Page 29 - Demo

Historical evolution of the TMJ prosthesis272IntroductionThe temporomandibular joint (TMJ) is subjected to more cyclic loading and unloading than any other joint in the body. As a result temporomandibular disorders (TMDs) are far from rare.(1) Early data from 1990 indicated a prevalence of TMD of about 12% in the general population, but more recent literature provides more conservative estimates.(1) A 2008 study by the National Health Interview Survey(2) concluded that up to 5% of all Americans deal with TMD-related pain, and a study conducted by Janal et al.(3) in 2008 noted an even higher prevalence, showing that up to 10% of all female patients examined had a TMD. The literature concurs, however, that a significantly higher proportion of TMDs manifest in women than in men (3:1 ratio). Furthermore, symptoms tend to first present themselves between the ages of 20-40 years, and tend to lessen as the patient ages.(1–3) Despite the high prevalence of TMDs, the use of a surgical approach is only rarely needed. As such, the pre-requisites for TMJ replacement surgery are a combination of positive radiological imaging confirming pathology and structural changes within the TMJ, a significant history of pain, dysfunction, and failure of previous conservative and surgical treatments. The current indications for TMJ replacement surgery by the American Association of Oral and Maxillofacial Surgeons (AAOMS)(4) and the National Institute for Health and Care Excellence guidelines(5) are listed in Table 1. Table 1: Indications for TMJ replacement surgery.(2,4,5) Multiple-operated TMJ with insufficient resultOngoing symptoms and severe functional limitation despite previous alloplastic implantsConnective tissue and autoimmune diseases Inflammatory, infective, or reactive diseasesAnkylosisFailed reconstruction with autogenous graftsNeoplasiaAt first, joint surgery largely consisted of surgical excision that was mainly performed for severely damaged joints, with the first documented hemiNikolas de Meurechy NW.indd 27 05-06-2024 10:14