Axiographic analysis of temporomandibular joint biomechanics in patients after reconstruction of mandibular defects with Uglekon M carbon implants

The purpose was to study the condition of the temporomandibular joints (TMJ) by patient’s axigraphic analysis after reconstruction of mandibular defects with carbon–carbon composite implants of the “Uglekon M” material. Materials and methods: аn analysis of TMJ function was conducted, based on axigraphic study results. Seven patients (3 men, 4 women) aged 32 to 84 years were examined; they had undergone plastic procedures for replacing mandibular defects following the removal of benign neoplasms. Surgical interventions were performed between 2003 and 2017. Replacing constructs consisted of mandible–maxillary implants made from the carbon–carbon composite material «Uglekon M». Delayed orthopedic treatment was carried out using removable maxillomandibular prostheses. Results: analysis of the axigraphic findings indicates deviations in TMJ functional status. However, clinically symptoms of TMJ dysfunction were not diagnosed. Patients didn’t complain to pain, clicking or discomfort in the TMJ region. This fact can be regarded as evidence of a high level of neuromuscular adaptation of the organism to mandibular defect replacement with orthotopic implant constructs. Conclusion: carbon–carbon composite implants «Uglekon M» are sufficiently effective for mandibular reconstruction and provide good functional adaptation. To prevent the development of dysfunctions in the TMJ and masticatory muscle complex, it is reasonable to transition to digital preoperative planning when manufacturing individually tailored implants.

1. Abramyan SV, Arzhantsev AP, Arutyunov AS, Astashina NB. [et al.]. Maxillofacial surgery: national guidelines. «GEOTAR-Media», 2019. https://www.elibrary.ru/item.asp?id=39250717.

2. Tereshchuk S.V., Demenchuk P.A., Gorbulenko V.B., Sukharev V.A. Features of planning reconstructive surgeries on the lower jaw in cancer patients using revascularized fibular autograft, virtual and stereolithographic models // Annals of plastic, reconstructive and aesthetic surgery. – 2012;3:50–55. https://www.elibrary.ru/item.asp?id=18922203.

3. Kalakutskiy N.V., Vavilov V.N., Soloviev M.M., Chebotarev S.Ya., Selskiy N.E., Petropavlovskaya O.Yu. Replacement of total defects of the mandible with a vascularized fibula graft. Annals of plastic, reconstructive and aesthetic surgery. 2006;4: 79–80. https://www.elibrary.ru/item.asp?id=12964872.

4. Melikov E.A., Drobyshev A.Yu., Volkov V.A., Yakimenko I.I., Klipa I.A., Shamrin S.V., Miterev A.A., Snigerev S.A., Redko N.A., Bondarev A.N. Features of distraction osteogenesis in patients with revascularized autografts: histo-morphological analysis. Genes and cells. 2017;12(2):110–115. https://www.elibrary.ru/item.as-p?id=36901599.

5. Bayrikov I.M., Dedikov D.N., Stolyarenko P.Yu., Bayrikov A.I., Korolev A.I., Bukaty A.S. Comparative characteristics of rehabilitation of patients with mandibular defects using individual endoprostheses and bioengineered structures. Medical almanac. 2023;2(75):57–63. https://www.elibrary.ru/item.asp?id=54126160.

6. Bayrikov I.M., Slesarev O.V., Tyumina O.V., Ovchinnikov P.A., Volchkov S.E., Dedikov D.N., Mal’chikov D.V., Pryanikov K.V. Method for eliminating defects and deformations of the lower jaw. Russian Federation Patent for Invention No. 2734756 / 10.23.2020 Bull. No. 34. https://elibrary.ru/sncztg.

7. Dedikov D.N. Replacement of mandibular defects using a vascularized autograft in combination with a non-woven titanium material with through porosity. Dissertation. 2020;167. https://elibrary.ru/item.asp?id=44599926.

8. Antsiferov V.N., Smetkin A.A., Rogozhnikov G.I., Kislykh F.I., Astashina N.B., Rapekta S.I. New-generation combined titanium-composite implants for plastic surgery of mandibular defects. Composite Material Designs. 2008;4: 33–37. https://www. elibrary.ru/item.asp?id=12795990.

9. Rapekta S.I. Plastic surgery of mandibular defects using Uglekon-M carbon implants. Dissertation. 2008;22. https://www.elibrary.ru/item.asp?id=16167093.

10. Slavichek R. Masticatory organ functions and dysfunctions / R. Slavichek; trans. by A. Ostrovsky [et al.], scientific editors N. Volosok and M. Antonik. – M. [et al.]: Azbuka stomatologiya, 2008. – 543 p. https://www.elibrary.ru/item.asp?id=18922203.

11. Hidalgo, D.A. Fibula free flap: a new method of mandible reconstruction. Plast. Reconstr. Surg. 1989;84(1):71–79.

12. R.C.W. Wong. Biomechanics of mandibular reconstruction. Oral and Maxillofacial Surgery. 2010;39(4):313–319. https://pubmed.ncbi.nlm.nih.gov/19944568.

13. Awad M.E., Altman A., Elrefai R., Shipman P., Looney S., Elsalanty M. The use of vascularized fibula flap in mandibular reconstruction; a comprehensive systematic review and meta-analysis of the observational studies. Craniomaxillofac Surg. 2019;47(4):629–641. https://pubmed.ncbi.nlm.nih.gov/30782453.