platform switching, gromov
DESCRIPTION
Brief presentation on PS, literature references, slidesTRANSCRIPT
SWITCHINGKONSTANTIN GROMOV, DDS
PLATFORM
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2006
1991 - wider implants for soft bone and lack of stability), standard 4mm components - less bone loss
The term“Platform Switching”
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2001
Apical migration of JE to “protect” the internal part of the body from inflammation
PS?
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Soft tissue <3mm - remodeling
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1997
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THIN<4.22mm<THICK
7x9mm
+ PS = enough room for BW
Soft tissue thickness effect on bone loss and relation to PS
LESS BONE LOSS !
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No initial x-rays(?)
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0.35 mm
Biomet 3i Prevail 4/5/4 was removed after 2 months from a patient
2008
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2009
Immediate placement, external hex vs PS - no differenceSupra-crestal placement - external hex?
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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
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2007
•2 mm sub-crestally, loaded, retrieved 1 month•Almost none inflammatory cells, no fibrotic tissue
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•Extreme PS, one connection•Very easy surgical part, 20-30Ncm - IL•Bone stability•Questionable esthetics for single units, FPDs•”Unusual” Prosth
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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
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•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
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Disconnecting - reconnecting healing abutments (5 times)PS - circular pattern of CT fibers at platformNPS - at the first thread
2012
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2010
ridge>7mm, two-stagemicro threads, internal connection
early cover screw exposure - exclusion from the study
9 MONTHS
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2009
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2013
2 mm
4 mm
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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!
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•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
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