The field of temporomandibular joint (TMJ) endoprosthetics developed in two waves. After an initial period of poor long-term results, the material and structural improvements of alloplastic TMJ replacements achieved in recent years have reduced these failures significantly. The indications for total TMJ replacement include inflammatory and degenerative TMJ diseases and, in particular, TMJ deformities, trauma, and tumor complications. Total TMJ replacement must be embedded in the general decision cascade of available conservative and surgical options, and it should always be regarded as the treatment of last resort, to be performed only after all other options have been exhausted. Both stock and custom-made total TMJ prostheses are used in a largely standardized operating procedure. Pre- and postoperative physical therapy is a key component of successful restoration of function. The results reported in the literature show low complication rates, with significant improvement in the areas of pain reduction, and improvement of function and quality of life. Thus, modern total alloplastic TMJ replacement is a safe and reliable treatment modality that has significantly expanded the range of treatments, especially for end-stage TMJ disorders. Keywords: alloplastic temporomandibular joint replacement, biological reconstruction, CAD/CAM prosthetics, conservative treatment cascade, endoprosthetics, functional analysis, joint resection, nerve damage, physical therapy