Vitek-Kent TMJ total joint

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Cited by (44)

Impact of technology in temporomandibular joint reconstruction surgeries: A systematic review
2021, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Later in the year 1861, Gluck published a case for total joint replacement using ivory as the material34. Since then, many techniques and materials have been tried to bring refinement in TMJ surgeries in the form of gap arthroplasty35,36,37,38,39, hemiarthroplasty40,41 and total joint replacement solutions42,43. Over the last two decades, the conventional total TMJ joint replacement solutions underwent tremendous transformation with the incorporation of virtual surgical planning and mechanically customized implant placements.
The digital technologies, in recent years, have integrated with temporomandibular joint reconstruction surgeries (TRS). Therefore, a systematic study was conducted to assess the impact of digital technologies in TRS. Besides, a brief comparison between the CAD/CAM and 3D printing (3DP) technologies is presented.
We searched in PubMed, ProQuest and Science direct using PRISMA guidelines. Population = Patients undergoing TRS, Intervention=CAD/CAM or 3DP, Comparison= conventional TRS (cTRS) vs technology integrated TRS (tiTRS), Outcome= Advantages/disadvantages of technology and Subjective/objective symptoms, Study design= Type of study. The quality of observational study was assessed using ROBINS-1 Assessment tool.
Out of 632 articles, 30 articles for CAD/CAM and 3DP were included in the study. A majority of TRS were done for ankylosis (new or re-entry), earlier failed surgery, osteoarthritis and neoplastic cases. The articles were divided into two groups. Group I: CAD/CAM(n = 16), Group II: 3DP (n = 14).
tiTRS had definite advantages over cTRS with lesser surgery time, defined osteotomies, précised implant fitting and better final result outcome however, evidence for tiTRS in long-term follow-up is inconclusive. The cost, time, infrastructure and ethical/regulatory issues are the downsides of assisted surgeries. It was observed that 3DP technology is versatile and its adaptation in the fabrication of customized implants has outpaced CAD/CAM technology. However, literature data is feeble qualitatively and quantitatively.
The TRS has leveraged the flexibility and precision of assisted surgeries. In future, tiTRS could successfully replace cTRS, provided that shortcomings should be dealt so that the technology can benefit the masses.
Will they fit? Determinants of the adaptability of stock TMJ prostheses where custom TMJ prostheses were utilized
2021, International Journal of Oral and Maxillofacial Surgery
Currently only two alloplastic temporomandibular joint (TMJ) total joint replacement (TJR) systems are available in the United States. The aim of this study was to define variables that determine whether a Biomet stock prosthesis could have been used to reconstruct a TMJ previously reconstructed with a TMJ Concepts patient-fitted prosthesis. All of the TMJ Concepts prostheses placed between 2010 and 2018 at the University of Texas – Health at San Antonio were analyzed retrospectively. There were 128 cases (241 joints) with intact stereolithographic models analyzed for successful adaptation of the Biomet stock TMJ prosthesis. Anatomical, demographic, etiological, and perioperative data were gathered for each joint to investigate possible causes of failure of stock adaptation. The majority of joints, 74% (178/241), could have had a stock prosthesis adapt. All joints with ≥40 mm gap arthroplasty failed stock prosthesis adaptation. Only 50% (32/64) of the joints with at least one previous open TMJ surgery and 60% (58/96) of the joints with concomitant orthognathic surgery could have had a stock TMJ prosthesis. The stock prosthesis could not be adapted for any of the patients requiring TMJ replacement for congenital disorders or those requiring TMJ salvage. Overall, the majority of cases treated with a patient-specific TMJ TJR could have been treated with a stock prosthesis.
Clinical guidelines for total temporomandibular joint replacement
2020, Japanese Dental Science Review
Total joint replacement (TJR) of the temporomandibular joint (TMJ) is a promising surgical procedure and device for treating end-stage diseases of the TMJ. For the functional and aesthetic reconstruction of the oral and maxillofacial head and neck region, TMJ TJR significantly helps maintain the patient’s quality of life in terms of a better diet, mastication, speech and social interaction. TMJ TJR was approved by regulatory authorities in 2019 in Japan, thus enabling the clinical application of the TJR system. However, the surgery demands particularly difficult and high-risk procedures, necessitating the prudent selection of indicated patients. The joint committee of the Japanese Society of Oral and Maxillofacial Surgeons and Japanese Society for Temporomandibular Joint is working together to develop an appropriate clinical guideline for TMJ TJR.
Patient-specific, printed titanium implants for reconstruction of mandibular continuity defects: A systematic review of the evidence
2019, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
It is reasonable to state that amongst the surgical community, there is considerable concern over the use of condyle-only temporomandibular joint reconstructions following the adverse outcomes of glenoid fossa erosion and heterotopic bone formation with stock implants identified by Lindqvist et al., in 1992 (Lindqvist et al., 1992). Consequently, the current vogue is to use a condylar and glenoid fossa component in combination wherever possible (Westermark et al., 2006). However, in a series of 9 patients with printed PSIs including condyle-only joint replacements, short-term outcomes were encouraging.
Comment on: “Does Accurate Positioning of the Temporomandibular Joint Titanium Condylar Prosthesis Prevent Complications?”
2019, Journal of Oral and Maxillofacial Surgery
Failure mechanisms of medical implants and their effects on outcomes
2019, Biointegration of Medical Implant Materials
This chapter is a current update discussing the mechanisms that are responsible for implant failure following clinical use. The main emphasis of this chapter includes discussions pertaining to the mechanical and biological factors that can influence the in vivo survival of medical implants. Some of the most advanced cutting-edge characterization techniques are discussed keeping in mind future iterations of implants for clinical use. One of the main challenges with newer medical devices and technologies is the translation of research data from in vitro to in vivo environments. In addition to traditional implant materials, the introduction of hybrid biomaterials that incorporate biological/organic with nonbiological/inorganic substrates adds new challenges to study their failure mechanisms. A brief discussion related to the clinical aspects that can influence implant failures, ethical issues pertaining to failure mechanisms, and statistical techniques that can be helpful are included in this chapter. A section pertaining to some of the ethical issues associated with this topic is discussed along with a perspective on the emergence of newer classes of regenerative technologies.

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Discussion PaperTMJ DisordersCondylar replacement alone is not sufficient for prosthetic reconstruction of the temporomandibular joint

Abstract

Section snippets

Case 1

Case 2

Discussion

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Atlas Oral Maxillofac Surg Clin North Am

Discussion Paper
TMJ Disorders
Condylar replacement alone is not sufficient for prosthetic reconstruction of the temporomandibular joint