PLATFORM SWITCHING: A

PANACEA FOR BONE LOSS

Dr.T.Sudhakar reddy
SVS Institute of Dental Sciences
Mahabubnagar
INTRODUCTION
The longevity of dental implants is highly
dependent on integration between implant
components and oral tissues.


Implant is regarded as successful if bone
loss around the implant is up to 2 mm during
the first year of implant function.
Studies have shown that submerged titanium implants had 0.9
mm to 1.6 mm marginal bone loss from the rst thread by the end
of rst year in function, while only 0.05 mm to 0.13 mm bone loss
occurred after the rst year.






Adell et al. Int J Oral Surg 1981
Jemt et al. Int J Perio Resto Dent 1990
Cox et al. Int J Oral Maxillofac Implants1987
The rst report in the literature to quantify the early crestal bone loss was a
15-year retrospective study evaluating implants placed in edentulous jaws.

In this study, Adell et al. reported an average of 1.2 mm marginal bone loss
from the rst thread during healing and the rst year after loading.

In contrast to the bone loss during the rst year, there was an average of
only 0.1 mm bone lost annually thereafter.

Adell et al. Int J Oral Surg 1981
Based on the ndings in sub-merged implants, Albrektsson et al. and Smith
and Zarb proposed criteria for implant success, including a vertical bone loss
less than 0.2 mm annually following the implants first year of function.





Albreksson et al. Int J Oral Maxillofac Implants 1986
Smith D and Zarb G. J Prosthet Dent 1989
Non-submerged implants also have demonstrated early crestal bone loss,
with greater bone loss in the maxilla than in the mandible, ranging 0.6 mm
to 1.1 mm, at the rst 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
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 implant
bone loss: myth or science? J Periodontol 2002;7:32233.
Many implant systems have an abutments used with conventional
implant types which are flush with the implant shoulder in the contact
zone.
This results in the formation of microgap between the implant and the
abutment.

MICROGAP AND THE PLATFORM-SWITCHING
CONCEPT
MICROGAP AND THE PLATFORM-SWITCHING CONCEPT
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. 2001
Todescan et al. Int J Oral Maxillofac Implants. 2002
Dibart et al. J Oral Maxillofac Surgery. 2005

Berglundh et al. and Lindhe et al. also evaluated the microgap of the
Brnemark 2-stage implant and found inamed connective tissue existed 0.5
mm above and below the abutment-implant connection, which resulted in 0.5
mm bone loss within 2 weeks after the abutment was connected to the
implant.




Lindhe et al. Clin Oral Implant Res1992;3:9-16
MICROGAP AND THE PLATFORM-SWITCHING
CONCEPT
CONCEPT OF PLATFORM SWITCHING
The platform switch concept was rst introduced by Lazzara & Porter
and Gardner
In 1991, Implant Innovations, Inc. (3i, Palm Beach Gardens, FL)
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 resorption was
not observed in platform switched implants.

Inward positioning of the implant-
abutment interface allowed the biologic
width to be established horizontally.

Design increases the distance between the inflammatory cell
infiltrate at the microgap and the crestal bone, thereby minimizing
the effect of inflammation on marginal bone remodelling.

LITERATURE SHOWING POSITIVE EFFECT
Wagemberg et al in their prospective study evaluated implant survival
and crestal bone levels around implants that used the platform switch.
showed that 99% of all the surfaces examined had 2.0 mm of bone
loss over this observation period.
Canullo et al. observed that implants restored according to the
platform-switching concept experienced significantly less marginal
bone loss than implants with matching implant-abutment diameters.

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

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

Prosper et al. in a randomized prospective study compared
platform-switched implants and implants with an enlarged platform
to cylindrical implants inserted with conventional surgical protocols
having abutments of matching diameter.

A significantly reduced post-restorative crestal bone loss was seen,
when implants were placed in both two-stage and one-stage
techniques.
BENEFITS OF PLATFORM SWITCHING

Increased implant longevity
Improved esthetics
LIMITATIONS OF PLATFORM SWITCHING

If normal sized abutments are to be used, implants of larger size need
to be placed. This might not be possible clinically always
If normal implants are to be used, smaller diameter abutments may
compromise the emergence profile in aesthetic areas



Around 3 mm of soft tissue should be present to place platform
switched implants or else bone resorption is likely to occur

For platform switching to be effective, the under sizing of the
components must be carried out during all phases of the implant
treatment.
CONCLUSION
Many factors contribute to marginal bone loss around implants and its
solution cannot be attributed to any single parameter.
However, an appropriate understanding and use of platform switching
concept in routine treatment improves crestal bone preservation and
controlled biologic space repositioning.
It appears to be a promising tool in preserving peri implant bone and
further research is needed to substantiate its application in
contemporary implantology.
References:

Qian J, Wennerberg A, Albrektsson T. Reasons for marginal bone loss around
oral implants. Clin Implant Dent Relat Res. 2012;14:792807.
Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for
controlling postrestorative crestal bone levels. Int J Periodontics Restorative
Dent. 2006;26:917.
Gardner DM. Platform switching as a means to achieving implant esthetics. N Y
State Dent J. 2005;71:347.
Luongo R, Traini T, Guidone PC, Bianco G, Cocchetto R, Celletti R. Hard and
soft tissue responses to the platform-switching technique. Int J Periodontics
Restorative Dent. 2008;28:5517.
Chang CL, Chen CS, Hsu ML. Biomechanical effect of platform switching in
implant dentistry: A three dimensional finite element analysis. Int J Oral
Maxillofac Implants. 2010;25:295304.
Canullo L, Goglia G, Iurlaro G, Iannello G. Short-term bone level
observations associated with platform switching in immediately placed and
restored single maxillary implants: A preliminary report. Int J Prosthodont.
2009;22:27782.
Cappiello M, Luongo R, Di Iorio D, Bugea C, Cocchetto R, Celletti R.
Evaluation of peri-implant bone loss around platform-switched implants. Int
J Periodontics Restorative Dent. 2008;28:34755.
Prosper L, Redaelli S, Pasi M, Zarone F, Radaelli G, Gherlone EF. A
randomized prospective multicentre trial evaluating the platformswitching
technique for the prevention of postrestorative crestal bone loss. Int J Oral
Maxillofac Implants. 2009;24:299308.
Atieh MA, Ibrahim HM, Atieh AH. Platform switching for marginal bone
preservation around dental implants: A systematic review and meta-
analysis. J Periodontol. 2010;81:135066.