Total Temporomandibular Joint Prosthesis Research Articles

Neurosensory assessment in patients with total reconstruction of the temporomandibular joint

Somatosensory sensitivity and postoperative endogenous pain modulation have not been investigated in temporomandibular joint (TMJ) prosthesis patients. The objectives of this study were to assess somatosensory function at the TMJ and examine possible differences in conditioned pain modulation (CPM) between patients with total TMJ prostheses (n=7) and a reference group of healthy controls (n=20). Somatosensory abnormalities were assessed using quantitative sensory testing (QST), which encompasses thermal and mechanical testing procedures. CPM was tested by comparing pressure pain thresholds (PPT) before (baseline), during, and after the application of painful and non-painful cold stimuli. PPTs were measured at the TMJ and thenar eminence (control). The effect of CPM on PPT values was tested with analysis of variance. Three patients exhibited mixed somatosensory loss (i.e., decreased thermal and mechanical detection) with mixed hyperalgesia (i.e., increased sensitivity to thermal and mechanical pain) and two patients exhibited mixed loss with only mechanical hyperalgesia. There was a significant decrease in pressure pain sensitivity at both sites during painful cold application in healthy controls (P<0.001) but not in patients (P=0.476). In conclusion, QST measures demonstrated somatosensory abnormalities in patients with total TMJ prostheses. Noxious conditioning cold stimuli evoked CPM-like effects in healthy subjects but not in patients with TMJ reconstruction.

Stability study of total temporomandibular joint replacement on sheep

ObjectiveTo evaluate the stability of our custom-made prosthesis by establishing the model of sheep total temporomandibular joint (TMJ) replacement. MethodsSix sheep were included in our study. Spiral computed tomography (CT) data of all sheep was obtained and transformed into 3-dimensional model by surgicase5.0 software preoperatively. Total TMJ prostheses were made based on the skull model. Ultra-high molecular weight polyethylene was used to make glenoid fossa lining, while titanium alloy to prefabricate mandibular retention handle and titanium plate over glenoid fossa. Cobalt-chromium-molybdenum alloy was also used to prefabricate the condyle. The right sides of all sheep, as the experimental group, were carried out total TMJ replacement, while the left sides were as the control group. The bone in both experimental and control side were excised after 3 and 6 months. Scanning electron microscope (SEM) was used to observe the interface between bone and prosthesis. Van Gieson staining and immunohistochemical staining (IHC) were used respectively to observe the interface of titanium screw and bone and the expression of alkaline phosphatase (ALP). ResultsSEM and Van Gieson staining showed that there was immature bone and osteoid formed in the interface of prosthesis and bone after 3 months. While after 6 months, there was osseointegration between them. IHC showed that the expression of ALP in the experimental side was much higher than in the control side after 3 months and its expression decreased after 6 months with no difference from the control side. ConclusionThe custom-made TMJ prosthesis which was designed and manufactured by ourselves has good stability after total TMJ replacement.

Résultats fonctionnels après reconstruction de l’articulation temporo-mandibulaire par prothèse totale (2e partie)

Temporomandibular joint (TMJ) disorders are usually managed medically. But partial or total reconstruction may be indicated according to the severity and the functional impairment. We assessed the functional results after total TMJ reconstruction using the Biomet Microfixation® prosthesis (Jacksonville, FL, USA). We reviewed the files of patients having undergone reconstruction, between 2009 and 2010, with a total TMJ prosthesis. We analyzed the pre- and postoperative mouth opening, the pre- and postoperative occlusion, pre- and postoperative pain according to a simple spoken scale ranging from 0 (no pain) to 4 (severe pain). Twelve total TMJ prostheses were placed in five women and three men (mean age 49.2 years). Restriction of mouth opening was the first cause of consultation. The etiology was trauma for four patients. Three patients had preoperative malocclusion. Four patients had bilateral reconstruction. Preoperative pain ranged between 2 and 4. The average initial mouth opening was 17.8mm. There was neither infection nor any major complication. No prosthesis was removed. The mean follow-up was 18.5 months. At the end of the study, pain ranged between 0 and 2. All patients with preoperative malocclusion resumed an Angle class I postoperatively. The average postoperative mouth opening was 39.5mm. Total TMJ reconstruction with the Biomet Microfixation® prosthesis improves mouth opening and reduces pain.

Evaluation of Temporomandibular Joint Total Replacement with Alloplastic Prosthesis: Observational Study of 27 Patients

Background Temporomandibular joint (TMJ) total replacement with alloplastic prostheses has been performed since 1960s. Research in these last two decades has achieved important improvement in the development of biomaterials, design, adaptation, and fixation of the prosthesis components. Objective To evaluate total TMJ replacement with alloplastic prostheses. Methods We studied 27 patients, between 19 and 73 years old, who had total TMJ uni- or bilateral replacement surgery with custom-made alloplastic prostheses manufactured by TMJ Concepts, Inc. (Ventura, CA) between 1996 and 2011. The general data and preoperative measurements were taken from medical records. Subjective data related to pain, diet consistency, and current quality of life were collected with a questionnaire answered by the patients; measures of maximum interincisal opening and lateral mandibular movements were obtained from direct examination. Results We found significant difference (p < 0.05) comparing pre- to postoperative results about improvement in mouth opening, pain relief, and satisfaction with the surgery and diet consistency. Conclusion The results of this study show that total alloplastic TMJ prostheses are an efficient, safe, and stable long-term solution for patients who need TMJ total replacement.

Ossifying Fibroma Affecting the Mandibular Condyle

We describe the surgical management of an uncommon case of ossifying fibroma affecting the mandibular condyle. A condylectomy was performed with an immediate temporomandibular joint reconstruction by a total temporomandibular joint prosthesis.

The mandibular symmetry evaluation of total temporomandibular joint replacement on developing sheep

ObjectiveTo evaluate the mandibular symmetry effect of temporomandibular joint (TMJ) replacement by surgicase5.0 software. MethodsSix developing sheep were included in our study. Spiral computed tomography (CT) data of all sheep was obtained and transformed into 3-dimensional model by surgicase5.0 software preoperatively. 3-dimensional resin skull models were obtained and total TMJ prostheses were made. The right sides of all sheep were carried out operation based on preoperative planning as the experimental group, while the left sides were as the control group. CT scanning was performed one, four and twelve weeks after operation. Ramus heights (RH), mandibularbody length (ML), condyle-incisor (CI) and supramental-condyle (BC) of both experimental and control group were measured to be compared by Wilcoxon Signed Rank. Meanwhile those measurements were also compared with preoperative counterpart by Wilcoxon Signed Rank respectively. ResultsAll animals were alive to the end of this experiment with normal eating. There were significant differences for RH, CI, BC between the experimental and control group after twelve weeks. The comparison before and after operation on experimental group showed that there was significant difference on ML, CI and BC after four and twelve weeks. The comparison on control group showed that there was significant difference on ML, CI, BC after four weeks and RH, ML, CI, BC after twelve weeks. ConclusionIn conclusion, we deduce that sheep carried out by custom-made TMJ prosthesis can eat well. However the long term results of total TMJ replacement on developing sheep may not be very good.

Evaluación clínica de pacientes con prótesis total de articulación temporomandibular

IntroductionThe temporomandibular joint (TMJ) can be affected by injuries that alter its morphology and compromise its normal function, and in some cases leading to the need for surgery to resect it and rebuild it. The reconstruction of the TMJ bone articular defects has been a challenge for the maxillofacial surgeon. It can be achieved by using alloplastic materials. Among these, we highlight the total temporomandibular joint prosthesis, developed until achieving its current form and composition, and which has led to the establishment of clear protocols for its use. Among these, we highlight the W.Lorenz™ prosthesis with a high technology and specific details that lead to an increased clinical and functional improvement. ObjectiveTo study the important clinical and functional aspects observed in surgically treated patients. Materials and MethodsThis study evaluated 15 patients between 24 to 44 years, who underwent TMJ replacement surgery with 23 TMJ implants, 8 bilateral and 7 unilateral, between the years 2000 to 2008. All surgeries were performed by the same surgeon. ResultsA large increase in functional improvement was observed, particularly in the cases of TMJ ankylosis. ConclusionsMany more studies and monitoring should be conducted to establish, especially in the long term, that these prostheses offer the stomatognathic system an effective and durable physiology.

Total temporomandibular joint prosthesis as a surgical option for severe mouth opening restriction. A case report of a bilateral intervention

Several conservative treatment approaches to the disorders of the temporomandibular joint (TMJ) have been described in the literature. Nonetheless, in a minority of cases not respondent to reversible conservative therapies a surgical approach to the TMJ is needed. In recent years, a total temporomandibular joint replacement with alloplastic prosthesis have been introduced as a treatment option in the presence of a severely damaged or mutilated joint, mainly resulting from severe joint diseases, as in the case of complex inflammatory-degenerative diseases, or failure of previous surgeries. The present paper described a case report of a bilateral temporomandibular joint replacement intervention in a female patient with severe mouth opening restriction and pain in the TMJ area. Also, a discussion of the potential indications for TMJ replacement has been provided, along with the description of the surgical procedure.

Development of a Mandibular Motion Simulator for Total Joint Replacement

The purpose of this study was to develop a motion simulator capable of recreating and recording the full range of mandibular motions in a cadaveric preparation for an intact temporomandibular joint (TMJ) and after total joint replacement. A human cadaver head was used. Two sets of tracking balls were attached to the forehead and mandible, respectively. Computed tomographic (CT) scan was performed and 3-dimensional CT models of the skull were generated. The cadaver head was then dissected to attach the muscle activation cables and mounted onto the TMJ simulator. Realistic jaw motions were generated through the application of the following muscle forces: lateral pterygoid muscle, suprahyoid depressors (geniohyoid, mylohyoid, and digastric muscles), and elevator muscles. To simulate muscle contraction, cables were inserted into the mandible at the center area of each muscle's attachment. To provide a minimum mouth closing force at the initial position, the elevator muscles were combined at the anterior mandible. During mandibular movement, each motion was recorded using a high-resolution laser scanner. The right TMJ of the same head was reconstructed with a total TMJ prosthesis. The same forces were applied and the jaw motions were recorded again. CT scan was performed and 3-dimensional CT models of the skull with TMJ prosthesis were generated. Mandibular motions, before and after TMJ replacement, with and without lateral pterygoid muscle reattachment, were re-created in a cadaveric preparation. The laser-scanned data during the mandibular motion were used to drive 3-dimensional CT models. A movie for each mandibular motion was subsequently created for motion path analysis. Compared with mandibular motion before TMJ replacement, mandibular lateral and protrusive motions after TMJ replacement, with and without lateral pterygoid muscle reattachment, were greatly limited. The jaw motion recorded before total joint replacement was applied to the mandibular and prostheses models after total TMJ replacement. The condylar component was observed sinking into the fossa during jaw motion. A motion simulator capable of re-creating and recording full range of mandibular motions in a cadaveric preparation has been developed. It can be used to simulate mandibular motions for the intact TMJ and total joint prosthesis, and to re-create and record their full range of mandibular motions. In addition, the full range of the recorded motion can be re-created as motion images in a computer. These images can be used for motion path analysis and to study the causation of limited range of motion after total joint replacement and strategies for improvement.

Osteochondroma of the Temporomandibular Joint Treated by Means of Condylectomy and Immediate Reconstruction with a Total Stock Prosthesis

ABSTRACTBackgroundOsteochondromas are one of the most common benign tumours of bone, but they are rare in the craniofacial region. These condylar tumours have been variably treated, including resection through local excision or condylectomy with or without reconstruction.MethodsA case of osteochondroma of the mandibular condyle and cranial base arising concurrently in the 76 years old patient was presented. The surgical excision of the skull base lesion and condylectomy with immediate reconstruction of temporomandibular joint was applied.ResultsBased on the history, clinical examination and radiographic findings, osteochondroma of the skull base was diagnosed, with a concurrent lesion of the condylar process. Treatment methods for this patient included excision of the skull base tumour and condylectomy with immediate temporomandibular joint reconstruction using appropriately sized stock total temporomandibular joint prosthesis. At the 24 month follow-up, patient was free of pain and her maximal incisal opening was maintained, with no radiographic evidence of tumour recurrence or failure of the device.ConclusionsTemporomandibular joint stock total replacement prosthesis became a good option to reconstruct both the fossa and the condyle in a one-stage surgery, due to the fact that both the condylar/mandibular and the fossa implants were stable in situ from the moment of fixation, with a good outcome at 24 month follow-up, with no loosening of the screws nor failure of the device.

Poster Board Number: 68: Outcomes in 90 Patients Reconstructed With Total Temporomandibular Joint Prostheses

Statement of the Problem: This was a retrospective review of subjective and objective outcomes in patients reconstructed with alloplastic total temporomandibular joint (TMJ) prostheses over an eight year period. Total temporomandibular joint reconstruction with alloplastic prostheses is relatively common for treatment of end stage temporomandibular disorder (TMD), and other pathologic conditions of the mandible and articular apparatus. Few studies have looked at outcomes of patients treated with total TMJ prostheses.

Transparotid approach for tumor excision from the infratemporal space in temporomandibular joint reconstruction: a 3-year follow-up

Surgery for tumors extending into the infratemporal fossa requires adequate exposure to identify and protect vital structures. We present a patient who had, at some time in the past, been treated by condylar resection of the right temporomandibular joint (TMJ) because of a pigmented villonodular synovitis. The condyle had been replaced with a standard reconstruction plate that had eroded deep into the skull base. Prosthetic reconstruction of the TMJ was performed 1.5 years later after renewed bone tumor excision from the infratemporal space. The standard preauricular and submandibular approaches for implantation of a total TMJ prosthesis did not offer adequate access for tumor removal from the infratemporal fossa. The tumor was excised successfully through an additional transparotid approach.

Outcomes of Total Alloplastic Replacement With Periarticular Autogenous Fat Grafting for Management of Reankylosis of the Temporomandibular Joint

The purpose of this investigation was to review the subjective, objective, and quality of life outcomes in a group of temporomandibular joint (TMJ) reankylosis patients managed by total alloplastic replacement surgery with a patient fitted system augmented with periarticular autogenous fat grafts to prevent the reformation of heterotopic bone. A review of the literature regarding the use of autogenous fat as evidence for its efficacy in such cases is also presented. All 20 TMJ reankylosis patients (4 males, 16 females) who had undergone total TMJ replacement with the TMJ Concepts (Ventura, CA) Patient-Fitted Total TMJ Prosthesis System were studied. Thirteen patients had bilateral, 7 unilateral for a total of 33 joint replacements. All patients had autogenous fat harvested from the abdomen and grafted around the articulating portion of the prostheses at implantation. The patients' subjective variable outcomes of TMJ pain, mandibular function, diet consistency, quality of life since the reconstruction, and objective variable of maximal interincisal opening were obtained in a detailed questionnaire and follow-up phone calls. Analysis of the subjective outcomes data showed improvement in reported pain, increased jaw function, and diet consistency. Further, a significant number of these patients reported improvement in their quality of life after surgery. Analysis of the objective outcomes data showed a significant increase in the maximum interincisal opening postreplacement that was maintained. In the patients followed over the course of this study, total alloplastic replacement with a patient-fitted prosthesis seemed to provide a safe and effective management for reankylosis of the TMJ. Autogenous fat transplantation seems to be a useful adjunct as its use seems to minimize the recurrence of joint heterotopic calcification, consequently providing improved and consistent range of mandibular motion.

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

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.

ARTHROPLASTY, USING ALLOPLASTIC IMPLANTS, IN THE UNUSUAL TMJ SURGICAL CASE

This presentation further affirms the safety and efficacy of hemi and total temporomandibular joint (TMJ) reconstruction with the Christensen TMJ Prostheses (TMJ Implants, Inc., Golden, CO, USA). Hemi and total TMJ reconstruction with the Christensen TMJ prostheses was first introduced by Robert W. Christensen, DDS in 1961 and 1965, respectively, and is gaining widespread acceptance as a viable alternative in the treatment of temporomandibular joint disorders (TMD). The Christensen TMJ devices have been used to treat various disorders in large numbers of patients, and the pertinent results of 10 years of study are reported in this chapter.

Design and wear testing of a temporomandibular joint prosthesis articulation.

As part of the development of a total temporomandibular joint prosthesis, a prosthesis articulation was designed. The articulation consists of a spherical head (ball) of the mandibular part, rotating against an enveloping ultra-high-molecular-weight polyethylene (UHMWPE) disc with a flat cranial side, which slides along the opposing skull part. The aim of this study was to determine the in vitro wear rate of the articulation, and to predict the in vivo wear rate from the results. Based on a disc thickness of 5 mm and a ball diameter of 8 mm, the stresses within the disc were calculated by means of a finite element computer model. The wear rate of the ball-disc articulation was determined by in vitro wear tests, with a stainless-steel ball rotating against a UHMWPE disc in a serum-based lubricant. Eight discs were tested for seven million cycles each. The in vitro wear rate of the disc-skull part articulation was calculated from the test results of the ball-disc articulation. The maximum Von Mises' stress was less than the yield strength of UHMWPE and, therefore, was sufficiently low. The in vitro wear rate of the ball-disc articulation was 0.47 mm3 per million cycles. The in vivo expected total wear rate is 0.65 mm3 per year, corresponding with a yearly decrease of disc thickness of 0.0094 mm. Although it is difficult to judge whether this wear rate is sufficiently low, because the influence of UHMWPE wear particles in the TMJ region is unknown, both the expected wear rate and the decrease of thickness appear to be acceptable.

Infection of a prosthetic temporomandibular joint in an intravenous drug abuser

Late infection of the temporomandibular joint (TMJ) prosthesis is a rare complication. 1 To our knowledge, this is the first reported case of an infected total TMJ prosthesis occurring from possible hematogenous bacterial seeding in an intravenous (IV) drug abuser.