Surface wear in a custom manufactured temporomandibular joint prosthesis

Abstract

The wear of a novel temporomandibular joint (TMJ) prosthesis was evaluated in an animal model. The prosthesis consisted of an additively manufactured titanium alloy (Ti6Al4V) mandibular condyle and glenoid fossa created through selective laser melting, with a machined vitamin E‐enriched ultra‐high molecular weight polyethylene (UHMWPE) surface attached to the fossa. Thirteen TMJ prosthesis were implanted in sheep, six of which had condylar heads coated with HadSat® diamond‐like carbon (H‐DLC). Euthanasia took place after 288 days, equaling 22 years of human mastication. Linear and volumetric wear analysis of the fossa was performed by optical scanning. The condylar head surfaces were assessed by scanning electron and confocal laser microscopy. The average linear UHMWPE wear, when combined with the coated condyle, was 0.67 ± 0.28 mm (range: 0.34–1.15 mm), not significantly differing (p = .3765, t‐test) from the non‐coated combination average (0.88 ± 0.41 mm; range: 0.28–1.48 mm). The respective mean volumetric wear volumes were 25.29 ± 11.43 mm3 and 45.85 ± 22.01 mm3, not significantly differing (p = .1448, t‐test). Analysis of the coated condylar surface produced a mean Ra of 0.12 ± 0.04 μm and Sa of 0.69 ± 0.07 μm. The non‐coated condylar surface measured a mean Ra of 0.28 ± 0.17 μm and Sa of 2.40 ± 2.08 μm. Both Sa (p = .0083, Mann–Whitney U test) and Ra (p = .0182, Mann–Whitney U test), differed significantly. The prosthesis exhibits acceptable wear resistance and addition of the H‐DLC‐coating significantly improved long‐term condylar surface smoothness.

Evolutionary Steps in the Development of a Patient-specific Temporomandibular Joint Prosthesis

“…After thoroughly evaluating the proposed implants in sheep experiments, 18,19 eleven patients (2 men, 9 women; mean age at surgery of 49 years, 1 months) received all together 16 customized total TMJ Parametro prostheses. The surgery was performed by one surgeon in the same hospital.…”

The Year 2022 in biomaterials research: A perspective from the editors of six leading journals

“…The top two most downloaded articles for 2022 were open‐access review articles: M. Azam Ali et al (University of Otago, Dunedin, New Zealand), “A review of current advancements for wound healing: Biomaterial applications and medical devices” 75 and Van der Borre et al (Vrije Universiteit Brussel, Belgium), “How surface coatings on titanium implants affect keratinized tissue: A systematic review” 76 . The two top‐most downloaded research articles were: De Meurechy et al (Vrije Universiteit Brussel, Belgium), “Surface wear in a custom manufactured temporomandibular joint prosthesis”, 77 and Schulten et al (RWTH Aachen University, Germany), “A polyurethane‐based surgical adhesive for sealing blood vessel anastomoses—A feasibility study in pigs” 78 . The top two cited papers are: 1.…”

Rationale for patient-fitted alloplastic temporomandibular joint replacement in childhood ankylosis

“…The patient has a reduced risk for reankylosis, can endure immediate aggressive physiotherapy and will not experience over-or undergrowth or graft fracture. [ 1 23 30 31 ] With ATJR, one can avoid a series of surgeries in childhood, as in the case described by Wu et al ., which involved tracheostomy, DO, gap arthroplasty with temporal muscle interpositioning,[ 32 33 ] CCG, and finally, ATJR in a child with Nager syndrome. [ 34 ]…”

“…The currently available ultra-high molecular weight polyethylene will likely need to be replaced every 20 years. [ 6 32 ] In addition, heterotopic bone formation occurs in 50% of post-ATJR adults,[ 35 ] although autologous fat packing can fence-off this adverse event. [ 35 36 37 ]…”