Can Patients With Metal Hypersensitivity Requiring TMJ Total Joint Prostheses be Successfully Treated With All-Titanium Alloy Mandibular Components?

Abstract

Patients with documented metal hypersensitivity to cobalt-chromium-molybdenum (CoCrMo) alloy with trace nickel requiring temporomandibular joint (TMJ) total joint prosthesis (TJP) may have adverse reactions to the metals in the standard TMJ Concepts TJP. This study aimed to determine if these patients can be successfully treated by eliminating CoCrMo alloy and constructing the mandibular components of all-titanium (Ti) alloy. This retrospective cohort study evaluated metal hypersensitive patients (MHG) that received the TMJ Concepts TJP modification of all-Ti alloy mandibular components with outcome results compared to a control group (CG) of non-metal-sensitive patients that received the standard TMJ Concepts prostheses. The primary predictor variables were the 2 groups, MHG and CG. Primary variables evaluated using Likert scales included TMJ pain, headache, jaw function, diet, and disability. Maximum incisal opening and quality of life were measured. Secondary variables included: age, gender, effect of the number and type of prior TMJ surgeries. Scores for pre- and postsurgery parameters (nonparametric variables) were analyzed using a Mann-Whitney U test (α=0.05). The MHG (n=30) received the Ti alloy TJP and CG (n=46) received the standard TJP, with statistically significant improvements in all variables in both groups and no statistically significant difference in outcome variables between the 2 groups. Patients with 0 to 1 previous TMJ surgeries had better outcomes in all parameters except maximum incisal opening compared to patients with 2 or more previous TMJ surgeries. Patients with documented hypersensitivity to CoCrMo alloy, requiring TMJ Concepts TJP may experience improvement in TMJ pain, headache, jaw function, diet, disability, jaw opening, and quality of life when the mandibular components are manufactured from all-Ti alloy, eliminating the CoCrMo alloy. The larger the number of previous TMJ surgeries and exposure to failed alloplastic implants, the less improvement in treatment outcomes.