Physiology of Osseointegration

Bone conduction implant devices rely on osseointegration of titanium implants with the underlying skull, characterized by endosseous healing and de-novo bone formation both surrounding and onto the implant surface. The key steps in osseointegration are the initial tissue response to implantation, pen-implant osteogenesis, and pen-implant bone remodeling. There is increasing evidence that osseointegration is primarily an immune-mediated process with the key players being the complement cascade and macrophages, which form part of the host innate immunity. Implant design and composition, patient systemic factors, surgical technique, and loading characteristics can all affect the success of osseointegration.