Page 371 - Demo

Summary in English and Dutch36914Chapter 8 further analyzed the 5 previously mentioned sheep which showed either a purely bony or partially bony and partially soft tissue attachment to the condylar scaffold. To do so, a detailed anatomical analysis was made to determine how the samples needed to be sectioned, after which histological analysis of the condylar scaffold and LPM was performed. This analysis revealed multiple osteogenic islands within the enthesis scaffold, yet no apparent bony ingrowth had occurred. Nevertheless, all specimens had developed an uninterrupted fibrotic connection between the enthesis and scaffold, allowing for a proper functional restoration of the LPM. Analysis of the ramal component revealed proper osseous integration onto the mandible. Further investigation of the reattachment technique in human subjects was proposed, to improve upon the osseous integration and to evaluate the effectiveness of a possible fibrotic connection.With the animal-model experiment proved successful, chapter 9 discussed the development of the novel patient-specific TMJ prosthesis, while staying true to the general design as previously evaluated, mimicking both normal joint anatomy and function, for human implantation. This chapter served as a summary and clinical application of the previous 8 chapters. In addition, early clinical results for pain, diet, maximal mouth opening and laterotrusion were included, which were all promising. We concluded that further human clinical use was justified.The 10th chapter continued and expanded where the previous chapter left off. As stated in chapter four, one of the advantages of a PSI over a stock implant is the possibility to treat larger defects, by means of an alloplastic eTMJR. In this chapter we developed 6 eTMJRs to treat 5 patients with severe defects. Each case was elaborated upon and asked to fill out a questionnaire, determining the patient-reported outcomes. We reported on the surgical difficulties that were encountered and suggested the use of a new subclassification system of eTMJR. This new system further elaborated on the classification according to Elledge et al., taking in account the need for contour corrections, occlusal adjustments and a simultaneous contralateral mandibular osteotomy.Nikolas de Meurechy NW.indd 369 05-06-2024 10:15