Rheumatoid arthritis is the most common autoimmune/connective tissue disease involving the temporomandibular joints (TMJ), but other systemic inflammatory diseases that can affect the TMJ include psoriatic arthritis, systemic lupus erythematosus, ankylosing spondylitis, and gout. Classic symptoms include pain, headaches, morning stiffness, clicking, crepitus, decreased bite force, mastication difficulty, and jaw immobility. Although initially a predominantly resorptive process, advanced disease may ultimately lead to ankylosis of the joint due to prolonged hypomobility. Progressive retrusion of the mandible and malocclusion can develop due to the loss of vertical condylar and ramus height, with subsequent downward and backward rotation of the mandible.
Primary treatment for the majority of systemic diseases involves use of medications for immune-modulation and pain control. However, surgery is a viable option for treatment of those TMJs that have undergone significant bone resorption or are symptomatic despite conservative therapy. Definitive management of these patients with advanced TMJ pathology usually requires replacement of the condyles and the goals of reconstruction include long-term stability, decrease in pain, and improvement in function and quality of life. The advent of 3-dimensional stereolithographic technology has improved the outcome quality and predictability by providing an accurate model for fabrication of custom-made total joint prostheses. This presentation specifically focuses on outcomes of surgical management of TMJ condylar resorption with patient-fitted, alloplastic TMJ total joint prostheses. Long-term results of a surgical protocol utilizing a single-stage approach for concomitant management of the TMJ disease and associated facial deformities in the management of these complex patients will be discussed.