**1.4 Indications for TMJ alloplastic joints**

The decision to take up TMJR [16, 17] has been suggested by various organisations such as national institute of health and care excellence (NICE) in May 2014(8) and the British association of oral and maxillofacial surgeons in 2008(9). A few situations where alloplastic joint reconstruction is preferred are


#### **1.5 Contraindications**

Absolute contraindications for alloplastic TMJR are many in which primary consideration is active infection [18–21]. In acute infection if prosthesis is placed it can lead to micromotion and difficulty to stabilise the process and ultimately leading to failure. Next important contraindication is in those with documented allergy to implant components which may be present before or may manifest after the placement of prosthesis and are generally type IV delayed hypersensitivities.

Placement of fat grafts around the head of condylar components to decrease the tissue exposure to alloy components has been previously proposed by some authors and although this approach is reasonable there is no objective scientific evidence to

support this hypothesis. Titanium prosthesis eliminate the possible allergy caused by Chromium cobalt Nickel Molebednum.

Uncontrolled systemic disease is considered yet another contraindication. A proper psychological preparation of preoperative evaluation must be considered essential particularly in elderly patients.

In a growing individual, alloplastic TMJR device necessitates reoperation.
