Визначення точності встановлення пацієнт-специфічних ендопротезів скронево-нижньощелепного суглоба з використанням навігаційних хірургічних шаблонів

R. O.  Terletskyi; Yu. V.  Chepurnyi; A. V. Kopchak

doi:10.33295/1992-576X-2025-1-107

Authors

R. O. Terletskyi O. O. Bogomolets National Medical University https://orcid.org/0009-0000-8265-9316
Yu. V. Chepurnyi Bogomolets National Medical University https://orcid.org/0000-0003-4393-3938
A. V. Kopchak O. O. Bogomolets National Medical University https://orcid.org/0000-0002-3272-4658

DOI:

https://doi.org/10.33295/1992-576X-2025-1-107

Keywords:

temporomandibular joint, computer-aided design and manufacturing (CAD/CAM), surgical templates, ankylo-sis, endoprosthesis, patient-specific implant

Abstract

Abstract. Total joint replacement is indicated for congenital developmental anomalies, hereditary craniofacial syndromes, post-traumatic defects, deformities, ankylosis, severe degenerative osteoarthritis, condylar hyperplasia, mandibular tumors extending to the temporomandibular joint (TMJ), significant condylar resorption, osteonecrosis, and other conditions. Advancements in computer-aided design and manufacturing (CAD/CAM) technologies have led to the widespread use of patient-specific endoprostheses designed to accommodate each patient’s unique craniofacial anatomy. Navigation surgical guides have recently been increasingly recommended to place patient-specific constructs, osteotomies, and bone fragment repositioning. These guides enhance surgical precision by providing clear reference points and directional guidance.
Objective. This study assessed the accuracy of TMJ patient-specific endoprosthesis placement achieved during surgery using navigation surgical guides compared to preoperative computer-aided planning. Additionally, factors influencing the magnitude of observed discrepancies were analyzed.
Results and Conclusions. A comparative analysis of preoperative planning and postoperative outcomes in patients with TMJ disorders and trauma who underwent total joint replacement with patient-specific constructs fabricated using a digital protocol and CAD/CAM technology revealed discrepancies in the condylar component position. The median mean deviation was 1.02 mm (IQR 0.78–1.47), with a maximum deviation of 2.42 mm (IQR 2.03–4.26). In the glenoid fossa region, deviations were significantly lower (p < 0.05), with a median of 0.65 mm (IQR 0.47–1.16) and a maximum of 1.79 mm (IQR 1.46–2.02). These deviations were biomechanically acceptable and did not affect the aesthetic outcomes of endoprosthesis placement. In no case did the condylar head extend beyond the glenoid fossa due to its spatial configuration. Overall, the findings confirm the high precision of TMJ endoprosthesis placement using CAD/CAM technology.

Downloads

Download data is not yet available.

Author Biographies

R. O. Terletskyi, O. O. Bogomolets National Medical University

Department of Maxillofacial Surgery and Innovative Dentistry

Yu. V. Chepurnyi, Bogomolets National Medical University

Doctor of Medical Sciences, Associate Professor of the Department of Maxillofacial Surgery and Modern Dental Technologies, Institute of Postgraduate Education

A. V. Kopchak, O. O. Bogomolets National Medical University

Doctor of Medical Sciences, Professor, Head of the Department of Maxillofacial Surgery and Modern Dental Technologies of the Institute of Postgraduate Education

References

Driemel, O., Braun, S., Müller-Richter, U.D. et al. (2009). Historical development of alloplastic temporomandibular joint replacement after 1945 and state of the art. Int. J. Oral. Maxillofac. Surg., 38(9), 909–920. DOI: https://doi.org/10.1016/j.ijom.2009.01.022.

Mani, B., Balasubramaniam, S., Balasubramanian S. et al. (2020). Role of custom-made prosthesis for temporomandibular joint replacement in unilateral ankylosis — an evaluative study. Ann. Maxillofac. Surg., 10(2), 344–352. DOI: https://doi.org/10.4103/ams.ams_132_20.

Elledge, R., Attard, A., Green, J., et al. (2017). UK temporomandibular joint replacement database: A report on one-year outcomes. Br. J. Oral. Maxillofac. Surg., 55(9), 927–931. DOI: https://doi.org/10.1016/j.bjoms.2017.08.361.

De Meurechy, N., Mommaerts, M.Y. (2018). Alloplastic temporomandibular joint replacement systems: A systematic review of their history. Int. J. Oral. Maxillofac. Surg., 47(6), 743–754. DOI: https://doi.org/10.1016/j.ijom.2018.01.014.

Mercuri, L.G., Wolford, L.M., Sanders, B. et al. (2002). Long-term follow-up of the CAD/CAM patient fitted total temporomandibular joint reconstruction system. J. Oral. Maxillofac. Surg., 60(12), 1440–1448. DOI: https://doi.org/10.1053/joms.2002.36103.

Chen, X., Mao, Y., Zheng, J. et al. (2021). Clinical and radiological outcomes of Chinese customized three-dimensionally printed total temporomandibular joint prostheses: A prospective case series study. J. Plast. Reconstr. Aesthet. Surg., 74(7), 1582–1593. DOI: https://doi.org/10.1016/j.bjps.2020.10.108.

Kozakiewicz, M., Wach, T., Szymor, P., Zieliński, R. (2017). Two different techniques of manufacturing TMJ replacements — A technical report. J. Cranio-Maxillofac. Surg., 45(9), 1432–1437. DOI: https://doi.org/10.1016/j.jcms.2017.06.003.

Boccalatte, L.A., Nassif, M.G., Figari, M.F. et al. (2020). Computer-assisted surgery for replacement of the temporomandibular joint with customized prostheses: can we validate the results? Oral. Maxillofac. Surg., 24(3), 317–325. DOI: https://doi.org/10.1007/s10006-020-00858-3.

Sembronio, S., Tel, A., Robiony, M. (2021). Protocol for fully digital and customized management of concomitant temporomandibular joint replacement and orthognathic surgery. Int. J. Oral. Maxillofac. Surg., 50(2), 212–219. DOI: https://doi.org/10.1016/j.ijom.2020.04.004.

Sembronio, S., Tel, A., Costa, F. et al. (2019). Accuracy of custom-fitted temporomandibular joint alloplastic reconstruction and virtual surgical planning. Int. J. Oral. Maxillofac. Surg., 48(8), 1077–1083. DOI: https://doi.org/10.1016/j.ijom.2019.01.024.

Hirjak, D., Vavro, M., Dvoranova, B. et al. (2021). Periangular transmasseteric infraparotid approach in the treatment of condylar-base and low condylar‑neck fractures. Bratisl. Med. J., 122(3), 184–189. DOI: https://doi.org/10.4149/BLL_2021_029.

Mercuri, L.G. (2012). Alloplastic temporomandibular joint replacement: Rationale for the use of custom devices. Int. J. Oral. Maxillofac. Surg., 41(9), 1033–1040. DOI: https://doi.org/10.1016/j.ijom.2012.05.032.

Mercuri, L.G. (2000). The use of alloplastic prostheses for temporomandibular joint reconstruction. J. Oral. Maxillofac. Surg., 58(1), 70–75. DOI: https://doi.org/10.1016/s0278-2391(00)80020-8.

Mercuri, L.G., Edibam, N.R., Giobbie-Hurder, A. (2007). Fourteen-year followup of a patient-fitted total temporomandibular joint reconstruction system. J. Oral. Maxillofac. Surg., 65(6), 1140–1148. DOI: https://doi.org/10.1016/j.joms.2006.10.006.

Sanovich, R., Mehta, U., Abramowicz, S. et al. (2014). Total alloplastic temporomandibular joint reconstruction using Biomet stock prostheses: The University of Florida experience. Int. J. Oral. Maxillofac. Surg., 43(9), 1091–1095. DOI: https://doi.org/10.1016/j.ijom.2014.04.008.

Dowgierd, K., Pokrowiecki, R., Kulesa Mrowiecka, M. et al. (2022). Protocol for multi-stage treatment of temporomandibular joint ankylosis in children and adolescents. J. Clin. Med., 11(2), 428. DOI: https://doi.org/10.3390/jcm11020428.

Mercuri, L.G. (2013). The role of custom-made prosthesis for temporomandibular joint replacement. Rev. Esp. Cir. Oral. Maxilofac., 35(1), 1–10. DOI: https://doi.org/10.1016/j.maxilo.2012.02.003.

Johnson, N.R., Roberts, M.J., Doi, S.A., Batstone, M.D. (2017). Total temporomandibular joint replacement prostheses: A systematic review and bias-adjusted meta-analysis. Int. J. Oral. Maxillofac. Surg., 46(1), 86–92. DOI: https://doi.org/10.1016/j.ijom.2016.08.022.

Westermark, A. (2010). Total reconstruction of the temporomandibular joint. Up to 8 years of follow-up of patients treated with Biomet® total joint prostheses. Int. J. Oral. Maxillofac. Surg., 39(10), 951–955. DOI: https://doi.org/10.1016/j.ijom.2010.05.010.

Gonzalez-Perez, L.M., Gonzalez-Perez-Somarriba, B., Centeno, G. et al. (2016). Evaluation of total alloplastic temporo-mandibular joint replacement with two different types of prostheses: A three-year prospective study. Med. Oral. Patol. Oral. Cir. Bucal., 21(6), e766—e775. DOI: https://doi.org/10.4317/medoral.21189.

Rajkumar, A., Sidebottom, A.J. (2022). Prospective study of the long-term outcomes and complications after total temporomandibular joint replacement: Analysis at 10 years. Int. J. Oral. Maxillofac. Surg., 51(5), 665–668. DOI: https://doi.org/10.1016/j.ijom.2021.07.021.

Chepurnyi, Yu.V., Chernohorskyi, D.M., Zhukovtseva, O.I., Kopchak A.V. (2021). Porivnialnyi analiz vidpovidnosti peredoperatsiinoho planuvannia ta pisliaoperatsiinoho rezultatu pry zamishchenni defektiv vylytsevoho kompleksu ta orbity z vykorystanniam patsiientspetsyfichnykh implantativ. U: Morfolohichni aspekty suchasnoi medytsyny ta stomatolohii, 19–20 travnia 2021, Poltava, Ukraina. Poltava: Poltavskyi derzhavnyi medychnyi universytet. s. 96–97. URL: https://repository.pdmu.edu.ua/handle/123456789/16662.