Outcomes of total temporomandibular joint replacement: a systematic review

Temporomandibular joint replacement (TMJR) is a reconstructive surgical modality that is available to patients with end-stage temporomandibular disorders (TMDs) that fail conservative treatment. Alloplastic prostheses are either custom-made or stock devices used to restore mandibular function and reduce pain; however, comparative data and long-term outcomes are limited. This systematic review aimed to assess post-surgical functional, pain, and quality-of-life outcomes following alloplastic total TMJR.

We searched PubMed, Google Scholar, Scopus, and institutional databases through March 2025, following PRISMA guidelines, to identify outcomes of alloplastic TMJR. Three reviewers independently screened and extracted the data, and a fourth reviewer resolved discrepancies. Results were summarised narratively because of variability in clinical and methodological approaches. We used ROBINS-I to evaluate study quality and the GRADE system to rate evidence certainty.

Eleven studies (569 patients, follow-up 12-62 months) fulfilled the inclusion criteria. Alloplastic TMJR was consistently associated with improved MMO, reduced pain, and better patient-reported QoL, although lateral excursion and protrusion were often lower than in healthy controls. Custom-made prostheses were more prevalent than stock devices, and no evidence supported one type over the other. Transient facial nerve paresis was a rare complication, and the 5-year survival rate of prostheses was > 90%. Nine out of eleven studies were at serious or critical risk of bias; however, across all outcomes, GRADE certainty was rated very low.

Although alloplastic TMJR holds promise of functional, pain, and quality-of-life improvements in carefully selected patients with end-stage TMD, current evidence is of very low certainty. Future multicentre trials with agreed-upon outcome measures and direct comparisons between custom and stock systems are required to reach definitive conclusions.