Alloplastic or autogenous reconstruction of the TMJ

Sidebottom, Andrew J.

doi:10.1016/j.jobcr.2013.07.003

Cited by 50 publications

(29 citation statements)

References 26 publications

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“…They are similar to constructs used in total knee replacements which are used well beyond 10 years and start to fail at 20 years due to wear debris. No case of wear debris has yet been reported following TMJ replacement with these prostheses, but it is too early to reach final conclusions [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report

et al. 2018

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BackgroundUpon orthognathic mandibular advancement surgery the adjacent soft tissues can displace the distal bone segment and increase the load on the temporomandibular joint causing loss of its integrity. Remodeling of the condyle and temporal fossa with destruction of condylar cartilage and subchondral bone leads to postsurgical condylar resorption, with arthralgia and functional limitations. Patients with severe lesions are refractory to conservative treatments, leading to more invasive therapies that range from simple arthrocentesis to open surgery and prosthesis. Although aggressive and with a high risk for the patient, surgical invasive treatments are not always efficient in managing the degenerative lesions.MethodsWe propose a regenerative medicine approach using in-vitro expanded autologous cells from nasal septum applied to the first proof-of-concept patient. After the required quality controls, the cells were injected into each joint by arthrocentesis. Results were monitored by functional assays and image analysis using computed tomography.ResultsThe cell injection fully reverted the condylar resorption, leading to functional and structural regeneration after 6 months. Computed tomography images showed new cortical bone formation filling the former cavity space, and a partial recovery of condylar and temporal bones. The superposition of the condyle models showed the regeneration of the bone defect, reconstructing the condyle original form.ConclusionsWe propose a new treatment of condylar resorption subsequent to orthognathic surgery, presently treated only by alloplastic total joint replacement. We propose an intra-articular injection of autologous in-vitro expanded cells from the nasal septum. The proof-of-concept treatment of a selected patient that had no alternative therapeutic proposal has given promising results, reaching full regeneration of both the condylar cartilage and bone at 6 months after the therapy, which was fully maintained after 1 year. This first case is being followed by inclusion of new patients with a similar pathological profile to complete an ongoing stage I/II study.Trial registrationThis clinical trial is approved by the National Commission of Ethics in Medical Research (CONEP), Brazil, CAAE 12484813.0.0000.5245, and retrospectively registered in the Brazilian National Clinical Trials Registry and in the USA Clinical Trials Registry under the Universal Trial Number (UTN) U1111–1194-6997.Electronic supplementary materialThe online version of this article (10.1186/s13287-018-0806-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report

et al. 2018

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“…It is hoped that this audit of patients will hopefully encourage surgeons to utilize alloplastic TMJ replacement surgery as a legitimate and effective means of treatment for advanced degenerative damage to the joint. [ 4 ] Further, it is hoped that general dental practitioners would also be encouraged to advise and refer their patients without fear of negative outcomes regarding alloplastic total joint replacement procedures. What is evident from this audit, is that patient perceptions with respect to pain, mastication, and overall QOL seems to be improved following such surgery; a trend reported by Leandro et al .…”

Section: Discussionmentioning

confidence: 99%

Patient perception following alloplastic total temporomandibular joint replacement

Desai

2018

Ann Maxillofac Surg

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Introduction:A retrospective analysis was done on patients who had undergone unilateral temporomandibular joint reconstruction using alloplastic temporomandibular prostheses.Aim:The study wished to highlight patient perceptions after surgery; specifically relating to pain, function, and aesthetics.Material and Method:Twenty three patients were assessed using a visual analogue scale (VAS) for pain, ability to eat, quality of life and scar appraisal.Results:Patients Vas scores were favourable for all parameters save for scar appreciation.Conclusion:Total temporomandibular alloplastic joint replacement is a viable treatment option, with generally positive surgical outcomes for patients.

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“…Therefore, two-piece 3D custom-made prostheses include an ultra-high molecular weight polyethylene (UHMWPE) implant for the replacement of the temporal articular surface (mandibular fossa). Such prostheses seem to currently be the most satisfying solution available for total surgical joint replacement [ 35 , 36 ].…”

Section: Current Status Of Temporomandibular Treatmentsmentioning

confidence: 99%

Temporomandibular Joint Regenerative Medicine

Bellinghen

Idoux-Gillet

Pugliano

et al. 2018

IJMS

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The temporomandibular joint (TMJ) is an articulation formed between the temporal bone and the mandibular condyle which is commonly affected. These affections are often so painful during fundamental oral activities that patients have lower quality of life. Limitations of therapeutics for severe TMJ diseases have led to increased interest in regenerative strategies combining stem cells, implantable scaffolds and well-targeting bioactive molecules. To succeed in functional and structural regeneration of TMJ is very challenging. Innovative strategies and biomaterials are absolutely crucial because TMJ can be considered as one of the most difficult tissues to regenerate due to its limited healing capacity, its unique histological and structural properties and the necessity for long-term prevention of its ossified or fibrous adhesions. The ideal approach for TMJ regeneration is a unique scaffold functionalized with an osteochondral molecular gradient containing a single stem cell population able to undergo osteogenic and chondrogenic differentiation such as BMSCs, ADSCs or DPSCs. The key for this complex regeneration is the functionalization with active molecules such as IGF-1, TGF-β1 or bFGF. This regeneration can be optimized by nano/micro-assisted functionalization and by spatiotemporal drug delivery systems orchestrating the 3D formation of TMJ tissues.

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Alloplastic or autogenous reconstruction of the TMJ

Cited by 50 publications

References 26 publications

Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report

Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report

Patient perception following alloplastic total temporomandibular joint replacement

Temporomandibular Joint Regenerative Medicine

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