The aim of this study was to compare stock (Biomet-Lorenz Stock, Parsippany, NJ) and custom (TMJ Concepts, Inc., Ventura, CA) total temporomandibular joint (TMJ) replacement prosthetics. This was a retrospective cohort study of 17 consecutive patients operated by the same surgeon from 2015 to 2020 comparing stock and custom options for total joint replacement (TJR). The inclusion criteria were patients who documented 1 year of follow-up post-TJR without previous TMJ replacement surgery. The predictor variable was the TMJ prosthetic replacement. The primary clinical outcome variables was pain via Visual Analog Scale (VAS) measured at 1, 3, and 6 months postoperatively and maximum incisal opening measured pre and post-surgery. The other variables were grouped into the following categories: surgery time, length of stay, and unilateral vs bilateral replacements. Our review showed no statistically significant difference in maximum incisal opening, subjective pain score, hospital stay, surgical time, or complication rate between Biomet-Lorenz stock and TMJ Concepts, Inc. custom total joint replacement. Bilateral TJR, irrespective of prosthesis type, did have greater improvement in maximal incisal opening (MIO) compared with unilateral that was statistically significant (P < .05). There was no statistically significant difference in the pain VAS or MIO using either stock or custom TJR. Both should be considered good surgical options for improvements in patient function and long-term jaw stability.