CC BY-NC-ND 4.0 · Indian J Plast Surg 2009; 42(01): 085-093
DOI: 10.1055/s-0039-1699318
Ideas and Innovations
Association of Plastic Surgeons of India

Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis

Suresh M. Chaware
Central India Institute of Medical Sciences, Bajaj Nagar, India
,
Vaibhav Bagaria
Central India Institute of Medical Sciences, Bajaj Nagar, India
,
Abhay Kuthe
1  Department of CAD/CAM, VNIT, Nagpur, India
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2020 (online)

ABSTRACT

Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ), successfully using a standard “one-size-fits-all” prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT) scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery.

 
  • REFERENCES

  • 1 Posnick JC, Jacobs JS, Magee WP. Prosthetic replacement of the condylar head for temporomandibular joint disease. Plastic Reconstruct Surg 1987;80:536-44.
  • 2 Dolwick M. Clinical diagnosis of temporomandibular joint internal derangement and myofascial pain and dysfunction. Oral Maxillofac Surg Clin N Am 1989;1:1-6.
  • 3 Fontenot MG, Kent JN. In vitro wear performance of proplast TMJ disc implants. J Oral Maxillofacial Surgery 1992;50:133-9.
  • 4 Christensen, R. Arthroplastic implantation of the temporomandibular joint. In: Cranin AN, editor. Oral Implantology. Charles C Thomas; 1970. p. 28-98.
  • 5 Morgan DH. Evaluation of alloplastic TMJ implants. Cranio 1988;6:22-38.
  • 6 Morgan DH, Hall WP. Addition of a temporal silastic and metal implant to a metallic condyle. Cranio 1985;3:l79-83.
  • 7 MacAfee KA, Quinn PD, Total temporomandibular joint reconstruction with a delrin titanium implant. J Craniofac Surg 1992;3:l60-9.
  • 8 Pertes RA, Heir GJ. Chronic orofacial pain; a practical approach to differential diagnosis. Dental Clin N Am 1991;35:123-39.
  • 9 Hoffman D. An Overview of TMJ Surgery, Seminar-Advances in Pain Management: Head, Neck and Shoulder Pain. Orlando: Dept Anesthesiology, Pain Management Center, N.J. Medical School, 1993.
  • 10 Crawley WA, Serletti JM, Manson PN. Autogenous reconstruction of the temporomandibular joint. J Craniofacial Surg 1993;4:28-34.
  • 11 Politis C, Fossion E, Bassuyt M. The use of costochondral grafts in arthroplasty of the temporomandibular joint. J Cranio-Maxillofac Surg 1987;15:345-54.
  • 12 Kent JN, Misiek DJ. Controversies in disc and condyle replacement for partial and total temporomandibular joint reconstructi. In: Worthington P, Evans JR, editors. Controversies in Oral and Maxillofacial Surgery. Philadelphia: WB Saunders;1994. p. 397-435.
  • 13 Macintosh RB. The case for autogenous reconstruction of the adult temporomandibular joint. In: Worthington P, Evans JR, editors. Controversies in Oral and Maxillofacial Surgery. Philadelphia: WB Saunders; 1994. p. 356-80.
  • 14 Wolford LM, Cottrell DA, Henry CH. Temporomandibular joint reconstruction of the complex patient with the Techmedica custom-made total joint prosthesis. J Oral Maxillofac Surg 1994;52:2-10.
  • 15 Feinberg S, Larsen P. The use of a pedicled temporalis muscle-pericranial flap for replacement of the TMJ disc. J Oral Maxillofac Surg 1994;47:142-6.
  • 16 Larry M. Wolford, DDS and Pushkar Mehra, DMD Custom-made total joint prostheses for temporomandibular joint reconstruction. Proc (Bayl Univ Med Cent) 2000;13:135-8.
  • 17 Wolford LM, Cottrell, DA, Henry CH. Temporomandibular joint reconstruction of the complex patient with the techmedica custom-made total joint prothesis. J Oral Maxillofac Surg 1994;52:2-10.
  • 18 Mercuri LG, Wolford L, Sanders B, White RD, Hurder A, Henderson W. Custom CAD/CAM total temporomandibular joint reconstruction system, Preliminary Multicenter Report. J Oral Maxillofac Surg 1995;53:l06-15.
  • 19 Wolford LM, Cottrell DA, Henry CH. Temporomandibular joint reconstruction of the complex patient with the Techmedica custom-made total joint prosthesis. J Oral Maxillofac Surg 1994;52:2-10.