A patient-specific prosthetic jaw joint, designed from your own CT scan — reserved for end-stage disease that cannot be salvaged.
When a jaw joint is beyond saving, a custom-made prosthesis can restore comfortable function.
A total joint replacement rebuilds the damaged joint with a two-part prosthesis — a component fixed to the skull and one fixed to the jaw — recreating a smooth, low-friction joint. Increasingly the device is custom-designed from your own CT scan (CAD/CAM) to fit your exact anatomy, and is manufactured in advance.
When we consider replacement — salvage first
A step most clinics skip
National guidance from NICE reserves total replacement for joints that are effectively unsalvageable and have not responded to conservative care. In our practice we go a step further before that point: using advanced Level 3 arthroscopy we aim to salvage the natural joint, and in suitable patients this can achieve good results even in advanced, Wilkes stage 5 (end-stage) disease.
Replacement is therefore reserved for joints that remain refractory to arthroscopic repair — as well as for conditions such as ankylosis (a fused joint), previous failed surgery or a failed prosthesis, severe injury, and certain tumours.
Why a custom (patient-specific) prosthesis
Because it is designed to your own anatomy from your CT scan, a custom prosthesis fits precisely — particularly valuable in complex or previously-operated joints — and long-term studies report durable improvement in jaw function and quality of life.
Nickel-free materials, by design
Some patients are sensitive to the nickel found in certain implant alloys. To minimise this risk we deliberately use pure titanium with a titanium-nitride (TiN) surface and a high-molecular-weight polyethylene (HMWPE) bearing — avoiding nickel-containing alloys.
Revision & salvage of failed prostheses
Some patients come to us with a previous replacement that has failed or a joint that another team could not resolve. This difficult, specialist work is an area of particular focus — we reassess carefully, plan revision where it is realistic, and are honest where it is not.
Correcting facial deformity at the same time
Where jaw-joint disease has also affected the position of the jaws or facial appearance, replacement can be combined with orthognathic (corrective jaw) surgery in the same plan — restoring both function and facial balance.
The procedure & recovery
Planned in advance with detailed imaging and a pre-assessment while the custom device is made.
Performed under general anaesthetic, usually taking 2–4 hours, through incisions in front of the ear and beneath the jaw.
A hospital stay of around 1–2 nights; gentle jaw function begins early.
Structured jaw physiotherapy is essential and central to the result.
A soft or blended diet for several weeks, with a phased return to work over roughly 2–6 weeks.
Total replacement is used selectively, as a considered secondary or tertiary step for complex, unresolved disease. Individual results vary; suitability is assessed case by case.
Risks
This is major surgery, and we consent you fully beforehand. The recognised risks are more extensive than for keyhole surgery and include:
Facial nerve — temporary weakness of some facial muscles (for example the forehead/eyebrow or lip) is common early on and usually recovers; lasting weakness is uncommon.
Very rarely, weakness of eyelid closure — a serious complication that can affect the eye and vision and cause facial asymmetry; if it proves permanent it may require further treatment.
Numbness or altered sensation of the ear, cheek or lip.
Infection — including, rarely, deep infection around the implant that may require further surgery or removal of the prosthesis.
Metal allergy — rarely, patients are sensitive to nickel in some implant alloys; we mitigate this by using nickel-free pure titanium and titanium-nitride (TiN) with an HMWPE bearing.
Bleeding or a collection of blood (haematoma), and scarring.
A change in the bite (malocclusion) and, initially, restricted opening.
Damage to the roots of teeth from the temporary fixation screws (intermaxillary fixation) used to set the bite during surgery.
Abnormal bone forming around the joint (heterotopic bone) — to reduce this risk, a dermal fat graft is routinely placed around the new joint.
Donor-site morbidity from the dermal fat graft — bruising, a scar and some discomfort at the harvest site (for example the abdomen or hip).
Over many years, wear or loosening of the device that may need revision.
Blood clots in the leg or lung (DVT/PE), chest infection, and the usual risks of a general anaesthetic.
Persistent symptoms — the goal is reliable improvement rather than a perfectly “normal” joint; some discomfort can remain.
Mr Komath explains the risks relevant to your case in full before you decide.
Evidence
NICE. Total prosthetic replacement of the temporomandibular joint. Interventional Procedures Guidance IPG500, December 2014. nice.org.uk/guidance/ipg500
Gerbino G, et al. TMJ ankylosis: long-term outcomes with alloplastic total joint replacement — a 20-year experience. J Clin Med, 2025. DOI
Dinesh Nag YD, et al. Evolving horizons in TMJ total replacement: a narrative review. Cureus, 2025. DOI
Considering jaw joint replacement?
We will assess whether your joint can be salvaged first, and advise honestly on replacement or revision.