Temporomandibular joint (TMJ) is a complex, sensitive, and highly mobile joint. Millions of people suffer from temporomandibular disorders (TMD) in USA alone. The TMD treatment options need to be looked at more fully to assess possible improvement of the available options and introduction of novel techniques. As reconstruction with either partial or total joint prosthesis is the potential treatment option in certain TMD conditions, it is essential to study outcomes of the FDA approved TMJ implants in a controlled comparative manner. Evaluating the kinetics and kinematics of the TMJ enables the understanding of structure and function of normal and diseased TMJ to predict changes due to alterations, and to propose more efficient methods of treatment. Although many researchers have conducted biomechanical analysis of the TMJ, many of the methods have certain limitations. Therefore, a more comprehensive analysis is necessary for better understanding of different movements and resulting forces and stresses in the joint components. This article provides the results of a state-of-the-art investigation of the TMJ anatomy, TMD, treatment options, a review of the FDA approved TMJ prosthetic devices, and the TMJ biomechanics.

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In this manuscript, we discuss our approach to developing novel patient-specific total TMJ prostheses. Our unique patient-fitted designs based on medical images of the patient’s TMJ offer accurate anatomical fit, and better fixation to host bone. Special features of the prostheses have potential to offer improved osseo-integration and durability of the devices. The design process is based on surgeon’s requirements, feedback, and pre-surgical planning to ensure anatomically accurate and clinically viable device design. We use the validated methodology of FE modeling and analysis to evaluate the device design by investigating stress and strain profiles under functional/normal and para-functional/worst-case TMJ loading scenarios.

Background: Biomechanical analysis of human mandible is important not only to understand mechanical behavior and structural properties, but also to diagnose and develop treatment options for mandibular disorders. Therefore, the objective of this research was to generate analytical and experimental data on mandibles, construct custom 3D models, and compare the analytically derived maximum strains with strain gage data in five areas of interest for each mandible. Methods: We investigated the surface strains in the cadaveric human mandibles under different configurations of cyclic compressive loads in an experimental setting and compared these experimental strain data with results derived from computational finite element analysis (FEA), accurately replicating the experiments. Strains on the surface of each mandible were measured with strain gauges, and subsequently a subject-specific finite element (FE) volume mesh was generated from computed tomography (CT) scans of each mandible. Strain patterns of each mandible were derived from the FEA simulating the experimental setup and matched with the experimental data. Findings: Analysis of experimental data showed that strain as measured at the condylar locations was significantly different from those at other locations on the mandible, and that the sex and age of the subject did not have a significant correlation with the strain. Comparing the FE numerical predictions with the experimental data, we found a good statistical correlation and statistical agreement between in-vitro measurements and FE results. Interpretation: The study demonstrates that our methodology of generating subject-specific FE models is a valid and accurate, non-invasive method to evaluate the complex biomechanical behavior of human mandibles.