Complications following stock, customized, and extended total alloplastic temporomandibular joint replacement: a...

Total alloplastic temporomandibular joint replacement (TMJ-AR) is an established treatment for end-stage temporomandibular joint disease; however, comparative data on different prosthesis designs remain limited. This retrospective 10-year cohort study analyzed complication and implant removal rates following stock, customized, and extended TMJ-AR. In total, 55 adult patients (38 females, 17 males; mean age 37.7 ± 12.2 years) received 72 TMJ-AR implants between 2014 and 2023, with a mean follow-up of 39.5 ± 21.1 months. Within the first 12 months, overall complication rates did not differ significantly among prosthesis types. Facial nerve dysfunction occurred in 23.8% of stock, 36.1% of customized, and 26.7% of extended TMJ-AR cases, and was predominantly transient. During follow-up >12 months, complication rates declined in stock and customized TMJ-AR, with low permanent morbidity. Restricted mouth opening persisted in 15.8% of stock TMJ-AR cases, while no long-term facial nerve palsy was observed. In contrast, extended TMJ-AR showed significantly higher mid-to-long-term complication rates, including persistent facial nerve palsy (28.6%), prosthesis exposure (21.3%), and a mean implant removal rate of 21.1% after approximately 5 years. Implant removal was required in two stock, one customized, and three extended TMJ-AR cases. These findings indicate comparable early outcomes across prosthesis types but inferior mid-to-long-term outcomes following extended TMJ-AR, largely reflecting case complexity rather than implant design. Careful patient selection and long-term monitoring are essential.