TMJ is a complex condition to diagnose and treat. Although we understand more about it than ever, we are still a long way from having a comprehensive grasp on the condition. In light of our limited understanding, most health officials recommend–and we here at Smile Columbia Dentistry follow–a cautious approach that encourages less intervention, including reversible and nonsurgical TMJ treatments first and only moving to more invasive treatments as necessary.
This is partly because of the high number of complications that come from surgical treatment of TMJ and the use of temporomandibular joint implants.
Temporomandibular Joint Implant Adverse Events Reported
The FDA monitors adverse outcomes associated with medical devices, including temporomandibular joint implants. In the MAUDE adverse event reporting system, there were 20 incidents reported in January, February, and March related to temporomandibular joint implants related to 14 different patients. The adverse events reported were:
- Infection: 4 reports
- Swelling and pain: 2
- Ankylosis: 2
- Revision surgery (no cause given): 2
- Dislocated jaw: 1
- Malocclusion: 1
- Anatomical mismatch: 1
- Implant loosening: 1
Most of these events were serious: 12 of them required hospitalization and/or revision surgery. In many cases, problems expanded beyond the implanted jaw joint. Some of these events occurred in December (and some March events won’t be reported until April), and two of the events were related to previous incidents that were just now being reported because of poor tracking of results and patients.
Increased Scrutiny of Implants
In 2011, FDA announced that it wanted to improve surveillance of temporomandibular joint implants because there seemed to be a high number of early failures. Although the implants were supposed to last five years, failures seemed to occur commonly at 3 years, and FDA felt postmarket surveillance needed to be stepped up. FDA hasn’t released a follow-up statement on the surveillance or made any concrete changes to the approval status of the implants.
A Complex Joint Is Hard to Replace
Although there are regularly problems with all types of joint implants, overall it is a successful procedure. It works best in joints that have simple, restricted motion, or joints where restricted motion is an acceptable outcome. The temporomandibular joint is one of the most complex in the body, and designing a suitable replacement has proven challenging.
Of course, there are some cases where temporomandibular joint replacement may be the best out of a number of bad options. The joint implants aren’t inherently bad, and for some appropriate candidates they give the best possible outcome.
However, nonsurgical TMJ treatment is to be considered and attempted for most people before surgery is considered.