Unilateral, Alloplastic Temporomandibular Joint Reconstruction, Biomechanically What Happens to the Contralateral Temporomandibular Joint?—A Prospective Cohort Study

Abstract

Unilateral alloplastic total temporomandibular joint reconstruction (TMJR) might influence the contralateral side joint function. This study's purpose was to estimate the risk for contralateral TMJR and the jaw function of the contralateral untreated temporomandibular joint (TMJ). A prospective cohort study design was used for patients who underwent unilateral alloplastic TMJR. The primary predictor was time after TMJR, and the secondary predictors were pre-TMJR mandibular angle resection, prior ipsilateral TMJ surgeries, and TMJR design (custom, stock). The primary outcome variable was the need for contralateral TMJR. The secondary outcome variables were the results of jaw function-jaw tracking, maximum voluntary clenching, surface electromyography, and pressure pain thresholds (PPT) and patient's quality-of-life (oral health-related quality-of-life [OHrQoL]). Data were collected preoperatively (T0), and 1year (T1), 2-3years (T2), and ≥ 4years postoperatively (T4). Analysis of variance with post hoc Tukey -HSD test and multiple linear regression analysis were used for statistical analysis. P<.05 was considered significant. Thirty-nine patients were enrolled, 15 males and 24 females, with an average age of 48.9±16.2 years. Two patients (5.1%) required a contralateral TMJR. Contralateral condylar motion, incisal laterotrusion, and protrusion slightly decreased, while incisal opening (P=.003), rotation angle (P=.013), opening deflection, surface electromyography activity, maximum voluntary clenching (P=.01), PPTs, and OHrQoL all increased. Pre-TMJR mandibular angle resection had an impact on PPTs and subjective outcomes and prior ipsilateral TMJ surgeries on the opening rotation angle. Based on this study, bilateral TMJR does not appear necessary when the contralateral TMJ is healthy. Unilateral alloplastic TMJR is associated with improved contralateral jaw function and OHrQoL.