Custom CAD/CAM total temporomandibular joint reconstruction system: preliminary multicenter report.
OBJECTIVE
The purpose was to test the outcome of a custom computer assisted design/computer assisted manufactured (CAD/CAM) total temporomandibular joint (TMJ) reconstruction system.


METHODS
There were 215 patients (13 males and 202 females); the average age at reconstruction was 40.9 +/- 10.3 years (range, 15 to 77 years). There were 363 joints placed, 296 bilateral and 67 unilateral. The patients had TMJ problems for an average of 10.3 +/- 7.0 years (range, 1 to 44 years), and had undergone a mean of 5.4 +/- 4.8 (range, 0 to 28) prior unsuccessful surgeries. Preoperative and postoperative data were collected for up to 48 months using a standardized data collection format. Subjective data related to pain, function of the lower jaw, and diet, were obtained using a visual analogue scale. Objective measures of mandibular range of motion were made directly on the patient preoperatively and postoperatively.


RESULTS
Preliminary analysis of these data reveals a statistically significant decrease in pain, an increase in function, and improvement in diet (P < .0001) from the preoperative measurements to 1 and 2 years postoperatively. There was also improvement in mandibular vertical range of motion. The number of previous surgeries was a strong predictor of postoperative pain, function, and diet scores, as well as of maximal interincisal opening. A life table analysis of failures indicates good durability of the prosthesis over time.


CONCLUSIONS
These preliminary data indicate that this custom CAD/CAM total TMJ reconstruction system seems to be useful in the treatment of the multiply operated, and/or anatomically mutilated TMJ.
Mercuri
L G
LG
Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153.
Wolford
L M
LM
Sanders
B
B
White
R D
RD
Hurder
A
A
Henderson
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D017076:Computer-Aided Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012044:Regression Analysis; D012086:Reoperation; D016019:Survival Analysis; D013704:Temporomandibular Joint / Q000293:injuries; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D016896:Treatment Outcome