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  • Bone Grafts for Joint Replacement-- Do they Work???

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    Old 06-01-2004, 11:34 PM   #1
    mybobby
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    Bone Grafts for Joint Replacement-- Do they Work???

    My situation is, I have an open byte with only the back teeth touching. My surgeon said that I have condyle resorption, my condyles are gone. The only way to correct it is to replace both of my joints with rib graft. If anyone has gone through this surgery, please share your experience. I haven't found any statistics so far, and information is almost nonexistant.

    Bobby

     
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    Old 06-02-2004, 07:07 AM   #2
    westin4
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    Re: Bone Grafts for Joint Replacement-- Do they Work???

    Bobby,
    My opinion in a word.................NO!!! That would be crazy. You need to go back and read posts from Cymey Sue and others that have had surgery........big mistake!
    Good luck,
    Karen

     
    Old 06-02-2004, 10:57 AM   #3
    Arleen
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    Re: Bone Grafts for Joint Replacement-- Do they Work???

    Hi Bobby:

    I would definitely get a second opinion. Did the oral surgeon do tomograms? If so, ask to look at them and have the dentist explain them to you. Condyles show up very clearly on tomos, so you'd know right off if what he's telling you is incorrect. Also, there are a number of sites online with pictures showing proper and problematic condyles placement, so you could compare your tomos against those. If your dentist didn't do tomos, then he/she won't have a clear picture of what's happening with your joints.

    Stay away from surgery, and read all the surgery posts here. Few and far between are the people who've ended up better from having surgery. Most end up much worse and in more pain.

    Take care.
    __________________
    Arleen

     
    Old 06-02-2004, 06:12 PM   #4
    TiffanyAnn
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    Re: Bone Grafts for Joint Replacement-- Do they Work???

    Quote:
    Originally Posted by mybobby
    My situation is, I have an open byte with only the back teeth touching. My surgeon said that I have condyle resorption, my condyles are gone. The only way to correct it is to replace both of my joints with rib graft. If anyone has gone through this surgery, please share your experience. I haven't found any statistics so far, and information is almost nonexistant.

    Bobby
    Hi Bobby:
    You should run as fast as you can from surgery. Get several opinions and take any x-rays, tomos, and MRI results to several different people before even considering anything this drastic. You might consult some dentists who specialize in TMJ rather than all surgeons because surgeons get rich doing surgery. Surgery is what they do and they will always suggest you have surgery.
    Tiffany

     
    Old 06-03-2004, 02:38 AM   #5
    Cymy Sue
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    Re: Bone Grafts for Joint Replacement-- Do they Work???

    Hello Bobby,

    I had (ear) cartilage graft replacements for deteriorated disc in 1992. At that point, I had very little left of either condlye. They did shave and reshape what I did have. The surgeon who knew me & my history had referred to my condyles as "toothpicks" for more years than I can remember. (The condular heads had been worn away many years before this procedure.)

    The Grafts started to fail in 1994 and I saw another Surgeon to get a 2nd opinion regarding "what" could be done.
    He had not seen prior images, tomo's. X-ray's. He said what I had left of condular bone, would last maybe a year. He wanted to do a Total Prosthesis.
    (I did run from his office.)

    In 1997, I had a Bilateral Discectomy to remove the deteriorated replacement cartilage, with no replacements. Shaving and smoothing the ends of my almost non-existant condyles again.

    When I had the Grafts in 92, I did ask if they didn't last, what would be the next step. I was told then they would use Rib-Bone & cartilage. They also said, "Not to worry, the Grafts 'WOULD" last".

    When they "DID" fail and I went back in 94, I had expected the Rib bone/cartilage replacement.
    I was told by this group of Surgeons, they were not doing this procedure anymore. It wouldn't last either.

    At this point, I have mostly nothing left of a "Joint Structure". Considered completely non-functional. No Disc. Very little left of condular bone.
    (In theory, they believe my joint capsules had always been abnormal or damaged at birth)

    However, the muscles have compensated and with a Splint designed for this "Condition", in 2002, I am functioning, have an opening of 34mm and have very few, minor problems. These problems stem from previous surgical damage.
    I jumped on the Surgery Train in 1988, with 2 Orthognathic Procedures.
    (I've been in some type of TM Joint treatment & having surgeries since 1977)

    Everyone's condition is different and bone changes or bone loss can occur for many reasons. It can be ongoing or stop. Mine stopped once the irritant (deteriorated disc) was removed and I quit having surgeries.

    You can live without disc and basically no condyles. The muscles will take over the jaw movement function. A splint will give the muscles direction and keep them from over compensating. Over compensating, repositioning and overworking by the muscles to maintain function is normally what causes pain & symptoms, after there is this kind of damage, either by deterioration or surgical intervention.
    The best advice, get more than one opinion, before you take this step.

    I'll post a Basic Hand-out I was given along the way about TM Joint surgeries. (Bone and/or cartilage grafts)
    This came from a Surgeon and their job is Surgery. You may have seen this, if not, it might help.

    Cymy Sue

    Last edited by Cymy Sue; 06-03-2004 at 02:56 AM.

     
    Old 06-03-2004, 02:49 AM   #6
    Cymy Sue
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    Re: Bone Grafts for Joint Replacement-- Do they Work???

    Bone and Cartilage Grafts for the TM Joint

    Bony or fiber-osseous ankylosis (fusion), severe degenerative osteoarthritic change in the head of the condyle, rheumatoid arthritis, malignant (neoplastic) disease of the condyle mandates surgical ablation, infectious disease, condylar aplasia and hypoplasia (birth defects), trauma resulting from complete avulsion (tearing away) of the condylar head, patients who have undergone repeated surgeries occasionally suffer partial or total resorption of the condyle, the condylar neck, or portions of the ramus.

    As with any joint replacement, it is NOT, possible to guarantee how long the graft will last. It should not be considered to be a lifetime implant. It may require removal and/or replacement at any time, and another TM joint reconstructive therapy may have to be performed. At that point options may be very limited. Parts of the graft may have to be modified or adapted during surgery to fit the TM joint anatomy. Such modification or bending of the graft can compromise its integrity and function and thus cause the early or late failure of the implant. As with all surgical procedures, there are potential complications inherent to surgery. These include, but are not limited to; pain, swelling, stiffness, infection, poor reaction to medication/anesthesia/surgical procedures, poor wound healing, paralysis, hematoma, serious fluid accumulation, motor or sensory nerve damage or irritation, neuralgia, loss of sensation, limitation of range of motion/function, intolerance to the implant(s), foreign body reactions, continued pain and/or other symptoms, failure to reduce/eliminate pain/other symptoms, changes in the bony architecture of the TM joint, changes in the surrounding tissue, open bite, change of a bite (malocclusion), graft failure, and possible removal and/or replacement with another implant, jaw deformity, excessive facial scarring, other additional surgical or medical intervention, blood clots in veins or lungs, or death. There may also be dysfunction of eyebrow and/or forehead muscles, numbness in the temple or ear, face, lips, tongue, and ringing in the ear. The patient must realize that they may experience difficulty in opening and closing their mouth, stiffness of the head, neck or facial muscles. The incision site may be visible after surgery and may never totally disappear.

    TMJ total/partial joint replacement utilizing an autogenous bone graft is an open joint surgery. Reconstructions of the TMJ with bone grafts are used primarily for the replacement of the condyle. However, in certain diagnosis to establish a normal anatomy entails bony repair to the fossa. There are several different autogenous bony grafts that have been used in the repair of the TMJ. However, the costochondral (rib) graft has the longest, most extensive documentation as a substitute for the mandibular condyle. The rib alone, even without its cartilage, had found extensive application in the construction of the fossa, the zygoma (cheek bone), and the zygomatic arch in severe reconstructive cases such as birth defects and traumatic injuries. Most patients have failed multiple modalities of previous treatment including non-surgical treatment and often multiple surgeries.

    A total joint replacement surgery requires two incisions on the face/neck. The upper incision is made over the joint area in front of the ear, the same as described for any open joint procedure. The lower incision is usually made in a skin crease on the neck in an attempt to camouflaged the scar. This incision is used for placement and visualization. This incision is made through the tissues of the neck until the mandible is encountered. This incision exposed the part of the lower jaw where the graft is screwed into place. The lower incision is connected to the upper incision through a tunnel under the tissues. Before any of the incisions are made, the patientís jaws are wired together. If the patient is not currently in orthodontic treatment arch bars are then placed in the gums of the upper jaw and the gums of the lower jaw. This is done to immobilize the teeth and place the occlusion in the right position. Some surgeons choose to leave the patient wired for a few days to a week. Other surgeons will remove the fixation at the conclusion of the surgery. The fossa (socket) is smoothed down with power tools. The condyle is cut off to allow room for the graft. The graft is then shaped and fit into position before it is attached to the lower jaw with bone screws. In addition to the two incisions on the face and neck there is an additional surgical site required. This site is where the autogenous bone graft is harvested (taken). Patients need to understand the harvesting procedure and possible further complications (i.e., scarring, infection, and predictability) involved in the harvesting of the graft. In children (consistently) and in adults (occasionally) the portion of the rib that was removed will be replaced by new growth within a year.



    Replacement surgery requires two incisions on the face/neck. The upper incision is made over the joint area in front of the ear, the same as described for any open joint procedure. The lower incision is usually made in a skin crease on the neck in an attempt to camouflaged the scar. This incision is used for placement and visualization. This incision is made through the tissues of the neck until the mandible is encountered. This incision exposed the part of the lower jaw where the graft is screwed into place. The lower incision is connected to the upper incision through a tunnel under the tissues. Before any of the incisions are made, the patientís jaws are wired together. If the patient is not currently in orthodontic treatment arch bars are then placed in the gums of the upper jaw and the gums of the lower jaw. This is done to immobilize the teeth and place the occlusion in the right position. Some surgeons choose to leave the patient wired for a few days to a week. Other surgeons will remove the fixation at the conclusion of the surgery. The fossa (socket) is smoothed down with power tools. The condyle is cut off to allow room for the graft. The graft is then shaped and fit into position before it is attached to the lower jaw with bone screws. In addition to the two incisions on the face and neck there is an additional surgical site required. This site is where the autogenous bone graft is harvested (taken). Patients need to understand the harvesting procedure and possible further complications (i.e., scarring, infection, and predictability) involved in the harvesting of the graft. In children (consistently) and in adults (occasionally) the portion of the rib that was removed will be replaced by new growth within a year.

    (I was given this a few years ago. From what I read currently, it is still used as a basic informational hand out for these procedures)

    Cymy Sue

     
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