Current Clinical and Translational Challenges in Temporomandibular Joint Reconstruction

Helena Bächer^1*Bhagvat Maheta²Lisa-Marie Lottner³Samuel Knoedler⁴Fernando Guastaldi⁵João F. Mano⁶Steffen Koerdt¹Carsten Rendenbach¹Max Heiland¹Leonard Knoedler¹Christian Doll¹

• ¹Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany, Berlin, Germany
• ²California Northstate University College of Medicine, Elk Grove, CA, USA, Elk Grove, United States
• ³Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany, Regensburg, Germany
• ⁴Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Munich, Germany
• ⁵Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA, Boston, United States
• ⁶Department of Chemistry, CICECO – Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal, Aveiro, Portugal

Total joint reconstruction (TJR) is essential for the management of end-stage temporo-mandibular joint (TMJ) disorders. Current reconstruction techniques include the use of autolo-gous grafts, such as chondrocostal tissue or fibula, and alloplastic TMJ replacement systems. Commercially available TMJ replacement systems provide both stock and customized prosthe-ses. Advances in computer-aided design/computer-aided manufacturing technology, three-dimensional printing, and virtual surgical planning have accelerated the trend toward individual-ized TMJ prostheses, enhancing anatomical adaptation, intraoperative efficiency, and postopera-tive outcomes. A promising alternative under preclinical investigation is TMJ tissue engineering, a regenerative approach utilizing scaffolds, stem cells, and growth factors to reconstruct specific TMJ components, including the skeletal condyle, fibrocartilaginous disc, and glenoid fossa. Bi-oprinting has further transformed the field by enabling the creation of complex, multi-tissue structures with cellular viability and functionality. Techniques such as integrated tissue and organ printing and volumetric printing have shown promise for enhancing graft performance by im-proving scaffold heterogeneity. However, these advanced approaches remain in the preclinical stage and require critical evaluation before clinical translation. Despite these advancements, chal-lenges such as high costs, technical complexities, and the need for extensive, robust datasets persist. Continued research into novel biomaterials, advanced biofabrication techniques, and digital surgical technologies, supported by larger preclinical and in vitro studies, is imperative to address these limitations and advance clinical applicability.