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Chapter 4118or higher compared to the other included articles. Furthermore, only Lobo Leandro et al.(20) provided dietary VAS scores for the stock prosthesis, significantly weakening the conclusion of these findings. Due to the large population size(20), these data have a significant effect on the metaanalysis results, heavily “benefitting” the overall results for the stock prosthesis. This remark was also made by Johnson et al.(8) in their metaanalysis. Excluding the data provided by Lobo Leandro et al.(20) had a significant effect on the effect size for MMO, leading to a smaller increase in MMO from 17.32 to 13 mm (95% CI, 9.60 to 16.39) and from 18.11 to 11.82 mm (95% CI, 6.33 to 17.30), and a smaller increase in MMO compared to patients treated with a patient-fitted implant. While the data of Lobo Leandro et al.(20) cannot simply be discarded, this demonstrates the sensitivity of the pooled data to bias.Lack of pathology gradingPathology grading was lacking in the included studies. While it is well known that TJR should be considered the last resort for patients with endstage joint disease, the studies had great variability in the clinical severity of the pathologies and indications for surgery.(26,27) For example, one of the indications was joint ankylosis. Sawhney et al.(28) made clear distinctions among four different types, whereas Turlington and Durr(29) identified three types (Tables 8, 9). While all four types of Sawhney et al.(28) come into consideration for TJR surgery, it is evident that differences in severity and type of ankylosis (osseous, fibrous, mixed, or extended) can affect results. Post-operative results obtained in the ankylosis group of one study were negatively influenced by the presence of more severe cases, even if they are diagnosed as being of the same type.(28) Table 8. Grading of ankyloses of the TMJ by Sawhney et al.(28)Type I The head of the condylar process is visible but significantly deformed, with fibroadhesions making TMJ movement impossibleType II Consolidation of the deformed head of the condylar process and articular surface occurs mostly at the edges and in the anterior and posterior parts of the structures, and the medial part of the surface of the condylar head remain undamagedType III The ankylotic mass involves the mandibular ramus and zygomatic arch; an atrophic and displaced fragment of the anterior part of the condylar head is in a medial locationType IV The TMJ is completely obliterated by a bony ankylotic mass growing between the mandibular ramus and cranial baseAbbreviation: TMJ: temporomandibular joint.Nikolas de Meurechy NW.indd 118 05-06-2024 10:14