Objectives: To report the clinical and functional outcomes of patients undergoing total temporomandibular joint (TMJ) replacement with customized prostheses. Materials and Methods: Six female patients treated between 2018 and 2024 for advanced TMJ pathology—severe osteoarthritis (n=5) or condylar osteochondroma (n=1)—were included. All underwent unilateral total joint replacement using customized prostheses planned with cone-beam computed tomography and magnetic resonance imaging. Interincisal mouth opening (IMO), pain (visual analog scale), jaw function (JF), and dietary intake (DI), assessed through a Likert-type psychometric scale, were recorded preoperatively and during a minimum follow-up of 24 months. Results: All patients showed postoperative improvement. Median JF decreased from 6.5 to 3.5, DI from 8 to 1.5, and pain from 7 to 2. Postoperative IMO averaged 32 to 33 mm. One patient required revision for screw displacement without long-term functional compromise. Conclusion Customized TMJ prostheses proved safe and effective, demonstrating consistent improvements in pain, mandibular function, and dietary capacity in patients with severe joint disease. This approach represents a reliable therapeutic option when combined with individualized surgical planning.