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Monje Gil F, Martínez Artal P, Cuevas Queipo de Llano A, Muñoz Guerra M, González Ballester D, López Arcas JM, López Cedrún JL, Gutiérrez Pérez JL, Martín-Granizo R, del Castillo Pardo de Vera JL, García Medina B, González-García R, Moreno Sánchez M, Rodríguez EV, Fernández Sanromán J, López Martos R, Peral Cagigal B, Redondo Alamillos M, Morey Mas M, Salcedo Gil C, Ramos Medina B, Valls Ontañón A, Masià Gridilla J, Dean Ferrer A. Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint. J Clin Med 2024; 13:3319. [PMID: 38893029 PMCID: PMC11173044 DOI: 10.3390/jcm13113319] [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: 02/29/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
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.
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Affiliation(s)
- Florencio Monje Gil
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | - Patricia Martínez Artal
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | - Alberto Cuevas Queipo de Llano
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | - Mario Muñoz Guerra
- Oral and Maxillofacial Surgery Department, La Princesa University Hospital, 28006 Madrid, Spain; (M.M.G.); (R.G.-G.)
| | - David González Ballester
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | | | - José Luis López Cedrún
- Oral and Maxillofacial Surgery Department, University Hospital A Coruña, 15008 A Coruña, Spain;
| | - José Luis Gutiérrez Pérez
- Oral and Maxillofacial Surgery Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain; (J.L.G.P.); (R.L.M.)
| | - Rafael Martín-Granizo
- Oral and Maxillofacial Surgery Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | | | - Blas García Medina
- Oral and Maxillofacial Surgery Department, University Hospital Virgen de las Nieves, 18014 Granada, Spain;
| | - Raúl González-García
- Oral and Maxillofacial Surgery Department, La Princesa University Hospital, 28006 Madrid, Spain; (M.M.G.); (R.G.-G.)
| | - Manuel Moreno Sánchez
- Oral and Maxillofacial Surgery Department, University Hospital Badajoz, 06080 Badajoz, Spain; (A.C.Q.d.L.); (D.G.B.); (M.M.S.)
| | - Ekaitz Valle Rodríguez
- Oral and Maxillofacial Surgery Department, University Hospital Reina Sofía, 30003 Murcia, Spain;
| | | | - Ricardo López Martos
- Oral and Maxillofacial Surgery Department, University Hospital Virgen del Rocío, 41013 Sevilla, Spain; (J.L.G.P.); (R.L.M.)
| | - Beatriz Peral Cagigal
- Oral and Maxillofacial Surgery Department, University Hospital Río Hortega, 47012 Valladolid, Spain;
| | - Marta Redondo Alamillos
- Oral and Maxillofacial Surgery Department, University Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Miguel Morey Mas
- GBCOM Dental and Maxillofacial Clinic, 07014 Palma de Mallorca, Spain;
| | - Carlos Salcedo Gil
- Oral and Maxillofacial Surgery Department, University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Benito Ramos Medina
- Oral and Maxillofacial Surgery Department, University Hospital Santa Lucía, 30202 Cartagena, Spain;
| | - Adaia Valls Ontañón
- Oral and Maxillofacial Surgery Department, Hospital Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Jorge Masià Gridilla
- Oral and Maxillofacial Surgery Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain;
| | - Alicia Dean Ferrer
- Oral and Maxillofacial Surgery Department, Hospital Reina Sofía, 14004 Córdoba, Spain;
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Woodford SC, Robinson DL, Abduo J, Lee PVS, Ackland DC. Muscle and joint mechanics during maximum force biting following total temporomandibular joint replacement surgery. Biomech Model Mechanobiol 2024; 23:809-823. [PMID: 38502434 PMCID: PMC11101553 DOI: 10.1007/s10237-023-01807-1] [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: 09/19/2023] [Accepted: 12/20/2023] [Indexed: 03/21/2024]
Abstract
Total temporomandibular joint replacement (TMJR) surgery is the established treatment for severe temporomandibular joint disorders. While TMJR surgery is known to increase mouth-opening capacity, reduce pain and improve quality of life, little is known about post-surgical jaw function during activities of daily living such as biting and chewing. The aim of this study was to use subject-specific 3D bite force measurements to evaluate the magnitude and direction of joint loading in unilateral total TMJR patients and compare these data to those in healthy control subjects. An optoelectronic tracking system was used to measure jaw kinematics while biting a rubber sample for 5 unilateral total TMJR patients and 8 controls. Finite element simulations driven by the measured kinematics were employed to calculate the resultant bite force generated when compressing the rubber between teeth during biting tasks. Subject-specific musculoskeletal models were subsequently used to calculate muscle and TMJ loading. Unilateral total TMJR patients generated a bite force of 249.6 ± 24.4 N and 164.2 ± 62.3 N when biting on the contralateral and ipsilateral molars, respectively. In contrast, controls generated a bite force of 317.1 ± 206.6 N. Unilateral total TMJR patients biting on the contralateral molars had a significantly higher lateral TMJ force direction (median difference: 63.6°, p = 0.028) and a significantly lower ratio of working TMJ force to bite force (median difference: 0.17, p = 0.049) than controls. Results of this study may guide TMJ prosthesis design and evaluation of dental implants.
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Affiliation(s)
- Sarah C Woodford
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jaafar Abduo
- Melbourne Dental School, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia
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Linsen SS, Teschke M, Heim N, Mercuri LG. Is the risk of chronic pain after total temporomandibular joint replacement independent of its indications? A prospective cohort study. Br J Oral Maxillofac Surg 2023; 61:337-343. [PMID: 37230824 DOI: 10.1016/j.bjoms.2023.03.006] [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: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients treated with TMJR regardless of the indication for the operation. A prospective, single-centre study was performed. Data on 36 patients (56 TMJR) were collected preoperatively and at follow up two to three years postoperatively. The primary outcome variable was subjective TMJ pain (none/mild, moderate/severe) at follow up. The predictor variables were objective pressure pain thresholds (PPTs) at the ipsilateral joint(s) and muscle(s), functional parameters (incisal range of motion, maximum voluntary clenching), subjective oral health-related quality of life (OHRQoL), and demographic and surgical variables. The number of patients with moderate/severe pain decreased from 17 preoperatively to 10 at follow up. Self-reported TMJ pain was significantly reduced in the entire group (p = 0.001). Patients with moderate/severe pain at follow up were more restricted in their OHRQoL but did not differ in PPT and functional parameters from the no/mild pain group. Moderate/severe TMJ pain at follow up was associated with unilateral TMJR and more preoperative pain. This study provides preliminary evidence that despite good pain reduction in most patients, persistent pain after TMJR is common and, in rare cases, may even worsen regardless of the original diagnosis. At follow up there was a close relation between OHRQoL and TMJ pain. TMJ pain after TMJR cannot be confirmed by objective measurement methods (PPTs and functional parameters).
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Affiliation(s)
- S S Linsen
- Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany.
| | - M Teschke
- Private Practice, Zeppelinstr.24, 61352 Bad Homburg, Germany
| | - N Heim
- Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - L G Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States; Department of Bioengineering, University of Illinois Chicago, 851 S Morgan St, Chicago, IL 60607, United States; Stryker/TMJ Concepts, 6059 King Drive, Ventura, CA 93003, United States
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Dowgierd K, Kawlewska E, Joszko K, Kropiwnicki J, Wolanski W. Biomechanical Evaluation of Temporomandibular Joint Reconstruction Using Individual TMJ Prosthesis Combined with a Fibular Free Flap in a Pediatric Patient. Bioengineering (Basel) 2023; 10:bioengineering10050541. [PMID: 37237610 DOI: 10.3390/bioengineering10050541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/14/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
The main aim of this study was to perform a complex biomechanical analysis for a custom-designed temporomandibular joint (TMJ) prosthesis in combination with a fibular free flap in a pediatric case. Numerical simulations in seven variants of loads were carried out on 3D models obtained based on CT images of a 15-year-old patient in whom it was necessary to reconstruct the temporal-mandibular joints with the use of a fibula autograft. The implant model was designed based on the patient's geometry. Experimental tests on a manufactured personalized implant were carried out on the MTS Insight testing machine. Two methods of fixing the implant to the bone were analyzed-using three or five bone screws. The greatest stress was located on the top of the head of the prosthesis. The stress on the prosthesis with the five-screw configuration was lower than in the prosthesis with the three-screw configuration. The peak load analysis shows that the samples with the five-screw configuration have a lower deviation (10.88, 0.97, and 32.80%) than the groups with the three-screw configuration (57.89 and 41.10%). However, in the group with the five-screw configuration, the fixation stiffness was relatively lower (a higher value of peak load by displacement of 171.78 and 86.46 N/mm) than in the group with the three-screw configuration (where the peak load by displacement was 52.93, 60.06, and 78.92 N/mm). Based on the experimental and numerical studies performed, it could be stated that the screw configuration is crucial for biomechanical analysis. The results obtained may be an indication for surgeons, especially during planning personalized reconstruction procedures.
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Affiliation(s)
- Krzysztof Dowgierd
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, Żołnierska 18a Street, 10-561 Olsztyn, Poland
| | - Edyta Kawlewska
- Department of Biomechatronics, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Kamil Joszko
- Department of Biomechatronics, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Jacek Kropiwnicki
- Scientific Department, ChM Sp Zoo Implants & Instruments, 16-061 Lewickie, Poland
| | - Wojciech Wolanski
- Department of Biomechatronics, Silesian University of Technology, 44-100 Gliwice, Poland
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Ritto FG, Zuniga JR. Total temporomandibular mandibular joint alloplastic replacement as first line treatment for condylar fracture. ORAL AND MAXILLOFACIAL SURGERY CASES 2023. [DOI: 10.1016/j.omsc.2023.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Scolaro A, Khijmatgar S, Rai PM, Falsarone F, Alicchio F, Mosca A, Greco C, Del Fabbro M, Tartaglia GM. Efficacy of Kinematic Parameters for Assessment of Temporomandibular Joint Function and Disfunction: A Systematic Review and Meta-Analysis. Bioengineering (Basel) 2022; 9:bioengineering9070269. [PMID: 35877320 PMCID: PMC9311583 DOI: 10.3390/bioengineering9070269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this review was to answer the following PICO question: “Do TMJ kinematic parameters (intervention and comparison) show efficacy for assessment of mandibular function (Outcome) both in asymptomatic and TMD subjects? (Population)”. PubMed, Scopus, Web of Science, Embase, Central databases were searched. The inclusion criteria were (1) performed on human, (2) English only, (3) on healthy, symptomatic or surgically altered TMJ, (4) measured dynamic kinematics of mandible or TMJ (5) with six degrees of freedom. To assess the Risk of Bias, the Joanna Briggs Institute tool for non-randomised clinical studies was employed. A pairwise meta-analysis was carried out using STATA v.17.0 (Stata). The heterogeneity was estimated using the Q value and the inconsistency index. Ninety-two articles were included in qualitative synthesis, nine studies in quantitative synthesis. The condylar inclination was significantly increased in female (effect size 0.03°, 95% CI: −0.06, 0.12, p = 0.00). Maximum mouth opening (MMO) was increased significantly in female population in comparison with males (effect size 0.65 millimetres (0.36, 1.66). Incisor displacement at MMO showed higher values for control groups compared with TMD subjects (overall effect size 0.16 millimetres (−0.37, 0.69). Evidence is still needed, considering the great variety of devices and parameters used for arthrokinematics. The present study suggests standardising outcomes, design, and population of the future studies in order to obtain more reliable and repeatable values.
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Affiliation(s)
- Alessandra Scolaro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Pooja Mali Rai
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Francesca Falsarone
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Francesca Alicchio
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Arianna Mosca
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Christian Greco
- Azienda Sanitaria dell’Alto Adige, Merano Hospital, 39100 Bolzano, Italy;
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- IRCC Orthopaedic Institute Galeazzi, 20161 Milan, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
- Correspondence:
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Rahman F, Femiano F, Louis PJ, Kau CH. An Evaluation of Jaw Tracking Movements in Patients with Total Joint Replacements versus a Control Group. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060738. [PMID: 35744001 PMCID: PMC9228249 DOI: 10.3390/medicina58060738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: One form of treatment for degenerative temporomandibular joint diseases such as osteoarthritis, rheumatic arthritis, TMJ ankylosis, and condylar resorption is total joint replacement. The aim of this study was to examine the function of the temporomandibular joint after prosthetic joint replacement. Materials and methods: Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via a SICAT JMT+ device. This non-invasive system measures 3D position and linear movements in all degrees of freedom and allows undisturbed functional mandibular movements to provide a quantitative evaluation. In addition, a TMJ questionnaire consisting of the subjective symptoms was also obtained. To date, no similar studies have been cited in the literature. Results: Mandibular movements after prosthetic joint replacement were recorded during opening, closing, protrusion, and lateral excursive movements and were all significantly decreased compared to those of controls. In the treatment group, the maximum incisal opening was 33.46 ± 5.47 mm, left lateral movement was 1.91 ± 2.7 mm, right lateral movement was 1.74 ± 1.74 mm, and protrusive movement was 2.83 ± 2.05 mm. The p-value comparison study and control group indicated significant difference (p < 0.0001) between the two groups. The study group stated a high level of satisfaction with the total joint replacement. Conclusion: Within the limitations of the study, the following conclusions can be drawn: (1) TMJ replacement patients showed significantly limited jaw movements compared to the control group; (2) a small percentage of TMJ replacement patients still present low levels of pain but improved chewing ability and quality of life.
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Affiliation(s)
- Farhana Rahman
- Department of Orthodontics, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA;
| | - Felice Femiano
- Dipartimento Multidiscilinare di Specialita Medico-Chirurgiche e Odontoiatriche, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Patrick J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA;
| | - Chung How Kau
- Department of Orthodontics, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA;
- Correspondence:
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Ding R, Hua J, Qin H, He D. Biomechanical analysis of a temporomandibular joint prosthesis for lateral pterygoid muscle reattachment. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:e245-e255. [PMID: 35484032 DOI: 10.1016/j.oooo.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the biomechanical properties of a novel temporomandibular joint (TMJ) prosthesis with an attachment area for the lateral pterygoid muscle (LPM). STUDY DESIGN Three prosthesis models were created and compared using finite element analysis for the displacement, stress, and strain when simulating the maximum bite force loading. A verification experiment and a compression test were conducted. RESULTS The displacement, stress, and strain of the novel TMJ prosthesis were larger than the solid condylar neck prosthesis and similar to the slotted condylar neck prosthesis, but the values were far less than the yield strength of titanium alloy. The maximum stress and strain in the novel TMJ prosthesis was concentrated in the inner and boundary areas of the LPM reattachment region beside the thinnest part of the prosthesis neck. The difference in the strain values measured using the verification test and those using finite element analysis was <20%. Compression testing of the novel TMJ prosthesis revealed that the mandible fractured when the force reached 588.97 N, whereas the prosthesis itself did not break or deform. CONCLUSIONS The mechanical distribution of the novel prosthesis was feasible under maximum bite force for potential clinical application.
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Affiliation(s)
- Ruoyi Ding
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; National Clinical Research Center of Stomatology, Shanghai, China
| | - Jiangshan Hua
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; National Clinical Research Center of Stomatology, Shanghai, China
| | - Haiyi Qin
- Department of Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China
| | - Dongmei He
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; National Clinical Research Center of Stomatology, Shanghai, China.
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Bulcher CM, Kalantari OB. Residents Commentary for "Unilateral, Alloplastic Temporomandibular Joint Reconstruction, Biomechanically What Happens to the Contralateral Temporomandibular Joint? A Prospective Cohort Study". J Oral Maxillofac Surg 2021; 79:e3-e5. [PMID: 34620423 DOI: 10.1016/j.joms.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Christopher M Bulcher
- PGY-5 Resident, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH
| | - Ouzhan B Kalantari
- PGY-5 Resident, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH.
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