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Can keratinocytes cause failure of osseointegration?

  • S Khwaja (a1), A Curry (a2), I H Chaudhry (a2) and K M J Green (a1)

Abstract

Aim:

Bone-anchored hearing aids are well established, implanted devices. We present two patients who suffered mixed hearing loss and who underwent titanium implant placement in the temporal bone to enable attachment of bone-anchored hearing aids. Osseointegration is necessary for such implants to function. We report these two cases to highlight how such osseointegration may be disrupted.

Method:

Attached tissue from the explanted or removed titanium implants was examined by transmission electron microscopy and histopathological analysis.

Results:

Attached tissue from both implants showed the presence of keratinocytes at the titanium implant and living bone interface. This was confirmed by histopathological analysis. In one case, there was frank keratinocyte proliferation, which had led to osseointegration failure; in the other case, such proliferation was present but not so advanced.

Conclusion:

These findings suggest that, in the cases reported, keratinocytes implanted between the titanium and the living bone, leading to disruption of osseointegration.

Copyright

Corresponding author

Address for correspondence: Ms S Khwaja, 3 Pexwood, Chadderton, Oldham OL1 2TS, UK. E-mail: sadiekhwaja@hotmail.com

References

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1 Bränemark, PI. Introduction to osseointegration. In: Bränemark, PI, Zarb, GA, Albrektsson, T, eds. Introduction to Osseointegration in Tissue-integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago: Quintessence Publishing, 1985;1176
2 Albrektsson, T, Bränemark, PI, Hansson, HA, Lindström, J. Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand 1981;52:155–70
3 Drinias, V, Granström, G, Tjellström, A. High age at the time of implant installation is correlated to increased loss of osseointegrated implants in the temporal bone. Clin Implant Dent Rel Res 2007;9:94–9
4 Mylanus, EAM, Johansson, CB, Cremers, CWRJ. Craniofacial titanium implants and chronic pain: histological findings. Otol Neurotol 2002;23:920–5
5 Tjellström, A. Osseointegration systems and their applications in the head and neck. Adv Otolaryngol Head Neck Surg 1989;3:3970
6 Huisman, MA, de Heer, E, Ten Dijke, P, Grote, JJ. Transforming growth factor beta and wound healing in human cholesteatoma. Laryngoscope 2008;118:94–8
7 Mempel, M, Voelcker, V, Kollisch, G, Plank, C, Rad, R, Gerhard, M et al. Toll-like receptor expression in human keratinocytes: nuclear factor kappaB controlled gene activation by Staphylococcus aureus is toll-like receptor 2 but not toll-like receptor 4 or platelet activating factor receptor dependent. J Invest Dermatol 2003;121:1389–96
8 Granström, G. Craniofacial osseointegration. Oral Dis 2007;13:261–9
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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