Page 369 - Demo

Summary in English and Dutch36714of pathology grading, bias of pooled data and lessened surgery time were discovered and discussed. In addition, advantages to the use of PSI were not taken into consideration during the statistical analysis. We concluded that, despite the initial higher cost of a custom-made TMJR, its use allows for optimal positioning of the screws thus decreasing the risk of damage to the alveolar and facial nerve, which can prevent for the need of a second corrective surgery.After determining the proper materials to be used for implantation, as well as the fact that the prosthetic design needs to consist of two components and is best designed as a patient-specific implant, the next 4 chapters discussed the development and findings of an animal-model experiment, using a total of fourteen sheep. One sheep served as a control group, whereas seven sheep were implanted with a sheep-specific TMJ TJR that did not receive any surface modification. This group was then compared to six sheep that were implanted with a TMJR, of which the condylar component underwent a surface modification, by means of a H-DLCcoating. Two-hundred and eighty-eight days after implantation, equaling 22 years of human masticatory function, the sheep were euthanized, and the tissues and prosthetic components were analyzed to determine the suitability of the novel implant for human application. In chapter 5 the amount of wear that occurred in the fossa component, using optical scanning, was evaluated. The average linear wear when combined with a coated condyle did not differ significantly from the non-coated combination average. The same was true for the volumetric analysis. In both cases, the amount of wear that occurred was well below the maximum that is allowed in a TKR. In addition, the condylar surfaces were assessed as well, using scanning electron and confocal laser microscopy. SEM-analysis revealed that the coated condyles had developed multi-directional scratches, which were also present on a pristine sample, indicating these were due to the polishing protocol (HadSat®)that is applied prior to implantation. One coated condyle developed deeper marks, penetrating through the H-DLC coating, potentially due to the fossa having become slightly displaced over time. In comparison, the uncoated condyles showed significantly more surface Nikolas de Meurechy NW.indd 367 05-06-2024 10:15