Alloplastic temporomandibular joint replacement—what does the future hold?

Abstract

Abstract: Salvage management of end-stage TMJ pathologic conditions are considered indications for alloplastic temporomandibular joint replacement (TMJR). The primary goal of TMJR is the safe and effective restoration of mandibular function and form. In order to provide successful function, form, as well as long-term subjective and objective outcomes, any present or future TMJR device must be able to safely and effectively manage the anatomic, functional, and aesthetic discrepancies presented to it for reconstruction. To accomplish this, all TMJR devices, present and future, must demonstrate that they are constructed using biologically compatible materials, designed and manufactured to bear the loads imposed on their components by function, and that they are accurately analyzed biomechanically and clinically tested to assure long-term efficacy for patients. In the future, biomechanical laboratory and clinical outcome studies should be a guide not only to surgeons and patients, but also regulatory, health care and the indemnification communities of interest. Additive manufacturing (3D printing), augmented reality (AR), artificial intelligence (AI) and robot-assisted surgery (RAS) will become important tools for the general growth and development of the specialty of oral and maxillofacial surgery. What role these will play in the future of TMJ disorder diagnosis, non-surgical and surgical management remains to be determined. This paper will discuss the past and present iterations of TMJR devices, the embodiments, the successes, and failures as a guide to what the future may hold for researchers and clinicians with regard to the development of the next generation of TMJR devices.