implant platform switching concept

8/12/2019 Implant Platform Switching Concept

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PLATFORM SWITCHING: APANACEA FOR BONE LOSS

Dr.T.Sudhakar reddy

SVS Institute of Dental Sciences

Mahabubnagar


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INTRODUCTION

The longevity of dental implants is highly

dependent on integration between implant

components and oral tissues.

Implant is regarded as successful if boneloss around the implant is up to 2 mm during

the first year of implant function.


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Studies have shown that submerged titanium implants ha

mm to 1.6 mm marginal bone loss from the first thread by

of first year in function, while only 0.05 mm to 0.13 mm bo

occurred after the first year.

Adell et al. Int J Oral Surg 1981Jemt et al. Int J Perio Resto Dent 1990

Cox et al. Int J Oral Maxillofac Implants1987


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The first report in the literature to quantify the early crestal bone los15-year retrospective study evaluating implants placed in edentulou

In this study, Adell et al. reported an average of 1.2 mm marginal bfrom the first thread during healing and the first year after loading.

In contrast to the bone loss during the first year, there was an avera

only 0.1 mm bone lost annually thereafter.

Adell et al. Int J Oral Surg 1981


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Based on the findings in sub-merged implants, Albrektsson et al. and

and Zarb proposed criteria for implant success, including a vertical boless than 0.2 mm annually following the implants first year of function

Albreksson et al. Int J Oral Maxillofac Implants 1986Smith D and Zarb G. J Prosthet Dent 1989


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Non-submerged implants also have demonstrated early crestal bon

with greater bone loss in the maxilla than in the mandible, ranging 0

to 1.1 mm, at the first year of function.

Buser et al. Clin Oral Implant Res 1990

Weber et al. Clin Oral Implant Res 1992

Brgger et al. Clin Oral Implants Res1998


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Factors effecting crestal bone loss around implants

1. The micro-gap

2. The implant crest module

3. Occlusal overload

4. The biologic width around the dental implant.

Oh TJ, Yoon J, Misch CE, Wang HL. The causes of early i

bone loss: myth or science? J Periodontol 2002;7:322


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Many implant systems have an abutments used with conventio

implant types which are flush with the implant shoulder in the c

zone.

This results in the formation of microgap between the implant a

abutment.

MICROGAP AND THE PLATFORM-SWITCHINGCONCEPT


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MICROGAP AND THE PLATFORM-SWITCHING

Sequence of events:

1. Exposure

2. bacterial contamination of the gap

3. affects the stability of the periimplant tissue.

4. axial forces

5. pumping effect

6. flow of bacteria from the micro-gap

7. formation of inflammatory connective tissue

Hermann et al. J Periodontol. 2001Todescan et al. Int J Oral Maxillofac Implants. 2002

Dibart et al. J Oral Maxillofac Surgery. 2005


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Berglundh et al. and Lindhe et al. also evaluated the microgap of th

Brnemark 2-stage implant and found inflamed connective tissue ex

mm above and below the abutment-implant connection, which resu

mm bone loss within 2 weeks after the abutment was connected to

implant.

Lindhe et al. Clin Oral Implant Res1992;3:9-16

MICROGAP AND THE PLATFORM-SWITCHINGCONCEPT


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CONCEPT OF PLATFORM SWITCHING

The platform switch concept was first introduced by Lazzara

and Gardner

In 1991, Implant Innovations, Inc. (3i, Palm Beach Gardens,

introduced 5 mm and 6 mm diameter implants.

Restored with standard 4.1 mm diameter components

After a 5-year period, the typical pattern of crestal bone resor

not observed in platform switched implants.


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Inward positioning of the implant-abutment interface allowed the biologic

width to be established horizontally.


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Design increases the distance between the inflammatory c

infiltrate at the microgap and the crestal bone, thereby min

the effect of inflammation on marginal bone remodelling.


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LITERATURE SHOWING POSITIVE EFFECT

Wagemberg et al in their prospective study evaluated imp

and crestal bone levels around implants that used the platf

showed that 99% of all the surfaces examined had 2.0 m

loss over this observation period.


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Canullo et al. observed that implants restored according to

platform-switching concept experienced significantly less m

bone loss than implants with matching implant-abutment di


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Cappiello et al. confirmed the important role of the microgap betweeand abutment in the remodelling of the peri-implant crestal bone.

Platform-switching seemed to reduce peri-implant crestal bone resorincrease the long-term predictability of implant therapy


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Prosper et al. in a randomized prospective study compare

platform-switched implants and implants with an enlarged

to cylindrical implants inserted with conventional surgical

having abutments of matching diameter.

A significantly reduced post-restorative crestal bone loss

when implants were placed in both two-stage and one-sta

techniques.


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BENEFITS OF PLATFORM SWITCHING

Increased implant longevity

Improved esthetics


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LIMITATIONS OF PLATFORM SWITCHING

If normal sized abutments are to be used, implants of larg

to be placed. This might not be possible clinically always

If normal implants are to be used, smaller diameter abutm

compromise the emergence profile in aesthetic areas


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Around 3 mm of soft tissue should be present to place p

switched implants or else bone resorption is likely to occ

For platform switching to be effective, the under sizing o

components must be carried out during all phases of thetreatment.


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CONCLUSION

Many factors contribute to marginal bone loss around impl

solution cannot be attributed to any single parameter.However, an appropriate understanding and use of platformconcept in routine treatment improves crestal bone preservcontrolled biologic space repositioning.

It appears to be a promising tool in preserving peri implant

further research is needed to substantiate its application incontemporary implantology.


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References:

Qian J, Wennerberg A, Albrektsson T. Reasons for marginal bone looral implants. Clin Implant Dent Relat Res. 2012;14:792807.

Lazzara RJ, Porter SS. Platform switching: A new concept in implancontrolling postrestorative crestal bone levels. Int J Periodontics ReDent. 2006;26:917.

Gardner DM. Platform switching as a means to achieving implant esState Dent J. 2005;71:347.

Luongo R, Traini T, Guidone PC, Bianco G, Cocchetto R, Celletti R.soft tissue responses to the platform-switching technique. Int J PeriRestorative Dent. 2008;28:5517.

Chang CL, Chen CS, Hsu ML. Biomechanical effect of platform swiimplant dentistry: A three dimensional finite element analysis. Int J OMaxillofac Implants. 2010;25:295304.


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Canullo L, Goglia G, Iurlaro G, Iannello G. Short-term bone levelobservations associated with platform switching in immediately plarestored single maxillary implants: A preliminary report. Int J Prost2009;22:27782.

Cappiello M, Luongo R, Di Iorio D, Bugea C, Cocchetto R, Celletti Evaluation of peri-implant bone loss around platform-switched impJ Periodontics Restorative Dent. 2008;28:34755.

Prosper L, Redaelli S, Pasi M, Zarone F, Radaelli G, Gherlone EF. randomized prospective multicentre trial evaluating the platformswtechnique for the prevention of postrestorative crestal bone loss. In

Maxillofac Implants. 2009;24:299308.

Atieh MA, Ibrahim HM, Atieh AH. Platform switching for marginal bpreservation around dental implants: A systematic review and metanalysis. J Periodontol. 2010;81:135066.

implant platform switching concept

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