platform switching, gromov

SWITCHINGKONSTANTIN GROMOV, DDS

PLATFORM

Wednesday, May 29, 13

2006

1991 - wider implants for soft bone and lack of stability), standard 4mm components - less bone loss

The term“Platform Switching”


2001

Apical migration of JE to “protect” the internal part of the body from inflammation

PS?


Soft tissue <3mm - remodeling


1997


THIN<4.22mm<THICK

7x9mm

+ PS = enough room for BW

Soft tissue thickness effect on bone loss and relation to PS

LESS BONE LOSS !


No initial x-rays(?)


0.35 mm

Biomet 3i Prevail 4/5/4 was removed after 2 months from a patient

2008


2009

Immediate placement, external hex vs PS - no differenceSupra-crestal placement - external hex?


2009

•5 year follow-up, almost no bone loss•20-30 Ncm for IL (vs 30-40 Ncm)•Morse connection - “cold welding”•Esthetics, emergence profile? •Quite a lot narrow 3,5mm implants


2007

•2 mm sub-crestally, loaded, retrieved 1 month•Almost none inflammatory cells, no fibrotic tissue


•Extreme PS, one connection•Very easy surgical part, 20-30Ncm - IL•Bone stability•Questionable esthetics for single units, FPDs•”Unusual” Prosth


Benefits of an Implant Platform Modification Technique to Reduce Crestal Bone ResorptionXavier Vela-Nebot, MD, DDS,* Xavier Rodrı ́guez-Ciurana, MD,† Carlos Rodado-Alonso, MD,†

2.53 mm

vs

0.76 mm


•Plaque induced inflammation vs

180° 90°

Micro-gap induced inflammation

Moreover, with the increased surface area created by the exposed implant seating surface, there might be a reduction in the amount of crestal bone resorption necessary to expose a mini- mum amount of implant surface to which the soft tissue can attach (Lazzara & Porter 2006).

•Mesializing micro-gap, causing inflammatory cell infiltrate (ICT)•Shifts the mechanical stress away from coronal bone-impl interface•Reestablishment of BW - horizontal component


Disconnecting - reconnecting healing abutments (5 times)PS - circular pattern of CT fibers at platformNPS - at the first thread

2012


2010

ridge>7mm, two-stagemicro threads, internal connection

early cover screw exposure - exclusion from the study

9 MONTHS


2009


2013

2 mm

4 mm


PLATFORMSWITCHING

• No difference single-stage vs two-stage• Esthetic considerations, location of the implant (TL?)• Need 3-4 mm of soft tissue for PS to work• “One abutment-one time” protocol• No universal implant system• Always think about the restorative outcome

INFLAMMATION - BONE LOSS!


•Overview•History•Biology•Benefits•Disadvantages•Measurements•Design variety (prevale, ankylos, astra, built-in by def. how many mm? need more than .35? or just versality of abt) - 1-piece-2-pice (welding impl article?)•Summary•extras: 1 abt-1 time, emergence vs PS•PS vs external hex (tissue level)•No bone loss - where’s bone level initially? loosing 1.5-2mm after abt (healing) connection•vertical positioning of the platform - ? at, below, above 0.4mm??,(piattelli) sloped platform switching, one abt-one time (desturbance articles?)•graphics - positioning of the impl - what might happen•fibers orientation NPS vs PS •connecting-reconnecting components - is epithelial faster than connective tissue?•bone growth over the PS ? •tapered, morse - less mobility 15-20Ncm - enough IL(?) - cold welding

•show graphic - related articles and studies•concl - no diff 1vs2stage, PS when possible, TL when possible (even better), 3-4mm soft tissue, one abutm one time, ANKYLOS when thin tissue(?) and no esthetics


platform switching, gromov

Documents

soft bone

bone loss20

bone growth

external hex vs ps

soft tissue

implant surface

inflammation ps

orientation nps vs ps