Study on the lateral pterygoid muscle status after artificial temporomandibular joint replacement

3D-Printed Porous Tantalum Scaffold Improves Muscle Attachment via Integrin-β1-Activated AKT/MAPK Signaling Pathway

3D-printed porous titanium (Ti) alloy scaffolds have been reported for facilitating muscle attachment in our previous study. However, the anti-avulsion ability needs to be improved. In this study, we used 3D-printed porous tantalum (Ta) scaffolds to improve muscle attachment. The differences in chemical and physical characteristics and muscle adhesion between the two scaffolds were tested and compared in the gene and protein level both in vitro and in vivo. The possible molecular mechanism was analyzed and further proved. The results showed that compared with the porous Ti alloy, porous Ta had better cell proliferation, differentiation, migration, and adhesion via the integrin-β1 (Itgb1)-activated AKT/MAPK signaling pathway in L6 rat myoblasts. When artificially down-regulated the expression of Itgb1, cell adhesion and myogenesis differentiation were affected and the phosphorylation of the AKT/MAPK signaling pathway was suppressed. In rat intramuscular implantation, porous Ta had a significantly higher muscle ingrowth rate (85.63% ± 4.97 vs 65.98% ± 4.52, p < 0.01) and larger avulsion force (0.972 vs 0.823 N/mm², p < 0.05) than the porous Ti alloy. These findings demonstrate that the 3D-printed porous Ta scaffold is beneficial for further clinical application of muscle attachment.

Alloplastic temporomandibular joint replacement: present status and future perspectives of the elements of embodiment

Medical device embodiment involves the following elements: materials, design, and manufacturing. Failure of any one of these elements can result in failure of the device, despite the others being satisfactory. The abundance of clinical and basic science literature published since 1986, demonstrates the safety and efficacy of alloplastic temporomandibular joint replacement (TMJR). Currently, there are 19 countries producing 41 TMJR devices. More than 75% are custom designed, and 27% are additively manufactured. In light of the increasing number of TMJR devices being designed and manufactured around the world, this paper will discuss TMJR embodiment so that clinicians understand their present status as well as the prospects for the future of new and/or improved TMJR devices, to ensure that these devices continue to be safe and effective long-term surgical options for the management of end-stage TMJ pathologies.

Biomechanical analysis of a temporomandibular joint prosthesis for lateral pterygoid muscle reattachment

OBJECTIVE

To analyze the biomechanical properties of a novel temporomandibular joint (TMJ) prosthesis with an attachment area for the lateral pterygoid muscle (LPM).

STUDY DESIGN

Three prosthesis models were created and compared using finite element analysis for the displacement, stress, and strain when simulating the maximum bite force loading. A verification experiment and a compression test were conducted.

RESULTS

The displacement, stress, and strain of the novel TMJ prosthesis were larger than the solid condylar neck prosthesis and similar to the slotted condylar neck prosthesis, but the values were far less than the yield strength of titanium alloy. The maximum stress and strain in the novel TMJ prosthesis was concentrated in the inner and boundary areas of the LPM reattachment region beside the thinnest part of the prosthesis neck. The difference in the strain values measured using the verification test and those using finite element analysis was <20%. Compression testing of the novel TMJ prosthesis revealed that the mandible fractured when the force reached 588.97 N, whereas the prosthesis itself did not break or deform.

CONCLUSIONS

The mechanical distribution of the novel prosthesis was feasible under maximum bite force for potential clinical application.