Sarah,

I would stay away from fat grafts.

They have been doing them since the 1960's and the results have never been good.

They don't last and none of the scientific literature supports it.

Look for a good Neuromuscular Dentist in your area.

Good Luck,

Dr. Scott Tamura
Daily Strength TMJ Expert

Sarah I have personally been to this doctor myself. He has a facebook page. Yes he does have good results and their are studies out their showing/proving that fat grafts DO hold up, but they need to be integrated properly....which from my understanding the doctor you are talking about does with his protocols.

Please come visit TMJ HOPE on facebook or their actual web page. Also please try and visit the facebook page of the doctor you are speaking about and other patients will talk with you.
As for what Dr. Tamura says, he is not entirely correct on that.

Here is something I ran across........in the end the failure rate for this study was 6.5%. Well last time I checked failure rates for knee replacement were 5%...........SOOOOOOOOO their is some indication that it can work. But each case varies and surgery is still a last resort.
Macroscopic and Histologic Analysis of
Abdominal Dermis-Fat Grafts Retrieved
From Human Temporomandibular Joints
George Dimitroulis, MDSc, PhD, FDS, FFD, FRACDS(OMS)*
Purpose: The purpose of the present study was to examine the fate of the abdominal dermis-fat grafts
that were implanted into human temporomandibular joints (TMJ) at the macroscopic and histologic
levels.
Patients and Methods: The clinical records of 123 patients who underwent TMJ discectomy with
dermis-fat grafting during a 10-year period (2000 to 2009) were reviewed, and 8 patients were identified
who had had the dermis-fat graft surgically removed from their TMJ at a subsequent operation. The
retrieved grafts were assessed at the macroscopic and histologic levels for size, consistency, and cellular
composition. The dermis-fat grafts were retrieved after a period of 8 to 46 months (mean, 22.3) after
initial implantation into the TMJ.
Results: The graft material was a rubbery consistency and filled the entire joint space between the
condylar head and glenoid fossa/articular eminence. The average size of the retrieved grafts was 16
mm _ 14 mm _ 7 mm, with a mean volumetric dimension of 1.57 _ 0.38 cm3. The interpositional
tissue retrieved from all joints demonstrated clear histologic evidence of mature adipose tissue
interspersed with dermal elements such as sweat glands and hair follicles that were atrophied. The
ratio of fat/nonfat tissue was significantly (P _ .01) less (mean, 31.3% _ 5.7%) than in the original
(mean, 90.2% _ 6.3%) graft. No evidence was found of dermoid cysts or necrotic fat in any of the
specimens examined.
Conclusion: The results of the present study showed that abdominal dermis-fat grafts transplanted to
the TMJ do thrive and adapt well to the confines of the joint cavity, allowing functional movement of the
joint. However, in the present study, the dermis-fat graft failed to protect the condyle against additional
deterioration in 6.5% of patients who went on to have total joint replacements.
2011 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 69:2329-2333, 2011


It's not perfect and do a lot of research before going into surgery but sometimes some people really have no choice.

Florida,

Thanks for posting the scientific study.

There are two problems with the study however.

First is that the sample size is too small. I would never recomend any procedure to any of my patients based on a scientific study that only had 123 subjects.

The second problem is that there is no long term follow up, and that contiues to be my major concern. Yes, right after the surgery the fat does appear to fill the joint space. The problems arrise 2, 3, 5 or 10 years later when the fat is absorbed into the body and disapears. Of the original 123 patients they only histologically evaluated 8 of the grafts (because they failed and the fat needed to be removed), and in those 89 the average amount of time before failre was less than 2 years (acutally it was 22 months). This has been my experience as well. They look good orginally, but do not last.....

Dr. Scott Tamura

Thankyou everyone really kind of you! Dr T I was wondering how a neuromuscular dentist can help me if my disc is off and there is no way to capture it !I used to pop when I opened my mouth but that has stopped now , I've had limited mouth opening for two years , and thankyou to the other post ! I think dr piper has been doing these fat grafts for 20 years so it would be helpful to hear from anyone else who had this operation and see how they are doing , and how long its been

Thankyou floridakris , can I ask what your situation is , did you have the fat graft surgery yourself !

I have not had the fat graft.......I'm still in the deciding factor. I have spoken with several patients that had it like 10yrs ago and are still doing fantastic. You should connect with other patients on his facebook page and the jaw crew, they can tell you lots about it.
As for me, I have bone on bone in both my joints(no recapture of discs). My right side joint is 10mm SHORTER than my left joint(this is my ear to molar MRI measurement). My left joint is slightly overgrown to compensate for the other side. Both of my discs are still there but are so misshapen it would be a bad idea to use them.

As for neuromuscular approach, from the research I've done they would bring your jaw down and forward with a repositioning splint to give you space in your joint. I've spoken with a doctor about this and they said that eventually necrosis would start happening with no cushioning there but honestly no one can truly answer that without studies.

Dr. T I do agree iwth you on the fact that the study size was small and that a decision should not be made based solely on that information, my point in posting that was to counter that their is no good results.........which is what you stated.

In the end TMJ research is LIMITED, very limited...including neuromuscular approaches. I would definitely say be cautious, do a lot of reserach and try to do as much conservative treatment as possible first(which you may have already done). Neuromuscular dentistry is NOT conservative because they ultimately change your bite with the splint and then need to do braces or crowns to fix your bite to that position. I've met some people that this approach has HELPED them greatly and others it has not, so again, lots of research.

I have not had the fat graft.......I'm still in the deciding factor. I have spoken with several patients that had it like 10yrs ago and are still doing fantastic. You should connect with other patients on his facebook page and the jaw crew, they can tell you lots about it.
As for me, I have bone on bone in both my joints(no recapture of discs). My right side joint is 10mm SHORTER than my left joint(this is my ear to molar MRI measurement). My left joint is slightly overgrown to compensate for the other side. Both of my discs are still there but are so misshapen it would be a bad idea to use them.

As for neuromuscular approach, from the research I've done they would bring your jaw down and forward with a repositioning splint to give you space in your joint. I've spoken with a doctor about this and they said that eventually necrosis would start happening with no cushioning there but honestly no one can truly answer that without studies.

Dr. T I do agree iwth you on the fact that the study size was small and that a decision should not be made based solely on that information, my point in posting that was to counter that their is no good results.........which is what you stated.

In the end TMJ research is LIMITED, very limited...including neuromuscular approaches. I would definitely say be cautious, do a lot of reserach and try to do as much conservative treatment as possible first(which you may have already done). Neuromuscular dentistry is NOT conservative because they ultimately change your bite with the splint and then need to do braces or crowns to fix your bite to that position. I've met some people that this approach has HELPED them greatly and others it has not, so again, lots of research.

Dr. Tamura,

What is the NM protocol for dispalced discs without reduction? How long do you wait for a psedo disc before trying surgery or fat grafts?
How do you know?

Thanks

Good blog about fat graft experience. She really tells all. Doesn't answer the question about long term success since she is really only 3 months post surgery.

grin-andbearit DOT blogspot DOT com

Oh yes I've been on the blog many times......she is on a few other support groups like tmjhope. If you want to see about long term patients go to the docs Facebook page and ask or scroll through the posts and you should see them

Hello floridakris. the blog and facebook page make compelling reading.
Can I ask you what you mean by "integrated properly"? Have you heard of any of the patients having problems after surgery, or cases of it not being successful. I was also surprised at the number of young patients. Could I also ask (you don't have to answer) what is holding you back from surgery?

Right now what is holding me back from surgery is that I live in Germany with my family and cannot leave my young children while I go have the surgery. My husband and I are in the process of trying to move back to America and get a support system going so I can have the surgery(if you've read the blog you know how long of a recovery it is. Also money is a factor, this surgery is very expensive(I can give you more details privately if you like) and so we are saving and working out the obstacles that we have.

As for the integration that I was talking about, it means that fat grafts have been shown to integrate well..........get a good blood supply and it will help it maintain and be healthy in your body within the joint space, but that requires time and healing. I'm not a doctor so that is my limited understanding of it. When I had my consult though I talked with the doc about it and he talked a lot about the body needing time for the joint to heal, for the fat graft to get a good blood supply for it to do well.

If you want you can private message me and I would be happy to talk with you more indepth about it

As for people who have had problems after the surgery, yes there are some, but I have only seen a few. In the end I know that surgery is for function only and there is no guarantee of pain reduction, although Dr. Piper has had better success than most I've seen. Plus what I like is how much he tracks his patients long term.

I understand this surgery costs up to 50 thousand dollars and insurance won't cover it.. so what does the normal person who is not rich do??

From my understanding and what I've seen in the TMJ community is that most insurance doesn't cover TMJ to begin with. I've talked with quite a few patients who had to pay upfront, file with there insurance and then the insurance doesn't pay them back or they get a very small amount. This isn't just a problem with this specific doctor, it's lots of doctors.

I believe there is financing for medical procedures as well, something to look into. I get the cost, it's A LOT of money. Right now with lack of research, no standard of care for TMJ patients, the ADA and AMA not being willing to recognize TMJ as a specialty it leaves us patietns to guess on our treatment options. It also stops more reserach from happening.

It's sad and very frustating for all of us