Page 37 - Demo

Historical evolution of the TMJ prosthesis352design in 1982, in which the position of the condyle could be adapted not only in the coronal plane but also in the axial and sagittal planes. The condyle was fixed with two screws in the correct position, after which the implant was fixed to the lower mandibular border using a reconstruction plate and four titanium-coated hollow screws.(18,19) While in theory a very interesting system, the prosthesis was only seldom used due to difficulty in positioning of the condyle. Flot et al.(33) (OCEBM LOE IV) also found clear inspiration in orthopedic prosthetic surgery. In 1984 they developed a condyle prosthesis with a polyethylene domed ‘cap’ that covered a steel or titanium head. This cap however was not fixed to the fossa, allowing for forward and lateral movement, as the cap could move over the fossa. Furthermore, Flot et al.(33) claimed that additional rotational mandibular movement was made possible due to movements between the head and the cap. The prosthesis was fixated using a screw-shaped intramedullary stem.(19)In 1987, due fretting and fragmentation of polyethylene, the material of the cap was changed to Al2O3-ceramic.(18) Table 3: Materials and TMJ condylar prosthesis.(6,13,20,21,26-35)Material Surgeon Year of introduction*Rubber Martin 1878*Rubber Schöder 1901Ivory Gluck 1890*Tin Fritzsche 1901Ivory König 1908Ivory Sudeck 1909*Glass Partsch 1917Co-Cr with acrylic condyle Hahn 1964Co-Cr with condylar Teflon coating Kent 1972Titanium Spiessl 1976Co-Cr with PMMA cement Silver 1977Titanium Raveh 1982Steel with polyethylene cap Flot 1984Titanium with Al2O3 cap 1987*: It should be remarked that these prostheses were immediate prosthesis instead of implantation devices. Nikolas de Meurechy NW.indd 35 05-06-2024 10:14