**1.7 Fabrication of the TMJ implant**

Over a period of time, TMJ implants were facing menace due to excessive healing or ankyloses and hence fascia interposed osteoarthroplasty, muscle interposed osseoarthroplasty were carried out but were unsuccessfully (**Figure 2**).

Gap arthroplasty was reasonably successful but the anatomical disfigurement was experienced and hence metal implants were successfully (CO, Ti, Mb) used if allergic reactions were not a problem. At later stages titanium came into rescue to eliminate allergic reactions.

**Figure 1.** *Preoperative limited mouth opening.*

**Figure 2.** *Custom made TMJ alloplastic device.*

Using such devices had some teething troubles.


The general difficulty all the surgeons experience were that the readymade implants did not have the ideal requisites of an implant as they do not snuggly fit.

Hence with the development of 3 D reconstruction digitally, the TMJR has come to near perfection.

The process involves making a CT for the patient and subsequent construction of Rapid prototyping (RP).

The resultant model involves the pathology of the TMJ (if any) which requires a trimming of the pathology in the model and 3D reconstruction of the implant digitally.

In this case, the prosthesis was patient specific. It consisted of the fossa and condylar components with the height of the device fabricated so as to compensate for the vertical height lost due to ramal shortening and gap arthroplasty.

The fossa eminence component articular surface was made of ultra-high-molecular-weight polyethylene over the stainless steel frame with 2 mm screw holes.

The stainless steel condylar unit has anteroposterior dimension of 5 mm and mediolateral dimension of 8 mm, with screw holes for fixation (**Figure 2**).

Intraoperative pictures show the snug fit of the prosthesis (**Figure 3a** and **b**).

Thus the main goal of the procedure was achieved viz., mouth opening and jaw function (**Figure 4**).

Postoperative check x ray was done to check for the proper positioning of the device (**Figure 5**).

**Figure 3.** *(a) TMJ alloplastic device in situ—Right side; and (b) TMJ alloplastic device in situ—Left side.*

**Figure 4.** *Postoperative mouth opening.*

**Figure 5.** *Postoperative radiograph confirming the TMJ alloplastic device in situ.*
