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Isthe risk of post-total temporomandibular joint replacement chronic pain independent of its indications? - a prospective cohort study

  • Sabine S. Linsen
    Corresponding author at: University of Bonn Welschnonnenstr. 17 D-53111 Bonn, Germany
    Department of Prosthodontics; Preclinical Education and Dental Material Science, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
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  • Marcus Teschke
    Zeppelinstr.24, 61352 Bad Homburg, Germany
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  • Nils Heim
    Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
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  • Louis G. Mercuri
    Department of Orthopaedic Surgery, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States; Adjunct Professor, Department of Bioengineering, University of Illinois Chicago, 851 S Morgan St, Chicago, IL 60607, United States; Clinical Consultant, Stryker/TMJ Concepts, 6059 King Drive, Ventura, CA, 93003, United States
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      Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients with TMJR regardless of the operation indication. A prospective, single-center study was performed. Data from 36 patients (56 TMJR) was collected preoperatively and at follow-up 2-3 years postoperatively. The primary outcome variable was subjective TMJ pain (no/mild, moderate/severe) at follow-up. The predictor variables were objective pressure pain thresholds (PPTs at the ipsilateral joint(s) and muscle(s)) and functional parameters (incisal range of motion; maximum voluntary clenching), subjective oHrQoL, demographic and surgical variables. The number of patients with moderate/severe pain decreased from 17 pre-operatively to 10 at follow-up. Self-reported TMJ pain was significantly reduced in the entire group (p=.001). Patients with follow-up moderate/severe TMJ pain were more restricted in their oHrQoL but did not differ in PPTs and functional parameters from the no/mild group. Follow-up moderate/severe TMJ pain was associated with unilateral TMJR and greater preoperative TMJ pain. This study provides preliminary evidence that despite good pain reduction in most patients, persistent pain after TMJR is common. In rare cases, pain may even worsen regardless of the original diagnosis. At follow-up there was a close relation between oHrQoL and TMJ pain. TMJ pain after TMJR cannot be confirmed by objective measurement methods (PPTs and functional parameters).


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