69 3.1 Clinical Evaluation of laser-ablated titanium implant BHX implant, underscoring the limitations of the ISQ measurement to distinguish the degree of osseointegration (22). A limitation in the present study is the small sample size in both the 12-mm abutment and fixture failure groups. Each group lacks significant statistical power to identify trends with regards to ISQ levels. Due to the wide range of indications for surgery and physical and psychological comorbidities of the recipients in our study cohort, comparisons with other published literature should be done with caution. The variation in surgical technique is also considered a limitation although the patient demographics, postoperative protocol, and routine follow-ups were identical for the three groups. In addition, the impact of missing reviews should be considered when interpreting the results of this study. Explanations reside in the exceptionally large geographic area from which many patients are referred. Time away from school, organization of care for siblings, and the additional challenges to attend contributed to the missing data. The added burden of additional reviews was considered a further inconvenience, especially when parents and carers had no concerns regarding the implant site or hearing following abutment placement. This was confirmed with telephone consultations when investigating missing appointments. It is concluded that the use of laser-ablated titanium implant for BAHIs in a large pediatric cohort resulted in superior survival rates and excellent clinical outcomes compared with previous implant systems utilized at BCH. Although absolute figures for the abutment-level ISQ increased over time, statistical significance was only demonstrated at 3 months. The absolute ISQ data did not provide an indication of probable fixture failure. Acknowledgments: The authors would like to thank Konstance Tzifa, Chana Panagamuwa, and Jo Williams-Outhwaite for allowing us to use their cases in our study.
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