Priv.-Doz., Dr. med. dent., MSc, Assistant Professor, Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Bonn, Germany.
Dr. med., Dr. med. dent., Assistant Professor, Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Bonn, Germany.
J Oral Maxillofac Surg. 2021 Dec;79(12):2433-2443. doi: 10.1016/j.joms.2021.06.018. Epub 2021 Jun 18.
The amount of maximum voluntary clenching (MVC) force may influence functional loading at the polyethylene/metal bearing surfaces in alloplastic total temporomandibular joint replacement (TMJR). The aim of this study was to measure ipsilateral MVC and estimate the risk for revision due to overloading of the TMJR.
A prospective cohort study design was used to study patients who underwent alloplastic TMJR. The primary predictor was time after TMJR, the secondary predictors were age at TMJR placement, coronoidectomy, prior ipsilateral TMJ surgeries, TMJR design (custom, stock), and bite location. The primary outcome variable was MVC, the secondary outcome was need for TMJR revision. Data were collected preoperatively (T0), and 1 year (T1), 2 to 3 years (T2) and ≥4 years postoperatively (T3). Analysis of variance (ANOVA) with post hoc Tukey-HSD and regression analysis was used for statistical analysis. P < .05 was considered significant.
Thirty-seven patients (58 TMJR) with unilateral (n = 16) and bilateral (n = 21) TMJR were enrolled; 8 males (12 TMJR) and 29 females (46 TMJR). Average age was 46.4 ± 14.9 years. MVC increased significantly over the observation period (P = .000). At all observation time points, age at TMJR placement and bite location significantly influenced MVC (P = .000). Coronoidectomy and prior ipsilateral TMJ surgeries did not demonstrate a significant influence on MVC. TMJR design influenced MVC significantly at T3 (P = .006). Regression analysis identified age as a significant factor for higher MVC. No TMJR required revision or replacement.
Based on this study, ipsilateral MVC increases significantly after TMJR. However, since MVC is significantly lower than in healthy test-patients, a considerably lower functional loading at the polyethylene/metal bearing surfaces can be assumed. Lower loading at the TMJR bearing surfaces and at the cortical screw fixation sites suggest a potential longer lifespan compared to other artificial joints like hip and knee prostheses.
最大自主紧咬（MVC）力的大小可能会影响全塑颞下颌关节置换（TMJR）中聚乙烯/金属承托面的功能负荷。本研究的目的是测量患侧 MVC，并估计因 TMJR 过度负荷而需要翻修的风险。
采用前瞻性队列研究设计，研究接受全塑 TMJR 的患者。主要预测因素是 TMJR 后的时间，次要预测因素是 TMJR 放置时的年龄、髁突切除术、同侧 TMJ 手术史、TMJR 设计（定制、库存）和咬合位置。主要结局变量为 MVC，次要结局变量为 TMJR 翻修需求。数据在术前（T0）、术后 1 年（T1）、2-3 年（T2）和≥4 年（T3）收集。采用方差分析（ANOVA）和事后 Tukey-HSD 检验及回归分析进行统计学分析。P<.05 被认为具有统计学意义。
共纳入 37 例（58 个 TMJR）单侧（n=16）和双侧（n=21）TMJR 患者；男性 8 例（12 个 TMJR），女性 29 例（46 个 TMJR）。平均年龄为 46.4±14.9 岁。MVC 在观察期内显著增加（P=.000）。在所有观察时间点，TMJR 放置时的年龄和咬合位置均显著影响 MVC（P=.000）。髁突切除术和同侧 TMJ 手术史对 MVC 无显著影响。TMJR 设计在 T3 时显著影响 MVC（P=.006）。回归分析确定年龄是 MVC 升高的显著因素。无 TMJR 需要翻修或更换。
根据本研究，TMJR 后患侧 MVC 显著增加。然而，由于 MVC 明显低于健康对照组，因此可以假设聚乙烯/金属承托面的功能负荷要低得多。TMJR 承托面和皮质螺钉固定部位的负荷较低表明与髋关节和膝关节假体等其他人工关节相比，其潜在寿命可能更长。
