Design optimisation of patient-specific implants and total joint replacements in oral & maxillofacial surgery

This thesis focuses on the development, implementation, evaluation, and optimization of 3D-virtual surgical planning (VSP) workflows and patient specific implants (PSI) for oral and maxillofacial surgery (OMFS). The studied fields are: head and neck reconstructive surgery (Section I) and temporomandibular joint (TMJ) replacement surgery (Section II). Section III of this thesis focuses on optimisation and validation workflows and intertwines with both aforementioned fields. Current conventional osteosynthesis reconstruction plates (RPs) and PSIs are accompanied by complications, such as, mechanical instability, screw loosening, plate fracture and inaccurate positioning. In TMJ total joint replacement (TMJ-TJR) surgery, correct positioning of TMJ-TJR prostheses and their movement behaviour are focus areas. The general aim of the research described in this thesis was to solve these complications and focus areas by means of mechanical reconsiderations, developing patient-specific (PS) solutions to be used in guided surgery and optimising current workflows in order to enhance the current generation of PS-RPs and TMJ-TJR prostheses by increasing their level of patient-specificity, making them more specific to the patient than currently is the case.

Improvements were made by developing patient specific alternatives, which were experimentally and clinically validated. Furthermore, by presenting workflows that allow for improvements in the development of patient specific implants and temporomandibular joint total joint replacements, and by presenting enhanced mechanical testing methodologies, the research presented in this thesis will come together in a next, even more patient specific generation of patient specific implants and temporomandibular joint total joint replacements.