Page 35 - Demo

Historical evolution of the TMJ prosthesis332Condylar prosthesis The early days of the condylar prosthesis began with development of the immediate prosthesis, including the natural rubber prosthesis developed by Martin in 1878 and the hollowed-out hard rubber prosthesis by Schöder that was first used in 1901. These first two ‘prototypes’ served as a blueprint from which many alterations were made, such as the removable immediate tin prosthesis by Fritzsche in 1901 and the Partsch glass prosthesis in 1917. They were fitted to the non-resected part of the mandible and could be either screwed onto the resection stump or secured to adjacent teeth using several clips. Their main purpose was not to serve as a functional replacement but rather to prevent postoperative scar contraction and provide sufficient soft tissue support.(6)The use of a functional condylar prosthesis was first mentioned in 1890, at the height of the ivory trade, by Gluck(24) (H). He described a partial joint arthroplasty with an ivory condylar prosthesis.(11) Gluck adapted his technique following previous success with this endo-prosthesis material in total wrist arthroplasty and developed one of the first implant prostheses that could be fixed to the residual jaw. About 20 years after development of the condylar prosthesis by Gluck, both König(25) (H) and Sudeck(26) (H) also implanted an ivory ramal prosthesis. These early designs were fixed by placing a spike situated at the corporal end into the spongious bone of the mandible. While initially retaining acceptable stability, an increase in mobility was seen over time, which made it necessary to remove the prosthesis.(6) 50 years later, in 1964, Hahn(27) (OCEBM LOE IV) introduced his ‘ramus prosthesis’ to reconstruct the vertical ramus and condyle following ablative surgery. Possibly inspired by the results of Christensen’s fossa prosthesis, Hahn developed a Vitallium mesh prosthesis with an acrylic condyle. The idea behind the mesh design was that it would allow enhanced fibroblast penetration and scar tissue formation to improve prosthesis stability.(18)During the 1970s, as the hip prosthesis was further developed, several of its principles and design aspects were clearly taken up by innovators who furthered the development of the TMJ prosthesis. The first, and probably most infamous in the history of the TMJ prosthesis, was the introduction Nikolas de Meurechy NW.indd 33 05-06-2024 10:14