Since the introduction of bone conduction hearing implants in 1977, quality of life of the implantees have improved substantially. The first available option were bone-anchored hearing devices, which improved sound quality, but had the major disadvantage of post-operative skin and wound infections. Therefore, new technologies seeking intact skin solution have emerged lately. The BONEBRIDGE system (MED-EL, Medical Electronics, Innsbruck, Austria) incorporates the first active bone conduction device, which especially aims to resolve abutment issues and still offers excellent audiological benefit. The successful implantation of this system in the first Romanian patient suffering from congenital lip and hard palate cleft with recurrent suppurative otitis media is presented. The authors report their experience with implantation, in terms of indications, selection assessment as well as functional results with a critical review of advantages and disadvantages in comparison with classical methods.