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General introduction and overview117of the prosthetic replacement of the joint, leading to several conclusions for future application. Whereas the second chapter briefly touches the prosthetic materials that were used in both the past and present, the third chapter further elaborates on this topic by means of a narrative review. The importance of the use of biocompatible materials is evident, yet certain materials are clearly less suited for loading or articulation, compared to other materials, as their use nearly resulted in an abandonment of the prosthetic replacement of the TMJ. Thus, this chapter discusses the criteria that a biomaterial must meet, other than biocompatibility, to be considered suitable for implantation. An insight is also provided into both surface modification techniques to further improve on current materials, as well as potential future materials. While at first, TMJ prostheses were stock implants, sometimes provided in different sizes, there was no possibility to deal with the patient’s specific anatomy. Through the development of computer-assisted design/computer-assisted manufacturing (CAD-CAM) systems, patient-specific implants (PSI) were developed. In chapter four a meta-analysis is performed to compare both types of protheses, with special attention for functionality (maximal mouth opening), pain and diet, as well as possible confounders that might influence these results. Part 2 Animal-model experimentUsing the data and conclusions from the literature analysis that was performed, a novel patient-specific implant was designed. To evaluate if the implant was suitable for human implantation and could meet orthopedic standards, an animal-model experiment using sheep was designed. The prosthesis was first implanted in one sheep, to evaluate the surgical procedure and to establish the standard procedure. Next, 6 sheep were implanted with a ‘regular’ prosthesis and 6 ewes were treated with a prosthesis that underwent surface modification on the condylar head. Ten months after implantation, the sheep were euthanized to evaluate the peri-articular tissues, as well as the implants themselves. Nikolas de Meurechy NW.indd 17 05-06-2024 10:14