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Ghaly GA, Espeso A, McIntyre G. Temporomandibular joint alloplastic replacement failure. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00211-0. [PMID: 39299812 DOI: 10.1016/j.bjoms.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 09/22/2024]
Abstract
Temporomandibular joint disorders are common, with alloplastic temporomandibular joint replacement (TMJR) being one method of addressing chronic pain and movement limitations that cannot otherwise be managed. Despite this, TMJR has known complications that can lead to failure. We present our experience of managing these cases and review the current evidence on the management and outcomes of alloplastic TMJR failures. Until 2015 our unit regularly used Dundee full metal prostheses, and encountered multiple issues such as infection, heterotopic bone formation, and progression of osteoarthritis beneath the condylar element. We also present our experience with other standard TMJR implants. One common cause of failure we observed is improper placement of a prosthesis due to poor technique, for instance, placement of the fossa implant too close to the ear canal can cause unresolved postoperative pain. There is no consensus on the management of TMJR, but non-surgical measures are preferred initially and surgical intervention is reserved for later stages. Recently our unit has managed numerous failure cases, employing a multidisciplinary approach combined with thorough preoperative planning and postoperative care, which has proven effective in reducing complications and improving outcomes. Based on our experience, we do not recommend the use of Dundee full metal prostheses for TMJR. Appropriate training in the placement of contemporary implants remains crucial. Suboptimal alignment of the implant in some cases does not need surgical intervention, but surgical management is justifiable in cases of persistent symptoms and functional limitations. When placing stock implants or designing a custom-made implant for an adult, we recommend that the posterior edge of the fossa component is at least 3 mm away from the bone of the ear canal.
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Affiliation(s)
| | | | - Grant McIntyre
- Dundee Dental Research Hospital & School, University of Dundee, Scotland.
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2
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Bhargava D. Hybrid total alloplastic temporomandibular joint replacement prosthesis: a pilot study to evaluate feasibility, functional performance and impact on post-operative quality of life. Oral Maxillofac Surg 2024; 28:767-777. [PMID: 38153609 DOI: 10.1007/s10006-023-01203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE The aim of the present study was to investigate the clinical efficiency of hybrid alloplastic temporomandibular joint (TMJ) prosthesis in patients undergoing TMJ total alloplastic joint replacement (TMJR). The prosthesis utilized for this study for TMJR is a hybrid variant with combination of stock prototype design and a partial customization of components. MATERIALS AND METHODS A prospective clinical study was conducted involving five patients with unilateral TMJ ankylosis or end-stage joint disease (ESJD) indicated for and requiring TMJR. The patients underwent resection of the joint or gap arthroplasty followed by TMJR using the hybrid alloplastic TMJ prosthesis. The subjective and objective variables that included the jaw function (JF), inter-incisal opening (IO), diet intake (DI) and quality of life (QoL) were assessed using the psychometric modified Likert scale. The nutritional status of the patients was evaluated using the mid-upper arm circumference (MUAC) as reference. RESULTS The assessed study variables demonstrated functional and observational improvement in the post-operative follow-up when compared to the pre-operative period. The patients showed an improvement in overall QoL and nutritional status post-operatively. The follow-up period showed subjective and objective improvement in the parameters assessed among the study population. CONCLUSION There is a technical and clinical feasibility to utilize the hybrid alloplastic TMJ prosthesis as a reliable alloplastic option for treating patients requiring TMJR, with prudent indications.
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Affiliation(s)
- Darpan Bhargava
- Oral and Maxillofacial Surgery, TMJ Consultancy Services, Bhopal, Madhya Pradesh, India.
- DAMER, Bhopal, India.
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3
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Lima FGGP, Rios LGC, Paranhos LR, Vieira WA, Zanetta-Barbosa D. Survival of temporomandibular total joint replacement: A systematic review and meta-analysis. J Oral Rehabil 2024; 51:775-784. [PMID: 38071499 DOI: 10.1111/joor.13635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Prosthetic total joint replacement has been incorporated as a treatment for complex temporomandibular disorder; however, the survival of those devices is unknown. OBJECTIVE To assess the survival rate of the total temporomandibular joint (TMJ) prothesis and their main causes of failure. METHODS An electronic search was conducted in eight databases until March 2023. Prospective studies reporting the survival rate of total TMJ prothesis with a minimum follow-up of 12 months were included. Studies with partial TMJ prostheses or those no longer available on the market were excluded. Two reviewers assessed the individual risk of bias using the JBI Systematic Reviews for Quasi-experimental studies tool. Meta-analysis of proportions was conducted to summarise the survival rate, using 95% confidence intervals (CI). The GRADE approach assessed the certainty of the body of evidence. RESULTS Data from 320 patients were collected from six prospective studies. The number of prothesis losses varied from none to four. All studies presented sources of bias related to follow-up description of the patients. The follow-up time varied from 12 months to 21 years. In most of the studies, prosthesis failure occurred within the first 6 months after surgery due to infection. The overall survival of total TMJ protheses was 97% (95% CI: 95%; 99%), with low heterogeneity (I2 = 29%) and a very low certainty of evidence. CONCLUSION TMJ total prosthesis apparently is a safe procedure with a high survival rate and the evidence is very uncertain and presents important sources of bias.
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Affiliation(s)
| | | | - Luiz Renato Paranhos
- Division of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Walbert A Vieira
- Department of Restorative Dentistry, Endodontics Division, School of Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - Darceny Zanetta-Barbosa
- Division of Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
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Mercuri LG. Alloplastic temporomandibular joint replacement - past, present, and future: "Learn from the past, prepare for the future, live in the present." Thomas S. Monson. Br J Oral Maxillofac Surg 2024; 62:91-96. [PMID: 38000963 DOI: 10.1016/j.bjoms.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/26/2023]
Abstract
Based on evidence from the orthopaedic, biomedical engineering, and oral and maxillofacial surgical literature, this paper discusses reported successes and failures of past alloplastic temporomandibular joint (TMJ) devices that have led to the development of present total temporomandibular joint replacement (TMJR) devices. The paper concludes with discussion of the ongoing research that will lead to future embodiment (materials, designs, and manufacture) advances in TMJR management of severe and debilitating end-stage TMJ disease, further improving patients' mandibular function, form, and overall quality of life.
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Affiliation(s)
- Louis G Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, United States; Department of Biomedical Engineering, University of Illinois Chicago, 851 S Morgan St, Chicago, IL 60607, United States.
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Ginat D. Surgical Implants in the Head and Neck: Normal and Abnormal Imaging Appearances. Semin Roentgenol 2023; 58:290-300. [PMID: 37507170 DOI: 10.1053/j.ro.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/07/2022] [Accepted: 01/08/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Daniel Ginat
- Department of Radiology, Pritzker School of Medicine, Chicago, IL.
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Nedrelow DS, Rassi A, Ajeeb B, Jones CP, Huebner P, Ritto FG, Williams WR, Fung KM, Gildon BW, Townsend JM, Detamore MS. Regenerative Engineering of a Biphasic Patient-Fitted Temporomandibular Joint Condylar Prosthesis. Tissue Eng Part C Methods 2023; 29:307-320. [PMID: 37335050 PMCID: PMC10402699 DOI: 10.1089/ten.tec.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023] Open
Abstract
Regenerative medicine approaches to restore the mandibular condyle of the temporomandibular joint (TMJ) may fill an unmet patient need. In this study, a method to implant an acellular regenerative TMJ prosthesis was developed for orthotopic implantation in a pilot goat study. The scaffold incorporated a porous, polycaprolactone-hydroxyapatite (PCL-HAp, 20wt% HAp) 3D printed condyle with a cartilage-matrix-containing hydrogel. A series of material characterizations was used to determine the structure, fluid transport, and mechanical properties of 3D printed PCL-HAp. To promote marrow uptake for cell seeding, a scaffold pore size of 152 ± 68 μm resulted in a whole blood transport initial velocity of 3.7 ± 1.2 mm·s-1 transported to the full 1 cm height. The Young's modulus of PCL was increased by 67% with the addition of HAp, resulting in a stiffness of 269 ± 20 MPa for etched PCL-HAp. In addition, the bending modulus increased by 2.06-fold with the addition of HAp to 470 MPa for PCL-HAp. The prosthesis design with an integrated hydrogel was compared with unoperated contralateral control and no-hydrogel group in a goat model for 6 months. A guide was used to make the condylectomy cut, and the TMJ disc was preserved. MicroCT assessment of bone suggested variable tissue responses with some regions of bone growth and loss, although more loss may have been exhibited by the hydrogel group than the no-hydrogel group. A benchtop load transmission test suggested that the prosthesis was not shielding load to the underlying bone. Although variable, signs of neocartilage formation were exhibited by Alcian blue and collagen II staining on the anterior, functional surface of the condyle. Overall, this study demonstrated signs of functional TMJ restoration with an acellular prosthesis. There were apparent limitations to continuous, reproducible bone formation, and stratified zonal cartilage regeneration. Future work may refine the prosthesis design for a regenerative TMJ prosthesis amenable to clinical translation.
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Affiliation(s)
- David S. Nedrelow
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, USA
- College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ali Rassi
- School of Industrial and Systems Engineering, University of Oklahoma, Norman, Oklahoma, USA
| | - Boushra Ajeeb
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, USA
| | - Cameron P. Jones
- College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Pedro Huebner
- School of Industrial and Systems Engineering, University of Oklahoma, Norman, Oklahoma, USA
| | - Fabio G. Ritto
- Department of Oral and Maxillofacial Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Wendy R. Williams
- Division of Comparative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Bradford W. Gildon
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma College of Allied Health, Oklahoma City, Oklahoma, USA
| | - Jakob M. Townsend
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, USA
| | - Michael S. Detamore
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, USA
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Brierly G, Thomas A, Dimitroulis G. A five-year review of the OMX temporomandibular prosthetic total joint replacement system. Oral Maxillofac Surg 2023; 27:131-139. [PMID: 35066650 DOI: 10.1007/s10006-021-01032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The aim of this study was to undertake a 5-year review of the OMX temporomandibular prosthetic total joint replacement system (OMX-TMJ). METHODS Data was collected from patients who had an OMX-TMJ implanted between May 2015 and November 2020 at Epworth-Freemasons and St. Vincent's hospitals in Melbourne, Australia. The data points included patient demographics, primary diagnosis, and clinical outcomes in terms of visual analogue scale (VAS) for pain, maximum inter-incisal mouth opening, and complication events. RESULTS There were 206 OMX-TMJ devices implanted in 151 patients over the 5-year study period. The vast majority were female patients (n = 137, 90.7%) with a mean age of 44.8 years (range 20-76 years) at the time of surgery. Most patients presented with primary (idiopathic) osteoarthritis (119 joints-57.8%) that failed to respond to conservative measures. Based on a mean follow-up period of 36 months (range 12 months to 73 months), the average mouth opening improved from 30.8 mm pre-surgery to an average of 39.1 mm following OMX-TMJ surgery (p < 0.05). Joint pain (VAS: 0-10) significantly improved from 6.14 pre-surgery to 0.87 following OMX-TMJ surgery (p < 0.001). Twenty-one patients (13.9%) experienced device-related complications which resulted in explantation of 7 (3.4%) OMX-TMJ devices over the 5-year period. CONCLUSION This study shows that the OMX-TMJ prosthetic total joint replacement system is a reasonably safe, versatile, and reliable implant that effectively improves mandibular opening and reduces joint pain across a broad range of end-stage TMJ disorders.
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Affiliation(s)
- Gary Brierly
- Oral and Maxillofacial Surgery, Ground Floor, Epworth-Freemasons Hospital, Suite 1, 124 Grey Street, East Melbourne, VIC, 3002, Australia
| | - Aaron Thomas
- Oral and Maxillofacial Surgery, Ground Floor, Epworth-Freemasons Hospital, Suite 1, 124 Grey Street, East Melbourne, VIC, 3002, Australia
| | - George Dimitroulis
- Oral and Maxillofacial Surgery, Ground Floor, Epworth-Freemasons Hospital, Suite 1, 124 Grey Street, East Melbourne, VIC, 3002, Australia.
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Wilken N, Warburton G. Reconstruction of the mandibular condyle due to degenerative disease. J Oral Biol Craniofac Res 2023; 13:367-372. [PMID: 36970306 PMCID: PMC10031477 DOI: 10.1016/j.jobcr.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 03/18/2023] Open
Abstract
Degenerative joint disease (DJD), also known as osteoarthritis is the most common form of arthritis and can affect the temporomandibular joint (TMJ). TMJ DJD is characterized by degradation of the articular cartilage and synovial tissues resulting in characteristic morphologic changes in the underlying bone. DJD can occur at any age, but it is more common in older age groups. TMJ DJD may be unilateral or bilateral. The American Academy of Orofacial Pain categorizes TMJ DJD into primary and secondary types. Primary DJD is seen in the absence of any local or systemic factors and secondary DJD is associated with a prior traumatic event or disease process. Frequently, these patients present with pain and limited residual mandibular function resulting in significantly diminished quality of life. Classic radiographic features on orthopantogram and CT imaging include loss of joint space, osteophytes (bird-beak appearance of the condyle), subchondral cysts, erosions, flattening of the condylar head, bony resorption and/or heterotopic bone (Figure 1). Conservative and medical management is successful in the majority of patients until the active degenerative phase burns out, but some will progress to end stage joint disease and require reconstruction of the TMJ. Reconstruction of the mandibular condyle should be considered to restore mandibular function and form to patients who have lost it secondary to degenerative joint disease affecting the glenoid fossa/mandibular condyle unit.
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Affiliation(s)
- Nicholas Wilken
- Department of Oral and Maxillofacial Surgery, University of Maryland, 650 W. Baltimore St, Baltimore, MD, 21201, USA
| | - Gary Warburton
- Department of Oral and Maxillofacial Surgery, University of Maryland, 650 W. Baltimore St, Baltimore, MD, 21201, USA
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McQuinn MW, Moreno SD, Perez L, Burkes JN. Management of Intraoperative Contamination of the Custom Total Temporomandibular Joint Prosthesis. J Oral Maxillofac Surg 2023; 81:17-23. [PMID: 36279938 DOI: 10.1016/j.joms.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/25/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023]
Abstract
Management of intraoperative contamination of a custom total temporomandibular joint prosthesis has not been reported in the literature. As this complication is rare, it can be unsettling for the surgeon. Improper management may lead to a complicated treatment course and financial consequences. Prevention is the primary strategy for avoidance and appropriate management is dependent on many variables. The purpose of this report is to identify a unique complication associated with placement of a custom temporomandibular joint prosthesis and offer an algorithm for management.
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Affiliation(s)
- Michael W McQuinn
- Staff Surgeon, Department of Oral and Maxillofacial Surgery, Naval Dental Center, Camp Lejeune, NC.
| | - Stephen D Moreno
- Fellow, Pediatric Craniofacial Surgery, Department of Oral and Maxillofacial Surgery, University of Florida-Jacksonville College of Medicine, Jacksonville, FL
| | - Leonel Perez
- Program Director and Staff Surgeon, Department of Oral and Maxillofacial Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jason N Burkes
- President of the Medical Staff and Staff Surgeon, Department of Oral and Maxillofacial Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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10
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Conventional Ameloblastoma. A Case Report with Microarray and Bioinformatic Analysis. Diagnostics (Basel) 2022; 12:diagnostics12123190. [PMID: 36553196 PMCID: PMC9777305 DOI: 10.3390/diagnostics12123190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Ameloblastoma is a rare benign epithelial odontogenic neoplasm, but with great clinical implications, as despite its benignity and slow growth, most cases are locally aggressive with a significant recurrence rate. Histological, cellular, or molecular analyses of its pathogenesis have confirmed the complexity of this neoplasm. We present the case of a 20-year-old patient with a suggestive clinical and radiographic diagnosis of ameloblastoma. An incisional biopsy was obtained confirming the diagnosis of conventional ameloblastoma. Left hemimandibulectomy and plate reconstruction were performed. Histopathological analysis of the surgical specimen confirmed the conventional ameloblastoma with a plexiform pattern and significant areas of cystic degeneration and amyloid-like-like deposits. Additionally, a microarray was carried out with bioinformatic analysis for the enrichment, protein interaction, and determination of eight hub genes (CRP, BCHE, APP, AKT1, AGT, ACTC1, ADAM10, and APOA2) related to their pathogenesis.
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11
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Kramer D, Van der Merwe J, Lüthi M. A combined active shape and mean appearance model for the reconstruction of segmental bone loss. Med Eng Phys 2022; 110:103841. [PMID: 36031526 DOI: 10.1016/j.medengphy.2022.103841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
This study investigates the novel combination of an active shape and mean appearance model to estimate missing bone geometry and density distribution from sparse inputs simulating segmental bone loss of the femoral diaphysis. An active shape Gaussian Process Morphable model was trained on healthy right femurs of South African males to model shape. The density distribution was approximated based on the mean appearance of computed tomography images from the training set. Estimations of diaphyseal resections were obtained by probabilistic fitting of the active shape model to sparse inputs consisting of proximal and distal femoral data on computed tomography images. The resulting shape estimates of the diaphyseal resections were then used to map the mean appearance model to the patients' missing bone geometry, constructing density estimations. In this way, resected bone surfaces were estimated with an average error of 2.24 (0.5) mm. Density distributions were approximated within 87 (0.7) % of the intensity of the original target images before the simulated segmental bone loss. These results fall within the acceptable tolerances required for surgical planning and reconstruction of long bone defects.
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Affiliation(s)
- D Kramer
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, Western-Cape, South Africa.
| | - J Van der Merwe
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, Western-Cape, South Africa.
| | - M Lüthi
- The Graphics and Vision Research Group, University of Basel, Basel 4001, Switzerland.
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Davies R, Cascarini L. The temporo-mandibular joint: Reconstruction of the condyle post-ablation. J Oral Biol Craniofac Res 2022; 12:593-598. [PMID: 35968039 PMCID: PMC9372739 DOI: 10.1016/j.jobcr.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/15/2022] [Accepted: 07/09/2022] [Indexed: 11/26/2022] Open
Abstract
Ablative surgery of the mandibular condyle poses a unique reconstructive challenge for many reasons. The condyle and it's relationship to the TMJ is a unique, complex, functional and aesthetically relevant piece of human anatomy. Resection may be required for both malignant and benign pathologies; each posing a differing set of surgical variables. Particularly in neoplastic processes, there must remain a certain degree of peri-operative flexibility with regards to the extent of the resection, and forethought to the requirement for post-operative radiotherapy; both of which further complicate choice of reconstructive option and surgical or prosthetic planning. The cases involved can often concern paediatric patients, and an additional aspect to be considered is that of growth potential. In this piece, we will discuss the indications for ablation and the techniques involved. We will elaborate on the reconstructive challenges specific to reconstructing the condyle in post-ablative cases. We will then describe and analyse the established reconstructive techniques; aiming to provide a balanced view on the advantages and disadvantages. Our focus will include autologous options such as vascularised and non-vascularised free tissue transfer, and the non-autologous options of custom and stock implants. We will also touch on distraction osteogenesis and ramus osteotomies. Lastly we will look to the future and consider possible innovative techniques which may become available to the surgeon.
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Affiliation(s)
- Rhodri Davies
- The Royal London Hospital, Whitechapel, E1 1FR, London, UK
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Genovesi W, Comenale IC, Genovesi Filho W, Veloso Fernandes M. Biomechanical comparative analysis of temporomandibular joint, glenoid fossa and head of the condyle of conventional models prothesis with new PEEK design. J Oral Biol Craniofac Res 2022; 12:529-541. [PMID: 35859613 PMCID: PMC9289641 DOI: 10.1016/j.jobcr.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 04/16/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022] Open
Abstract
This article reviews the design of the temporomandibular joint (TMJ) prostheses used for TMJ joint replacement from 2000 to 2020. The TMJ is a complex joint, with distinct anatomical and functional characteristics making it challenging to maintain. Many authors from the early 20th century reported techniques for TMJ reconstruction, with the goal of restoring its shape and ideal function. Many prototypes have been developed in pursuit of an ideal prosthesis that adheres to the principles of biomechanics and biocompatibility, with good long-term performance and lower cost. The TMJ prosthesis is divided in two parts: the glenoid fossa and the mandibular ramus component. These two parts are fixed with metal screws in the glenoid fossa and fixed in the zygomatic arch with 4 or 5 screws. The mandibular part is fixed to the mandible ramus with 8 or 9 titanium screws. In our review, since 2000 to 2020, little has changed to improve the design and allow for natural mandible movement. From 2000 to 2006, 48 TMJ surgeries were performed using UHMWPE with this design. All patients had good results, preserving opening mouth and lateral movements. All the designs are similar in principle. The glenoid fossa, which resembles a box, limiting the rotation and translation movement. It is known that lateral movements are lost in function as the lateral pterygoid muscle is detached.
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Affiliation(s)
| | - Iara Cristina Comenale
- Oral and Maxillofacial Surgery, São Paulo, Brazil
- Biomechanics Laboratory, São Judas Tadeu University, São Paulo, Brazil
| | | | - Moises Veloso Fernandes
- Oral and Maxillofacial Surgery, São Paulo, Brazil
- Biomechanics Laboratory, São Judas Tadeu University, São Paulo, Brazil
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14
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Mercuri LG, Neto MQ, Pourzal R. Alloplastic temporomandibular joint replacement: present status and future perspectives of the elements of embodiment. Int J Oral Maxillofac Surg 2022; 51:1573-1578. [PMID: 35717278 DOI: 10.1016/j.ijom.2022.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/14/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
Medical device embodiment involves the following elements: materials, design, and manufacturing. Failure of any one of these elements can result in failure of the device, despite the others being satisfactory. The abundance of clinical and basic science literature published since 1986, demonstrates the safety and efficacy of alloplastic temporomandibular joint replacement (TMJR). Currently, there are 19 countries producing 41 TMJR devices. More than 75% are custom designed, and 27% are additively manufactured. In light of the increasing number of TMJR devices being designed and manufactured around the world, this paper will discuss TMJR embodiment so that clinicians understand their present status as well as the prospects for the future of new and/or improved TMJR devices, to ensure that these devices continue to be safe and effective long-term surgical options for the management of end-stage TMJ pathologies.
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Affiliation(s)
- L G Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - M Q Neto
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - R Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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15
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A novel 3D-printed, patient-specific alloplastic temporomandibular joint replacement allowing enthesis reconstruction: A finite element analysis. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zoabi A, Redenski I, Oren D, Kasem A, Zigron A, Daoud S, Moskovich L, Kablan F, Srouji S. 3D Printing and Virtual Surgical Planning in Oral and Maxillofacial Surgery. J Clin Med 2022; 11:jcm11092385. [PMID: 35566511 PMCID: PMC9104292 DOI: 10.3390/jcm11092385] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Compared to traditional manufacturing methods, additive manufacturing and 3D printing stand out in their ability to rapidly fabricate complex structures and precise geometries. The growing need for products with different designs, purposes and materials led to the development of 3D printing, serving as a driving force for the 4th industrial revolution and digitization of manufacturing. 3D printing has had a global impact on healthcare, with patient-customized implants now replacing generic implantable medical devices. This revolution has had a particularly significant impact on oral and maxillofacial surgery, where surgeons rely on precision medicine in everyday practice. Trauma, orthognathic surgery and total joint replacement therapy represent several examples of treatments improved by 3D technologies. The widespread and rapid implementation of 3D technologies in clinical settings has led to the development of point-of-care treatment facilities with in-house infrastructure, enabling surgical teams to participate in the 3D design and manufacturing of devices. 3D technologies have had a tremendous impact on clinical outcomes and on the way clinicians approach treatment planning. The current review offers our perspective on the implementation of 3D-based technologies in the field of oral and maxillofacial surgery, while indicating major clinical applications. Moreover, the current report outlines the 3D printing point-of-care concept in the field of oral and maxillofacial surgery.
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Affiliation(s)
- Adeeb Zoabi
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Idan Redenski
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Daniel Oren
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Adi Kasem
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Asaf Zigron
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Shadi Daoud
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Liad Moskovich
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Fares Kablan
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Samer Srouji
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- Correspondence:
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Cheng KJ, Liu YF, Wang JH, Wang R, Xia J, Xu X, Jiang XF, Dong XT. 3D-printed porous condylar prosthesis for temporomandibular joint replacement: Design and biomechanical analysis. Technol Health Care 2022; 30:1017-1030. [PMID: 35275582 DOI: 10.3233/thc-213534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Customized prosthetic joint replacements have crucial applications in severe temporomandibular joint problems, and the combined use of porous titanium scaffold is a potential method to rehabilitate the patients. OBJECTIVE The objective of the study was to develop a design method to obtain a titanium alloy porous condylar prosthesis with good function and esthetic outcomes for mandibular reconstruction. METHODS A 3D virtual mandibular model was created from CBCT data. A condylar defect model was subsequently created by virtual condylectomy on the initial mandibular model. The segmented condylar defect model was reconstructed by either solid or porous condyle with a fixation plate. The porous condyle was created by a density-driven modeling scheme with an inhomogeneous tetrahedral lattice structure. The porous condyle, supporting fixation plate, and screw locations were topologically optimized. Biomechanical behaviors of porous and solid condylar prostheses made of Ti-6Al-4V alloy were compared. Finite element analysis (FEA) was used to evaluate maximum stress distribution on both prostheses and the remaining mandibular ramus. RESULTS The FEA results showed levels of maximum stresses were 6.6%, 36.4% and 47.8% less for the porous model compared to the solid model for LCI, LRM, and LBM loading conditions. Compared to the solid prosthesis, the porous prosthesis had a weight reduction of 57.7% and the volume of porosity of the porous condyle was 65% after the topological optimization process. CONCLUSIONS A custom-made porous condylar prosthesis with fixation plate was designed in this study. The 3D printed Ti-6Al-4V porous condylar prosthesis had reduced weight and effective modulus of elasticity close to that of cortical bone. The.
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Affiliation(s)
- Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, Zhejiang, China.,National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, Zhejiang, China.,National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Joanne H Wang
- Department of Orthopedic Surgery, University Hospitals of Cleveland, Case Medical Center, Cleveland, OH, USA
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Jiang Xia
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Xu Xu
- Department of Stomatology, People's Hospital of Quzhou, Quzhou, Zhejiang, China
| | - Xian-Feng Jiang
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Xing-Tao Dong
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, Zhejiang, China
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Kanatsios S, Thomas AM, Tocaciu S. Comparative cClinical oOutcomes bBetween sStock vVs cCustom tTemporomandibular tTotal jJoint rReplacement sSystems. J Craniomaxillofac Surg 2022; 50:322-327. [DOI: 10.1016/j.jcms.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/25/2021] [Accepted: 02/10/2022] [Indexed: 10/19/2022] Open
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De Meurechy N, Aktan MK, Boeckmans B, Huys S, Verwilghen DR, Braem A, Mommaerts MY. Surface wear in a custom manufactured temporomandibular joint prosthesis. J Biomed Mater Res B Appl Biomater 2022; 110:1425-1438. [PMID: 35088936 PMCID: PMC9306732 DOI: 10.1002/jbm.b.35010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022]
Abstract
The wear of a novel temporomandibular joint (TMJ) prosthesis was evaluated in an animal model. The prosthesis consisted of an additively manufactured titanium alloy (Ti6Al4V) mandibular condyle and glenoid fossa created through selective laser melting, with a machined vitamin E‐enriched ultra‐high molecular weight polyethylene (UHMWPE) surface attached to the fossa. Thirteen TMJ prosthesis were implanted in sheep, six of which had condylar heads coated with HadSat® diamond‐like carbon (H‐DLC). Euthanasia took place after 288 days, equaling 22 years of human mastication. Linear and volumetric wear analysis of the fossa was performed by optical scanning. The condylar head surfaces were assessed by scanning electron and confocal laser microscopy. The average linear UHMWPE wear, when combined with the coated condyle, was 0.67 ± 0.28 mm (range: 0.34–1.15 mm), not significantly differing (p = .3765, t‐test) from the non‐coated combination average (0.88 ± 0.41 mm; range: 0.28–1.48 mm). The respective mean volumetric wear volumes were 25.29 ± 11.43 mm3 and 45.85 ± 22.01 mm3, not significantly differing (p = .1448, t‐test). Analysis of the coated condylar surface produced a mean Ra of 0.12 ± 0.04 μm and Sa of 0.69 ± 0.07 μm. The non‐coated condylar surface measured a mean Ra of 0.28 ± 0.17 μm and Sa of 2.40 ± 2.08 μm. Both Sa (p = .0083, Mann–Whitney U test) and Ra (p = .0182, Mann–Whitney U test), differed significantly. The prosthesis exhibits acceptable wear resistance and addition of the H‐DLC‐coating significantly improved long‐term condylar surface smoothness.
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Affiliation(s)
- Nikolas De Meurechy
- European Face Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Doctoral School of Life Sciences and Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Bart Boeckmans
- Department of Mechanical Engineering, KU Leuven, Heverlee, Belgium.,Flanders Make, Heverlee, Belgium
| | - Stijn Huys
- Department of Mechanical Engineering, KU Leuven, Heverlee, Belgium
| | - Denis R Verwilghen
- Sydney School of Veterinary Sciences, Faculty of Science, University of Sydney, Sydney, Australia
| | - Annabel Braem
- Department of Materials Engineering, KU Leuven, Heverlee, Belgium
| | - Maurice Y Mommaerts
- European Face Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Doctoral School of Life Sciences and Medicine, Vrije Universiteit Brussel, Brussels, Belgium
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20
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A PRECISE MODIFICATION OF THE SURGICAL AND POSITIONING GUIDES FOR TMJ PROSTHESES. Br J Oral Maxillofac Surg 2022; 60:855-858. [DOI: 10.1016/j.bjoms.2021.12.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022]
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21
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Neto MQ, Radice S, Hall DJ, Mathew MT, Mercuri LG, Pourzal R. Alloys used in different Temporomandibular joint reconstruction replacement prostheses exhibit variable microstructures and electrochemical properties. J Oral Maxillofac Surg 2021; 80:798-813. [DOI: 10.1016/j.joms.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 01/30/2023]
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22
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Pinheiro M, Willaert R, Khan A, Krairi A, Van Paepegem W. Biomechanical evaluation of the human mandible after temporomandibular joint replacement under different biting conditions. Sci Rep 2021; 11:14034. [PMID: 34234245 PMCID: PMC8263622 DOI: 10.1038/s41598-021-93564-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023] Open
Abstract
Temporomandibular joint (TMJ) replacement with an implant is only used when all other conservative treatments fail. Despite the promising short-term results, the long-term implications of TMJ replacement in masticatory function are not fully understood. Previous human and animal studies have shown that perturbations to the normal masticatory function can lead to morphological and functional changes in the craniomaxillofacial system. A clearer understanding of the biomechanical implications of TMJ replacement in masticatory function may help identify design shortcomings that hinder their long-term success. In this study, patient-specific finite element models of the intact and implanted mandible were developed and simulated under four different biting tasks. In addition, the impact of re-attaching of the lateral pterygoid was also evaluated. The biomechanics of both models was compared regarding both mandibular displacements and principal strain patterns. The results show an excessive mediolateral and anteroposterior displacement of the TMJ implant compared to the intact joint in three biting tasks, namely incisor (INC), left moral (LML), and right molar (RML) biting. The main differences in principal strain distributions were found across the entire mandible, most notably from the symphysis to the ramus of the implanted side. Furthermore, the re-attachment of the lateral pterygoid seems to increase joint anteroposterior displacement in both INC, LML and RML biting while reducing it during LGF. Accordingly, any new TMJ implant design must consider stabilising both mediolateral and anteroposterior movement of the condyle during biting activities and promoting a more natural load transmission along the entire mandible.
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Affiliation(s)
- Manuel Pinheiro
- Department of Materials, Textiles and Chemical Engineering, Mechanics of Materials and Structures (MMS), Ghent University, Ghent, Belgium.
| | - Robin Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Afaq Khan
- Materials Innovation Institute (M2i), Delft, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Anouar Krairi
- Materials Innovation Institute (M2i), Delft, The Netherlands
| | - Wim Van Paepegem
- Department of Materials, Textiles and Chemical Engineering, Mechanics of Materials and Structures (MMS), Ghent University, Ghent, Belgium
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23
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Comparison in clinical performance of surgical guides for mandibular surgery and temporomandibular joint implants fabricated by additive manufacturing techniques. J Mech Behav Biomed Mater 2021; 119:104512. [PMID: 33930652 DOI: 10.1016/j.jmbbm.2021.104512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/01/2020] [Accepted: 04/07/2021] [Indexed: 01/27/2023]
Abstract
Additive manufacturing (AM) offers great design freedom that enables objects with desired unique and complex geometry and topology to be readily and cost-effectively fabricated. The overall benefits of AM are well known, such as increased material and resource efficiency, enhanced design and production flexibility, the ability to create porous structures and on-demand manufacturing. When AM is applied to medical devices, these benefits are naturally assumed. However, hard clinical evidence collected from clinical trials and studies seems to be lacking and, as a result, systematic assessment is yet difficult. In the present work, we have reviewed 23 studies on the clinical use of AM patient-specific surgical guides (PSGs) for the mandible surgeries (n = 17) and temporomandibular joint (TMJ) patient-specific implants (PSIs) (n = 6) with respect to expected clinical outcomes. It is concluded that the data published on these AM medical devices are often lacking in comprehensive evaluation of clinical outcomes. A complete set of clinical data, including those on time management, costs, clinical outcomes, range of motion, accuracy of the placement with respect to the pre-operative planning, and extra complications, as well as manufacturing data are needed to demonstrate the real benefits gained from applying AM to these medical devices and to satisfy regulatory requirements.
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24
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Mehrotra D, Kumar S, Mehrotra P, Khanna R, Khanna V, Eggbeer D, Evans P. Patient specific total temporomandibular joint reconstruction: A review of biomaterial, designs, fabrication and outcomes. J Oral Biol Craniofac Res 2021; 11:334-343. [PMID: 33786297 DOI: 10.1016/j.jobcr.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The aim of this article was to systematically review the available literature on patient specific total temporomandibular joint total joint replacement (PS-TMJR) implants for their biomaterial, designs, fabrication techniques and their outcomes. Methods A literature review was conducted using PubMed, and science direct databases using the key words three-dimensional printing, 3D printing, CAD CAM, computer aided designing, computer aided manufacturing, additive technology, custom made implants, patient specific implants in combination with Temporomandibular joint, TMJ surgery. Results The search revealed 2760 articles, of which 374 were in English and discussed TMJ reconstruction. Further filtering shortlisted 74 articles that discussed PS-TMJR. Duplicates were removed and additional added from article references. 39 articles describing biomaterial, designing and fabrication of PS-TMJR implants and their outcomes were selected for analysis. Conclusions Although PS-TMJR implants allow a better anatomical fit, improved fixation, and safeguard various structures such as the inferior alveolar nerve, they vary in designs, material and fabrication techniques. However, PS-TMJR printed with SLM and EBM technologies have yet to be compared with the conventional ones in terms of mechanical strength, and clinical outcome. With emerging bioprinting technologies, even newer biomaterials should be considered for 3D printing of PS-TMJR devices designed to achieve harmony in function between the joint device, bone and masticatory muscles.
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Affiliation(s)
- Divya Mehrotra
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Sumit Kumar
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Pankhuri Mehrotra
- Dept of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - Richa Khanna
- Dept of Preventive and Paediatric Dentistry, King George's Medical University, Lucknow, India
| | - Vikram Khanna
- Dept of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | | | - Peter Evans
- Healthcare Consultant in Maxillofacial Prosthetics, Maxillofacial Laboratory, Morriston Hospital, Swansea, Wales, UK
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Lateral pterygoid muscle enthesis reconstruction in total temporomandibular joint replacement: An animal experiment with radiological correlation. J Craniomaxillofac Surg 2021; 49:256-268. [PMID: 33622558 DOI: 10.1016/j.jcms.2021.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/15/2020] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
A novel total temporomandibular joint replacement (TMJR) was developed with CADskills BV (Ghent, Belgium), aiming to achieve reinsertion of the (LPM) onto a scaffold in the implant. In order to investigate the possibility of reinsertion of the LPM, an animal experiment was conducted. An in vivo sheep experiment was conducted, which involved implanting sheep with a TMJR. Clinical parameters were recorded regularly and computed tomography (CT) scan images of two randomly selected sheep per scan were made at 1, 3, and 6 months. After 9.5 months, the sheep were euthanized, and CT scans of all animals were performed in order to evaluate the LPM's enthesis. A total of 13 sheep were implanted with a TMJR. One sheep was used as a sham. Radiographs revealed four outcome types of enthesis reconstruction. In four sheep, there was no reconstruction between the implant and the LPM. In three sheep, there was a purely soft tissue connection of 0.5-0.9 mm (average 0.7 mm) between the ostectomized bony LPM insertion and the implant's lattice structure. A combination of partial bony and partial soft tissue enthesis attachment (0.3-0.5 mm, average 0.4 mm) was found in three sheep. A bony ingrowth of the enthesis into the scaffold occurred in two sheep. A secondary bony connection between the mandible and the insertion of the LPM was found in 10 of 13 sheep. Four fossa components were found to be displaced, yet TMJ function remained in these ewes. The heterotopic ossification that was seen may be a confounding factor in these results. This in vivo experiment showed promising results for improving the current approach to TMJR with the possibility of restoring the laterotrusive function. The fossa displacement was considered to be due to insufficient fixation and predominant laterotrusive force not allowing for proper osseointegration. Further optimization of the reattachment technique, scaffold position and surface area should be done, as well as trials in humans to evaluate the effect of proper revalidation.
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Temporomandibular Joint Prostheses: Optimal Materials for the Optimal Stomatognathic System Performance-Preliminary Study. J Funct Biomater 2021; 12:jfb12010007. [PMID: 33530438 PMCID: PMC7839040 DOI: 10.3390/jfb12010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to quantitatively evaluate alloplastic Temporomandibular Joint (TMJ) Prostheses against other treatment modalities regarding the jaw kinematics. Six patients with Temporomandibular Joint Prostheses, four with mandibular ramus Patient-Specific Implant (PSI) with condylar head preservation, and four after mandibular condylectomy were evaluated by the means of axiography (Cadiax Compact 2), which is the noninvasive three-dimensional study of condylar movements. The patients were also evaluated clinically for the mandibular movements. The study revealed that the significant movement limitations occurred bilaterally in patients fitted with TMJ prosthesis. For the protrusion movement, the vector length of the movement (L) for the TMJ prosthesis was 0.31 vs. 3.01 mm for the PSI (Kruskal–Wallis chi-squared = 9.1667, df = 2, p-value = 0.01022, post hoc Dunn p-value = 0.015) and for the laterotrusion to the operated side, the length of the vector (L) was 0.66 vs. 3.35 mm, respectively. Statistically significant differences between groups were most frequent for the laterotrusion to the unoperated side. The study shows that a further development on TMJ Prostheses geometry and materials is needed.
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Mani B, Balasubramaniam S, Balasubramanian S, Jayaraman B, Thirunavukkarasu R. Role of Custom-Made Prosthesis for Temporomandibular Joint Replacement in Unilateral Ankylosis - An Evaluative Study. Ann Maxillofac Surg 2020; 10:344-352. [PMID: 33708578 PMCID: PMC7943995 DOI: 10.4103/ams.ams_132_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Ankylosis is a physically and psychologically distressing condition to a patient. The aim of this study was to evaluate the efficiency of custom-made temporomandibular joint (TMJ) prosthesis (fossa-condyle component) in patients with unilateral ankylosis in restoring the form and functions of the TMJ. Materials and Methods This retrospective study was conducted in ten patients with unilateral TMJ ankylosis who had undergone TMJ reconstruction with custom-made TMJ prosthesis. Clinical parameters assessed were maximal mouth opening, lateral movements, improvement of the pain levels, and dietary efficiency of the patient. The data were analyzed using SPSS version 20 (IBM Corporation, SPSS Inc.; Chicago, IL, USA). Results The mean preoperative mouth opening was 5.70 ± 3.62 mm. After gap arthroplasty, it was 32.50 ± 3.31 mm. The postoperative mouth opening after the reconstruction of TMJ using alloplastic joint prosthesis was 34.90 ± 2.69 mm, and after a mean follow-up period of 4 years, the mean postoperative mouth opening was 34.60 ± 2.50 mm. The mean preoperative movement toward the right and left side was 0.9 ± 1.2 mm and 1.3 ± 1.25 mm, respectively. The mean right and left lateral movements of the TMJ after reconstruction were 3.5 ± 0.97 mm and 3.70 ± 1.06 mm, respectively. There was decrease in deviation of the unaffected jaw during mouth opening and closure. Functional occlusion was maintained postoperatively. There was no appreciable change in the visual analog pain scales. The dietary efficiency improved from a scale of 10 (liquids) to a scale of 0 (no restriction to diet) in eight patients and 1 in two patients. The dietary score improved significantly after alloplastic reconstruction (P = 0.000). No evidence of facial nerve paralysis or foreign body reactions was noted in the patients during the follow-up period. Radiographic assessment revealed good positioning and adaptation of the fossa component and the condylar ramal component both postoperatively and after a mean 4-year follow-up period. There was no evidence of screw loosening or prosthesis breakage during the follow-up period. Discussion and Conclusion The custom-made TMJ-total joint replacement (TJR) devices provide stable, improved long-term results, thereby increasing the quality of life of the patient. The custom-made alloplastic TMJ-TJR prosthesis proves to be the optimal surgical procedure to reconstruct the TMJ in comparison to the autogenous grafts (to avoid complications) in severe degenerated and ankylosed joints. However, long-term clinical and radiological studies on a larger sample size are imperative to establish the versatility of this procedure.
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Affiliation(s)
- Bharathi Mani
- Department of Oral and Maxillofacial Surgery, L. P. Mohan Dental Hospital, Chennai, Tamil Nadu, India
| | - Saravanan Balasubramaniam
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | | | - Balaji Jayaraman
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Rohini Thirunavukkarasu
- Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
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Chen X, Mao Y, Zheng J, Yang C, Chen K, Zhang S. Clinical and radiological outcomes of Chinese customized three-dimensionally printed total temporomandibular joint prostheses: A prospective case series study. J Plast Reconstr Aesthet Surg 2020; 74:1582-1593. [PMID: 33281084 DOI: 10.1016/j.bjps.2020.10.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/27/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Temporomandibular joint (TMJ) diseases are highly prevalent in China. However, no commercialized custom-made prostheses are available now. This study introduces a three-dimensionally (3D) printed customized total TMJ prosthesis manufactured by a standardized workflow. MATERIALS AND METHODS Consecutive patients with end-stage TMJ diseases were recruited from Jan 2018 to Sep 2018. The computed tomography (CT) data for patients were obtained and transformed into the Mimics 18.0 software preoperatively for designing of prostheses and digital templates. 3D printing, friction spot welding and computer-assisted manufacture (CAM) were used to fabricate different components of the prosthesis. The clinical and radiographic evaluations were performed postoperatively. RESULTS A series of 9 patients were included. All the prostheses were placed smoothly and fixed stably during surgical procedure. Without severe postoperative complications, all patients exhibited significant improvements in maximum mouth opening, pain, diet, and mandibular function, with good facial symmetry. For the whole prosthesis, the average mean deviation was 0.432 mm (range: from 0.279 to 0.561 mm). CONCLUSIONS This study suggests that Chinese customized 3D-printed total TMJ prostheses produces excellent short-term clinical outcomes, with high accuracy in implantation.
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Affiliation(s)
- Xuzhuo Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology. Shanghai, China
| | - Yi Mao
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology. Shanghai, China
| | - Jisi Zheng
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology. Shanghai, China
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology. Shanghai, China
| | - Ke Chen
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Material Laser Processing and Modification, Shanghai Jiao Tong University, Shanghai, China.
| | - Shanyong Zhang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology. Shanghai, China.
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29
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Validation of an extended total joint replacement (eTJR) classification system for the temporomandibular joint (TMJ). Br J Oral Maxillofac Surg 2020; 59:788-791. [PMID: 34272106 DOI: 10.1016/j.bjoms.2020.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 01/16/2023]
Abstract
The aim of this paper was to validate a previously described classification system for extended total joint replacements (eTJRs) of the temporomandibular joint (TMJ). We engaged an expert panel to review 60 TMJ eTJR devices and classify them using the system, examining their responses for inter-rater agreement and concordance with the correct response as determined by the authors. Conger's kappa was 0.34 for the fossa (F) component sub-classification and 0.67 for the mandibular (M) component. A posthoc analysis showed improvements in inter-rater agreement for a modified three-tiered F sub-classification system which is suggested in a revised version of the TMJ eTJR classification system.
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30
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Zhong Z, Sun J, Yu Z, Han Y, Kang C. Morphological study of safe fixation region of temporomandibular joint prosthesis in Chinese northeast population with 3-dimensional computed tomographic image. Medicine (Baltimore) 2020; 99:e22779. [PMID: 33120789 PMCID: PMC7581044 DOI: 10.1097/md.0000000000022779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to measure temporomandibular joint (TMJ) with 3-dimensional (3D) reconstruction technique in Chinese northeast population, and to clarify the region for fixation and to provide morphological basis for the application of TMJ prosthesis in Chinese setting.Computed tomography (CT) scan and 3D reconstruction were performed with 132 individuals. Structural markers and measurements were further performed with a 3D model of the total TMJ, including the width, thickness and angle of zygomatic arch, the width and height of articular fossa, as well as the area, width, thickness and angle of mandible in the fixation region of the TMJ prosthesis. All the measured indicators values were compared between bilateral sides and gender groups.There was no statistical difference in the measured indicators between the left side and the right side (P > .05). However, certain parameters, including S, L5, L7, P4, and P5, were significantly different among males and females (P < .05).In this study, 3D CT image was used to obtain the measurement data of TMJ, which provided data support for the clinical application of TMJ prosthesis in Chinese population.
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Affiliation(s)
- Zhuan Zhong
- Department of Orthopaedics, The Second Hospital of Jilin University
| | - Jialiang Sun
- Department of Pediatrics, The First Hospital of Jilin University
| | - Zhentao Yu
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, 130033 Changchun, Jilin, China
| | - Yingying Han
- Department of Neurology, China-Japan Union Hospital of Jilin University
| | - Chunyang Kang
- Department of Neurology, China-Japan Union Hospital of Jilin University
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31
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Sembronio S, Tel A, Robiony M. The use of cutting/positioning devices for custom-fitted temporomandibular joint alloplastic reconstruction: current knowledge and development of a new system. Int J Oral Maxillofac Surg 2020; 50:530-537. [PMID: 33097370 DOI: 10.1016/j.ijom.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/17/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Alloplastic replacement of the temporomandibular joint (TMJ) is the treatment of choice in cases of TMJ end-stage disease. Improvements in computer-aided design/computer-aided manufacturing (CAD/CAM) translated into the possibility ongf designi very precise TMJ prostheses based on the anatomy of each single patient. Custom-made TMJ prostheses are described in the most recent literature and provide facilitations in terms of ease of placement and accuracy. Although before the era of custom-made surgical guides, they did not play a prominent role in the field of TMJ surgery, their use has become mandatory when custom-made prostheses are used. Surgical guides, generally known also as cutting guides, allow the subcondylar bone cut to be performed according to the exact shape and size of the planned prostheses. Additionally, they allow the predrilling of fixation holes in the mandible to minimize errors in prostheses positioning. However, the design of surgical guides did not evolve over time as much as prostheses did. In this paper the authors critically analysed literature on this topic and described the improvements of surgical guides over time. Moreover, based on the findings of literature research, a new cutting guide system was developed and is proposed in this article.
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Affiliation(s)
- S Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - A Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - M Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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Koneru G, Bhargava D, Somuri AV, Manoj M, Nesan J, Pillai AK, Beena S. Temporomandibular joint alloplastic reconstruction of post-traumatic joint degeneration with Sawhney Type I ankylosis using 3D-custom GD-condylar cap prosthesis to restore condylar form and function. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:315-318. [PMID: 32977036 DOI: 10.1016/j.jormas.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Temporomandibular Joint (TMJ) ankylosis as a sequelae following hemarthrosis from trauma, middle ear infection and progressive debilitating arthritis of various etiologies has been well understood, but challenges always arise in terms of choosing least morbid procedure with maximum functional outcome. Total joint replacement (TJR) is the common final stage correction mandating extensive surgical exposure with good technical expertise with its limitations of risk of failure and complications. A case of post-traumatic TMJ degeneration with ankylosis reconstructed using a customised GD-condylar cap prosthesis is described. The patient had an uneventful post-operative period with an acceptable functional outcome. CONCLUSION: The condylar cap prosthesis is a bio-compatible and biomechanically designed in such a way that it can be used for indicated cases by performing minimally invasive surgical technique to achieve an optimal functional and aesthetic outcome.
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Affiliation(s)
- G Koneru
- Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India.
| | - D Bhargava
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Center, People's University, Bhanpur, Bhopal 462 037, Madhya Pradesh, India.
| | - A V Somuri
- Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India.
| | - M Manoj
- Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India.
| | - J Nesan
- Center for Technology Assisted Reconstructive Surgery, Santhome, Chennai, India.
| | - A K Pillai
- Department of Oral and Maxillofacial Surgery, People's Dental Academy, People's University, Bhanpur, Bhopal 462 037, Madhya Pradesh, India.
| | - S Beena
- TMJ Consultancy Services, Bhopal 462 001, Madhya Pradesh, India.
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33
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Merema BJ, Kraeima J, Witjes MJH, van Bakelen NB, Spijkervet FKL. Accuracy of fit analysis of the patient-specific Groningen temporomandibular joint prosthesis. Int J Oral Maxillofac Surg 2020; 50:538-545. [PMID: 32943309 DOI: 10.1016/j.ijom.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Total joint replacement (TJR) with a prosthesis can be indicated for patients with severe temporomandibular joint (TMJ) dysfunction. Surgical accuracy is necessary for correct translation of the preoperatively predicted functional outcome, wear, and biomechanical behaviour of the patient-specific TMJ-TJR prosthesis. This study describes the first clinical applications of the patient-specific TMJ-TJR prosthesis according to the Groningen principles (G-TMJ-TJR), which was developed and validated in a prior human cadaver test study. The aim of this study was to validate the accuracy of placement of the patient-specific G-TMJ-TJR in the clinical setting. It was hypothesized that a virtual surgical plan (VSP) combined with guided placement of the patient-specific G-TMJ-TJR would be performed as predictably and accurately as in the prior cadaver series. All patients who received a VSP-based patient-specific G-TMJ-TJR between December 2017 and March 2020 were included in this study. The accuracy analysis was based on postoperative cone beam computed tomography (CBCT) data. All 11 prostheses could be inserted using routine pre-auricular and retromandibular surgical approaches. Analysis of the VSPs and postoperative CBCTs showed an average three-dimensional deviation of 1.07mm (standard deviation 0.46mm, range 0.33-1.91mm) for all of the fossa and mandibular components. The patient-specific G-TMJ-TJR can be applied predictably and accurately in a clinical setting.
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Affiliation(s)
- B J Merema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - N B van Bakelen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Evaluation of complications following stock replacement of the temporomandibular joint performed between the years 2006 and 2015: a retrospective study. Oral Maxillofac Surg 2020; 24:373-379. [PMID: 32328836 DOI: 10.1007/s10006-020-00840-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Alloplastic total temporomandibular joint replacement (TMJR) is now considered to be a standard procedure for temporomandibular joint (TMJ) reconstruction. TMJR can improve mandibular mobility, restore the dental occlusion and improve facial aesthetics. The purpose was to assess the presence of intraoperative and post-operative complications, including the presence of post-operative chronic pain. METHODS This retrospective study evaluated the use of 62 stock TMJR devices implanted in 45 patients who underwent surgery between the years 2006 and 2015 by the same surgeon at the Department of Oral and Maxillofacial Surgery, Stomatology Clinic, General Teaching Hospital (VFN) Charles University, Prague, Czech Republic. RESULTS Intraoperative and post-operative complications recorded were facial nerve dysfunction (14-22%), open bite/malocclusion (2-3.2%), condylar component dislocation (1-1.6%), infection requiring revision surgery (1-1.6%) and (27-43%) reported chronic pain 24 months after surgery. CONCLUSIONS As with any surgical procedure, TMJR can have complications. The results of this study demonstrate that the most common post-operative complication was continued pain. Chronic pain after TMJR was more common in patients with a preoperative diagnosis of degenerative joint disease. Also, the incidence of post-operative TMJR pain increased with the duration of symptoms prior to TMJR, leading to a question of the best timing for TMJR.
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35
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Re: re: Review of emerging temporomandibular joint total joint replacement systems. Br J Oral Maxillofac Surg 2020; 58:380. [PMID: 32131981 DOI: 10.1016/j.bjoms.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 11/22/2022]
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36
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De Meurechy N. Re: Review of emerging temporomandibular joint total joint replacement systems. Br J Oral Maxillofac Surg 2020; 58:379. [PMID: 32113726 DOI: 10.1016/j.bjoms.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N De Meurechy
- European Face Centre, University Hospital Brussels, Brussels, Belgium.
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