A Novel Fiber Embedded Hydrogel Temporomandibular Joint Disc Replacement

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Project Summary Temporomandibular joint (TMJ) disorders inflict approximately 5% to 12% of the population. For advanced disorders of the articular TMJ disc, which typically do not respond to conservative treatments, disc resection is the most common surgical intervention. However, the TMJ disc plays a critical role in distributing mechanical stresses and preventing wear to the articular surfaces of the joint. Thus, removing the disc can further disrupt joint homeostasis, driving degeneration and the development of osteoarthritis, which can lead to highly invasive and challenging surgical interventions such as reconstructions and total joint replacement. Prior attempts at replacing the disc with alloplastic implants have led to deleterious pathological changes related to wear debris, implant fragmentation, and adverse inflammatory responses. Therefore, it is crucial to consider wear, mechanical strength, and biocompatibility of disc replacement materials in the context of long-term cyclic loading in the TMJ. Overall, there is a critical need for disc replacements that can restore the homeostasis of the joint when disc resection is required prior to the development of severe joint degeneration. Accordingly, the objective of this proposal is to create an artificial TMJ disc that replaces the mechanical function of the native disc and prevents subsequent degeneration of the joint. Towards this goal, the proposed research will characterize the mechanical loading environment of the TMJ in order to determine the mechanical criteria of a TMJ disc replacement needed to minimize internal stresses in the joint (Specific Aim 1). Further, non- resorbable fiber-embedded hydrogel materials will be fabricated, optimized to exhibit biomimetic properties, and developed into a patient-specific synthetic TMJ disc implant. Rigorous mechanical evaluations will determine material durability and suitability as a TMJ disc replacement (Specific Aim 2). Finally, a large animal study will be utilized to evaluate the safety and efficacy of the developed TMJ disc replacement (Specific Aim 3). Successful completion of the proposed work would represent a paradigm shift in the treatment of TMJ disc disorders that can mitigate further joint degeneration and prevent more invasive and complicated surgeries.