PLATEFORM SWITCH

HISTORY

The introduction of wide-diameter dental implants in the late 1980s created a situation in
which mismatched standard-diameter abutments were used simply because of the lack of
commercial availability of components to match the wide-diameter implants.
Serendipitously, it was found that these implants exhibited less-than-expected initial
crestal bone lossthe effect of bone modeling at the crest of the alveolar bone into which
dental implants are placedduring healing. Several early clinical reports demonstrated
enhanced soft (gingiva) and hard (bone) tissue responses to these platform switched
implants, leading many implant companies to incorporate platform switching into their
implant systems even for narrower-body implants.

Baumgarten H, et al. A new implant design for crestal bone preservation: Initial
observations and case report. Pract Proceed Aesthet Dent 2005;17:735-740.

Lazzara RJ, et al. Platform switching: A new concept in implant dentistry for controlling
postoperative crestal bone levels. Int J Perio Rest Dent 2006;26:9-17

RATIONALE

It has been observed that some degree of bone resorption occurs at the crest of bone
following implant placement. Through extensive investigation, it has been discovered that
the extent of bone resorption is related to both the texture of the surfaces of the implant
and abutment at and the morphology of the implant-abutment junction (IAJ). A number of
investigators have zeroed in on the proposed inflammatory cell infiltrate that forms a zone
around the IAJ.[4] Although not yet fully understood, the current theory of the benefit of
platform switching is related to the physical repositioning of the IAJ away from the outer
edge of the implant and the surrounding bone, thereby containing the inflammatory
infiltrate within the width of the platform switch.[3]

In line with the supposed mechanism of action, it is not merely the introduction of a
platform switch, but the magnitude of the implant-abutment diameter mismatch, that
makes a difference. Difference in bone levels became statistically significant when the
implant-abutment diameter mismatch was greater than 0.8 mm, providing a 0.4 mm
circumferential width of platform switch when the center of the abutment is aligned with
and fixed to the center of the implant. [5]

Ericsson I, et al. Different types of inflammatory reactions in peri-implant soft tissues. J Clin Perio 1995;22:255-261.
Atieh MA, et al. Platform switching for marginal bone preservation around dental implants: A systematic review and meta -analysis. J
Perio 2010;81:1350-1366.

This vertical loss of bone (X in the diagram at right) diminishes the bone-to-implant
contact, contributing to a potential decrease in long-term biomechanical stability[9] and
has been well researched.[10]

Tarnow DP, et al. The effect of inter-implant distance on the height of the inter-implant
bone crest. J Perio 2000;71:546-549.

PLATFORM SWITCHING AND THE VERTICAL

COMPONENT OF BIOLOGIC WIDTH

Because the abutment is narrower in diameter than the implant fixture, a certain amount
of the implant platform is exposed when an implant is platform switched, and this exposed
area of the platform can allow for the tissues of the biologic width -- junctional epithelium
and soft connective tissueto begin forming here, requiring less bone to be resorbed to
make room for attachment on the lateral surface of the implant fixture.[11] Platform
switching has been shown to have the potential to reduce the vertical bone resorption by
as much as 70%.[12]

Greenstein G, et al. Treatment planning implant dentistry with a 2-mm twist drill.
Compendium 2010;31(2):2-10

Vela-Nebot X, et al. Benefits of an implant platform modification technique to reduce

crestal bone resorption. Implant Dent 2006;15:313320.

PLATFORM SWITCHING AND THE HORIZONTAL

COMPONENT OF BIOLOGIC WIDTH

Furthermore, by platform switching implants that are 3mm apart or less or within 1.5mm of
the facial aspect of a thin buccal plate, the implant-abutment junction (IAJ) is shifted onto
the implant platform away from the peri-implant bone, mitigating the deleterious impact of
the inflammatory zone at the microgap of the implant-abutment junction on the bone,
allowing for a reduction in the horizontal extent of bone loss.[3]