Clinical guidelines for total temporomandibular joint replacement

Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Considerations for the Use of Alloplastic Temporomandibular Joint Replacement in Irradiated Patients: Report of an Off-Label Indication

BACKGROUND

Custom-made alloplastic temporomandibular joint replacement (ATMJR) is not validated in irradiated patients. However, in specific situations, after previous reconstructive surgical failures, the authors hypothesized the role of a customized ATMJR after radiotherapy.

METHODS

A 65-year-old male patient was referred to Instituto Português da Face-Lisbon, Portugal-after failed attempts of mandibular reconstruction secondary to oral carcinoma resection and partial hemi-mandibulectomy plus radiotherapy of 60 total Grays. Primary reconstruction was performed with fibula free flap. Due to failure, secondary reconstructions were performed with osteosynthesis plate without success. The patient was unable to have adequate mastication and deglutition due to a severe crossbite. The authors treated the patient with an extended customized alloplastic temporomandibular joint replacement (F0M2).

RESULTS

With 3 years of follow-up, the patient showed an improvement in masticatory function, mandibular motion, pain levels, and overall quality of life. No complications were observed related to ATMJR.

CONCLUSIONS

The presented case described how ATMJR, although not a validated option after radiotherapy, can be considered to restore functionality in complex cases with bone and soft tissues problems.

A Patient Who Recently Underwent Total Temporomandibular Joint Replacement Reporting for Endodontic Therapy

A patient who underwent a recent total joint replacement (TJR) of the left temporomandibular joint presents for evaluation and management of #19. The diagnosis was consistent with irreversible pulpitis, and root canal therapy was recommended. Because of the recent TJR and limitations in opening, a bite block was used during the procedure.

Extended total temporomandibular joint reconstruction prosthesis: A comprehensive analysis

Alloplastic total temporomandibular joint replacement (TMJR) is the treatment of choice for end-stage temporomandibular joint diseases. Extended TMJR (eTMJR) is a modification of the standard alloplastic fossa-condyle joint that includes components extending further to the skull base or the mandible. The aim of this study is to review the use of the eTMJR prosthesis for the treatment of large craniomaxillofacial defects. Data mining was performed according to the PRISMA statement using online search in databases such as PubMed (Medline), Google Scholar, Dimensions, Semantic Scholar and Web of Science. A total of 19 case reports, 08 case series and 03 retrospective studies were identified. A total of 49 patients were presented in the case reports and case series, who were implanted with 56 eTMJR prostheses (07 bilateral and 42 unilateral procedures). The mean age of the patients was 36.02±16.54 years, the male to female patient ratio was 1:1.72 and the mean follow-up time was 23.74 ± 19.83 months. The eTMJR prosthesis was most frequently used to treat ameloblastoma and hemifacial microsomia. Analysis of the retrospective studies was performed in three domains: the baseline characteristic of patients, treatment outcomes in terms of functional variables and complications after eTMJR prostheses implantation. This study concluded that the implantion of the eTMJR prosthesis was uncommon, that appropriate class of eTMJR prosthesis was not reported, and that the width of the mandibular component (like the length) of eTMJR prosthesis has substantial variations.

Recent Advances in Temporomandibular Joint Surgery

Temporomandibular disorders (TMDs) affect a high percentage of children and adults worldwide. Surgery may be indicated in severe or recalcitrant cases. Several recent advancements in TMD and temporomandibular joint (TMJ) surgery have elevated understanding and the ability to treat affected patients. We discuss recent advances in TMD epidemiology, juvenile idiopathic arthritis (JIA) of the TMJ, and surgical techniques and technologies. Technical advancements have been identified in TMJ arthroscopy, the treatment of TMJ subluxation and dislocation, and extended prosthetic total TMJ reconstruction (eTMJR). Overall, this review provides valuable insights into significant recent advancements in TMJ disorders and their surgical management.

Concomitant Temporomandibular Joint Replacement and Orthognathic Surgery

The treatment of patients with severe temporomandibular joint (TMJ) disorders and associated skeletal discrepancies presents a complex challenge for oral and maxillofacial surgeons. It is widely recognized that TMDs can impact the stability and outcomes of surgical treatments for dentofacial deformities. Consequently, addressing TMDs prior to or in conjunction with orthodontic or surgical interventions may be necessary to achieve optimal and long-lasting results. Alloplastic temporomandibular joint replacement (TMJR) and orthognathic surgery have emerged as the standard approach due to their predictability, long-term stability and excellent outcomes when addressing end-stage TMJ disease in conjunction with DFDs as it provides a comprehensive solution to address both functional and aesthetic aspects of these patients' conditions. Understanding the appropriate utilization of TMJR in conjunction with orthognathic surgery can lead to improved treatment planning and successful outcomes for patients with complex TMJ disorders and associated dentofacial deformities. This review aims to discuss the indications, preoperative evaluation, staging, sequencing, and surgical considerations involved in utilizing alloplastic TMJ replacement in the presence of dentofacial deformities.

Temporomandibular disorders-review of evidence-based management and a proposed multidisciplinary care pathway

Temporomandibular disorders (TMDs) are a prevalent but complex group of conditions that cause orofacial pain. Temporomandibular disorders are recognized as one of the most common chronic pain conditions, alongside back pain and headache disorders. Given the competing theories surrounding what causes TMDs and limited high-equality evidence on optimally treating TMDs, clinicians often encounter challenges in developing an effective management plan for patients. Furthermore, patients will often seek advice from multiple health care providers from varying specialties, seeking curative management, often resulting in inappropriate treatments and no improvement in pain symptoms. Throughout this review, we explore the existing evidence base surrounding the pathophysiology, diagnosis, and management of TMDs. An existing United Kingdom-based multidisciplinary care pathway for the management of TMDs is described herein, highlighting the benefits of a multidisciplinary approach to patient care for TMDs.

Treatment Strategy for Condyle/Ramus Deficiency Using 3D Virtual Surgery and CAD/CAM Technologies; Total Joint Replacement or Inverted-L Osteotomy

OBJECTIVE

To introduce a guideline for selecting proper surgical modalities for correction of skeletal Class II malocclusion with moderate-to-severe vertical height deficiency (VHD) of the condyle/ramus complex (CRC) using bimaxillary surgery in conjunction with total joint replacement (TJR) or inverted-L osteotomy (ILO) assisted by 3D virtual surgical planning and CAD/CAM technologies.

CASES

Four cases of severe skeletal Class II patients with moderate-to-severe VHD of CRC were presented. They underwent bimaxillary surgery using Le Fort I osteotomy in the maxilla and TJR or ILO in the mandible, with the help of virtual surgical planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM)-printed surgical guides and osteosynthesis plates. Guidelines are as follows: (1) if a patient has a moderate degree of VHD and the function of the temporomandibular joint (TMJ) is normal, ILO would be preferred for vertical elongation of the ramus; (2) if a patient has congenitally small condyle or severe condylar resorption, TJR would be preferred to resolve severe VHD of CRC; and (3) when a patient has a metal allergy, foreign body reaction or anatomic limitations (ie, thin cranial base cortex for fossa fixation), ILO would be a better option than TJR.

RESULTS

TJR or ILO using VSP and CAD/CAM-printed surgical guides, wafers, and customized plates can provide a proper selection of the surgical plan, accurate transfer of surgical plans to actual surgical procedures, and esthetic improvement of the facial profile.

CONCLUSION

This guideline based on the degree of VHD and functional aspects of CRC might help clinicians to select effective surgical modality for correction of skeletal Class II malocclusion with moderate-to-severe VHD of CRC.

Quality of Life After Total Temporomandibular Joint Prothesis Surgery

INTRODUCTION

Total temporomandibular joint (TMJ) prostheses are increasingly used in patients with joint destruction presenting significant pain and mouth opening limitation. This surgery can be considered as the last resort solution whose goal is to restore the mandible function. The aim of this study was to evaluate the patient quality of life (QoL) before and after TMJ replacement surgery with a total TMJ prosthesis, using a modified QoL scale.

MATERIALS AND METHODS

All patients with a total uni or bilateral TMJ prosthesis who could be contacted were included. All patients completed 2 retrospective questionnaires: once relative to the preoperative QoL and another for the post-operative QoL, including the assessment of mouth opening limitation, daily eating difficulties and also a QoL score, adapted from the TMJ-QoL questionnaire.

RESULTS

A total of 17 patients were included: 13 temporomandibular ankylosis, 3 condylar resorptions and 1 congenital malformation. Mouth opening limitation and daily eating difficulties were significantly reduced after surgery (P < 0.001). Nine of the 11 QoL questions showed a significant decrease in score and thus an improvement of the QoL after surgery: having a conversation (P = 0.006), eating (P < 0.001), yawning (P < 0.001), sleeping (P= 0.043), recreational activities (P = 0.005), relaxing (P= 0.021), feeling depressed because of TMJ problems (P = 0.032), daily activities (P = 0.008) and patient self-assessment of QoL (P = 0.003). Two showed no significant difference: taking analgesics, and social life. Total score of QoL showed a significant improvement (P= 0.003).

CONCLUSIONS

Quality of life, mouth opening, and daily eating were significantly improved after total TMJ prosthesis, in agreement with the litterature. The TMJ prosthesis could be considered ealier in the management of end-stage temporomandibular disease.

Functional outcomes after using the glenoid fossa as a fixed anchorage for the temporomandibular joint discopexy in patients with disc displacement without reduction

The aim of the present study was to evaluate the use of the glenoid fossa as an anchorage for the temporomandibular joint (TMJ) disc repositioning in patients with a disc displacement (DD) without reduction. A prospective case series study included patients with DD without reduction. According to the Wilkes staging system for the TMJ internal derangement, preoperative magnetic resonance imaging (MRI) scans and clinical examinations determine the stage of the DD. The discopexy treatment consists of combined endaural/preauricular incision on the tragus, and freeing the anteromedial displaced disc from its attachments. An intra bony hole was drilled 2 mm away from the postero-lateral lip of the glenoid fossa and perpendicular to it. The disc was securely fixed to the roof of the fossa via a Prolene 0 suture in a double-pass suture fashion. The functional assessment was based on the pain visual analogue scale (VAS) and measurements of the maximum inter-incisal opening (MIO) after 1, 6, 12, and 18 months. P values ≤ 0.05 were considered significant. Thirteen of 25 joints were diagnosed with Wilkes stage III. The mean VAS score significantly decreased to 2.2 ± 1.0 and the MIO also significantly improved with a mean of 35.9 ± 3.5 mm after 18 months (P < 0.001). The rest of the cases (12 joints) were diagnosed with Wilkes stage IV, and the VAS score decreased to 1.6 ± 0.7. The MIO increased to 34.2 ± 3.3 mm at the end of the follow-up (P < 0.001). Within the limitations of the study, it seems that using the glenoid fossa as anchorage for the TMJ disc might have some clinical relevance and therefore might be taken into consideration whenever it is deemed appropriate.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.

A Bibliometric Analysis of International Publication Trends in Total Temporomandibular Joint Replacement Research (1986-2020)

PURPOSE

To conduct a bibliometric analysis that systematically characterizes publications on temporomandibular joint temporomandibular joint replacement from 1986 to 2020.

MATERIALS AND METHODS

The articles were retrieved on the same day from the Web of Science Core Collection database of the Web of Science on December 31, 2020 to prevent bias due to daily database updates. Excel 2016, CiteSpace IV, and VOSviewer v1.6.16 were used for analysis.

RESULTS

A sum of 610 publications from 1986 to 2020 were analyzed. The highest number of publications were identified and published in the Journal of Oral and Maxillofacial Surgery. The United States had the highest number of publications and the highest H-index. The highest co-citations were from Mercuri.

CONCLUSIONS

In this study, developments, the most influential publications, journals, and countries in the field of temporomandibular joint temporomandibular joint replacement were determined based on evidence through bibliometric analysis.

Quality of life, chronic pain, insomnia, and jaw malfunction in patients after alloplastic temporomandibular joint replacement: a questionnaire-based pilot study

Studies of patients undergoing alloplastic total temporomandibular joint replacement seldom report on quality of life (QoL) and sleep. The aim of this pilot study was to assess these factors in such a patient cohort using validated psychometric questionnaires. Data were collected via online surveys comprising the following six questionnaires: Short Form-12 Health Survey (SF-12), Patient Health Questionnaire-15, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, Insomnia Severity Index, Graded Chronic Pain Scale, and Jaw Disability List. Pain intensity, limitation in nutrition, and treatment satisfaction were assessed using numerical rating scales. Mouth opening was measured at follow-up. The SF-12 Physical Composite Score was markedly lower than that of the age-matched general population, whereas the Mental Composite Score did not differ significantly. Participants indicated a low somatization level and low level of disability due to pain, but reduced QoL. Clinically relevant insomnia was reported by 36% of participants. In conclusion, the results of this pilot study indicate that QoL and sleep in patients with a total temporomandibular joint replacement differ from those in the general population, indicating the need for a comprehensive outcome assessment utilizing validated psychometric tools in accordance with the current biopsychosocial model of chronic disorders.

Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature

Background and objectives: There are an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.