Abstract
Bone conduction hearing implants can rehabilitate some types of hearing loss. A hydroxyapatite (HA)-coated skin-penetrating abutment was developed to allow for soft tissue preservation and increased skin-abutment adherence. Inflammation is thought to relate to bacterial infection of pockets around the abutment. Upon integration, the host’s ability to cover the abutment surface (“race for the surface”), and thus control and prevent competitive bacteria from colonizing it, is improved. However, the attachment mechanisms behind it are not clear. In this study, we applied two-photon microscopy to visualize tissue attachment on abutments retrieved from patients. Skin integration markers were validated and applied to four HA-coated abutments. Evidence of skin integration was found, including the presence of hemidesmosomes, a basement membrane, dermal collagen and vascularization. Cases with clinical signs of severe inflammation and evident biofilm formation showed limited skin integration based on these indicators, confirming the applicability of the “race for the surface” model.
Highlights
Percutaneous implants are associated with frequent inflammation throughout all branches of medicine [1,2]
The implant system consists of a screw-shaped intraosseous implant that integrates with the skull bone and an abutment that permanently penetrates the skin and attaches to an external sound processor
Abutments were retrieved from five patients
Summary
Percutaneous implants are associated with frequent inflammation throughout all branches of medicine [1,2]. A point of entry for pathogens is created, challenging the host’s immune defense [4,5] and wound healing response [6] In this respect, the semi-implantable bone conduction hearing implant (BCHI) is no exception [7]. The implant system consists of a screw-shaped intraosseous implant that integrates with the skull bone (osseointegration [8]) and an abutment that permanently penetrates the skin and attaches to an external sound processor. This system rehabilitates patients with a specific type of hearing impairment [9]. Inflammation of the tissue surrounding the skin-penetrating abutment affects approximately 30% of patients within two years [10]
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