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Animal experiment: Histological analysis of the LPM reattachment2158A total of 14 ewes (Swifter crossbreed) were enrolled after approval by the ethics committee at Medanex Clinic (license number LA 1210576 - code of approval EC MxCl 2018-090) was acquired. All the animals were in good health before surgery, weighed 73.4 kg on average (range: 52-86 kg) and were aged between 2 and 5 years. None had missing teeth. The sheep were allowed to roam freely in the meadow until the day of surgery. During the first week after surgery, they were kept in solitary confinement, followed by indoor confinement in a large stable for remaining duration of the study. ImplantMandibular componentThe mandibular component was additively manufactured from grade 23 extra-low interstitial (ELI) Titanium 6-Aluminum 4-Vanadium (Ti6Al4V). A large connecting lattice structure at the bony interface was provided, to allow osseous mandibular integration. In order to allow for LPM reattachment, a subcondylar a tunnel with a small ‘hook-like’ extension on the lateral side was designed. By running a PDS 0 suture through the preserved bony or fibrocartilaginous enthesis of the LPM, this suture could then be threaded through the subcondylar tunnel and be fixed to the extension. Additionally, a large subcondylar lattice structure was designed to allow for osseous integration of the enthesis.Through the process of computer-assisted design (CAD), the TMJR bone interface contained interconnecting pores with a 500 µm diameter and a 80% porosity, as improved bone ingrowth and stability are found in a porosity of up to at least 70%.(20) By micro-shot peening using alumina grit with a 550 µm diameter and etching using 2 wt% oxalic acid at 85 °C for 10 min, a sandblasted, large-grit, and acid-etched (SLA) surface at the bony interface of the implant was achieved. To remove any remaining alumina residue, which can reduce corrosion resistance and interfere with proper osseointegration, acidic etching with 2 wt% oxalic acid was applied.(21–23) This process also further increases the surface roughness through micro-pitting.(21,24,25)Nikolas de Meurechy NW.indd 215 05-06-2024 10:14