Temporomandibular joint disorders (TMD) affect people across every continent; up to 31% of adults worldwide may experience symptoms.[i] Symptoms vary: some may hear a popping noise when moving the jaw, others may have pain when masticating, and many more may be unable to fully open their mouth.[ii]
TMD patients can be managed in a variety of ways, depending on the severity of their symptoms. Those reporting pain should be recommended to eat soft foods, hold ice or heat packs to the sensitive area, and massage the jaw muscles. If these solutions fail to alleviate severe symptoms, temporomandibular joint (TMJ) reconstruction may be needed – a surgical operation with many approaches. For dental clinicians, patients with TMD symptoms should be educated and guided towards the appropriate treatment options and any post-recovery actions, providing a comprehensive overview of the different TMJ reconstruction protocols.
Built in a day
The mandibular condyle is the head of the lower jaw and, with the temporal bone, articulates to form the TMJ, allowing the jaw to move. Reconstruction of the TMJ is a multifaceted challenge, infrequent in occurrence but capable of transforming a patient’s life, alleviating pain and restoring function to the jaw. However, there is no unified approach to it. Autologous tissue transplantation is one option; historically, reconstructing the TMJ in the early 20th century drew on the costochondral rib joint, the iliac crest, transport distraction osteogenesis (TDO), the fibular and more as the most common sources for hard tissue grafting.[iii]
The complications of autologous transplantation are well-documented: resorption, fracture, ankylosis, and unpredictable growth patterns frequently emerge post-grafting. More longer-term studies have also noted that costochondral grafts reveal excessive growth on the treated side in over half the patients. Only 38% achieved a symmetrical ramus condyle unit four years after the reconstruction surgery.[iv] Whilst autologous grafts are reliable for their biocompatibility, they are complicated by the need for an additional surgical site, donor site morbidity, the potential for graft fracture or resorption, and extended surgery duration.[v] These considerations can make the treatment less appealing to TMD patients.
A superior option
Alloplastic joint replacements are more innovative biomechanical alternatives: they manage unilateral or bilateral TMJ ankylosis and offer fewer complications. The risk of re-operation is also lower.[vi]
In 1965, the first TMJ implant was introduced that combined an alloy of cobalt, chromium and molybdenum for the fossa and the standardised ramus component. This utilised a polymethylmethacrylate condylar head and was sealed with cement – later breakthroughs led to titanium emerging as the optimal material choice for more complex prostheses.[vii] There are two types of alloplastic devices: stock-type and custom-designed, with the latter produced using CAD/CAM technologies. Both replace the ramus and condylar component and the fossa component using titanium screws for fixing.[viii] Alloplastic devices offer greater effectiveness than autologous transplantation, with custom-designed prostheses working especially well for patients with ankylosis – those treated with one experienced improved quality of life over a 12-year period.[ix] This included maximum mouth opening and superior mastication.
The use of titanium, combined with tailored 3D printed designs, supports a solution that is biocompatible and long lasting, with a minimised risk of rejection – as the metal quickly reacts to oxygen, it forms a titanium oxide layer that reduces the release of any metal particles into the surrounding surgical area.[x] Titanium alloys enhance these qualities without compromising on strength or wear-resistance too.
Road to recovery
Regardless of treatment type or material, patients who have received TMJ reconstruction surgery will need a reliable rehabilitation protocol to improve range of motion and jaw strength. Clinicians can support TMD patients by recommending the OraStretchâ Press Rehab System from Total TMJ. An easy-to-use device perfect for both home and travel, it stretches the orofacial tissues to restore strength and function to the TMJ. Patients can feel empowered in their recovery due to the notable improvements in mouth movement thanks to the device, when following the daily exercises as recommended by a healthcare professional.
Knowledge of the TMJ has increased dramatically in recent years, with innovative techniques and solutions employed to deliver life-changing treatments.[xi] Having a stronger understanding of the different reconstruction approaches allows clinicians to better support their patients and ensure that they feel confident in their recovery of the TMJ.
For more details about Total TMJ and the products available, please email info@totaltmj.co.uk
Author: Karen Harnott Total TMJ Operations Director
[i] Wroclawski, C., Mediratta, J.K. and Fillmore, W.J. (2023). Recent Advances in Temporomandibular Joint Surgery. Medicina (Kaunas, Lithuania), [online] 59(8), p.1409. doi:https://doi.org/10.3390/medicina59081409.
[ii] NHS Choices (2020). Temporomandibular disorder (TMD). [online] NHS. Available at: https://www.nhs.uk/conditions/temporomandibular-disorder-tmd/.
[iii] Liu, H., Huang, L., Liu, S., Liu, L., Li, B., Zheng, Z., Liu, Y., Liu, X. and Luo, E. (2025). Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement. International Journal of Oral Science, [online] 17(1). doi:https://doi.org/10.1038/s41368-024-00339-3.
[iv] Liu, H., Huang, L., Liu, S., Liu, L., Li, B., Zheng, Z., Liu, Y., Liu, X. and Luo, E. (2025). Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement. International Journal of Oral Science, [online] 17(1). doi:https://doi.org/10.1038/s41368-024-00339-3.
[v] Liu, H., Huang, L., Liu, S., Liu, L., Li, B., Zheng, Z., Liu, Y., Liu, X. and Luo, E. (2025). Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement. International Journal of Oral Science, [online] 17(1). doi:https://doi.org/10.1038/s41368-024-00339-3.
[vi] Liu, H., Huang, L., Liu, S., Liu, L., Li, B., Zheng, Z., Liu, Y., Liu, X. and Luo, E. (2025). Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement. International Journal of Oral Science, [online] 17(1). doi:https://doi.org/10.1038/s41368-024-00339-3.
[vii] Liu, H., Huang, L., Liu, S., Liu, L., Li, B., Zheng, Z., Liu, Y., Liu, X. and Luo, E. (2025). Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement. International Journal of Oral Science, [online] 17(1). doi:https://doi.org/10.1038/s41368-024-00339-3.
[viii] Olate, S., Ravelo, V., Huentequeo, C., Parra, M. and Unibazo, A. (2023). An Overview of Clinical Conditions and a Systematic Review of Personalized TMJ Replacement. Journal of Personalized Medicine, 13(3), p.533. doi:https://doi.org/10.3390/jpm13030533.
[ix] Liu, H., Huang, L., Liu, S., Liu, L., Li, B., Zheng, Z., Liu, Y., Liu, X. and Luo, E. (2025). Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement. International Journal of Oral Science, [online] 17(1). doi:https://doi.org/10.1038/s41368-024-00339-3.
[x] Silva, R.C.S., Agrelli, A., Andrade, A.N., Mendes-Marques, C.L., Arruda, I.R.S., Santos, L.R.L., Vasconcelos, N.F. and Machado, G. (2022). Titanium Dental Implants: An Overview of Applied Nanobiotechnology to Improve Biocompatibility and Prevent Infections. Materials, 15(9), p.3150. doi:https://doi.org/10.3390/ma15093150.
[xi] Wroclawski, C., Mediratta, J.K. and Fillmore, W.J. (2023). Recent Advances in Temporomandibular Joint Surgery. Medicina (Kaunas, Lithuania), [online] 59(8), p.1409. doi:https://doi.org/10.3390/medicina59081409.
