Authors: Ana Prates Soares, Heilwig Fischer, Vincenzo Orassi, Denise Jahn, Sara Checa, Katharina Schmidt-Bleek, Carsten Rendenbach.

In the world of surgery, trust needs to be earned. A new material, no matter how sophisticated or well-researched, will not find its way into the operating theatre unless the surgeon believes in it. Not just in the data, but in the feel of it, the fit of it, the way it responds to bone and blood and healing.

For this reason, the InterLynk project - focused on developing next-generation scaffolds for complex joint defects - has embraced co-creation as a key strategy: involving clinicians and other stakeholders not just at the end, but throughout the development process. Since its conception, InterLynk has brought together a multidisciplinary team of engineers, material scientists, veterinarians, biologists, physicians, and dentists, whose strength lies in their ability to translate needs, constraints, and perspectives across disciplines. After all, the best results in regenerative medicine emerge when science and surgery move forward together.

In addition to a workshop with clinicians and a dedicated survey involving patients, one major co-creation effort focused on understanding surgical practice itself. To that end, researchers from Charité – Universitätsmedizin Berlin, a key InterLynk partner, carried out a dedicated survey among German oral and maxillofacial surgeons. The focus: their views and experiences with temporomandibular joint (TMJ) replacement, the materials they use, and how open they are to new regenerative solutions.

The findings offer valuable insight into how surgical experience, institutional practice, and exposure to research shape clinical choices - and how these choices, in turn, can help guide the design of better biomaterials.

Understanding the Clinical Landscape

The survey ran for one year, beginning in 2022. A total of 37 oral and maxillofacial surgeons responded, all working in German hospitals and/or private clinics. Most respondents were experienced professionals, with more than 12 years of practice in the field.

However, despite their extensive experience, only a minority had ever operated on the temporomandibular joint themselves or knew how many TMJ procedures were performed in their departments each year. In fact, only 16 out of the 30 participants had a general idea of the number of TMJ replacement cases handled annually by their teams. Among those 16, the majority (57.2%) estimated between 0 and 10 cases per year.

Interestingly, more experienced clinicians tended to report more frequent involvement in TMJ cases, suggesting a correlation between years in practice and exposure to these complex procedures.

How Surgeons Choose Regenerative Materials

An important part of the survey explored how surgeons select materials for bone regeneration. Responses showed that choices were influenced by a variety of factors, including:

• Availability in the clinic
• Learned techniques from training courses
• Department or workgroup decisions
• Evidence from research and literature

When the data was broken down by years of practice, clear trends emerged. Research and continued education had a stronger influence on more experienced clinicians, while those earlier in their careers more often followed institutional preferences or team decisions.

These findings are particularly useful for the InterLynk team: understanding how clinicians form their preferences can shape how new materials are introduced and adopted. In other words, clinical integration begins with understanding professional behaviour and context.

Shared Priorities in Tissue Regeneration

The survey also explored how clinicians view the broader goal of developing regenerative solutions for the TMJ - not just for bone, but for surrounding tissues such as muscles, ligaments, and cartilage. Here, most respondents' perspectives aligned strongly with InterLynk’s objectives: they clearly saw the necessity of innovation in this area.

When asked about their openness to new materials for TMJ replacement, 62.1% of the 30 respondents said they would be open to trying new developments. Even more strikingly, 86.2% recognized the importance of regenerating all the tissues involved in TMJ function, rating it as of medium to high importance.

From Skepticism to Adoption: What Drives Confidence

Finally, the survey asked clinicians how they felt about InterLynk’s proposed solution: a multimaterial resorbable osteogenic scaffold designed to support regeneration in TMJ tissues.

Most respondents reacted positively. However, as expected, some of the more experienced surgeons expressed skepticism - a healthy and predictable response when it comes to new technologies that have yet to be validated in clinical settings.

Importantly, the data also showed that more experienced clinicians are strongly influenced by scientific publications and practical training. This insight offers a clear way forward: robust evidence and hands-on experience are key to translating innovation into surgical routines.

Co-Creation in Action

The InterLynk survey demonstrates how collaborative development can shape not just what gets built in the lab, but what stands a real chance of being used in hospitals. By directly engaging the clinicians who will one day work with these materials, the project ensures that its scaffolds are informed by real-world experience.

By aligning research with clinical realities from the start, InterLynk lays a strong foundation for future validation, one that is shaped by those who know the operating room best.