KKU Dentistry announces success in treatment of patient with “Bone Reconstruction Innovation – Temporomandibular Joint”, the first case in Thailand and Isan

Thursday November 23, 2023 – Faculty of Dentistry, Khon Kaen University reported the success in treatment of patient by customized-temporomandibular joint prosthesis for bilateral total TMJs reconstruction and jaw-in-a-day with fibula free flap reconstruction, at Sirikunakorn Room 3, Sirikunakorn Building, Khon Kaen University.

Assoc. Prof. Saowalak Limmonthon, D.D.S., Head of the Department of Oral and Maxillofacial Surgery reported that the principle missions of the Department are to provide service in general, a specific oral treatment, and diagnosis for amending oral abnormality. Up to now, the Department has adopted the 3-D technology to treat patients in order to reduce the time spent in the operation hall. This mission was successful and the patient could resume his normal lifestyle. The press conference today has been held to public relate to all sectors about the success of Thai dentists in the field of oral and maxillofacial surgery of the success in bone reconstruction innovation and temporomandibular joint prosthesis.
Asst. Prof. Ajiravudh Subarnbhesaj, Ph.D., D.M.D., Dean of the Faculty of Dentistry, Khon Kaen University said that he was very happy to join in congratulating another major step of the Faculty in the success of customized-temporomandibular joint prosthesis for bilateral total TMJs reconstruction and jaw-in-a-day with fibula free flap reconstruction, which is the first case of the Northeast, and the two dentists and their team from the Department of Oral and Maxillofacial Surgery.
“This is another pride of the Faculty, of the success in treating a patient with the bone reconstruction innovation and temporomandibular joint prosthesis. The success corresponds to the determination of the Faculty of Dentistry of Khon Kaen University in academic service and development of the profession towards advanced dental service to the community with the best quality and standard.”

Doctor Nipon Khlai-on, D.D.S., a lecturer of the Department of Oral and Maxillofacial Surgery added about treatment with customized-temporomandibular joint prosthesis for bilateral total TMJs reconstruction, that the patient received treatment under the clinical research project after the diagnosis showed that the patient had severe temporomandibular joint disorder, which could be related to the congenital disease, i.e., the connective tissue disease, leading to decomposition of jaw joints. This affected the patient’s daily living from inability to chew by front teeth and inability to close the mouth.

The customized-temporomandibular joint prosthesis consists of two approaches: by TMJ prosthesis and autogenous graft/flap. The dentist team planned the treatment by replacing the jaws with an entire set of false jaws at the joints and at the sockets of the mandibular joints by autogenous flap. The reconstruction was done on both sides. The outstanding point was that there were only few operations performed. The patient did not suffer pain at many points and other tissues were not interfered. Moreover, the patient was able to quickly train in the joint therapy and resume the chewing.

“The work piece was constructed from a simulated model similar to a normal person with the same size. The design technology was from advanced computer program by specialized engineer possessing high skill in constructing false human organs. The materials used were titanium alloy and ultra-high molecular weight polyethylene. The modern equipment was from CTEC laboratory that received international standard certification. The workpiece is about 8 cm high, 2.5 cm wide and 0.5 cm thick. It was fixed to the remaining part of the patient’s jaw.”
No severe complications were found after the operations. Now, it is the following up stage – during the 5 month period after the operation. Overall, the patient is able to use the false jaw nearly normally, can eat food and the quality of life has been improved.
“The treatment is the first time of Thailand and is a new design with different form from other false jaws. It fitted firmly in the socket. Thus, this marks a chance in the dentistry circle in assisting other patients with the same condition. There are many patients with the loss of the temporomandibular joints from removing tumor, from accidents or from dissolving like this case.”

The patient who is a male aged 57 years said after the treatment that he had had difficult time living especially in chewing food. After the team of dentists from Khon Kaen University treated him, he has been able to resume the normal life and can eat like before. The patient then thanked the dentists and told other patients not to worry and to come to Khon Kaen University for treatment.
Doctor Teerat Joengprapakorn, D.M.D., from the Department of Oral and Maxillofacial Surgery said that the patient was diagnosed with benign tumor on the lower jaw, and it was necessary to remove it. Therefore, reconstruction was required by the use of leg bone and vein connection.
Reconstruction of temporomandibular joint by using leg bone and vein connection is the method popular for over 40 years. The leg bone reconstructed enables dentist to make false teeth that enable the patient to chew. However, false teeth fixed on leg bone require time and many operations. A patient has to wait 12 to 18 months before false teeth can be fixed in.

The dentists therefore decided to treat by using leg bone to reconstruct the jaw and connecting the vein, after which an implant was fixed by just one operation. This is possible by implanting on the leg bone used on the operation day and planning for dentures within one day. For this operation, a computer program was used together with the use of a customized reconstruction plate.
“The surgery was introduced for the first time in 2013, but in Thailand the first surgery was in 2022, at the Faculty of Dentistry, Mahidol University. The case of patient presented here is the third case of Thailand and the first case in Isan, which was a success.””
After the surgery, the patient recovered well and did not develop any complications from the
operation of leg bone. No other negative condition was found. The implant and dentures could be
used normally. The patient could return home within 2 weeks after being operated. Normally, this should require two operations and 12-18 months altogether before a patient can have the false teeth.

A female patient aged 54 years old related that after she learned that she had oral cancer, she felt completely disparate. Luckily, the team of dentists of Khon Kaen University helped performing operations on her until she is now able to live normally. Her highest hope is not to have a beautiful face, but to be able to live with her children as long as possible. The lady then thanked the dentist team for the assistance.

News: Panit Khatnak



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