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The clinical outcome and microbiological profile of bone-anchored hearing systems (BAHS) with different abutment topographies: a prospective pilot study

Journal article
Authors Margarita Trobos
Martin L Johansson
S. Jonhede
H. Peters
Maria Hoffman
Omar Omar
Peter Thomsen
M. Hultcrantz
Published in European Archives of Oto-Rhino-Laryngology
Volume 275
Issue 6
Pages 1395-1408
ISSN 0937-4477
Publication year 2018
Published at Institute of Clinical Sciences, Department of Biomaterials
Pages 1395-1408
Language en
Keywords Abutment, Bacteria, BAHS, Bone-anchored hearing system, Skin, Staphylococcus, biomaterial-associated infection, percutaneous titanium implants, soft-tissue integration, human-skin, biofilm formation, surface-topography, microbial ecology, site infection, complications, colonization
Subject categories Biomaterials Science, Otorhinolaryngology


In this prospective clinical pilot study, abutments with different topologies (machined versus polished) were compared with respect to the clinical outcome and the microbiological profile. Furthermore, three different sampling methods (retrieval of abutment, collection of peri-abutment exudate using paper-points, and a small peri-abutment soft-tissue biopsy) were evaluated for the identification and quantification of colonising bacteria. Twelve patients, seven with machined abutment and five with polished abutment, were included in the analysis. Three different sampling procedures were employed for the identification and quantification of colonising bacteria from baseline up to 12 months, using quantitative culturing. Clinical outcome measures (Holgers score, hygiene, pain, numbness and implant stability) were investigated. The clinical parameters, and total viable bacteria per abutment or in tissue biopsies did not differ significantly between the polished and machined abutments. The total CFU/mm(2) abutment and CFU/peri-abutment fluid space of anaerobes, aerobes and staphylococci were significantly higher for the polished abutment. Anaerobic bacteria were detected in the tissue biopsies before BAHS implantation. Anaerobes and Staphylococcus spp. were detected in all three compartments after BAHS installation. For most patients (10/12), the same staphylococcal species were found in at least two of the three compartments at the same time-point. The common skin coloniser Staphylococcus epidermidis was identified in all patients but one (11/12), whereas the pathogen Staphylococcus aureus was isolated in five of the patients. Several associations between clinical and microbiological parameters were found. There was no difference in the clinical outcome with the use of polished versus machined abutment at 3 and 12 months after implantation. The present pilot trial largely confirmed a suitable study design, sampling and analytical methodology to determine the effects of modified BAHS abutment properties.

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