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Chapter 13348infiltration with minimal lymphatic response, a mixed macrophagic and lymphocytic response with the presence of mast cells, plasma cells and eosinophils, a granulomatous pattern.(103–105) The risk of a type VI reaction increases significantly, in case of a volumetric wear volume of more than 80mm³ or when linear wear is exceeds 0.1mm/year. In neither of the prosthetic groups was this amount of wear found and no type VIreaction was found.Although no SLIM-reactions were found, there was a significant increase in the amount of lymphocytes in the peri-articular tissues of both the coated (24.6 ± 18.45) and uncoated prostheses (34.51 ± 28.58) compared to the control group (9.5 ± 5.2). Although the role of lymphocytes in the periarticular tissues is not yet fully understood, it is believed that higher tissue concentrations of metals resulted in a higher lymphocytic infiltration. Our findings were consistent with these studies, showing a stronger lymphocytic reaction in the peri-articular tissues of the uncoated TMJR, which also developed more condylar wear. (106,107) In turn, if this exposure becomes high enough, it is believed this lymphocyte response could lead to metal hypersensitivity and in turn aseptic loosening of the implant.(108) Although no clear threshold has been reported on, the increase in lymphocytes was relatively limited in the coated samples, nor was any aseptic loosening of the implant seen in any of the sheep, thus we concluded that the custom-made prosthesis was not at risk of aseptic loosening. It should be noted that both the uncoated and coated groups exhibited a large standard deviation during statistical analysis, presumably due to the relatively small sample sizes in the animal experiment.The tribological evaluation of the custom made total TMJR revealed that the prosthesis answered to all the wear-related standards that have been set in orthopedic surgery.In vivo analysis – LPM reconstructionWith the development of this novel custom-made total TMJR, one of the objectives that was aimed for, was to achieve functional improvement compared to current total joint replacements, by means of reattachment of the lateral pterygoid muscle’s enthesis. To achieve this, a scaffold in Nikolas de Meurechy NW.indd 348 10-06-2024 11:12