TMJ Replacement
Total TMJ replacement, also known as total joint replacement (TJR), replaces a severely damaged or degenerated jaw joint with a custom-made artificial joint. It is a complex operation performed by a relatively small number of oral and maxillofacial surgeons, and our surgeons are among those in the region who provide it. The procedure is performed under general anesthesia in a hospital, usually with a one- to two-night stay.
Key indications: when is total joint replacement necessary?
Total joint replacement is the standard of care for end-stage, severely degenerated jaw joints. When conservative treatment such as splints, physical therapy, joint injections or arthroscopy has not provided lasting relief, joint replacement can restore function and reduce chronic pain. Less invasive options are described on the TMJ surgery page.
Common indications for an artificial TMJ include:
- Severe osteoarthritis or rheumatoid arthritis: advanced joint destruction leaving a painful “bone-on-bone” joint.
- Ankylosis: fibrous or bony fusion of the joint that locks the jaw.
- Failed prior TMJ surgery: revision of earlier implants or failed tissue grafts.
- Avascular necrosis: loss of blood supply causing the head of the jaw joint (condyle) to collapse.
Idiopathic condylar resorption (ICR)
We also care for patients with idiopathic condylar resorption (ICR), a progressive condition in which the head of the jaw joint (condyle) gradually resorbs without a clear cause. It most often affects young women and is sometimes called “cheerleader syndrome.” As the lower jaw moves backward, typical changes include:
- A progressively receding chin
- A developing anterior open bite, where the front teeth no longer meet
- Chronic joint noise
- Airway narrowing that can contribute to sleep apnea
Treatment aims to halt the process, using custom joint replacement to reconstruct the jaw joint, stabilize the bite and restore facial balance and airway.
Your TMJ workup consultation
A custom jaw joint is designed from precise diagnostic records. If you are a candidate for total joint replacement, these are gathered at your initial workup in our Irvine office:
- High-resolution 3D CBCT and medical CT scans of the skull base and the remaining joint structures. This data is sent to biomedical engineers to manufacture your custom device.
- Digital intraoral scans of the teeth, used to plan the post-operative bite and replacing traditional impressions.
- Clinical photography and range-of-motion measurement, including maximum opening, side-to-side jaw movement and facial proportions.
- Insurance pre-authorization: our team coordinates with your medical insurer to request pre-authorization for the custom-fabricated implants.
Virtual surgical planning for TMJ and ICR patients
Each operation is planned with virtual surgical planning (VSP). Your anatomy is used to engineer a patient-specific joint replacement system from TMJ Concepts, a manufacturer of custom TMJ prostheses. Our surgeons work with clinical engineers to rehearse the surgery digitally before the day of the operation:
- The boundaries of bone preparation are planned in advance.
- The fossa (socket) and condylar (ball and stem) components are made to match the shape of your bone.
- If the bite also needs correction, orthognathic jaw movements are planned in the same software and performed at the same operation.
The surgical procedure
Where are the incisions located?
Two concealed incisions are used on each side to reach the joint safely:
- Preauricular incision: placed in the natural creases just in front of the ear, to reach the joint socket.
- Submandibular incision: a small incision in a natural crease beneath the jawline, to place and secure the lower stem component.
Will my jaws be wired shut?
No. The jaws are not wired shut after TMJ replacement. Rigid internal fixation screws secure the custom components. Light, flexible orthodontic elastics are used after surgery to guide the muscles into the new bite, and you can breathe, speak and clear your airway from the first day.
Expected recovery
- Hospital stay: patients typically remain in the hospital for 1 to 2 nights for pain control and the start of physical therapy.
- Early movement: gentle jaw movement begins soon after surgery to limit scar tissue and preserve long-term mobility of the new joint.
- Diet: a liquid or soft, non-chew diet is needed after surgery while healing progresses.
TMJ replacement in Orange County
End-stage joint disease and progressive ICR can affect eating, speaking and sleep. If conservative treatment has not helped, an evaluation in our Irvine office can clarify whether total joint replacement, or a less invasive option, is appropriate. Please bring prior imaging, operative reports and a list of the treatments you have tried.
Your surgeons
Both surgeons perform TMJ surgery.
Youn Sagong, DDS
Oral and maxillofacial surgeon. Board-certified by the American Board of Oral and Maxillofacial Surgery. Residency and chief residency, Yale. Assistant Clinical Professor, UCI Medical Center; operating privileges at Hoag Hospital and UCI Medical Center.
TMJ surgery, corrective jaw surgery and facial trauma.
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Andrei Marechek, MD, DDS
Oral and maxillofacial surgeon. Board-certified by the American Board of Oral and Maxillofacial Surgery. Residency, Case Western Reserve University. Assistant Clinical Professor, UCI Medical Center; operating privileges at Hoag Hospital and UCI Medical Center.
TMJ surgery, corrective jaw surgery and nerve repair.
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