The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

Skip to main content

TMJ Total Joint Replacement

Custom prosthetic reconstruction for end-stage temporomandibular joint disease

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ağız ve Diş Sağlığı department. Book Appointment →

What is TMJ Total Joint Replacement?

Total temporomandibular joint (TMJ) replacement is the definitive surgical option for end-stage TMJ pathology when conservative therapy, arthrocentesis, arthroscopy, and discectomy have failed. Indications include bony or fibrous ankylosis, severe inflammatory arthritis (rheumatoid, psoriatic), avascular necrosis, condylar resorption (idiopathic or post-orthognathic), failed alloplastic implants from prior eras (silicone or Proplast-Teflon), and reconstruction following tumor resection or trauma.

Modern total joints use cobalt-chromium-molybdenum or titanium fossa components articulating with cobalt-chromium condylar heads on titanium ramus extensions. Patient-specific implants are designed from CT-derived virtual surgical planning using CAD/CAM technology, optimizing fit, occlusion, and ramus reconstruction. Stock implants offer cost advantages but limited customization.

Outcomes after total joint replacement demonstrate sustained pain reduction, improved maximal interincisal opening (MIO), and durable function with appropriate patient selection. Failures relate to infection, fibrous ankylosis around the implant, heterotopic ossification, and rare implant fracture. Lifelong follow-up monitors function, occlusion, and metal ion levels (cobalt-chromium serum levels in select cases).

Symptoms

Severe persistent TMJ pain unresponsive to conservative care
Limited mouth opening (MIO often under 25 mm)
Inability to chew or maintain nutrition
Joint sounds (clicking, crepitus) often absent in advanced disease
Asymmetric mandibular movement
Facial asymmetry from condylar resorption
Open bite from bilateral condylar collapse
Class II occlusion progression
Headache, ear pain, neck pain referred from TMJ
Sleep disturbance from pain
Quality-of-life impairment
Failed prior TMJ surgery
Imaging evidence of condylar destruction or ankylosis
Rheumatoid disease with destructive TMJ involvement
Tumor or post-traumatic deformity

Risk Factors

Inflammatory arthritis (rheumatoid, psoriatic, juvenile idiopathic)
Severe degenerative joint disease
Bony or fibrous ankylosis
Idiopathic condylar resorption (often young women)
Failed prior alloplastic implants (silicone, Proplast-Teflon)
Failed costochondral graft reconstruction
Avascular necrosis of condyle
Tumor or pseudotumor of TMJ
Trauma with extensive condylar destruction
Connective tissue disease (lupus, scleroderma)
Heterotopic ossification predisposition
Bruxism, parafunction (relative consideration)
Smoking (impaired healing)
Diabetes mellitus (infection risk)
Immunosuppression

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe persistent TMJ pain not responding to splint therapy, physical therapy, or medications
  • Progressive limited mouth opening
  • Inability to chew or eat
  • Worsening malocclusion or anterior open bite
  • Documented condylar resorption on imaging
  • Facial asymmetry from joint disease
  • Failure of prior TMJ surgical procedures
  • Severe inflammatory arthritis affecting TMJ function
  • Reconstruction need after tumor resection
  • Trauma with extensive condylar damage
  • TMJ ankylosis with functional limitation
  • Severe disability and quality-of-life impairment

Treatment Methods

01
Comprehensive evaluation by oral and maxillofacial surgeon with TMJ expertise
02
Detailed imaging with CT (3D reconstruction) and MRI for soft tissue assessment
03
Failed conservative therapy documentation (splints, physical therapy, medications, arthrocentesis, arthroscopy)
04
Multidisciplinary planning with prosthodontics and orthodontics for occlusal management
05
Patient-specific implant design using virtual surgical planning and CAD/CAM
06
Stock implant fitting if patient-specific not available or contraindicated
07
Preoperative dental clearance to minimize bacteremia risk
08
Smoking cessation and glycemic optimization
09
General anesthesia with nasal intubation
10
Preauricular and submandibular surgical approaches
11
Resection of pathologic condyle with preservation of facial nerve
12
Glenoid fossa preparation for prosthetic component fixation
13
Ramus preparation and prosthesis placement
14
Coronoidectomy if needed for adequate range of motion
15
Fat graft from abdomen to prevent heterotopic ossification
16
Postoperative immediate jaw mobilization and aggressive physiotherapy
17
Pain management with multimodal analgesia
18
Antibiotic prophylaxis perioperatively and dental procedure prophylaxis lifelong
19
Soft to mechanical soft diet for 6 weeks transitioning to regular diet
20
Lifelong avoidance of hard foods and parafunctional habits
21
Annual follow-up with imaging surveillance
22
Cobalt-chromium serum monitoring in select cases
23
Revision surgery for infection, fibrous ankylosis, or implant failure

Which Department to Visit?

You can visit our Ağız ve Diş Sağlığı department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Ağız ve Diş Sağlığı Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Related Health Topics

Other articles from the same department you may want to explore.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Fatty Liver Disease

Dahiliye (İç Hastalıkları)

Non-alcoholic fatty liver disease (NAFLD) is closely related to obesity and metabolic syndrome and is largely reversible with early treatment.

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.