Temporomandibular Joint Surgeons Research Articles

Does surgical volume correlate with outcomes in TMJ replacement surgery?

ObjectivesTo survey oral and maxillofacial surgeons (OMS) who perform temporomandibular joint replacement (TMJR) to determine whether length of surgery, specific TMJR protocols, or the incidence of complications are related to experience and case volume. Study DesignAn anonymous electronic survey was emailed to 407 surgeon members of the American Association of Oral and Maxillofacial Surgeons, American Society of Temporomandibular Joint Surgeons, and European Society of Temporomandibular Joint Surgeons known to have TMJR experience via publications or reputation. The descriptive survey contained multiple choice and open-ended questions. Descriptive statistics were computed for each variable for data analysis. Results49 surgeons completed the survey. The average stock TMJR cases included 54.6% unilateral and 50.5% bilateral cases. The average custom TMJR cases included 50.5% unilateral and 49.5% bilateral cases. Average procedure time for stock TMJR was 2.86 hours for unilateral, and 5.30 hours for bilateral cases. The average procedure time for a custom TMJR was 2.75 hours for unilateral, and 4.87 hours for bilateral cases. Average duration of hospital stay for stock and custom TMJR cases was 1.49 and 1.41 days (unilateral), and 1.98 and 1.95 days (bilateral). ConclusionThis study provides some pilot data that demonstrates that the length of surgery, specific TMJR surgical protocols, and the incidence of complications may be related to surgeon TMJR experience and case volume. IntroductionAlloplastic temporomandibular joint replacement (TMJR) is indicated for patients with end-stage temporomandibular joint pathology.1 As with any surgery, complications may occur, however, to date the relationship between the incidence of adverse events and surgeon experience has been unreported for TMJR surgery. The orthopedic literature demonstrates that the risk of complications decreases with more surgeon experience with alloplastic joint replacements.2,3 The aim of this study was to survey OMS who perform TMJR to determine whether length of surgery, specific TMJR protocols, and the incidence of complications could be related to their TMJR experience and case volume. It is hypothesized that with more TMJR surgical experience and case volume there will be fewer complications. Materials and MethodsThe study received Institutional Review Board approval (IRB #2023-0095) by the University of Illinois Chicago Research Office of Protection of Research Subjects. The study complies with the Helsinki Declaration and Health Insurance Portability and Accountability Act of 1996 (HIPAA). An invitation to participate in an anonymous electronic survey, via Survey Monkey (http://www.surveymonkey.com), was emailed to 407 surgeon members of the American Association of Oral and Maxillofacial Surgeons (AAOMS), American Society of Temporomandibular Joint Surgeons (ASTMJS), and European Society of Temporomandibular Joint Surgeons (ESTMJS) list serves. Two weeks after the initial recruitment email was sent, a reminder email was sent to the surgeons. All potential participants were provided with 4 weeks to sign a detailed informed consent form and complete the survey.The descriptive survey contained multiple choice and open-ended questions including: practice type, years in practice, if alloplastic TMJR is preformed, if TMJR Fellowship was completed, years of TMJR practice, average number of annual unilateral and bilateral TMJR cases, number considered an annual “high volume number” of TMJR procedures, average procedure time in hours for unilateral, bilateral, stock, and custom TMJR cases, average duration of hospital stay in days, and any complications and management. Descriptive statistics were computed for each variable for data analysis. ResultsThe survey was successfully sent to 394 emails, with a response rate of 12.9%. 13 emails were returned from the original 407 emails. 49 surgeons completed the survey, and 2 surgeons replied that they did not complete the survey because they are retired. 63.27% of the responding surgeons identified as academic, 53.06% as private practice, 22.45% as both academia and private practice, and 2.04% as military (Figure 1A). 93.88% reported they perform alloplastic TMJR (Figure 1B). 79.17% had not completed a TMJR fellowship (Figure 1C). 27.08% employed TMJR surgery in their practices >26 years (Figure 2).

Antibiotic prophylaxis in alloplastic temporomandibular joint replacement surgery: A multi-national survey of temporomandibular joint surgeons

Temporomandibular disorders include a wide spectrum of extra-articular and intra-articular conditions affecting the temporomandibular joint (TMJ). In salvage cases involving intra-articular end-stage disease, alloplastic temporomandibular joint replacement (TMJR) is a management option which can be utilised to rehabilitate a disabled joint’s function and form. Whilst post-TMJR infection is rare, it is one of the most serious complications. The principles governing TMJR surgery antibiotic prophylaxis have been based on those established in orthopaedic surgery literature. Antibiotic resistance due to antibiotic over-use is a significant concern, therefore antibiotic stewardship has been developed to deal with this world-wide public health concern. The TMJ’s anatomical proximity to the external auditory canal and oral cavity creates the potential for bacterial contamination. The aim of this study was to explore the views of 39 sub-specialist TMJ surgeons across nine nations usual approach to antibiotic prophylaxis and their management of TMJR infection. To accomplish this, an international survey was developed and conducted using Google Forms. The results demonstrated that 97.4% of the respondents employ prophylactic antibiotics at TMJR surgery, 83.8% on discharge. Variability in antibiotic choice with additional antimicrobial perioperative practices were also reported. Opinions on the management of a TMJR infection also varied. This survey establishes there is an agreement on the use of antibiotic prophylaxis, However the variability in choice, timing, course, duration of antibiotic use as well as the management of a postoperative TMJR infection demonstrates the need for further study leading to development of standardised antibiotic prophylaxis and infection management protocols for TMJR surgery.

Does Emotional State Improve Following Temporomandibular Joint Total Joint Replacement?

Temporomandibular joint total joint replacement (TMJTJR) offers patients the opportunity for improved function and reduced pain. TMJTJR also has the potential to affect a patient's emotions in a positive or negative manner. The purpose of this study was to evaluate changes in emotional state for subjects undergoing TMJTJR. The authors implemented a retrospective cohort study. Subjects who received TMJTJR were identified from the TMJ Inter Network, which is a study group comprising more than 130 temporomandibular joint surgeons. Subjects between the ages of 18 and 65 years with complete medical records and pre/post TMJTJR video/audio recordings were enrolled in the study. The predictor variable was time (preoperative and postoperative). The primary outcome variable is change in the emotional state. All subjects had preoperative (T0) recorded interview as well as a postoperative (T1) interview at 3 to 6months. The eight-category emotional state was classified as neutral, happy, sad, angry, fearful, disgusted, surprised, and bored. The three-category emotional state was classified as neutral, positive, and negative. The emotional state was measured using artificial intelligence at T0 and T1. The secondary outcome variable was pain score and maximal interincisal opening. The covariates are gender, age, diagnosis, prosthetic side, TMJTJR design, and TMJTJR type. The relationship between emotional state change and covariates was examined using both the χ2 test and the Kruskal-Wallis H test. The significance of the change in categorical data after surgery was examined using the McNemar-Bowker test. P values < .05 were considered statistically significant. Thirty-three subjects were included in the study. The mean age was 30.09±8.69 with 15 males (45%) and 18 females (55%). The percentage of subjects with preoperative neutral, happy, sad, angry, and fearful emotional states was 24, 15, 24, 9, and 27%, respectively. The percentage of subjects with postoperative neutral, happy, sad, angry, and fearful emotional states was 21, 39, 21, 12, and 6%, respectively. Thechange in emotional state was statistically significant (P=.037). There was no statistically significant relationship between covariates and emotional state changes (P>.05). According to the assessment of artificial intelligence, TMJTJR improves the emotional state of patients.

The ESTMJS (European Society of Temporomandibular Joint Surgeons) Consensus and Evidence-Based Recommendations on Management of Condylar Dislocation.

Although condylar dislocation is not uncommon, terminology, diagnostics, and treatment concepts vary considerably worldwide. This study aims to present a consensus recommendation based on systematically reviewed literature and approved by the European Society of TMJ Surgeons (ESTMJS). Based on the template of the evidence-based German guideline (register # 007-063) the ESTMJS members voted on 30 draft recommendations regarding terminology, diagnostics, and treatment initially via a blinded modified Delphi procedure. After unblinding, a discussion and voting followed, using a structured consensus process in 2019. An independent moderator documented and evaluated voting results and alterations from the original draft. Although the results of the preliminary voting were very heterogenous and differed significantly from the German S3 guideline (p < 0.0005), a strong consensus was achieved in the final voting on terminology, diagnostics, and treatment. In this voting, multiple alterations, including adding and discarding recommendations, led to 24 final recommendations on assessment and management of TMJ dislocation. To our knowledge, the ESTMJS condylar dislocation recommendations are the first both evidence and consensus-based international recommendations in the field of TMJ surgery. We recommend they form the basis for clinical practice guidelines for the management of dislocations of the mandibular condyle.

Autogenous Fat as an Ideal Interpositional Material in Temporomandibular Joint Surgery.

Interpositional gap arthroplasty has established itself as the the standard surgical treatment of Temporomandibular joint (TMJ) ankylosis. The autogenous tissue has replaced the alloplastic and other xenografts materials owing to its bioavailability, easy uptake, and no additional cost. Commonly used autogenous tissue has been temporalis muscle and fascia, fascia lata, skin graft, auricular and costal cartilage, the masseter and/or medial pterygoid muscle. With the turn of the century, TMJ surgeons started using autogenous fat from the lower abdomen and today it has taken over as the most favored autogenous filler material in TMJ ankylosis surgery or total joint replacement (TMJ-TJR). The use of buccal fat pad (BFP) has increased in the last decade due to its local availability and pedicled nature. This paper will discuss various autogenous tissues used in interposition and bring forth the journey of the autogenous fat as the preferred interpositional material now and rest the case in its favor.

An International Survey on Temporomandibular Joint Surgeon’s Implementation and Management of Discectomy in Treating Temporomandibular Joint Internal Derangement

To survey temporomandibular joint (TMJ) surgeons to determine current practice trends and perceptions regarding the role of discectomy for the treatment of TMJ internal derangements. An anonymous 5-part web-based survey was sent to TMJ surgeons. The survey was created and distributed, and the data were collected with the University of Michigan Qualtrics platform. Responses were compared based on operative volume, tendency to replace the disc, and likelihood of requiring temporomandibular joint replacement (TJR) after discectomy. Spearman correlations were used to test statistically significant differences. Domain-level analyses were also performed by summarizing items into 3 domain scores. Analyses were performed in SAS V9.4 (SAS Institute Inc., Cary, NC, USA). Fifty-nine surgeons (33.9%) completed the survey. Discectomy was not considered to be a useful procedure by 85% of respondents, and 74% would not consider discectomy as a first surgical option. Most would consider discectomy (64%) before alloplastic total joint replacement. Discectomy was preferred over discopexy for the management of anterior disc displacement with reduction by high volume surgeons (89%), but most (72%) did not feel that discectomy was beneficial over arthroscopy in the treatment of anterior disc displacement without reduction and concomitant degenerative bony changes. In managing symptomatic disc perforation, 66% agreed that discectomy is the procedure of choice and 49% felt that interpositional tissue is indicated in most cases after discectomy. Respondents who reported fewer re-operations requiring alloplastic TJR after discectomy had, onaverage, more positive perceptions of discectomy on the benefits domain (P=.03), better than alternatives domain (P=.03), and fewer concerns on the perceived adverse effects domain (P=.03). TMJ surgeons do not employ TMJ discectomy in most cases of TMJ internal derangement. However, discectomy is considered useful in cases of disc perforation or for persistent symptomatic disc displacement without reduction, in an attempt to avoid alloplastic TJR. Common adverse effects included joint noises and osteoarthrosis, and the use of interpositional disc replacement tissue did not alter the incidence of adverse effects or complications reported.

Temporomandibular Joint Prosthesis Revision and/or Replacement Survey and Review of the Literature

The purpose of the present study was to report the temporomandibular joint (TMJ) alloplastic reconstruction (TMJR) revision and/or replacement rates and associated complication outcomes data gathered from experienced TMJ surgeons and to review the recent relevant data. A 21-question anonymous on-line survey was sent to all Commission on Dental Accreditation-approved oral and maxillofacial surgery program directors and to members of the European Society of TMJ Surgeons and the American Society of Temporomandibular Joint Surgeons. Of the surgeons sent the survey, 22% completed the full questionnaire. Most responses were from surgeons who routinely perform TMJR surgery (93.5%). Of the respondents, 28.3% had more than 30years of experience and 73.9% were full-time academic faculty. A total of 4638 TMJR procedures were recorded and analyzed. The incidence of TMJR revision (keeping the same device) was 3% and that of replacement (placing a new device) was 4.9%. The most common reason for revision was heterotopic ossification (27.5%). The most common reason for replacement was infection (21.1%). Revision was successful in 86.7% and replacement in 94.6% of the patients at the longest follow-up reported. The data from the present study have shown that the incidence is low and the success rate is high for TMJR revision and replacement.

Does Metal Hypersensitivity Have Relevance in Patients Undergoing TMJ Prosthetic Replacement?

Although concerns regarding implant-related metal hypersensitivity exist, no guidelines have been accepted for screening or treatment of patients with metal sensitivity before temporomandibular joint replacement (TMJR). The present study aimed to determine the trends in TMJR metal sensitivity screening and the effect of positive test results on patient treatment. A questionnaire was distributed to members of the American Society of Temporomandibular Joint Surgeons and the European Society of Temporomandibular Joint Surgeons using a web-based data collection and analysis tool. The questions aimed to establish the screening methods used to establish a diagnosis of metal hypersensitivity and any changes in management when metal hypersensitivity had been documented. A total of 72 responses (32.43%) were collected through the survey, with respondents primarily practicing in the United States (47.22%). Of the participants, 75% believed that metal hypersensitivity occurs with TMJR and only 2.77% did not. Most agreed that patients should be questioned about any metal sensitivities before consideration for TMJR (91.66%), and 80.55% routinely asked their patients if they had a previous sensitivity to any metals. Nickel was the most commonly encountered metal allergen (64.28%). If a metal allergy were reported, 44.28% of surgeons would refer the patient to determine the specific metal allergen. The diagnosis for metal allergy was based primarily on patient signs and symptoms (52.85%) and an allergist or dermatologist consultation (44.28%). The lymphocyte transformation test was the test most used by respondents to confirm the diagnosis. Of the surgeons, 41.42% would choose to observe/monitor as their first choice for patients testing positive for metal hypersensitivity. In the case of a "mild" reaction to metal hypersensitivity testing, 54.28% would alter their implant choice to a nonreactive metal component. For "severe" reactions to preoperative metal hypersensitivity testing, 62.85% would alter their implant choice to a nonreactive metal component, and 22.85% would choose not to perform TMJR. The results from the present study have demonstrated that respondent TMJ surgeons agree that metal hypersensitivity occurs with TMJR. However, their approaches to screening and managing metal hypersensitivity vary. Further research of this topic is required to eventually develop specific management pre- and postoperative guidelines for the treatment of patients with metal sensitivities.

A disease-focused view on the temporomandibular joint using a Delphi-guided process.

Temporomandibular joint (TMJ) disease classification and subsequent treatment selection are highly debated subjects within dentistry and medicine. Several suggestions for diagnostic classification and treatment algorithms have been proposed thus far without achieving a clear gold standard. A universally accepted diagnostic classification is essential for therapeutic decision-making as well as a prerequisite for prognostic evaluation and is necessary for achieving research results that are reproducible, comparable, relevant, and applicable in the clinical setting. Often, problems of the TMJ are viewed as mere symptoms or as a syndrome-like group of conditions, without clear demarcation, impeding individualized treatment planning. A Scandinavian group of experienced TMJ surgeons participated in an iterative, structured group discussion process in accordance with the Delphi method, aiming to produce recommendations for a standardized patient clinical evaluation in relation to TMJ dysfunction. Guided by this standardized evaluation, a disease-focused and simplified diagnostic classification scheme is herein suggested.

Are Rib Grafts Still Used for Temporomandibular Joint Reconstruction?

Patients with end-stage temporomandibular joint (TMJ) pathology require TMJ reconstruction, which can be accomplished with autogenous tissue or alloplastic materials. This survey study evaluates experienced TMJ surgeons' preferences for autogenous costochondral grafts (CCGs) and/or alloplastic prostheses for TMJ reconstruction. This cross-sectional study used an online public survey domain to query an anonymous cohort of volunteer surgeons from the American and European Societies of Temporomandibular Joint Surgeons about their TMJ reconstruction preferences. The survey questioned these surgeons' current and previous use of CCG for TMJ reconstruction, changes in practice pattern in this regard over the years, indications for CCG, and postoperative CCG outcomes. The responses were subsequently catalogued, means were calculated, descriptive statistics were analyzed, and trends were identified. Of 150 surgeons contacted, 92 responded to the survey. Of the respondents, 84 (91.3%) reported that they had performed total TMJ reconstruction in the past or continue to perform total TMJ reconstruction. However, only the 66 surgeons who completed the survey in its entirety were included in the analysis. Among these surgeons, 95.5% (63 of 66) reported that their current preferred method for TMJ reconstruction was an alloplastic TMJ replacement prosthesis; 86.4% (57 of 66) preferred a custom TMJ prosthesis, whereas 9.1% (6 of 66) preferred a stock TMJ prosthesis. Only 4.5% of the respondents (3 of 66) currently preferred CCG for TMJ reconstruction. Of the respondents, 95.5% preferred alloplastic TMJ replacement. This preference was reported based on fewer postoperative complications and more predictable outcomes using alloplastic TMJ prostheses. In cases in which CCG revision was indicated, an alloplastic TMJ prosthesis was used, indicating that surgeons should consider an alloplastic TMJ replacement device as the primary option for TMJ reconstruction for the management of most end-stage TMJ diseases.

Idiopathic Condylar Resorption: A Survey and Review of the Literature

Idiopathic condylar resorption (ICR) is a relatively uncommon condition. Its diagnosis, etiology, and management options are controversial. Furthermore, it is difficult for 1 provider to collect a large cohort of ICR patients to develop a statistically significant study of these concerns. Therefore, the purpose of this study was to survey experienced temporomandibular joint (TMJ) surgeons who have managed ICR cases relative to these concerns, as well as review the management outcome literature. SurveyMonkey (Palo Alto, CA) was used to canvas the 88 international TMJ surgeons on the TMJ Concepts (Ventura, CA) InterNetwork. This network connects a group of surgeons across the world who consistently perform TMJ surgery. The intent was to provide a global snapshot of the demographic, epidemiologic, diagnostic workup, and outcome data related to the management of ICR cases. The surveys from surgeons who did not respond to all 12 questions were not included in the results. After application of the exclusion criteria, complete data on a cohort of 100 patients were obtained and used for the study. A history of hormonal imbalance was reported in only 10% of patients; however, 42 of 94 women were reportedly taking birth control pills presumably affecting their menstrual cycles. The most common reason for consultation was Class II malocclusion (98% of patients). Treatment modalities varied and included orthodontics, orthotics, TMJ total joint replacement, orthognathic surgery, and disc repositioning. ICR management proved to be controversial among the surveyed surgeons. Multiple treatment options have been described in the literature, including medical management, orthognathic surgery only, TMJ and orthognathic surgery, and total joint prosthesis reconstruction. Long-term, controlled, multicenter clinical studies should be developed to evaluate outcomes of all nonsurgical and surgical management options for the ICR patient.

A Prospective Study On Response To Treatment Of Patients With Temporomandibular Disorder: A Clinical Study

Introduction: Temporomandibular joint dysfunction (TMD) is regarded as multifactorial in origin and this may influence the diagnosis and treatment plan. Early detection of TMD with suitable management may provide good response. This study was to relate demographic factors, signs and symptoms, diagnosis, stage of detection and treatment modalities on review outcome. Materials and Methods: 71 TMD patients were selected from Oral Medicine and Oral Pathology clinics. Patients’ details were recorded. Staging of patients was done based on guidelines by American Society of Temporomandibular Joint Surgeons (ASTMJS). Treatment modalities including selftherapy, occlusal splint and medication proposed to patients were based on their signs and symptoms. Prosthetic rehabilitation was indicated for free-end extension ridge. Treatment outcomes measure recommended by International Association of Oral and Maxillofacial Surgeons (IAOMS) was used during review visit. Results: Female showed higher incidence of TMD compared to male, with ratio of 2.5:1. 46(64.79%) patients were detected at early stage. Patients in their twenties [54(76.06%)] had the highest occurrence of TMD. Treatment modalities were correlated with signs and symptoms (p= 0.046), stage of detection (p= 0.030), and diagnosis (p= 0.023). Multiple regression displayed significant association on improvement of patients’ condition after treatment, mediated by stage of detection (r = - 0.216). 30(42.25%) patients detected at early stage had improvement of (on) signs and symptoms. Conclusion(s): Demographic factors contributed to incidence of TMD. Treatment plans were related to patients' condition, diagnosis and stage of detection. Early detection of TMD with proper management/s influenced patients’ condition.

UK temporomandibular joint replacement database: a report on one-year outcomes

Alloplastic temporomandibular joint (TMJ) replacements are increasingly subspecialised, and supraregional centres that treat sufficient numbers to ensure high standards are emerging. Having recently reported the introduction of a national TMJ joint replacement database that is endorsed by the British Association of TMJ Surgeons (BATS), we now present the first-year outcomes. This was a review of all data in the BATS National Case Registration of TMJ Replacement as of June 2014. A total of 252 one-year outcome records were available. Key outcomes were median (IQR) improvements in interincisal distance of 9 (4–15) mm (p<0.001) and worst-sided pain score of 6 (4–8) (p<0.001). Pain scores improved or remained static at one year in all but 3 (2%) patients. There was a significant improvement in the proportion of patients who reported a good, very good, or outstanding quality of life at one year (38% at baseline to 87% at one year; p<0.001). While outcome reports from single centres for alloplastic TMJ replacements have already been published in the United Kingdom, this is the first dedicated national database in this country that will yield valuable longitudinal follow-up data. Outcomes were comparable with smaller published series and showed improvements in pain, dietary intake, quality of life, and function, with few outliers. The database has recently moved to a new software system and we hope to publish three-year and five-year outcomes in due course.

Status of alloplastic total temporomandibular joint replacement procedures performed by members of the American Society of Temporomandibular Joint Surgeons

The purpose of this study was to assess the number of alloplastic total temporomandibular joint replacement (TMJ TJR) devices implanted and the complications encountered by members of the American Society of Temporomandibular Joint Surgeons (ASTMJS). A questionnaire was developed using REDCap (Chicago, IL) and an on-line link was e-mailed four times over a 6-week period (February to March 2015) to all members of the ASTMJS. The questionnaire included eight questions related to the surgeon's TMJ TJR experience. A Likert scale was included to assess the respondents’ opinions concerning the future demand for TMJ TJR and their thoughts on potential device improvements. The study sample was composed of 36 ASTMJS respondents (42.4%). TMJ TJR is performed successfully and in relatively high numbers by members of the American Society of Temporomandibular Joint Surgeons.

How Many Temporomandibular Joint Total Joint Alloplastic Implants Will Be Placed in the United States in 2030?

The purpose of this study is to provide a statistical projection of the number of alloplastic temporomandibular joint (TMJ) total joint replacements (TJRs) that will be performed in the United States through the year2030. The program directors of all 101 Commission on Dental Accreditation-accredited oral and maxillofacial surgery training programs in the United States were surveyed online by use of a questionnaire developed using Redcap (Chicago, IL) over a 6-week period (February 2015-March 2015). The questionnaire included 19 questions related to each program's TMJ disorder and TMJ TJR curricula, as well as clinical experience. In addition, members of the American Society of Temporomandibular Joint Surgeons were surveyed online using Redcap and via direct survey forms. Moreover, requests for the total number of TMJ TJR devices produced and implanted during the same period were made to the 3 manufacturers of Food and Drug Administration-approved TMJ TJR devices in the United States. The response rate among program directors was 52.5%, and the total number of TMJ TJR devices implanted in oral and maxillofacial surgery programs in 2005 was 412. This total increased by 38% to 572 in 2014. Statistically, this projects an increase of 58% over the next 16years to 902 TMJ TJR operations by 2030 (95% prediction limits, 768 and 1,037). The total number of TMJ TJR devices distributed by one manufacturer increased from 430 in the year 2000 to 1,004 in 2014 (133%). By use of these data, statistically over the next 16years, the number of TMJ TJR devices distributed by this company is projected to be 1,658 (95% prediction limits, 1,380 and 1,935). The data presented in this study show an increasing demand for the use of TMJ TJR devices in the management of end-stage TMJ disorders to the year2030.

Training in TMJ surgery: experience of a one-year fellowship

In the United Kingdom, most training programmes in oral and maxillofacial surgery (OMFS) do not sufficiently cover management of the temporomandibular joint (TMJ) to enable newly appointed consultants to practise independently as TMJ surgeons. We describe a one-year fellowship programme for a senior OMFS trainee who had just completed training, which included various international courses in the USA and Europe on specific aspects of TMJ surgery. Under the direct supervision of a consultant, the trainee completed 70 arthroscopic procedures, 13 TMJ cryotherapies, 16 TMJ arthrocenteses, 9 TMJ arthroplasties, and 20 total prosthetic TMJ replacements. Our experience indicates that specific training is required for those who wish to practise in the field of TMJ management and surgery.

Post-operative steroids in the management of capsulitis following TMJ arthroscopy

Post-operative steroids in the management of capsulitis following TMJ arthroscopy

Temporomandibular Joint Disorders: Artificial Joint Replacements and Future Research Needs

Temporomandibular disorders (TMD) affect a significant section of the American population. According to the National Institutes of Health (NIH), an estimated 3% to 5% of Americans suffer from temporomandibular disorders. Majority of TMDs can be treated by conservative methods, albeit surgical interventions are indicated for some pathological/clinical conditions (according to the American Association of Temporomandibular Joint Surgeons). A distinction can be made between the TMD and the TMJ disease/dysfunction. In the case of TMD, it most correctly relates to a neuromuscular type of problem in the general area of the Temporomandibular Joint (TMJ), but may not intrinsically be related to the TM joint itself. However, TMJ disease/dysfunction relates to a true joint type of pathology, which ultimately may lead to the use of either a partial or a total joint reconstruction. Degeneration of the meniscus and the actual bony portions of the joint is often seen in cases of true TMJ pathology. The use of custom made or predesigned partial and/or total artificial TMJ replacement remains one of the surgical alternatives for treating various TMJ diseases when other conservative treatments fail. The purpose of this article is to provide an overview of currently existing TMJ implants and to discuss relevant issues, including some of the challenges and current needs facing TMJ research. Additionally, this article describes some of the currently available TMJ surgical procedures, the use of autografts and alloplastic materials (with primary emphasis on TMJ implants) for TMJ reconstruction, and some suggestions for future research. Past incidents of clinical failures of TMJ implants have been attributed to several reasons. The important factors that are responsible for the past failures include lack of a sound scientific approach and inadequate basic research to study the underlying causes for pathologies and their remedies of the TMJ. All these previously mentioned concerns have prompted current biomedical researchers to address many overlooked issues in relation to studying temporomandibular disorders and TMJ implants. Future research should be aimed toward addressing TMJ problems with a multidisciplinary approach, emphasizing simultaneous involvement from clinical (i.e., dentists and physicians) and nonclinical personnel (i.e., oral biologists, bioengineers, biostatisticians, physiotherapists, and pain management specialists).