Outcomes of total temporomandibular joint replacement: a systematic review.

Abstract

Background: Temporomandibular joint replacement (TMJR) is a reconstructive surgical modality that is available to patients with end-stage temporomandibular disorders (TMDs) that fail conservative treatment. Alloplastic prostheses are either custom-made or stock devices used to restore mandibular function and reduce pain; however, comparative data and long-term outcomes are limited. This systematic review aimed to assess post-surgical functional, pain, and quality-of-life outcomes following alloplastic total TMJR.

Methods: We searched PubMed, Google Scholar, Scopus, and institutional databases through March 2025, following PRISMA guidelines, to identify outcomes of alloplastic TMJR. Three reviewers independently screened and extracted the data, and a fourth reviewer resolved discrepancies. Results were summarised narratively because of variability in clinical and methodological approaches. We used ROBINS-I to evaluate study quality and the GRADE system to rate evidence certainty.

Results: Eleven studies (569 patients, follow-up 12-62 months) fulfilled the inclusion criteria. Alloplastic TMJR was consistently associated with improved MMO, reduced pain, and better patient-reported QoL, although lateral excursion and protrusion were often lower than in healthy controls. Custom-made prostheses were more prevalent than stock devices, and no evidence supported one type over the other. Transient facial nerve paresis was a rare complication, and the 5-year survival rate of prostheses was > 90%. Nine out of eleven studies were at serious or critical risk of bias; however, across all outcomes, GRADE certainty was rated very low.

Conclusions: Although alloplastic TMJR holds promise of functional, pain, and quality-of-life improvements in carefully selected patients with end-stage TMD, current evidence is of very low certainty. Future multicentre trials with agreed-upon outcome measures and direct comparisons between custom and stock systems are required to reach definitive conclusions.