Biomaterials of interpositional arthroplasty – A systematic review / Wong Ling Vuan

Wong , Ling Vuan (2023) Biomaterials of interpositional arthroplasty – A systematic review / Wong Ling Vuan. Masters thesis, Universiti Malaya.

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Abstract

Temporomandibular joint (TMJ) ankylosis can occur due to fibrous or bony union of the anatomical joints post trauma, infection, inadequate past surgical treatment, long-term joint inflammation, congenital or idiopathic. It compromises patients’ function, appearance, growth of mandible, and oral hygiene care. Different surgical procedures have been introduced to treat TMJ ankylosis issue. The three most described surgical techniques are gap arthroplasty, ramus-joint reconstruction, and interpositional arthroplasty. In this study, different types of biomaterials for interpositional arthroplasty at TMJ region post ankylotic mass resection were reviewed. This systematic review aimed to determine the most utilised biomaterials in TMJ interpositional arthroplasty, and to identify biomaterials that can produce good maximal incisal opening post-surgery, as well as complications that are associated with types of biomaterials used in TMJ interpositional arthroplasty. Papers published up to 16th October 2021 were screened using PICO format, through electronic and hand search. All details reported were collected using Cochrane Collaboration (2014) data collection form before further scrutinised using Revised Cochrane risk-of-bias tool for cluster-randomized trials (RoB 2 CRT) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for randomised controlled trial (RCT) and non-RCT articles respectively. A total of 26 non-randomised controlled trial (non-RCT) papers and 5 RCT papers were included in this systematic review. The reported biomaterials used for interpositional arthroplasty were temporalis fascia / temporalis muscle, silicone block / sheet, abdominal fat, buccal fat pad, native articular disc, skin graft, costal cartilage, bone wax and porcine accelular dermal matrix and acrylic marbles. The most utilized biomaterials in interpositional arthroplasty were temporalis myofascial flap / temporalis fascia and fat grafts (buccal fat pad and abdominal fat). All the studied biomaterials were able to produce good post operative mouth opening. Most complications were related to surgical approaches and patients’ non-compliance to jaw physiotherapy rather than the biomaterials itself. Each biomaterials has its own pros and cons upon application clinically. Good pre-surgical planning with aid of radiographic imaging can reduce intra- and post-op complications. Compliance of patients to jaw physiotherapy can ensure long term success.

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