Chapter 1 18 spontaneous fixture loss. Implant surface modification has been the main strategy to promote biological reactions to accelerate and promote its integration with bone. In dental applications, most surface modifications employ techniques that increase the roughness of the surface [58] with benefits in terms of a stronger bone response and better clinical results compared with non-modified implants [59]. A recent review reported a survival rate of 1166 BAHI implants of various designs, of 97.7% over an average follow-up time of 17 months across a predominantly adult population [60]. For adult populations, the failure rates for wide diameter implant systems are reported between 2.6-4.2%. [61,62,63,64]. Recent meta-analysis supports these findings in children demonstrating a 17.1% loss in small-diameter implants compared with a 5.9% for wide-diameter implants [65]. Currently Available Percutaneous BAHI [66] CochlearTM Baha® Connect System (Cochlear Bone-Anchored Solutions AB, Mölnlycke, Sweden) [67] 4.5mm wide BI300 titanium fixation screw (3-4mm length) + BA400 hydroxyapatite – coated abutment (6-14mm length) Processors available - Baha® 5 (45 dB HL), Baha® 5 Power (55 dB HL), and the Baha® 5 SuperPower (65 dB HL). Baha® 6 (55 dB HL) Oticon Ponto System (Oticon Medical AB, Askim, Sweden) [68] 4.5mm wide BHX titanium screw (3-6mm length) + abutments (6, 9, 12 and 14 mm length) Processors available - Ponto 3 (45 dB HL), Ponto 3 Power (55 dB HL) and Ponto 3 Superpower (65 dB HL), Ponto 4 (45 dB HL), Ponto 5 Mini (45 dB HL) and Ponto 5 Superpower (65 dB HL). Processor development Substantial developments in connectivity and streaming have been made in all processors, seamlessly integrating with apps and accessories to improve patient satisfaction. This also aids streamlining the fitting process where wireless and remote fitting can be undertaken. Oticon Ponto (Oticon Medical AB, Askim, Sweden) Ponto, the latest version of the Ponto (Oticon processor) the 5 mini, focuses on reducing size and weight rather than increasing power and maximal output. The processor has decreased in size over time from a footprint of 34x21x11mm (Ponto 3) to 26x19x11mm (Ponto 5 mini) with a weight reduction from 14g to 13.2g respectably.
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