title: Twenty-year follow-up study on a patient-fitted temporomandibular joint prosthesis: the Techmedica/TMJ Concepts device.
abstract: OBJECTIVE
  To evaluate subjective and objective outcomes of patients receiving Techmedica (currently TMJ Concepts) patient-fitted temporomandibular joint (TMJ) total joint replacement (TJR) devices after 19 to 24 years of service.
  
  
  METHODS
  This prospective cohort study evaluated 111 patients operated on by 2 surgeons using Techmedica (Camarillo, CA) patient-fitted TMJ TJR devices from November 1989 to July 1993. Patients were evaluated before surgery and at least 19 years after surgery. Subjective evaluations used standard forms and questions with a Likert scale for 1) TMJ pain (0, no pain; 10, worst pain imaginable), 2) jaw function (0, normal function; 10, no movement), 3) diet (0, no restriction; 10, liquid only), and 4) quality of life (QoL; improved, the same, or worse). Objective assessment measured maximum incisal opening (MIO). Comparison analysis of presurgical and longest follow-up data used nonparametric Mann-Whitney and Wilcoxon signed rank tests. Spearman correlations evaluated the number of prior surgeries in relation to objective and subjective variables.
  
  
  RESULTS
  Of the 111 patients, 56 (50.5%) could be contacted and had adequate records for inclusion in the study. Median follow-up was 21 years (interquartile range [IQR], 20 to 22 yr). Mean age at surgery was 38.6 years (standard deviation, 10 yr). Median number of previous TMJ surgeries was 3 (IQR, 4). Presurgical and longest follow-up data comparison showed statistically significant improvement (P < .001) for MIO, TMJ pain, jaw function, and diet. At longest follow-up, 48 patients reported improved QoL, 6 patients reported the same QoL, and 2 patients reported worse QoL. Spearman correlations showed that an increased number of previous surgeries resulted in lower levels of improvement for TMJ pain and MIO.
  
  
  CONCLUSIONS
  At a median of 21 years after surgery, the Techmedica/TMJ Concepts TJR continued to function well. More previous TMJ surgeries indicated a lesser degree of improvement. No devices were removed owing to material wear.
authors: Clinical Professor, Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas; Private Practice, Baylor University Medical Center, Dallas, TX. Electronic address: lwolford@drlarrywolford.com.
authors: Larry M
authors: LM
authors: Wolford
authors: Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; Clinical Consultant, TMJ Concepts, Ventura, CA.
authors: Louis G
authors: LG
authors: Mercuri
authors: Professor, Department of Biomedical Sciences, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas, TX.
authors: Emet D
authors: ED
authors: Schneiderman
authors: Former Fellow, Department of Oral and Maxillofacial Surgery, Texas A&M University Health Science Center, Baylor College of Dentistry, Baylor University Medical Center, Dallas, TX; Clinical Assistant Professor, Department of Orthodontics, St Louis University, Center for Advanced Dental Education, St Louis, MO.
authors: Reza
authors: R
authors: Movahed
authors: Former Fellow, Department of Oral and Maxillofacial Surgery, Texas A&M University Health Science Center, Baylor College of Dentistry, Baylor University Medical Center, Dallas, TX; Private Practice, Louisville, KY.
authors: Will
authors: W
authors: Allen
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D008341:Mandibular Prosthesis; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology / Q000601:surgery*