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Soft tissue stability around hydroxyapatite-coated abutments for bone conduction implants placed using
soft tissue preservation surgery
Larsson A. , Wigren S. , Andersson M. , Flynn M.C. , Nannmark U.
University of Gothenburg, Head and Neck Surgery, Department of Otolaryngology, The Sahlgrenska Academy, Gothenburg, Sweden,
Cochlear Bone Anchored Solutions AB, Mölnlycke, Sweden, 3University of Gothenburg, Oral & Maxillofacial Surgery, Department of
Odontology, The Sahlgrenska Academy, Gothenburg, Sweden
Introduction: Meticulous removal of subepidermal tissues is the recommended surgical procedure to ensure
soft tissue stability around skin-penetrating titanium abutments for bone conduction implants. Previous research
has shown that soft tissue does not adhere to a machined titanium surface, leaving deep epidermal pockets
around skin-penetrating titanium devices. However, research has demonstrated that with calcium phosphates,
such as hydroxyapatite, it is possible to establish close contact with the surrounding soft tissue, thus limiting
epidermal down growth and subsequent pocket formation. The aim of the present investigation was to
demonstrate that hydroxyapatite-coated abutments improve soft tissue stability, thus providing favorable
conditions for obtaining good outcomes when performing bone conduction implant surgery without soft tissue
Methods: Forty-eight bone conduction implants with hydroxyapatite-coated abutments (n=24) or standard
titanium abutments (n=24) were inserted in the skull of eight adult sheep. A minimally invasive surgical technique
was used, leaving the soft tissue thickness intact. After a 4-week healing period, implants and abutments with
surrounding tissue were retrieved for qualitative and quantitative histology. Statistical analyses were performed
by an independent biostatistician; a mixed model analysis was used for statistical comparisons.
Results: Qualitative histological assessment showed healthy soft tissues around the abutments with limited or
no signs of inflammation. Tight adherence between hydroxyapatite-coated abutments and surrounding dermis
was consistently observed, while less firm adherence was generally noted on titanium abutments. Morphometric
measurements showed significantly smaller pocket depth (p=0.0013) and less epidermal down growth
(p=0.0003) around hydroxyapatite-coated abutments compared to titanium abutments.
Discussion: The results suggest that the use of hydroxyapatite coatings may make it possible to obtain good
clinical outcomes with bone conduction implants without having to remove subepidermal tissues around the skinpenetrating abutment. Leaving the soft tissue thickness intact has significant advantages in terms of healing and
aesthetic outcomes for the patient.
Conclusion: The results confirm that hydroxyapatite-coated abutments improve soft tissue adherence and
reduce epidermal down growth and pocket formation compared to standard titanium abutments.