Arthritic diseases: an indication for alloplastic temporomandibular joint replacement

Arthritic disease or degenerative joint disease (DJD) affecting the temporomandibular joints (TMJs) has the potential to cause degeneration of soft and hard tissues secondary to inflammation leading to significant dysfunction, pain and deformity. Low and high-inflammatory varieties of arthritic diseases have different pathophysiology, clinical course and prognosis. While low-inflammatory arthritic conditions such as osteoarthritis (OA) are more common in older age, high-inflammatory conditions can affect younger individuals. Accurate diagnosis forms the basis of timely and appropriate management. Many patients if diagnosed early, can often be managed with conservative non-surgical and/or minimally invasive surgical modalities. Severe or late-stage arthritic involvement of the TMJ can cause significant loss of bone volume with resultant dentofacial deformity, malocclusion and/or ankylosis. Such conditions may require reconstruction of the condyle with either autogenous or alloplastic options. Autogenous options such as costochondral grafts have fallen out of favor but may be a viable option for use in skeletally immature patients due to potential for growth. Based on current evidence, alloplastic total joint reconstruction with a stock or patient-fitted prosthesis is the most predictable treatment option with least risk of re-ankylosis, no donor site morbidity and allowing earlier return to function with long-term stability. This chapter will focus on common low- and high- inflammatory arthritic conditions that affect the TMJs and should be considered indications for alloplastic TMJ reconstruction.