Major considerations and outcomes of clinical studies on the treatment of temporomandibular disorders using prostheses: a systematic review

Abstract

Introduction: The temporomandibular joint (TMJ) can be affected by end-stage pathologies, such as arthritic disease, trauma, and ankylosis. Around 70% of the general population has suffered at least one symptom of temporomandibular disorder (TMD), which constitutes TMJ disease that may be related to the joints, muscles, ligaments, bones, teeth, and psychological aspects. As a treatment, the implantation of a total alloplastic TMJ prosthesis is an innovative approach. Objective: It was to present the main considerations and outcomes of clinical studies on the treatments of temporomandibular disorders using customized or prefabricated prostheses. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 121 articles were found, 40 articles were evaluated in full and 21 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 10 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.8%>50%. It was concluded that stock and CAD/CAM prostheses suggested great improvements in mouth opening and pain reduction as a result of the rehabilitation of TMJ function. The results showed comparable data for both types of prosthesis design at 6 months postoperatively. However, the additional advantages of custom prosthetics, along with increasing access to digital technology, will likely result in custom devices dominating the market in TMJ total joint replacement systems. The custom-made combined prosthesis with custom design and 3D printing fabrication represents a safe and reliable implantable reconstruction method for combined TMJ-skull base injuries.