Contemporarily alloplastic temporomandibular joint replacement (TMJR) devices have been reserved for adult and skeletally mature patients. TMJ surgical procedures in the growing patient are undertaken with caution due to concerns about future growth and the need for additional surgeries. Traditionally, the primary indications for TMJ surgery in skeletally immature patients have been ankylosis, trauma, neoplasia, and developmental or congenital pathology. Joint reconstruction using autogenous bone, including costochondral grafts (CCG) and sternoclavicular grafts (SCG), have been regarded as the gold standard in children mainly due to their growth potential. However, the competing interests of early rehabilitative physical therapy and restriction of mandibular function to allow for bony union can result in re-ankylosis, non-union, resorption, and graft failure. Such complications, which are not insignificant, necessitate additional surgeries, and with each failed attempt, result in worse scarring and possible growth disturbances leading to a decrease in mandibular function and form.

Recently, there has been increased discussion about how best to manage TMJ reconstruction in skeletally immature patients; namely, whether to utilize autogenous grafts or alloplastic devices. While autogenous grafts have been classically considered the first treatment option in such cases, those grafts are not without reports of complications and failures (Saeed and Kent, 2003). Therefore, surgeons have recently looked to alloplastic reconstruction as a way to deliver more stable and predictable outcomes, especially in cases of relapse and prior failure (Hawkins et al., 2020). To provide some information on this issue, a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines (Moher et al., 2009) was conducted to assess the current evidence for the use of the TMJR reconstruction option in skeletally immature patients.