Page 203 - Demo

Animal experiment: Radiological analysis of the LPM reattachment2017subjected to. While no loosening or displacement of the fossa component was seen in humans, further trails in humans are needed to support this statement.(7)Although no evidence is available concerning HO following TMJ implant displacement, a significant effect was found between the occurrence of HO and the displacement of the fossa component. (p <0.01). As trauma and fractures have been validated as causes for HO in orthopedic literature, as well as TMJ ankylosis, we would advise not to apply this technique of enthesis reconstruction in young patients, nor in patients suffering from an ankylotic joint.(40,41) This to avoid any risk of (re-)ankylosis, until further trials in humans are done.The effects of imaging artifacts should also be considered. Because the TMJR was completely made of titanium, artifacts that caused decreases in image quality might have affected the results. Titanium has a high density, so low-energy photons are more absorbed than high-energy photons, leading to beam hardening.(42) This effect is even more apparent between an implant and other high density materials or tissue such as bone.(43) When photons change direction they can end up in the wrong detector, which results in dark streaks in the areas of photon loss.(42) These artifacts can lead to blurred inaccurate images.(42,44) Limiting these artifacts was attempted by decreasing the reconstruction thickness, as proposed by Moon et al.(45) However, the kilovoltage was 120 kV, and an increase to 140kV might have resulted in further reduction of metal artifacts.(45) A metal artifact-reducing sequence (MARS algorithm) was used as to improve the image during processing. Nevertheless, due to the high density and possibly due to the irregular shape of the scaffold, current artifact removal software is unable to completely remove artifacts.(42) The darkened areas can reduce the accuracy of the evaluation between the reconstructed enthesis and the implant, and increase the need for histological analysis of the scaffold and enthesis insertion. Nikolas de Meurechy NW.indd 201 05-06-2024 10:14