TEMPOROMANDIBULAR-JOINT DEVICES - TREATMENT FACTORS AND OUTCOMES

TMI devices have been used for many years in reconstruction of the tem poromandibular joint (TMI). The most common endosseous implant current ly used in TMI reconstruction is a mini-anchor that is placed in the p osterior head of the condyle to support artificial ligaments to stabil ize the articular disk in the proper position. A 2-year follow-up stud y shows a success rate of 90% in reference to incisal opening, jaw and occlusal stability, and significant reduction in presurgical pain lev el. Some materials that have been used in TMJ reconstruction, includin g Proplast-Teflon (PT) and Silastic devices, have caused devastating p roblems for patients. These materials, (particularly the PT) can cause severe foreign-body giant-cell reaction, severe bone and soft-tissue destruction, and migration of particles to other body areas, and may i nitiate or exacerbate connective tissue and autoimmune disease problem s. Christensen joint prosthesis has been reported to have very good su ccess in TMJ reconstruction. The most thoroughly studied TMI total joi nt device is the Techmedica custom-made total joint prosthesis, with a 5-year follow-up study on 31 patients and 52 reconstructed joints. Al l patients have functioning prostheses with good jaw and occlusal stab ility and an average pain reduction of 4.4 points on a 0-to-10 visual analog pain scale. However, this device currently is unavailable. In c omplex cases requiring multiple TMI operations, particularly those wit h previously failed alloplast, a custom-made total joint prosthesis, u sing materials with proven safety and efficacy in orthopedic joint rec onstruction, may be the only option available to improve predictably t he quality of life of these patients.