Temporomandibular joint alloplastic replacement failure.

Area of Science:

• Oral and Maxillofacial Surgery
• Biomaterials Science
• Orthopedic Surgery

Background:

• Temporomandibular joint (TMJ) disorders are prevalent, with alloplastic temporomandibular joint replacement (TMJR) used for intractable pain and limited motion.
• TMJR, while effective, is associated with known complications that can lead to implant failure.
• This study reviews management strategies and outcomes for alloplastic TMJR failures based on clinical experience and existing evidence.

Purpose of the Study:

• To present the authors' experience in managing alloplastic TMJR failures.
• To review current evidence on the management and outcomes of failed TMJR.
• To provide recommendations for improving TMJR procedures and outcomes.

Main Methods:

• Retrospective review of clinical cases managed by the authors' unit.
• Analysis of complications encountered with Dundee full metal prostheses and other standard TMJR implants.
• Review of existing literature on TMJR failure management.

Main Results:

• Common complications include infection, heterotopic bone formation, osteoarthritis progression, and pain from improper implant placement (e.g., fossa component too close to the ear canal).
• A multidisciplinary approach with meticulous preoperative planning and postoperative care has proven effective in managing TMJR failures.
• The authors do not recommend Dundee full metal prostheses and emphasize the importance of appropriate surgical training and implant placement techniques.

Conclusions:

• Non-surgical management is preferred initially for TMJR complications, with surgical intervention reserved for persistent cases.
• Proper training and technique are crucial for successful alloplastic TMJR.
• Recommendations include ensuring the posterior edge of the fossa component is at least 3 mm from the ear canal bone to prevent complications.