TMJ Replacement as a System: Results of an International Surgeon Survey on Design, Fixation, Materials, and Digital Workflow.

The evolution of TMJ-replacements has been driven by advancements in personalization, materials and digital planning technologies. However, there is little data on how surgeons perceive the prosthetic systems and their limitations in practice. The perspective from surgeons is critical to identifying the gap between current technology and clinical need. Using an international, structured survey based on a modified Delphi methodology, including expert validation, pilot testing and global distribution through professional networks, the status of the TMJ-replacement ecosystem was obtained. The questions covered aspects such as the workflow, the integration of components, the design features, the use of materials, the fixation strategy for each component, and usability of surgical guides. The responses were quantitatively analyzed using descriptive statistics. 250 surgeons were included; the majority of surgeons preferred to have all elements of the TMJ-replacement system provided by a single system or company (i.e., the prosthesis and plates), with 86.0% of surgeons indicating this preference and 71.2% of surgeons indicating that having access to STL files for use in surgical navigation is an important feature. Approximately 88.4% of surgeons indicated that flexibility in the design of the prosthesis is important, while 61.6% of respondents indicated that design issues contribute to failures of TMJ prostheses. Issues related to the fixation of the prosthetic components, particularly screw loosening, were also commonly reported by surgeons with respect to failure. Surgeons also indicated concerns with regard to the bulkiness (73.2%) and the fit accuracy (68.4%) of the surgical guides. In terms of material selection, 78.0% of respondents preferred to be able to choose the type of metal alloy for the TMJ replacement system. TMJ replacement is viewed by surgeons as a system-dependent procedure that requires the integration of design, materials, fixation and digital workflow. The currently available prosthetic solutions only partially meet the needs of surgeons.