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e-TMJ replacement: Clinical analysis28110ConclusionObstacles during unilateral alloplastic eTMJR surgery relate to 3D rotations of the remaining mandible. Sagging of the prosthesis was noted in patients with neuromuscular deficiency, for which suspension techniques are proposed. Patients reported high satisfaction with the procedure. We suggest a treatment paradigm shift, with consideration of alloplastic eTMJR as the primary surgical approach, instead of reconstruction through microvascular osseous transplantation, in patients not requiring radiotherapy. This will avoid donor-site morbidity and lengthy reconstructive surgery while leaving autologous osseous transplantation available as a future possibility in case of implant failure. A subclassification system of eTMJR is proposed that takes into account three potential obstacles: contour corrections, occlusal adjustments, and simultaneous contralateral mandibular osteotomy.Nikolas de Meurechy NW.indd 281 05-06-2024 10:15