Custom-Made Total Temporomandibular Joint Replacement: A Long-Term Observational Case Series of Four Patients

Background/Objectives: Advanced acquired or congenital temporomandibular joint (TMJ) pathology may severely impair oral function and quality of life, often requiring total joint replacement when conservative and reconstructive treatments fail. Custom-made TMJ prostheses (CMTMJP) have been developed to improve anatomical adaptation and functional outcomes. The aim of this study was to evaluate the medium- to long-term clinical outcomes of CMTMJP from Avinent^® in patients with advanced TMJ pathology requiring TMJ replacement. Methods: An observational follow-up study was conducted in patients treated with CMTMJP at the Department of Oral and Maxillofacial Surgery of Hospital Clínic and Barnaclínic (Barcelona, Spain). Clinical outcomes, including pain intensity assessed using a numerical rating scale, maximum interincisal opening (mm), and occlusal stability, were evaluated before and after surgery. Patients were followed for 50-70 months after implantation. Results: Functional improvement was maintained over time, with satisfactory pain control, stable occlusion, and adequate mandibular mobility. No CMTMJP failures, complications, or adverse events related to the prostheses were recorded. Surgeons reported favorable outcomes regarding the planning protocol, surgical placement, and postoperative management of the CMTMJP. Conclusions: CMTMJP replacement appears to be a predictable and reliable treatment option when the TMJ needs to be replaced for any cause, such as degenerative, acquired or congenital condition. The CMTMJP described in this series demonstrated good functional performance and long-term stability, with no major complications observed during 50-70 months of follow-up.