151 6 Summary Summary Research presented in this thesis adds to the increasing body of evidence that the application of wide diameter surface modulated implant in combination with appropriate length abutment minimise the risk of adverse skin reactions, spontaneous losses, and fixture failures. It presents some of the largest single centre, consecutively implanted patient groups in the paediatric setting in the world. It is also the only centre to directly compare the impact of clinical outcomes of fixture design in paediatric Down syndrome patients. This thesis also explored the audiological improvements of a novel adhesive bone conductive hearing device and its impact of quality of life in the short and medium term. These were the largest studies in the paediatric population at the time of publication. Chapter 2 Application of a wide diameter implant in paediatric population This chapter comprises of a retrospective review of the first forty-seven children implanted with 70 4.5mm Oticon wide implants over a 5-year period. The finding of this study demonstrated an improved rate of skin complication that the previously used BAI300 Cochlear fixture 11% vs 77% but a higher fixture loss 10% vs 5% however the mean follows up time for this study was twice as long at the BAI300. The improvement in skin complication was because of better abutment design and the lack of a hydroxyapatite coating found in the BAI300. Chapter 3 3.1 Impact of laser ablating the surface of a wide diameter implant on clinical outcomes and the application of RFA in the paediatric population Following the success of the previously studied 4.5mm wide diameter implant, Oticon released an implant with a laser ablated surface. This prospective study analysed 115 paediatric patients with 176 implants with regards to clinical outcomes and application of Resonance frequency analysis in the paediatric population. The findings of this study demonstrated significant improvement in regards to both fixture failure rate and soft tissue complication when compared to all previously utilised implant systems at BCH. An overall fixture loss of 3.4% was reported with a skin complication rate of 4.4% of all post-operative visits. RFA analysis found an overall increase over time following implantation, however, this increase only became statistically significant at the 3 months review point. No correlation between RFA and fixture loss could be identified. Therefore, utilising RFA an implant outcome predictor could not be verified, and conclusions cannot be drawn based on individual ISQ values alone. Trends can be followed but only in individuals or groups in which variables remain the same, this is challenging in the paediatric setting with a heterogenous patient group.
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