In vivo deterioration of proplast-teflon temporomandibular joint interpositional implants: a scanning electron...

The surgical treatment of internal derangements of the temporomandibular joint (TMJ) often involves disc removal. Alloplastic interpositional implants for disc replacement have been widely used to avoid the development of osteoarthritic changes in the TMJ. This study reports the in vivo wear characteristics of Proplast-Teflon (Vitek Inc, Houston, TX) interpositional implants (PTIPI) in 12 patients who had their implants for 13 to 71 (mean 54.6 +/- 5.8 SEM) months. In all cases, changes in the condyle and fossa were found resulting from resorption and replacement of the articulating bone by granulomatous tissue. All implants showed significant signs of wear, such as thinning, cracks, and tears, and overt perforations were seen in five cases. Scanning electron microscopy (SEM) combined with energy-dispersive x-ray microanalysis (EDAX) showed numerous microfragments of the PTIPI in the peri-implant soft tissues. Microfragments were demonstrated by their aluminum content. In addition to the inflammatory foreign-body reaction, it is suggested that there also were toxic and hypersensitivity reactions to aluminum involved in the pathogenesis of the bone destruction.