Total temporomandibular joint replacement (TMJR) is an established reconstructive option for patients with end-stage TMJ disease (severe degenerative joint disease, ankylosis, failed prior reconstructions, tumor resection, or severe post-traumatic destruction). Modern alloplastic prostheses—stock and patient-specific—provide reproducible pain relief, improved jaw function, and durable outcomes when used with proper indications, meticulous technique, and structured postoperative rehabilitation. This chapter summarizes relevant anatomy, indications and contraindications, preoperative planning, operative technique highlights, prosthesis types, expected outcomes, complications and their prevention/management, and evidence from recent systematic reviews and registry data.