Does Maximum Voluntary Clenching Force Pose a Risk to Overloading Alloplastic Temporomandibular Joint Replacement?—A Prospective Cohort Study

Linsen, Sabine S.; Schön, Andreas; Teschke, Marcus; Mercuri, Louis G.

doi:10.1016/j.joms.2021.06.018

Cited by 5 publications

(5 citation statements)

References 54 publications

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“…When comparing the load on the contralateral side of a mandible that has undergone total TMJ replacement with the load on the condyle of a healthy mandible, the load increase is approximately 15% when using a stock prosthesis. [8][9][10][11][12][13] Increases in mechanical loads have been shown to stimulate cartilage production and articular disc damage 14 which can negatively affect the patient (e.g., pain) and should thus be avoided. 15 In order to prevent disease development in the unaffected joint, an attempt was made to prevent an increase in load in the untreated joint.…”

Section: Surface Finishingmentioning

confidence: 99%

Evolutionary Steps in the Development of a Patient-specific Temporomandibular Joint Prosthesis

Huys

Braem

Meurechy

et al. 2022

Craniomaxillofacial Research & Innovation

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Study Design Descriptive study (/review containing supporting case studies). Objective The temporomandibular joint has some distinctive features that were not taken into account during the initial development of temporomandibular joint prostheses, such as laterotrusive movements that are necessary for the proper grinding of food as well as synchronous and congruent movements made in conjunction with the healthy, contralateral joint. The aim of this article is to describe the development of a novel type of TMJ prosthesis that optimizes temporomandibular joint replacement. Methods The development was initiated by using contemporary technologies like computer-aided design customization, additive manufacturing, and surface treatments. Biocompatibility, proper fixation, and wear resistance, being prerequisites for the longevity of prostheses, were investigated next. Individual variables (condylar path, condylar axis angle, Bennet shift) were introduced as the main basis for physiological movements with the restoration of all functions. Early post-operative results ranging from 1 month to 4.5 years (11 patients, average follow-up period was 23.3 months) were assessed. Results The experience with 16 individualized total joint replacements in 11 patients is presented. The 3-year follow-up results of two-patient detailed studies are discussed, which show evidence of the promising restoration of all mandibular movements, when preoperatively present. Conclusions By incorporating various innovative and novel features (scaffold for re-attachment of lateral pterygoid, patient-specific functional parametrization, saddle-like design for retention, …) into a novel TMJ prosthesis concept, a major advance in function-reconstructive temporomandibular joint replacement was achieved. Early in vivo results (1 year after surgery) showed promising outcomes, involving both high increases in mandibular movements and decreases in pain scores.

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Section: Surface Finishingmentioning

confidence: 99%

Evolutionary Steps in the Development of a Patient-specific Temporomandibular Joint Prosthesis

Huys

Braem

Meurechy

et al. 2022

Craniomaxillofacial Research & Innovation

View full text Add to dashboard Cite

show abstract

“…Clinical studies demonstrate that TMJR surgery reduces pain, increases mouth-opening capacity, reduces dietary restrictions and improves patient quality of life (Dimitroulis et al 2018 ; Zou et al 2018 ; Woodford et al 2023 ); however, unilateral TMJR patients often experience post-surgical degradation of their native contralateral joint, with up to 40% of patients requiring bilateral TMJR surgery within two years (Franco et al 1997 ). While thought to be broadly related to joint loading (Perez et al 2016 ; Linsen et al 2021b ), there is currently no consensus on mechanical factors associated with contralateral joint disease post-TMJR.…”

Section: Introductionmentioning

confidence: 99%

“…Bite force and jaw muscle and TMJ forces are important determinates of implant and joint functional performance following TMJR; however, they remain poorly understood post-operatively. Bite force has been measured using uniaxial transducers (Röhrle et al 2018 ), with maximum voluntary bite force measurements for total TMJR patients ranging from 177 to 201 N (Linsen et al 2021b ; Speksnijder et al 2022 ), substantially lower than that of healthy individuals. This functional decrease has been attributed to muscle atrophy and degeneration, lower occlusal contact area and psychological factors (Linsen et al 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Muscle and joint mechanics during maximum force biting following total temporomandibular joint replacement surgery

Woodford,

Robinson,

Abduo

et al. 2024

Biomech Model Mechanobiol

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Total temporomandibular joint replacement (TMJR) surgery is the established treatment for severe temporomandibular joint disorders. While TMJR surgery is known to increase mouth-opening capacity, reduce pain and improve quality of life, little is known about post-surgical jaw function during activities of daily living such as biting and chewing. The aim of this study was to use subject-specific 3D bite force measurements to evaluate the magnitude and direction of joint loading in unilateral total TMJR patients and compare these data to those in healthy control subjects. An optoelectronic tracking system was used to measure jaw kinematics while biting a rubber sample for 5 unilateral total TMJR patients and 8 controls. Finite element simulations driven by the measured kinematics were employed to calculate the resultant bite force generated when compressing the rubber between teeth during biting tasks. Subject-specific musculoskeletal models were subsequently used to calculate muscle and TMJ loading. Unilateral total TMJR patients generated a bite force of 249.6 ± 24.4 N and 164.2 ± 62.3 N when biting on the contralateral and ipsilateral molars, respectively. In contrast, controls generated a bite force of 317.1 ± 206.6 N. Unilateral total TMJR patients biting on the contralateral molars had a significantly higher lateral TMJ force direction (median difference: 63.6°, p = 0.028) and a significantly lower ratio of working TMJ force to bite force (median difference: 0.17, p = 0.049) than controls. Results of this study may guide TMJ prosthesis design and evaluation of dental implants.

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“…Studies have demonstrated that TMJR surgery reduces pain, increases mouth opening capacity, reduces dietary restrictions and improves patient quality of life (Dimitroulis et al 2018;Zou et al 2018;Woodford et al 2023); however, unilateral TMJR patients often experience post-surgical degradation of their native contralateral joint, with up to 40% of patients requiring bilateral TMJR surgery within two years (Franco et al 1997). While thought to be broadly related to joint loading (Perez et al 2016; Linsen et al 2021b), there is currently no consensus on mechanical factors associated with contralateral joint disease post-TMJR.…”

Section: Introductionmentioning

confidence: 99%

“…Bite force and TMJ muscle and joint forces are important determinates of implant and joint functional performance following TMJR, however they remain poorly understood post-operatively. Bite force has been measured using uniaxial transducers (Röhrle et al 2018), with maximum voluntary bite force measurements for total TMJR patients ranging from 177 N to 201 N (Linsen et al 2021b;Speksnijder et al 2022), substantially lower than that of healthy individuals. This functional decrease has been attributed to muscle atrophy and degeneration, lower occlusal contact area and psychological factors (Linsen et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Muscle and Joint Mechanics During Maximum-Force Biting Following Total Temporomandibular Joint Replacement Surgery

Woodford,

Robinson,

Abduo

et al. 2023

Preprint

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Total temporomandibular joint replacement (TMJR) surgery is the established treatment for severe temporomandibular joint disorders. While TMJR surgery is known to increase mouth opening capacity, reduce pain and improve quality of life, little is known about post-surgical jaw function during biting and chewing. The aim of this study was to use subject-specific 3D bite force measurements to evaluate the magnitude and direction of joint loading in unilateral total TMJR patients and healthy control subjects. An optoelectronic tracking system was used to measure jaw kinematics during maximum-force biting on a rubber sample in 5 unilateral total TMJR patients and 8 controls. Finite element model simulations driven by the measured kinematics were then employed to calculate the resultant bite force generated when compressing the rubber sample between the maxillary and mandibular teeth. Subject-specific musculoskeletal models were subsequently used to calculate muscle and TMJ loading. Unilateral total TMJR patients generated a bite force of 249.6 ± 24.4 N and 164.2 ± 62.3 N when biting on the contralateral and ipsilateral molars, respectively. In contrast, controls generated a bite force of 317.1 ± 206.6 N. Unilateral total TMJR patients biting on the contralateral molars had a significantly higher lateral TMJ force direction (median difference: 63.6°, p = 0.028), and a significantly lower ratio of working TMJ force to bite force compared to controls (median difference: 0.17, p = 0.049). The findings of this study provide insight into the loading of dental structures, which may influence the design and evaluation of dental implants, and guide TMJ prosthesis design.

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Does Maximum Voluntary Clenching Force Pose a Risk to Overloading Alloplastic Temporomandibular Joint Replacement?—A Prospective Cohort Study

Cited by 5 publications

References 54 publications

Evolutionary Steps in the Development of a Patient-specific Temporomandibular Joint Prosthesis

Evolutionary Steps in the Development of a Patient-specific Temporomandibular Joint Prosthesis

Muscle and joint mechanics during maximum force biting following total temporomandibular joint replacement surgery

Muscle and Joint Mechanics During Maximum-Force Biting Following Total Temporomandibular Joint Replacement Surgery

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