CRANIOMAXILLOFACIAL DEFORMITIES/COSMETIC SURGERY Twenty-Year Follow-up Study on a Patient-Fitted Temporomandibular Joint Prosthesis: The Techmedica/TMJ Concepts Device Larry M. Wolford, DMD, * Louis G. Mercuri, DDS, MS,y Emet D. Schneiderman, PhD,z Reza Movahed, DMD,x and Will Allen, DMDk Purpose: To evaluate subjective and objective outcomes of patients receiving Techmedica (currently TMJ Concepts) patient-fitted temporomandibular joint (TMJ) total joint replacement (TJR) devices after 19 to 24 years of service. Patients and Methods: This prospective cohort study evaluated 111 patients operated on by 2 surgeons using Techmedica (Camarillo, CA) patient-fitted TMJ TJR devices from November 1989 to July 1993. Patients were evaluated before surgery and at least 19 years after surgery. Subjective evaluations used stan- dard forms and questions with a Likert scale for 1) TMJ pain (0, no pain; 10, worst pain imaginable), 2) jaw function (0, normal function; 10, no movement), 3) diet (0, no restriction; 10, liquid only), and 4) quality of life (QoL; improved, the same, or worse). Objective assessment measured maximum incisal opening (MIO). Comparison analysis of presurgical and longest follow-up data used nonparametric Mann- Whitney and Wilcoxon signed rank tests. Spearman correlations evaluated the number of prior surgeries in relation to objective and subjective variables. Results: Of the 111 patients, 56 (50.5%) could be contacted and had adequate records for inclusion in the study. Median follow-up was 21 years (interquartile range [IQR], 20 to 22 yr). Mean age at surgery was 38.6 years (standard deviation, 10 yr). Median number of previous TMJ surgeries was 3 (IQR, 4). Presur- gical and longest follow-up data comparison showed statistically significant improvement (P < .001) for MIO, TMJ pain, jaw function, and diet. At longest follow-up, 48 patients reported improved QoL, 6 patients reported the same QoL, and 2 patients reported worse QoL. Spearman correlations showed that an increased number of previous surgeries resulted in lower levels of improvement for TMJ pain and MIO. Conclusions: At a median of 21 years after surgery, the Techmedica/TMJ Concepts TJR continued to function well. More previous TMJ surgeries indicated a lesser degree of improvement. No devices were removed owing to material wear. Ó 2015 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg -:1-9, 2015 *Clinical Professor, Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas; Private Practice, Baylor University Medical Center, Dallas, TX. yVisiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; Clinical Consultant, TMJ Concepts, Ventura, CA. zProfessor, Department of Biomedical Sciences, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas, TX. xFormer Fellow, Department of Oral and Maxillofacial Surgery, Texas A&M University Health Science Center, Baylor College of Dentistry, Baylor University Medical Center, Dallas, TX; Clinical Assistant Professor, Department of Orthodontics, St Louis University, Center for Advanced Dental Education, St Louis, MO. jjFormer Fellow, Department of Oral and Maxillofacial Surgery, Texas A&M University Health Science Center, Baylor College of Dentistry, Baylor University Medical Center, Dallas, TX; Private Practice, Louisville, KY. Address correspondence and reprint requests to Dr Wolford: 3409 Worth Street, Suite 400, Dallas, TX 75246; e-mail: lwolford@ drlarrywolford.com Received May 18 2014 Accepted October 29 2014 Ó 2015 American Association of Oral and Maxillofacial Surgeons 0278-2391/14/01633-4 http://dx.doi.org/10.1016/j.joms.2014.10.032 1