Bone-anchored implants for facial prostheses

For much of the history of facial prosthetics the great practical problem was keeping the thing on. Glasses, straps and adhesives all worked after a fashion. Then, in the second half of the twentieth century, a discovery about titanium and bone changed what was possible. This page explains the idea in plain terms, what the clinical literature reports about how well it works, and what it cannot promise.

What osseointegration means

A review of implant-retained craniofacial prostheses credits the Swedish researcher Per-Ingvar Branemark with discovering in the 1950s that titanium has an exceedingly high biocompatibility with bone, and with coining the term osseointegration. The word began as a description of direct contact between implant and bone under a light microscope. Because that was hard to apply in a clinic, the review quotes a working definition by Zarb and Albrektsson: "Osseointegration is a process whereby clinically asymptomatic rigid fixation of alloplastic materials is achieved, and maintained, in bone during functional loading." In other words, the implant becomes firmly fixed in living bone and stays that way while it carries a load.

The same review notes that after the 1950s discovery dental implants began to be made of titanium in the 1960s. The first extraoral use came later: the ear, nose and throat surgeon Anders Tjellstrom placed percutaneous titanium fixtures outside the mouth in 1977 for a bone-anchored hearing aid, and in 1979 for a bone-anchored prosthesis. The International Journal of Dentistry review likewise dates osseointegrated implants in maxillofacial rehabilitation from 1979. Where this sits among the other advances is on the timeline.

How the system works

In outline, the surgeon places small titanium implants in bone, in the areas the review names as mastoid, orbital and nasal regions, and later attaches posts, called abutments, that pass through the skin. The review describes two stages: the first is bone drilling and implant placement; the second involves reducing the soft tissue and obtaining a hair-free skin area around the abutment, then inserting the abutment through the skin. The two steps can be done in one operation or two. In the review's technical notes, irradiated patients should wait a longer interval, six months, before the second stage.

The prosthesis then attaches to the abutments. Historically a metal bar was screwed onto the posts and the prosthesis clipped to it. The review says bar constructions are obsolete in most nasal and orbital cases because the posts there cannot be made parallel, and that magnets are used almost exclusively in those areas today. Magnets also make cleaning and insertion easier for the wearer. Cambridge University Hospitals describes the patient side of a magnet system in its leaflet on implant-retained prostheses, including daily cleaning of the magnets with a soft toothbrush and mild soap.

What it offers

The Heidelberg review lists several advantages of bone anchorage: more reliable retention, retention that is not affected by environmental factors such as sweating, easier placement by the wearer, more comfort through not using adhesive, and thin, transparent silicone edges that last longer than with adhesive prostheses. It also lists situations in which bone-anchored prostheses are indicated, including the need for optimal tumor aftercare, skin that has been badly damaged by radiation, failed reconstruction, a patient's rejection of reconstruction, and the desire for speedy rehabilitation. The introduction to a 2013 quality-of-life study adds that recent studies have shown implant-retained facial prostheses were tolerated more easily than adhesively retained ones, which is a general observation and not a prediction for any one person.

How well does it work?

Results depend on where the implant sits and on the patient's history. The review reports the classic implant system doing best in the mastoid, with a loss rate of only 8 percent, against about 50 percent in the frontal bone and 20 percent in the malar bone in the data it cites. Another cited series reported loss rates of around 5.8 percent in the auricular region, 23.5 percent in the orbital region and 40 percent in the nasal region. A United States multicenter study cited there found an implant failure rate in the orbital region of 23 percent after 5 years and 42 percent after 10 years. The same review reports that radiotherapy matters: in one series, the overall failure rate of the implants, dental ones included, was 23.3 percent in irradiated patients versus 10.8 percent in non-irradiated patients.

More recent data are small. A 2025 retrospective review from a single center, in Craniomaxillofacial Trauma and Reconstruction, followed 27 patients who received 79 osseointegrated implants for ear, nose or orbital prostheses. Implant survival was 86 percent (68 of 79), six patients lost at least one implant, and two (7.4 percent) were unable to use their prosthesis because of implant loss. Prior radiation and prior surgery to the implanted bone were both associated with more implant loss. The 2025 study is small and retrospective, and none of these figures tells any individual how their own implants would fare. Suitability is a decision for the surgical and prosthetic team.

What can go wrong

The Heidelberg review says the most frequent problems come from the site where the abutment passes through the skin, and that important factors are thinning of the skin and personal hygiene. It describes a four-point scoring scale for skin reactions (from no reaction through redness, moist redness and granulation tissue to infection serious enough that the abutment has to be removed). In the studies it cites, 92.5 percent of hearing-aid patients, 91.1 percent of those wearing an orbital prosthesis and 89.3 percent of those with an ear prosthesis had reaction-free skin around the implant. Otherwise, it says, complications are extremely rare. Absolute contraindications it lists are severe psychiatric disorders and cachexia (severe wasting), with poor hygiene and some other factors counting as relative contraindications to be assessed individually.

Anyone with an implant who notices redness, swelling, discharge or pain around it should contact their clinical team without waiting for the next review. Routine care of the skin around implants follows the team's own instructions, which the Cambridge leaflet notes are supplied separately. See care and cleaning for the general picture.

Beside reconstruction

Bone anchorage is one answer among several, not a verdict on surgery. The Heidelberg review states plainly that for less complex aesthetic units, plastic surgery procedures are extremely suitable, and that mobile areas such as the lips should be surgically reconstructed. The page on prosthesis or reconstruction sets out how teams weigh the choice, and how a facial prosthesis is made shows where the implants fit into the workflow.

In brief

Osseointegrated titanium implants give a facial prosthesis a firm anchor in bone and often make adhesive unnecessary. Success varies widely by site and with prior radiotherapy, skin problems at the abutment are the most common difficulty, and the evidence base is modest. Whether this route suits a person is for them and their clinical team to decide.