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 first thread by the end
of first year in function, while only 0.05 mm to 0.13 mm bone loss
occurred after the first 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 first 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 first thread during healing and the first year after loading.

In contrast to the bone loss during the first 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 findings 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 implant’s 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 first year of function.

Buser et al. Clin Oral Implant Res 1990

Weber et al. Clin Oral Implant Res 1992
Brägger 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;7:322—33.
MICROGAP AND THE PLATFORM-SWITCHING
CONCEPT

 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
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
MICROGAP AND THE PLATFORM-SWITCHING
CONCEPT
Berglundh et al. and Lindhe et al. also evaluated the microgap of the

Brånemark 2-stage implant and found inflamed 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

 CONCEPT OF PLATFORM SWITCHING

 The platform switch concept was first 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;14:792–807.
 Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for
controlling postrestorative crestal bone levels. Int J Periodontics Restorative
Dent. 2006;26:9–17.
 Gardner DM. Platform switching as a means to achieving implant esthetics. N Y
State Dent J. 2005;71:34–7.
 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;28:551–7.
 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;25:295–304.
 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;22:277–82.
 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;28:347–55.
 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;24:299–308.
 Atieh MA, Ibrahim HM, Atieh AH. Platform switching for marginal bone
preservation around dental implants: A systematic review and meta-
analysis. J Periodontol. 2010;81:1350–66.