Functional Prosthesis Research Articles

A lightweight prosthetic hand with 19-DOF dexterity and human-level functions

A human hand has 23-degree-of-freedom (DOF) dexterity for managing activities of daily living (ADLs). Current prosthetic hands, primarily driven by motors or pneumatic actuators, fall short in replicating human-level functions, primarily due to limited DOF. Here, we develop a lightweight prosthetic hand that possesses biomimetic 19-DOF dexterity by integrating 38 shape-memory alloy (SMA) actuators to precisely control five fingers and the wrist. The prosthetic hand features real-time sensing of joint angles in each finger, feeding data into a control module for selectively heating or cooling SMA actuators in a closed-loop manner, mimicking the functioning of human muscles. Enabled by the high-power density of SMAs, the hand part (from the wrist to the fingertip) only weighs 0.22 kg, much lower than existing products. We also integrate an onboard power management module that provides electricity for operating the entire system. In addition to 33 standard grasping modes, this prosthetic hand supports 6 advanced grasping modes designed for enhanced dexterity evaluation, expanding the range of achievable ADLs for amputees while facilitating standard prosthesis function tests and validation in real-world scenarios. This innovation offers a significant advancement in prosthetic hand functions, promising improved quality of life for users.

Biomechanical Advances in Total Hip Arthroplasty: From Surgical Approach to Functional Recovery

This technical article discusses biomechanical advancements in total hip arthroplasty (THA), from surgical techniques to functional recovery. Focusing on the evolution of surgical approaches, it highlights the use of robotics and artificial intelligence to enhance implant positioning precision and minimize misalignments. Advanced materials, such as high-density polyethylene, and innovative prosthesis designs were also discussed, emphasizing their contribution to prosthesis durability and functionality. Additionally, perioperative management strategies, including modern analgesic blocks and nutritional support, have improved postoperative recovery, while structured rehabilitation protocols are essential for restoring gait and joint biomechanics. Finally, long-term considerations regarding prosthesis survival and patients' quality of life were explored, reinforcing the importance of a multidisciplinary approach and cutting-edge technologies.

Rehabilitation of Completely Edentulous Patient with Cleft Palate Using Neutral Zone and Palatogram Technique

Cleft lips and palates are congenital anomalies affecting the mouth and face. For fully edentulous patients with a cleft palate, crafting complete dentures is particularly challenging. These dentures, which incorporate an obturator and extend into the palate, must be meticulously designed to address issues related to appearance, speech, swallowing, and chewing. Treatment for cleft lip and palate aims to restore function, speech, and aesthetics through the use of fixed prostheses, removable prostheses, and implants. The approach should follow key principles of oral rehabilitation, including maintaining proper physiology, stability, aesthetics, hygiene, and considering patient expectations. To ensure the durability of prosthetic solutions, it is crucial to respect both the periodontal and dental tissues and the biomechanics of the prosthesis. Palatogram is an effective and straightforward technique for assessing and verifying palatal contours, which helps in addressing speech deficiencies related to affected sounds. Managing completely edentulous adults with cleft palates, particularly those who have not undergone surgical intervention, presents a significant challenge for prosthodontists. This case report explores the use of a conventional complete denture for a cleft palate patient, utilizing the palatogram technique to precisely record the palatal contours, the neutral zone technique to optimize denture stability by aligning forces in harmony with oral musculature, and monoplane teeth to reduce lateral forces and enhance denture stability. Together, these techniques aim to improve speech, mastication, and comfort, providing a functional and aesthetic prosthesis suited to the patient’s unique anatomical needs. This case demonstrates the successful rehabilitation of an edentulous cleft palate patient using a conventional complete denture with specialized techniques to address the unique anatomical and functional challenges presented. The neutral zone technique, monoplane teeth arrangement, and palatogram technique were crucial in achieving a stable, functional, and aesthetically pleasing denture. These methods helped optimize denture retention and stability, improve phonetics, and enhance masticatory efficiency, providing the patient with a significant improvement in quality of life and self-confidence. For patients unable to pursue more invasive and costly implant-supported options, such techniques offer a viable and effective solution for complete denture fabrication, allowing for functional and aesthetic rehabilitation within economical constraints.

Utilizing a Fully Digital Approach for Oral Squamous Cell Carcinoma Treatment and Zygomatic Implant-Based Rehabilitation for Maxillary Defects.

This clinical report details the functional and esthetic rehabilitation of a patient with a severe maxillary defect secondary to subtotal maxillectomy for oral squamous cell carcinoma using a maxillary prosthesis anchored by 4 zygomatic implants. The procedure involved meticulous subtotal maxillectomy and defect repair with zygomatic implant support, incorporating advanced digital surgical methods, including 3D reconstruction, computer-guided surgery, and photogrammetry (Icam4D). A 3D finite element analysis was conducted to assess the method's efficacy in analyzing stress distribution around the zygomatic implants. The patient expressed high satisfaction with the prosthesis's functionality, esthetics, speech, and swallowing capabilities, underscoring the value of zygomatic implant-supported maxillofacial prosthetics. This synergy of advanced planning, surgical precision, and biomechanical analysis marks a significant advancement in maxillofacial prosthetics.

Gait Analysis of Ankle Joints of Indonesians at Low, Medium and High Speeds

Background : Amputation is a loss of body part, and most amputations are lower extremity amputations. The most common is transtibial amputation. After an amputation a person will need a prosthesis. However, up to now there has been no functional prosthesis specifically made for Indonesians who undergo transtibial amputation because the ankle joint gait data that are currently used are European gait data. So it is necessary to measure the normal gait data of Indonesians' ankle joint. The aims of this study was to measure the normal gait data of the ankle joint of Indonesian population Methods : The Research sample is Indonesians aged 18–26 years with normal gait measured by the 2DMA (two-dimensional motion analyzers) at low, medium and high speeds. The resulting data is searched for the mean and standard deviations and then an independent t-test is performed between normal gait data of Indonesians and Europeans Results : Indonesians have a range of maximum dorsiflexion values for low, medium, and high speeds of : 7.9°, 8.3°, 8.9° and maximum plantar flexion for low, medium, and high speeds of 13.4°, 20.6°, 26°. In the comparison test there was a significant difference between the maximum plantar flexion angle of Indonesians and Europeans. Conclusion : Indonesians have a range of maximum dorsiflexion values for low, medium, and high speeds of 7.9°, 8.3°, 8.9° and maximum plantar flexion for low, medium, and high speeds of: 13.4°, 20.6°, 26°. There is a difference between the normal gait of the ankle joint of Indonesians and Europeans.

Healthcare, school and daily life experiences of patients with microphthalmia or anophthalmia and their parents.

This qualitative study explored the lived experiences of the patients with microphthalmia and anophthalmia and their parents, focusing on the healthcare, school settings and daily life challenges to improve patient management. In-depth interviews were conducted in Stockholm, Sweden, from October 2022 to June 2023. Participants were recruited through the St Erik Eye Hospital database (2008-2022), and the data was analysed using reflexive thematic analysis. The study included 15 patients (9 female and 6 male), with a median age of 21 years (range 15-31), and 1 parent per patient. Five key themes were identified from the parental interviews and three from the patient interviews. Both groups emphasised the need for improvements in healthcare, including better physician continuity, emotional support, information provision and prosthesis functionality. Families of those with severe bilateral visual impairment highlighted the need for additional school and daily life support. While some parents had future concerns, most patients viewed their condition as a natural part of life. Patients and parents shared insights on the psychosocial impact and suggested improvements in the healthcare and school settings, providing valuable guidance for enhancing care and management for this patient group.

Design of a Customized Thumb Prosthesis: Focus on Functionality and Comfort

This research focuses on addressing the scarcity of personalized and affordable prostheses in Honduras by designing and developing a functional prosthesis for a thumb. The general objective was to design a model suitable for 3D printing adapted to the specific needs of a patient who had her index and thumb fingers amputated. To achieve this, an integral methodology was employed, ranging from an exhaustive literature review of current solutions to detailed material evaluations, including interviews with patients and medical experts, SolidWorks modeling, and simulations. The result was the successful design of a functional prosthesis prototype, with the selection of intentionally 3D printable materials to ensure comfort and functionality. In conclusion, this research demonstrates the viability of addressing the scarcity of personalized prostheses through innovative approaches and comprehensive design methodologies, with a focus on effectiveness and streamlining the process.

Assocation between trapezium size and failure of total trapeziometacarpal prosthesis. A survival analysis

AimsTo assess the survival function of cementless total trapezium metacarpal prostheses (TTMPs) at 20 years, to compare survival functions by trapezium size, and to evaluate the association between the instantaneous risk of TTMP failure and small trapezium size using a multivariate Cox regression model.MethodsThis observational cohort study included 221 consecutive patients with a mean follow-up after TTMP of 137.3 months (maximum of 246 months). Kaplan-Meier and actuarial life-table methods were used to evaluate the survival function of thecohort. Kaplan-Meier survival curves were compared by trapezium size. Multivariate Cox regression analysis was used to determine the effect of potential confounders on the association between small trapezium and the instantaneous risk of TTMP failure.ResultsAt the end of follow-up, there was a 89.01% chance of the TTMP surviving for 246 months or more. There was an association between TTMP survival time and trapezium size showing a significant trend such that the survival curves weresignificantly higher with larger trapezium size (Mantel-Cox test, p = 0.0001; WilcoxonBreslow test, p = 0.0002; Tarone-Ware test, p = 0.0001).The unadjusted Cox regression model showed a significant association between small trapezium size (smaller than 9 mm) and the instantaneous risk of TTPM failure (HR: 7.37, 95% CI: 2.46-22.07). In the multivariate Cox analysis, “age”, “trapezium morphology”, and “complications” were confounders in the association between small trapezium size and the hazard ratio of prosthetic failure (HR = 3.76; 95% CI 0.96 to 13.82).ConclusionThese results confirm the long-term functional survival of TTMP prostheses and reveal a significant increase in trend of the survival curve with larger trapezium size. Patient age, trapezium morphology, and the presence of post-surgical complications are confounders in the association between small trapezium size and the hazard ratio of TTMP failure.

Adhesion of retinal cells to gold surfaces by biomimetic molecules.

Neural cell-electrode coupling is crucial for effective neural and retinal prostheses. Enhancing this coupling can be achieved through surface modification and geometrical design to increase neuron-electrode proximity. In the current research, we focused on designing and studying various biomolecules as a method to elicit neural cell-electrode adhesion via cell-specific integrin mechanisms. We designed extracellular matrix biomimetic molecules with different head sequences (RGD or YIGSR), structures (linear or cyclic), and spacer lengths (short or long). These molecules, anchored by a thiol (SH) group, were deposited onto gold surfaces at various concentrations. We assessed the modifications using contact angle measurements, fluorescence imaging, and X-ray Photoelectron Spectroscopy (XPS). We then analyzed the adhesion of retinal cells and HEK293 cells to the modified surfaces by measuring cell density, surface area, and focal adhesion spots, and examined changes in adhesion-related gene and integrin expression. Results showed that YIGSR biomolecules significantly enhanced retinal cell adhesion, regardless of spacer length. For HEK293 cells, RGD biomolecules were more effective, especially with cyclic RGD and long spacers. Both cell types showed increased expression of specific adhesion integrins and proteins like vinculin and PTK2; these results were in agreement with the adhesion studies, confirming the cell-specific interactions with modified surfaces. This study highlights the importance of tailored biomolecules for improving neural cell adhesion to electrodes. By customizing biomolecules to foster specific and effective interactions with adhesion integrins, our study provides valuable insights for enhancing the integration and functionality of retinal prostheses and other neural implants.

Replacing Missing Teeth with Screw-Cement Retained Implant Supported Fixed Partial Denture: A Case Report

An accurate impression with proper interocclusal relationship are the two essential criteria used for the best fit and functionality of the final prosthesis when replacing a partly edentulous arch with an implant-supported fixed partial denture. A detailed process about the open tray impression technique and registering the interocclusal relationship for implant- supported partial denture has been described in this case report.

Outcomes of Birmingham Hip Resurfacing Based on Clinical Aspects and Retrieval Analysis of Failed Prosthesis.

This research aims to identify the prevalence of failure for Birmingham Hip Prosthesis (BHR) in total hip arthroplasty and to analyze its reasons from biomaterials and biofunctional perspectives. We present our current analysis and tests on a series of different BHR-retrieved prostheses after premature failure. Relevant clinical data, such as X-ray investigations and intraoperative images for clinical case studies, were analyzed to better understand all factors involved in BHR prosthesis failure. A detailed analysis of the failures highlighted uneven cement distribution, overloading in certain areas, and void formation in the material. A closer investigation using microscopical techniques revealed the presence of a crack originating from the gap between the cement mantle and human bone. Additionally, scanning electron microscopy analyses were conducted as part of the investigation to examine bone cement morphology in detail and better understand the interactions at the interfaces between implant, cement, and bone. In conclusion, this research emphasizes the importance of surgical technique planning and the cementation procedure in the success rate of BHR prostheses. It also underscores the need to carefully evaluate patient characteristics and bone quality to minimize the risk of BHR prosthesis failure. The cementation procedure seems to be essential for the long-term functionality of the BHR prosthesis.

Optimizing Sensor Placement and Machine Learning Techniques for Accurate Hand Gesture Classification

Millions of individuals are living with upper extremity amputations, making them potential beneficiaries of hand and arm prostheses. While myoelectric prostheses have evolved to meet amputees’ needs, challenges remain related to their control. This research leverages surface electromyography sensors and machine learning techniques to classify five fundamental hand gestures. By utilizing features extracted from electromyography data, we employed a nonlinear, multiple-kernel learning-based support vector machine classifier for gesture recognition. Our dataset encompassed eight young nondisabled participants. Additionally, our study conducted a comparative analysis of five distinct sensor placement configurations. These configurations capture electromyography data associated with index finger and thumb movements, as well as index finger and ring finger movements. We also compared four different classifiers to determine the most capable one to classify hand gestures. The dual-sensor setup strategically placed to capture thumb and index finger movements was the most effective—this dual-sensor setup achieved 90% accuracy for classifying all five gestures using the support vector machine classifier. Furthermore, the application of multiple-kernel learning within the support vector machine classifier showcases its efficacy, achieving the highest classification accuracy amongst all classifiers. This study showcased the potential of surface electromyography sensors and machine learning in enhancing the control and functionality of myoelectric prostheses for individuals with upper extremity amputations.

Functional Restoration of Bilateral Wrist Level Hand Amputee with Six-Toe Transfers and Three Free Flaps: An Alternative to Hand Allotransplantation or Prosthesis.

Introduction Hand amputation at the wrist level is severely disabling, especially when bilateral. It is paramount to restore the hand function to the best possible level for the patient's daily living activities, as well as optimal social and occupational rehabilitation. There are various options for restoration of function after amputation at wrist and distal forearm levels including Krukenberg's operation, variations of toe transfers, hand allotransplantation, and prosthesis. Krukenberg's procedure and the reconstruction using toe transfer like Vilkki's procedure or two-toe transfers, restore only the pinch. Hand allotransplantation, although it gives excellent function, has limitations due to the complications of immunosuppression. Functional hand prosthesis, though superior in cosmetic appearance, have again limitations in function, and the cost is prohibitive for most patients in our country. Materials and Methods We present the unique case of a bilateral hand amputation at the wrist level reconstructed with three toes and free anterolateral thigh (ALT) flap in a single-stage surgery for each hand. In two stages, the patient had six toes transferred to both hands. Result All transferred toes and all three free (two ALT and one thoracodorsal artery perforator) flaps survived completely. Three-finger grip (tripod pinch) was thus restored in each hand. The hook grip was also restored well by the reconstructed two fingers. Within 3 months after surgery, the patient could perform all activities of daily living. He resumed his original job with some modification of his work within 6 months postinjury. Conclusion Hand reconstruction using three toes and a free flap is an excellent option for functional restoration for amputation at the wrist and distal forearm level. It allows an early return to function and good social and professional integration of the patient. This procedure is a potential alternative to expensive prosthesis and allotransplantation for a bilateral hand amputation.

One-stage prosthodontically driven jaw reconstruction in patients with benign and malignant pathologies: A 7- to 11-year cohort study.

One stage functional jaw reconstructionis defined as the resection and reconstruction of segmental defects in conjunction with the placement of dental implants in an ideal prosthetic position and loaded with a provisional restoration, during one surgical procedure. The aim of the study is to describe clinical outcomes of patients who underwent one stage functional jaw reconstruction. Patients who underwent one-stage functional jaw reconstruction, from January 2013 to March 2016 were recalled in 2022 and 2023. Planning and execution for the reconstruction utilized either analogue or digital techniques. Outcome parameters recorded were treatment-related outcomes at patient level, implant-related outcomes and patient-reported outcome measures. Eighteen patients underwent one-stage jaw reconstruction with a total of 57 implants. Four patients had maxillary and 14 had mandibular reconstructions. Ten patients underwent postoperative radiotherapy. Ten patients were planned using analogue and eight by digital planning. Three patients had partial flap necrosis, three patients had plate fractures, implant loss was seen in one patient and four patients died during the period. A functional prosthesis was provided in 16 out of the 18 patients. One-stage functional jaw reconstruction is a predictable method for providing rehabilitation with successful outcomes at 7-11 years. However, caution should be exercised when the treatment modality is carried out in patients with malignant pathologies who have undergone radiotherapy.

Evaluation of ozonated olive oil in the success of immediate dental implants placed into infected sockets

Abstract Purpose This prospective study was conducted to assess the clinical and radiographic influences of topical application of ozonated olive oil on immediate implants inserted into infected fresh extraction sockets. Patients and methods This study was implemented on 14 cases with infected nonrestorable teeth or remaining roots. All cases underwent two-stage implant surgery, stage I: extraction of the tooth, application of ozonated olive oil gel into the infected postextraction socket, and immediate insertion of dental implant fixture, and stage II: 4 months after stage I surgery, the abutment was installed onto the implant fixture. After soft tissue healing around the abutment, the implant was loaded with the final functional prosthesis. All the patients had regular follow-up intervals throughout the study period to evaluate soft tissue and bone healing and implant stability. Results Fourteen patients enrolled in this study, of which there were six (42.9%) males and eight (57.1%) females. The age of the patients ranged between 21 and 45 years with a mean of 33.21 ± 9.16 years. The clinical outcomes including visual analog scale, soft tissue dehiscence, infection, implant stability quotient, gingival index, and peri-implant probing depth all indicated uneventful postoperative healing and 100% survival rate of the implants throughout the follow-up intervals. Radiographic outcome included interpreting cone beam computed tomography measurement of alveolar bone height which showed marked significant positive difference between stage I and stage II surgeries indicating a potential enhancing effect of ozonated olive oil on osseointegration and tissue healing. Conclusion Based on the outcomes of this study, we concluded that topical administration of ozonated olive oil might potentially enhance healing and osseointegration of implants immediately inserted into infected fresh extraction sockets and could exhibit a significant influence on increasing the success rate and minimizing complications. However, further investigation employing a control group, larger sample size, and longer follow-up duration is required to confirm this influence.

Способ улучшения фиксации полных съёмных протезов на беззубой верхней челюсти при помощи последовательно-замкнутых клапанных зон

There has been an increase in the ratio of elderly and senile people to the general population who need prosthetics. At the same time, complete teeth loss leads to various anatomical-topographical changes in the denture bed in the elder age group. Meanwhile, there are insufficient researches aimed at improving the fixation and stabilization of complete removable dentures, which determined the direction of our study. The aim of this research was to increase the degree of retention of complete removable dentures by creating additional valve zones, taking into account the individual anatomical-topographical variability of the denture bed structure of the maxilla. Material and Methods. Prosthetics of 115 people aged from 60 to 93 years old with complete teeth loss on the upper jaw was carried out. Prosthetics were performed by the method of determining the locations of individual valve zones in the area of the pliable mucous membrane of the denture bed on the edentulous upper jaw, including the use of a digital model of the denture bed obtained by cone-beam computed tomography (CBCT) with the use of a contrast agent and subsequent analysis in 3D graphics editors. Results. Additional retention elements were determined with the individual anatomical-topographical variability of the location of the malleability zones, places of exit of the neurovascular bundles and places with dense mucosa on the upper jaw to improve the retention of the prosthetic structure. At the same time, the obtained results characterize the increase in the efficiency of functional retention of complete removable prostheses due to the creation of consecutive concentrically closed valve zones, which create negative pressure zones medial to the borders of the prosthetic bed. Discussion. The developed method provides conditions for increasing the efficiency of retention and functionality of complete removable plate prostheses on the upper jaw due to accurate determination of individual anatomical-topographical features of the prosthetic bed, thickness of the mucous membrane, places of exit of neurovascular bundles, torus and exostoses. The probability of vascular compression with microcirculation disturbance and traumatization of soft tissues adjacent to the prosthetic structure was significantly reduced. The method minimizes alternating loads in the area of torus and exostoses in the area of maxillary tubercles, which significantly reduces the probability of fracture of the base of a full removable plate prosthesis. Conclusion. Our method in case of depressurization of external valve zones increases the degree of retention and stabilization of complete removable orthopedic constructions on the upper jaw during the operation. At the same time, retention is provided by additional internal valve zones located in places where there is sufficient pliability and there are no neurovascular bundles and exostoses. Keywords: upper jaw, anatomy and topography, complete teeth loss, denture bed, full removable plate prosthesis, retention, prosthetic efficiency.

A Photographic Approach Studying the Orientation of the occlusal plane of the Malaysian Population. A Proposal for an Orienting Device

The occlusal plane is crucial in prosthodontic reconstructive treatment as it affects the most important factors for the proper functioning of the artificial prostheses. The achievement of correct occlusal plane position offers maximum aesthetic, phonetic, mastication, and patient’s satisfaction. An incorrectly oriented occlusal plane interferes with denture stability and retention, in addition to more vital functions of the teeth and oral cavity. This study used a photographic approach to determine the occlusal plane inclination in relation to some anatomical references. 95 young volunteers of Mahsa University College, aged between 20 and 25 years, were selected for this study. The participants were selected according to specific inclusion criteria. A standardized digital profile and front images were taken for each participant using a digital camera that is fixed on a tripod with the fox bite plane placed on the occlusal surfaces of the maxillary teeth. The angle amplitude of the reference planes in relation to the occlusal plane was measured using a digital protractor on the screen display. The results revealed that the least mean angle difference was with the AT1, while higher variability was found using the Frankfort plane. In addition, there were no significant differences between the two genders or among the three ethnic groups. It is concluded that the photographic method can be used successfully to study the occlusal plane, and the lowest point of the tragus is the best posterior reference point to determine the ideal location of the occlusal plane.

The Gritti-Stokes Amputation: Is It Still a Reliable Technique in the 21st Century? A Narrative Review.

Lower limb amputation is a common surgical procedure performed worldwide. Many individuals require amputation due to various circumstances, with amputations occurring above or below the knee. Surgeons rely on published research to determine the most appropriate technique based on intraoperative and postoperative outcomes. The Gritti-Stokes amputation (GSA) procedure, introduced in 1857, has shown positive results in terms of primary wound healing, reduced mortality rates during and after surgery, and accelerated healing and mobility. However, due to the need for highly trained surgeons and limitations in functional and cosmetic prosthesis fitting, concerns have been raised regarding its utility. Additionally, the procedure is underutilized in cases where it could potentially yield better results. This article provides a comprehensive review of the documented benefits of GSA, suitable candidate selection, limitations, various modifications, and a comparison with traditional approaches to lower limb amputation. The review is focused on evidence published in the last 100 years.

Intuitive control of additional prosthetic joints via electro-neuromuscular constructs improves functional and disability outcomes during home use—a case study

Objective. The advent of surgical reconstruction techniques has enabled the recreation of myoelectric controls sites that were previously lost due to amputation. This advancement is particularly beneficial for individuals with higher-level arm amputations, who were previously constrained to using a single degree of freedom (DoF) myoelectric prostheses due to the limited number of available muscles from which control signals could be extracted. In this study, we explore the use of surgically created electro-neuromuscular constructs to intuitively control multiple bionic joints during daily life with a participant who was implanted with a neuromusculoskeletal prosthetic interface. Approach. We sequentially increased the number of controlled joints, starting at a single DoF allowing to open and close the hand, subsequently adding control of the wrist (2 DoF) and elbow (3 DoF). Main results. We found that the surgically created electro-neuromuscular constructs allow for intuitive simultaneous and proportional control of up to three degrees of freedom using direct control. Extended home-use and the additional bionic joints resulted in improved prosthesis functionality and disability outcomes. Significance. Our findings indicate that electro-neuromuscular constructs can aid in restoring lost functionality and thereby support a person who lost their arm in daily-life tasks.

Transcatheter Aortic Valve Implantation for Severe Chronic Aortic Regurgitation.

Transcatheter aortic valve implantation (TAVI) has revolutionised the management of aortic valve disease, offering a less invasive alternative to traditional surgical valve replacement for severe aortic stenosis (AS). TAVI for pure aortic regurgitation (AR) is less well established, and, in fact, it was previously labelled as a relative contraindication. However, TAVI has been utilised for selected cases of pure or predominant AR. The primary limitations regarding the use of TAVI in AR are related to the absence of anatomical factors seen in patients with AS that have contributed to the safe and stable functioning of current-generation prostheses. These include aortic root dilatation, mobile valve leaflets and labile blood pressure within the aortic root, which may further increase the risk of valve migration and periprosthetic leak after deployment. Furthermore, patients with AR have more heterogeneous aortic root anatomies when compared to the population of patients with calcific or degenerative AS. This review article describes the current evidence for the off-label use of TAVI in pure AR and the various clinical syndromes associated with AR where there may be specific challenges in the application of TAVI.