{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:12:21Z","timestamp":1791972741750,"version":"4.3.4"},"reference-count":69,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Materials"],"abstract":"<jats:p>Stapedotomy is performed to restore ossicular chain sound transmission by inserting a piston prosthesis that couples the long process of the incus to the oval window, thereby addressing conductive hearing loss associated with otosclerosis. This study investigates the effects of crimping force, prosthesis material, and loop geometry on incus to optimize fixation while minimizing complications such as incudal necrosis. Finite element analyses were performed to quantify interface pressures and von Mises stresses for titanium prostheses with loop-band widths of 0.2, 0.3, and 0.5 mm under crimping forces of 300\u2013500 mN and for polytetrafluoroethylene (PTFE) prostheses with loop outer diameters (OD) of 1.2, 1.4, and 1.8 mm. The analysis results showed that PTFE prostheses generated significantly lower interface pressures and stress compared to titanium. For PTFE prostheses, the equivalent von Mises stresses remained well below the critical threshold, with values ranging from 3.5 MPa up to peaks of approximately 43 MPa depending on the loop\u2019s outer diameter. In contrast, titanium prostheses exhibited a marked dependency on crimping force and band width. At a force of 300 mN, stresses were modest (approximately 16\u201324 MPa). However, when increasing the force to 400 mN, stresses approached the critical threshold (up to approximately 53 MPa). With crimping forces of 500 mN, especially with band widths greater than 0.3 mm, stresses exceeded the cortical bone strength threshold (approximately 61\u201364 MPa), indicating an increased risk of mechanical overload and potential incudal necrosis. These findings highlight the importance, in a clinical context, of controlling the crimping force and selecting the material and geometry of the prosthesis to achieve secure coupling while preserving the incus\u2019s structural integrity.<\/jats:p>","DOI":"10.3390\/ma19010065","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:22:27Z","timestamp":1766578947000},"page":"65","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["FEA Simulation of Crimping Pressure Distribution in Titanium and Teflon Stapedotomy Prostheses"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2002-9938","authenticated-orcid":false,"given":"Mario","family":"Ceddia","sequence":"first","affiliation":[{"name":"Department of Mechanics, Mathematics and Management, Polytechnic of Bari, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6214-2336","authenticated-orcid":false,"given":"Nicola","family":"Quaranta","sequence":"additional","affiliation":[{"name":"Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4012-9637","authenticated-orcid":false,"given":"Vito","family":"Pontillo","sequence":"additional","affiliation":[{"name":"UOC Otolaryngology, University AOUC Policlinico di Bari, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5958-8086","authenticated-orcid":false,"given":"Alessandra","family":"Murri","sequence":"additional","affiliation":[{"name":"UOC Otolaryngology, University AOUC Policlinico di Bari, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4236-4539","authenticated-orcid":false,"given":"Alessandra","family":"Pantaleo","sequence":"additional","affiliation":[{"name":"Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5759-0692","authenticated-orcid":false,"given":"Bartolomeo","family":"Trentadue","sequence":"additional","affiliation":[{"name":"Department of Mechanics, Mathematics and Management, Polytechnic of Bari, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.otot.2024.01.001","article-title":"Contemporary Mechanics of Conductive Hearing Loss","volume":"35","author":"Remenschneider","year":"2024","journal-title":"Oper. Tech. Otolaryngol.-Head Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.heares.2012.11.015","article-title":"Sound transmission along the ossicular chain in common wild-type laboratory mice","volume":"301","author":"Dong","year":"2013","journal-title":"Hear. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1121\/1.401306","article-title":"The effects of external- and middle-ear filtering on auditory threshold and noise-induced hearing loss","volume":"90","author":"Rosowski","year":"1991","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Puria, S. (2013). The Middle Ear: Science and Applications. The Middle Ear: Science, Otosurgery, and Technology, Springer.","DOI":"10.1007\/978-1-4614-6591-1"},{"key":"ref_5","first-page":"48","article-title":"Is the Carhart notch a predictive factor of hearing results after stapedectomy?","volume":"12","author":"Schmerber","year":"2022","journal-title":"J. Hear. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1001\/archoto.2011.14","article-title":"Carhart notch 2-kHz bone conduction threshold dip: A nondefinitive predictor of stapes fixation in conductive hearing loss with normal tympanic membrane","volume":"137","author":"Kashio","year":"2011","journal-title":"Arch. Otolaryngol.-Head Neck Surg."},{"key":"ref_7","first-page":"e939255","article-title":"Retrospective Study of 157 Patients with Otosclerosis to Evaluate Association Between Carhart Notch on the Preoperative Bone-Conduction Audiogram and Postoperative Hearing and Balance Evaluated by the Vestibular Disorders Activities of Daily Living Scale","volume":"29","author":"Job","year":"2023","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Necula, V., Maniu, A.A., Ujv\u00e1ry, L.P., Dindelegan, M.G., T\u0103nase, M., T\u0103nase, M., and Blebea, C.M. (2023). Vertigo associated with otosclerosis and stapes surgery\u2014A narrative review. Medicina, 59.","DOI":"10.3390\/medicina59081485"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"36","DOI":"10.5001\/omj.2013.08","article-title":"Outcome of management of otosclerosis by stapedotomy compared to stapedectomy in a jordanian population","volume":"28","year":"2013","journal-title":"Oman Med. J."},{"key":"ref_10","first-page":"001","article-title":"Stapedotomy or stapedectomy: Does it really matter?","volume":"29","author":"Teixeira","year":"2025","journal-title":"Int. Arch. Otorhinolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3353","DOI":"10.1007\/s12070-024-04687-8","article-title":"Comparison of Bone Cement Fixation for Stapes Prostheses with Different Materials in Endoscopic Primary Stapedectomy","volume":"76","author":"Hamead","year":"2024","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_12","first-page":"e89692","article-title":"Impact of Fenestration Size and Prosthesis Diameter on Hearing Outcomes After Stapedotomy: A Review","volume":"17","author":"Shrikrishna","year":"2025","journal-title":"Cureus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/MAO.0b013e318216795b","article-title":"The influence of prosthesis diameter in stapes surgery: A meta-analysis and systematic review of the literature","volume":"32","author":"Laske","year":"2011","journal-title":"Otol. Neurotol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2931","DOI":"10.1007\/s00405-023-08407-w","article-title":"The effect of piston diameter in primary stapes surgery on surgical success","volume":"281","author":"Blijleven","year":"2024","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1159\/000101329","article-title":"Hearing results after stapedotomy: Role of the prosthesis diameter","volume":"12","author":"Marchese","year":"2007","journal-title":"Audiol. Neuro-Otol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.otorri.2020.06.004","article-title":"Primary stapedotomy: Influence of prosthesis diameter on hearing outcome","volume":"72","author":"Salvador","year":"2021","journal-title":"Acta Otorrinolaringol. Esp."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1288\/00005537-198101000-00007","article-title":"Revision stapedectomy: A review of 258 cases","volume":"91","author":"Sheehy","year":"1981","journal-title":"Laryngoscope"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1017\/S0022215120002595","article-title":"Hearing results after stapedotomy for otosclerosis: Comparison of prosthesis variables","volume":"135","author":"Odat","year":"2021","journal-title":"J. Laryngol. Otol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/01.mlg.0000154727.85539.76","article-title":"Stapedectomy outcomes: Titanium versus Teflon wire prosthesis","volume":"115","author":"Massey","year":"2005","journal-title":"Laryngoscope"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"234","DOI":"10.5152\/iao.2020.5129","article-title":"Comparison between fluoroplastic and platinum\/titanium piston in stapedotomy: A prospective randomized clinical study","volume":"16","author":"Faramarzi","year":"2020","journal-title":"J. Int. Adv. Otol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"s40463-023","DOI":"10.1186\/s40463-023-00654-5","article-title":"Comparison of dislocation rates of Teflon and Titanium stapes prostheses: A retrospective survival analysis on 855 patients","volume":"52","author":"Gargula","year":"2023","journal-title":"J. Otolaryngol.-Head Neck Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1001\/archotol.133.8.758","article-title":"Hearing results after stapedotomy with a Nitinol piston prosthesis","volume":"133","author":"Brown","year":"2007","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"63","DOI":"10.5312\/wjo.v10.i2.63","article-title":"Allergy in total knee replacement surgery: Is it a real problem?","volume":"10","author":"Saccomanno","year":"2019","journal-title":"World J Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.otohns.2008.03.018","article-title":"Laser-assisted stapedotomy with a Nitinol heat-crimping prosthesis: Outcomes compared with a platinum-fluoroplastic prosthesis","volume":"139","author":"Pudel","year":"2008","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/00129492-200205000-00009","article-title":"Causes of conductive hearing loss after stapedectomy or stapedotomy: A prospective study of 279 consecutive surgical revisions","volume":"23","author":"Lesinski","year":"2002","journal-title":"Otol. Neurotol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1097\/00005537-200305000-00015","article-title":"Stapes prosthesis attachment: The effect of crimping on sound transfer in otosclerosis surgery","volume":"113","author":"Huber","year":"2003","journal-title":"Laryngoscope"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e025","DOI":"10.1097\/ONO.0000000000000025","article-title":"Rates of sensorineural hearing loss and revision surgery after stapedotomy: A single-institution experience using the nitinol prosthesis","volume":"2","author":"Quimby","year":"2022","journal-title":"Otol. Neurotol. Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1111\/joa.13457","article-title":"Micro-CT of the human ossicular chain: Statistical shape modeling and implications for otologic surgery","volume":"239","author":"Bartling","year":"2021","journal-title":"J. Anat."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1002\/lary.20166","article-title":"Necrosis of the long process of the incus following stapes surgery: New anatomical observations","volume":"119","author":"Gerlinger","year":"2009","journal-title":"Laryngoscope"},{"key":"ref_30","first-page":"23","article-title":"Comparison of fluoroplastic Causse loop piston and titanium Soft-CliP in stapedotomy","volume":"29","author":"Faramarzi","year":"2017","journal-title":"Iran J. Otorhinolaryngol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/j.1749-4486.2008.01756.x","article-title":"KTP-laser stapedotomy with a self-crimping, thermal shape memory Nitinol SMart piston: 1-year follow-up results","volume":"33","author":"Gerlinger","year":"2008","journal-title":"Clin. Otolaryngol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Gherasie, L.-M., Zainea, V., Hainarosie, R., Rusescu, A., Ionita, I.-G., Alius, R.-O., and Voiosu, C. (2025). Stapes Prostheses in Otosclerosis Surgery: Materials, Design Innovations, and Future Perspectives. Actuators, 14.","DOI":"10.3390\/act14100502"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"14","DOI":"10.21037\/ajo-20-83","article-title":"Outcomes in revision stapes surgery: Ionomeric bone cement vs. malleostapedotomy in incus necrosis","volume":"4","author":"McOwan","year":"2021","journal-title":"Aust. J. Otolaryngol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.14639\/0392-100X-suppl.1_3-45-2025-A1336","article-title":"Update on stapes surgery","volume":"45","author":"Bruschini","year":"2025","journal-title":"ACTA Otorhinolaryngol. Ital."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/0194599818815144","article-title":"Applied Force during Piston Prosthesis Placement in a 3D-Printed Model: Freehand vs Robot-Assisted Techniques","volume":"160","author":"Razavi","year":"2019","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.actbio.2023.01.048","article-title":"Numerical model characterization of the sound transmission mechanism in the tympanic membrane from a high-speed digital holographic experiment in transient regime","volume":"159","author":"Furlong","year":"2023","journal-title":"Acta Biomater."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hirabayashi, M., Kurihara, S., Ito, R., Kurashina, Y., Motegi, M., Okano, H.J., Yamamoto, Y., Kojima, H., and Asakura, T. (2022). Combined analysis of finite element model and audiometry provides insights into the pathogenesis of conductive hearing loss. Front. Bioeng. Biotechnol., 10.","DOI":"10.3389\/fbioe.2022.967475"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s10439-020-02612-y","article-title":"3D Finite element modeling of blast wave transmission from the external ear to cochlea","volume":"49","author":"Brown","year":"2021","journal-title":"Ann. Biomed. Eng."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1007\/s10439-023-03200-6","article-title":"3D finite element model of human ear with 3-chamber spiral cochlea for blast wave transmission from the ear canal to cochlea","volume":"51","author":"Bradshaw","year":"2023","journal-title":"Ann. Biomed. Eng."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Ceddia, M., Quaranta, N., Pontillo, V., Murri, A., Pantaleo, A., and Trentadue, B. (2025). Effect of Middle Ear Prosthesis Diameter in Platinotomy and Partial Platinectomy on Hearing Gain: A Finite Element Study. Materials, 18.","DOI":"10.3390\/ma18133002"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ceddia, M., Romasco, T., De Bortoli, N., Mello, B.F., Piattelli, A., Mijiritsky, E., Di Pietro, N., and Trentadue, B. (2024). Biomechanical Finite Element Analysis of Two Types of Short-Angled Implants Across Various Bone Classifications. Materials, 17.","DOI":"10.2139\/ssrn.4876911"},{"key":"ref_42","first-page":"469","article-title":"Stapes surgery: The diameter of the long process of the incus","volume":"27","author":"Kwok","year":"2006","journal-title":"Otol. Neurotol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1243\/09544119JEIM783","article-title":"The influence of the mechanical behaviour of the middle ear ligaments: A finite element analysis","volume":"225","author":"Gentil","year":"2011","journal-title":"Proc. Inst. Mech. Engineers. Part H J. Eng. Med."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Liang, J., Wang, J., Yao, W., and Wang, M. (2023). Development of an Assessment Model for the Effect of the Replacement of Minimal Artificial Ossicles on Hearing in the Inner Ear. Micromachines, 14.","DOI":"10.3390\/mi14020483"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2495\/SECM130061","article-title":"Three-dimensional finite element analysis of the human middle ear and an application for clinics for tympanoplasty","volume":"78","author":"Higashimachi","year":"2013","journal-title":"WIT Trans. Eng. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1121\/1.1451073","article-title":"Modeling of the human middle ear using the finite-element method","volume":"111","author":"Koike","year":"2002","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Ceddia, M., Solarino, G., Cassano, G.D., and Trentadue, B. (2023). Finite Element Study on Stability in the Femoral Neck and Head Connection to Varying Geometric Parameters with the Relates Implications on the Effect of Wear. J. Compos. Sci., 7.","DOI":"10.20944\/preprints202307.0806.v1"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1021\/bm034513k","article-title":"Biomedical application of commercial polymers and novel polyisobutylene-based thermoplastic elastomers for soft tissue replacement","volume":"5","author":"Puskas","year":"2004","journal-title":"Biomacromolecules"},{"key":"ref_49","first-page":"1","article-title":"Duality between azimuthal shear and radial loading of a hollow circular cylinder and related problems","volume":"28","author":"Lubarda","year":"2025","journal-title":"Proc. Monten. Acad. Sci"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1177\/10812865241249750","article-title":"A simple method for mechanical analysis of pressurized functionally graded material thick-walled cylinder","volume":"29","author":"Liu","year":"2024","journal-title":"Math. Mech. Solids"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"109586","DOI":"10.1016\/j.triboint.2024.109586","article-title":"Tribological properties of titanium alloy with micro-nano multiscale texturing against bone under simulated implant contact conditions","volume":"194","author":"Zhang","year":"2024","journal-title":"Tribol. Int."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/(SICI)1097-4636(19970605)35:3<329::AID-JBM7>3.0.CO;2-J","article-title":"Friction properties at the bone-metal interface: Comparison of four different porous metal surfaces","volume":"35","author":"Dammak","year":"1997","journal-title":"J. Biomed. Mater. Res. Off. J. Soc. Biomater. Jpn. Soc. Biomater."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"104564","DOI":"10.1016\/j.jmbbm.2021.104564","article-title":"Understanding wear behavior of 3D-Printed calcium phosphate-reinforced CoCrMo in biologically relevant media","volume":"120","author":"Sahasrabudhe","year":"2021","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1080\/10402004.2024.2384516","article-title":"Behavior of the Coefficient of Friction of Textured Tibial Inserts of Total Knee Replacements under the Conditions Prescribed by ISO 14243-3: 2014","volume":"67","year":"2024","journal-title":"Tribol. Trans."},{"key":"ref_55","first-page":"1081","article-title":"Bone\u2019s mechanostat: A 2003 update","volume":"275","author":"Frost","year":"2003","journal-title":"Anat. Rec. Adv. Integr. Anat. Evol. Biol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1097\/00005537-200211000-00025","article-title":"Stapedectomy versus stapedotomy: Comparison of results with long-term follow-up","volume":"112","author":"House","year":"2002","journal-title":"Laryngoscope"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1177\/000348940111001003","article-title":"Short- and long-term results of stapedotomy and stapedectomy with a teflon-wire piston prosthesis","volume":"110","author":"Kos","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1097\/00005537-200208000-00003","article-title":"Long-term results of small fenestra stapedectomy compared with large fenestra technique","volume":"112","author":"Esquivel","year":"2001","journal-title":"Laryngoscope"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.otohns.2005.03.011","article-title":"Air and bone conduction change after stapedotomy and partial stapedectomy for otosclerosis","volume":"133","author":"Quaranta","year":"2005","journal-title":"Otolaryngol.-Head Neck Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s40136-021-00379-x","article-title":"Revision stapes surgery","volume":"10","author":"Sakano","year":"2022","journal-title":"Curr. Otorhinolaryngol. Rep."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1017\/S0022215100064653","article-title":"The blood supply of the long process of the incus and the head and neck of stapes","volume":"79","author":"Alberti","year":"1965","journal-title":"J. Laryngol. Otol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/00129492-200205000-00010","article-title":"Stapes surgery: How precisely do different prostheses attach to the long process of the incus with different instruments and different surgeons?","volume":"23","author":"Kwok","year":"2002","journal-title":"Otol. Neurotol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1017\/S0022215122002316","article-title":"Impact of manual crimping on stapedotomy outcomes","volume":"137","author":"Couvreur","year":"2023","journal-title":"J. Laryngol. Otol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/MAO.0b013e3180340a1d","article-title":"Comparison of hearing results of nitinol SMART stapes piston prosthesis with conventional piston prostheses: Postoperative results of nitinol stapes prosthesis","volume":"28","author":"Harris","year":"2007","journal-title":"Otol. Neurotol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Achena, A., Pacelli, L., Prizio, C., Mantini, G., Placentino, A., Accorona, R., Valenzise, V., Pilolli, F., Ormellese, G.L., and Mevio, N. (2025). Nitinol Prosthesis in Stapes Surgery: Evolution from Heat-Activated to Superelastic Nitinol: A Systematic Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041069"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/01.mao.0000178132.89353.54","article-title":"First experience with a new stapes clip piston in stapedotomy","volume":"26","author":"Grolman","year":"2005","journal-title":"Otol. Neurotol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"101303","DOI":"10.1016\/j.bjorl.2023.101303","article-title":"Brazilian Society of Otology task force-Otosclerosis: Evaluation and treatment","volume":"89","author":"Silva","year":"2023","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/MAO.0b013e318259b34b","article-title":"Experimental study on admissible forces at the incudomalleolar joint","volume":"33","author":"Lauxmann","year":"2012","journal-title":"Otol. Neurotol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1007\/s00405-017-4572-1","article-title":"Modifications to a 3D-printed temporal bone model for augmented stapes fixation surgery teaching","volume":"274","author":"Nguyen","year":"2017","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."}],"container-title":["Materials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1996-1944\/19\/1\/65\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T05:24:17Z","timestamp":1766640257000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1996-1944\/19\/1\/65"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":69,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["ma19010065"],"URL":"https:\/\/doi.org\/10.3390\/ma19010065","relation":{},"ISSN":["1996-1944"],"issn-type":[{"value":"1996-1944","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]}}}