The role of alloplastic temporomandibular joint (TMJ) replacement in the management of condylar resorption—a narrative review of the literature

Abstract

Background and Objective: It has been hypothesized that condylar resorption is the result of maladaptive articular bone remodeling due to increased or constant temporomandibular joint (TMJ) functional overload surpassing the innate capacity of the local bone and cartilage to adapt to the situation. The literature has consistently demonstrated the successful utilization of alloplastic temporomandibular joint reconstruction devices (TMJR) in the management of end-stage TMJ disease. In light of the safety and efficacy demonstrated by TMJR in such cases over the years, this paper will discuss the rationale, advantages and disadvantages related to the use of TMJR devices for the management of mandibular condylar resorption. Methods: A review of the pertinent English language orthopedic and TMJ literature on PubMed (pubmed. gov) between the years 1996 and 2021 was conducted using the terms “bone adaptive remodeling” and “TMJ condylar resorption”. Key Content and Findings: Based on the effects of increased or extreme joint overload resulting in a maladaptive remodeling of the TMJ condyle, potential comorbid factors, the severity and activity of the process, as well as patients’ desires, the following management options were found and can be considered: no treatment, orthodontics, medical management with orthognathic surgery, disc repositioning with orthognathic surgery and alloplastic TMJ replacement. Based on the relevant literature reviewed, TMJR appears to be a safe and effective surgical option for the management of patients with end-stage condylar resorption. Conclusions: Based on the literature reviewed for this paper, TMJR is a safe and effective surgical option for the management for both the skeletally mature and skeletally immature patient with end-stage condylar resorption. Therefore, it also appears appropriate for surgeons to consider a management option for condylar resorption such as TMJR that does not depend on a biomechanically compromised, degenerated condyle with documented biological maladaptive capacity under loading functions. Future studies with large condylar resorption subject cohorts should be pursued to further support this management option.