Advancements in temporomandibular joint total joint replacements (TMJR)

  • Siva Kumar Mamidi
  • Kristin Klutcharch
  • Shradha Rao
  • Julio C. M. Souza
  • Louis G. Mercuri
  • Mathew T. MathewEmail author
Review Article


The goal of this paper is to review the advantages and disadvantages of the various treatment options of temporomandibular joint (TMJ) total joint replacement (TJR). TMJ articles published within the last 20 years were reviewed to collect the information on non-invasive and invasive TMD treatment methods. Recent technological advancements helped the evolution of treatment methods and offered significant value to TMD patients and surgeons. Considering the TMD levels, the therapeutic procedures can involve general health examiniations, physical therapy, medication, oral rehabilation or as an end stage clinical invention, temporomandibular joint replacement. In fact when intra-articular TMD is present, the effective treatment method appears to be TJR. However, concern for infection, material hypersensitivity, device longevity and screws loosening issues still exists. Further combined research utilizing the knowledge and expertise of, surgeons, material scientists, and bioengineers is needed for the development of improved TMD therapeutic treatment.


Temporomandibular joint disorder (TMD) Total joint replacement (TJR) Technical advancements of TMJR 



Authors acknowledge the Blazer foundation, UICOM, Rockford.

Compliance with ethical standards

Conflict of interest

The authors declares that they have no conflict of interest. Except, Dr. Mercuri is a compensated clinical consultant and shareholder in TMJ Concepts, Ventura, CA.

Ethical approval

The article does not contain any studies with human participants or animals performed by the author.

Informed consent

Yes all authors agreed and given consent.


  1. 1.
    Mercuri L. A heuristic approach to the management of muscle-related temporomandibular disorders. Facial Dent J. 2013;4:112–7.CrossRefGoogle Scholar
  2. 2.
    Schiffman E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network and orofacial pain special interest group. J Oral Facial Pain Headache. 2014;28:6–27.CrossRefGoogle Scholar
  3. 3.
    Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359:2693–705.CrossRefGoogle Scholar
  4. 4.
    Mercuri LG. Alloplastic temporomandibular joint replacement: rationale for the use of custom devices. Int J Oral Maxillofac Surg. 2012;41:1033–40.CrossRefGoogle Scholar
  5. 5.
    Ingawalé S, Goswami T. Temporomandibular joint: disorders, treatments, and biomechanics. Ann Biomed Eng. 2009;37:976–96.CrossRefGoogle Scholar
  6. 6.
    Mercuri LG. End-stage TMD and TMJ reconstruction. Peterson’s Princ Oral Maxillofac Surg. 2012;52:1173–86.Google Scholar
  7. 7.
    McNeely ML, Armijo Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther. 2006;86:710–25.Google Scholar
  8. 8.
    Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular joint disorders: a review of etiology, clinical management, and tissue engineering strategies. Int J Oral Maxillofac Implants. 2013;28:e393–414.CrossRefGoogle Scholar
  9. 9.
    Mercuri LG. The role of custom-made prosthesis for temporomandibular joint replacement. Rev Esp Cir Oral Maxilofac. 2013;35:1–10.CrossRefGoogle Scholar
  10. 10.
    Onoriobe U, et al. How many temporomandibular joint total joint alloplastic implants will be placed in the United States in 2030? J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2016;74:1531–8.CrossRefGoogle Scholar
  11. 11.
    Morouço P, Angelo D, Francisco L, Monteiro de Moura CS, Alves N. Tissue engineering for temporomandibular joint disc repair and regeneration: a methodological perspective. Adv Cell Mol Otolaryngol. 2016; 4.Google Scholar
  12. 12.
    de Araújo AN, do Nascimento MA, de Sena EP, Baptista AF. Temporomandibular disorders in patients with schizophrenia using antipsychotic agents: a discussion paper. Drug Healthc Patient Saf. 2014;6:21–7.Google Scholar
  13. 13.
    LeResche L, Drangsholt M. Chapter 93—Temporomandibular disorders. In: Goldman MB, Troisi R, Rexrode KM, editors. Women and health. Cambridge: Academic Press; 2013. p. 1367–78.CrossRefGoogle Scholar
  14. 14.
    Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015;91:378–86.Google Scholar
  15. 15.
    Hansson T, Nilner M. A study of the occurrence of symptoms of disease of the temporomandibular joint masticatory musculature and related structures. J Oral Rehabil. 1975;2:313–24.CrossRefGoogle Scholar
  16. 16.
    Alzarea BK. Temporomandibular disorders (TMD) in edentulous patients: a review and proposed classification (Dr. Bader’s Classification). J Clin Diagn Res JCDR. 2015; 9:ZE06-ZE09.Google Scholar
  17. 17.
    Sharma S, Gupta DS, Pal US, Jurel SK. Etiological factors of temporomandibular joint disorders. Natl J Maxillofac Surg. 2011;2:116–9.CrossRefGoogle Scholar
  18. 18.
    LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med Off Publ Am Assoc Oral Biol. 1997;8:291–305.CrossRefGoogle Scholar
  19. 19.
    Jerjes W, et al. Muscle disorders and dentition-related aspects in temporomandibular disorders: controversies in the most commonly used treatment modalities. Int Arch Med. 2008;1:23.CrossRefGoogle Scholar
  20. 20.
    Eweka O, Ogundana O, Agbelusi G. Temporomandibular pain dysfunction syndrome in patients attending lagos university teaching hospital, Lagos, Nigeria. J West Afr Coll Surg. 2016;6:70–87.Google Scholar
  21. 21.
    Jensen A, Nolet PS, Diwan MA. Oral squamous cell carcinoma: an atypical presentation mimicking temporomandibular joint disorder. J Can Chiropr Assoc. 2004;48:266–72.Google Scholar
  22. 22.
    Kim BC, Lee YC, Cha HS, Lee S-H. Characteristics of temporomandibular joint structures after mandibular condyle fractures revealed by magnetic resonance imaging. Maxillofac Plast Reconstr Surg. 2016;38:24.CrossRefGoogle Scholar
  23. 23.
    An S-Y, Jung J-K. Fracture of the articular disc in the temporomandibular joint: two case reports. Dentomaxillofac Radiol. 2015;44:20140218.CrossRefGoogle Scholar
  24. 24.
    Dolwick MF. Intra-articular disc displacement part I: Its questionable role in temporomandibular joint pathology. J Oral Maxillofac Surg. 1995;53:1069–72.CrossRefGoogle Scholar
  25. 25.
    Herb K, Cho S, Stiles MA. Temporomandibular joint pain and dysfunction. Curr Pain Headache Rep. 2006;10:408–14.CrossRefGoogle Scholar
  26. 26.
    Klasser GD, Greene CS. The changing field of temporomandibular disorders: what dentists need to know. J Can Dent Assoc. 2009;75:49–53.Google Scholar
  27. 27.
    Brul ELD. Sicher’s oral anatomy. Missouri: Mosby-Year Book; 1980.Google Scholar
  28. 28.
    Suenaga S, Nagayama K, Nagasawa T, Indo H, Majima HJ. The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders. Jpn Dent Sci Rev. 2016;52:93–106.CrossRefGoogle Scholar
  29. 29.
    Nagarajan A, Perumalsamy R, Thyagarajan R, Namasivayam A. Diagnostic imaging for dental implant therapy. J Clin Imaging Sci. 2014;4:4.CrossRefGoogle Scholar
  30. 30.
    Gupta S, Patil N, Solanki J, Singh R, Laller S. Oral implant imaging: a review. Malays J Med Sci MJMS. 2015;22:7–17.Google Scholar
  31. 31.
    Shetty S, Pitti V, SatishBabu CL, SurendraKumar GP, Deepthi BC. Bruxism: a literature review. J Indian Prosthodont Soc. 2010;10:141–8.CrossRefGoogle Scholar
  32. 32.
    Monje-Gil F, Nitzan D, González-Garcia R. Temporomandibular joint arthrocentesis. Review of the literature. Med Oral Patol Oral Cir Bucal. 2012;17:575–81.CrossRefGoogle Scholar
  33. 33.
    Neeli AS, Umarani M, Kotrashetti SM, Baliga S. Arthrocentesis for the treatment of internal derangement of the temporomandibular joint. J Maxillofac Oral Surg. 2010;9:350–4.CrossRefGoogle Scholar
  34. 34.
    Ng CH, Lai JB, Victor F, Yeo JF. Temporomandibular articular disorders can be alleviated with surgery. Evid Based Dent. 2005;6:48–50.CrossRefGoogle Scholar
  35. 35.
    Neelakandan RS, Raja AVDK, Krishnan AM. Total alloplastic temporomandibular joint reconstruction for management of TMJ Ankylosis. J Maxillofac Oral Surg. 2014;13:575–82.CrossRefGoogle Scholar
  36. 36.
    Schwartz HC, Relle RJ. Distraction osteogenesis for temporomandibular joint reconstruction. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2008;66:718–23.CrossRefGoogle Scholar
  37. 37.
    Stucki-McCormick SU, Fox RM, Mizrahi RD. Reconstruction of a neocondyle using transport distraction osteogenesis. Semin Orthod. 1999;5:59–63.CrossRefGoogle Scholar
  38. 38.
    Sinno H, Tahiri Y, Gilardino M, Bobyn D. Engineering alloplastic temporomandibular joint replacements. McGill J Med MJM. 2011;13:63.Google Scholar
  39. 39.
    Oh D-W, Kang T-W, Kim S-J. Effect of stomatognathic alignment exercise on temporomandibular joint function and swallowing function of stroke patients with limited mouth opening. J Phys Ther Sci. 2013;25:1325–9.CrossRefGoogle Scholar
  40. 40.
    Kerwell S, et al. Examination of failed retrieved temporomandibular joint (TMJ) implants. Acta Biomater. 2016;32:324.CrossRefGoogle Scholar
  41. 41.
    Driemel O, et al. Historical development of alloplastic temporomandibular joint replacement after 1945 and state of the art. Int J Oral Maxillofac Surg. 2009;38:909–20.CrossRefGoogle Scholar
  42. 42.
    Yuan K, Lee T-M, Huang J-S. Review: temporomandibular joint reconstruction: from alloplastic prosthesis to bioengineering tissue. J Med Biol Eng. 2010;30:65.Google Scholar
  43. 43.
    Mercuri L. Temporomandibular joint total joint replacement—TMJR: a comprehensive reference for researchers, materials scientists, and surgeons. 2015.
  44. 44.
    Westermark A, Leiggener C, Aagaard E, Lindskog S. Histological findings in soft tissues around temporomandibular joint prostheses after up to eight years of function. Int J Oral Maxillofac Surg. 2011;40:18–25.CrossRefGoogle Scholar
  45. 45.
    Mathew MT, Kerwell S, Lundberg HJ, Sukotjo C, Mercuri LG. Tribocorrosion and oral and maxillofacial surgical devices. Br J Oral Maxillofac Surg. 2014;52:396–400.CrossRefGoogle Scholar
  46. 46.
    Sanovich R, Mehta U, Abramowicz S, Widmer C, Dolwick MF. Total alloplastic temporomandibular joint reconstruction using Biomet stock prostheses: the University of Florida experience. Int J Oral Maxillofac Surg. 2014;43:1091–5.CrossRefGoogle Scholar
  47. 47.
    Wolford LM, Mercuri LG, Schneiderman ED, Movahed R, Allen W. Twenty-year follow-up study on a patient-fitted temporomandibular joint prosthesis: the techmedica/TMJ concepts device. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2015;73:952–60.CrossRefGoogle Scholar
  48. 48.
    Baena JC, Wu J, Peng Z. Wear performance of UHMWPE and reinforced UHMWPE composites in arthroplasty applications: a review. Lubricants. 2015;3:413–36.CrossRefGoogle Scholar
  49. 49.
    Barão VA, Sukotjo C, Mathew MT. Fundamentals of linking tribology and corrosion (tribocorrosion) for medical applications: Bio-tribocorrosion. In: Tribology for scientists and engineers. New York: Springer; 2013. p. 637–55.Google Scholar
  50. 50.
    Mathew MT, Srinivasa Pai P, Pourzal R, Fischer A, Wimmer MA. Significance of tribocorrosion in biomedical applications: overview and current status. Adv Tribol. 2009.Google Scholar
  51. 51.
    Mantripragada VP, Lecka-Czernik B, Ebraheim NA, Jayasuriya AC. An overview of recent advances in designing orthopedic and craniofacial implants. J Biomed Mater Res A. 2013;101:3349–64.Google Scholar
  52. 52.
    Mercuri LG. Avoiding and managing temporomandibular joint total joint replacement surgical site infections. J Oral Maxillofac Surg. 2012;70:2280–9.CrossRefGoogle Scholar
  53. 53.
    Salash JR, et al. Potential indications for tissue engineering in temporomandibular joint surgery. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2016;74:705–11.CrossRefGoogle Scholar
  54. 54.
    Wang L, Detamore MS. Tissue engineering the mandibular condyle. Tissue Eng. 2007;13:1955–71.CrossRefGoogle Scholar
  55. 55.
    Johns DE, Athanasiou KA. A comparison of primary and passaged chondrocytes for use in engineering the temporomandibular joint. Arch Oral Biol. 2009;54:138–45.CrossRefGoogle Scholar
  56. 56.
    Hu K, Qiguo R, Fang J, Mao JJ. Effects of condylar fibrocartilage on the biomechanical loading of the human temporomandibular joint in a three-dimensional, nonlinear finite element model. Med Eng Phys. 2003;25:107–13.CrossRefGoogle Scholar
  57. 57.
    Metcalfe AD, Ferguson MW. Tissue engineering of replacement skin: the crossroads of biomaterials, wound healing, embryonic development, stem cells and regeneration. J R Soc Interface. 2007;4:413–37.CrossRefGoogle Scholar
  58. 58.
    Praveen S, Krishnakumar K, Sahoo S. New era in health care: tissue engineering. J. Stem Cells Regen Med. 2006;1:8–24.Google Scholar
  59. 59.
    Chia HN, Wu BM. Recent advances in 3D printing of biomaterials. J Biol Eng. 2015;9:4.CrossRefGoogle Scholar
  60. 60.
    Li X, et al. 3D-printed biopolymers for tissue engineering application. Int J Polym Sci. 2014.Google Scholar
  61. 61.
    Chaware SM, Bagaria V, Kuthe A. Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis. Indian J Plast Surg. 2009;42:85.CrossRefGoogle Scholar
  62. 62.
    Antonio Ramos et al. Load transfer in Christensen TMJ in alloplastic total joint replacement for two different mouth apertures. European Association of Cranio -Maxillo Facial Surgery, 2014.Google Scholar
  63. 63.
    Hsu Jui-Ting, et al. Effect of screw fixation on temporomandibular joint condylar prosthesis. J Oral Maxillofac Surg. 2011;69:1320–8.CrossRefGoogle Scholar
  64. 64.
    De Meurechy N, et al. Biomaterial in temporomandibular joint replacement: current status and future perspectives—a narrative review. Int J Oral Maxillofac Surg. 2018;47:518–33.CrossRefGoogle Scholar

Copyright information

© Korean Society of Medical and Biological Engineering 2019

Authors and Affiliations

  1. 1.Department of Biomedical Science, School of MedicineUniversity of Illinois College of Medicine at RockfordRockfordUSA
  2. 2.Department of Restorative DentistryCollege of Dentistry, University of Illinois at ChicagoChicagoUSA
  3. 3.Center for MicroElectroMechanical System (CMEMS-UMINHO)Universidade do MinhoGuimaraesPortugal
  4. 4.Department of Dental Sciences, University Institute of Health Science (IUCS-CESPU)GandraPortugal
  5. 5.Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA
  6. 6.TMJ ConceptsVenturaUSA

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