86 Chapter 3.2 4. Discussion The demonstrated high implant survival rate 95.3% and low adverse skin reaction rate 3.2% in this cohort is in keeping with published literature and indicate the influence of implant design and surgical technique on the survival rate. In comparison to other results at our centre, outcomes using the previous Ponto wide implant (without a laser ablated surface) showed a 10% implant failure rate in 75 implanted systems [37], indicating a benefit in terms of survival rate using the laser ablated implant. The results from the present study can also be compared with the use of a wide blasted implant (BIA300, Cochlear Nordic AB, Mölnlycke, Sweden) demonstrating 5% implant loss at our centre [38] however this BAI300 implant system was noted to have significant adverse skin reactions in 77% of patients. A recent meta-analysis of wide diameter implant systems in the paediatric population demonstrated a 5.9% fixture loss, whereas the corresponding result for the previous narrow BAHI implant was 17.1%, corroborating our findings [27]. The use of two stage surgery remains popular in our centre especially for children with additional medical and educational needs such as those with Down syndrome. Whilst there is literature supporting single stage surgery in older children [39], two stage surgery offers a perfect healing environment whilst osseointegration occurs. There is no wound care or periabutment care required during the healing period and the child can easily wear their softband band post-surgery without concerns about interference with the ‘healing’ abutment. Families are involved in the pre-operative discussion regarding two stage versus single stage surgery and the need for two very short admissions for general anaesthesia and surgery has not been seen to be a deterrent. There is evidence in the literature supporting early loading of implants in children using RFA to support their decision [40], however care must be taken when translating results from study populations that are not homogeneous with regards to patient demographics or comorbidities. The osseointegration period is still in the order of 12 weeks in our centre and early loading of the implant is not a priority since the children continue to wear their softband. Good osseointegration is a priority in the aim of reducing fixture loss and the need for further surgery once the child has become confident in wearing their BAHI. Implant survival and soft tissue outcomes can also be directly compared to a previous paediatric DS cohort from this same institution. In 2008 McDermott et al. followed up 15 patients over a 14-month period who were implanted using the narrower Brannemark flanged fixture system and demonstrated a no fixture failures, a 20% adverse skin response rate and a 6.7% revision surgery rate [17]. This previous work allows for a unique comparison being matched
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