by Keith Webster

One of our many correspondents wrote about problems after a Teflon TMJ Implant:
” I had a Teflon implant removed from my TMJ joints in 1987 which had been implanted in 1984. At the time there seemed to be no negative reaction although the surgical report stated foreign body reaction had been observed. Unfortunately I was involved in a car accident complications from which affected the TMJ requiring grafting of rib material to reconstruct the jaw.

My question is: Are there any tests to see if the teflon residue can be detected in either the tissue removed in the later surgery or even now post surgically (there seem to be some complications in the right joint).”

A TMJ implant, which was made out of a Teflon-Proplast material and used as a meniscus replacement. With hindsight severe degenerative changes occurred in about 90% of cases.

The implant disintegrated under load, producing a foreign body giant cell reaction , subsequent bone erosion and lymphadenopathy. [disease of the lymph nodes]

Vitek withdrew the implant and went into liquidation. The U.S. Food and Drug administration subsequently produced a consensus statement advising the removal of all symptomatic implants and 6 monthly radiographic follow-up of asymptomatic patients. 

A foreign body reaction is seen after any implantation of any alloplastic material and is a chronic inflammatory response. However if the response is low-grade and produces no symptoms then no action is necessary. There are analogies here with the similar response to reactions to implantable silicone breast implants.

Unfortunately the search for a biocompatible TMJ implant has not produced any serious contenders and in the UK and USA.  Most TMJ reconstructions are performed with auto-grafts of cartilage capped rib (costochondral grafts) or new menisci are formed by using interpositional muscle or dermal grafts. The main prosthetic TMJ under consideration in the UK and USA is the Christensen prosthesis composed of a cobalt-chrome articular fossa and a methyl methacrylate condyle replacement attached to a cobalt chrome ascending ramus. However there appear to be no long-term solutions to the multiply operated patient and only about 5% of all patients treated for TMJ disorders undergo open TMJ surgery.

References:

US Food and Drug Administration: FDA Safety Alert. Rockville, MD, US Food and Drug Administration Dec. 28 1990

Kaplan PA, Tu HK, Williams SM. Erosive arthritis of the temporomandibular joint caused by Teflon-Proplast implants: Plain film features. Am J Roentgenol 1988; 151: 337-340

Dolwick MF, Dimitroulis G. Is there a role for temporomandibular joint surgery? Br J Oral Maxillofac Surg 1994; 32: 307-313.

“To answer the question whether tests could detect traces of Teflon, yes, a biopsy of the joint area might show microscopic bits of Teflon. However, it is not clear what the results could mean. It would be quite difficult to remove all particles of Teflon when removing an implant. Many patients who have had Teflon implants removed are now showing signs of foreign body reaction, and traces of Teflon surely remain. Teflon implants are used successfully in other parts of the body – in places not subjected to heavy stress – indicating that Teflon itself may not be harmful.

In general, patients who undergo TMJ surgery are rarely pain -free and seldom experience a complete resolution of TMJ symptoms They usually have some continued complications. Armed with this knowledge, patients with mild or minimal TMJ symptoms can avoid wasting time and money seeking a medical ‘cure’ which probably does not exist. Instead, concentrate on changing behavior patterns or bad habits like bruxing, clenching, chewing gum, etc.

Teflon-coated TMJ implants were manufactured exclusively by the Vitek Corporation beginning in 1973 until the company folded about 1993. The U.S. Public Health Service sent warning letters to 20,000 people who received Vitek implants. Symptoms of TMJ implant breakdown include;

• pain radiating from around the ear
• limited lower jaw movement
• joint noise
• change in occlusion (bite)
• difficulty chewing
• headaches

Concerned patients in the US may call Medic Alert, a non-profit foundation, telephone 800-554-5297, for further information about where to find TMJ support groups. The U.S. Food & Drug Administration has information about TMJ implants, telephone 301-443-4190 or 301-443-3170.”

Submitted by Robert B. Stevenson, DDS, MS
Columbus, Ohio
gold2ooth@aol.com

Further contributions on this subject are invited.

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Baroness Says:  If you are reading this because you have been diagnosed (d/x) with TMJ disease please feel free to contact me with any questions or comments.  Let me tell you this now; If I had to do it over again and I had the hindsight of information that today I carry, I WOULD NOT HAVE SURGERY with man-made foreign material implants. IF, and I say if you have bone on bone in the joint(s) than a surgical reconstruction of the disintegrated cartilage should be considered to repair so to alleviate pain and bone erosion.  The only way I would go today armed with the knowledge I have today and that is with auto-graf. Harvested from somewhere else on your body (mine are cartilage from the backs of my ears in my second surgery). If you do not have any degeneration of the joint and a doctor is recommending surgery I would run as fast I could to the closest exit.  Today after over 28 years of reasearch and study concerning TMJ disease and talking with other people afflicted the popular treatment modality today is wait it out. There are many things that can be mastered to help cope and alleviate the pain and spasms.

Please just don’t be ready to jump when surgery is offered. It can make things much worse even though today the implants that have caused so much destruction are no longer marketed there is still a risk with any surgery.

Again, Thank you so much for your time, and your attention.