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Accuracy of custom temporomandibular joint replacement surgery using a virtual surgical planning protocol

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Abstract

Background

Accurate placement of TMJ implant components may be facilitated by virtual surgical planning (VSP) technologies. The aim of this study was to assess the accuracy of a typical VSP protocol and describe the pattern of surgical error associated with total alloplastic TMJ replacement.

Methods

A retrospective analysis was undertaken on 40 adult patients who were implanted with a fully customised, 3D printed TMJ prosthesis due to end-stage TMJ disease. Planned TMJ implant position based on preoperative CBCT images was compared with final position on postoperative OPGs using a previously validated linear rescaling method. Translational discrepancy was described in the anterior-posterior direction and superior-inferior direction. Rotational discrepancy was described as anterior or posterior.

Results

Lin’s concordance between preoperative and postoperative position was 0.97, with no significant differences (p > 0.05). The Bland-Altman analysis showed a 95% limit of agreement between planned and final position of − 5.9 to 5.4 mm. Overall, final implant position was more anterior (0.4 mm), superior (0.4 mm) and posteriorly rotated (2.4°) compared with planned position.

Conclusion

The use of VSP in TMJ replacement surgery results in accurate implant placement with good agreement between planned and final implant position. Discrepancies in planned and final implant position tended to result in the mandibular component of the implant being translated anterior superiorly and rotated posteriorly, with potential implications for the biomechanical performance of the implant and overall device longevity. These results should be used to assist TMJ surgeons pre- and intraoperatively to facilitating accurate implant positioning and optimal surgical rehabilitation.

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Authors and Affiliations

  1. Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Carlton, Victoria, Australia

    Mustafa Mian

  2. Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia

    Mustafa Mian

  3. Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia

    David Ackland

  4. OMX Solutions, Melbourne, Victoria, Australia

    Sarah Fink, Nathan Wang & George Dimitroulis

  5. Department of Surgery, St Vincent’s Hospital, Fitzroy, Victoria, Australia

    George Dimitroulis

Authors
  1. Mustafa Mian
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  2. David Ackland
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  3. Sarah Fink
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  4. Nathan Wang
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  5. George Dimitroulis
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Correspondence to Mustafa Mian.

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Conflict of interest

The senior author (G.D.) holds shares in OMX Solutions Pty Ltd. Co-authors (S.F. and N.W.) are employed by OMX Solutions Pty Ltd.

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Mian, M., Ackland, D., Fink, S. et al. Accuracy of custom temporomandibular joint replacement surgery using a virtual surgical planning protocol. Oral Maxillofac Surg 25, 367–371 (2021). https://doi.org/10.1007/s10006-020-00928-6

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  • DOI: https://doi.org/10.1007/s10006-020-00928-6

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