TMJ Concepts Related Articles Page 1 of 14 Item Bibliography Entry Abstract / Summary A retrospective study of 107 patients (male, n = 13; female, n = 94) with 163 joints previously treated with Proplast-Teflon (PT; Vitek, Inc, Houston, TX) implants was performed. The average time in situ for the PT was 59.8 months (range, 2 to 126 months). Average length of follow-up was 84.6 months (range, 59 to 126 months). Only 12% of joints showed no significant osseous changes radiographically. Forty-five patients (42%) continue to have in situ PT implants and 36% of them experience pain that requires medication; 25% have developed an Henry CH, Wolford LM: Treatment outcomes for temporomandibular joint anterior open bite and malocclusion; 9% have limited vertical opening; and 40% are asymptomatic. Temporomandibular joint (TMJ) reconstruction after PT implant failure was performed 1 reconstruction after Proplast-Teflon implant failure. J Oral Maxillofac Surg with five different autologous tissues or a total joint prosthesis. Autologous tissues used to reconstruct the TMJ and the rates of success were as follows: 1) 31% free temporalis fascia and 51:352-358, 1993 muscle graft with and 13% without sagittal split ramus osteotomy, 2) 8% dermis, 3) 25% conchal cartilage, 4) 12% costochondral grafts, and 5) 21% sternoclavicular grafts. The success rate decreased in all autologous tissue groups as the number of TMJ surgeries performed before reconstruction increased. Ankylosis was the most common cause of failure. Results of TMJ reconstruction with a total joint prosthesis were as follows: 1) 88% functional and occlusal stability of total joint prosthesis; 2) level of pain reduction was rated as 46% good, 38% fair, and 16% poor; and 3) an average interincisal opening of 27 mm at 24 months or less, and 33 mm at 25 months and beyond. A study of 56 patients (55 female, one male) with 100 reconstructed temporomandibular joints (TMJ) using the Techmedica custom-made total joint system (Techmedica Inc, Camarillo, CA) is presented. The patients ranged in age from 15 to 61 years (average, 39 years) and had 16 to 46 months' follow-up (average 30 months). Outcome groups were categorized as good, fair, or poor, based on clinical assessment. Results show that 35 patients (63%) with 58 joints (58%) had a good outcome, and 13 patients (23%) with 26 joints (26%) had a fair outcome, and 8 Wolford LM, Cottrell DA, Henry CH: Temporomandibular joint patients (14%) with 16 joints (16%) had a poor outcome. Patients with one or no previous temporomandibular joint surgeries had 86% in the good group, 14% in the fair group, and no 2 reconstruction of the complex patient with the Techmedica custom-made patients in the poor group. In patients with two or more previous surgeries, the success rate decreased to 55% with good results, 26% with fair results and 19% with poor results. Long-term total joint prosthesis. J Oral Maxillofac Surg 52:2-10, 1994 morbidity included five ramus prostheses that were removed or revised. Seventeen patients (30%) received further operations because of heterotopic bone formation, fibrosis, calcification, inflammation, and/or pain which occurred mostly in patients with previous Proplast/Teflon (Vitek, Inc, Houston, TX) implants. Continued pain has been associated with the poor group, which may be related to problems such as cervical neuropathy, sympathetic dystrophy, a residual inflammatory or immunologic reaction to Proplast/Teflon or silastic particles, fibrosis, calcification, heterotopic bone, or other unidentified factors. Purpose: The purpose was to test the outcome of a custom computer assisted design/computer assisted manufactured (CAD/CAM) total temporomandibular joint (rMJ) reconstruction system. There were 215 patients (13 males and 202 females); the average age at reconstruction was 40.9 ±10.3 years (range, 15 to 77 years). Patients and Methods: There were 363 joints placed, 296 bilateral and 67 unilateral. The patients had TMJ problems for an average of 10.3 ± 7.0 years (range, 1 to 44 years), and had undergone a mean of 5.4 ± 4.8 (range, 0 to Mercuri LG, Wolford LM, Sanders B, White D, Hurder A, Henderson W: 28) prior unsuccessful surgeries. Preoperative and postoperative data were collected for up to 48 months using a standardized data collection format. Subjective data related to pain, 3 Custom CAD/CAM total temporomandibular joint reconstruction system: function of the lower jaw, and diet, were obtained using a visual analogue scale. Objective measures of mandibular range of motion were made directly on the patient preoperatively and Preliminary multicenter report. J Oral Maxillofac Surg 53:106-115, 1995 postoperatively. Results: Preliminary analysis of these data reveals a statistically significant decrease in pain, an increase in function, and improvement in diet (P < .0001) from the preoperative measurements to 1 and 2 years postoperatively. There was also improvement in mandibular vertical range of motion. The number of previous surgeries was a strong predictor of postoperative pain, function, and diet scores, as well as of maximal interincisal opening. A life table analysis of failures indicates good durability of the prosthesis over time. Conclusions: These preliminary data indicate that this custom CAD/CAM total TMJ reconstruction system seems to be useful in the treatment of the multiply operated, and/or anatomically mutilated TMJ. James RB: Surgical treatment of temporomandibular dysfunction (revised 4 edition). Otolaryngology Vol. 3, Chapter 21, 1998 Patients with very advanced degenerative disease, ankylosis, post-traumatic condylar destruction, and multi-operated patients may be candidates for joint replacement with fossa and condylar prostheses. Great advances have been made in developing biocompatible materials, improved designs for patient-fitted prostheses. These devices have treated internal derangement cases after multiple surgical and nonsurgical treatment failures, as well as restoring form and function following the removal of failed Vitek Proplast-Teflon (Houston, Texas) Mercuri LG: Considering total alloplastic temporomandibular joint 5 containing temporomandibular joint implants. This paper will provide practitioners dealing with complex, debilitated, functionless temporomandibular joint (TMJ) patients with information replacement. Cranio 17:44-48, 1999 related to this treatment modality. They will then be able to address the indications for the use of alloplastic temporomandibular joint replacement devices, the devices presently available, the surgery involved in their placement, possible complications of implantation and post-operative outcomes and expectations with patients who would benefit from the implantation of these devices. Purpose: This study looked at prospective subjective and objective preoperative and postoperative outcome data from a set of multiply operated, anatomically mutilated, functionless, chronic temporomandibular joint (TMJ) pain patients who have undergone TMJ reconstruction with a custom-fitted prosthetic system. Patients and Methods: Two hundred fifteen patients (363 joints: 296 bilateral, 67 unilateral) who had undergone total TMJ reconstruction with a custom-fitted TMJ prosthesis (Techmedica; now TMJ Concepts, Camarillo, CA) made up the Mercuri LG: Subjective and objective outcomes in patients with a custom- subjects reviewed in this study. The mean follow-up period was 30.7 months. The patients were divided into 3 groups based on the number of prior unsuccessful TMJ arthrotomies they had 6 fitted alloplastic temporomandibular joint prosthesis. J Oral Maxillofac Surg undergone (group 1 = 0 to 2; group 2 = 3 to 8; and group 3 = 9 or more). Results: Subjective improvement ratio data indicated that postoperatively group 1 had a 61.3% improvement in 57:1427-1430, 1999 subjective parameters, group 2 had a 51.0% improvement, and group 3 had only a 27.5% improvement. Objective improvement ratio data showed that postoperatively group 3 had the largest increase in maximum interincisal opening, whereas the other groups had less improvement. Conclusion: The data from this study confirm, as previously reported in the literature, that the greater the number of surgical procedures performed on the TMJ, the less the chance of significant subjective improvement. Mercuri LG: The use of alloplastic prostheses for temporomandibular joint 7 reconstruction. J Oral Maxillofac Surg 58:70-75, 2000 Mercuri LG: The TMJ Concepts patient fitted total temporomandibular joint 8 reconstruction prosthesis. Oral Maxillofac Surg Clinics North Am 12:73-91, 2000 Jaw joint (temporomandibular joint or TMJ) disease is estimated to affect 30 million Americans, with approximately 1 million new patients diagnosed each year (1). Although many of these patients can be managed with nonsurgical therapies, some patients require surgical intervention. The TMJ is a unique joint in that it does not function independently but works in tandem with its contralateral joint. Therefore, disease affecting 1 joint can either directly or indirectly affect the functioning and health of the contralateral joint. When surgical intervention of the TMJ is Wolford LM, Mehra P: Custom-made total joint prostheses for required, the joint can often be reconstructed with autogenous tissues. However, certain TMJ conditions and pathology require reconstruction with a total joint prosthesis for predictable 9 temporomandibular joint reconstruction. Bayl Univ Med Cent Proc 13:135- treatment outcomes. Some of these conditions include ≥2 previous