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
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 first 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.
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

Brnemark 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;14:792807.
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.