Learning Objectives: Early loading of the BAHA abutment is feasible, safe and provides evidence for a change of clinical practice to ever shorter loading times.

Introduction: BAHA placement is routinely undertaken as a single stage process. Loading is performed at an interval period – usually six days – to allow for osseointegration. We report the successful early loading of a BAHA, at four hours post-operatively, undertaken as a result of hearing loss on a background of learning difficulties in a paediatric patient with Down's syndrome and autism. Satisfactory short and long-term outcomes are reported.

Methods: Case Report.

Results: A 16-year-old male with Down's syndrome and autism underwent a left BAHA placement. A conventional hearing aid had not been tolerated by the patient. Since the age of 9, a soft-band device had been trialled and had been well tolerated.

The procedure involved single-stage placement of a 4 mm implant with 10 mm abutment, performed via the FAST technique, using a curvilinear incision.

Post-operatively the patient was agitated and it was elected to load the abutment early, at four hours, to overcome difficulties in communication.

The initial intra-operative resonance frequency analysis (RFA) stability measurement was 49 (implant stability quotient (ISQ) 65 units after correction for abutment length). Medium and long-term follow-up at 12 months confirmed maintenance of implant stability by maintained ISQ values. No local complications occurred.

Conclusions: A successful outcome following early loading of the BAHA abutment was achieved, and is considered the earliest recorded BAHA loading described in the literature. The procedure is predicated upon the use of real time RFA measurement.