Page 105 - Demo

Stock or patient-specific TMJ replacement1034IntroductionProsthetic treatment of the temporomandibular joint (TMJ) is far from new, with the first alloplastic interpositioning dating back to the mid19th century and total joint replacement (TJR) first reported in 1965.(1) Since then, TJR has seen significant changes, using different designs and materials, as well as the development of both stock and computerassisted design/computer-assisted manufacturing (CAD-CAM) systems. Most well-known current systems are the stock and patient-fitted Zimmer Biomet Microfixation TMJ Replacement System (Jacksonville, FL, USA) and the TMJ Concepts Patient-Fitted Total TMJ Replacement System (Ventura, CA, USA). While several other PSI are available on the market as well, these two systems are currently the only U.S. Food & Drug Administration (FDA)-approved TJR systems available.(1,2) The stock Biomet system makes use of three differently sized mandibular and fossa components, requiring the surgeon to select a size and intraoperatively alter the recipient’s bone to achieve a desirable fit.(2,3) In contrast, PSI joint replacements, such as the TMJ Concepts prosthesis, rely on CAD/CAM technology. A pre-operative computed tomographic scan of the region of interest is digitally converted to a dataset by which the TJR components are designed, considering any anatomical abnormalities and the need for occlusal correction. As such, the surgeon is not forced to adapt the anatomical structures to achieve a tight fit, and operating time is reduced. Fixation screw placement can be optimized, minimizing the risk of inferior alveolar nerve damage.(2,4,5) As stated by Mercuri et al.(5,6), it is expected that PSI, also known as custom(ized) systems, provide significantly better results compared to stock prostheses. Reimbursement stakeholders worry if the results outweigh the higher production cost. Keeping in mind that the number of TMJ TJRs is increasing over time and is projected to exceed 1000 procedures within 15 years in the U.S. alone(7), we set out to evaluate both systems by means of a meta-analysis, as to guide craniomaxillofacial (CMF) surgeons and reimbursement stakeholders.Nikolas de Meurechy NW.indd 103 05-06-2024 10:14