FSTMK Annual Meeting 2011 - Foreningen af Specialtandlæger i ...

Interpositional arthroplasty of patients with TMJ-arthrosis. Short term results.
A prospective study of 25 patients surgically treated forTMJ-arthrosis with interpositional arthroplasty
using homologeous costal cartilage grafts (Tutoplast®) from 2007-2010.
Results: Interincisal opening increased from median 31 mm (17-42) to 40 mm (37-44) and VAS pain
score (0-10) was reduced from median 8 (6-9) to 2 (0-5.5) during the first year of follow-up.
Complication with fragmentation of the interpositional material happened in one patient who was later
reoperated. No other complications occurred
From 2010 to 2011 ten additional patients have been operated with similar good results, except for two
problematic cases.
Conclusions: If the results of this moderate surgical approach are more long-standing it may be an
alternative to more aggressive surgery in patients with severe TMJ arthrosis, although there are some
limitations.
Esben Aagaard, Consultant Oral and Maxillofacial Surgeon
Dept. of Maxillofacial Surgery, Odense University Hospital, Denmark
Abstract 1
Combining Alloplastic TMJ Reconstruction with Orthognathic Movements via Digital
Preoperative Planning and Custom Prostheses
Aagaard E.*, Thygesen T.H.*, Flannery N.M.P.**, Weimer K.A.**, Christensen A.M.**
*Dept. of Oral & Maxillofacial Surgery, Odense University Hospital, Denmark
**Medical Modeling Inc., Golden, Colorado USA
Purpose: Virtual surgical planning with CAD/CAM templates have been shown to facilitate
orthognathic surgery as a viable alternative to traditional planning methods. Alloplastic reconstruction
of the temporomandibular joint (TMJ) is performed with either off-the-shelf or custom components
designed using traditional, non-digital methods. Over the last few years digital design of custom TMJ
prostheses (Biomet MicroFixation) has proven to be accurate and effective. Concomitant reconstruction
of the TMJ with orthognathic movements can now be directed from a completely digital plan involving
CAD/CAM joint prostheses and CAD/CAM intermediate and/or final occlusal splints.
Methods & Materials: Preoperative CT scans (0.75mm - 1.25mm slice spacing, .3mm-.45mm pixel
size) were taken of patients requiring both orthognathic surgery and alloplastic replacement of the TMJ.
The medical images were imported into the virtual surgical planning software and three-dimensional
virtual models were created. The orthognathic surgery was digitally planned in a meeting between the
surgeon and an engineer at the modeling company. Simulated post-operative digital models were then
utilized to design customized total TMJ prostheses in a completely digital fashion. Custom implant
components, anatomical model(s), surgical guide(s), orthognathic splint(s) and other template(s) were
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