Histologic Evaluation of Soft Tissue Integration of Experimental Abutments for Bone Anchored Hearing Implants Using Surgery Without Soft Tissue Reduction
Histologic Evaluation of Soft Tissue Integration of Experimental Abutments for Bone Anchored Hearing Implants Using Surgery Without Soft Tissue Reduction
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DOI：
10.1097/mao.0b013e318268d4e0
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发表时间：
2012-10-01
影响因子：
2.1
通讯作者：
Nannmark, Ulf
中科院分区：
文献类型：
--
作者：
Larsson, Anna;Wigren, Stina;Nannmark, Ulf
目的：骨锚定助听器（如Baha (R)）手术的方案包括复位基台周围的软组织，以尽量减少皮肤相关并发症的风险。假设如果改良的基台设计和/或材料可以增强与周围软组织的整合，则无需进行皮肤缩小即可获得良好的软组织结果。本研究的目的是探讨软组织对不同基台设计/材料的反应。方法：将36个Baha种植体和基台置入6只绵羊颅骨，不做软组织复位。采用四种不同的基台：1)标准Baha基台，2)羟基磷灰石涂层的标准Baha基台，3)凹钛基台，4)羟基磷灰石涂层的凹基台。治疗时间分别为1、2、4周（每个时间点2只）。使用描述性组织学和形态计量学测量对样本进行分析，并使用Wilcoxon's sign -rank检验对结果进行比较。结果：组织学检查显示基牙周围软组织健康，炎症症状有限或无炎症迹象。羟基磷灰石包覆的基台与真皮层粘附紧密，表皮向下生长和袋状形成有限。无涂层钛基牙的粘附性较弱，通常伴有明显的表皮下生长和袋状形成。A、B、C、D型基台的平均袋深分别为1.38、0.42、1.51、0.24 mm。C与D的差异有统计学意义（p = 0.031）。结论：羟基磷灰石包覆基牙可增强基牙的真皮粘附性，减少表皮下生长和囊袋形成，其中凹形羟基磷灰石包覆基牙效果最显著。
Objective: The protocol for bone-anchored hearing implants (e. g., Baha (R)) surgery involves reduction of soft tissues around the abutment to minimize the risk of skin-related complications. It is hypothesized that good soft tissue outcomes may be achieved without performing skin reduction if improved abutment designs and/or materials are used that provide enhanced integration with surrounding soft tissues. The aim of the study was to investigate soft tissue response to different abutment designs/materials.Methods: Thirty-six Baha implants and abutments were inserted in the skull of six sheep without performing soft tissue reduction. Four different abutments were used: 1) standard Baha abutments, 2) hydroxyapatite-coated standard Baha abutments, 3) concave titanium abutments, and 4) hydroxyapatite-coated concave abutments. Healing times of 1, 2, and 4 weeks were used (2 animals per time point). Samples were analyzed using descriptive histology and morphometric measurements, and results were compared using Wilcoxon's signed-ranked test.Results: Histologic assessment showed healthy soft tissues around the abutments with limited or no signs of inflammation. Hydroxyapatite-coated abutments showed tight adherence with dermis and limited epidermal downgrowth and pocket formation. Weaker adherence, often associated with significant epidermal downgrowth and pocket formation, was noted for noncoated titanium abutments. The mean pocket depth for abutment types A, B, C, and D was 1.38, 0.42, 1.51, and 0.24 mm, respectively. The difference between C and D was statistically significant (p = 0.031).Conclusion: The results showed enhanced dermal adherence and reduced epidermal downgrowth and pocket formation for hydroxyapatite-coated abutments, with the most significant effect recorded for the hydroxyapatite-coated abutments with a concave shape.