Can the Hydroxyapatite-Coated Skin-Penetrating Abutment for Bone Conduction Hearing Implants Integrate with the Surrounding Skin?

Abstract

IntroductionPercutaneous implants, such as bone conduction hearing implants, suffer from complications that include inflammation of the surrounding skin. A sealed skin–abutment interface can prevent the ingress of bacteria, which should reduce the occurrence of peri-abutment dermatitis. It was hypothesized that a hydroxyapatite (HA)-coated abutment in conjunction with soft tissue preservation surgery should enable integration with the adjacent skin. Previous research has confirmed that integration is never achieved with as-machined titanium abutments. Here, we investigate, in vivo, if skin integration is achievable in patients using a HA-coated abutment.Materials and methodsOne titanium abutment (control) and one HA-coated abutment (case) together with the surrounding skin were surgically retrieved from two patients who had a medical indication for this procedure. Histological sections of the skin were investigated using light microscopy. The abutment was qualitatively analyzed using scanning electron microscopy.ResultsThe titanium abutment only had a partial and thin layer of attached amorphous biological material. The HA-coated abutment was almost fully covered by a pronounced thick layer of organized skin, composed of different interconnected structural layers.ConclusionProof-of-principle evidence that the HA-coated abutment can achieve integration with the surrounding skin was presented for the first time.

The use of CO2 laser in skin complications following BAHA implantation: our experience in the eight patients

“…In the literature, the rate of skin complications varies from 7.1% up to 88%. [1][2][3][4][5] Our results (25.77%) are not different from those published previously.…”

“…Skin reactions are the most common complications after BAHA implantation. In the published series this rate varies from 7.1% up to 88% . In 1988 Holgers et al proposed the 5‐grade classification for skin complications (Figure ) .…”

Clinical Outcomes of Soft Tissue Preservation Surgery With Hydroxyapatite-Coated Abutments Compared to Traditional Percutaneous Bone Conduction Hearing Implant Surgery—A Pragmatic Multi-Center Randomized Controlled Trial

“…Sealing the abutment-skin interface could reduce the impact of bacterial infiltration (29) which thrive in biofilms (30) in niches created between the abutment and surrounding skin. Viable device-tissue adherence ("integration") could provide the immune system access to the abutment surface to control this interface (31,32). Integration does not occur with standard titanium abutments (33) and the use of an abutment surface allowing soft tissue integration was thought necessary for good clinical results.…”

Cytokine expression profile in the bone‐anchored hearing system: 12‐week results from a prospective randomized, controlled study

“…Abutments coated with hydroxyapatite that are believed to integrate with the skin have been introduced. 42 An alternative approach using extra-smooth abutment surfaces is currently being investigated (NCT02304692). Antibiotic-releasing, steroid-releasing and silvercoated abutments might be possible as well.…”