Substituição aloplástica da articulação temporomandibular com próteses customizadas: uma revisão de literatura

Abstract

The temporomandibular joint (TMJ) can be affected by pathologies and changes that interfere with its function and movement. Some of these changes cannot be resolved with conservative treatments and require more complex treatments, such as alloplastic joint replacement with customized or stock prostheses. The present work aims to review the literature on alloplastic replacement of the TMJ with customized prostheses and discuss its indications and advantages in relation to stock prostheses. Indications for the procedure include ankylosis, congenital deformities, necrosis, condylar fracture, inflammatory and degenerative disease, failure of graft reconstruction and extensive mandibular resections. The customized prosthesis is produced using CAD-CAM technology, through the generation of a prototype and consists of a device with anatomical specificity, allowing for a more precise reconstruction and in a shorter surgical time. The components of the prosthesis consist of a joint fossa covered with ultra-high molecular weight polyethylene; in a condylar head composed of a Chrome-Cobalt-Molybdenum alloy (Cr-Co-Mo) and in a body composed of Titanium, Aluminum and Vanadium (Ti-Al-V). Stock prostheses also consist of an articular fossa, supplied in sizes (small, medium and large) and a mandibular component available in three sizes (45, 50 and 55 mm). Both reconstruction systems present satisfactory clinical and functional results. However, customized prostheses have some advantages, such as reduced surgical time and greater adaptation to the patient's anatomy, providing more relevant anatomical and functional results.