The role of custom-made prosthesis for temporomandibular joint replacement Papel de la prótesis hecha a medida para la sustitución de la articulación temporomandibular

Alloplastic temporomandibular joint replacement (TMJ TJR) presents unique problems due to the integral and multifaceted roles this joint plays within the stomatognathic system to establish and maintain appropriate mandibular function and form. The TMJ not only acts as a secondary mandibular growth center pre-puberty, but is also crucial in maintaining proper mastication, speech, airway support and deglutition. Further, these essential life functions place the TMJ under more cyclical loading and unloading than any other body joint over a lifetime. Therefore, when TMJ TJR is indicated the device chosen must be able to provide long-term mandibular function and form outcomes. End-stage TMJ pathology accompanied by physiological function and anatomical form distortions dictates the need for replacement. Due to the complex nature of joint related masticatory muscle functional and anatomical associations, it is unreasonable to expect an autogenous reconstructed TMJ or an alloplastic replaced TMJ can be returned to "normal" pre-morbid function. Therefore, as is understood with any orthopaedic joint replacement, patient and surgeon must agree and accept that there will always be some functional disability involved with any reconstructed or replaced TMJ. Further, in the multiply operated, anatomically distorted patients, chronic neuropathic centrally mediated pain will always be a major component of their disability. Therefore, it is imperative that surgeon and patient understand that the primary goal of any TMJ TJR is the restoration mandibular function and form and that any pain relief must be considered of only secondary benefit. This paper will discuss the role of custom TMJ TJR devices have in the management of severe and debilitating TMJ disorders. La sustitución aloplástica de la articulación temporomandibular plantea problemas exclusivos debido al papel esencial y polifacético que esta articulación desempe a en el sistema estomatognático para establecer y mantener la función y forma mandibular apropiadas. La articulación temporomandibular no sólo actúa como un centro prepuberal del crecimiento mandibular secundario sino que también es decisiva en el mantenimiento de la masticación, el habla, soporte de las vías respiratorias y deglución apropiadas. Además, estas funciones vitales esenciales producen en la articulación una mayor carga y descarga cíclicas que en cualquier otra articulación corporal durante la vida. Por consiguiente, cuando está indicada una sustitución aloplástica de la articulación, el dispositivo elegido debe ser capaz de proporcionar dese