{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:43:09Z","timestamp":1792107789959,"version":"4.4.0"},"reference-count":55,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Temporomandibular joint (TMJ) ankylosis, characterized by osseous\u2013fibrous fusion, severely impairs mandibular function. While alloplastic total joint replacement (TJR) is the gold standard, long-term outcomes remain understudied. The aim of this study is to evaluate the long-term esthetic and functional outcomes of prosthetic replacement and to retrospectively analyze our 20-year experience. Methods: A retrospective observational study (2003\u20132024) was conducted at a tertiary referral center in Turin and enrolled patients who underwent alloplastic total joint replacement for TMJ ankylosis. Data collected included demographic variables, etiology, characteristics of the ankylosis, prosthesis type (stock\/custom), surgical details, and outcomes (maximal interincisal opening [MIO], pain, quality of life, diet consistency, Helkimo index, complications). Results: Among 28 patients (61% female, mean age 51.8 years), etiologies included post-traumatic (39%), osteoarthritis (32%), congenital (25%) and neoplastic (4%) causes. Custom prostheses were used in 57% of cases. Median follow-up was 11.5 years. Significant improvements were observed in MIO (p = 0.001), pain level (p = 0.001), quality of life (p = 0.001), diet score (p = 0.002), and Helkimo index (p = 0.001). Complications included facial nerve dysfunction (32.1%), salivary leakage (14.3%), and one recurrence (2.2%). Conclusions: Alloplstic TJR provides durable functional and esthetic restoration for TMJ ankylosis, with custom prostheses excelling in complex anatomies. Long-term stability (&gt;10 years) supports its role as a definitive solution.<\/jats:p>","DOI":"10.3390\/jcm14134639","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T13:06:17Z","timestamp":1751288777000},"page":"4639","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Temporomandibular Joint Ankylosis: Long-Term Outcomes with One-Stage Resection and Reconstruction Using Total Joint Alloplastic Replacement\u2014A 20-Year Experience"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7251-4209","authenticated-orcid":false,"given":"Giovanni","family":"Gerbino","sequence":"first","affiliation":[{"name":"Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Citt\u00e0 della Salute e delle Scienze Hospital, Via Genova 3, 10131 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2667-8809","authenticated-orcid":false,"given":"Michela","family":"Omed\u00e8","sequence":"additional","affiliation":[{"name":"Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Citt\u00e0 della Salute e delle Scienze Hospital, Via Genova 3, 10131 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Raveggi","sequence":"additional","affiliation":[{"name":"Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Citt\u00e0 della Salute e delle Scienze Hospital, Via Genova 3, 10131 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Silvestri","sequence":"additional","affiliation":[{"name":"Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Citt\u00e0 della Salute e delle Scienze Hospital, Via Genova 3, 10131 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Zavattero","sequence":"additional","affiliation":[{"name":"Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Citt\u00e0 della Salute e delle Scienze Hospital, Via Genova 3, 10131 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3131-9669","authenticated-orcid":false,"given":"Guglielmo","family":"Ramieri","sequence":"additional","affiliation":[{"name":"Division of Maxillofacial Surgery, Department of Surgical Sciences, University of Turin, Citt\u00e0 della Salute e delle Scienze Hospital, Via Genova 3, 10131 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/SCS.0000000000004134","article-title":"Temporomandibular Joint Ankylosis: Algorithm of Treatment","volume":"29","author":"Canto","year":"2018","journal-title":"J. Craniofacial Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s12663-018-1121-4","article-title":"Guidelines for Single-Stage Correction of TMJ Ankylosis, Facial Asymmetry and OSA in Adults","volume":"18","author":"Anchlia","year":"2019","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Miloro, M., Ghali, G.E., Larsen, P.E., and Waite, P. (2022). Peterson\u2019s Principles of Oral and Maxillofacial Surgery, Springer. [4th ed.].","DOI":"10.1007\/978-3-030-91920-7"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/0030-4220(83)90366-3","article-title":"Interpositional arthroplasty for ankylosis of the temporomandibular joint","volume":"55","author":"Shira","year":"1983","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/S1010-5182(05)80055-1","article-title":"The Temporalis Muscle Flap in Temporo-Mandibular Joint Surgery","volume":"18","author":"Brusati","year":"1990","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.bjoms.2010.09.012","article-title":"Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: A critical review","volume":"50","author":"Arakeri","year":"2012","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e117","DOI":"10.1016\/j.jcms.2012.11.038","article-title":"Treatment guidelines for temporomandibular joint ankylosis with secondary dentofacial deformities in adults","volume":"41","author":"Zhu","year":"2013","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1016\/j.joms.2008.04.004","article-title":"Outcomes of Total Alloplastic Replacement with Periarticular Autogenous Fat Grafting for Management of Reankylosis of the Temporomandibular Joint","volume":"66","author":"Mercuri","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2512","DOI":"10.1016\/j.joms.2019.06.172","article-title":"Recurrence-Related Factors of Temporomandibular Joint Ankylosis: A 10-Year Experience","volume":"77","author":"Chen","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"392","DOI":"10.4103\/njms.NJMS_57_20","article-title":"Temporomandibular joint ankylosis: A tertiary center-based epidemiological study","volume":"12","author":"Nitesh","year":"2021","journal-title":"Natl. J. Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.mehy.2013.06.031","article-title":"Temporomandibular joint ankylosis: Is hypercoagulable state of blood a predisposing factor?","volume":"81","author":"Bhatt","year":"2013","journal-title":"Med. Hypotheses"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6695664","DOI":"10.1155\/2021\/6695664","article-title":"Temporomandibular Joint Ankylosis among Patients at Saint Paul\u2019s Hospital Millennium Medical College, Ethiopia: A 9-Year Retrospective Study","volume":"2021","author":"Mekonnen","year":"2021","journal-title":"Int. J. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.ijom.2015.05.003","article-title":"Temporomandibular joint ankylosis caused by condylar fractures: A retrospective analysis of cases at an urban teaching hospital in Nigeria","volume":"44","author":"Anyanechi","year":"2015","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1016\/j.ijom.2019.04.017","article-title":"Quality of life assessment in temporomandibular joint ankylosis patients after interpositional arthroplasty: A prospective study","volume":"48","author":"Sharma","year":"2019","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.ijom.2010.11.020","article-title":"A critical review of interpositional grafts following temporomandibular joint discectomy with an overview of the dermis-fat graft","volume":"40","author":"Dimitroulis","year":"2011","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"344","DOI":"10.4103\/ams.ams_132_20","article-title":"Role of custom-made prosthesis for temporomandibular joint replacement in unilateral ankylosis\u2014An evaluative study","volume":"10","author":"Mani","year":"2020","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E728","DOI":"10.1097\/SCS.0000000000007709","article-title":"Three-Dimensional Osteosynthesis Plates for the Surgical Treatment of Mandibular Fractures","volume":"32","author":"Khalil","year":"2021","journal-title":"J. Craniofacial Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"194","DOI":"10.4103\/ams.ams_120_16","article-title":"Evaluation of the sternoclavicular graft for the reconstruction of temporomandibular joint after gap arthroplasty","volume":"7","author":"Rao","year":"2017","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"216","DOI":"10.17126\/joralres.2017.060","article-title":"Management of temporomandibular joint ankylosis in Yemeni children by metatarsal bone grafts","volume":"6","author":"Aldialami","year":"2017","journal-title":"J. Oral Res."},{"key":"ref_20","first-page":"19831","article-title":"Effectiveness of different surgical modalities in the management of temporomandibular joint ankylosis: A meta-analysis","volume":"8","author":"Liu","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2001.e1","DOI":"10.1016\/j.joms.2018.05.004","article-title":"Temporomandibular Joint Ankylosis After Ramus Construction with Free Fibula Flaps in Children with Hemifacial Microsomia","volume":"76","author":"Resnick","year":"2018","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.bjoms.2017.12.001","article-title":"Grafts of autogenous coronoid process to reconstruct the mandibular condyle in children with unilateral ankylosis of the temporomandibular joint: Long-term effects on mandibular growth","volume":"56","author":"Yang","year":"2018","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jobcr.2021.05.006","article-title":"Alloplastic total joint replacement in management of temporomandibular joint ankylosis","volume":"11","author":"Roychoudhury","year":"2021","journal-title":"J. Oral Biol. Craniofac. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.ijom.2024.10.007","article-title":"Extended temporomandibular joint prostheses: A retrospective analysis of feasibility, outcomes, and complications","volume":"54","author":"Gerbino","year":"2025","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/fomm-22-28","article-title":"Management of failed autogenous tissues temporomandibular joint reconstruction: Case series and literature review","volume":"5","author":"Borbon","year":"2023","journal-title":"Front. Oral Maxillofac. Med."},{"key":"ref_26","first-page":"455","article-title":"Alloplastic temporomandibular joint reconstruction","volume":"10","author":"Vincent","year":"1998","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.jcms.2016.01.003","article-title":"One stage treatment of temporomandibular joint complete bony ankylosis using total joint replacement","volume":"44","author":"Gerbino","year":"2016","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/j.joms.2014.02.019","article-title":"Improved outcomes after alloplastic TMJ replacement: Analysis of a multicenter study from Australia and New Zealand","volume":"72","author":"Burgess","year":"2014","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.ijom.2014.05.019","article-title":"A prospective, single-centre study on patient outcomes following temporomandibular joint replacement using a custom-made Biomet TMJ prosthesis","volume":"43","author":"Aagaard","year":"2014","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.joms.2011.09.031","article-title":"Biomet microfixation temporomandibular joint replacement system: A 3-year follow-up study of patients treated during 1995 to 2005","volume":"70","author":"Giannakopoulos","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1016\/j.jcms.2017.07.011","article-title":"Temporomandibular joint reconstruction with stock and custom-made devices: Indications and results of a 14-year experience","volume":"45","author":"Gerbino","year":"2017","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.ijom.2014.10.017","article-title":"A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis","volume":"44","author":"Mounair","year":"2015","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/00006534-198601000-00006","article-title":"Bony ankylosis of the temporomandibular joint: Follow-up of 70 patients treated with arthroplasty and acrylic spacer interposition","volume":"77","author":"Sawhney","year":"1986","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/1477-7525-3-71","article-title":"The visual analogy rating scale of health-related quality of life: An examination of end-digit preferences","volume":"3","author":"Shmueli","year":"2005","journal-title":"Health Qual Life Outcomes"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Alonso-Royo, R., S\u00e1nchez-Torrelo, C.M., Ib\u00e1\u00f1ez-Vera, A.J., Zagalaz-Anula, N., Castellote-Caballero, Y., Obrero-Gait\u00e1n, E., Rodr\u00edguez-Almagro, D., and Lomas-Vega, R. (2021). Validity and Reliability of the Helkimo Clinical Dysfunction Index for the Diagnosis of Temporomandibular Disorders. Diagnostics, 11.","DOI":"10.3390\/diagnostics11030472"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/019459988509300202","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985","journal-title":"Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_37","first-page":"e948365","article-title":"Defining Effect Size Standards in Temporomandibular Joint and Masticatory Muscle Research","volume":"31","author":"Gawda","year":"2025","journal-title":"Med. Sci. Monit."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2810","DOI":"10.1016\/j.joms.2010.05.089","article-title":"Management of the infected temporomandibular joint total joint prosthesis","volume":"68","author":"Wolford","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/0278-2391(90)90529-B","article-title":"A Protocol for Management of Temporomandibular Joint Ankylosis","volume":"48","author":"Kaban","year":"1990","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s12663-018-1150-z","article-title":"Gap Arthroplasty or Interpositional Arthroplasty for the Management of TMJ Ankylosis? A Prospective Randomized Comparative Multicenter Clinical Trial","volume":"18","author":"Bansal","year":"2019","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.bjoms.2022.05.012","article-title":"Autogenous grafts for reconstruction arthroplasty in temporomandibular joint ankylosis: A systematic review and meta-analysis","volume":"60","author":"Mittal","year":"2022","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"218","DOI":"10.5125\/jkaoms.2023.49.4.218","article-title":"Temporomandibular joint re-ankylosis: A case report and literature review","volume":"49","author":"Kalita","year":"2023","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."},{"key":"ref_43","first-page":"245","article-title":"L\u2019ankylose temporo-mandibulaire","volume":"117","author":"Chatellier","year":"2016","journal-title":"Rev. Stomatol. Chir. Maxillo-Faciale Chir. Orale"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.maxilo.2012.02.003","article-title":"The role of custom-made prosthesis for temporomandibular joint replacement","volume":"35","author":"Mercuri","year":"2013","journal-title":"Rev. Esp. Cir. Oral Maxilofac."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.bjoms.2014.01.004","article-title":"Single stage treatment of ankylosis of the temporomandibular joint using patient-specific total joint replacement and virtual surgical planning","volume":"52","author":"Haq","year":"2014","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1016\/j.joms.2013.07.024","article-title":"Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation","volume":"71","author":"Movahed","year":"2013","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1054\/ijom.2002.0350","article-title":"TMJ concepts\/techmedia custom-made TMJ total joint prosthesis: 5-year follow-up study","volume":"32","author":"Wolford","year":"2003","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.bjoms.2013.03.012","article-title":"One-year prospective outcome analysis and complications following total replacement of the temporomandibular joint with the TMJ Concepts system","volume":"51","author":"Sidebottom","year":"2013","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.ijom.2009.01.022","article-title":"Historical development of alloplastic temporomandibular joint replacement after 1945 and state of the art","volume":"38","author":"Driemel","year":"2009","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_50","first-page":"2022","article-title":"Quality of Life After Total Temporomandibular Joint Prothesis Surgery. Quality of life after total temporomandibular joint prothesis surgery. Life After Total Temporo-mandibular Joint Prothesis Surgery","volume":"33","author":"Beret","year":"2022","journal-title":"J. Craniofacial Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.joms.2018.12.027","article-title":"Postoperative Physiotherapy After Open Temporomandibular Joint Surgery: A 3-Step Program","volume":"77","author":"Loos","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13005-024-00416-2","article-title":"The role of physiotherapy interventions in the management of temporomandibular joint ankylosis: A systematic review and meta-analysis: Running title: Physiotherapy in TMJ ankylosis","volume":"20","author":"Saini","year":"2024","journal-title":"Head Face Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/j.bjoms.2021.02.007","article-title":"Strategies to reduce re-ankylosis in temporomandibular joint ankylosis patients","volume":"59","author":"Yadav","year":"2021","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.joms.2020.07.214","article-title":"Outcome of Stock Total Joint Replacement with Fat Grafting in Adult Temporomandibular Joint Ankylosis Patients","volume":"79","author":"Roychoudhury","year":"2021","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/j.joms.2016.01.017","article-title":"Temporomandibular joint ankylosis can be successfully treated with TMJ concepts patient-fitted total joint prosthesis and autogenous fat grafts","volume":"74","author":"Wolford","year":"2016","journal-title":"J. Oral Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4639\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:01:46Z","timestamp":1760032906000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4639"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":55,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134639"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134639","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]}}}