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. 2008 Jun;66(6):1112-24.
doi: 10.1016/j.joms.2007.09.013.

Evaluation of surgically retrieved temporomandibular joint alloplastic implants: pilot study

Joao N A R Ferreira  1 , Ching-Chang Ko, Sandra Myers, James Swift, James R Fricton
Affiliations

Evaluation of surgically retrieved temporomandibular joint alloplastic implants: pilot study

Joao N A R Ferreira et al. J Oral Maxillofac Surg. 2008 Jun.

Abstract

Purpose: The purpose of this study was to perform a retrieval analysis of temporomandibular joint (TMJ) alloplastic interpositional implants and test possible correlation between implant failure features and patient clinical outcomes. In addition, we investigated the implants' surface and examined the foreign body reaction associated with different types of alloplastic materials.

Materials and methods: Twelve implants (Proplast/Teflon [Vitek, Houston, TX] and Silastic [Dow Corning, Midland, MI]) were surgically removed from the patients' TMJs. Implant surface failure features (fracture length, perforation of the implants) were observed using stereomicroscopy and recorded for description of the failure mechanisms and to statistically compare with clinical outcomes. Patients' clinical data (pain symptoms and mandibular function) were collected and examined. Clinical outcomes were obtained relative to symptom severity (Symptom Severity Index [SSI]) and jaw function (modified Mandibular Function Impairment Questionnaire [mMFIQ]). Peri-implant soft tissues and implants were analyzed with light microscopy and stereo zoom microscopy. Electron microprobe analysis of implant fragments and peri-implant tissues was performed.

Results: The statistical results showed that only the presence of implant perforation was statistically associated with the SSI, specifically with the pain tolerability dimension. No statistical association was seen between any of the other implant failure predictors and the SSI and between the predictors and the mMFIQ. Stereo zoom microscopy suggested that Proplast/Teflon implants (n = 7) were susceptible to perforation, layer tearing, fracture and fiber extrusion. The Silastic implants (n = 3) revealed a possible center perforation with fracture lines towards the periphery and fiber extrusion. Teflon implant wear debris particles appear to trigger a multinucleated giant cell foreign body reaction.

Conclusion: Facial pain was a significant correlate to perforation and breakdown of the alloplastic TMJ interpositional implants, and most likely was the reason for implant removal.

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Figures

Figures 1
Figures 1
TMJ PTE implant fragments observed in the stereo zoom microscope; a.Condylar smooth fluorinated ethylene propylene (FEP) surface of a PTE implant (arrow indicates traces of friction) (Magnification: 0.63X); b. Porous PTFE glenoid fossa surface with (*) perforation in the center (Magnification: 0.63X); c. PTE implant with extruded fibers (arrows) (Magnification: 4X); d. PTE fragment, smooth PTFE surface with attached osseous tissue (arrow) (Magnification: 0,.63 X). PTFE: Polytetrafluorethylene.
Figures 2
Figures 2
TMJ Silastic implant fragments observed in the stereo zoom microscope; a. TMJ Silastic implant with a fracture line along its width (Magnification: 0.63X); b. TMJ Silastic implant with several fracture lines (Magnification: 2X); c. TMJ Silastic implant with Dacron fiber extrusion (Magnification: 4X).
Figures 3
Figures 3
a. H&E histological sections of TMJ soft tissue attached to PTE implants. b. PTE implant fragments (large arrow) surrounded by giant cells (small arrow) (H & E, Magnification: 200X); Top Right: PTE implant fragments (large arrow) with bone ingrowth (arrow) on porous Proplast surface (stained with Stevenel's blue and Van Gieson's picric fuchsin. Polarized light with Magnification: 100X). c. H & E stained tissue sections from Silastic implant samples with inflammatory infiltration (arrow). (Magnification: 200X)
Figures 4
Figures 4
Backscattered electron image of PTE implant sample #2 with a labeled area for element mapping and two line profiles (upper left). Element mapping images (upper right). Line profile 1 graph with Aluminum, Phosphorus, Calcium and Fluor x-ray counts (bottom).
Figures 5
Figures 5
BSI of PTE implant section #3 with selected area for element mapping (left). Element mapping images (right).
Figure 6
Figure 6
Upper left corner: Selected H&% histological section for EMA showing a multinucleated giant cell reaction to PTE implant fragment. (H & E. Magnification: 200X). Upper right corner: BSI with a labeled Line profile. Bottom: Line profile graphs with Carbon (upper) and Fluorine (bottom) x-ray counts.
Figures 7
Figures 7
Silastic implant sample #8. Top: BSI of the Silastic implant (left). Element mapping images (right). Bottom: BSI of same Silastic implant with a labeled line profile (left), and its corresponding line profile graph with C, Si, F, N, and O x-ray counts (right).
Figures 8
Figures 8
Top. p-values for JFQ to test what Predictors are related to this outcome measure. Bottom Left. p-values for SSI to test what predictors (including age and gender variables) are possibly related to this outcome measure. Bottom Right. Adjusted p-values (for age and gender) for all SSI symptom domains to test what Predictors are related to these outcome domains.
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