ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title TMJ Replacement May Be the Treatment of Choice for TMD Patients with Advanced TMJ Disease
Clinical Question Among TMD patients with advanced TMJ disease and high levels of persistent long-term TMJ pain, without severe hyperfunctional habits, and who have not obtained satisfactory improvement from other surgical therapies, would a total TMJ replacement result in improved pain intensity and jaw opening than prior treatments?
Clinical Bottom Line A total TMJ replacement may provide significant improvement in pain intensity and jaw opening for patients with advanced TMJ disease and high levels of persistent long-term TMJ pain, and without severe hyperfunctional habits. This is supported by a study in which 4% of the patients had a problem that required replacement of their new total TMJ. Patients considering total TMJ replacement must balance their choices with the cost of the therapies, potential for adverse sequelae, and the potential need to replace the reconstructed TMJ in the future.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26377771Gonzalez-Perez/201652 patients with advanced TMJ diseaseProspective Cohort Study
Key resultsAmong adults with advanced TMJ disease, experiencing long-term TMJ pain, without severe hyperfunctional habits, and decreased mandibular range of motion of at least 1-year duration obtained significant improvement after receiving bilateral or unilateral total TMJ replacements. These patients averaged two previous surgeries, including arthrocentesis or arthroscopy, for each joint. After the joint replacement procedure, average pain scores dropped from 6.4 ± 1.4 to 1.6 ± 1.2 on a visual analog scale (VAS) (p < 0.001), and average maximum jaw opening improved from 2.7 ± 0.9 cm to 4.2 ± 0.7 cm (p < 0.001). This correlates to a pain reduction average of 76.5% and average improvement of maximum mouth opening of 74.2%. During this study, 4% of the patients had a problem that required replacement of their new total TMJ.
#2) 24659775Al-Baghdadi/20141,305 patients in 20 eligible studiesSystematic review of non-randomized trials
Key results“In this review, analysis was conducted between and within groups. When the interventions were compared with each other, the least invasive conservative interventions, including patient education and self-management, seemed to exert effects comparable with those of more ‘active’ (combined splint plus physiotherapy) or ‘invasive’ (TMJ surgery) treatment approaches. Splints as a solitary treatment approach, however, seemed to have no additional effect over other active interventions or no treatment, although as an adjunct to others, they may help to alleviate symptoms.”
Evidence Search "total temporomandibular joint replacement outcomes" "Temporomandibular Joint Disorders/therapy"[Mesh]
Comments on
The Evidence
Validity: These two studies investigate two different spectrums of the currently practiced treatment for TMJ disorders. The Gonzalez-Perez study is a prospective study in which each of the subjects were thoroughly examined (imaging evidence of disease, documented history of at least 1 year of TMJ dysfunction, and documentation of failed prior treatments) to assess their qualifications for inclusion in the study. Once included, each of the subjects was treated with the same joint replacement system, and follow-up evaluation was conducted precisely at 3, 6, 12, and 24 months following surgery. The Al-Baghdadi study is a systematic review that used Cochrane guidelines for the analysis of records on the many different treatment modalities of TMJ disk displacement without reduction. This one subset of TMD disorders cannot be representative of the many different TMD patients, but this study did a thorough job of identifying and examining 172 potentially eligible papers. Perspective: The research on total TMJ replacement is still young, but this study provides an early opportunity to see how the treatment can provide relief to TMD patients who have not seen relief from more conservative or surgical therapies. The systematic review is included as an example of how some patients experience relief of their TMD symptoms through combined conservative treatments. More research is needed on total TMJ replacement to analyze its viability for patients where conventional conservative and surgical treatment has failed.
Applicability The treatment of TMJ disorders has long been a multiple-modality practice using physiotherapy, splint devices, stretching programs, self-management, behavioral intervention and medication, etc. Even so, some patients will not see relief through these paths of treatment. Total TMJ replacement is a pertinent option to provide improvement to the long-term TMD patient with advanced TMJ disease who have not obtained satisfactory improvement from conservative and other surgical TMD treatments.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords TMD treatment, TMD treatment comparison, TMD treatment options
ID# 3193
Date of submission: 03/29/2017spacer
E-mail COTTONGAME@livemail.uthscsa.edu
Author Colby Cottongame
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
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