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Can Patients With Metal Hypersensitivity Requiring TMJ Total Joint Prostheses be Successfully Treated With
Larry M Wolford1, Pilar Amaya2, Matthew Kesterke3
1Clinical Professor. Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University College of Dentistry. Private Practice Baylor University Medical Center, Dallas, TX.
Patients with metal hypersensitivity can benefit from titanium (Ti) alloy temporomandibular joint total joint prostheses (TJP). This study found titanium TJPs improved outcomes for patients with cobalt-chromium-molybdenum (CoCrMo) alloy hypersensitivity, comparable to standard prostheses.
Area of Science:
- Oral and Maxillofacial Surgery
- Biomaterials Science
- Orthopedic Surgery
Background:
- Metal hypersensitivity to cobalt-chromium-molybdenum (CoCrMo) alloy can cause adverse reactions in patients requiring temporomandibular joint total joint prostheses (TJP).
- Standard TMJ Concepts TJP utilize CoCrMo alloy, posing a risk for hypersensitive patients.
- Alternative materials are needed to mitigate risks associated with metal hypersensitivity in TMJ TJP.
Purpose of the Study:
- To evaluate the efficacy of all-titanium (Ti) alloy mandibular components in TMJ TJP for patients with documented CoCrMo alloy hypersensitivity.
- To compare treatment outcomes between metal-hypersensitive patients receiving Ti alloy TJP and non-hypersensitive patients receiving standard CoCrMo alloy TJP.
Main Methods:
- A retrospective cohort study comparing a metal-hypersensitive group (MHG) with Ti alloy TJP (n=30) to a control group (CG) with standard TJP (n=46).
- Outcomes assessed included TMJ pain, headache, jaw function, diet, disability, maximum incisal opening, and quality of life using Likert scales and objective measurements.
- Statistical analysis included Mann-Whitney U test to compare pre- and postsurgery parameters between groups.
Main Results:
- Both MHG and CG showed statistically significant improvements in all evaluated variables post-surgery.
- No significant differences in outcome variables were observed between the MHG (Ti alloy TJP) and CG (standard TJP).
- Patients with fewer prior TMJ surgeries (0-1) demonstrated better outcomes compared to those with multiple surgeries (≥2), except for maximum incisal opening.
Conclusions:
- All-titanium alloy mandibular components in TMJ TJP can successfully treat patients with CoCrMo alloy hypersensitivity, yielding outcomes comparable to standard prostheses.
- Eliminating CoCrMo alloy in favor of Ti alloy may alleviate TMJ pain, headache, and improve jaw function, diet, disability, opening, and quality of life.
- The number of previous TMJ surgeries and prior alloplastic implant exposure negatively impacts treatment outcome improvement.
