PMC8042154_01
(A) The BAHS with a mounted abutment at the 12-week follow-up. In the lower-left quadrant, a reddish moist irritated site can be observed. (B) The skin after abutment removal. No signs of inflammation are observed. (C) The implant in the bone during removal surgery. On the left: Trephine used to remove the implant is shown. (D) Retrieved implant with the surrounding bone. (E) Illustration of sampling performed at baseline prior to implantation where a skin swab (2x2 cm) is taken at the intended implantation site, prior to the retrieval of a 1 mm soft tissue biopsy using a 1 mm biopsy punch, (F) at 12 weeks, and during episodes with adverse skin reactions, a swab from the external side of the abutment and the peri-abutment skin are taken, and a 1 mm skin biopsy is retrieved. Finally, at implant removal, swabs were taken on the cover screw (G) and the top of the implant (H).
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During follow-up, the patient experienced adverse soft-tissue reactions with two episodes of Holgers score 2 (at 6 and 11 months) and one with a registered Holgers score of 3 (at 14 months) ( Table 1 ,  Figure 1A ). After removal of the abutment, the skin healed, closing the wound over the implant without macroscopic signs of inflammation ( Figure 1B ). However, the patient continued to experience episodes of pain leading to elective implant removal surgery in March 2017, 25 months after implantation ( Figures 1C, D ).