Nanocrystalline Diamond Coating on a Temporomandibular Joint Resurfacing Device: An Animal Model

Patrick J. Louis DDS, MD, Oral & Maxillofacial Surgery, University of Alabama School of Dentistry, Birmingham, AL
Benjamin R. Abt DMD, MD, Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
Paul A. Baker PhD, Vista Engineering, University of Alabama at Birmingham, Birmingham, AL
Raymond Thompson PhD, Vista Engineering, University of Alabama at Birmingham, Birmingham, AL
William R May MD, DMD, Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
Yogesh K Vohra PhD, Physics, University of Alabama at Birmingham, Birmingham, AL
Purpose:  To evaluate the implantation and long term functional and wear characteristics of a diamond-on-diamond temporomandibular joint resurfacing device using a swine model.

Materials and Methods:  Eight Yucatan (Sinclair) miniature swine were selected to undergo bilateral total temporomandibular joint (TMJ) resurfacing over a three month period.  A nanocrystalline diamond coated prosthesis was placed into seven animals. Plain titanium was used in one animal as a control. All animals were placed in intermaxillary fixation prior to the procedure to maintain occlusion and post operative imaging was utilized to evaluate placement. The animals are monitored clinically for signs of inflammation and infection at the surgical site as well as for diet tolerance and weight maintenance. Care of the animals and monitoring of the health and behavior of the animals is performed by the veterinarian and surgical team. The animals will be sacrificed at one year post implant placement and the prosthesis as well as the surrounding soft tissue will be harvested and evaluated for wear and surrounding tissue reaction.

Results:  All animals have had excellent occlusion after surgery. Anterior dislocation was observed in one animal immediately postoperatively but was reduced without further occurrence. All wounds have healed well without infection. One animal developed a hematoma that required conservative incision and drainage. No animal had evidence of CN VII injury. All animals have tolerated the post-operative diet protocol. There has been no weight loss by any of the animals postoperatively nor has there been any change in behavior.

Conclusions:  TMJ replacement materials have required modification over time due unfavorable outcomes. A promising alternative to the current implants lies in nanostructured diamond coating of titanium alloy surfaces. The swine as a model of the human TMJ has been supported due to its similar range of motion and its comparable anatomic and articular relationships. The current goal is focused on development of a device utilizing a more conservative surgical procedure to provide low friction and no wear debris with significantly enhanced articulation. 

Herring, S. W., J. D. Decker, Z. J. Liu, and T. Ma.     Temporomandibular joint in miniature pigs: Anatomy, cell replication, and relation to loading. Anat. Rec. 266:152–166, 2002

JJ Jacobs, A Shanbhag, TT Glant, J Black and JO Galante. Wear debris in Total Joint Replacements. J Am Acad Orthrop Surg 1994:2:212-220.

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